内镜超声联合经肛门内镜微创手术治疗直肠肿瘤29例体会

目的:总结内镜超声联合经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗经验,探讨其在直肠肿瘤中的治疗效果.方法:回顾分析我院2009年7月-2011年9月29例内镜超声联合经肛门内镜微创手术治疗直肠肿瘤患者临床资料,其中为直肠腺瘤12例,早期直肠癌和腺瘤癌变10例,直肠炎性息肉及直肠间质瘤等粘膜下结节共7例.距肛缘为5～15 cm.术后平均随访5～17月.结果:29例全部成功完成TEM术式,其中2例术后病理证实为T2期直肠癌1,例进一步扩大手术行TME,另1例拒绝进一步手术而放弃.肠壁全层切除17例,粘膜下及部分肌层切除12例.所有标本切缘均为阴性.手术时间35～130 min,平均时间70 min;术中失血2～20 mL,平均失血7 mL.术后并发出血2例,泌尿系感染1例.术后住院日3～8 d,平均住院日5 d;术后随访5～17月,除1例外未发现肿瘤复发及转移.结论:内镜超声联合TEM治疗直肠肿瘤具有定位准确、手术创伤小、出血少、恢复快等优点,是直肠肿瘤局部切除理想的方法,但须严格掌握适应症.图3,参10.     

腹腔镜疝手术的临床应用

目的总结应用腹腔镜技术治疗腹股沟疝及切口疝的手术抉择、临床效果及并发症.方法回顾性分析2004年10月至2009年12月期间对腹股沟疝和切口疝行腹腔镜手术71例患者的临床资料,其中腹腔镜小儿腹股沟斜疝疝囊高位结扎43例(51侧),TAPP25例(31侧),腹腔镜切口疝修补术3例.结果无一例中转开放手术.平均手术时间34.5 min,术中出血量5 ml,术后并发症发生率为11%(5/71),其中血清肿2例,阴囊气肿4例,腹股沟区血肿2例,术后平均住院时间2.8 d,术后随访1~12个月均未出现疝复发、慢性神经性疼痛、异物感、补片及切口感染等.结论腹腔镜疝手术安全性良好、复发率低、术后疼痛轻、并发症少及术后住院时间短;对于疝开放手术术后复发、双侧疝、复合疝等是首选术式,并可避免隐匿疝的遗漏.参4.     

三种手术治疗原发性精索静脉曲张的临床疗效观察

探讨3种手术方法治疗原发性精索静脉曲张(Varicocele,VC)的临床效果.回顾性分析2009年1月至2013年7月收治的单侧VC患者135例的临床资料,按照手术方式不同分为3组,腹膜后高位结扎组45例,腹腔镜组52例,显微镜组38例,就手术时间、术后住院时间、术后并发症、复发情况、手术前后精液质量对比等临床资料进行临床疗效观察.显微镜组比腹膜后组、腹腔镜组手术时间明显延长,3组患者术后住院时间无明显差异,并发症发生率在腹膜后组、腹腔镜组、显微外科组分别为33.3%、25.0%和10.5%.6个月后复查精索彩超及精液常规,显微镜组精液质量改善最为明显,并未见有术后复发.显微镜下精索静脉结扎术为治疗VC的安全有效方法,推荐行显微镜下精索静脉结扎术.表2,参6.     

伽玛刀治疗垂体瘤的临床疗效分析

目的探讨伽玛刀对垂体瘤的疗效.方法对120例垂体瘤患者采用伽玛刀治疗.结果患者随访6~18个月,随访方式为临床+影像学复查,视力或/和视野障碍者复查时都有不同程度的好转,临床症状、内分泌激素有明显改善,有不同程度改善.有两例直径3 cm的垂体瘤在治疗后分别于1和2个月时出现垂体内出血后手术治愈,并未再复发.其余目前尚无垂体功能低下、视力下降等并发症出现,无一例死亡.结论:伽玛刀治疗垂体瘤治疗微创、无出血,风险小,比常规放疗发生副作用机率小得多,行之有效,值得推广.表1,参8.     

