The Timing of Primary Neurosurgical Repair and Wound-Site Infection in Children with Myelomeningocele

Background: The optimal time to closure of a newborn with a myelomeningocele has been the focus of a number of evaluations. The Timing of primary surgery has received significant attention due to its relationship to repair-site infection that can lead to increased morbidity and prolonged hospital stays. It is on this basis that recommendations have utilized 48 - 72 hours post birth as ideal time of closure. This is not only prevent infection at the site but also prevent ventriculitis and neural structure damage. We therefore, hypothesized an increase in wound infection rates in those patients with delays in myelomeningocele repair. Methods: We retrospectively reviewed the records of 103 children with myelomeningocele treated between 2016 and 2023. At discharge the patients were followed up at the post-operative clinic visit 2 weeks later. Children were assigned to 1 of 2 groups, those who underwent primary neurosurgical repair within 72 hours of delivery (Group 1) and those undergoing repair after 72 hours (Group 2). We compared the infection rates. Results: 103 children who underwent myelomeningocele repair were identified, with a median time from birth to treatment of 1 day. Eight (7.8 %) patients were noted to have post-repair surgical site complications. There was no significant difference in rates of infection between Group 1 and Group 2 repair times. The presence of infection was associated increased length of stay when compared to neonates without infection. Conclusion: In children with myelomeningocele, the timing of primary neurosurgical repair appears not to have a significant impact on surgical site infection. Closure of the spinal lesion within the first 72 hours of life may be more favorable for neural damage prevention. These results suggest that early myelomeningocele repair may not impart significantly on the rate of wound-site infection.

Role of real-time three-dimensional transesophageal echocardiography in mitral valve repair

Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy,RT-3D TEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT- 3DTEE in MV repair.Methods RT-3DTEE was performed in six patients with mitral valve prolapse (MVP) by using Philips 1E33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valve repair,and quantitative evaluation was performed by QLab 6.0 software before and after surgical mitral valve repair.Results RT- 3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It could provide surgical views of the valves and the valvular apparatus.These results were consistent with surgical findings.The quantitative evaluation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annulus,anterior to posterior diameter of annulus,perimeter of annulus,and area of annulus in projection plane were significantly smaller after operation compared with those before operation (P【0.05).The length of posterior leaflet,the area of anterior and posterior leaflet,the maximal prolapse height,the volume of leaflet prolapse and the length of coaptation in projection plane were significantly reduced after operation (P【0. 05).Conclusion RT-3DTEE is a unique new modality for rapid and accurate evaluation ofmitral valve prolapse and mitral valve repair.

Repair and Strengthening Assessment of Existing Bridges Based on Time-Dependent Reliability Analysis

The strategy on repair and strengthening of existing bridges based on time-dependent reliability was analyzed with the maximum expected benefit as the objective function. A sample of risk-ranking decision was illustrated based on updated inspection information with 35 survival age. The effect of improvement of live loads and difference of repair methods on time-dependent reliability of existing bridges are considered. The results show that the decision method can be used in real project, with the cost of failure consequence and the risk of failure considered.

RELIABILITY ANALYSIS FOR A REPAIRABLE PARALLEL SYSTEM WITH TIME-VARYING FAILURE RATES

To solve a real problem:how to calculate the reliability of a system with time-varying failure rates in industry systems,this paper studies a model for the load-sharing parallel system with time-varying failure rates,and obtains calculating formulas of reliability and availability of the system by solving differential equations.In this paper,the failure rates are expressed in polynomial configuration.The constant,linear and Weibull failure rate are in their special form.The polynomial failure rates provide flexibility in modeling the practical time-varying failure rates.

