NSF-Based Analysis of the Structural Stressing State of Trussed Steel and a Concrete Box Girder

This paper analyses the characteristics of the mechanical behavior of a trussed steel and concrete box beam under bending conditions based on the structural stressing state theory and the numerical shape function method. Firstly, the parametric generalized strain energy density was introduced to characterize the structural stressing state of trussed steel stud concrete box girders, and the strain energy density sum was plotted. Then the Mann-Kendall criterion was used to discriminate the leap point of the curve change and to redefine the structural failure load. By analyzing the strain and displacement, the existence of a sudden change in the structural response during the load-bearing process was again demonstrated. Afterwards, the numerical shape function method was used to extend the strain data, and further in-depth analyses of strain/stress fields and internal forces were carried out to show in detail the working characteristics of each under load. Through an in-depth analysis from different angles, the rationality of updating the failure load was verified. Finally, the effects of different structure parameters on the evolution of the structural stresses of the members were analyzed in a transversal comparison. The analysis results of the stress state of a steel-concrete truss structure reveal the working behavior characteristics of a steel-concrete truss structure from a new angle, which provides a reference for the design of a steel-concrete truss structure in the future.     

医疗保障制度对医院的影响与对策

在基本医疗保险制度建立过程中,各级医疗卫生机构将面临功能定位的重新调整,现有的医疗体系格局是改变会给医疗机构带来深远的影响。大医院在“减负”的同时,必须积极地适应新的形势下医疗市场的需要,充分发挥大医院人才密集、知识密集、资源密集的优势,提供高质量、高效率、高附加值的医疗服务。同时还必须认识到三级医院既是社区医疗服务的补充和延伸,也应该成为社区医疗服务的保障和后盾。     

北京市流动人口中孕妇营养知识、态度和行为的研究

[目的]描述北京市流动孕妇的营养知识、态度及饮食行为(KAP)现状,探讨其影响因素,为城市流动孕妇营养保健工作提供科学依据.[方法]采用问卷调查法对北京市近郊区150名流动孕妇和150名户籍孕妇进行调查.[结果]流动孕妇的营养KAP水平较差,总分合格率为52.32%,其中营养知识知晓及格率仅为27.15%.流动孕妇在"钙的最佳食物来源"和"孕期为什么补充叶酸"等知识上低于户籍孕妇,差异有统计学意义,营养态度普遍较好,对孕妇和胎儿健康特别重要的畜禽肉类、蛋类、水产品类、奶类、豆类及坚果、动物内脏和血摄入频率不足,尤其是蛋类明显低于户籍孕妇;对流动孕妇的营养K、A、P之间进行相关性分析发现,K、A、P之间具有明显相关性,K-A相关系数为0.4;K-P相关系数为0.3,A-P相关系数为0.2.孕妇营养KAP水平主要受孕妇学历的影响,偏回归系数β值为3.6.孕妇获得营养知识的主要途径是网络.[结论]目前北京市流动孕妇的营养知识和饮食行为仍存在一定问题,应加强对流动孕妇进行营养知识和孕期正确生活方式的宣传及指导.     

Effects of temperature and air pollutants on cardiovascular and respiratory diseases for males and females older than 65 years of age in Tokyo, July and August 1980-1995

We studied exposures to higher daily maximum temperatures and concentrations of air pollutants in Tokyo during the summer months of July and August from 1980 to 1995 and their effects on hospital emergency transports for cardiovascular and respiratory diseases for males and females > 65 years of age. Cardiovascular diseases were angina, cardiac insufficiency, hypertension, and myocardial infarction. Respiratory diseases were asthma, acute and chronic bronchitis, and pneumonia. Except for pneumonia, daily maximum temperatures were not associated with hospital emergency transports. Increasing daily maximum temperatures, however, were associated with decreased hospital emergency transports for hypertension. Concentrations of nitrogen dioxide or particulate matter < or = 10 microm, however, were associated with daily hospital emergency transports for angina, cardiac insufficiency, myocardial infarction, asthma, acute and chronic bronchitis, and pneumonia. For cardiac insufficiency, hypertension, myocardial infarction, asthma, chronic bronchitis, and pneumonia, the expected daily number of emergency transports per million were greater for males than for females. For angina and acute bronchitis, there were no differences for the expected daily numbers of emergency transports per million between males and females.     

