实时三维超声引导 VACORA真空微创穿刺活检系统在乳腺良性疾病微创诊疗中的应用

目的探讨三维超声引导下VACORA真空微创穿刺活检系统在乳腺良性疾病诊疗中的应用价值。方法选取术前诊断为乳腺良性肿块患者103例（223个肿块）,经二维超声引导治疗54例（二维组）,经实时三维超声引导治疗49例（三维组）,记录两组患者肿块容积、手术切除条数、手术耗时、术后血肿发生情况及血肿吸收情况。结果全部肿块均成功引导切除,两组患者手术耗时无明显差异（P＞0.05）,三维组肿块切除条数及术后血肿发生率均明显少于二维组（均P＜0.05）,而且血肿0.16～3.80ml者平均吸收时间均显著明显短于血肿4.7～19.5及25.2～32.0ml者（均P＜0.01）。两组患者术后随访1～12个月均无复发。结论超声引导VACORA真空微创穿刺活检系统适用于体积＜2.4ml乳腺良性肿块的微创切除,实时三维超声引导定位准确、安全、损伤小,是乳腺肿块微创切除的一种有效方法。     

全胸腔镜手术与胸腔镜辅助小切口手术对Ⅰ期非小细胞肺癌的临床疗效比较

目的比较全胸腔镜手术与胸腔镜辅助小切口手术对Ⅰ期非小细胞肺癌的临床疗效。方法选择86例Ⅰ期非小细胞肺癌患者,按随机数字表法分为使用全胸腔镜手术治疗组（全胸腔镜组46例,采用3孔法）及使用胸腔镜辅助小切口手术治疗组（胸腔镜辅助组40例,采用2孔法）。比较两组患者一般手术情况、术后生存质量及无瘤生存情况。结果两组患者的手术时间、术中出血量、术后带胸管时间及住院时间比较差异均无统计学意义（均P＞0.05）,全胸腔镜组患者术后胸腔液引流量[（217.8±50.5）ml]和视觉模拟评分（VAS）[（3.9±0.6）分]均低于胸腔镜辅助组[（258.0±48.6）ml、（6.5±1.2）分],差异均有统计学意义（t=3.75、12.96,均P＜0.05）。全胸腔镜组患者术后生存质量评分[总分（88.7±9.6）分]高于胸腔镜辅助组[总分（71.1±8.2）分],差异有统计学意义（t=9.1,P＜0.05）。两组患者术后无瘤生存时间比较差异无统计学意义（P＞0.05）。结论全胸腔镜手术治疗Ⅰ期非小细胞肺癌的近、远期疗效均较好,值得推广应用。     

带蒂脾段后腹膜固定术在门静脉高压症外科治疗中的应用

目的：评价带蒂脾段后腹膜固定术治疗门静脉高压症的临床应用可行性及疗效。方法选择肝炎后肝硬化、门静脉高压症、脾功能亢进患者44例,其中行带蒂脾段后腹膜固定术24例（观察组）,行全脾切除术20例（对照组）。比较两组患者手术时间、术中出血量、术后住院时间及术后并发症发生情况,以及周围血象（白细胞计数、血小板计数）、免疫功能指标（CD4、CD8、CD4/CD8）等。结果观察组手术时间明显短于对照组、术后并发症发生率明显低于对照组（均P＜0.05）;观察组术后10d、术后2个月白细胞计数均明显低于对照组（均P＜0.05）,术后3、10d及术后2个月血小板计数均明显低于对照组（均P＜0.05）;观察组术后10d CD4比例及IgG含量均明显高于对照组（均P＜0.05）,术后2个月CD4比例、CD4/CD8及IgA、IgM含量均明显高于对照组（均P＜0.05）,CD8比例明显低于对照组（P＜0.05）。结论带蒂脾段后腹膜固定手术是一种较好的保脾手术方式,保留了脾脏的部分或大部分功能,避免了术后门静脉血栓的发生,并且远期具有分流作用,技术上是安全可行的。     

腹腔镜下经肠系膜途径与结肠旁 途径左侧输尿管上段切开取石术 的疗效比较

目的 寻找疗效更佳的腹腔镜下左侧输尿管上段切开取石术的手术途径。方法 收集43例经肠系膜途径（A组）和 46 例结肠旁途径（B 组）患者的手术时间、术中出血量、术后肠道功能恢复时间、住院时间、术后并发症、下床活动时间等临床资料,比较两组的差异。结果 A 组在手术时间、术中出血量、术后肠道功能恢复时间、住院天数明显优于B 组,差异有统计学意义（均P＜0.05）;术后并发症、下床活动时间,两组差异无统计学意义（均P＞0.05）。结论 腹腔镜下经肠系膜途径左侧输尿管上段切开取石术是一种更安全、有效、微创的手术方法,值得在临床上推广应用。     

