全胸腔镜经主动脉切口行改良Morrow术的可行性

目的探索全胸腔镜经主动脉切口行改良Morrow术的可行性及早期效果。方法收集梗阻性肥厚型心肌病(HCM)患者13例,男性9例,女性4例,年龄(59.3±13.3)岁(30~77岁),术前室间隔厚度为(1.83±0.21)mm、左心室流出道峰值压差(LVOTGP)为(76.90±27.61)mmHg(1 mmHg=0.133 kPa),收缩期前向运动(SAM)征均阳性。患者均接受全胸腔镜下经主动脉切口行改良Morrow术,同期行二尖瓣二孔成形术3例。结果全组手术成功,无中转开胸,术中主动脉阻断时间(93.00±18.68)min,体外循环时间(137.70±20.49)min,术后气管插管时间(10.70±4.30)h。术后室间隔厚度为(1.18±0.26)mm、LVOTGP为(13.46±9.46)mmHg,均较术前降低,差别有统计学意义(P<0.001)。术后二尖瓣均为轻微反流,无中度以上反流,SAM征消失。随访3~12个月,临床症状改善,患者无死亡,无室间隔穿孔、左心室流出道残留梗阻和Ⅲ度房室传导阻滞。结论全胸腔镜入路经主动脉切口可更好地暴露梗阻的室间隔组织,保留胸廓的完整性,避免损伤二尖瓣前叶,早期效果良好,是一种良好的手术入路方式。

Effect of distribution of fines on evolution of cooperation in spatial public goods game

In the realm of public goods game,punishment,as a potent tool,stands out for fostering cooperation.While it effectively addresses the first-order free-rider problem,the associated costs can be substantial.Punishers incur expenses in imposing sanctions,while defectors face fines.Unfortunately,these monetary elements seemingly vanish into thin air,representing a loss to the system itself.However,by virtue of the redistribution of fines to cooperators and punishers,not only can we mitigate this loss,but the rewards for these cooperative individuals can be enhanced.Based upon this premise,this paper introduces a fine distribution mechanism to the traditional pool punishment model.Under identical parameter settings,by conducting a comparative experiment with the conventional punishment model,the paper aims to investigate the impact of fine distribution on the evolution of cooperation in spatial public goods game.The experimental results clearly demonstrate that,in instances where the punishment cost is prohibitively high,the cooperative strategies of the traditional pool punishment model may completely collapse.However,the model enriched with fine distribution manages to sustain a considerable number of cooperative strategies,thus highlighting its effectiveness in promoting and preserving cooperation,even in the face of substantial punishment cost.

Discreet investors exert greater influence on cooperation in the public goods game

This paper studies the evolutionary process of cooperative behavior in a public goods game model with heterogeneous investment strategies in square lattices.In the proposed model,players are divided into defectors,cooperators and discreet investors.Among these,defectors do not participate in investing,discreet investors make heterogeneous investments based on the investment behavior and cooperation value of their neighbors,and cooperators invest equally in each neighbor.In real life,heterogeneous investment is often accompanied by time or economic costs.The discreet investors in this paper pay a certain price to obtain their neighbors'investment behavior and cooperation value,which quantifies the time and economic costs of the heterogeneous investment process.The results of Monte Carlo simulation experiments in this study show that discreet investors can effectively resist the invasion of the defectors,form a stable cooperative group and expand the cooperative advantage in evolution.However,when discreet investors pay too high a price,they lose their strategic advantage.The results in this paper help us understand the role of heterogeneous investment in promoting and maintaining human social cooperation.

曹伟云教授治疗Good’s综合征合并支气管扩张验案1例

Good’s综合征是一种免疫缺陷性疾病,属于少见病,关于本病的报道并不多,尤其是采用中药治疗的报道少之又少。Good’s综合征患者因免疫力欠佳,易合并感染,尤以合并支气管扩张伴感染偏多。目前,西医治疗多为对症治疗,急性期予抗生素控制感染,但患者病情易反复。本文主要从曹伟云教授对Good’s综合征合并支气管扩张病的中医病因病机和辨证论治等方面展开论述,认为Good’s综合征合并支气管扩张或因初感外邪、侵犯肺系,或因痰热日久、消耗阴液,或因久病体虚、伤及阴阳引起,在治疗上或予以清热散邪,或予以养阴清热、化痰排脓,或予以补阳养阴,同时根据伴随症进行药物加减,通过整体观念辨证论治,扶正与祛邪动态调整,尤以扶正为要,增强患者的免疫力,改善患者体质,迅速缓解患者临床症状,减少病情发作次数和患者住院次数。

