Ⅱ度以上宫腔粘连分离术采用不同物理屏障抗粘连疗效分析

目的探讨Ⅱ度以上宫腔粘连分离术采用不同物理屏障抗粘连的临床效果。方法选取212例Ⅱ度以上宫腔粘连患者,其中宫腔粘连分离术留置宫内节育器者作为A组（Ⅱ度47例,Ⅲ度38例,Ⅳ度43例）,宫腔粘连分离术留置宫内球囊后改放置节育器者作为B组（Ⅱ度28例,Ⅲ度30例,Ⅳ度26例）。以上两组术后其他后续治疗方法均一致。术后每28d复查1次,性激素序贯治疗3周期结束后予以宫腔镜下节育器取出术同时行二次探查并登记月经情况。结果（1）月经情况：两组术前月经过少的同度患者相比,月经恢复情况差异无统计学意义（P＞0.05）。术前闭经患者术后月经复潮率89.3%（92/103）。IV度术后月经复潮率B组高于A组,差异有统计学意义（93.8%vs 62.5%,P＜0.05）。（2）并发症发生率及预后情况：宫内节育器嵌顿共12例,A组8例,B组4例,总发生率5.7%,两组之间差异无统计学意义（P＞0.05）。未发现泌尿道生殖道感染病例。宫腔粘连重新形成110例（51.9%）;其中IV度A组高于B组,差异有统计学意义（P＜0.05）。结论对于IV度宫腔粘连行宫腔镜下分离术,术中留置宫内球囊后改宫内节育器将比单独使用宫内节育器有更好的治疗效果。     

COPD急性加重合并活动性肺结核患者的危险因素及临床特征分析

目的分析慢性阻塞性肺疾病（COPD）急性加重合并活动性肺结核患者的危险因素及临床特征,以指导临床治疗。方法选取COPD急性发作合并活动性肺结核患者42例（合并组）及同期单纯COPD急性发作的患者72例（对照组）,比较两组患者的临床特征,并采用单因素分析及logistic回归分析其危险因素。结果两组患者的部分临床特征有统计学差异（均P＜0.05）。单因素分析表明,吸烟史、营养不良、长期吸入糖皮质激素史及既往有肺结核史是COPD急性发作合并活动性肺结核的主要危险因素（均P＜0.05）。多因素分析发现,营养不良（OR=4.100,95%CI：1.471～11.431）、长期吸入糖皮质激素史（OR=2.695,95%CI：1.078～6.739）及既往肺结核史（OR=11.102,95%CI：3.076～40.065）为独立危险因素（均P＜0.05）。结论根据危险因素早期识别合并活动性肺结核的高危COPD患者,可尽早明确诊断,给予积极治疗。     

氟比洛芬酯对子痫前期患者剖宫产术后静脉自控镇痛疗效观察

目的 观察氟比洛芬酯复合丁丙诺啡和单用丁丙诺啡对子痫前期患者剖宫产术后静脉自控镇痛（PCIA）的临床效果和 应用价值。方法 选择90例ASAⅠ～Ⅱ级在腰硬联合麻醉下行子痫前期剖宫产术患者,按随机数字表法分为A组（胎儿娩出后氟比洛芬酯+术后丁丙诺啡PCIA）、B 组（术后氟比洛芬酯+丁丙诺啡PCIA）和C 组（术后丁丙诺啡PCIA）,每组30例。观察并记录患者术后1、2、4、12、24h 视觉模拟评分（VAS）、Ramassay镇静评分,平均动脉压（MAP）、心率（HR）及术后恶心、呕吐、嗜睡、皮肤瘙痒等不良反应发生情况,分别于麻醉前、术后4、12 和24h抽取静脉血,检测血清肾上腺素、去甲肾上腺素、多巴胺、血浆儿茶酚胺和内皮素的水平。结果 A 组和B组患者术后各时点VAS 评分均明显低于C组（P＜0.05）,A 组和B 组各时点Ramsay 镇静评分均明显高于C组（P＜0.05）;A 组和B 组术后各时点MAP 和HR 均明显低于C 组（P＜0.05）;术后24h 内PCIA 按压次数A 组和B 组明显低于C组（P＜0.05）;A 组和B 组术后各时点血清肾上腺素、去甲肾上腺素、多巴胺和内皮素水平均明显低于C 组（均P＜0.05）;A 组术后4h 内皮素水平明显低于B 组（P＜0.05）;A 组和B 组头晕、嗜睡、恶心、呕吐发生率均低于C 组（均P＜0.05）。结论 氟比洛芬酯能有效抑制术后应激,镇痛效果好且不良反应少,在胎儿娩出后应用氟比洛芬酯并结合术后丁丙诺啡进行PCIA更适合用于子痫前期剖宫产术后患者术后镇痛。     