斯奇康联合糖皮质激素对初治原发性肾病综合症患儿疗效观察

目的观察糖皮质激素联合斯奇康对初治原发性肾病综合症患儿缓解率和复发率的影响.方法将我院确诊的108例初发肾病综合症病人随机分为对照组和治疗组.对照组病例给予足量泼尼松治疗,治疗组病人在对照组病人治疗方案基础上给予斯奇康肌肉注射.记录两组病人缓解率和复发率.结果两组病人在随访1个月后缓解率无明显差别,随访2月、6月时,治疗组患者缓解率较对照组升高.治疗2月后,治疗组血清IgG、IgA、IgM显著增高(P0.05).随访1 a,与对照组相比,治疗组肾病综合症复发人次数显著减少,缓解率增加.结论糖皮质激素联合卡介苗多糖核酸治疗肾病综合症,可以提高缓解率,减少复发率.表3,参15.     

舒芬太尼联合小剂量硫酸镁胃肠术后静脉镇痛

目的比较小剂量硫酸镁联合舒芬太尼与单纯舒芬太尼术后静脉镇痛的临床效应.方法选择行胃肠道手术后患者60例,随机均分为二组,每组30例,以一次性静脉镇痛泵(2ml/h)分别行静脉术后镇痛,S组:单纯舒芬太尼镇痛,2μg/kg舒芬太尼+3mg格拉司琼,MS组:硫酸镁联合舒芬太尼镇痛,2μg/kg舒芬太尼+50mg/kg硫酸镁+3mg格拉司琼,各组镇痛泵中药物均用生理盐水稀释至100ml,观察各组患者镇痛48 h内的静息镇痛评分(VAS方法),恶心呕吐,皮肤瘙痒和尿潴留的发生情况,术后血清镁离子和钙离子的浓度变化情况.结果二组患者的静息镇痛评分在MS组明显低于S组(P0.05),恶心呕吐发生率MS组显著低于S组(P0.01).两组患者血清中钙离子浓度差异无统计学意义(P0.05).两组患者血清镁离子浓度减少有统计学意义(P0.05).结论小剂量硫酸镁用于术后静脉镇痛可明显减少舒芬太尼的剂量,使恶心呕吐等不良反应发生率降低,镇痛效果明显优于单纯舒芬太尼术后静脉镇痛,且可改善术后镁离子浓度下降的程度.表3,参9.     

颅内动脉瘤夹闭术围手术期的护理

目的:探讨颅内动脉瘤夹闭术围手术期的护理要点.方法:对我科2011年1月～2012年5月收治的100例动脉瘤夹闭术患者进行细致的围手术期护理,严密观察病情,术前预防动脉瘤再破裂出血,积极做好术前准备,术后做好引流管、并发症及康复等护理.结果:100例动脉瘤夹闭术患者,80例无任何并发症治愈出院,15例出现一侧肢体偏瘫,经术后康复治疗,随访3～6个月均恢复,5例死亡.结论:精心细致的围手术期护理,可有效提高手术成功率及治愈率,改善患者术后生活质量.     

经皮穿刺气管切开术与传统气管切开术的临床应用及护理

目的:研究经皮穿刺气管切开术和传统气管切开术的应用对比及护理差异,探索两者临床护理意义.方法:选择40例患者,治疗组20例行经皮穿刺气管切开术,对照组20例行传统气管切开术,比较两组的手术时间、切口大小、术中出血量及术后并发症.结果:治疗组手术时间(6.30±2.42)min,切口大小(0.86±0.12)cm,术中出血(1.91±1.73)ml,明显低于对照组(P0.05),术后并发症发生率也低于对照组.结论:经皮穿刺气管切开术与传统气管切开术比较,具有手术时间短、切口小、出血量少、并发症少等优点,适合在临床普及应用.表2,参4.     

