神经内镜下单鼻孔经蝶窦入路垂体瘤切除手术的临床体会

目的 探讨神经内镜下单鼻孔经蝶窦入路垂体瘤切除的手术方法及疗效。方法 2011 年3 月至2013年6 月收治 的垂体瘤患者共53 例,均行神经内镜下单鼻孔经蝶窦入路垂体瘤切除手术,对患者的手术效果、术后并发症、住院天数等指标进行回顾性分析。结果 神经内镜下单鼻孔经蝶窦入路垂体瘤完全切除49 例（92.4%）,次全切除4 例（7.6%）,术后平均住院天数6.2d,无手术死亡病例。术后出现并发症5 例（9.4%）,1 例患者术后出现鞍内出血及额叶血肿,1 例患者麻醉清醒后视力下降,2例出现一过性尿崩,1例出现脑脊液漏。结论 神经内镜下单鼻孔经蝶窦入路垂体瘤手术具有创伤小、术后并发症少及恢复快等优点,是治疗垂体瘤较为有效的术式。     

驾驶员生理节律状态与交通事故的统计分析

本文指出用生理节律分析驾驶员交通事故的计算问题，给出正确的分析方法，并对 大连市１９８７年１２月～１９８８年２月１７７例交通事故按生理节律进行统计分析，得出生理节 律对安全生产是否有应用价值和驾驶员的体力节律、情绪节律、智力节律均处于临界期 对发生交通事故的可能性最大的结论．     

3.0T 磁共振血管成像诊断颅内动脉成窗畸形的临床应用

目的 探讨3.0T 磁共振血管成像（MRA）诊断颅内动脉成窗畸形（FIA）的临床应用价值，了解FIA 的MRA 表现、好发部位以及临床特征。方法 回顾性分析2012 年4 月至2014年12 月共78例FIA 患者的血管畸形好发部位、类型及其合并其它颅内血管性病变的情况。78例患者均行MRA 扫描，再将原始图像经AW4.5 工作站采用最小密度投影（MIP）及三维容积重建（VR）两种方法进行血管重组，并对血管图像进行后处理。结果78例FIA 患者中，单发61 例，多发17 例，共计95 处。其中61 例单发病例中位于基底动脉15 例，位于前交通动脉区13 例，位于大脑前动脉26 例，位于大脑中动脉5例，位于大脑后动脉2 例；17 例多发病例中，位于基底动脉及左大脑前动脉6例，位于左椎动脉颅内段及左大脑前动脉7 例，位于基底动脉及前交通动脉4 例。78 例患者中合并其它颅内血管性病变者占83.3%（65/78），双侧动脉对比一侧优势者36 例，伴动静脉畸形（AVM）1 例，永存三叉动脉3例，大脑前动脉A1 段缺失16 例，血管狭窄9例。结论 3.0T MRA 能清楚显示FIA 的位置、形态及合并颅内其它血管病变的情况，是诊断FIA 的首选、有效、无创的影像检查方法。     

儿童伤害的模糊综合评价应用

本在对1990～1999年安徽医科大学第一附属医院收治的3450例0～7岁儿童因发生伤害而住院治疗的病例进行归纳整理的基础上，运用模糊综合评价的方法，分析了不同年龄段儿童伤害原因与康复状况的关系，针对性地提出了预防儿童伤害事故发生的有效措施。     