急诊冠状动脉介入治疗围术期使用负荷量阿托伐他汀的疗效及安全性观察

目的观察急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗（PCI）围术期使用负荷量阿托伐他汀的疗效及安全性。方法对2009-03-2010-03行急诊PCI的33例急性ST段抬高型心肌梗死患者,确诊后立即给予阿托伐他汀80mg负荷剂量,经绿色通道完成急诊PCI术后予以阿托伐他汀40mg/d继续治疗1个月,观察负荷量阿托伐他汀的疗效和安全性。结果 PCI术后血流再灌注情况（如TIMI血流等级、无复流现象发生情况、ST段水平回落情况及心肌酶谱峰值情况等）结果令人满意;除1例患者因肺部感染、呼吸衰竭转入ICU经积极救治无效死亡外,无围术期心肌梗死、靶血管重建及支架内血栓等主要心脏不良事件的发生;全程观察肝肾功能等药物安全性指标,30d时血碱性磷酸酶、肌酐和尿素氮水平与入院当天相比差异均无统计学意义（均P＞0.05）,30d时测AST、ALT分别为（27.50±8.69）、（23.63±8.03）U/L,均在正常参考值范围内,与入院当天相比明显下降（均P＜0.01）。结论对于急性ST段抬高型心肌梗死拟急诊行PCI治疗的患者,围术期使用负荷量阿托伐他汀不仅安全而且疗效令人满意。     

伽玛刀联合紫杉醇治疗高级别胶质瘤的临床研究

目的 探讨伽玛刀联合紫杉醇治疗术后复发的高级别胶质瘤的临床疗效及不良反应。方法 将73 例胶质瘤术后 患者分为联合治疗组（35 例）和伽玛刀组（38 例）。联合治疗组在伽玛刀治疗前2h 静脉滴注紫杉醇100mg/m2,伽玛刀组仅行伽玛刀治疗。所有患者伽玛刀治疗方案均采用50%剂量曲线包绕病灶,病灶中心剂量28~32Gy,周边剂量14~16Gy。结果 联合治疗组与伽玛刀组近期有效率分别为37.1%和39.5%,无统计学差异（P=0.838）;近期疾病控制率分别为97.1%和81.6%,两组间比较有统计学差异（P=0.041）;生活质量改善率分别为42.9%和42.1%,无统计学差异（P=0.948）;两组中改善及稳定的患者比例分别为97.1%和76.3%（P=0.010）;无进展生存率分别为57.1%和34.2%,两组间比较有统计学差异（P=0.049）;总生存率分别为17.1%和13.2%,组间比较无统计学差异（P=0.634）。治疗不良反应发生率两组比较无统计学差异（P=0.258）。结论 伽玛刀联合紫杉醇治疗能提高术后复发高级别胶质瘤患者的近期疾病控制率,提高临床症状稳定改善率,并能延长患者无进展生存期,改善生活质量。     