四磨汤口服液对脾虚便秘小鼠肠道细菌多样性的影响

为向治疗脾虚便秘提供实验依据,将24只实验小鼠随机分成模型组、正常对照组、四磨汤口服液治疗组和枳术汤治疗组,进行小鼠脾虚便秘造模;造模结束后,治疗组分别用四磨汤口服液和枳术汤灌胃,模型组和正常对照组均用无菌水灌胃,7 d后提取小肠微生物总DNA,进行细菌16S r DNA V4区测序分析.结果发现,四磨汤口服液促进、枳术汤抑制肠道细菌OTU数目的恢复.从细菌门分类比较,枳术汤组Firmicutes的相对丰度显著低于正常组和模型组,四磨汤口服液组的Firmicutes的相对丰度明显低于模型组.从细菌目分类比较,枳术汤组中Bifidobacteriales、Clostridiales的相对丰度分别显著高于、低于模型组,Lactobacillales的相对丰度均显著低于正常组和模型组,Erysipelotrichales与Burkholderiales的相对丰度均极显著高于正常组和模型组;四磨汤口服液组中Lactobacillales的相对丰度显著低于正常组和模型组,Burkholderiales的相对丰度显著低于枳术汤组.从细菌属比较,四磨汤口服液对促进脾虚便秘小鼠肠道菌群属结构的效果要优于枳术汤.本研究说明四磨汤口服液通过对门、目、属分类的组成比例来达到治疗脾虚便秘的效果,并且比枳术汤更能显著恢复肠道细菌多样性.     

水分和氧气对毛萼田菁茎瘤固氮作用的影响

水分剥夺引起毛萼田菁（Ｓｅｓｂａｎｉａｒｏｓｔｒａｔａ）茎瘤固氮活性的下降；水分剥夺还导致茎瘤类菌体固氮的最适Ｏ２分压（ｐＯ２）和呼吸强度的下降及茎瘤豆血红蛋白和细胞质可溶性蛋白含量的下降。测定水分剥夺的茎瘤在不同ｐＯ２下的固氮活性和茎瘤组织切片的显微观察，支持水分胁迫可使Ｏ２扩散阻力增大这一观点。测定不同ｐＯ２下离体茎瘤固氮活性以ｐＯ２为６０％最高；当把茎瘤切碎后，茎瘤皮层的扩散屏障作用降低或失去，最适ｐＯ２降至４０％，说明Ｏ２是茎瘤固氮作用的限制因子。     

上消化道出血的常见诱因分析及护理对策

本文对上消化道出血的常见诱因进行了分析,并对临床护理方法进行了实践探讨,以求对上消化道出血的护理工作提供参考.     

Conservation decision-making in large state spaces

When looking for the best course of management decisions to efficiently conserve metapopulation systems, a classic approach in the ecology literature is to model the optimisation problem as a Markov decision process and find an optimal control policy using exact stochastic dynamic programming techniques. Stochastic dynamic programming is an iterative procedure that seeks to optimise a value function at each timestep by evaluating the benefits of each of the actions in each state of the system defined in the Markov decision process.Although stochastic dynamic programming methods provide an optimal solution to conservation management questions in a stochastic world, their applicability in metapopulation problems has always been limited by the so-called curse of dimensionality. The curse of dimensionality is the problem that adding new state variables inevitably results in much larger (often exponential) increases in the size of the state space, which can make solving superficially small problems impossible. The high computational requirements of stochastic dynamic programming methods mean that only simple metapopulation management problems can be analysed. In this paper we overcome the complexity burden of exact stochastic dynamic programming methods and present the benefits of an on-line sparse sampling algorithm proposed by Kearns, Mansour and Ng (2002). The algorithm is particularly attractive for problems with large state spaces as the running time is independent of the size of the state space of the problem. This appealing improvement is achieved at a cost: the solutions found are no longer guaranteed to be optimal.We apply the algorithm of Kearns et al. (2002) to a hypothetical fish metapopulation problem where the management objective is to maximise the number of occupied patches over the management time horizon. Our model has multiple management options to combat the threats of water abstraction and waterhole sedimentation. We compare the performance of the optimal solution to the results of the on-line sparse sampling algorithm for a simple 3-waterhole case. We find that three look-ahead steps minimises the error between the optimal solution and the approximation algorithm. This paper introduces a new algorithm to conservation management that provides a way to avoid the effects of the curse of dimensionality. The work has the potential to allow us to approximate solutions to much more complex metapopulation management problems in the future.     

