简介：摘要目的分析不同手术方式治疗Bismuth-Corlette III、IV型肝门部胆管癌(HCCA)的疗效及预后，探讨其合理的治疗方式。方法回顾性分析2010年1月至2016年12月安徽医科大学第一附属医院手术治疗的86例Bismuth-Corlette III、IV型HCCA患者的临床资料，其中男性45例，女性41例，年龄(59.5±10.5)岁。按照手术方式不同分为扩大肝切除组(57例)和围肝门切除组(29例)，比较两组患者的围手术期指标和生存率。通过住院复查、定期门诊复查或电话随访。单因素及多因素Cox回归分析影响预后的因素。结果扩大肝切除组的手术时间和术中失血量均大于围肝门切除组[320(270，380)min比270(210，300)min，P<0.001；300(200，400)ml比100(100，150)ml，P<0.001]。扩大肝切除组Clavien-Dindo III级及以上并发症发生率和国际肝脏外科研究组C级肝功能衰竭发生率均高于围肝门切除组[36.4%(20/57)比13.8%(4/29)，P＝0.037；13.8%(7/57)比0(0/29)，P＝0.047]，差异均具有统计学意义。扩大肝切除组手术后1、3、5年累积生存率分别为89.5%、38.6%、19.3%，围肝门切除组分别为86.2%、20.7%、10.3%，两组比较生存差异具有统计学意义(P＝0.048)。多因素分析显示围肝门切除(HR＝1.958，95%CI：1.174~3.268，P＝0.010)、非R0切除(HR＝6.040，95%CI：2.915~12.513，P<0.001)、TNM分期III/IV期(HR＝2.144，95%CI：1.257~3.654，P＝0.005)是影响HCCA患者手术后总体生存的独立危险因素。结论Bismuth-Corlette III、IV型HCCA行扩大肝切除术后总体生存率高于行围肝门切除者，但其手术并发症和肝功能衰竭的发生率也增高。

简介：摘要目的探讨应用肌皮瓣联合负载抗生素聚甲基丙烯酸甲酯（PMMA）骨水泥来治疗Cierny-Mader III~IV型骨髓炎的临床效果。方法2014年4月至2019年3月,对53例Cierny-Mader III~IV型慢性骨髓炎患者,应用负载抗生素PMMA骨水泥联合肌皮瓣技术进行修复。其中男33例,女20例,年龄52.2±3.0（29~78）岁。53例骨髓炎病灶创面大小为2.0 cm×2.0 cm~14.0 cm×28.0 cm。皮瓣供区均直接缝合。术后3个月取出骨水泥23例,未取出骨水泥30例。术后观察皮瓣血运、创面渗液、供区并发症、X线复查有无新鲜骨破坏征象及皮瓣的色泽、质地、瘢痕等情况。门诊定期随访。结果49例创口一期愈合,4例创口延期愈合。术后发生血管危象6例,及时手术探查后缓解。术后随访0.6~3.0年,平均为18个月。53例肌皮瓣全部成活,色泽与受区相似,皮瓣平整,质地柔软,外形满意。随访期间X线复查无新鲜骨破坏征象,局部骨髓炎征象明显控制。皮瓣均未出现红肿、疼痛、局部破溃、渗液等炎症反应,无骨髓炎复发。所有供瓣区一期愈合。结论肌皮瓣联合负载抗生素PMMA骨水泥治疗Cierny-Mader III~IV型骨髓炎,抗感染效果好,疗效满意,术后并发症少,复发率低,值得临床推广应用。

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简介：AbstractBackground:Disease activity indices (DAIs) including disease activity score 28 (DAS28), simplified disease activity index (SDAI), and clinical disease activity index (CDAI) have been widely used in clinical practice and research studies of rheumatoid arthritis (RA). The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study, including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018, was conducted. The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots, quadratic weighted kappa, and discordance rates in the crosstab. For other indices, the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included, of whom 80.46% were women. Most individuals were with moderate disease activity or high disease activity. High correlations among DAS28-erythrocyte sedimentation rate (ESR) and DAS28-C-reactive protein (CRP), SDAI and CDAI were observed. Similarly, the weighted kappa value among the indices was high. In Bland-Altman plots, a positive difference between DAS28-ESR and DAS28-CRP was observed, with an absolute difference of >1.2 in 3079 (10.09%) patients. In crosstab, approximately 30% of the patients were classified into different groups. Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR, DAS28-CRP, and CDAI were 3.06, 2.37, and 3.20, respectively.Conclusions:Although DAIs had high correlations and weighted kappa values, the discordance between DAIs was significant in Chinese patients with RA. The four DAIs are not interchangeable.