支气管哮喘患者白三烯受体1基因MicroRNA的表达

目的探讨支气管哮喘患者外周血细胞白三烯受体-1（CysLTR1）基因MicroRNA的表达及临床意义。方法选择支气管哮喘急性发作患者17例（哮喘发作组）、支气管哮喘诊断明确且临床症状完全缓解3个月以上患者15例（哮喘缓解组）和健康体检者20例（正常对照组）,采用RT-PCR技术检测外周血细胞CysLTR1基因MicroRNA的表达,并比较分析3组检测结果。结果CysLTR1基因MicroRNA在正常对照人群和支气管哮喘患者中均有表达,但表达水平不同：哮喘发作组、哮喘缓解组和正常对照组CysLTR1/GAPDH分别为2.4059±0.1983、2.1800±0.2210和1.2300±0.1174,与正常对照组相比,哮喘发作组和哮喘缓解组CysLTR1基因MicroRNA的表达均明显增高（均P＜0.05）;哮喘发作组与哮喘缓解组比较,差异无统计学意义（P＞0.05）。结论哮喘患者CysLTR1基因MicroRNA高表达可能与哮喘发生或急性发作相关。     

快速康复外科在肝癌肝切除术中的应用及对细胞免疫功能的影响

目的探讨快速康复外科（FTS）在肝癌肝切除患者围术期的临床应用效果及对细胞免疫功能的影响。方法选取择期行肝癌肝切除术患者48例,按随机数字表法分为FTS组与常规组,各24例,比较两组患者术后肝功能、细胞免疫功能及临床疗效指标。结果两组患者临床基线资料比较差异均无统计学意义（均P＞0.05）。术后第３天,FTS组TBil为（113.96±61.39）μmol/L,ALT为（146.17±72.51）U/L,AST为（155.04±54.04）U/L;常规组TBil为（165.25±64.38）μmol/L,ALT为（213.46±107.48）U/L,AST为（225.92±81.51）U/L,两组比较差异均有统计学意义（均P＜0.05）;FTS组CD3+、CD4+、CD4+/CD8+指标均明显优于常规组（均P＜0.05）。FTS组患者术后首次肛门排气时间、首次进半流质时间、首次排便时间均较常规组提前（均P＜0.05）,术后住院时间亦缩短（P＜0.05）。结论FTS理念用于肝癌肝切除术患者围术期处理可降低患者术后应激反应、提高术后细胞免疫功能,改善患者术后肝功能恢复效果、缩短术后肛门排气时间和住院时间,安全性好,加快患者康复,值得临床应用。     

后路短节段内固定经椎弓根液态人工骨植骨治疗胸腰椎骨折的临床应用研究

目的 分析胸腰椎骨折后路复位短节段内固定经椎弓根Wright 液态人工骨植骨的疗效。方法 38 例胸腰椎骨折患者结合患者的经济能力分为两组，A（未植骨）组24 例单纯行后路切复椎弓根螺钉内固定术，B（植骨）组14 例一期行后路切复椎弓根螺钉内固定并经椎弓根行椎体内Wright 液态人工骨植骨术，分别随访10~27 个月，比较两组患者拆钉时伤椎前缘高度的再压缩率、Cobb角变化及伤椎影像学的变化。结果 B 组患者拆钉时伤椎前缘高度再压缩率为（5.43±2.71）%，术后Cobb 角增大为（2.03±0.51）°，与A 组（6.29±2.24）°相比差异有统计学意义（P＜0.05），A 组患者术后不同程度的出现蛋壳样改变，其中2例出现断钉，1例患者出现上位椎弓根钉切割出椎体，而B 组患者未出现明显蛋壳样改变及断钉现象。结论 胸腰椎骨折后路复位短节段椎弓根钉内固定经椎弓根Wright 液态人工骨植骨能明显改善伤椎骨折的愈合，维持椎体的高度，减少蛋壳样改变及断钉等情况的发生。     

