基于系统输出分布的智能控制

提出了文题所述的控制策略,依据输出分布曲线的特征变量选取方法和依据该项信息的规则控制系统。仿真研究得到了满意的结果。在一个实验性二元精馏塔上用IBM-PC进行试验亦获成功。本法对具有非线性特性的分布参数对象,较常规控制策略有明显的优越性。     

Effects of mailed preoperative instructions on learning and anxiety

This study sought to contrast mailing a booklet to accomplish preoperative instruction with teaching performed by nurses after hospital admission. Sixty-six patients were studied in a 700-bed medical center and were assigned to three teaching groups and a control group which did not receive teaching. The researcher compared the four groups preoperatively after admission to determine the patients' knowledge and ability to perform surgical exercises, as well as their anxiety levels.

Findings were that patients who received a booklet by mail preadmission learned surgical exercises equally well compared to patients taught postadmission, and mastered significantly more exercise behaviors than those receiving no instruction. No statistical difference in anxiety level was found among groups. One may infer that mailing preadmission material should be considered as an effective teaching mode and alternative to postadmission instruction.     

Central cardiovascular and oxygen variables during haemorrhage in the pig

Background: We evaluated the ability of the standards issued by the Danish Society of Anaesthesiologists to reflect a blood loss.
Methods: In 9 pigs bled (0–24 ml kg^-1) and retransfused (to 28 ml kg^-1) during halothane anaesthesia, central cardiovascular, thoracic electrical impedance (TI), oxygen, acid-base and temperature variables were recorded.
Results: With the recommendation for minor surgery (mean arterial pressure (MAP) and heart rate (HR)), the correlation to the blood loss was 0.74 ( P < 0.001) and with that for major surgery (MAP, HR, central venous pressure (CVP) and rectal temperature (Temp_r)) it was 0.79 ( P < 0.001). With the recommendation for extensive surgery (MAP, HR, CVP, pulmonary artery catheter variables and the central-peripheral temperature difference (ΔTemp_r-t)), the correlation was 0.84 ( P < 0.001). Non-invasive monitoring (MAP, HR, ΔTemp_r-t TI and near-infrared spectroscopy of the brain (S_invosO₂)) was only slightly better than basal monitoring (r=0.76, P < 0.001). However, adding arterial base excess (BE), TI and peripheral temperature (Temp_t) to the recommendation for major surgery resulted in a correlation of 0.87 ( P < 0.001), while adding BE and TI to the recommendation for extensive surgery raised correlation to only 0.88 ( P < 0.001).
Conclusion: When the recommendations were followed the correlation to the blood loss ranged from 0.74–0.84. However, with the recording of MAP, HR, CVP, ΔTemp_r-t, BE and TI a correlation of 0.87 was achieved, indicating that a pulmonary artery catheter may not be in need for patients undergoing surgical procedures with expected haemorrhage.     

Electrocardiographic and Clinical Predictors of Torsades de Pointes Induced by Almokalant Infusion in Patients with Chronic Atrial Fibrillation or Flutter: A Prospective Study

The aim of this study was to identify predictors of torsades de pointes (TdP) in patients with atrial fibrillation (AF) or flutter exposed to the Class III antiarrhythmic drug almokalant. TdP can be caused by drugs that prolong myocardial repolarization. One hundred patients received almokalant infusion during AF (infusion 1) and 62 of the patients during sinus rhythm (SR) on the following day (infusion 2). Thirty-two patients converted to SR. Six patients developed TdP. During AF, T wave alternans was more common prior to infusion (baseline) in patients developing TdP (50% vs 4%, P < 0.01). After 30 minutes of infusion 1, the TdP patients exhibited a longer QT interval (493 ± 114 vs 443 ± 54 ms [mean ± SD], P < 0.01), a larger precordial QT dispersion (50 ± 74 vs 27 ± 26 ms, P < 0.05), and a lower T wave amplitude (0.12 ± 0.22 vs 0.24 ± 0.16 mV. P < 0.01). After 30 minutes of infusion 2, they exhibited a longer QT interval (672 ± 26 vs 489 ± 74 ms, P < 0.001), a larger QT dispersion in precordial (82 ± 7 vs 54 ± 52 ms, P < 0.01) and extremity leads (163 ± 0 vs 40 ± 34 ms, P < 0.001), and T wave alternans was more common (100% vs 0%, P < 0.001). Risk factors for development of TdP were at baseline: female gender, ventricular extrasystoles, and treatment with diuretics; and, after 30 minutes of infusion: sequential bilateral bundle branch block, ventricular extrasystoles in bigeminy, and a biphasic T wave. Patients developing TdP exhibited early during almokalant infusion a pronounced QT prolongation, increased QT dispersion, and marked morphological T wave changes.     

