腹腔镜下经肠系膜途径与结肠旁 途径左侧输尿管上段切开取石术 的疗效比较

目的 寻找疗效更佳的腹腔镜下左侧输尿管上段切开取石术的手术途径。方法 收集43例经肠系膜途径（A组）和 46 例结肠旁途径（B 组）患者的手术时间、术中出血量、术后肠道功能恢复时间、住院时间、术后并发症、下床活动时间等临床资料,比较两组的差异。结果 A 组在手术时间、术中出血量、术后肠道功能恢复时间、住院天数明显优于B 组,差异有统计学意义（均P＜0.05）;术后并发症、下床活动时间,两组差异无统计学意义（均P＞0.05）。结论 腹腔镜下经肠系膜途径左侧输尿管上段切开取石术是一种更安全、有效、微创的手术方法,值得在临床上推广应用。     

双侧标准外伤大骨瓣开颅术中自体骨瓣临时回纳脑保护作用的探讨

目的探讨双侧标准外伤大骨瓣开颅术中脑组织医源性损伤的发生机制及防范措施,以降低非预期再次手术率及病死率.方法选择97例具双侧标准外伤大骨瓣开颅手术指征的颅脑损伤患者,采用随机数字表法分为回纳组(41例)和常规组(56例).回纳组术中采用自体骨瓣临时回纳技术,常规组采用双侧标准外伤大骨瓣开颅术.记录两组患者非预期再次手术率及病死率,并进行统计学分析.结果回纳组患者术后非预期再次手术5例(12.20%),其中先手术侧3例(7.3%),后手术侧2例(4.9%);死亡6例(14.6%).常规组患者术后非预期再次手术17例(30.3%),其中先手术侧14例(25.0%),后手术侧3例(5.3%);死亡19例(33.9%).回纳组非预期再次手术率及病死率均显著低于常规组,常规组先手术侧再次手术率较同组后手术侧及回纳组的先手术侧明显为高,差异均有统计学意义(均P<0.05).结论自体骨瓣术中临时回纳能有效减少术中脑组织医源性损伤,显著降低非预期再次手术率及病死率.     

克氏针联合外固定支架治疗桡骨远端不稳定骨折疗效分析

目的探讨克氏针联合外固定支架治疗桡骨远端不稳定骨折的临床疗效.方法选取桡骨远端不稳定骨折患者120例,其中采用经皮克氏针联合外固定支架治疗60例(观察组),采用切开复位锁定接骨板系统内固定治疗60例(对照组).比较两组患者术中出血量及手术时间,术后切口愈合时间、骨折愈合时间以及并发症发生情况.结果观察组患者手术时间、切口愈合时间、骨折愈合时间均明显短于对照组、术中出血量显著少于对照组,差异均有统计学意义(P<0.05或0.01).两组患者术后腕关节功能及复位质量均无明显差异(均P>0.05).观察组患者术后仅创伤性关节炎发生率明显低于对照组(P<0.05),两组患者其他并发症发生率的差异均无统计学意义(均P>0.05).结论克氏针联合外固定支架治疗桡骨远端不稳定骨折,具有创伤小、岀血量少,缩短手术时间、伤口愈合时间及骨折愈合时间,恢复快、功能良好、术后并发症发生率低等优点,值得临床推广.     

梗阻型肥厚性心肌病冠状动脉造影特点及其对经皮室间隔心肌化学消融的临床意义

目的评价冠状动脉造影的形态学特征对经皮室间隔心肌化学消融(PTSMA)术治疗肥厚型梗阻性心肌病(HOCM)的指导意义.方法选择32例药物疗效欠佳并行PTSMA手术的HOCM患者,研究其冠状动脉造影特点,并与30例年龄、性别相匹配的冠状动脉造影正常的患者(对照组)进行比较.根据定量冠状动脉造影(QCA)测定目标消融间隔支的直径,分为≤1.5mm(小间隔支组)和>1.5mm组(大间隔支组),比较两组PTSMA术前、术后心导管测量左心室流出道压差(LVOTG)的变化.结果冠状动脉造影显示HOCM组的左主干、左前降支、左回旋支及左间隔支内径均显著大于对照组(均P<0.05),HOCM组左前降支肌桥的发生率较对照组亦明显增加(P<0.05);23例消融成功,PTSMA术前、术后导管测量LVOTG分别为(85.8±31.1)、(37.25±31.9)mmHg(P<0.01),其中大间隔支组PTSMA成功率明显高于小间隔支组(P<0.05),大间隔支组LVOTG的下降程度明显大于小间隔支组(P<0.05),两组间无水乙醇用量差异无统计学意义(P>0.05).结论 HOCM患者的左前降支肌桥发生率增加,且左冠状动脉内径较粗大,尤其是左间隔支粗大;间隔支>1.5mm的HOCM患者是PTSMA手术成功的重要预测因素,这对PTSMA目标消融间隔支的选择具有重要指导意义.     

