白城市52年间法定报告传染病流行趋势分析

目的：了解掌握法定报告传染病流行情况及变化。方法：采用描述流行病学方法，分析报告传染病的消长分布。结果：传染病的发病率，死亡率，病死率都呈显著下降趋势，病种间消长有明显变化。结论：血源及性传播疾病为新时期的主要传染病病种。     

食管胃结合部腺癌65例形态超声及其分型和病理诊断

目的 探究体表超声诊断食管胃结合部腺癌(AEG)的分型及肿块大小的准确性.方法 选取65例AEG病人,均术前行体表超声及CT检查,结合术后病理进行分析对比.结果 65例AEG病人,大体标本BorrmannⅢ型31例,占47.7%,组织学标本低分化腺癌29例,占44.6%;参照Siewert分型,体表超声和CT对AEG临床分型诊断正确率分别为90.8%、92.3%,其中Ⅰ型85.7%、92.9%,Ⅱ型91.4%、88.6%,Ⅲ型93.8%、100%,两者诊断AEG分型存在一致性,差异有统计学意义(Kappa=0.852,P<0.05);体表超声测量肿块最长径为(4.00±1.84) cm,术后病理测量肿块最长径为(4.41±2.52) cm,两者差异无统计学意义 (t=-1.512,P>0.05).结论 体表超声可以作为诊断AEG分型及测量AEG肿块大小的可靠检查手段,对于指导手术以及判断预后有很大意义.     

鼻内镜辅助支撑喉镜下新生儿咽喉部肿物的手术治疗

目的 探讨新生儿咽喉部肿物患者的临床表现及手术方式。方法 通过回顾2020—2022年就诊于兰州大学第二医院的3例新生儿咽喉部肿物患者的临床资料,总结分析3例新生儿咽喉部肿物患者的临床表现及治疗方法。3例患者中,咽喉部囊肿1例,咽部毛息肉1例,咽部畸胎瘤1例。结果 3例患儿均表现为呼吸或吸吮困难,均在鼻内镜辅助下顺利进行支撑喉镜咽喉部肿物切除手术。随访10个月以上,均无复发。结论 鼻内镜的运用可以帮助明确肿物基底部及其与周围组织的关系,确定手术切除范围,在鼻内镜辅助的支撑喉镜下行咽喉部肿物切除,可以完整切除肿瘤,充分止血,并发症少,应用于新生儿患者具有一定的优势。     

丁苯酞联合丹红注射液治疗急性脑梗死的疗效及其对PKC、CRP、PTX3的影响

目的探讨丁苯酞联合丹红注射液治疗急性脑梗死的疗效及对蛋白激酶C(PKC)、C反应蛋白(CRP)和正五聚体蛋白3(PTX3)的影响。方法选取2017年1月至2018年12月该院收治的100例急性脑梗死患者进行研究,采用随机数字表达法将所有急性脑梗死患者分为对照组和观察组,每组各50例。对照组给予丹红注射液治疗,观察组给予丁苯酞联合丹红注射液治疗。比较2组患者的疗效,治疗前后2组患者PKC、CRP、PTX3水平,欧洲卒中量表评分(ESS评分),日常生活能力评定量表(Barthel指数)及药物不良反应的发生情况。结果观察组总有效率明显高于对照组(82.00%vs.58.00%),差异有统计学意义(P<0.05)。治疗前,2组患者的PKC、CRP、PTX3水平、ESS评分及Barthel指数相比,差异无统计学意义(P>0.05);治疗后,2组患者PKC、CRP、PTX3水平均降低,且观察组PKC、CRP、PTX3水平降低幅度比对照组大,2组ESS评分及Barthel指数均改善,观察组优于对照组,差异均有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论丁苯酞联合丹红注射液治疗急性脑梗死疗效确切,且可降低患者的PKC、CRP、PTX3水平,患者恢复好,日常生活能力提升,同时不增加不良反应发生率。     

涎腺嗜酸细胞性脂肪腺瘤二例

报道2例罕见的发生于腮腺的涎腺嗜酸细胞性脂肪腺瘤。大体观察:2例均包膜完整,1例呈多结节状,1例呈哑铃状。镜下观察:2例肿瘤均被覆薄的纤维性包膜,由不同比例的脂肪组织和大小不等的嗜酸性细胞巢混合构成。免疫组织化学染色:2例嗜酸性细胞均表达人低分子量细胞角蛋白,部分表达细胞角蛋白(CK)7、CK5/6、CK19、p63、上皮细胞膜抗原(EMA),不表达S-100蛋白、Calponin、DOG1,Ki-67阳性指数约1%~2%。2例分别随访4和5个月,均未见复发。     

Experimental test of a predicted dynamics–structure–thermodynamics connection in molecularly complex glass-forming liquids