子宫切除术后残端阴道上皮内瘤变临床分析

目的探讨子宫切除术后残端阴道上皮内瘤变（VaIN）的临床特点、治疗及预后。方法2008年1月至2013 年12 月收治子宫切除术后残端阴道VaIN 43例,对其先期疾病、临床表现、辅助检查、治疗方法及预后进行回顾性分析。结果先期疾病有宫颈上皮内瘤变17 例（39.5%）,子宫颈癌24例（55.8%）,子宫肌瘤1例,子宫内膜癌1 例。继发VaIN的中位时间为术后21个月。24例(55.8%)无临床症状,13例（30.2%）阴道分泌物增多,6例(14.0%)有阴道烧灼感。病变多位于上段阴道（34/43,79.1%）。38例行高危型人乳头状瘤病毒（HPV）检测,阳性率为92.1%（35 /38）,其中30例在两次病程中均为阳性。40例患者采用手术治疗：4例经腹行全阴道切除术,7例经会阴行阴道部分切除术,29 例行高频氩气刀黏膜剥脱术。术后2 例（4.7%）病变持续,5例（11.6%）缓解后复发,均为VaIN。4例再次行黏膜剥脱术,无一例进展为浸润癌。结论子宫切除术后残端阴道VaIN多见于子宫颈癌及宫颈上皮内瘤变,中位发病时间为术后21个月。HPV 感染是其发生的主要原因,手术导致的阴道黏膜受损可能促进了VaIN 的发生。高频氩气刀阴道黏膜剥脱术治疗VaIN 是一种安全有效的治疗手段。     

纵隔副神经节瘤的诊断和治疗

副神经节瘤是一类非常少见的肿瘤，多发生在颈部，也有发生在纵隔、腹膜后等，诊断和治疗有其特殊性。本科收治1例纵隔副神经节瘤，笔者结合文献对收治的副神经节瘤的临床表现、诊断、治疗及预后作逐步的探讨。     

分段式不同阈值颅内压控制在重型颅脑损伤患者治疗中的临床意义

目的探索分段式不同阈值颅内压（ICP）控制对颅脑损伤（TBI）患者治疗的临床意义。方法收集2012年3月至2015年3月救治的重型TBI患者188例,其中2014年1月至2015年3月收治的92例患者设为试验组,采用分段式不同阈值控制ICP;而2012年3月至2013年12月收治的96例患者设为历史对照组,采用传统的单一阈值控制ICP。评估两组患者6个月格拉斯哥预后评分（GOS）、病死率、降ICP治疗措施使用情况、病程中神经功能恶化的发生率、并发症发生率、患者ICU住院时间及总住院时间的差异。结果两组患者发生神经功能恶化的比例无统计学差异（P＞0.05）,两组患者的高渗治疗时间和行脑室外引流时间均无统计学差异（均P＞0.05）,但试验组患者中行过度通气、去大骨瓣减压术及亚低温治疗的比例均显著低于历史对照组（均P＜0.05）。试验组患者的6个月预后良好率为50.0%,显著高于历史对照组患者的28.1%（P＜0.01）。logistic多因素分析显示,试验组患者6个月预后良好的可能性显著高于历史对照组（OR=2.56,95%CI：1.29~5.11）。另外,试验组患者的总住院时间（P＜0.01）和ICU住院时间（P＜0.01）也均低于历史对照组,而且肺部感染、脑积水、肾功能不全和弥散性血管内凝血（DIC）的发病率均显著低于历史对照组（均P＜0.05）。结论分段式不同阈值ICP控制可以安全有效的减少TBI患者二线降颅压措施的使用、住院时间及并发症的发生,并且改善患者预后。     

根治性经括约肌间切除术治疗低位直肠癌的远期疗效观察

目的 评估经括约肌间切除术（ISR）对低位直肠癌实施根治性切除的远期疗效（包括肿瘤学效果及肛门功能）。方法 对2006 年2月至2013年5月采用ISR 进行R0 切除术并成功保肛的91例低位直肠癌患者的临床资料进行回顾性分析。结果 术后病理分期pTNMI期35 例、Ⅱ期30 例、Ⅲ期26 例。无围术期死亡。发生吻合口瘘2例,新直肠黏膜坏死2 例,吻合口狭窄15例。术后随访6～94 个月,平均随访（40.3±23.9）个月。中途失访10 例。远处转移9例,局部复发3 例,1例术后36 个月发现左侧盆壁淋巴结转移,1例术后35个月骶前复发,1 例术后52 个月发现骶骨转移。无吻合口复发。随访截止时,8例死于肿瘤远处转移。5年累积生存率90.9%,5 年累积无病生存率81.3%。至术后1年,行部分、次全、完全ISR 患者肛管最大静息压分别为（8.5±1.4）、（7.9±2.2）、（4.4±1.2）kPa,大便失禁严重程度Vaizey 评分为4.2±3.0、5.7±3.0、13.7±3.2。结论 在进行R0切除的前提下,低位直肠癌患者使用ISR 技术进行保肛治疗具有较低局部复发率以及可以接受的肛门节制功能。     

论多目标分式规划

论多目标分式规划徐增堃（浙江师范大学数学系，金华３２１００４）基金项目：浙江省教委自然科学基金资助课题．１９９０年１０月２９日收到，１９９１年１０月５日收到第一次修改稿．１９９２年９月７日收到第二次修改稿，１９９３年２月１３日收到第三次修改、压缩稿．...     