活性改性剂合成及其对环氧胶黏剂力学与界面粘接性能的影响

综合考虑环氧胶黏剂的施工性能、力学性能及与砂浆界面的粘接性能,利用三羟甲基丙烷三缩水甘油醚(TMPGE)与1,4-丁二醇(BDO),通过控制反应物物质的量比以及反应时间制备了四种低环氧值兼具高羟基含量的预聚体(PPM)。通过1H-NMR、盐酸-丙酮法及凝胶渗透色谱(GPC)对PPM进行了表征。进一步研究了PPM对改性环氧胶黏剂工作性能、固化力学性能、与水泥砂浆粘接强度以及表面性质的影响。结果显示:延长反应时间以及增加BDO用量使PPM的数均分子量更大、环氧值更低。四种PPM改性后,胶黏剂的放热峰值温度降低,可操作时间延长。同时,PPM使环氧固化物的延性显著增加。四种PPM改性后使环氧与水的接触角降低,固化物表面的极性组分升高。XPS分析表明,PPM使环氧固化物的羟基含量显著提高。最后,PPM使胶黏剂对湿砂浆基体的粘接强度提高了一倍以上。

高聚物注浆修复的面板堤坝探地雷达波场特征分析

针对高聚物注浆修复堤坝面板脱空病害的修复效果问题,依据实际堤坝面板层间结构和材料介电参数,基于时域有限差分法和完全匹配层边界条件建立了高聚物注浆修复面板脱空堤坝的探地雷达电磁波计算模型,分析了雷达中心频率、面板脱空修复程度及脱空区域大小、面板厚度及配筋等因素对高聚物注浆修复面板脱空堤坝探地雷达波场特征的影响。结果表明:随着激励源中心频率增大,探地雷达剖面图分辨率逐渐增加;随着脱空区域长度增加,探地雷达剖面图中产生的水平状界面反射波增长;随着脱空区域深度增加,探地雷达剖面图水平状反射线之间时间间隔逐渐增大;随着堤坝面板厚度增加,在面板脱空修复区域绕射波和衍射波幅值减小;探地雷达发射的电磁波遇到钢筋时将产生能量较强的绕射波,强绕射波将脱空区域上下分界面的反射波分割开,难以判断反射波的水平长度。根据高聚物注浆修复面板脱空堤坝的探地雷达波场特征,能有效判断堤坝面板脱空区域的高聚物注浆修复效果,有助于解释实际堤坝面板高聚物注浆修复效果的探地雷达图像。

不同补焊次数对X2CrNi12铁素体不锈钢焊接接头耐点蚀性能的影响研究

以X2CrNi12铁素体不锈钢为研究对象,采用MAG焊进行不同次数的补焊,探讨了补焊次数对焊接接头组织及耐点蚀性能的影响。研究结果表明,一次补焊和二次补焊接头的焊缝区显微组织基本相似,主要由白色的奥氏体基体以及黑色的板条状和网状δ铁素体组成。与母材相比,焊接接头的晶粒尺寸明显增大。电化学测试结果显示,焊缝区的耐蚀性最好,其次是母材,而HAZ的耐蚀性最差。SEM观察发现,焊缝区无点蚀产生,而母材和HAZ出现了均匀分布的小点蚀坑。与一次补焊相比,二次补焊后的焊缝区耐蚀性更好。因此,二次补焊有利于提高X2CrNi12铁素体不锈钢焊接接头的耐点蚀性能。这一研究结果为根据焊接接头的电化学点蚀性能选择合适的补焊次数提供了理论依据。