Understanding in a unified manner the generic and chemically specific aspects of activated dynamics in diverse glass-forming liquids over 14 or more decades in time is a grand challenge in condensed matter physics, physical chemistry, and materials science and engineering. Large families of conceptually distinct models have postulated a causal connection with qualitatively different “order parameters” including various measures of structure, free volume, thermodynamic properties, short or intermediate time dynamics, and mechanical properties. Construction of a predictive theory that covers both the noncooperative and cooperative activated relaxation regimes remains elusive. Here, we test using solely experimental data a recent microscopic dynamical theory prediction that although activated relaxation is a spatially coupled local–nonlocal event with barriers quantified by local pair structure, it can also be understood based on the dimensionless compressibility via an equilibrium statistical mechanics connection between thermodynamics and structure. This prediction is found to be consistent with observations on diverse fragile molecular liquids under isobaric and isochoric conditions and provides a different conceptual view of the global relaxation map. As a corollary, a theoretical basis is established for the structural relaxation time scale growing exponentially with inverse temperature to a high power, consistent with experiments in the deeply supercooled regime. A criterion for the irrelevance of collective elasticity effects is deduced and shown to be consistent with viscous flow in low-fragility inorganic network-forming melts. Finally, implications for relaxation in the equilibrated deep glass state are briefly considered.

An enormous number of seemingly orthogonal proposals exist for a fundamental connection between a (typically scalar) structural or excess (configurational) thermodynamic quantity and activated relaxation in supercooled liquids (1–12). High chemical complexity for fragile glass formers which exhibit strongly non-Arrhenius relaxation greatly complicates the formulation of predictive theories. A common generic view (1, 3, 8) is that the structural or alpha relaxation time (and viscosity, inverse diffusivity) evolves with cooling as shown in Fig. 1A. Different dynamical mechanisms in the high-, intermediate-, and low-temperature regimes are often envisioned: noncooperative Arrhenius (∼1 ps to 100 ps), critical power law (∼0.1 ns to 100 ns), and cooperative non-Arrhenius (∼0.1 μs to 100 s or beyond), respectively. Typically a causal connection is postulated between the logarithm of the alpha time (an effective barrier in thermal energy units) and a specific “order parameter”: 1) in the structural class (6, 7, 13–17), the intensity of the cage peak of the structure factor S(k), local aspect(s) of the radial distribution function g(r), or specific packing motifs; 2) in the thermodynamics class, various measures of free volume (18, 19), excess entropy (20), configurational entropy (21–25), internal energy and enthalpy (26), or with some arguing for an equilibrium phase transition at an inaccessibly low (high) temperature (density) (23, 27–29); 3) in the short time class, the high-frequency shear modulus (2, 30–32), Debye–Waller factor (33), or amplitude of special vibrational modes (33–35); and 4) in the intermediate time class, the concentration of dilute mobile excitations [e.g., strings (36, 37) or facilitating defects (38)]. Many of the proposed order parameters are hard or impossible to uniquely define and/or experimentally measure. The diverse models often claim to capture relaxation data over limited time windows typically based on fitting but usually fail at low and/or high enough temperature (5).Open in a separate windowFig. 1.Global relaxation map and theoretical picture and key predictions. (A) Three-regime relaxation map (curves) for the alpha time with Arrhenius and strongly non-Arrhenius behaviors separated by a crossover regime perhaps of a critical power law (6) form. The proposed two-regime scenario of ECNLE theory (39–42) is based solely on noncooperative and cooperative activated dynamics (slightly overlapping orange and green regions) with the inverse dimensionless compressibility (S0−1) as the relevant thermodynamic quantity. The approximately five to six decade range that simulations can probe is indicated. (B) Dynamic free energy for a metastable hard sphere (diameter σ) fluid (42) as a function of particle displacement at a high packing fraction of ϕ = 0.58. Relevant length and energy scales are indicated. (Inset) Schematic of the core physical idea for the alpha relaxation: hopping on the cage scale coupled with a collective elastic displacement of all particles outside the cage. (C) Main: local cage barrier as a function of inverse dimensionless compressibility for 0.44<ϕ <0.61 corresponding to a 16 decade increase of the alpha time (39, 41, 42). The metastable regime begins at ϕ ∼ 0.5 where the total barrier is ∼1.5 k_BT. (Inset) Total barrier as a function of S0−3 normalized by its ϕ = 0.5 value. The elastic barrier is 1 k_BT at ϕ ∼ 0.55. Packing fractions are given along the top x-axis.Here we present, using only experimental data, a test of a relationship between activated relaxation, local pair structure, and a specific thermodynamic property predicted by the Elastically Collective Nonlinear Langevin Equation (ECNLE) theory (39–41). The results provide support for the following: 1) the coupled local–nonlocal nature of relaxation deeply connected with collective elasticity, 2) the dimensionless amplitude of thermal density fluctuations, S₀, as the relevant (nonexcess) thermodynamic property, 3) a roadmap for organizing relaxation data in S₀, not in temperature, space, 4) irrelevance of collective elasticity as the origin for the crossover from fragile to strong glass formers, and 5) an explicit demonstration that a dynamics–thermodynamics correlation can be a noncausal consequence of the causal relation between local pair structure and S₀.     

