汉化简明围术期疲劳评测量表在消化道肿瘤术后患者中的应用效果

目的探讨汉化简明围术期疲劳评测量表(ICFS-10)在消化道肿瘤术后患者中的应用价值。方法选取医院2017年9月—2019年9月160例消化道肿瘤术后患者为研究对象,采用性别、年龄匹配的原则分为对照组和观察组,每组80例。对照组实施常规护理,观察组在汉化简明围术期疲劳测量表指导下制定护理方案,对比两组患者术后癌因疲乏和生活质量改善效果。结果观察组患者感觉、情感、认知/情绪、行为/严重程度评分低于对照组,差异有统计学意义(P<0.05);观察组患者生理功能、情感功能、角色功能、社会功能、认知功能、恶心呕吐、疲乏、疼痛、食欲下降、呼吸困难、睡眠障碍、便秘、腹泻及经济困难及总体生活质量评分均高于对照组,差异有统计学意义(P<0.05)。结论消化道肿瘤患者围术期采用汉化简明疲劳测评量表指导的护理模式,可有效改善患者术后由于症状或疾病所带来的癌因疲乏,提高生活质量。

评课的道与术

在一些评课活动中,有这样一个奇怪的现象：评课会要么变成没有学术深度你好我好大家好的“套话会”,要么变成优点不说只说问题的“批斗会”.这两者都不可取.尤其是后者,在“优点不说不会跑,问题不说不知道”思想的主导下,评课者往往会针对上课教师在教学中的“个别语言使用不恰当,或者个别问题设计粗放,或者个别案例使用不确切,或者个别字句把握不准确,或者个别动作有闪失,或者方法设计有失误”抓住不放.

废钢铁标准述评

评述了中国、美国、俄罗斯、日本、韩国、罗马尼亚六国废钢铁标准结构、适用范围、分类、技术要求及包装、运输、贮存等,建议我国废钢铁标准修订时,减少标准数量,调整标准内容结构等。

战略管理理论发展特征

战略管理是一门年轻而又丰富多彩的学科 ,它的发展过程及其特征受到了学术界与实业界的广泛重视。本文从战略思维、战略者、战略选择、战略实施、战略分析、战略资源、战略基础、战略结构系统和战略变革等九个方面作了尝试性讨论。

Technology Research on Lightning Strike Risk Evaluation of a Cable Car

According to structure function and lightning damage of a cable car, a feasible method of lightning strike risk evaluation for a cable car was put forward based on the evaluation model and evaluation method in the standard IEC62305-2. According to the difference between common buildings and cable cars, problems of height non-uniformity of equivalent section caused by inclination of the cable car and diversity of lightning activity regularity caused by the large area were resolved, and expected annual average frequency of lightning strike was calculated using three dimensional graphic approach and regional lightning characteristic analysis. Based on different types of damage process and loss consequences, according to interception effect against lightning invasion of the lightning protection measures and the method of probability selection proposed in the standard, the probability of casu- alty caused by direct lightning strike in a cable car and a waiting area as well as probabilities of casualty caused by failure of electronic information systems were cal- culated.

Research of Comprehensive Evaluation of Agricultural Land Suitability in Typical Area of Huanghuaihai Plain based on GIS

The paper aims to study agricultural land suitability in typical agricultural area in Huanghuaihai plain by the comprehensive evaluation of natural factors and environmental conditions of agricultural land with Liaocheng area in Shangdong Province in the center of Huanghuaihai plain as a case.The results suggested that the land quality in Liaocheng was above the average and accorded with the local practical situation.The authors validated the scientificity of agricultural land suitability study by using GIS technology and proposed some suggestions on analysis results.

Application of Participatory Monitoring and Evaluation in Development of Animal Husbandry Technology

[Objective] This study aimed to provide references for the application of participatory monitoring and evaluation in the development of animal husbandry tech- nology. [Method] With the livelihood improvement program for agricultural and pas- toral area in northern Yunnan as the example, the development process of partici- patory animal husbandry was overviewed. And the monitoring and evaluation pro- cesses of participatory animal husbandry were introduced and analyzed. [Result] The monitoring and evaluation indicator system of participatory animal husbandry technol- ogy included 4 layers, namely technology, institutional system, personnel ability con- struction and effectiveness, and 11 third-level indicators, namely, technical characteristics, superiority-inferiority comparison, community and farmers, technical personnel, project personnel, economic indicators and social indicators. [Conclusion] This study provided the references for the application of participatory monitoring and evaluation in the development of animal husbandry technology.