标准化皮肤管理在乳腺癌放疗所致皮肤损害中的应用研究

目的探讨标准化皮肤管理在乳腺癌放疗所致皮肤损害中的应用效果。方法选取2022年1月—2023年6月在泉州市第一医院放疗科行放疗的乳腺癌患者108例,采用抽签法分为对照组与研究组,各54例。对照组患者行常规皮肤护理,研究组在此基础上增加标准化皮肤管理干预。对比2组的患者皮肤损伤程度、护理效果、皮肤损伤出现时间及修复时间,使用肿瘤患者生活质量测定量表(quality of life questionnaire:core 30,QLQ-C30)比较2组患者护理前后生活质量情况,对比2组护理满意度情况。结果研究组患者急性放射性损伤皮肤分级显著低于对照组(P<0.05)。研究组皮肤护理有效率显著高于对照组(P<0.05)。研究组皮肤损伤出现时间晚于对照组,修复时间早于对照组,差异有统计学意义(P<0.05)。护理前,2组QLQ-C30各维度评分比较,差异无统计学意义(P>0.05);护理后,研究组QLQ-C30心理、生理、社会及总体健康评分均显著高于对照组(P<0.05)。研究组护理满意度显著高于对照组(98.15%vs.81.48%)(P<0.05)。结论在乳腺癌放疗患者皮肤护理中增加标准化皮肤管理,具有改善皮肤损伤、延缓损伤进程、促进皮肤修复、提高患者生活质量的效果,且患者护理满意度高。

生物基席夫碱自修复聚氨酯的制备与性能研究

动态共价键是一种能在特定条件下断开并复原的化学键。其中,席夫碱是一种由醛和胺类化合物缩合形成的动态共价键。通过1,8-对䓝烷二胺(MD)的氨基与香草醛的醛基反应合成了一种生物基席夫碱化合物(MV/S),用乙二胺代替MD合成了无脂肪环的席夫碱化合物(EV/S),并以MV/S和EV/S为扩链剂制备了自修复的席夫碱聚氨酯膜(PU/SM和PU/SE),同时以不添加MV/S和EV/S时制备的不含席夫碱的聚氨酯(PU/BDO)为空白对照探讨MD对自修复聚氨酯性能的影响,采用多种测试方法对聚氨酯的结构、力学性能和自修复性能进行分析。研究结果表明:PU/SM的拉伸强度为30.7 MPa,与PU/BDO相比,拉伸强度提高了20.1 MPa。TG/DTG分析发现:MD的引入能显著提高PU/SM的耐热性;在相同温度下对比发现,PU/SM的松弛时间相比PU/SE明显减小,说明MD的引入促进了动态共价键的交换速率。与PU/SE相比,PU/SM的松弛速率较快,并且活化能(E_(a))降低了35.84 kJ/mol。自修复性能测试结果表明:与PU/BDO和PU/SE相比,PU/SM具有更优异的自修复性能,剪断后的PU/SM膜在80℃加热24 h的自修复率达到了77%。

不同皮瓣修复术对口腔颌面部肿瘤术后缺损手术时间及口腔功能指标的影响

目的:分析口腔颌面部肿瘤术后缺损患者行不同皮瓣修复术治疗的效果。方法:选择口腔颌面部肿瘤术后缺损患者58例,随机分为对照组和观察组,各29例。两组均施以皮瓣修复手术治疗,对照组胸大肌位置选择皮瓣,观察组为股前外侧皮瓣,比较不同部位皮瓣的效果差异。结果:观察组并发症总发生率低于对照组;手术时间、拔除胃管时间、经口进食时间、皮瓣愈合时间短于对照组;皮瓣制作+显微吻合时间长于对照组;外形修复、正常进食、口腔开合功能、口腔容纳水测试、正常吞咽、咀嚼功能、语言表达能力、正常咬合功能分数,皮瓣成活率和修复满意度高于对照组(P<0.05)。结论:口腔颌面部肿瘤术后皮瓣修复患者行不同皮瓣修复术的效果存在差异,股前外侧皮瓣相对比胸大肌皮瓣更具备优势,可缩短手术时间,改善口腔功能,安全度、患者满意度较高。

基于编辑距离算法的技改大修项目工程时间节点数据研究与应用

文章针对电网企业技改大修项目的工程时间节点数据挖掘及其在项目管理中的应用进行了深入研究,旨在解决电网设备老化和规模增加导致设备成新率下降的问题,提高电力系统设备运行可靠性和供电质量。研究方法包括审计模型中的编辑距离算法原理及应用、技改大修工程时间节点数据分析中的审计模型设计、审计规则的梳理和验证、后台数据寻源及数据挖掘分析和建模等。