正畸患者对上颌牙列中线轴向倾斜的审美评价

目的:探讨正畸患者对不同程度上颌牙列中线轴向倾斜的审美评价。方法:采用上颌牙列中线不同程度轴向倾斜的图片模型,制作电子问卷软件,对203位符合条件的正畸患者(男79人,女124人)分理想值、觉察值和容忍值3个层次进行问卷调查。结果:受试对象对女性图片上颌牙列中线轴向向左、右倾斜的平均觉察值分别是4.7°、4.9°,容忍值是9.7°、9.5°;男性图片则为4.1°、5.1°和9.0°、9.7°。其中除了男性图片左、右侧的觉察值之间有统计学差异之外(P<0.05),其余评价值左、右侧之间无统计学差异(P>0.05)。觉察值的中位数和四分位数间距均为4.0°,2.0°;容忍值则均为10.0°,6.0°。女性和男性图片平均理想值分别为0.1°和0.4°,且与总体均数μ=0间无统计学差异(P>0.05)。女性受试者对男性图片牙列中线右侧轴向倾斜的觉察值要明显低于男性受试者。结论:该审美评价的3个层次是合理的,其研究结果对口腔科医生具有临床指导意义。     

重危瓣膜病变合并巨大心脏的外科治疗

目的:报道181例重危瓣膜病变合并巨大心脏的外科治疗体会。方法:回顾性分析181例瓣膜外科病例中合并巨大心脏临床资料,男性76例,女性105例,年龄15～57岁,平均(45.7±15.2)岁。分为2组:巨大左心房(GLA)组84例,左心房内径(LAD)70～150mm,平均(80.3±17.5)mm;巨大左心室(GLV)组97例,左心室舒张末内径(LVEDD)70～112mm,平均(79.4±12.7)mm。患者全部行瓣膜置换术,其中GLA组行主动脉瓣与二尖瓣双瓣膜置换术12例,二尖瓣置换术72例,同期行三尖瓣环缩成形术42例,左心房血栓清出13例;84例均作左心房折叠术。GLV组行主动脉瓣置换术38例,主动脉瓣与二尖瓣双瓣膜置换术27例,二尖瓣置换术32例,二尖瓣置换术均保留全部或部分瓣膜和瓣下结构,同期行三尖瓣环缩成形术18例,左心房血栓清出4例,左心房折叠术21例。结果:手术早期死亡率GLV组和GLA组分别为9.3%和6.0%,GLV组明显高于GLA组(P<0.05);死亡原因GLV组以室性心律紊乱为主(55.6%),明显高于GLA组(P<0.05);GLA组以呼吸衰竭为主。术后1个月超声心动图显示,GLA组LAD平均(60.1±12.1)mm,GLV组LVEDD平均(56.6±16.1)mm,较术前明显缩小(P<0.01)。心功能恢复良好。结论:瓣膜置换同期左心房折叠术有利于改善合并巨大左心房的术后恢复;保留二尖瓣瓣膜及瓣下结构有利于合并巨大左心室病例的恢复。     

多形核白细胞在体外循环后急性肺损伤中的作用

目的研究多形核白细胞(PMN)在体外循环后急性肺损伤发生发展过程中的作用。方法选择24例瓣膜置换术患者,其中男4例,女20例;年龄29～69岁,体重37～73kg。采用支气管肺泡灌洗(bronchoalveolarlavage,BAL)方法收集支气管肺泡灌洗液(bronchoalveolarlavagefluild,BALF),同时采集血标本,以观察体外循环心内直视手术后PMN的激活与肺损伤情况。结果本组病例术中转流时间(106.46±33.58)min,阻断时间(77.58±28.02)min,呼吸机辅助时间(24.17±30.90)h。术后患者氧合指数降低明显(P=0.000)。术后周围血WBC计数明显升高(P=0.000)。术后BALF中的白细胞总数(P=0.000)与白细胞分类中PMN所占的比率也明显增加(P=0.000)。BALF与血浆的中性粒细胞弹性蛋白酶(NeutrophilElastase,NE)和MPO水平明显升高(P=0.000)。术后血浆中的血管性假血友病因子(VonWillebrandFactor,vWF)水平也明显升高(P=0.000)。而且,患者血浆与BALF中的NE与患者同时期的氧合指数呈负相关关系,血浆中的vWF水平与患者的氧合指数也呈负相关关系。结论体外循环后周围血液及肺泡中的PMN募集、激活并大量释放蛋白酶,是体外循环后肺损伤的重要机制。