确定多术式单病种临床路径实施范围和住院时间方法的研究

目的 探讨多种手术方式的单个病种在实施临床路径 (Clinicalpathway ,CP)时确定其实施范围和住院时间的途径。方法 查阅一定时期内腰椎间盘突出手术患者的住院信息 ,按不同术式对其分组后进行组间的差异性分析 ,对可以纳入同一CP流程的组将其诊疗过程进行作业流程重组。结果 把差异不显著的术式纳入同一CP流程并确定了其CP住院时间。结论 在CP的设计阶段 ,对不同术式进行组间差异性分析并运用科学的方法确定CP住院时间 ,为CP的实施奠定好的基础。

腹腔镜辅助经阴道子宫全切除术联合多术式治疗中重度盆腔器官脱垂的临床分析

目的 探讨腹腔镜辅助经阴道子宫全切除术联合多术式治疗中重度盆腔器官脱垂(pelvic organ prolapse,POP)性疾病的疗效、安全性及并发症。方法回顾性分析海宁市人民医院2009年5月~2012年12月收治的55例POP患者的临床资料,其中腹腔镜辅助经阴道子宫全切除术联合多术式治疗组26例、传统手术组29例。观察手术时间、术中出血量,术后并发症等情况,并定期随访和评价术后疗效。结果两组治愈率均为100%,尽管腹腔镜组手术时间比传统手术组平均长24 min,但腹腔镜组的术中出血量只有传统手术组的一半,住院时间也缩短了1.5d,且两组在手术时间、住院天数及术中出血量3个方面比较,差异均有统计学意义。结论腹腔镜辅助经阴道子宫切除术联合多术式的手术方式在治疗中重度盆腔器官脱垂中应用有效,是传统经阴道子宫全切除术的一种补充。它可以扩大经阴道手术的适应人群,并且是安全可行的手术方式。

一期手术多术式结合治疗顽固性癫癎

目的 采用一次开颅 ,将几种手术结合使用 ,治疗部分复杂的顽固性癫 病人 ,并对其临床效果进行评价。方法 回顾分析 10例手术治疗的顽固性癫 病例 ,均采用 2种或 2种以上术式结合的方法分别进行了前颞叶切除术、脑内病灶 +致 灶切除术及功能区多处软脑膜下横切术多处软脑膜下横切术 (MST)、胼胝体切开术。结果 术后无死亡及并发症 ,术后继续服用抗癫 药物 ,术后随诊 3～ 17个月 ,均无癫 发作。结论 采用多种术式结合治疗多灶性异常脑电改变的顽固性癫 治疗安全有效。

多术式配合治疗环状混合痔临床观察

目的 选择环状混合痔的最佳手术方法。 方法 回顾分析 1996～ 2 0 0 2年间收治 180例环状混合痔患者诊疗资料。 结果 180例全部一次性治愈 ,无复发以及后遗症。 结论 多术式配合治疗环状混合痔治愈率高、无后遗症 ,操作简便安全。

多术式经皮内固定在髌骨骨折治疗中的应用

目的探讨多术式经皮内固定治疗髌骨骨折的疗效。方法2005年10月～2007年2月收治56例髌骨骨折,应用多术式经皮内固定治疗。结果经2～26个月随访,所有患者均获得骨性愈合。结论多术式经皮内固定可以应用于各种类型髌骨骨折的治疗,无需常规切开,具有创伤小、切口美观、手术范围广等特点。

New Form of Legendre Polynomials Obtained by Virtue of Excited Squeezed State and IWOP Technique in Quantum Optics

Using the technique of integration within an ordered product of operators and the intermediate coordinatemomentum representation in quantum optics, as well as the excited squeezed state we derive a new form of Legendre polynomials.

Reliability analysis of structure with random parameters based on multivariate power polynomial expansion

A new method for calculating the failure probabilityof structures with random parameters is proposed based onmultivariate power polynomial expansion, in which te uncertain quantities include material properties, structuralgeometric characteristics and static loads. The structuralresponse is first expressed as a multivariable power polynomialexpansion, of which the coefficients ae then determined by utilizing the higher-order perturbation technique and Galerkinprojection scheme. Then, the final performance function ofthe structure is determined. Due to the explicitness of theperformance function, a multifold integral of the structuralfailure probability can be calculated directly by the Monte Carlo simulation, which only requires a smal amount ofcomputation time. Two numerical examples ae presented toillustate te accuracy ad efficiency of te proposed metiod. It is shown that compaed with the widely used first-orderreliability method （ FORM） and second-order reliabilitymethod （ SORM）, te results of the proposed method are closer to that of the direct Monte Carlo metiod,and it requires much less computational time.

A dynamic coefficient polynomial predistorter based on direct learning architecture

A dynamic coefficient polynomial predistorter based on direct learning architecture is proposed.Compared to the existing polynomial predistorter,on the one hand,the proposed predistorter based on thedirect learning architecture is more robust to initial conditions of the tap coefficients than that based on in-direct learning architecture;on the other hand,by using two polynomial coefficient combinations,differ-ent polynomial coefficient combination can be selected when the input signal amplitude changes,whicheffectively decreases the estimate error.This paper introduces the direct learning architecture and givesthe dynamic coefficient polynomial expression.A simplified nonlinear recursive least-squares(RLS)algo-rithm for polynomial coefficient estimation is also derived in detail.Computer simulations show that theproposed predistorter can attain 31 dB,28dB and 40dB spectrum suppression gain when our method is ap-plied to the traveling wave tube amplifier(TWTA),solid state power amplifier(SSPA)and polynomialpower amplifier(PA)model,respectively.

