岩斜区脑膜瘤手术治疗及全切影响因素分析

目的探讨岩斜区脑膜瘤手术全切影响因素。方法回顾性分析2011年1月—2021年12月于长江航运总医院手术治疗的57例岩斜区脑膜瘤患者的临床资料。采用多因素Logistic回归分析检验岩斜区脑膜瘤全切的影响因素,并分析对比术前术后卡氏功能状态评分(KPS评分)。结果57例患者肿瘤完全切除35例,非完全切除22例,全切率61.40%。多因素Logistic回归分析结果显示,肿瘤质地、直径、肿瘤血供及侵犯海绵窦是岩斜区脑膜瘤全切的独立影响因素(P<0.05)。术前平均KPS评分为83.51,随访平均KPS评分为87.34,脑干受压重患者KPS改善明显(P<0.05)。结论岩斜区脑膜瘤全切术后多数可减少复发,改善功能预后。肿瘤质地、直径、侵袭海绵窦、压迫脑干以及肿瘤被血管神经包绕血运丰富,和手术入路的选择等是影响肿瘤全切除的重要因素。

论新时代实现卓越领导的三重意蕴

中国特色社会主义进入新时代对领导者的素养和能力提出了新的要求。实现卓越领导不能仅仅依靠职位和权力等外在属性,还必须紧贴时代的需要,不断提高自我的专业能力和专业精神,优化知识结构,提高能力素养,坚定理想信念,奉行"实"字为本的工作精神和清正廉洁的优良作风,并在领导活动中辅之以包容、开放、民主等灵活务实的领导艺术,着力提升科学领导力,适应中国特色社会主义进入新时代对于提高党的执政能力和领导水平的客观要求。

经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖

目的探讨经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖特征。方法利用10具(20侧)成人尸头标本,模拟经鼻蝶入路神经内镜手术,从颅底内、外两面观察,测量斜坡及相关毗邻骨性结构。结果①斜坡外表面呈凸状向下倾斜,长度为28.12 mm,由外展神经硬膜孔和舌咽神经水平将斜坡分为上、中、下三段:舌下神经管外口到颈静脉结节距离,左侧(5.80±0.82)mm,右侧(5.91±0.79)mm;到枕骨大孔前缘中点距离,左侧(19.54±1.72)mm,右侧(18.42±1.69)mm;到中线距离,左侧(17.08±2.25)mm;咽结节到枕骨大孔前缘中点距离(12.12±1.63)mm;斜坡可切除面积(805.92±5.24)mm^(2),枕髁可切除面积(144.47±4.76)mm^(2)。②斜坡内面观,斜坡由枕骨大孔向前上方宽而浅的倾斜而成,两侧以岩斜裂与岩骨相毗邻:舌下神经管内口到枕骨大孔前缘,左侧(15.12±1.59)mm,右侧(14.25±1.63)mm;到枕髁前缘距离,左侧(12.77±1.47)mm,右侧(11.16±1.44)mm。结论熟悉斜坡的重要解剖标记对经鼻蝶入路神经内镜手术中切除范围有重要指导作用。

儿童乳突炎继发静脉窦血栓伴脑脓肿1例并文献复习

目的 儿童乳突炎继发静脉窦血栓伴脑脓肿的临床、影像学、诊疗方法及预后。方法 回顾性分析1例儿童乳突炎继发静脉窦血栓伴脑脓肿患者的临床资料,并复习相关文献。结果 患儿男,12岁,临床表现为发热、头痛、呕吐及左侧肢体无力,考虑乳突炎引起的多发脑脓肿伴静脉窦血栓。行右额钻孔硬膜下脓肿引流,术后脓液微生物培养提示金黄色葡萄球菌,采用万古霉素+美罗培南+甲硝唑注射液治疗3周余后好转出院,出院后口服利奈唑胺抗感染治疗2个月后恢复良好。结论 感染性的静脉窦血栓极为少见,儿童相较成人多,近半数近期有感染。诊断和治疗需结合病史,影像学特点及微生物检验来判断,可考虑手术并积极抗感染治疗。