Dynamics of insect resistance in Bt-corn

The development of genetically modified Bt-corn, incorporating various toxin genes from Bacillus thuringiensis that act as a chemical defense against insect pests, such as the European Corn Borer, provides farmers with a new pest management option. However, the emergence of insect resistance is a threat to the continued use of Bt-corn. The United States Environment Protection Agency (US EPA) has developed planting strategies, for preventing insect resistance by planting a mixture of Bt- and non-Bt-corn. Decisions about the exact proportion of Bt- and non-Bt-corn are based on complex spatially explicit mathematical models using detailed biological assumptions about the population genetics and life history of the European Corn Borer. We develop an alternative simpler model for the spread of resistance based on the logistic growth model, which we believe has utility in situations where it is impossible or impractical to estimate the different life history and genetics parameters required by more detailed models. We use our model to investigate the US EPA’s planting rules for Bt-corn and find that short-term economic behavior is likely to lead to these rules not being followed. Our results add weight to existing work on this problem. We also investigate the economics of planting Bt-corn in markets where consumers do and do not differentiate between the modes of production for the corn. We find that Bt-corn appears to be economic in markets that do not differentiate and uneconomic in markets where consumers do differentiate.     

Obtaining species: sample size considerations

Suppose fish are to be sampled from a stream. A fisheries biologist might ask one of the following three questions: ‘How many fish do I need to catch in order to see all of the species?’, ‘How many fish do I need to catch in order to see all species whose relative frequency is more than 5%?’, or ‘How many fish do I need to catch in order to see a member from each of the species A, B, and C?’. This paper offers a practical solution to such questions by setting a target sample size designed to achieve desired results with known probability. We present three sample size methods, one we call ‘exact’ and the others approximate. Each method is derived under assumed multinomial sampling, and requires (at least approximate) independence of draws and (usually) a large population. The minimum information needed to compute one of the approximate methods is the estimated relative frequency of the rarest species of interest. Total number of species is not needed. Choice of a sample size method depends largely on available computer resources. One approximation (called the ‘Monte Carlo approximation’) gets within ±6 units of exact sample size, but usually requires 20–30 minutes of computer time to compute. The second approximation (called the ‘ratio approximation’) can be computed manually and has relative error under 5% when all species are desired, but can be as much as 50% or more too high when exact sample size is small. Statistically, this problem is an application of the ‘sequential occupancy problem’. Three examples are given which illustrate the calculations so that a reader not interested in technical details can apply our results.     

Bandwidth determination for kernel density analysis of wildfire events at forest sub-district scale

Forest fire is regarded as one of the most significant factors leading to land degradation. While evaluating fire hazard or producing fire risk zone maps, quantitative analyses using historic fire data is often required, and during all these modeling and multi-criteria analysis processes, the fire event itself is taken as the dependent variable. However, there are two main problematic issues in analyzing historic fire data. The first difficulty arises from the fact that it is in point format, whereas a continuous surface is frequently needed for statistically analyzing the relationship of fire events with other factors, such as anthropogenic, topographic and climatic conditions. Another, and probably the most bothersome challenge is to overcome inaccuracy inherent in historic fire data in point format, since the exact coordinates of ignition points are mostly unknown. In this study, kernel density mapping, a widely used method for converting discrete point data into a continuous raster surface, was used to map the historic fire data in Mumcular Forest Sub-district in Mu?la, Turkey. The historic fire data was transferred onto the digital forest stand map of the study area, where the exact locations of ignition points are unknown; however, the exact number of ignition points in each compartment of the forest stand map is known. Different random distributions of ignition points were produced, and for each random distribution, kernel density maps were produced by applying two distinct kernel functions with several smoothing parameter options. The obtained maps were compared through correlation analysis in order to illustrate the effect of randomness, choice of kernel function and smoothing parameter. The proposed method gives a range of values rather than a single bandwidth value; however, it provides a more reliable way than comparing the maps with different bandwidths subjectively by eye.     