房颤复律前后血BNP水平变化及复发的相关因素

目的探讨房颤对血脑利钠肽(BNP)水平的影响及房颤复发的相关因素.方法选择阵发性或持续性房颤非心衰患者49例(房颤组),另择同期类似疾病窦性心律患者50例作为对照组.检测对照组及房颤组复律前的血BNP水平.房颤组患者使用胺碘酮药物复律,在复律后24h检测血BNP水平,并随访观察6个月.比较分析6个月内房颤组复发与未复发患者的血BNP水平及临床特征.结果复律前房颤组血BNP水平显著高于对照组(P<0.01);房颤组复律后血BNP水平显著低于复律前(P<0.01),与对照组比较差异无统计学意义(P>0.05).随访期间房颤组31例未复发,18例复发;复律前后复发者血BNP水平均显著高于未复发者(均P<0.01);复发者与未复发者仅左房内径、病程、束支传导阻滞、二尖瓣反流等临床特征的差异具有统计学意义(P<0.05或0.01).结论房颤患者血BNP水平升高,并在复律时降低.血BNP水平、左房内径、房颤病程、束支传导阻滞、二尖瓣反流等特征可能与房颤复发有关.     

GnRH-a治疗中重度盆腔子宫内膜异位症后妊娠情况分析

目的探讨中重度子宫内膜异位症患者使用促性腺激素释放激素激动剂(GnRH-a)治疗后妊娠情况.方法选取中重度子宫内膜异位症患者61例,其中期待组(48例)予期待妊娠,必要时监测排卵或常规促排卵,辅助生殖组(13例)予体外受精-胚胎移植,观察比较两组患者术后使用GnRH-a治疗后的妊娠情况.结果61例患者总妊娠率67.2%(41/61).期待组月经恢复的0~3个月妊娠率(56.3%,27/48)明显高于月经恢复第4~12个月的妊娠率(12.5%,6/48),差异有统计学意义(P<0.05).辅助生殖组月经恢复的0~3个月妊娠率(30.8%,4/13)与月经恢复第4~12个月的妊娠率(30.8%,4/13)差异无统计学意义(P>0.05).月经恢复后的1年内,两组患者妊娠率的差异无统计学意义(P>0.05).GnRH-a使用3次与使用4~6次比较,妊娠率的差异无统计学意义(P>0.05).结论中重度子宫内膜异位症性患者,使用3次GnRH-a治疗,在月经恢复前及恢复最初3个月积极指导患者期待妊娠,在月经恢复3个月后及合并子宫内膜异位症外其他不孕因素的患者尽早给予辅助生殖治疗,有利于提高妊娠率.     

不同目标的早期液体复苏对老年脓毒症血管外肺水的影响

目的探讨以中心静脉压(CVP)或每搏输出量变异(SVV)为目标的早期液体复苏方案对老年脓毒症患者血管外肺水(EVLW)及预后的影响.方法将59例老年脓毒症患者随机分为CVP组和SVV组,根据不同的复苏目标(分别是CVP、SVV达标)进行早期液体复苏,评价两组患者的预后,比较不同的液体复苏方案对血管外肺水指数(EVLWI)的影响,并分析复苏后EVLWI过高的影响因素.结果复苏后,与CVP组相比,SVV组机械通气时间及ICU住院时间缩短(均P<0.05),但两组28d病死率(SVV组35.7%,CVP组48.3%)差异无统计学意义(P>0.05).两组复苏前EVLWI差异无统计学意义(P>0.05),复苏后均有增加(均P<0.05),且复苏后SVV组EVLWI≥9ml/kg的例数较少(SVV组11例,CVP组18例).回归分析显示复苏后EVLWI≥9ml/kg的主要影响因素包括:基础EVLWI较高、达标时SVV较低、复苏导致的CI增加较少和SVV增加较多.结论早期液体复苏可导致老年脓毒症患者的EVLWI明显升高.依据SVV对老年脓毒症患者进行液体复苏比CVP作为复苏目标,达标时EVLWI过高的危险性减小.     