国际关系史教学中三个问题的平衡浅析

国际关系史课程旨在普及国际关系历史常识、梳理国际关系历史脉络并阐发国际关系演变规律。但在实际教学过程中，人们需解决好三个问题：一是国际关系史与国际关系理论的有机结合，二是严肃的学术分析与鲜活的时政评析合理兼顾，三是价值引导与知识传授的明确定位，这是完善教学框架、明确教学定位、优化教育取向的关键，进而使历史厚度、理论高度和现实温度融为一体。

STUDY ON MEASURES OF FAULT TOLERANCE FOR DISTRIBUTED SYSTEM

Fault tolerant ability is an important aspect for overall evaluation of distributed system(DS). This paper discusses three measures for the evaluation: node/edge connectivity, number of spanning trees and synthetic connectivity. A numerical example for illustration and analysis is given, and the synthetic connectivity measure presented by this paper is proved to be rational and satisfactory.

Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

AIM： To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma. METHODS： From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS： The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage （P 〈 0.05）. The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly （P 〈 0.001）. Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection （28 mo vs 18 mo; P 〈 0.05）. The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy （91.4% vs 68%; P 〈 0.05 ）. And it was also higher in detecting port vein involvement （90% vs 54.5%; P 〈 0.05）.CONCLUSION： The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler UItrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.（OR = 2.46, 95% CI = 0.98-6.14）, and a significantly elevated risk of developing esophageal cancer among alcohol drinkers among alcohol drinkers （OR = 9.86, 95% CI = 3.10-31.38）. CONCLUSION： ADH2 and ALDH2 genotypes areassociated with esophageal cancer risk. ADH2＊1 allele and ALDH2＊2 allele carriers have a much higher risk of developing esophageal cancer, especially among alcohol drinkers.

Identification and quality evaluation of Lepidium meyenii. (Maca) based on gas chromatographic analysis of its essential oils from roots

Lepidium meyeniiWalp. （Maca）, a perennial herbaceous plant with narrow distdbution in the Andean region, was cultivated by local residents as early as 1600 B.C. It has high nutritional values and multiple medicinal effects. In recent years the plant source of Maca has been greatly scarce since Maca products are increasingly becoming popular in the world. This makes the study urgent on the identification and quality evaluation of Maca materials. In present work, four Mace samples of different origins or handlings and three other natural plants, including radish, odental ginseng and American ginseng, were investigated. Their essential oils （steam distillates） of the hypogeal parts were weighed and analyzed by GC/MS. Through comparison of the characteristics of their chromatograms, it was found that the essential oil of Maca had unique GC/MS behaviors, and the characteristic peaks produced by the major essential oil components （Phenylacetonitrile, Benzaldehyde, 3-Methoxyphenylacetonitrile, etc） were distinct. Furthermore, the chromatograms of several Maca samples showed a similar qualitative pattern except for some differences in the quantitative composition, and the percentage of total essential oils in the samples varied from 0.88 % to 1.59 %. These behaviors and technologies can be applied to the identification of Maca materials in the markets and be a supplement to assess the quality of Maca matedals.

Urban Expansion in China Based on Remote Sensing Technology：A Review

Urban areas and its evolution are important anthropogenic indicators and human ecological footprints, and play decisive roles in environmental change analysis, global geo-conditional monitoring, and sustainable development. China has the highest rate of urban expansion and has emerged as an urban expansion hotspot worldwide. In this paper, the progress of studies on Chinese urban expansion based on remote sensing technology are summarized and analyzed from the aspects of urban area definition, remotely sensed imagery applied in urban expansion, monitoring methods of urban expansion, and urban expansion applications. Existing issues and future directions of Chinese urban expansion are discussed and proposed. Results indicate that: 1) The fusion of multi-source remotely sensed imagery is imperative to meet the needs of urban expansion with various monitoring terms and frequencies on different scales and dimensions. 2) To guarantee the classification accuracy and efficiency and describe urban expansion and its influences on local land use simultaneously, the combination of visual interpretation and automatic classification is the tendency of future monitoring methods of urban areas. 3) Urban expansion data have become the prerequisite for recognizing the urban development process, excavating its driving forces, simulating and predicting the future development directions, and also is conducive to revealing and explaining urban ecological and environmental issues. 4) In the past decades, Chinese scholars have promoted the application of remote sensing technology in the urban expansion field, with data construction, methods and models developing from the quotation stage to improvement and innovation stage; however, an independent and consistent urban expansion data on the national scale with long-term and high-frequency(such as annual monitoring) monitoring is still lacking.

Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn's disease

AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.

Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

Gastrointestinal stromal tumor and mitosis,pay attention

The difference between stages I and ]]I of gastric gas- trointestinal stromal tumor depends principally on the number of mitosis. According with TNM classification, the presence in the tumor of high mitotic rate deter- mines the upgrading. Many studies exposed different count techniques in evaluating the number of mitosis. An international standardized method to assess mitotic rate is needed.