侧方扩散反应在面肌痉挛疾病中的应用进展

侧方扩散反应(LSR)是面肌痉挛疾病诊断中的一种标志性电生理现象。在微血管减压术的治疗中起着重要的作用。本文从LSR的历史、基本原理、测量方法、和F波的关系、临床意义等方面阐述了LSR的应用进展。

A wear-resistant metastable CoCrNiCu high-entropy alloy with modulated surface and subsurface structures

Sliding friction-induced subsurface structures and severe surface oxidation can be the major causes influencing the wear resistance of ductile metallic materials.Here,we demonstrated the role of subsurface and surface structures in enhancing the wear resistance of an equiatomic metastable CoCrNiCu high-entropy alloy(HEA).The CoCrNiCu HEA is composed of a CoCrNi-rich face-centered cubic(FCC)dendrite phase and a Cu-rich FCC inter-dendrite phase.Copious Cu-rich nano-precipitates are formed and distributed uniformly inside the dendrites after tuning the distribution and composition of the two phases by thermal annealing.Although the formation of nano-precipitates decreases the hardness of the alloy due to the loss of solid solution strengthening,these nano-precipitates can be deformed to form continuous Cu-rich nanolayers during dry sliding,leading to a self-organized nano-laminated microstructure and extensive hardening in the subsurface.In addition,the nano-precipitates can facilitate the formation of continuous and compacted glaze layers on the worn surface,which are also beneficial for the reduction of the wear rate of CoCrNiCu.The current work can be extended to other alloy systems and might provide guidelines for designing and fabricating wear-resistant alloys in general.

Classification of yearly extreme precipitation events and associated flood risk in the Yangtze-Huaihe River Valley

Fifty cases of regional yearly extreme precipitation events （RYEPEs） were identified over the Yangtze-Huaihe River Valley （YHRV） during 1979-2016 applying the statistical percentile method. There were five types of RYEPEs, namely Yangtze Meiyu （YM-RYEPE）, Huaihe Meiyu （HM-RYEPE）, southwest-northeast-oriented Meiyu （SWNE-RYEPE） and typhoon I and II （TC-RYEPE） types of RYEPEs. Potential vorticity diagnosis showed that propagation trajectories of the RYEPEs along the Western Pacific Subtropical High and its steering flow were concentrated over the southern YHRV. As a result, the strongest and most frequently RYEPEs events, about 16-21 cases with average rainfall above 100 mm, occurred in the southern YHRV, particularly in the Nanjing metropolitan area. There have been 14 cases of flood-inducing RYEPEs since 1979, with the submerged area exceeding 120 km2 as simulated by the FloodArea hydraulic model, comprising six HM-RYEPEs, five YM- RYEPEs, two TC-RYEPEs, and one SWNE-RYEPE. The combination of evolving RYEPEs and rapid expansion of urban agglomeration is most likely to change the flood risk distribution over the Nanjing metropolitan area in the future. In the RCP6.0 （RCPS.5） scenario, the built-up area increases at a rate of about 10.41 km2 （10 yr）-t（24.67 km2 （10 yr）-1） from 2010 to 2100, and the area of high flood risk correspondingly increases from 3.86 km2（3.86 km2） to 9.00 kin2（13.51 km2）. Areas of high flood risk are mainly located at Chishan Lake in Jurong, Lukou International Airport in Nanjing, Dongshan in Jiangning District, Lishui District and other low-lying areas. The accurate simulation of flood scenarios can help reduce losses due to torrential flooding and improve early warnings, evacuation planning and risk analysis. More attention should be paid to the projected high flood risk because of the concentrated population, industrial zones and social wealth throughout the Nanjing metropolitan area.

