The Dosimetric Characteristics and Potential Limitation in Clinical Application of a Low Energy Photon Intra-Operative Radiotherapy System

Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.

Impact of intra-operative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation

BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.

Role of Intra-Operative Nerve Monitoring in Thyroidectomies: An Institutional Review

Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. Intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.

Estimation of intra-operator variability in perfusion parameter measurements using DCE-US

AIM:To investigate intra-operator variability of semiquantitative perfusion parameters using dynamic contrast-enhanced ultrasonography(DCE-US),following bolus injections of SonoVue.METHODS:The in vitro experiments were conducted using three in-house sets up based on pumping a fluid through a phantom placed in a water tank.In the in vivo experiments,B16F10 melanoma cells were xenografted to five nude mice.Both in vitro and in vivo,images were acquired following bolus injections of the ultrasound contrast agent SonoVue(Bracco,Milan,Italy) and using a Toshiba Aplio ultrasound scanner connected to a 2.9-5.8 MHz linear transducer(PZT,PLT 604AT probe)(Toshiba,Japan) allowing harmonic imaging("Vascular Recognition Imaging") involving linear raw data.A mathematical model based on the dye-dilution theory was developed by the Gustave Roussy Institute,Villejuif,France and used to evaluate seven perfusion parameters from time-intensity curves.Intra-operator variability analyses were based on determining perfusion parameter coefficients of variation(CV).RESULTS:In vitro,different volumes of SonoVue were tested with the three phantoms:intra-operator variability was found to range from 2.33% to 23.72%.In vivo,experiments were performed on tumor tissues and perfusion parameters exhibited values ranging from 1.48% to 29.97%.In addition,the area under the curve(AUC) and the area under the wash-out(AUWO) were two of the parameters of great interest since throughout in vitro and in vivo experiments their variability was lower than 15.79%.CONCLUSION:AUC and AUWO appear to be the most reliable parameters for assessing tumor perfusion using DCE-US as they exhibited the lowest CV values.

闭环链式管理下IAPI评估量表在晚期卵巢癌患者术中的应用

目的探讨多学科闭环链式护理管理模式下应用术中获得性压力性损伤(IAPI)风险评估量表评估晚期卵巢癌手术患者发生IAPI的应用护理效果,总结管理经验.方法选取宁夏医科大学总医院2021年1月—2022年1月Ⅲ、Ⅳ期卵巢癌手术患者40例临床资料,采用常规术中压力性损伤管理模式及Braden评估量表作为对照组(40例),同时收取2022年2月—2023年8月的病例资料作为研究组(44例),采用多学科闭环链式护理管理模式下IAPI评估量表,分析两组IAPI预测能力及其发生率、体位安置规范率、防护措施达标率.结果术中压力性损伤风险评估量表评分比较,研究组中华手术护理学会(CORN)评分明显低于对照组Braden评分,IAPI发生率研究组明显低于对照组,术前术后IAPI风险评估准确率、防护措施合格率、皮肤规范交接单执行率研究组均高于对照组,差异均具有统计学意义(P<0.05).术前术后患者护理满意度研究组高于对照组,差异具有统计学意义(P<0.05).结论多学科链式护理管理模式促进了IAPI的闭环实施,术中获得性压力性损伤风险评估量表更加准确地预测IAPI的发生,大大降低了晚期卵巢癌手术患者IAPI的发生率,使其管理更加规范化、科学化,值得临床推广应用.