The Violent Redemption Theme in A Good Man is Hard to Find

Flannery O’Connor is one of the representative figures of American Southern writers.Being recognized as the most outstanding writer of the American South after Faulkner,she has great influence in the literary world.Her works are always shrouded in a strange and grotesque atmosphere and full of death as well as religious metaphors.The protagonists are a series of American Southern freaks struggling with the crisis of spiritual belief.The protagonists of her novel A Good Man is Hard to Find are a hypocritical believer in the world of sinners and a lost man suffering in the midst of real sin,thus O’Connor uses the highest form of violence-death to bring ultimate redemption to them.In people’s conception,violence and redemption are often opposite to each other,but O’Connor uses bloody and violent plots to explore the theme of religious salvation,integrating and unifying the two contrary concepts to form her unique and profound violent redemption writing.

Convenience on Three Wheels China-made motor tricycles are transforming the way goods and people are transported in Uganda

In most cities,towns and villages in Uganda,Chinamade motor tricycles have become a game-changer for commuters and entrepreneurs alike.

Changes in the Supply of Public Intermediate Goods,Fixed Wage,and the Relative Price in the Harris-Todaro Model

Since the Harris-Todaro model was proposed in 1970,it has played a crucial role in analyzing various environmental and trade issues in developing countries.This paper analyzes the effects of the amount of public intermediate goods provided by the government,the increase in the fixed wage rate in the urban sector,and the changes in the relative international prices of agricultural and manufacturing goods on labor employment,unemployment,and the economic welfare in the context of a small open economy.It also proposes relevant policies to reduce the unemployment rate while improving national welfare.

微创Morrow联合二尖瓣缘对缘修复技术治疗肥厚型梗阻性心肌病

肥厚型心肌病(hypertrophic cardiomyopathy,HCM)是一种常见的以左心室壁不对称性肥厚为解剖特征的遗传性心肌病,在成年人群中HCM的发病率在0.2%左右,约70%的HCM会发生左心室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)进展成肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)^([1-3])。

梗阻性肥厚型心肌病改良Morrow术同期行二尖瓣成形术患者围手术期管理效果分析

目的探索行改良Morrow术的梗阻性肥厚型心肌病患者联合二尖瓣成形术的围手术期管理和效果。方法收集2018年1月至2020年12月在首都医科大学附属北京安贞医院进行外科治疗的100例梗阻性肥厚型心肌病患者的临床资料。对患者的术前评估、术中配合以及围手术期管理等情况进行回顾性分析,根据术中是否行二尖瓣成形术将患者分为单一手术组(51例)和联合手术组(49例),比较2组围手术期相关指标差异。结果所有患者均在全身麻醉体外循环下顺利完成手术。联合手术组3例患者心脏复跳后二尖瓣反流为中度以上关闭不全,再次进行二尖瓣成形术,效果满意。联合手术组患者体外循环时间、主动脉阻断时间、术后即刻左心室流出道压差均长于/高于单一手术组[(121±39)min比(108±47)min、(77±30)min比(64±36)min、(10.9±4.8)mmHg(1 mmHg=0.133 kPa)比(8.6±2.7)mmHg],差异均有统计学意义(均P<0.05)。所有患者术后均无伤口渗血、出血等情况,均康复出院,出院前2组患者血红蛋白水平基本正常。联合手术组于出院前再次进行超声心动图检查,35例存在二尖瓣轻度反流、14例无反流。2组患者术后6个月随访无死亡。2组患者术后第7天血红蛋白水平、左心室舒张末期内径、左心室流出道压差、左心室射血分数及中重度二尖瓣关闭不全、术后心房颤动、心功能Ⅰ级、压力性损伤、脑梗死比例差异均无统计学意义(均P>0.05)。结论改良Morrow术同期行二尖瓣成形术安全可行,做好患者的围手术期管理是取得良好手术疗效的重要保证。

改良扩大Morrow手术治疗肥厚型梗阻性心肌病的近中期随访疗效

目的:观察改良Morrow手术治疗肥厚型梗阻性心肌病(HOCM)的近中期随访疗效。方法:选取我院2014年1月—2020年12月采用改良Morrow手术治疗的HOCM病人25例。所有病人术前均经超声心动图和心脏磁共振成像确诊为HOCM,行冠状动脉CT或冠状动脉造影,评估冠状动脉情况。所有病人均有二尖瓣前叶前向运动(收缩期前向运动征阳性)。所有病人均在全身麻醉、中度低温体外循环下经主动脉切口行改良Morrow手术,术中经食道超声评估手术效果,术后定期随诊。结果:25例病人住院期间无死亡,其中1例病人术后出现完全性房室传导阻滞,行永久起搏器置入,所有病人均治愈出院。结论:改良Morrow手术是治疗HOCM的有效方法,对药物治疗无效和乙醇消融术后再次复发的病人有效,可彻底解除左心室流出道梗阻,近中期疗效良好。