Markov repairable systems with stochastic regimes switching

Compared with the classical Markov repairable system, the Markov repairable system with stochastic regimes switching introduced in the paper provides a more realistic description of the practical system. The system can be used to model the dynamics of a repairable system whose performance regimes switch according to the external conditions. For example, to satisfy the demand variation that is typical for the power and communication systems and reduce the cost, these systems usually adjust their operating regimes. The transition rate matrices under distinct operating regimes are assumed to be different and the sojourn times in distinct regimes are governed by a finite state Markov chain. By using the theory of Markov process, Ion channel theory, and Laplace transforms, the up time of the system are studied. A numerical example is given to illustrate the obtained results. The effect of sojourn times in distinct regimes on the availability and the up time are also discussed in the numerical example.

特高压换流站抗震韧性及震后修复策略快速评估方法

地震作用下特高压换流站中设备极易损坏,然而由于资源条件限制使得震后抢修效率较低,从而导致了大量经济损失。为寻求高效的震后修复策略,该文搭建一套基于功能状态模型的抗震韧性快速评估框架。从结构和电气两方面建立换流站系统的二维功能网络模型,并利用贝叶斯网络进行功能状态快速评估。为提高系统震后修复效率,提出一种生物启发式多目标优化算法,利用震后迭代模拟得到系统阶梯型功能时变函数。通过对一典型±800 kV特高压换流站进行抗震韧性分析,得到换流站系统的关键抢修设备及最优修复策略,证明了最优修复策略的有效性和必要性。该框架量化了特高压换流站的震后修复过程及抗震韧性水平,可为换流站系统的震后应急抢修提供参考。

Further Study on a Virtual Age Repair Model

A new virtual age repair model with non-uniform aging speed is presented on the basis of Kijima classical virtual age repair models which can be viewed as of uniform aging nature.In this model are included three types,of perfect,of imperfect and of minimal,all having a non-uniform aging speed.Formulas of expected count of repair and length of working time of these three models are derived,and numerical examples are also given to illustrate and verify obtained theoretical indices.As an extended work,a sketchy model of maintenance time of the non-uniform aging virtual age repair model is discussed.Overall,the three models discussed in the paper,each with non-uniform aging speed,are expansions to existing virtual age repair models,relevant formulas given here are new results,and the systems introduced are without the lifetime distribution assumption,all of which may be expected to improve maintenance work.

Numerical simulation of the modulation to incident laser by the repaired damage site in a fused silica subsurface

One of the main factors of laser induced damage is the modulation to incident laser which is caused by the defect in the subsurface of the fused silica. In this work, the repaired damage site irradiated by CO2 laser is simplified to a Gaussian rotation according to the corresponding experimental results. Then, the three-dimensional finite-difference time-domain method is employed to simulate the electric field intensity distribution in the vicinity of this kind of defect in fused silica front subsurface. The simulated results show that the modulation is notable, the Emax is about 2.6 times the irradiated electric field intensity in the fused silica with the damage site （the width is 1.5 μm and depth is 2.3 μm） though the damage site is repaired by CO2 laser. The phenomenon and the theoretical result of the annular laser enhancement existed on the rear surface are first verified effectively, which agrees well with the corresponding experimental results. The relations between the maximal electric field intensity in fused silica with defect depth and width are given respectively. Meanwhile, the corresponding physical mechanism is analysed theoretically in detail.

Grey Repairable System Analysis

In this paper, we systematically discuss the basic concepts of grey theory, particularly the grey differential equation and its mathematical foundation, which is essentially unknown in the reliability engineering community. Accordingly, we propose a small-sample based approach to estimate repair improvement effects by partitioning system stopping times into intrinsic functioning times and repair improvement times. An industrial data set is used for illustrative purposes in a stepwise manner.

