完全性大动脉转位(transposition of the great artieries,TGA)是一种严重且复杂的紫绀型先天性心脏畸形,发病率为0.2‰~0.3‰。占先天性心脏病总数的5%~7%,男女患病比例为2∶1~4∶1[1]。大动脉调转术(arterial switch operation,ASO)即...完全性大动脉转位(transposition of the great artieries,TGA)是一种严重且复杂的紫绀型先天性心脏畸形,发病率为0.2‰~0.3‰。占先天性心脏病总数的5%~7%,男女患病比例为2∶1~4∶1[1]。大动脉调转术(arterial switch operation,ASO)即Switch术是目前公认的根治大动脉转位畸形的有效手术[2]。而改良超滤技术通过浓缩患者的血液,去除肺间质多余水分,减轻心肌水肿,减少炎症介质产生,改善肺顺应性和气体交换,减少出血及输血,可明显改善体外循环术后肺功能的恢复。本文报道1例出生仅1 d的低体质量新生儿完全性大动脉转位行Switch术后改良超滤时进气造成患儿延迟关胸的病例。展开更多
Face stability is an essential issue in tunnel design and construction.Layered rock masses are typical and ubiquitous;uncertainties in rock properties always exist.In view of this,a comprehensive method,which combines...Face stability is an essential issue in tunnel design and construction.Layered rock masses are typical and ubiquitous;uncertainties in rock properties always exist.In view of this,a comprehensive method,which combines the Upper bound Limit analysis of Tunnel face stability,the Polynomial Chaos Kriging,the Monte-Carlo Simulation and Analysis of Covariance method(ULT-PCK-MA),is proposed to investigate the seismic stability of tunnel faces.A two-dimensional analytical model of ULT is developed to evaluate the virtual support force based on the upper bound limit analysis.An efficient probabilistic analysis method PCK-MA based on the adaptive Polynomial Chaos Kriging metamodel is then implemented to investigate the parameter uncertainty effects.Ten input parameters,including geological strength indices,uniaxial compressive strengths and constants for three rock formations,and the horizontal seismic coefficients,are treated as random variables.The effects of these parameter uncertainties on the failure probability and sensitivity indices are discussed.In addition,the effects of weak layer position,the middle layer thickness and quality,the tunnel diameter,the parameters correlation,and the seismic loadings are investigated,respectively.The results show that the layer distributions significantly influence the tunnel face probabilistic stability,particularly when the weak rock is present in the bottom layer.The efficiency of the proposed ULT-PCK-MA is validated,which is expected to facilitate the engineering design and construction.展开更多
目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研...目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。展开更多
文摘完全性大动脉转位(transposition of the great artieries,TGA)是一种严重且复杂的紫绀型先天性心脏畸形,发病率为0.2‰~0.3‰。占先天性心脏病总数的5%~7%,男女患病比例为2∶1~4∶1[1]。大动脉调转术(arterial switch operation,ASO)即Switch术是目前公认的根治大动脉转位畸形的有效手术[2]。而改良超滤技术通过浓缩患者的血液,去除肺间质多余水分,减轻心肌水肿,减少炎症介质产生,改善肺顺应性和气体交换,减少出血及输血,可明显改善体外循环术后肺功能的恢复。本文报道1例出生仅1 d的低体质量新生儿完全性大动脉转位行Switch术后改良超滤时进气造成患儿延迟关胸的病例。
基金supported by Science and Technology Project of Yunnan Provincial Transportation Department(Grant No.25 of 2018)the National Natural Science Foundation of China(Grant No.52279107)The authors are grateful for the support by the China Scholarship Council(CSC No.202206260203 and No.201906690049).
文摘Face stability is an essential issue in tunnel design and construction.Layered rock masses are typical and ubiquitous;uncertainties in rock properties always exist.In view of this,a comprehensive method,which combines the Upper bound Limit analysis of Tunnel face stability,the Polynomial Chaos Kriging,the Monte-Carlo Simulation and Analysis of Covariance method(ULT-PCK-MA),is proposed to investigate the seismic stability of tunnel faces.A two-dimensional analytical model of ULT is developed to evaluate the virtual support force based on the upper bound limit analysis.An efficient probabilistic analysis method PCK-MA based on the adaptive Polynomial Chaos Kriging metamodel is then implemented to investigate the parameter uncertainty effects.Ten input parameters,including geological strength indices,uniaxial compressive strengths and constants for three rock formations,and the horizontal seismic coefficients,are treated as random variables.The effects of these parameter uncertainties on the failure probability and sensitivity indices are discussed.In addition,the effects of weak layer position,the middle layer thickness and quality,the tunnel diameter,the parameters correlation,and the seismic loadings are investigated,respectively.The results show that the layer distributions significantly influence the tunnel face probabilistic stability,particularly when the weak rock is present in the bottom layer.The efficiency of the proposed ULT-PCK-MA is validated,which is expected to facilitate the engineering design and construction.
文摘目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。