Dynamic environ analysis of compartmental systems: A computational approach

Ecosystems are often modeled as stocks of matter or energy connected by flows. Network environ analysis (NEA) is a set of mathematical methods for using powers of matrices to trace energy and material flows through such models. NEA has revealed several interesting properties of flow–storage networks, including dominance of indirect effects and the tendency for networks to create mutually positive interactions between species. However, the applicability of NEA is greatly limited by the fact that it can only be applied to models at constant steady states. In this paper, we present a new, computationally oriented approach to environ analysis called dynamic environ approximation (DEA). As a test of DEA, we use it to compute compartment throughflow in two implementations of a model of energy flow through an oyster reef ecosystem. We use a newly derived equation to compute model throughflow and compare its output to that of DEA. We find that DEA approximates the exact results given by this equation quite closely – in this particular case, with a mean Euclidean error ranging between 0.0008 and 0.21 – which gives a sense of how closely it reproduces other NEA-related quantities that cannot be exactly computed and discuss how to reduce this error. An application to calculating indirect flows in ecosystems is also discussed and dominance of indirect effects in a nonlinear model is demonstrated.     

A new meta-analysis on the WTP/WTA disparity

This study reports a new meta-analysis of papers that elicit willingness-to-pay (WTP) and willingness-to-accept compensation (WTA) measures of value for the same good. We investigate the effects of type of good and several survey-design features on the WTP/WTA disparity, measured as the logarithm of the ratio of mean WTA to mean WTP. Confirming Horowitz and McConnell?s (2002) pioneering meta-analysis, we find the disparity is smaller for ordinary private goods than for public and non-market goods, that it is not solely an artifact of using hypothetical transactions or other weak experimental or survey methods, and that it is smaller for studies using student subjects. In addition, we find that the disparity is smaller when subjects have experience valuing the good in real markets or through repeated experimental trials. In contrast to Horowitz and McConnell, we find the disparity is significantly smaller in studies using incentive-compatible elicitation mechanisms. The disparity is smaller in more recent studies, an effect that is attributable only in part to changes in study characteristics.     

Abschätzung des Beitrages kommunaler Kläranlagen an Schadstoffkonzentrationen in Oberflächengewässern

A number of products, such as washing agents or pharmaceuticals, enter the hydrosphere mainly with municipal wastewater. In this case the predicted environmental concentrations (PEC) of substances are largely determined by their elimination in municipal wastewater treatment plants and by the dilution ratio of wastewater in the rivers. In this article some rough estimates of the wastewater ratio in German rivers are presented and as a starting point for a more complex model for calculating the PEC more exactly, data on the fluctuation of river flow rates are shown.     

Detection and delineation of critical areas using echelons and spatial scan statistics with synoptic cellular data

Geographical surveillance for hotspot detection and delineation has become an important area of investigation both in geospatial ecosystem health and in geospatial public health. In order to find critical areas based on synoptic cellular data, geospatial ecosystem health investigations apply recently discovered echelon tools. In order to find elevated rate areas based on synoptic cellular data, geospatial public health investigations apply recently discovered spatial scan statistic tools. The purpose of this paper is to conceptualize a joint role for these together in the spirit of a cross-disciplinary cross-fertilization to accomplish more effective and efficient geographical surveillance for hotspot detection and delineation, and early warning system.     

中国降水量区域变化稳定性研究

利用中国气象中心160站点的实际观察资料,对中国半个世纪的降水变化进行了系统分析,发现中国的夏季降水变化稳定性有显著的纬度与海拔效应:纬度越高,方差值越小,降水变化的幅度也越小,稳定性越大;从海拔来看,海拔越高,降水稳定性越好,降水量的变化稳定性与海拔是成反相关关系.除过受区域水汽来源稳定性的影响,主要受全球降水稳定性的分布规律所制约;在海拔上,降水量稳定性的分布,除过受水汽来源影响外,还与水汽凝结的高度效应有一定的关系.