消毒供应中心设备管理App的设计与应用

目的探讨设备管理App在消毒供应中心设备故障报修和维保管理中的应用效果。方法将2020年8月至2021年4月在用的56台设备为对照组,采用常规人工手工管理;2021年8月至2022年4月同批设备为观察组,采用设备管理App进行管理。比较两组维修响应时间和设备定期维护保养超期次数。结果观察组维修响应时间短于对照组,定期维保超期次数少于对照组,差异有统计学意义(均P<0.05)。结论设备管理App应用于消毒供应中心设备维护管理中,实现了消毒供应中心设备的可视化、可追溯化、便捷化、精细化管理,保证设备正常运行,确保性能稳定,提高了工作效率,保障了无菌医疗器械的供应质量。

缓凝剂对PC-CSA-FDG三元胶凝体系修补砂浆性能的影响

利用硅酸盐水泥-硫铝酸盐水泥-脱硫石膏三元胶凝体系制备修补砂浆,研究了酒石酸、硼砂及六偏磷酸钠等缓凝剂及其复掺时对修补砂浆性能的影响.结果表明:酒石酸在修补砂浆中无明显的缓凝作用,并且显著降低了修补砂浆的流动度、力学性能和干燥收缩率;硼砂和六偏磷酸钠均能有效延长修补砂浆的凝结时间,改善其流动度;硼砂虽能提高修补砂浆的强度,但增大了干燥收缩率;六偏磷酸钠有利于修补砂浆的中后期强度,显著降低了干燥收缩率;3种缓凝剂均使得修补砂浆的拉伸黏结强度有所降低,复掺缓凝剂的影响介于单掺2种相应缓凝剂的作用效果之间.

胸主动脉钝性损伤诊治流程探讨

胸主动脉钝性损伤(BTAI)严重威胁创伤患者的生命,大部分患者在到达医院前死亡,到达医院的幸存者通常合并全身多发伤。由于此类疾病相对少见,且患者通常处于危重状态,目前我国对此类患者的诊断与救治存在诸多问题,严重影响患者的预后。本文综合国内外最新研究,结合自身经验,综述了BTAI诊断、分级、修复方式及时机,并总结了此类患者的诊治流程,旨在为临床实践提供参考,提高此类患者的预后水平。

日间手术方式管理及结算模式的改进效果

目的 基于两类手术分析日间手术管理及结算模式的改进效果。方法 选取2012年1—12月收治的263例日间手术患者作为对照组,选取2021年12月至2022年5月收治的210例日间手术患者作为观察组。对照组和观察组中分别有97例、61例患者在局部麻醉下行成人无张力疝修补术(单侧),分别有166例、149例在全身麻醉下行腹腔镜胆囊切除术。对照组采用常规的日间手术管理与结算模式;观察组基于多学科手术平台、加速康复外科理念及PDCA理论优化日间手术管理模式,并在完善“互联网+医疗”建设的的基础上推行电子发票和出院一体化快速结算。比较两组患者两种日间手术各项费用的构成比、变动率,以及人均出院费用结算时间及患者结算满意度。结果 在成人无张力疝修补术(单侧)中,相较于对照组,观察组的药费、材料费、床位费及其他费用均有所降低,手术费、麻醉费、化验检查费、治疗费、护理费均有所增加,而人均住院费用及自付费用降低。在腹腔镜胆囊切除术中,相较于对照组,观察组的药费、化验检查费、材料费及其他费用均有所降低,手术费、麻醉费、治疗费、床位费、护理费、人均住院费用均有所增加,而自付费用则降低。观察组人均出院费用结算时间短于对照组,患者结算满意度高于对照组(P<0.05)。结论 改进日间手术的管理及结算模式可优化住院费用的构成,更好地体现医护人员的劳动价值,降低患者自身承担的医疗负担,并可缩短出院费用结算时间,提高患者的结算满意度。