SEVERE SHORT-BOWEL SYNDROME AFTER TOTAL SMALL BOWEL RESECTION

ＩＮＴＲＯＤＵＣＴＩＯＮＳｈｏｒｔｂｏｗｅｌｓｙｎｄｒｏｍｅｌｅａｄｓｔｏｓｉｇｎｉｆｉｃａｎｔｍｏｒｂｉｄｉｔｙａｎｄｉｓｐｏｔｅｎｔｉａｌｌｙｌｅｔｈａｌ,ｅｓｐｅｃｉａｌｌｙｗｈｅｎｉｎｔｅｓｔｉｎａｌｌｏｓｓｉｓｅｘｔｅｎｓｉｖｅａｎｄｗｈｅｎｔｈｅｐａｔｉｅｎｔｉｓｖｅｒｙｙｏｕｎｇ (Ｋｕｒｋｃｈｕｂａｓｃｈｅｅｔａｌ.,1 993;Ｗｅｂｅｒｅｔａｌ.,1 991 ;Ｖａｎｄｅｒｈｏｏｆｅｔａｌ.,1 997) .Ｄｅｓｐｉｔｅｔｈｅａｄｖａｎｃｅｓｉｎｍｅｄｉｃａｌａｎｄｓｕｒｇｉｃａｌｔｅｃｈｎｉｑｕｅａｎ…     

Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: convergent evidence for crying as a trigger to shaking

OBJECTIVE: To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported "normal crying curve," as a form of indirect evidence that crying is an important stimulus for SBS. DESIGN AND SETTING: The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000. PATIENTS: All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned. RESULTS: There were 273 hospitalizations for SBS. Like the "normal crying curve," the curve of age-specific incidence starts at 2-3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5-6 weeks, the peak of SBS hospitalizations occurs at 10-13 weeks. CONCLUSIONS: The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4-6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention.     

知识吸收能力研究现状的文献计量学分析

利用CNKI和ISI检索平台检索1989～2011年知识吸收能力的文献数据,并运用Bibexcel软件,从文献的年代分布、刊载期刊分布、著作者分布、高频关键词分布四个方面,定量地分析和比较国内和国外知识吸收能力的研究现状,得出知识吸收能力的相关研究处于快速持续的增长阶段、刊载的期刊存在明显的核心区、创新绩效的研究可能成为新的研究热点等结论。     

Socioeconomic determinants of academic achievement

This study aims to investigate the relationship between academic achievement and the socioeconomic characteristics of elementary school 7th grade students in Burdur. The population of the study are 7th grade students who had education at elementary schools in Burdur in the 2007?C2008 academic year. Two staged sampling was chosen as suitable for the aim of research. In the first stage, settlements were chosen with the random settlement group sampling method. In the second stage, schools in chosen settlements were picked up with the random method considering the number of students who have taken SBS examination. Socioeconomic variables of students generally explain 39.2?% of SBS points of student. When standard beta values are observed, variables which have the most effect on the SBS points of students are: attending a course or having private lessons, father??s education, the average monthly income per capita, attending a course or having private lessons and mother??s education.     

经翼点入路显微手术切除蝶骨嵴脑膜瘤

目的：探讨经翼点入路显微手术切除蝶骨嵴脑膜瘤的方法及周围神经血管保护问题,提高蝶骨嵴脑膜瘤治疗效果。方法：采用显微神经外科技术,经常规翼点或扩大翼点入路,切除蝶骨嵴脑膜瘤。结果：按Simpson分级法评价肿瘤的切除程度：Ⅰ级切除5例,Ⅱ级切除5例,Ⅳ级切除4例。术后患者均每6个月进行随访,影像学提示未见肿瘤复发。结论：准确全面的术前评估、正确的手术方法、积极的术后治疗是提高蝶骨嵴脑膜瘤全切率、改善神经症状、减少术后并发症的关键。     