神经内镜手术切除侵袭型巨大垂体腺瘤七例体会

目的探讨侵袭型巨大垂体腺瘤神经内镜手术适应证、手术切除过程中风险规避以及手术技巧。方法回顾性分析经鼻蝶神经内镜手术切除61例垂体腺瘤患者中7例侵袭型巨大垂体腺瘤患者的临床资料。结果全切除肿瘤1例，次全切除6例均侵袭海绵窦，其中5例切除肿瘤后均见鞍膈，2例未见鞍膈下落。手术时间平均100min。无术中输血患者。术后术区血肿2例，1例术后36h死亡，1例进行内镜下血肿切除术后痊愈。结论伴随神经内镜技术的发展，对于手术适应证的选择有了新的变化，对于侵袭型巨大垂体腺瘤的手术治疗，神经内镜技术为我们提供了一次性手术切除的可能，该方法是安全的，可以避免出现灾难性后果。     

实验室信息管理系统在医院信息系统中的应用

本文扼要地介绍了LIS以及LIS工作流程,总结了我院LIS应用体会,建立LIS需注意解决的问题,以及LIS的成功实施,给检验科、患者、临床部门、医院等带来的诸多好处。     

完全胃肠外营养相关性胆汁淤积的检测指标及危险因素分析

目的 探讨胃肠外营养相关性胆汁淤积的影响因素及检测的敏感指标,降低并发症损害.方法 回顾分析完全胃肠外营养并且持续时间在5 d以上的80例患儿病例,按有无胃肠外营养相关性胆汁淤积（PNAC）分为两组,对其静脉营养液的量、持续时间及生化指标进行分析.结果 80例完全胃肠外营养的患儿中有14例存在胆汁淤积,发病率为17.5%,PNAC组肝功能及胆红素指标均高于无PNAC组,患儿体重、平均完全胃肠外营养（TPN）持续时间、PN热卡摄入量与无PNAC组相比差异具有统计学意义（P〈0.05）.结论 PNAC的发生与患儿TPN时间、TPN使用量、低出生体重有关,及时检测分析肝功能、胆红素代谢指标有利于早期发现PNAC,尽早干预,降低器官功能损害.     

我国医疗器械临床试验现状与思考

目的：提高我国医疗器械临床试验的质量和水平。方法：分析我国医疗器械临床试验现状及存在问题．探讨解决办法。结果与结论：我国医疗器械临床试验现状表现为起点低、法规制度不完整,申办者和研究者不够重视,临床试验质量不高,需要在涉及医疗器械临床试验的各方面加以完善。     

Da Vinci S手术机器人在胸外科应用的初步经验

目的 评价17例使用da Vinic S手术机器人系统行不开胸手术,观察其实用性及手术效果.方法 da Vinic S手术机器人系统包括主刀医生控制台,患者平车,内窥镜摄像系统.控制台与患者平车连接,在患者平车上载有三个机械臂和一个为了连接内窥镜摄像系统的中央机械臂.手术器械借着胸壁的孔洞连接到机器人的机械臂.外科医生坐于控制台前双手抓于操作台上十分敏感的模拟抓手,它可将外科医生的动作转换传递到手术器械的尖端.内置模拟手腕系统（EndoWrist）技术可使机械手进行上下左右旋转等七个自由度的连续动作,超过了人手在开放手术时的灵活性.本组17例患者包括重症肌无力12例（其中胸腺瘤3例）、膈疝1例、食管癌2例、肺大泡1例、肺癌1例.结果 总共17例手术14例完全用机器人做完,12例胸腺和胸腺瘤切除,1例膈疝修补,1例肺大泡切除;2例食管癌患者腹部用机器人行胃游离及腹部淋巴清扫加胸部小切口;1例左肺上叶切除术近结束时,由于出血,及时转为开胸手术.患者术后均恢复平稳.结论 机器人不开胸可以做儿乎所有类型的胸科手术,安全可靠,效果确实,尤其在行胸腺切除时优势明显.有胸科开放及腔镜手术经验的医生及其它操作人员短期培训即可胜任工作,但是,要注意选择患者,并有紧急开胸的准备,以保证患者的安全.     

乳腺癌病理分型与X线表现的关系探讨

目的 探讨乳腺癌的x线影像学特点及与其病理分型的关系,以进一步提高乳腺癌的诊断水平.方法 总结经手术病理证实的97例女性乳腺癌患者的临床资料,包括浸润性导管癌62例、导管原位癌9例、浸润性小叶癌12例、黏液腺癌8例、髓样癌6例.观察乳腺癌的X线表现,并与其病理分型对照.结果 肿瘤X线表现为有钙化57例(58.8%),有肿块76例(78.4%),有结构紊乱10例(10.3%).肿块并钙化多见于浸润性导管癌(56.5%,35/62)(x2=10.36,P＜0.05).单纯钙化多见于导管原位癌(66.7%,6/9)(x2=31.75,P＜0.01).有钙化多见于导管原位癌(88.9%,8/9)和浸润性导管癌(64.5%,40/62)(x2=10.51,P＜0.05).结构紊乱多见于浸润性导管癌(14.5%,9/62)(x2=3.88,P＞0.05).肿块样表现多见于浸润性导管癌(82.3%,51/62)、浸润性小叶癌(83.3%,10/12)、黏液腺癌(87.5%,7/8)、髓样癌(83.3%,5/6).结论 诊断乳腺癌应综合肿瘤的各种X线征象.乳腺癌的病理基础不同,导致了不同的X线影像学特点.