拉米夫定治疗慢性乙型肝炎YMDD变异的相关因素分析

目的分析拉米夫定治疗后慢性乙型肝炎酪氨酸(Y)、蛋氨酸(M)、天冬氨酸(D)、天冬氨酸(D)变异的相关因素.方法对169例经拉米夫定治疗12个月后的慢性乙型肝炎患者发生YMDD变异情况进行回顾性分析.采用荧光定量PCR和PCR产物测序等方法检测慢性乙型肝炎拉米夫定治疗前、治疗后HBV基因型、HBV DNA水平、HBeAg状态、ALT水平等指标.结果在169例患者中,基因型B共76例(44.97%),基因型C共93例(55.03%).拉米夫定治疗12个月后,46例(27.22%)患者发生YMDD变异,其中,基因型B变异27例(35.53%),基因型C变异19例(20.43%),两者有统计学差异(P<0.05).YMDD变异组患者治疗前HBV DNA水平显著高于YMDD未变异组[(7.26±0.58 vs6.44±0.65)log拷贝/ml,P<0.05].HBeAg阳性患者YMDD变异率显著高于HBeAg阴性患者(38.10%vs20.75%,P<0.05).YMDD变异组与未变异组在治疗前ALT水平上无明显差异[(136.09±28.21 vs 124.15±26.52)U/L,P>0.05].结论拉米夫定治疗慢性乙型肝炎发生YMDD变异与HBV基因型、HBV DNA水平、HBeAg状态等密切相关.拉米夫定治疗前,检测HBV基因型、HBV DNA水平,HBeAg状态等指标对慢性乙型肝炎抗病毒治疗具有重要意义.     

老年静止期翼状胬肉两种手术方法的临床评价

目的比较显微镜下单纯翼状胬肉切除与切除后联合角膜缘干细胞移植两种手术方式对老年静止期翼状胬肉患者的治疗效果.方法将>65岁的原发性静止期翼状胬肉患者随机分为两组,A组行显微镜下单纯翼状胬肉切除术,B组在翼状胬肉切除后行自体角膜干细胞移植,术后随访6~36个月(平均10个月),观察手术时间及术后复发情况.结果 A组手术时间(14.2±1.3)min,明显短于B组(24.1±1.2)min,比较有统计学差异(P=0.000).而复发率比较,A组复发率6.67%(2/30),B组复发率3.33%(1/30),两组间无统计学差异(P=0.550).结论两种手术复发率均较低,但单纯切除术手术时间短,对不能长时间耐受手术或手术配合度较差的老年静止期翼状胬肉患者,可以作为首选手术方式.     

高钠血症与颅脑损伤患者死亡相关风险研究

目的探讨不同程度高钠血症与颅脑损伤患者死亡的相关风险.方法将近5年ICU的颅脑损伤患者431例根据血钠水平分为4组,非高钠组(<150mmol/L)、轻度高钠组(150~155mmol/L)、中度高钠组(155~160 mmol/L)、重度高钠组(≥160mmol/L),分析血钠水平与患者死亡的相关风险.结果重度高钠组患者的Glasgow昏迷评分(GCS)3.27±0.89,APACHE-II评分35.25±6.01,病死率93.82%,与轻、中度高钠组患者相比,具有统计学差异(P<0.05).Logistic多因素分析提示GCS评分下降(OR=3.96,95%CI=1.43~10.96,P<0.05),APACHE-II评分升高(OR=1.32,95%CI=1.21~1.41,P<0.05)和重度高钠血症(OR=6.07,95%CI=3.19~13.87,P<0.05)是颅脑损伤患者的死亡危险因素.结论重度高钠血症是脑外伤患者死亡的主要危险因素之一.     