计及分布式光伏和储能主动支撑的配电网日前日内协调优化运行策略

为充分挖掘分布式光伏与储能对配电网的主动支撑能力,提高配电网运行效益与供电质量,提出计及分布式光伏和储能主动支撑的配电网日前日内协调优化运行策略。考虑到光伏和负荷预测误差所带来的调度成本风险,采用条件风险价值的方法对其进行量化。日前优化模型以配电网运行成本与成本风险最小为优化目标,制定日前优化方案,为日内优化提供参考;日内优化模型对分布式光伏与储能的有功无功功率进行调度,以加权电压偏差、线路损耗、储能有功功率偏差最小为优化目标,在提升配电网供电质量的同时保证日内运行的经济性。将所提出的模型转化成便于求解的二阶锥规划模型,采用IEEE 33节点算例对所提出的策略进行验证。算例结果表明,所提出的日前日内协调优化策略充分挖掘了分布式光伏与储能的主动支撑能力,有效降低了配电网的运行成本,并对电压越限问题有明显的缓解作用。

透析动静脉内瘘狭窄PTA术后再狭窄应用高压球囊治疗临床研究

目的探究高压球囊在透析患者动静脉内瘘狭窄行经皮腔内血管成形术(PTA)后再狭窄中的应用价值。方法选取2021年2月至2023年1月我院82例行动静脉内瘘狭窄PTA术后再狭窄患者,电脑随机法分为两组,观察组41例采用高压球囊治疗,对照组41例采用普通球囊治疗。比较两组手术一般情况、手术前后狭窄动静脉血流指标[血管峰值流速、横截面积、阻力指数(RI)]、炎性氧化应激指标[C反应蛋白(CRP)、红细胞分布宽度变异系数(RDW-CV)、超氧化物歧化酶(SOD)、丙二醇(MDA)]、并发症及术后3个月开通率。结果观察组球囊扩张压力高于对照组,球囊扩张次数、住院天数均少于对照组(P<0.05);观察组术后3 d血管峰值流速、RI低于对照组,横截面积大于对照组(P<0.05);术后3 d观察组CRP、RDW-CV、MDA水平低于对照组,SOD水平高于对照组(P<0.05);观察组术后3个月开通率高于对照组(P<0.05);两组并发症发生率间差异无统计学意义(P>0.05)。结论透析患者动静脉内瘘狭窄PTA后再狭窄患者采用高压球囊治疗效果确切,能减少球囊操作次数,提高动静脉开通率,改善狭窄动静脉血流状态,减轻炎性氧化应激反应,促进术后恢复,且具有较高安全性。

Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration

Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones. Methods From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively. Results All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was （8.3±2.5） minutes, and the operative duration was （105.4±23.1） minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones （〈0.5 cm） and dilated cystic duct （〉0.3 cm）, dilated common bile duct （〉0.8 cm）, history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients （5.2%） by intra-operative cholangiography. The post-operative hospital stay was （4.7±2.2） days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3-7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 （0.7%） presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications. Conclusions Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.

新时代党内治理的运行机制、主要问题与优化路径

党内治理是新时代中国共产党为加强自身建设、巩固执政地位、实现历史使命而作出的重大创新,是在国家治理现代化视域下进行党的自我革命的具体表现和现实成果。党内治理以健全制度为前提条件、以高效执行为核心要素、以有力监督为关键环节、以及时反馈为必要依托、道德建设为重要保障。党的十八大以来,党内治理取得了显著成效,但仍有不少问题亟待解决。文章认为,在新时代新征程中,可从坚持党的集中统一领导与发展全过程人民民主相统一、激发作为“绝大多数”的党员干部的“雁群活力”、积极探索作为非正式制度的“软”治理措施、建立科学的党内法治文化、在纵向与横向两个维度上学习和汲取政党治理的经验与教训、切实用党的治理能力和执政水平来检验实际效果等几个方面,来优化党内治理。