Toward inclusive list-making for trade liberalization in environmental goods to reduce carbon emissions

The Asia-Pacific Economic Cooperation(APEC)is contemplating expanding its list of environmental goods(EG)for trade liberalization to fight climate change.In support of doing so,this study proposes that a long list that retains controversies is better for carbon emission reduction than a short common list.This study examines four mechanisms of longer lists:enlarging market scales,enriching product mixes,enhancing product sophistication,and enriching trade patterns.Using China’s emerging EG trade during the 2001-2015 period as a case study,this study compares four EG lists with different EG.The results show that:(1)a longer list reduces carbon emissions from both imports and exports,making domestic regions with different advantages have better chances of improving carbon efficiencies.(2)Product sophistication reduces the emission gap between trading partners,regardless of the length of EG lists.(3)China’s EG exports contribute to carbon reduction in leading regions,while EG imports provide laggard regions with better chances of reducing carbon emissions.These findings provide three implications for future list-making:it is important to(1)seek a long and inclusive list rather than a short common list,(2)shift the focus from environmental end-use to the technological contents of products,and(3)balance the demand of laggard regions to import and the capacity of leading regions to export.

Application of Dual-Energy X-Ray Image Detection of Dangerous Goods Based on YOLOv7

X-ray security equipment is currently a more commonly used dangerous goods detection tool, due to the increasing security work tasks, the use of target detection technology to assist security personnel to carry out work has become an inevitable trend. With the development of deep learning, object detection technology is becoming more and more mature, and object detection framework based on convolutional neural networks has been widely used in industrial, medical and military fields. In order to improve the efficiency of security staff, reduce the risk of dangerous goods missed detection. Based on the data collected in X-ray security equipment, this paper uses a method of inserting dangerous goods into an empty package to balance all kinds of dangerous goods data and expand the data set. The high-low energy images are combined using the high-low energy feature fusion method. Finally, the dangerous goods target detection technology based on the YOLOv7 model is used for model training. After the introduction of the above method, the detection accuracy is improved by 6% compared with the direct use of the original data set for detection, and the speed is 93FPS, which can meet the requirements of the online security system, greatly improve the work efficiency of security personnel, and eliminate the security risks caused by missed detection.

Discussion on the Supply of Child-friendly City Construction Based on the Attributes of Public Goods

Child friendliness is the need for a good life in the new era.The problems related to the construction of child-friendly cities were discussed from the perspective of the supply of public goods.Through literature research and summary,the basic concepts,construction factors,sources of supply goods,structure of the main supplies,and supply behavior of public goods supply in child-friendly cities were sorted out.Some effective suggestions were proposed,such as improving the resource conversion and integration ability of the main suppliers,establishing an effective incentive system,optimizing the structure of the main suppliers,improving multi-party collaborative efficiency,ensuring benefits for all parties,raising child-friendly awareness,innovating funding sources for projects,ensuring adequate funding supply,building urban supply system in accordance with local conditions,and ensuring the supply of public goods.

Strategy dominance mechanism of autonomous collaboration in unmanned swarm within the framework of public goods game

The key advantage of unmanned swarm operation is its autonomous cooperation. How to improve the proportion of cooperators is one of the key issues of autonomous collaboration in unmanned swarm operations. This work proposes a strategy dominance mechanism of autonomous collaboration in unmanned swarm within the framework of public goods game. It starts with the requirement analysis of autonomous collaboration in unmanned swarm;and an aspiration-driven multiplayer evolutionary game model is established based on the requirement. Then the average abundance function and strategy dominance condition of the model are constructed by theoretical derivation. Furthermore, the evolutionary mechanism of parameter adjustment in swarm cooperation is revealed via simulation,and the influences of the multiplication factor r, aspiration levelα, threshold m and other parameters on the strategy dominance conditions were simulated for both linear and threshold public goods games(PGGs) to determine the strategy dominance characteristics;Finally, deliberate proposals are suggested to provide a meaningful exploration in the actual control of unmanned swarm cooperation.

The g-Good-Neighbor Connectivity of Some Cartesian Product Graphs

The g-good-neighbor connectivity of G is a generalization of the concept of connectivity, which is just for, and an important parameter in measuring the fault tolerance and reliability of interconnection network. Many well-known networks can be constructed by the Cartesian products of some simple graphs. In this paper, we determine the g-good-neighbor connectivity of some Cartesian product graphs. We give the exact value of g-good-neighbor connectivity of the Cartesian product of two complete graphs and for , mesh for , cylindrical grid and torus for .