肛周脓肿局部组织及外周血中IL-22 的表达及临床意义

目的 探讨细胞因子IL-22 在肛周脓肿局部组织及外周血中的表达和意义。方法 选取50例肛周脓肿患者（肛周 脓肿组）和50例无感染的混合痔患者（对照组）,两组患者均行手术治疗,并术中留取病变组织标本。术后观察患者转归,免疫组织化学法检测IL-22 表达、RT-PCR 法检测外周血单核细胞中IL-22 mRNA 的表达,观察IL-22 表达的变化及其与患者临床病理特征之间的关系。结果 IL-22在肛周脓肿组的表达阳性率高于对照组（P＜0.01）;肛周脓肿组根据不同转归分为治愈组、脓肿复发组、肛痿组,3 组患者IL-22 表达阳性率比较,治愈组显著降低,而肛瘘组最高（P＜0.01）。肛周脓肿组外周血单核细胞中IL-22 mRNA表达水平显著高于对照组（P＜0.01）;在肛周脓肿组中随着疾病的进展,肛瘘组患者外周血单核细胞中IL-22 mRNA表达水平显著高于治愈组（P＜0.01）。肛周脓肿组中IL-22的表达与患者性别、年龄均无关（均P ＞0.05）,而与脓肿直径（P＜0.01）、创面愈合时间（P＜0.05） 及进展为肛瘘有关（P＜0.05）。结论 IL-22在肛周脓肿局部组织及外周血中表达增强,在其发病机制中起了重要作用。     

细菌溶解产物对预防 COPD急性发作的临床价值--基于多项随机对照试验的荟萃分析

目的评价细菌溶解产物减少慢性阻塞性肺疾病（COPD）的急性发作及其应用的临床价值。方法检索Cochrane、MEDLINE、EMBASE、CNKI、CBM，纳入细菌溶解产物用于预防COPD急性发作的随机对照研究。评价对照试验的方法学，提取试验的相关指标，对临床数据进行荟萃分析。结果纳入16个研究，共1746例稳定期COPD患者，结果显示细菌溶解产物相较于安慰剂组，可明显减少患者的年平均急性感染次数[SMD=-0.93，95%CI （-1.26~-0.60），P＜0.01]，急性感染的持续时间[SMD=-1.38,95%CI （-1.6~-1.11），P＜0.01]，平均住院时间[SMD=-9.01，95%CI （-10.24~-7.78），P＜0.01]，抗生素应用时间[SMD=-1.07，95%CI （-1.32~-0.82），P＜0.01]，提高患者的 T淋巴细胞水平[SMD=1.38，95%CI （0.64~2.13），P＜0.01]、IgG [SMD=1.46，95%CI （1.18~1.59），P=0.02]、IgM [SMD=0.26，95%CI （0.18~0.41），P=0.01]及6min步行距离[SMD=58.7，95%CI （33.5~84.1），P＜0.01]。然而，细菌溶解产物对肺功能指标并无影响。结论细菌溶解产物对COPD的急性发作的临床价值在于减少感染次数，其对COPD的肺功能并无改善。     

Classification of repeated measurements data using tree-based ensemble methods

In many medical applications, longitudinal data sets are available. Longitudinal data, as well as observations from paired organs, show a dependency structure which should be respected in the evaluation. Adler et al. (Comput Stat Data Anal 53(3):718–729, 2009) proposed various bootstrapping strategies for ensemble methods based on classification trees for two measurements of paired organs. These strategies have shown to improve the classification performance compared to the traditional approach, where only one observation per subject is used. We extend the methodology to the situation, where an arbitrary number of observations per individual are available and investigate the performance of the proposed methods with bagged classification trees (bagging) and random forests in the situation of longitudinal data. Moreover, we adapt the estimation of classification performance criteria to repeated measurements data. The clinical data set consists of morphological examinations of both eyes of glaucoma patients and healthy controls over a time period of up to 7 years. The performance of our modified classifiers is evaluated by a subject-based leave-one-out bootstrap ROC analysis. Simulation results and results for the glaucoma data set demonstrate that our proposal is an improvement of adhoc strategies and of the use all measurements of each subject or block strategy.     

Characterizing the human postural control system using detrended fluctuation analysis

Detrended fluctuation analysis is used to study the behaviour of the time series of the position of the center of pressure, output from the activity of a human postural control system. The results suggest that these trajectories present a crossover in their scaling properties from persistent (for high frequencies, short-range time scale) to anti-persistent (for low frequencies, long-range time scale) behaviours. The values of the scaling exponent found for the persistent parts of the trajectories are very similar for all the cases analysed. The similarity of the results obtained for the measurements done with both eyes open and both eyes closed indicate either that the visual system may be disregarded by the postural control system, while maintaining quiet standing, or that the control mechanisms associated with each type of information (visual, vestibular and somatosensory) cannot be disentangled with this technique.     