A Modified Polynomial Preserving Recovery and Its Applications to A Posteriori Error Estimates

A modified polynomial preserving gradient recovery technique is proposed. Unlike the polynomial preserving gradient recovery technique,the gradient recovered with the modified polynomial preserving recovery(MPPR) is constructed element-wise, and it is discontinuous across the interior edges.One advantage of the MPPR technique is that the implementation is easier when adaptive meshes are involved.Superconvergence results of the gradient recovered with MPPR are proved for finite element methods for elliptic boundary problems and eigenvalue problems under adaptive meshes. The MPPR is applied to adaptive finite element methods to construct asymptotic exact a posteriori error estimates.Numerical tests are provided to examine the theoretical results and the effectiveness of the adaptive finite element algorithms.

Nonlinear Analysis of Laminated Shells via Piece-wise Rayleigh-Ritz Technique

Based on Reddy higher-order shear deformation theory, a general refined shell theory suitable to nonlinear analysis of tire structure is developed in this paper. The piece-wise Rayleigh-Ritz procedure and Bezier polynomials are applied to analyze deformations and stress distributions of the multlayered tire subjected to uniform inflation in detail. Furthermore, 3-dimension FEM analysis of laminated tire by standard software ANSYS is adopted to compare with the present model. It is demonstrated that both two solutions are in fairly good agreement.

乳腺手术新型无菌包手巾的设计与应用

乳腺手术的较多术式均要求消毒患侧腋窝及上肢，临床上常以无菌手术单包裹已消毒上肢，后以无菌绷带缠绕固定于搁手板。该方法在操作中易污染无菌区域，且费时费物。据此，2008年我科设计了新式乳腺手术无菌包手巾，至今已应用于566例乳腺改良根治手术，效果满意，现将制作及使用方法介绍如下。

Paralinguistic and Kinesic Codes of Performance： An Intercultural Gilgamesh

This paper examines the directing, acting and rehearsal process in transforming the ancient Babylonian epic Gilgamesh for the stage using performers＇ journals as a means of determining the effect of corporeal non-western styles on actors whose prior experience was almost exclusively in naturalistic and text-based theatre. The introduction of theatrical elements from multiple cultures including puppetry and the masks and techniques of Noh drama created a multi-tiered field for intercultural exchange. While Patrice Pavis＇s hourglass model for the transfer of theatrical material from a source to a target culture may hold true for productions that use linear modes of transmission, translation and incorporation of text, music, costumes and styles, its limitations make it necessary to posit alternative theories that take into account intercultural rehearsal practices, the collaboration of source and target culture and the dynamic interactions that take place through the agency of actor training in the fleshly physical theatre.

Music on Line or in the City？ How Listening to Music Changes Because of Piracy

Music has often changed, from a social point of view, and also the relationship between music and the city. This paper attempts to describe how music changes under the impact of Internet. The milieu of musicians and the audiences are concerned. The economic model of music has not burst into pieces, but it has deeply changed. There is a trend to pure consumerism thanks to internet （probably the sales of downloaded music will become more and more important）. Also, independent artists can use Internet and have a livelihood （fat tail phenomenon）. Therefore the diversity of music can be preserved. Concerts （music in the city） allow escaping from the losses of money because of piracy. There are several experiences for listeners, which are possible, some of them involving going to concerts and festivals.

Solution to the Balanced Academic Curriculum Problem Using Tabu Search

The Balanced Academic Curriculum Problem （BACP） is a constraint satisfaction problem classified as （Non-deterministic Polynomial-time Hard） NP-Hard. This problem consists in the allocation of courses in the periods that are part of a curriculum such that the prerequisites are satisfied and the load of courses is balanced for the students. This paper presents the solution for a modified BACP where the academic loads and number of curses may be the same or different for each one of the periods and allows having some courses in a specific period. This problem is modeled as an integer programming problem and is proposed the use of Tabu search with short-term memory for its solution because it is not possible to find solutions for all the instances of this modified problem with an exact method.

A trigonometric interval method for dynamic response analysis of uncertain nonlinear systems

This paper proposes a new non-intrusive trigonometric polynomial approximation interval method for the dynamic response analysis of nonlinear systems with uncertain-but-bounded parameters and/or initial conditions.This method provides tighter solution ranges compared to the existing approximation interval methods.We consider trigonometric approximation polynomials of three types:both cosine and sine functions,the sine function,and the cosine function.Thus,special interval arithmetic for trigonometric function without overestimation can be used to obtain interval results.The interval method using trigonometric approximation polynomials with a cosine functional form exhibits better performance than the existing Taylor interval method and Chebyshev interval method.Finally,two typical numerical examples with nonlinearity are applied to demonstrate the effectiveness of the proposed method.

Analytic Solutions of a Polynomial-Like Iterative Functional Equation near Resonance

In this paper existence of local analytic solutions of a polynomial-like iterative functional equation is studied. As well as in previous work, we reduce this problem with the SchrSder transformation to finding analytic solutions of a functional equation without iteration of the unknown function f. For technical reasons, in previous work the constant α given in the Schroder transformation, i.e., the eigenvalue of the linearized f at its fixed point O, is required to fulfill that α is off the unit circle S^1 or lies on the circle with the Diophantine condition. In this paper, we obtain results of analytic solutions in the case of α at resonance, i.e., at a root of the unity and the case of α near resonance under the Brjuno condition.