Study on good clinical practices among researchers in a tertiary healthcare institute in India

BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.

Research on Culture Goods and the Image of Mixed-blood in The Bluest Eye

The Bluest Eye is Toni Morrison’s maiden work,through which Morrison carried out independent thinking on the question of“What is beauty?”In The Bluest Eye,the image of mixed-blood is characterized as a self-satisfied beautiful girl or lady due to light skin color.However,Morrison shatters their proud aesthetic edifice through satirical techniques.Firstly,this paper starts with the analysis of Shirley Temple on the blue-and-white cup and Mary Jane on candy wrapper as culture goods,in order to reveal the aesthetic standards of the mainstream.Next,through close reading,this paper,taking the example of a high-yellow child Maureen Peal,and the graceful sugar-brown lady Geraldine,makes deep analysis on their sense of superiority and artistic characteristics,and aims to better understand Morrison’s satirical techniques and interpretation of beauty.

Pursuing the Distilled Good Practices to Improve the Quality of Environmental Impact Assessment Reports and Hence Enhance the EIA Effectiveness and Help Address the Concerns of Project Proponents:An Indian Context

Despite a wealth of literature on the different facets of the EIA,and copious theoretical knowledge and practical experience,the general agreement is eluding definitions of EIA effectiveness,quality,and good practices.There are apprehensions about EIA meeting its basic objectives while project proponents continue to treat EIA as an impediment to development.Governments tend to adopt a“practical”approach,sacrificing pillars of EIA and overlooking the prime objective of environmental protection.Based on an extensive literature study and the author’s long EIA-related experience,some key workable practices for the EIA process are elaborated.Meticulous scoping using different sets of lenses,spotlighting significant impacts to determine the breadth and depth of EIA reports for focussed EIAs,robust EIA review and decision-making,commitment from the regulators for environmental protection,and use of strategic planning,strategic environmental assessment,and tiering practices are expected to address scholars’apprehensions and project proponents’concerns.

以听力下降为主要表现的Good综合征1例

本文报道1例54岁女性Good综合征患者,因进行性听力下降伴反复发热入院。实验室检查提示血清免疫球蛋白水平低下、外周血B淋巴细胞数量减少、T淋巴细胞亚群比例异常,且伴有前纵隔占位。纵隔肿物穿刺病理提示:胸腺瘤B1型。结合症状、实验室检查及病理诊断支持Good综合征诊断。且该病例纯音测听符合双耳极重度感音神经性耳聋,结合听力下降的特点并排除其他继发性因素,考虑免疫介导性内耳病(IMIED)。确诊后患者未行胸腺瘤手术切除,不定期接受抗感染、免疫球蛋白输注等一系列综合治疗,听力损害无改善,2个月后听力损害进展至耳聋。确诊半年后患者死于严重播散性感染。

环境产品贸易网络的结构特征及演进机制——基于共建“一带一路”国家的实证

加强环境产品贸易合作是推进区域绿色发展的重要途径。该研究基于社会网络分析视角,利用2000—2020年共建“一带一路”国家的54种环境产品贸易数据构建环境产品贸易网络,采用时间指数随机图模型(TERGM),探究区域环境产品贸易网络结构特征及其演化机制。研究发现:①样本区间内,环境产品贸易网络密度和平均聚类系数总体呈上升趋势,平均路径长度缩减,网络直径较短,但是受疫情影响,2020年网络特征指标数值明显下降。②意大利、中国、韩国和新加坡的点出度与点入度排名位于前列,在贸易网络中发挥“桥梁”与“枢纽”作用。中国后来居上,成为点出度与点入度最高的国家,引领区域环境产品贸易发展。③欧洲与亚洲是环境产品贸易网络中贸易合作最密集的两个地区,非洲、拉丁美洲地区的共建“一带一路”国家具有较少的环境产品贸易关系,且源自板块外进口关系数显著多于出口关系数。④TERGM分析表明,环境产品贸易网络存在显著的互惠性、连通性、稳定性和变异性。工业增加值、经济自由度和绿色创新存在发送效应和接收效应,人均GDP、环境规制存在发送效应。地理距离不利于形成环境产品贸易合作。⑤环境保护型产品、可再生能源产品、环境监测分析与评价设备贸易网络的形成和演化具有异质性。基于该结论,从引领区域绿色低碳发展、因地制宜深化环保产业合作、加快环保产业转型升级等方面,提出了深化和拓展“一带一路”环境产品贸易关系的对策建议。