Estimation of the Defect Status on Visual Field Longitudinal Data

In this paper, we show the use of Multivariate Time Series models, Markov Random Fields and Bayesian methodologies to solve an applied ophthalmological problem related to the study of glaucoma. Glaucoma is a very serious and widely extended eye disease characterized by a gradual decrease in the intensity of the patient’s sight. It is not, however, homogeneous over all the visual field, and starts at one or several sites and gradually spreads to nearby sites. Measurement of the patient’s “seeing threshold” at different points in the visual field is an important diagnostic tool for glaucoma and other diseases. It results in a map with 52 numerical values, each of which represents the level of intensity perceived by the patient at that site, and ranges from 0 (complete blindness) to 35 (exceptional vision). Additionally a “defect status” variable can be attached at each site in the visual field. This variable would indicate whether the site is normal or defective. Using Bayesian methodologies, the “defect status” process can be regarded as a parameter of the probability distribution of the thresholds and can be estimated as the maximum of its posterior distribution. The stochastic model assumed for the observed “threshold”, given the “defect status”, is a first order autoregressive integrated model (VARI(1,1)) in time, with first order homogeneous spatial correlation. The defect status is modeled by using a Spatiotemporal Autologistic Model with non-homogeneous spatial dependence. This dependence assumes that the propagation of the lesions follows the directions taken by the nerve fibers. MCMC methods are used to jointly estimate the defect status, and parameters and hyperparameters of the model.     

突发事件中对嫌疑犯有效封堵的模型与算法

基于CUMCM-2011 B题中关于嫌疑犯的封堵问题的研究.通过建立描述市区交通网络图的权矩阵,采用求最短路的Dijstra算法求出市区任意两节点的最短路径及路长,构作最佳路径阵和距离矩阵,以此为基点建立封堵路口的最优调度方案模型,再在此基础上建立封堵住嫌疑犯的最优模型,并设计了模型求解的算法.将算法应用于CUMCM-2011 B题中关于嫌疑犯的封堵问题,获得最优封堵方案.     

On the Mathematical Simulation of the Measuring of the Intraocular Pressure by Applanation Method after Refractive Surgery

Applanation tonometry estimates intraocular pressure (IOP) by quantifying the force needed to create a defined amount of deformation of the cornea (Goldmann tonometer) or by estimating the diameter of the circular contact area of the cornea and flat tonometer of defined load (Maklakov tonometer). The first simplest models of the applanation method for measurement of the IOP were based on approach, in which an eyeball is modelled as a thin-walled spherical liquid-filled soft shell with corneal biomechanical properties. It was usually supposed that these properties were the same for all patients. In this work numerical simulation have been carried out using finite element code ANSYS. The eye shell is modeled as two joint shells (cornea and sclera) with different mechanical properties. The results are obtained for numerous sets of parameters and were compared to clinical data. For statistics the measurements of IOP for both eyes of 120 patients before and one month after refractive surgery are used. All parameter of refractive surgery (depth, the width and the place of ablation - refractive surgery for myopia or hypermetropia) have effect on IOP reading obtained with both Goldmann and Maklakov tonometry. The results obtained by Goldmann tonometer are significantly more sensitive to all parameters of refractive surgery than those found with Maklakov tonometer with load 10 g. (© 2011 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim)     

About the concept of angle in elementary school: Misconceptions and teaching sequences

This paper reports classroom research dealing with the difficulties encountered by schoolchildren in the acquisition of angle concept. Two obstacles were pointed out in previous studies: the side-length obstacle and the salience of the prototypical right angle. The first aim of the present study is to determine the extent to which a teaching sequence based on a concrete situation in the meso-space can enable pupils to progress in their conceptualization of angles. This problem situation is based on the notion of visual field. The angle appears in real space between two infinite directions that correspond to two lines of sight. The specificity of this situation is to confront pupils with an angle between two infinite directions in space. The second goal of this research is to study the links between the two obstacles. To answer these research questions, we compared two versions of the teaching sequence, one dynamic (the angle varies) and one static (the angle does not vary) in 3rd and 4th grade classes. The unfolding of the sequence was analyzed and pupils were tested individually before and after the sequence. They were requested to draw angles and angle variations. The results showed that (1) the sequence helped the pupils progress (2) the obstacle of side-length is not the only difficulty faced by pupils; the salience of the prototypical right angle constitutes a real learning obstacle and (3) the type of angle produced and the ability to change its size are linked. In conclusion, the implications for teaching are presented.     