玻璃酸钠联合塞来昔布用于膝骨关节炎射频术后临床评价

目的探讨玻璃酸钠联合塞来昔布用于膝骨关节炎(KOA)患者射频术后的临床疗效。方法选取医院2020年10月至2022年1月收治的行射频术的KOA患者108例,按治疗方案的不同分为对照组和观察组,各54例。两组患者均于射频术后第1天起口服塞来昔布胶囊,观察组患者加予膝眼关节腔内注射玻璃酸钠注射液。两组均连续用药5周,随访6个月。结果观察组总有效率为94.44%,显著高于对照组的79.63%(P<0.05)。治疗后,观察组患者的P物质、β-内啡肽、神经肽Y、5-羟色胺和前列腺素E2水平,以及肿瘤坏死因子-α、类风湿因子和白细胞介素6水平均显著低于对照组(P<0.05);治疗后1个月、3个月、6个月,观察组患者的美国特种外科医院(HSS)评分量表得分均显著高于对照组(P<0.05)。结论玻璃酸钠联合塞来昔布用于KOA患者射频术后,能有效提高临床疗效,降低疼痛介质和炎性因子水平,改善患者的疼痛程度和膝关节功能。

铁路货运站站机一体化模式下列尾运用效率提升研究

当前,铁路货运在运输市场竞争日益激烈的形势下,部分货源流失严重。近些年,随着“公转铁”政策以及铁路货运向现代物流转型的逐步推进,铁路货运站也制定了一系列改革措施。通过机务段机务调度员驻站、机务段管理人员交流到车站任职、调车机司机划归车站管理等方式实行站机一体化,大大方便了站机协调联系,增加配合精准度,提高了机车出勤效率,缩短了机车辅时。通过在机务段库内设置列尾作业点,在库内直接进行列尾单机携带,送至外围中间站,不仅实现了编组站1 min发车,提高了发车效率,还为列尾需求站解决了发车难题。以上改革方案的实施,大大地促使列尾运用效率提升,列尾调配的精准度得以提高,货运周时、中时得以压缩,编组站办理辆数大幅增加,最终提升铁路货运经营收入,为地方经济和社会发展做出更大贡献。

Influential factors and effect evaluation of the intra-operative puncture biopsy for pancreatic masses

Background It is a challenge for the surgeons to accurately diagnose the pancreatic masses preoperatively,which decides the choice of surgical managements and subsequently results in different survivor outcomes,operative complications,and mortality rates.The purposes of this study were to evaluate the diagnostic role that intra-operative puncture biopsy may play in pancreatic masses and to explore the relevant factors influencing the diagnosis.Methods A retrospective study was performed on 94 in-patients admitted to Peking University First Hospital for pancreatic masses during the period from June 1994 to December 2007.They all underwent intra-operative puncture biopsy during exploratory laparotomy.The sensitivity and specificity of intra-operative puncture biopsy were calculated and the relevant factors to the diagnosis of biopsy were selected for the statistical analysis.Results The overall sensitivity,specificity,positive predictive value,and negative predictive value of intra-operative puncture biopsy were 76.0%,94.7%,98.3% and 50.0%,respectively.The analysis of bivariate correlations showed that the size of the pancreatic masses （P=-0.000）,the number of puncture biopsies （P=0.000）,and the presence of pancreatic fibrosis （P=-0.012） had statistic significance for the diagnosis.But the multivariate analysis identified the size of the pancreatic masses （P=0.004） and the number of puncture biopsies （P=0.000） as independent predictive factors for intra-operative puncture biopsy.In addition,as the number of puncture biopsies increased,the sensitivity and specificity of diagnosis was improved （P=0.000）.The sensitivity and specificity of intra-operative puncture biopsy were found to be lower for the pancreatic masses less than 25 mm compared with the masses larger than 25 mm （P=0.000）.It was noted,however,that even if the masses were less than 25 mm,the sensitivity and specificity could be improved significantly as the number of puncture biopsies reached 3 to 6 （P=0.007）.Conclusions Intra-operative puncture biopsy is simple and accurate for qualitatively differentiating various types of pancreatic masses.Three to 4 biopsies could significantly improve the diagnostic effect for pancreatic masses,even if the masses are less than 25 mm in size.