斑节对虾和日本对虾肝胰腺脂肪成份和含量及其与斑节对虾杆状病毒的关系

体长10～12cm养殖健康斑节对虾肝胰腺含水量71．06％，干重样品脂肪含量34．28％，湿重样品脂肪含量9．60％；班节对虾杆状病毒（MBV）感染严重的班节对虾肝胰腺含水量较健康班节对虾少，干重样品脂肪含量和湿重样品脂肪含量明显高，二者比较，3项指标均具显著位差异；MBV轻度感染斑书对虾肝胰腺含水量和脂肪含量与健康斑节对虾相近，无显著性差异，养殖健康斑节对虾肝胰腺饱和脂肪酸以棕榈酸为主，不饱和脂肪酸以十八碳和二十二碳脂肪酸为主；必需脂肪酸亚油酸达21．72％，体长16～18cm日本对虾肝胰腺饱和脂肪酸以棕榈酸为主，不饱和脂肪酸中油酸、花生烯酸和二十二碳烯酸（C22：1）含量较高，亚油酸和亚麻酸含量较少，二十二碳六烯酸含量达9．91％．     

唐宋敦煌岁时佛俗--二月至七月

唐宋敦煌岁时佛俗:二月八日设道场讲经说法、行像.二月十五日营会供养、设供悼念佛逝世等.三月寒食清明设乐踏歌、上坟祭拜.每个季度未都举行罢四季道场,祈福禳灾.四月八日佛诞辰日有造幡、写经、四月大会、寺院礼佛、求儿女等活动.五月端午节僧官向节度使献物送礼,佛家以受气法供养十方诸佛.七月盂兰盆节整修粉刷佛堂、设盂兰盆道场、造盆破盆、户内祭拜、造花树、图像写经.     

SEREX技术筛选EID3及其表达的实验研究

[目的]新的大肠癌相关性抗原EID3的基因克隆及其诊断价值研究.[方法]利用大肠癌病人体内血清中所含的对肿瘤抗原产生的特异性抗体筛选睾丸组织cDNA噬菌体表达文库和大肠癌组织cDNA噬菌体表达文库(SEREX),并用RT-PCR技术研究EID3 mRNA在正常组织和大肠癌传代细胞表达.[结果]睾丸组织cDNA噬菌体表达文库筛选得到了可以诱导大肠癌病人抗体免疫应答的新抗原EID3基因(Gen-bank NM_001008394.1).它们定位于染色体19q13.2,EID3含1个外显子.通过RT-PCR分析发现,EID3基因在43例大肠癌传代细胞株中,39例阳性,阳性率为90.7%.在正常组织中,除睾丸组织外不表达或有极低水平转录.[结论]EID3 mRNA表达检测用于诊断大肠癌,可能具有高特异性和高敏感性的特点.EID3蛋白被首次发现在大肠癌病人中能够诱导机体的抗体免疫应答,为一个新的大肠癌相关性抗原分子.其功能可能与抑制细胞的恶性增殖相关,并可进一步研究其用于治疗和诊断大肠癌的可行性.     

FDI对福建产业结构升级影响的实证分析——基于区域吸收能力的视角

在理论回顾的基础上提出相关假设,将区域吸收能力与FDI的交互项引入回归模型,选取1985-2011年26年的数据,通过平稳性、协整等相关检验发现,FDI对福建产业结构升级具有较弱的促进作用;吸收能力整体上对福建产业结构升级的影响不显著;人力资本、对外开放程度对FDI促进福建产业结构升级具有正向调节作用,而技术创新能力对FDI促进福建产业结构升级的调节作用不显著.针对检验实证提出继续扩大FDI的规模并提升其质量、优化FDI在三大产业或各行业的分布、加快提升福建区域吸收能力等政策建议.     

微型内固定系统联合超关节外固定装置治疗手部"漂浮掌指关节"损伤

目的：探讨“漂浮掌指关节”的治疗方法及效果。方法：2003．5～2005．4月，对16例42处手部同一掌指关节掌骨、近节指骨同时骨折作切开复位、理贝尔微型接骨板内固定系统及微型外固定系统治疗。结果：术后随访5～12个月，平均6月，42处骨折全部顺利愈合．掌指关节功能恢复良好。根据TAM评分，42处为优良，优良率为100％。结论：联合应用微型内外固定系统做超关节固定治疗手部“漂浮掌指关节”骨折，早期能达到坚强可靠固定，辅助以早期功能锻炼，手部功能恢复好，达到满意治疗效果。是治疗手部掌指关节部位骨折的一种理想方法。     