永存原始玻璃体增生症的超声诊断价值

目的 探讨永存原始玻璃体增生症（PHPV）的超声表现，以提高对本病的诊断准确率。方法 回顾性分析9例经病 理检查证实的PHPV 患儿的超声表现，其中8例经超声检查确诊。结果 9 例（10 眼）PHPV 患儿在超声上均表现为患侧小眼球，眼轴缩短，玻璃体无回声区内出现从晶状体后连接到视乳头的圆锥形或漏斗状强回声团块，CDFI可见血流信号。5 例（6 眼）患侧眼球晶状体异常，表现为晶状体不同程度变形、轮廓不光滑，晶状体位置后移，前房变浅。3 例（3 眼）患侧玻璃体内出现絮状高回声。2 例（2 眼）患侧视网膜脱离。2 例（2 眼）患侧伴有白内障。超声诊断PHPV 的准确率为88.9%。结论 PHPV 的超声检查具有特征性的表现，有助于该病的鉴别诊断，指导制定治疗方案。     

电子监控探测人物身高的分析

依据重庆市公安局刑警大队提供的监控数据,分析监控器摄象时影响身高的因素,利用多元回归的原理建立了三个预测身高的回归模型,并对其作出了优劣评价,最终确定出犯罪嫌疑人实际身高与其在照片上的像高、电子监控器距地面的高度、人与监控器的垂直和偏离距离四个因素的最优回归模型.该最优模型的可决系数R2=0.9931,预测身高与实际身高有97.89%的误差点在±0.02m范围内,73.09%在±0.01m范围内.并对最优模型中的预测身高与实际身高进行配对样本的t检验,两者间无显著性差异.     

New eyes for building models from video

Models of real-world objects and actions for use in graphics, virtual and augmented reality and related fields can only be obtained through the use of visual data and particularly video. This paper examines the question of recovering shape models from video information. Given video of an object or a scene captured by a moving camera, a prerequisite for model building is to recover the three-dimensional (3D) motion of the camera which consists of a rotation and a translation at each instant. It is shown here that a spherical eye (an eye or system of eyes providing panoramic vision) is superior to a camera-type eye (an eye with restricted field of view such as a common video camera) as regards the competence of 3D motion estimation. This result is derived from a geometric/statistical analysis of all the possible computational models that can be used for estimating 3D motion from an image sequence. Regardless of the estimation procedure for a camera-type eye, the parameters of the 3D rigid motion (translation and rotation) contain errors satisfying specific geometric constraints. Thus, translation is always confused with rotation, resulting in inaccurate results. This confusion does not happen for the case of panoramic vision. Insights obtained from this study point to new ways of constructing powerful imaging devices that suit particular tasks in visualization and virtual reality better than conventional cameras, thus leading to a new camera technology. Such new eyes are constructed by putting together multiple existing video cameras in specific ways, thus obtaining eyes from eyes. For a new eye of this kind we describe an implementation for deriving models of scenes from video data, while avoiding the correspondence problem in the video sequence.     

The numerical range and the spectrum of a product of two orthogonal projections

The aim of this paper is to describe the closure of the numerical range of the product of two orthogonal projections in Hilbert space as a closed convex hull of some explicit ellipses parametrized by points in the spectrum. Several improvements (removing the closure of the numerical range of the operator, using a parametrization after its eigenvalues) are possible under additional assumptions. An estimate of the least angular opening of a sector with vertex 1 containing the numerical range of a product of two orthogonal projections onto two subspaces is given in terms of the cosine of the Friedrichs angle. Applications to the rate of convergence in the method of alternating projections and to the uncertainty principle in harmonic analysis are also discussed.