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简介：AbstractBackground:Although de novo stage IV breast cancer is so far incurable, it has entered an era of individualized treatment and chronic disease management. Based on systemic treatment, whether the surgical resection of primary or metastatic foci of de novo stage IV breast cancer can bring survival benefits is currently controversial. We aimed to explore the clinicopathological factors and current status of the management of de novo stage IV breast cancer in China to provide a reference for clinical decisions.Methods:Based on the assistance of Chinese Society of Breast Surgery, a retrospective study was conducted to analyze the clinical data of patients with de novo stage IV breast cancer in 33 centers from January 2017 to December 2018. The relationship between basic characteristic (age, menstrual status, family history, reproductive history, pathological type, estrogen receptor [ER] status, progesterone receptor [PR] status, human epidermal growth factor receptor 2 [HER2] status, Ki-67 percentage, and molecular subtype), and metastasis sites (lung metastasis, liver metastasis, and bone metastasis) was examined by Pearson Chi-square tests.Results:A total of 468 patients with de novo stage IV breast cancer were enrolled. The median age of the enrolled patients was 51.5 years. The most common pathological type of primary lesion was invasive carcinoma (97.1%). Luminal A, luminal B, HER2 overexpressing, and triple-negative subtypes accounted for 14.3%, 51.8%, 22.1%, and 11.8% of all cases, respectively. Age, PR status, and HER2 status were correlated with lung metastasis (χ2= 6.576, 4.117, and 8.643 and P = 0.037, 0.043, and 0.003, respectively). Pathological type, ER status, PR status, and molecular subtype were correlated with bone metastasis (χ2 = 5.117, 37.511, 5.224, and 11.603 and P = 0.024, <0.001, 0.022, and 0.009, respectively). Age, PR status, HER2 status, Ki-67 percentage, and molecular subtype were correlated with liver metastasis (χ2= 11.153, 13.378, 10.692, 21.206, and 17.684 and P= 0.004, <0.001, 0.001, <0.001, and 0.001, respectively). Combined treatment with paclitaxel and anthracycline was the most common first-line chemotherapy regimen for patients with de novo stage IV breast cancer (51.7%). Overall, 91.5% of patients used paclitaxel-containing regimens. Moreover, 59.3% of hormone receptor-positive patients underwent endocrine therapy.Conclusions:In 2018, 1.07% of patients from all studied centers were diagnosed with de novo stage IV breast cancer. This study indicated that 95.1% of patients received systemic therapy and 54.2% of patients underwent surgical removal of the primary lesion in China.

简介：摘要紧急阀漏泄故障是制动故障中重要问题。针对紧急阀漏泄对其进行分析研究，发现放风阀套松动是导致其漏泄的重要原因，列车管压力空气通过放风阀盖漏向大气，漏泄达到一定程度，紧急放风阀上下两侧形成足够压差，导致放风阀开启，产生意外紧急作用。

简介：摘要目的分析Ahmed青光眼引流阀植入术后引流阀暴露的临床特点。方法回顾性分析郑州市第二人民医院2010年1月至2020年1月共598例(598只眼)Ahmed青光眼阀植入术术后发生引流阀暴露30只眼的临床资料。术后随访6个月～10年。观察引流阀暴露的临床特征及危险因素。结果植入术后青光眼引流阀暴露的发生率为5.02%(30/598)，发生时间为术后1个月至4年(13.67±13.32)个月。临床表现球结膜侵蚀及破裂者18例(60.00%)、引流盘脱出者7例(2.33%)。暴露组年龄为(49.87±19.89)岁，低于非暴露组的年龄(66.21±16.41)岁(t＝2.815，P＝0.004)。暴露组糖尿病患者10例(33.33%，10/30)高于非暴露组的(17.60%，100/568)(χ2＝4.830，P＝0.030)。暴露组之前曾有眼部其他手术者22例(73.33%，22/30)，高于非暴露组的21.12%(20/568)(χ2＝17.320，P<0.05)。结论Ahmed青光眼引流阀植入术后引流阀暴露发生率不高。年龄、糖尿病及眼部手术可能是Ahmed阀暴露的危险因素。