常益长高速铁路本跨线列车开行模式设计

以常益长高速铁路为研究对象,为提升沿线旅客服务质量需对列车开行模式进行设计。针对沿线既有线列车存在的开行频率低、通达范围小、运行时间长等问题,提出常益长高速铁路适合采用本线及跨线列车结合的列车开行模式,采用多要素分析法,对拟开行的本线及跨线列车起讫点、列车等级、列车编组、列车开行频率等要素进行设计,确保列车开行模式能够适应旅客出行需求,为列车开行方案和运行图的合理编制奠定基础。

颅内未破裂动脉瘤介入治疗程序相关性术中破裂的危险因素及临床特点分析

目的探讨颅内未破裂动脉瘤介入治疗过程中发生术中破裂的危险因素及临床特点,为临床降低术中破裂的发生率提供对策。方法回顾性收集2010年1月至2017年2月间在第二军医大学长海医院接受介入治疗的1 232例颅内未破裂动脉瘤患者的临床资料,分析其临床及影像学特点,并对术中破裂可能的危险因素行单因素和多因素分析。结果 1 232例患者中有11例(0.89%)发生术中破裂。单因素分析结果显示心血管疾病史(P=0.025)、前交通动脉瘤(P=0.009)、肿瘤不规则形态(P=0.001)、支架应用(P=0.016)与术中破裂相关,多因素分析结果显示心血管疾病史(OR=6.919,P=0.008)、肿瘤不规则形态(OR=9.758,P<0.001)、前交通动脉瘤(OR=4.648,P=0.024)为术中破裂的独立危险因素,支架应用为术中破裂的保护因素(OR=0.238,P=0.026)。结论心血管疾病史、不规则形态、前交通动脉瘤为颅内未破裂动脉瘤发生术中破裂的独立危险因素。支架治疗患者术中破裂的发生率低于非支架治疗患者。

手术室护理人员对患者术中压疮认知与防范行为培训研究

目的:评价短期培训对手术室护理人员术中压疮认知和预防术中压疮相关护理行为的影响。方法:采用类实验性研究方法,对北京市某三级甲等医院62名在职手术室护理人员进行患者术中压疮知识和预防术中压疮相关护理行为的现状调查,并进行为期2个月的术中压疮知识与防范行为培训。培训方法包括教学培训、行为演示、发放宣传材料等。比较培训前、后的问卷调查结果并评价培训效果。结果:实施培训后,该手术室护理人员术中压疮相关知识得分及预防术中压疮相关护理行为得分较培训前明显提高(P<0.01)。结论:有效的培训可提高手术室护理人员术中压疮相关知识水平,促进其形成预防术中压疮的安全护理行为模式。

电视胸腔镜肺叶切除术中并发症的分析与对策

目的:总结预防及处理胸腔镜肺叶切除术中并发症的方法。方法:2007年1月至2012年12月,实施VATS肺叶切除手术317例。观察术中并发症的发生情况并总结处理对策。结果:术中发生并发症患者28例(8.8%),包括血管意外损伤出血16例(5.0%)、误伤/断支气管2例(0.6%)、缝合器切割血管残端渗血4例(1.3%)、缝合器切割残端肺漏气3例(0.9%)、肺损伤2例(0.6%)、膈肌损伤1例(0.3%)。中转开胸17例,中转率5.4%。出血镜下修补成功14例,成功率70%(14/20)。术中无死亡病例。结论:胸腔镜肺叶切除是胸外科难度较高的手术方法,需注重预防及正确处理术中并发症,尤其是大血管的损伤出血,才能减少中转开胸率及术后并发症的发生率,使其得到广泛的推广。