外伤性迟发性结肠破裂21例分析

目的:探讨外伤性迟发性结肠破裂的临床特征、诊断和治疗方法,提高早期确诊率和治疗疗效。方法:对21例结肠损伤患者的临床资料进行回顾性分析。结果:全组患者均行二期手术治愈。6例患者术后切口感染,4例肠粘连。无造瘘术后肠梗阻、造瘘口狭窄及切口疝等并发症。结论:二期手术适用于严重的休克,全身状态不佳,腹内多脏器损伤和严重的感染。治疗外伤性迟发性结肠破裂重要的是准确判断结肠损伤程度和范围,了解合并损伤的脏器,术中仔细探查,彻底进行肠道和腹腔冲洗,并严格清创和消毒。     

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

Objective: The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods: Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. Results: A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received EUS examinations. Conclusion: EUS is an effective and reliable diagnostic method for duodenal protruding lesions.     

Surgical management of gastric stump cancer： a report of 37 cases

Objective: To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. Methods: The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical pTMN stage. Survival curves were traced by using Kaplan-Meier methods. Results: Most GSC (32/37) was detected in patients who had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=1 1.48, P＜0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage Ⅰ, 60% (3/5) for stage Ⅱ, 14.2% (1/7) for stage Ⅲ, and 0% (0/5) for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0m vs 13.0m, xL2=36.31, P＜0.01), the median survival time of stage Ⅳ patients with radical resection was 23.8months. Conclusions: Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage Ⅳ GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth Ⅱ reconstruction procedure at 15-20 years.     

胎儿大脑皮层枕极突触超微结构的形态学观察与分析

本文用 H-600型透射电子显微镜观察了6例眙儿大脑皮层枕极245个突触的超微结构,结果表明在4.5个月胎儿枕极大脑皮层未见到突触,在5个月胎儿仅观察到少量突触,以后随胎龄的增加,突触数逐渐增多。在六个月以后胎儿大脑皮层,突触数明显增多,在新观察到的245个突触中,次轴树突触占绝大多数,占胎儿突触观察总数的77.6%。其次为轴棘突触,占胎儿突触观察总数的4.5%,从五个月胎脑开始观察到轴极突触,且这些轴棘突出的后成分中均不含有棘器。另外在胎儿枕极皮层,还观察到较多的轴-体突触,占胎儿突触观察总数的3.7%。此外,尚见到少量轴-轴,树-树,树-棘突触和串,并联突触。     

Empirical benchmarks for changes in social and emotional skills over time

This study provides empirical benchmarks that quantify typical changes in students’ reports of social and emotional skills in a large, diverse sample. Data come from six cohorts of students (N = 361,815; 6% Asian, 8% Black, 68% White, 75% Latinx, 50% Female) who responded to the CORE survey from 2015 to 2018 and help quantify typical gains/declines in growth mindset, self-efficacy, self-management, and social awareness. Results show fluctuations in skills between 4th and 12th grade (changes ranging from −.33 to .23 standard deviations). Growth mindset increases in fourth grade, declines in fifth to seventh grade, then mostly increases. Self-efficacy, self-management, and social awareness decline in sixth to eighth grade. Self-management and social awareness, but not self-efficacy, show increases in 10th to 12th grade.     

Scaling-up aid to education: Is absorptive capacity a constraint?

“Absorptive capacity” is a frequently used term amongst development practitioners in education. It is adopted by some as a reason for caution over scaling up aid. Others are of the view that absorptive capacity is an excuse by some donors for not delivering on their Education for All financing commitments. Drawing on interviews with representatives from NGOs, development agencies and international consultants, the paper highlights that there are a variety of ways in which the term is understood. Overall, it finds that absorptive capacity should not be seen as a reason for not increasing aid. Rather there is a need to unpack the concept to ensure that bottlenecks can be identified and addressed. In breaking “absorptive capacity” down into component parts, it then becomes possible to identify alternative strategies that donors and national governments need to address to ensure that increased aid reaches schools and improves educational outcomes.     