简介：摘要先导式气动减压阀属于以压缩气体为工作介质，先导结构的反馈来实现稳定工作压力气动控制元件。先导式气动减压阀需要适应气动系统的波动性，之后，就可以在普通工业用气中进行广泛应用，把以气动技术作为主要的研究方向进行延伸。从工业用气现场先导式气动减压阀来看，小型化的减压阀让模块化能降低成本，并在此基础上，方便更换零件。可以在内部先导式的基础上，缩小体积。展现减压阀整体结构布局，并在先导阀部件与主阀部件的基础上，实现有效的结构设计。从另外一个角度看，创建减压阀整体参数方程之后，就会对气动系统稳定工作状态，动态压力调节的影响进行分析和探究。分析参数之间的有效规律，完成设计，实施先导式气动减压阀测试与改进。

简介：摘要主蒸汽隔离阀（MSIV）是核电厂重要安全设备之一，事故情况下可以迅速切断核岛与常规岛之间的连接，实现蒸发器隔离。本文重点从仪控方面对主蒸汽隔离阀进行介绍，并结合主蒸汽隔离阀在三门核电及其他核电站的调试运行经验，通过分析对比，进一步思考并探讨后续项目主蒸汽隔离阀在调试运行期间可能出现的问题，同时给出应对方案以及改进方法，为后续相关的调试生产工作提供支持。

简介：摘要HXD2型电力机车原车设计的受电弓风缸阀在未开启的状态下受电弓压力表仍然可以显示受电弓风压，容易导致操作人员误判受电弓风缸阀已开启。通过对这一故障现象统计、梳理、归类、分析，找出故障原因，并提出解决办法，保证机车的正常运用。

简介：摘要目的了解长远航官兵中功能性胃肠病（FGIDs）的发生情况及其相关影响因素。方法选取某年执行长远航任务的某医院船307名官兵作为研究对象，采用罗马IV成人FGIDs诊断调查问卷进行调查，利用多因素Logistic回归进行相关影响因素分析。结果共回收有效问卷300份，合格率为97.7%。长远航官兵FGIDs总发生率为11.0%（33例），其中非特异性功能性肠病发生率最高，为3.33%，其次为功能性消化不良（2.00%）、功能性便秘（1.67%）、功能性腹泻（1.33%）、恶心和呕吐症（1.33%）等。经单因素分析，性别、体质量指数、工作类型、出海次数、居住甲板位置、晕船及进食方便面与FGIDs的发生具有相关性（P<0.05）。经多因素Logistic回归分析显示，男性是FGIDs发生的保护因素，而体质量指数的降低和频繁进食榨菜是FGIDs发生的危险因素。结论长远航官兵FGIDs发生率较高，其发生率与性别、体质量指数和进食榨菜相关。

简介：摘要为了有效提高特高压直流输电的运行能力，保障直流输电的安全水平，进一步提升我国智能电网建设当中的电能质量满足用户用电需求，本文将从直流输电环境的建设发展角度入手，对换流站所采用的换流阀安装施工技术进行深入探究，首先将特高压输电环境当中的换流站换流阀安装技术规范和施工要求为研究方向，总结相关安装施工的技巧和经验，对如何正确开展换流阀安装施工提出建设性意见。

简介：AbstractBackground:The Shexiang Baoxin Pill (MUSKARDIA) has been used for treating coronary artery disease (CAD) and angina for more than 30 years in China. Nevertheless, methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce. The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy (OMT) in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months. Both groups received OMT according to local tertiary hospital protocols. The primary outcome was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. Secondary outcomes included all-cause mortality, non-fatal MI, non-fatal stroke, hospitalization for unstable angina or heart failure, peripheral revascularization, angina stability and angina frequency.Results:In all, 99.7% of the patients were treated with aspirin and 93.0% with statin. After 2 years of treatment, the occurrence of MACEs was reduced by 26.9% in the MUSKARDIA group (MUSKARDIA: 1.9% vs. placebo: 2.6%; odds ratio = 0.80; 95% confidence interval: 0.45-1.07; P = 0.2869). Angina frequency was significantly reduced in the MUSKARDIA group at 18 months (P = 0.0362). Other secondary endpoints were similar between the two groups. The rates of adverse events were also similar between the two groups (MUSKARDIA: 17.7% vs. placebo: 17.4%, P = 0.8785).Conclusions:As an add-on to OMT, MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD. Moreover, the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD. The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn, No. ChiCTR-TRC-12003513