膝关节手术后注射透明质酸钠效果观察

目的 探讨膝关节术后关节腔内注射透明质酸钠的效果。方法 1998年 1月～ 2 0 0 1年 2月 ,对关节镜手术 134例于手术结束时 ,以及膝关节开放手术 91例于术后 2 4小时拔引流管时 ,分别在关节腔内注射透明质酸钠 4ml(用药组 ) ;术后第 5天抽出关节积液 ,再注入透明质酸钠注射液 2 ml;每周 1次 ,连续 5周为一个疗程 ,根据病情注射 1～ 2个疗程 ,观察各时间点疼痛 VAS评分和达到最大无痛活动度的时间。与同期手术未用药的 85例进行比较。结果 用药组术后各时间点的疼痛程度评分均低于未用药组 ,关节镜手术用药组术后达最大无痛活动度所需的时间为 3天 ,未用药组为 5天 ;膝关节开放手术用药组达最大无痛活动度的时间为 6天 ,未用药组为 9天。结论 膝关节手术后关节腔内注射透明质酸钠能有效止痛 。

皮层体感诱发电位及经颅电刺激运动诱发电位联合监护在脊柱畸形矫正术中的应用

目的:探讨脊柱畸形矫正术中皮层体感诱发电位(CSEP)及经颅电刺激运动诱发电位(TES-MEP)联合监护在脊柱畸形矫正手术中的应用。方法:对我院收治的脊柱畸形患者根据术中监护方法分为两组:A组37例,其中男25例,女12例,年龄13～42岁,平均26.1岁,术中进行CSEP及TES-MEP联合监护;B组29例,其中男10例,女19例,年龄13～20岁,平均15.8岁,单纯采用CSEP监护作为对照组。术中持续观察CSEP及TES-MEP波幅及潜伏期变化,出现波幅下降50%、潜伏期延长10%或刺激强度高于初始刺激强度100V仍未引出者,停止手术并对症处理,术后给予激素治疗。结果:A组术中出现CSEP异常者4例(10.8%),TES-MEP异常者19例(60%)。术中CSEP及TES-MEP均异常者4例(10.8%),无术中CSEP异常而TES-MEP正常者。2例(陈旧性结核并后凸畸形1例,陈旧性骨折并后凸畸形1例)术中合拢截骨平面时,TES-MEP波形均消失,但仅1例出现CSEP异常,经术中积极处理,至手术结束时波形仍未恢复至术前水平,术后均出现神经功能障碍。余35例患者术后无神经功能损伤(假阴性率0%)。B组9例(21%)术中出现CSEP波形异常,其中2例虽经减少矫形角度及激素冲击治疗,术后仍出现双下肢瘫,余术后未出现神经功能障碍。3例术中监护未见异常者,术后出现重度不可逆性脊髓损伤(假阴性率10%)。结论:CSEP结合TES-MEP联合监护能较可靠、准确的反映术中脊髓功能状态,可降低监护假阴性率,为手术治疗过程提供参考。

腹腔镜直肠癌术中低体温相关因素及其护理进展

应用腹腔镜手术治疗直肠癌是腹腔镜消化系肿瘤外科中较成熟的手术方式。但手术期间低体温对患者的影响也日益受到关注。对人体这一恒温机体而言,轻度低体温（34～36℃﹚是一种不良刺激,机体会做出一系列应激反应,对人体生理功能和术后康复影响较大[1]。

术中超声结合导航在神经外科手术中的应用

目的探讨超声结合导航的影像引导系统在神经外科手术中的作用及应用价值。方法回顾130例在超声结合神经导航下接受手术患者的临床资料。其中海绵状血管瘤50例,动静脉畸形42例,胶质瘤22例,转移瘤5例,室管膜瘤2例,其他病变9例。结果本组病变全切率为95.4%。导航误差1.2～3.5mm(平均2.1mm),发生较明显结构性影像漂移14例(10.8%);超声对本组病变均能良好显示。结论超声结合导航适合于血管畸形、皮层下脑内肿瘤及脑室内肿瘤的手术。神经导航和术中超声是目前最为常用的两种神经外科术中影像引导系统,各自有不能被取代的特点,同时也存在不可避免的缺陷。合理使用超声和导航系统,才能更好地发挥二者的优势。