Systematic review on the surgical treatment for T1 gallbladder cancer

AIM:To evaluate the efficacy of simple and extended cholecystectomy for mucosa(T1a) or muscularis(T1b) gallbladder(GB) cancer. METHODS:Original studies on simple and extended cholecystectomy for T1a or T1b GB cancer were searched from MEDLINE(PubMed) ,Cochrane Library,EMBase,and CancerLit using the search terms of GB,cancer/carcinoma/tumor/neoplasm. RESULTS:Twenty-nine out of the 2312 potentially relevant publications met the eligibility criteria.Of the 1266 patients with GB cancer included in the publications,706(55.8%) and 560(44.2%) had T1a and T1b GB cancer,respectively.Simple cholecystectomy for T1a and T1b GB cancer was performed in 590(83.6%) and 375(67.0%) patients,respectively(P<0.01) .In most series,the treatment of choice was simple cholecystectomy for T1a GB cancer patients with a 5-year survival rate of 100%.Lymph node metastasis was detected in 10.9% of the T1b GB cancer patients and in 1.8%of the T1a GB cancer patients,respectively(P<0.01) .Eight patients(1.1%) with T1a GB cancer and 52 patients(9.3%) with T1b GB cancer died of recurrent GB cancer(P<0.01) . CONCLUSION:Simple cholecystectomy represents the adequate treatment of T1a GB cancer.There is no definite evidence that extended cholecystectomy is advantageous over simple cholecystectomy for T1b GB cancer.

Dosimetric evaluation of VMAT radiation therapy technique for breast cancer after conservative surgery based on three different types of multileaf collimators

Objective Radiotherapy combined with conservative surgery plays an important role in the treatment of early-stage breast cancer. Volumetric modulated arc therapy(VMAT) has been introduced into clinical practice. The purpose of this study was to investigate the dosimetric effects of different multileaf collimators(MLC) on VMAT radiotherapy plans for treating breast cancer.Methods Fifteen breast cancer patients who were treated using a conventional technique in our department were selected to participate in this retrospective analysis. VMAT plans based on three types of Elekta MLCs [Beam Modulator(BM) with 4-mm leaf width, Agility with 5-mm leaf width and MLCi2 with 10-mm leaf width] were independently generated for each patient. Plan comparisons were performed based on dose-volume histogram(DVH) analysis including dosimetric parameters such as the homogeneity index(HI), conformity index(CI), Dmax, Dmin, and Dmean for the planning treatment volume(PTV), in addition to dose-volume parameters for the organs at risk(OARs). The delivery efficiency of the three types of MLCs was compared in terms of the beam delivery time and the monitor units(MUs) per fraction for each plan. Results Both target uniformity and conformity were improved in plans for Agility and BM MLC compared with the plan using MLCi2. The mean HI decreased from 1.14 for MLCi2 to 1.13 for BM and 1.10 for Agility, while the mean CI increased from 0.68 for MLCi2 to 0.73 for BM and 0.75 for Agility. Furthermore, at both low and high dose levels, smaller volumes of ipsilateral lung, heart, contralateral lung, and breast were irradiated with Agility MLC than with the other two types of MLCs. The delivery time with Agility MLC was reduced by 10.8% and 32.1%, respectively, compared with that for MLCi2 and BM.Conclusion Our results indicate that the Agility MLC exhibits a dosimetric advantage and a significant improvement in delivery efficiency for the treatment of breast cancer using VMAT.

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.

The application of stereo-video technology for the assessment on population change of black rockfish Sebastes schlegeli in a vessel reef area in Haizhou Bay,China

The assessment of population structure and abundance of fish assemblages associated with artificial reefs(ARs) is an important aspect of AR management.In the present study,we used a DiveOperated Stereo Video(stereo-DOV) technique to assess the population structure and abundance of Sebastes schlegeli associated with two metallic,and three wooden,vessel reefs in Haizhou Bay during 2012 and2013.The study used video systems to obtain length measurements and estimates of abundance.The size composition of S.schlegeli differed among reefs and individuals around vessel reefs were all adults,with total lengths(TL) of >20 cm.Juvenile fish were encountered by divers in a rocky area near the island away from the vessel reefs.The largest individual S.schlegeli(with the highest TL) among five reefs were found around a metallic vessel reef in both 2012 and 2013.TL of S.schlegeli from all reefs increased by an average of 3.2 cm(P<0.05) from 2012 to 2013,with an estimated mean weight increase of 250.4 g(P<0.05).The video survey also indicated a decrease in the biomass of schools near two metallic vessels between the years.Stereo-video technology was found to be suitable for rockfish surveys around the reefs.

Assessing proprioception:A critical review of methods

To control movement,the brain has to integrate proprioceptive information from a variety of mechanoreceptors.The role of proprioception in daily activities,exercise,and sports has been extensively investigated,using different techniques,yet the proprioceptive mechanisms underlying human movement control are still unclear.In the current work we have reviewed understanding of proprioception and the three testing methods:threshold to detection of passive motion,joint position reproduction,and active movement extent discrimination,all of which have been used for assessing proprioception.The origin of the methods,the different testing apparatus,and the procedures and protocols used in each approach are compared and discussed.Recommendations are made for choosing an appropriate technique when assessing proprioceptive mechanisms in different contexts.