Verbal information-processing capabilities and cochlear implants: implications for preoperative predictors of speech understanding

In this study, we examined preoperative verbal cognitive capacity in 11 deafened adults who were cochlear implant candidates and reexamined level of speech understanding after 6-8 months' experience with the implant. Verbal cognitive performance in the implant group was compared in a group of normal hearing subjects and in nonimplanted group of deafened adults. The three groups performed on par with each other with an exception: The individuals in the cochlear implant group and the nonimplanted group of deafened adults performed significatly worse than those of normal hearing in tasks in which use of internal speech is a key feature (i.e., rhyme judgement and lexical decision tasks). Postoperative observations of the implanted individuals' level of speech understanding suggest that it is possible to predict the level of speech understanding by means of a properative cognitive assessment. The characteristics of three verbal cognitive abilities prove to be critical indicators of 6 - 8 months' postoperative outcome: internal speech functioning, speed of verval information processing, and working memory capacity - the first factor proved the most decisive. We discuss the results with respect to direct versus indirect predictors of outcomes from cochlear implant operations and the effect of auditory deprivation on deafened adults' capability to process auditory information.     

Absorptive capacity: A conceptual framework for understanding district central office learning

Globally, school systems are pressed to engage in large-scale school improvement. In the United States and other countries, school district central offices and other local governing agencies often engage with external organizations and individuals to support such educational change efforts. However, initiatives with external partners are not always productive. We draw on the idea of absorptive capacity to present a conceptual framework for understanding when and under what conditions partnerships are likely to foster district learning and support change efforts. We contend that prior knowledge, communication pathways, strategic knowledge leadership, and resources to partner are preconditions for a district central office’s absorptive capacity, and we identify the features of the external partner that likely matter for productive partnering. We argue that the relationship between district absorptive capacity and features of the partner is mediated by the nature of the interactions between district and partner, with likely consequences for organizational learning outcomes. For researchers, this framework serves as a tool for understanding how a district central office can learn from an external partner for educational improvement efforts. For school district leaders and external partners, this framework provides a structure for thinking strategically about when and under what conditions a partnership is likely to be productive.     

老年梗阻性左半结肠癌的外科治疗

目的探讨老年梗阻性左半结肠癌患者的围手术期处理及手术方式的选择。方法对25例老年梗阻性左半结肠癌的临床资料进行回顾性分析。结果行一期切除吻合术20例,行Hartmann术2例,行姑息性结肠造口3例。术后无吻合口漏发生,无手术死亡病例,发生切口感染2例,肺部感染3例。结论在老年梗阻性左半结肠癌的患者治疗中,选择合适病例行一期肠切除吻合术是安全可行的,充分的围手术期处理、术中良好的肠道灌洗和仔细的手术操作是手术成功的关键。     

Children referred for possible sexual abuse: medical findings in 2384 children

OBJECTIVE: The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination. RESULTS: There were 2384 children evaluated in a tertiary referral center between 1985 and 1990 for possible sexual abuse. Children were referred after they disclosed sexual abuse, because of behavioral changes or exposure to an abusive environment, and because of possible medical conditions. A total of 96.3% of all children referred for evaluation had a normal medical examination; 95.6% of children reporting abuse were normal, 99.8% who were referred for behavioral changes or exposure to abuse were also normal. Of the 182 children referred for evaluation of medical conditions, 92% were found to be normal at the time of examination by the Child Advocacy Center. The remaining 15/182 (8%) that were found to be abnormal were diagnosed with sexually transmitted diseases, acute or healed genital injuries, and were 17% (15/88) of the total cases found to have medical findings diagnostic of abuse. Interviews of the children indicated that 68% of the girls and 70% of the boys reported severe abuse, defined as penetration of vagina or anus. Penetration was associated with a higher percentage of abnormal findings in girls (6%) compared to 1% of the boys. The relationship of the abuser impacted on the severity of the abuse. CONCLUSION: Research indicates that medical, social, and legal professionals have relied too heavily on the medical examination in diagnosing child sexual abuse. History from the child remains the single most important diagnostic feature in coming to the conclusion that a child has been sexually abused. Only 4% of all children referred for medical evaluation of sexual abuse have abnormal examinations at the time of evaluation. Even with a history of severe abuse such as vaginal or anal penetration, the rate of abnormal medical findings is only 5.5%. Biological parents are less likely to engage in severe abuse than parental substitutes, extended family members, or strangers.