Mechanical and tribological performance of CoCrNiHf_(x)eutectic medium-entropy alloys

The excellent properties of the multi-principal element alloys(e.g.,the CoCrNi medium-entropy alloy)make them a perfect candidate for structure materials.Their low strength and poor wear-resistance,however,limit considerably their applications.In this study,a lamellar eutectic microstructure was introduced by addition of Hf into CoCrNi alloy to produce a series of CoCrNiHf_(x)(x=0.1,0.2,0.3 and 0.4)eutectic medium-entropy alloys.A homogeneous eutectic microstructure with an alternate array of the soft FCC solid-solution phase and the hard Laves phase was identified for the as-cast CoCrNiHf_(0.3)alloy.After an investigation of the microstructure,mechanical and tribological properties,it was found that the hardness(plasticity)increases(decreases)with the increasing volume fraction of the Laves phase and the CoCrNiHf_(0.3)eutectic alloy exhibits both good plasticity and high strength.The wear behavior is strongly dependent on the applied normal load.For a low normal load,its tribological behavior follows the Archard's equation and a higher hardness due to Hf addition can resist plastic deformation and abrasive wear.When the normal load is high enough,the hypoeutectic or hypereutectic alloy,which possessing either high strength or good ductility but not at the same time,exhibit a poor wear resistance.In comparison,the full eutectic CoCrNiHf_(0.3)alloy with a superior combination of strength and toughness shows the best wear performance,as it can significantly reduce fracture during wear.

Cryogenic wear behaviors of a metastable Ti-based bulk metallic glass composite

Bulk metallic glass composites(BMGCs)are proven to be excellent candidates for cryogenic engineering applications due to their remarkable combination of strength,ductility and toughness.However,few efforts have been done to estimate their wear behaviors that are closely correlated to their practical service.Here,we report an improvement of∼48%in wear resistance for a Ti-based BMGC at the cryogenic temperature of 113 K as compared to the case at 233 K.A pronounced martensitic transformation(β-Ti→α''-Ti)was found to coordinate deformation underneath the worn surface at 233 K but was significantly suppressed at 113 K.This temperature-dependent structural evolution is clarified by artificially inducing a pre-notch by FIB cutting on aβ-Ti crystal,demonstrating a strain-dominated martensitic transformation in the BMGC.The improved wear resistance and suppressed martensitic transformation in BMGC at 113 K is associated with the increased strength and strong confinement of metallic glass on metastable crystalline phase at the cryogenic temperature.The current work clarifies the superior cryogenic wear resistance of metastable BMGCs,making them excellent candidates for safety-critical wear applications at cryogenic temperatures.

Global Financial Crisis Making a V-Shaped Fluctuation in NO_2 Pollution over the Yangtze River Delta

The Yangtze River Delta（YRD）,China’s main cultural and economic center,has become one of the most seriously polluted areas in the world with respect to nitrogen oxides（NO_x）,owing to its rapid industrialization and urbanization,as well as substantial coal consumption.On the basis of nitrogen dioxide（NO_2）density data from ozone monitoring instrument（OMI）and ground-based observations,the effects of industrial fluctuations due to the financial crisis on local NO_2 pollution were quantitatively assessed.The results were as follows.（1）A distinct V-shaped fluctuation of major industrial products,thermal generating capacity,electricity consumption,and tropospheric NO_2 densities was associated with the global financial crisis from May 2007 to December 2009,with the largest anomalies 1.5 times more than standard deviations at the height of the crisis period from November 2008 to February 2009.（2）Among all industrial sectors,thermal power plants were mainly responsible for fluctuations in local NO_2 pollution during the crisis period.Thermal generating capacity had its greatest decrease of 12.10%at the height of the crisis compared with that during November 2007–February 2008,leading to local tropospheric NO_2 density decreasing by 16.97%.As the crisis appeased,thermal generating capacity increased by 29.63%from November 2009 to February 2010,and tropospheric NO_2 densities correspondingly increased by 30.07%.（3）Among all industrial sectors in the YRD,the thermal power sector has the greatest coal consumption of about 65.96%.A decline in thermal power of about 10% can induce a decrease of about 30%in NOx emissions and NO_2 densities,meaning that a relative small fluctuation in industrial production can lead to a large decrease in tropospheric NO_2 densities over industrially developed areas like the YRD region.Since electricity is mainly obtained from local coal-burning thermal plants without NO_x-processing equipment,installing NO_x-removal devices for all thermal power plants is an important and feasible way of controlling local NO_x pollution at present.