右半结肠癌完全结肠系膜切除术清扫肠系膜根部淋巴结效果观察

目的 探讨右半结肠癌行完全结肠系膜切除术（CME）清扫肠系膜根部淋巴结的临床疗效。方法 以2010年12月 至2012 年12 月行CME 的57 例右半结肠癌患者作为观察组,同期接受传统结肠癌根治术的99 例右半结肠癌患者作为对照组,对两组患者的淋巴结清扫数量、平均出血量、手术时间、住院时间、术后排气、排便时间、手术并发症、2年局部复发率及生存率等情况进行比较,初步评价CME 清扫肠系膜根部淋巴结的临床效果。结果 CME 组与对照组总淋巴结清扫数量分别为（22.6±2.8）、（14.6±2.7）枚,CME 组淋巴结清扫数量明显多于对照组（P＜0.05）;CME 组平均出血量为（167.4±20.8）ml,对照组为（205.4±19.3）ml,CME 组出血量少于对照组（P＜0.05）;两组的手术时间、住院时间、术后排气、排便时间比较差异均无统计学意义（均P＞0.05）;CME 组手术并发症发生率与对照组比较差异无统计学意义（P ＞0.05）;Ⅲ期患者CME 组2 年局部复发率38.2％、生存率88.2％,对照组分别为64.8％和68.5％,两组差异有统计学意义（均P＜0.05）。结论 右半结肠癌患者采用CME 清扫肠系膜根部 淋巴结是安全和有效的。     

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。     

远端胃大部分切除术后消化道重建术式的对比研究

目的 对比远端胃大部分切除术后行连续性空肠间置术与BillrothⅠ式及Roux-en-Y 式吻合术的临床效果。方法 回顾性分析2012 年1 月至2013 年6 月接受手术的远端胃癌患者95 例,按不同消化道重建方式分为3 组。A 组30 例患者行连续性空肠间置术,B 组32 例行BillrothⅠ式吻合术,C 组33 例行Roux-en-Y 式吻合术。比较3 组患者术前预后营养指数（PNI）、手术时间、术后6个月及1 年并发症发生率、进食量、血浆白蛋白水平、体重及Visick 分级指数。结果 3 组患者术前PNI均无统计学差异（均P＞0.05）。A 组患者手术时间与B 组无明显差异,且均明显少于C 组的手术时间（均P＜0.05）。术后6 个月及术后1 年3 组患者的进食量、体重及营养状况的恢复均无统计学差异（均P＞0.05）。A 组患者术后腹胀情况明显少于C 组（P＜0.05）,胆汁反流性胃炎明显少于B 组（P＜0.05）。结论 胃大部分切除术后连续性空肠间置,安全有效,与传统的BillrothⅠ式及Roux-en-Y 式吻合术比较,可缩短手术时间,更快的恢复患者的消化功能,维持消化道正常通路,防止胆汁反流,将有可能成为消化道重建的主要方式之一。     

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。     

帕金森病患者左旋多巴治疗时测定血同型半胱氨酸水平的临床意义

目的探讨接受左旋多巴治疗的帕金森病（PD）患者血同型半胱氨酸水平与临床特征的关系及测定的意义。方法测定44例PD患者（PD组）与38例健康体检者（对照组）的血同型半胱氨酸、叶酸、维生素B12水平并进行比较,将PD组分为≥14mmol/L与＜14mmol/L两个亚组,比较两组统一帕金森量表评分。分析PD患者血同型半胱氨酸水平的影响因素。结果 PD组患者血同型半胱氨酸水平[（16.1±7.8）μmol/L]高于对照组[（10.9±2.8）μmol/L],高同型半胱氨酸水平与叶酸、维生素B12水平呈负相关（r=-0.467,P＜0.01;r=-0.347,P＜0.05）,与左旋多巴用量及UPDRSⅢ呈正相关（r=0.464,P＜0.01;r=0.378,P＜0.05）,与年龄、起病年龄、病程、左旋多巴使用时间无关（均P＞0.05）,≥14mmol/L与＜14mmol/L两组UPDRS评分的差异无统计学意义（P＞0.05）。结论左旋多巴治疗会导致高同型半胱氨酸血症发生,补充叶酸及维生素B12治疗可能是有效的治疗方法。     

下肢静脉曲张腔内激光治疗与传统剥脱手术治疗的远期疗效对比研究

目的 比较静脉腔内激光治疗（EVLT）和传统剥脱手术治疗下肢静脉曲张（VVLE）的远期疗效。方法 选取VVLE患者120例,随机分为EVLT 组与对照组,每组各60例。EVLT组采用EVLT治疗,对照组采用传统剥脱手术治疗。分别对两组患者手术并发症、术后1、2、3 年复发率以及术后生活质量进行对比评价。结果 术后3 个月EVLT 组患者生活质量调查表（CIVIQ）评分显著高于对照组（P＜0.05）,术后6 个月两组患者CIVIQ 评分比较则无统计学差异（P＞0.05）。EVLT 组患者术后皮下瘀血、感觉麻木、硬结、皮下脂肪液化感染的发生率均显著低于对照组（均P＜0.01）,皮肤灼伤的发生率则高于对照组（P＜0.05）,两组患者静脉炎的发生率无统计学差异（P＞0.05）;两组患者术后1、2、3年复发率比较均无统计学差异（均P＞0.05）。结论 应用EVLT治疗VVLE 手术并发症少,患者术后恢复较快,远期疗效理想,值得临床推广应用。     

On a class of self-similar processes with stationary increments in higher order Wiener chaoses

We study a class of self-similar processes with stationary increments belonging to higher order Wiener chaoses which are similar to Hermite processes. We obtain an almost sure wavelet-like expansion of these processes. This allows us to compute the pointwise and local Hölder regularity of sample paths and to analyse their behaviour at infinity. We also provide some results on the Hausdorff dimension of the range and graphs of multidimensional anisotropic self-similar processes with stationary increments defined by multiple Wiener–Itô integrals.     