Qualitative Analysis of Bifurcating Solutions in the Lengyel-Epstein Model

One of the most fundamental problems in theoretical biology is to explain the mechanisms by which patterns and forms are created in the＇living world. In his seminal paper ＂The Chemical Basis of Morphogenesis＂, Turing showed that a system of coupled reaction-diffusion equations can be used to describe patterns and forms in biological systems. However, the first experimental evidence to the Turing patterns was observed by De Kepper and her associates（1990） on the CIMA reaction in an open unstirred reactor, almost 40 years after Turing＇s prediction. Lengyel and Epstein characterized this famous experiment using a system of reaction-diffusion equations. The Lengyel-Epstein model is in the form as follows     

(0,1 ;0)-INTERPOLATION ON INFINITE INTERVAL (-∞, +∞)

In this paper, we study the explicit representation and convergence of (0, 1; 0)-interpolation on infinite interval, which means to determine a polynomial of degree ≤ 3n - 2 when the function values are prescribed at two set of points namely the zeros of Hn(x) and H′n(x) and the first derivatives at the zeros of H′n(x).     

RECENT PROGRESS ON SPHERICAL HARMONIC APPROXIMATION MADE BY BNU RESEARCH GROUP ——In memory of Professor Sun Yongsheng

As early as in 1990, Professor Sun Yongsheng, suggested his students at Beijing Normal University to consider research problems on the unit sphere. Under his guidance and encouragement his students started the research on spherical harmonic analysis and approximation. In this paper, we incompletely introduce the main achievements in this area obtained by our group and relative researchers during recent 5 years （2001-2005）. The main topics are： convergence of Cesaro summability, a.e. and strong summability of Fourier-Laplace series; smoothness and K-functionals; Kolmogorov and linear widths.     

On a class of self-similar processes with stationary increments in higher order Wiener chaoses

We study a class of self-similar processes with stationary increments belonging to higher order Wiener chaoses which are similar to Hermite processes. We obtain an almost sure wavelet-like expansion of these processes. This allows us to compute the pointwise and local Hölder regularity of sample paths and to analyse their behaviour at infinity. We also provide some results on the Hausdorff dimension of the range and graphs of multidimensional anisotropic self-similar processes with stationary increments defined by multiple Wiener–Itô integrals.     

A REPRESENTATION FORMULA RELATED TO SCHR(O)DINGER OPERATORS

Schr(o)dinger operator is a central subject in the mathematical study of quantum mechanics.Consider the Schrodinger operator H = -△ V on R, where △ = d2/dx2 and the potential function V is real valued. In Fourier analysis, it is well-known that a square integrable function admits an expansion with exponentials as eigenfunctions of -△. A natural conjecture is that an L2 function admits a similar expansion in terms of "eigenfunctions" of H, a perturbation of the Laplacian (see [7], Ch. Ⅺ and the notes), under certain condition on V.     

On a class of Riemann surfaces

It is considered the class of Riemann surfaces with dimT1 = 0, where T1 is a subclass of exact harmonic forms which is one of the factors in the orthogonal decomposition of the spaceΩH of harmonic forms of the surface, namely The surfaces in the class OHD and the class of planar surfaces satisfy dimT1 = 0. A.Pfluger posed the question whether there might exist other surfaces outside those two classes. Here it is shown that in the case of finite genus g, we should look for a surface S with dimT1 = 0 among the surfaces of the form Sg\K , where Sg is a closed surface of genus g and K a compact set of positive harmonic measure with perfect components and very irregular boundary.     

Journal of the Operations Research Society of China Special issue on Operations Research in Healthcare Management

正Guest Editors:Hong Chen,Shanghai Jiao Tong University,Shanghai,China Guohua Wan,Shanghai Jiao Tong University,Shanghai,China David Yao,Columbia University,New York,USA Scope:Healthcare delivery worldwide has been fraught with high cost,low efficiency and poor quality of patient care service.For the field of operations research(OR),healthcare offers some of the biggest challenges as well as best opportunities in     

ANALYSIS IN THEORY AND APPLICATIONS Vol. 30, 2014 CONTENTS

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An alternative mathematical algorithm for the photo- and videokeratoscope

Due to the resolution of current laser technology, the accuracy of corneal topography as measured by the videokeratoscope is no longer adequate to provide precise enough data for refractive surgery or for the fitting of customized contact lenses. We present an algorithm for recovering corneal topography that makes use of modern differential geometric techniques and numerical descent in Sobolev spaces. We believe this algorithm may be used with the photo- and videokeratoscope to increase the accuracy of the recovered corneal topography.