激素受体阳性乳腺癌预后影响因素分析

目的 分析激素受体阳性乳腺癌患者预后影响因素并为乳腺癌的临床治疗提供帮助。方 法根据入组标准收集2006 年1 月1日至2008 年12 月31 日收治的激素受体阳性乳腺癌患者285 例,并回顾性分析285 例乳腺癌患者的临床病理特点、治疗方式与患者无病生存率（disease free survival,DFS）与总生存率（overall survival,OS）之间的关系,探究其预后的影响因素。结果 随访的285 例中,5年DFS 为90.3%,5 年OS 为94.6%。年龄≤35 岁患者相比35~60 岁患者DFS 与OS 均缩短（P＜0.01）。淋巴结未转移患者比转移患者预后更佳（P＜0.01）。术后辅助化疗、术后辅助放疗、内分泌治疗可显著改善患者的DFS 及OS（P＜0.01）。间断或中断内分泌治疗能影响患者DFS 与OS（P＜0.01）。中药巩固治疗能改善患者DFS（P＜0.05）,但未能影响OS。结论 淋巴结转移是全组患者的不良预后因素。辅助化疗、辅助放疗、内分泌治疗均能改善激素受体阳性乳腺癌的生存,加强术后的个体化管理对规范内分泌治疗意义重大。     

A general view of pseudoharmonics and pseudoantiharmonics to calculate external arguments of Douady and Hubbard

Harmonics give us a compact formula and a powerful tool in order to calculate the external arguments of the last appearance hyperbolic components and Misiurewicz points of the Mandelbrot set in some particular cases. Antiharmonics seem however to have no application. In this paper, we give a general view of pseudoharmonics and pseudoantiharmonics, as a generalization of harmonics and antiharmonics. Pseudoharmonics turn out to be a more powerful tool than harmonics since they allow the calculation of external arguments of the Mandelbrot set in many more cases. Likewise, unlike antiharmonics, pseudoantiharmonics turn out to be a powerful tool to calculate external arguments of the Mandelbrot set in some cases.     

Qualitative study of a quarantine/isolation model with multiple disease stages

Recent studies suggest that, for disease transmission models with latent and infectious periods, the use of gamma distribution assumption seems to provide a better fit for the associated epidemiological data in comparison to the use of exponential distribution assumption. The objective of this study is to carry out a rigorous mathematical analysis of a communicable disease transmission model with quarantine (of latent cases) and isolation (of symptomatic cases), in which the waiting periods in the infected classes are assumed to have gamma distributions. Rigorous analysis of the model reveals that it has a globally-asymptotically stable disease-free equilibrium whenever its associated reproduction number is less than unity. The model has a unique endemic equilibrium when the threshold quantity exceeds unity. The endemic equilibrium is shown to be locally and globally-asymptotically stable for special cases. Numerical simulations, using data related to the 2003 SARS outbreaks, show that the cumulative number of disease-related mortality increases with increasing number of disease stages. Furthermore, the cumulative number of new cases is higher if the asymptomatic period is distributed such that most of the period is spent in the early stages of the asymptomatic compartments in comparison to the cases where the average time period is equally distributed among the associated stages or if most of the time period is spent in the later (final) stages of the asymptomatic compartments. Finally, it is shown that distributing the average sojourn time in the infectious (asymptomatic) classes equally or unequally does not effect the cumulative number of new cases.     