简介：摘要目的探讨腹腔镜结直肠癌经自然腔道取标本手术（NOSES）术后发生并发症的相关危险因素。方法采用回顾性病例对照研究方法，收集并分析自2014年1月~2019年6月在中国医学科学院肿瘤医院结直肠外科行结直肠癌NOSES IV式手术患者的临床病理资料。共纳入172例患者，分析患者一般资料、病理资料、术者经验、术中情况等临床资料与术后并发症的关系，应用χ2检验进行单因素分析，并将有意义因素纳入logistic回归模型进行多因素分析。结果172例患者中，共21例（12.2%）患者出现术后并发症，常见并发症依次为腹盆腔感染（4.7%）、吻合口漏（3.5%）、腹腔出血（1.7%）、肺部感染（1.7%）、吻合口狭窄（1.2%）、直肠阴道瘘（1.2%）、肺栓塞（1.2%）、切口感染（1.2%）。单因素分析结果显示：肿瘤直径（χ2=5.144，P=0.023）、术者经验（χ2=4.412，P=0.042）、手术时间（χ2=4.713，P=0.030）是影响NOSES IV式术后出现并发症的相关因素。进一步将单因素分析有统计学意义的因素纳入Logistic回归分析，结果显示，手术时间（OR=3.317，95%CI：1.024~10.747；P=0.046）是NOSES IV式术后并发症发生的独立危险因素。结论手术时间≥135 min是结直肠癌腹腔镜NOSES IV式术后并发症发生的独立危险因素。严格把握NOSES适应证、熟练灵活使用腔镜器械是降低NOSES术后并发症的有效保障。

简介：摘要Ahmed青光眼引流阀（AGV）是一种可有效控制青光眼眼压的房水引流植入物。AGV植入术作为我国难治性青光眼的首选手术方法，与其他抗青光眼手术相比具有良好的疗效和安全性。本文从AGV植入术的降眼压机制以及可能存在的影响疗效和导致并发症的问题出发，总结AVG植入术的应用及进展，比较各种术式的特点，以期为规范化推广AGV植入术，减少术后并发症，提高临床青光眼治疗水平提供参考。

简介：摘要换流阀是直流输电工程的核心设备，由于换流阀在运行中的波形复杂，目前在计算换流阀损耗时，主要的方法是先独立计算晶闸管阀的损耗分量，然后通过相加得到最终的换流阀损耗。但是晶闸管损耗分量包含内容较多，如通态损耗、扩散损耗、阻尼损耗等，不同损耗所占比例不同，加上计算过程中受到误差的影响，导致换流阀实际损耗与计算结果有较大出入。本文首先分析了换流变抽头的不同控制模式下，对换流阀损耗带来的影响，随后结合金官换流站的故障实例，就损耗原因和处理措施进行了简要概述。

简介：摘要换流阀是高压、特高压直流输电系统中的重要组成设备，随着直流输电系统电压的不断升高，换流阀承担了更多的负荷，运行时经常会出现发热现象，对冷却系统提出了更高的要求。保证换流阀冷却系统的正常运行对于提高整个直流输电系统的稳定和安全也有重要作用。现阶段国内多数直流输电换流阀冷却系统中，都是采用双母线供电，如果阀冷控制系统电源出现故障，会直接影响换流阀冷却效果。在此基础上，探究一种阀冷系统电源配置的优化对策，确保阀冷电气控制系统的稳定运行就显得十分必要。

简介：摘要随着经自然腔道取标本手术（NOSES）目前在国内逐渐开展，其术后腹壁无辅助切口，术后恢复快，美容效果好的优势得到广泛肯定。达芬奇机器人手术系统创新性地克服了传统腹腔镜技术的许多局限性，在结直肠外科领域的临床疗效得到国内外广泛认可。机器人腹部无辅助切口经直肠拖出标本的高位直肠癌根治术是一项值得推广的术式。