Indoor air pollution and pulmonary performance: investigating errors in exposure assessment

We use pulmonary function measurements on pre-adolescent children and indoor air pollution measurements in the homes of these children to illustrate estimation techniques for linear regression models containing independent variables measured with error. In our data set, replicate measures of indoor air pollutant concentrations provide one method of estimating measurement error variances. Surrogate information in the form of cigarettes smoked is also available for the pollutant of interest. Several estimation procedures are presented, and we combine two estimators, one based on surrogate information and one based on replication information, using generalized least squares.     

术前选择性血管栓塞减少脊柱转移瘤术中出血

目的:改变脊柱转移瘤治疗长期以来采用的姑息、保守的治疗方法。手术切除脊柱肿瘤后,给予坚强的内固定,辅以术后放化疗,可延长病人的生命,使病人无痛生存,提高了病人的生活质量。但由于脊柱转移瘤切除术中出血异常多,使手术切除肿瘤椎管减压内固定较难进行,为解决这一问题我们于1991年始用下述方法治疗脊柱转移瘤。方法:应用术前选择性脊柱血管栓塞,肿瘤切除椎管减压,内固定器材固定治疗脊柱转移瘤16例,取得了满意的效果。16例病人均为胸腰段转移瘤,均在术前48h行相应脊柱血管,胸段选择相应肋间动脉,腰段选择相应腰动脉进行栓塞,然后行胸段、胸腰段、腰段前路或后路肿瘤切除,椎管减压、内固定术。结果:16例病人术中出血平均900ml,出血量最少者仅600ml,出血量较未行血管栓塞病例明显减少,术野更为清晰、使术者更易操作;术后病人脊髓及神经根受压症状明显减轻,16例脊髓及脊神经根受压症状明显减轻,16例病人中8例脊髓及脊神经受压症状完全解除。结论:术前脊柱血管栓塞,手术切除肿瘤椎管减压内固定明显减少了术中出血、降低了手术风险、缩短了手术时间,是治疗脊柱转移瘤的安全有效的方法。     

脑膜瘤的术前栓塞

目的 通过对16例脑膜瘤栓塞，探索脑膜瘤的术前栓塞效果。方法 选择性全脑血管造影了解脑膜瘤血供．证实无颈内、外动脉“危险吻合”存在后，用明胶海绵颗粒栓塞脑膜瘤颈外供血动脉。结果 本组16例脑膜瘤DSA表现典型，栓塞术后除5例局部头皮痛外无严重并发症发生。术后3～4d均手术顺利切除。术中出血明显减少，与未行栓塞者对比平均每例减少出血约300ml，以Ⅱ型明显。结论 脑膜瘤术前供血动脉栓塞能明显减少术中出血，安全有效。     

The pitfalls of the dexamethasone suppression test: A biological marker of endogenous depression?

In the past few years there have been numerous publications which have stressed the value of the dexamethasone suppression test (DST) as a diagnostic marker of endogenous depression. Our own studies in 333 psychiatric inpatients and 121 healthy subjects did not reveal a differential diagnostic use for the DST. This result is in good agreement with other results in the literature. Our data demonstrate that intervening variables such as severity of illness, weight loss, sleep disturbances, situational stress, drug and alcohol withdrawal, and the pharmacokinetics of dexamethasone have an important influence on DST results, regardless of the diagnostic classification.     

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目的 探讨临床Ⅰ、Ⅱ期乳腺癌术前短程化疗的意义。方法 122例临床Ⅰ、Ⅱ期乳腺癌术前用CEF方案化疗1疗程，化疗后3-5d手术。结果 部分缓解21例(占17．2％)，轻度缓解76例(占62．3％)，无变化25例(占20．5％)，无临床进展病例。术前可扪及腋窝肿大淋巴结42例，化疗后30例见淋巴结明显缩小或消失。病理组织学观察75例镜下见肿瘤细胞有小点片状坏死。106例按计划手术；16例因白细胞降低等化疗反应推迟手术。全组随访1～6年，无局部复发病例；6例在随访期间1～3年内发现骨转移，经放疗和化疗控制；仅1例同时有骨转移和肺转移者于术后4年死亡；余均健在。结论 可手术乳腺癌的术前短程化疗可观察到肿瘤缩小等治疗效果，为术后化疗提供指导。并可能减少术中血行转移和提高疗效。