Asymptotic behavior of dynamic equations ontime scales

As a way to unify a discussion of many kinds of problems for equations in the contionous and discrete case(but also in order to reveal discrepancies between both cases), a theory of "time scales" was proposed and developed by Sulbach and Hilger. In our paper we investigate the asymptoic behaviour of so-called dynamic equations on time scales, and sych dynamic equations are differentialequations in the continous case and difference equations in the discrete case. We offer a perturbation result that leads to a time scales version of Levinson's Fundamental Lemma. Crucial are a dichotomy condition and a growth condition on the perturbation. Also, in the case that Levinson's result cannot be applied immediately, we suggest several preliminary transformations that might lead to a situation where Levinson's lemma is applicable. Such tranformations have been suggested by Harris and Lutz in the continuous case and by Benzaid and Lutz in the discrete case. Both those cases are covered by our theory, plus cases "in between". Examples for such cases will also be discussed in this paper.     

A generalization of the Fourier transform and its application to spectral analysis of chirp-like signals

We show that the de Branges theory provides a useful generalization of the Fourier transform (FT). The formulation is quite rich in that by selecting the appropriate parametrization, one can obtain spectral representation for a number of important cases. We demonstrate two such cases in this paper: the finite sum of elementary chirp-like signals, and a decaying chirp using Bessel functions. We show that when defined in the framework of de Branges spaces, these cases admit a representation very much similar to the spectral representation of a finite sum of sinusoids for the usual FT.     

The Combination of Forecasts: a Bayesian Approach

This paper develops a general Bayesian approach to the problem of combining forecasts. This approach leads to the results of Bates and Granger in certain special cases and to a geometric averaging formula in other special cases.     

Weak convergence of laws of stochastic processes on Riemannian manifolds

Weak convergence of the laws of discrete time re-metrized stochastic processes derived from Brownian motions on compact Riemannian manifolds with heat kernels uniformly bounded by a constant on each compact set of the time parameter and bounded volumes to a stochastic process is given. With a weak condition, we also give weak convergence of those of Brownian motions themselves on manifolds in the same class. Several examples are given, which cover the cases when the manifolds collapse, the cases when the original Brownian motions converge to a non-local Markov process, and the cases when the Gromov-Hausdorff limit and the spectral limit by Kasue and Kumura are different. Received: 22 February 2000?Published online: 9 March 2001     

多元线性回归模型参数估计的递推算法及误差分析

讨论新增数据信息对多元线性回归模型的修正原理,给出不断加入新增数据信息的多元线性回归模型参数估计值的一种递推算法.利用影响因子的概念来刻画新增信息对预测误差的影响,并给出了算法和应用实例.     

Probabilistic behaviour of optical bin-packing solutions

The bin-packing problem is studied from a probabilistic view point. It is shown that, when the sizes of the n elements to be packed are drawn independently from a probability distribution F, then the minimum number of bins necessary for the packing of these n elements is asymptotically (a.e.) proportional to n in three cases. In all three cases, the constant of proportionality to n is explicitly given. Furthermore, in two of the cases, a heuristic is described which is asymptotically almost surely closed to the optimal solution.     

On equilibrium in the presence of friction I

A known equilibrium rule that refers to rigid bodies possibly subject to some external constraintsK _(e), and that is essential in many cases where friction is present, is shown to give unacceptable results in some cases that can be carried out experimentally. Then the same rule is replaced by a new one which is more complex. When the bearings that carry outK _(e) are kinematically independent in a suitable sense, the new rule is proved to simplify into the old one. The afore-mentioned cases can be treated satisfactorily by means of another simple rule. However this rule is shown to be too weak to treat other (simple) cases.     

Classification of Non-self-adjoint Singular Sturm-Liouville Difference Equations

This paper is concerned with non-self-adjoint singular Sturm-Liouville difference equations. By introducing a new spectral parameter, we rewrite the Sturm-Liouville difference equation as a formally self-adjoint Hamiltonian difference system. Applying the theory of the limit point and limit circle cases for this difference system, we classify the considered equation into cases I, II, and III. Two examples are illustrated to show the dependence of cases II and III on the corresponding half planes. Furthermore, the exact dependence of cases II and III on the corresponding half planes is obtained.