A REPRESENTATION FORMULA RELATED TO SCHR(O)DINGER OPERATORS

Schr(o)dinger operator is a central subject in the mathematical study of quantum mechanics.Consider the Schrodinger operator H = -△ V on R, where △ = d2/dx2 and the potential function V is real valued. In Fourier analysis, it is well-known that a square integrable function admits an expansion with exponentials as eigenfunctions of -△. A natural conjecture is that an L2 function admits a similar expansion in terms of "eigenfunctions" of H, a perturbation of the Laplacian (see [7], Ch. Ⅺ and the notes), under certain condition on V.     

Qualitative Analysis of Bifurcating Solutions in the Lengyel-Epstein Model

One of the most fundamental problems in theoretical biology is to explain the mechanisms by which patterns and forms are created in the＇living world. In his seminal paper ＂The Chemical Basis of Morphogenesis＂, Turing showed that a system of coupled reaction-diffusion equations can be used to describe patterns and forms in biological systems. However, the first experimental evidence to the Turing patterns was observed by De Kepper and her associates（1990） on the CIMA reaction in an open unstirred reactor, almost 40 years after Turing＇s prediction. Lengyel and Epstein characterized this famous experiment using a system of reaction-diffusion equations. The Lengyel-Epstein model is in the form as follows     

On a class of Riemann surfaces

It is considered the class of Riemann surfaces with dimT1 = 0, where T1 is a subclass of exact harmonic forms which is one of the factors in the orthogonal decomposition of the spaceΩH of harmonic forms of the surface, namely The surfaces in the class OHD and the class of planar surfaces satisfy dimT1 = 0. A.Pfluger posed the question whether there might exist other surfaces outside those two classes. Here it is shown that in the case of finite genus g, we should look for a surface S with dimT1 = 0 among the surfaces of the form Sg\K , where Sg is a closed surface of genus g and K a compact set of positive harmonic measure with perfect components and very irregular boundary.     

(0,1 ;0)-INTERPOLATION ON INFINITE INTERVAL (-∞, +∞)

In this paper, we study the explicit representation and convergence of (0, 1; 0)-interpolation on infinite interval, which means to determine a polynomial of degree ≤ 3n - 2 when the function values are prescribed at two set of points namely the zeros of Hn(x) and H′n(x) and the first derivatives at the zeros of H′n(x).     

CONTENTS OF VOLUME 30

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Instructions for contributions

正Applied Mathematics-A Journal of Chinese Universities,Series B(Appl.Math.J.Chinese Univ.,Ser.B)is a comprehensive applied mathematics journal jointly sponsored by Zhejiang University,China Society for Industrial and Applied Mathematics,and Springer-Verlag.It is a quarterly journal with     

Journal of Mathematical Research with Applications Guide for Authors

正Journal overview:Journal of Mathematical Research with Applications(JMRA),formerly Journal of Mathematical Research and Exposition(JMRE)created in 1981,one of the transactions of China Society for Industrial and Applied Mathematics,is a home for original research papers of the highest quality in all areas of mathematics with applications.The target audience comprises:pure and applied mathematicians,graduate students in broad fields of sciences and technology,scientists and engineers interested in mathematics.     

Staircase transportation problems with superadditive rewards and cumulative capacities

A cumulative-capacitated transportation problem is studied. The supply nodes and demand nodes are each chains. Shipments from a supply node to a demand node are possible only if the pair lies in a sublattice, or equivalently, in a staircase disjoint union of rectangles, of the product of the two chains. There are (lattice) superadditive upper bounds on the cumulative flows in all leading subrectangles of each rectangle. It is shown that there is a greatest cumulative flow formed by the natural generalization of the South-West Corner Rule that respects cumulative-flow capacities; it has maximum reward when the rewards are (lattice) superadditive; it is integer if the supplies, demands and capacities are integer; and it can be calculated myopically in linear time. The result is specialized to earlier work of Hoeffding (1940), Fréchet (1951), Lorentz (1953), Hoffman (1963) and Barnes and Hoffman (1985). Applications are given to extreme constrained bivariate distributions, optimal distribution with limited one-way product substitution and, generalizing results of Derman and Klein (1958), optimal sales with age-dependent rewards and capacities.To our friend, Philip Wolfe, with admiration and affection, on the occasion of his 65th birthday.Research was supported respectively by the IBM T.J. Watson and IBM Almaden Research Centers and is a minor revision of the IBM Research Report [6].