With the rise of populist leaders over the last 20 years,this paper examines whether we have seen a corresponding increase in the distribution of nationalist sentiments in a country,a strengthening of the effect of th...With the rise of populist leaders over the last 20 years,this paper examines whether we have seen a corresponding increase in the distribution of nationalist sentiments in a country,a strengthening of the effect of those sentiments on attitudes toward free trade,cooperation,and immigration,and nationalism conditioning the effect of education on those three attitudes.Using data from the ISSP,we show that while the distribution of nationalist attitudes in countries has not changed much and the effect of nationalism on those three attitudes has not changed,nationalism conditions the effect of education on trade and immigration and that effect is increasing over time.展开更多
The effects of particle size, impeller clearance and impeller speed are assessed to show how condition variations influence power consumption in the water-solid slurry suspension in an agitated tank. The energy effici...The effects of particle size, impeller clearance and impeller speed are assessed to show how condition variations influence power consumption in the water-solid slurry suspension in an agitated tank. The energy efficiency of slurry height variation, impeller type and diameter, and solid movement speed has been investigated with six soil series stirred in a soil-water slurry. Coarser sand particles are observed to significantly increase power consumption, while finer particles, for instance clay, decrease the stirring power requirement. The 3-blade HR100 SUPERMIX? impeller manufactured by SATAKE generally performs more efficiently than a conventional4-pitched blade turbine. The impeller's geometric design, including diameter and number of blades influences the impeller's energy efficiency, and HR100 impellers with greater diameters remarkably reduce power consumption. The tests demonstrated that the power required to provide off-bottom solid suspension and solid dispersion can be reduced dramatically by increasing the slurry height rather than by accelerating the impeller, if this option is possible.展开更多
We report an improved measurement of the neutrino mixing angle θ13 from the Daya Bay Reactor Neutrino Experiment. We exclude a zero value for sin22θ13 with a significance of 7.7 standard deviations. Electron antineu...We report an improved measurement of the neutrino mixing angle θ13 from the Daya Bay Reactor Neutrino Experiment. We exclude a zero value for sin22θ13 with a significance of 7.7 standard deviations. Electron antineutrinos from six reactors of 2.9 GWm th were detected in six antineutrino detectors deployed in two near （flux-weighted baselines of 470 m and 576 m） and one far （1648 m） underground experimental halls. Using 139 days of data, 28909 （205308） electron antineutrino candidates were detected at the far hall （near halls）. The ratio of the observed to the expected number of antineutrinos assuming no oscillations at the far hall is 0.944± 0.007（stat.） ± 0.003（syst.）. An analysis of the relative rates in six detectors finds sin22θ13=0.089± 0.010（stat.）±0.005（syst.） in a three-neutrino framework.展开更多
Anatomic location/size and number of lesions,inadequate volume of future liver remnant,or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma(HCC).Liver tran...Anatomic location/size and number of lesions,inadequate volume of future liver remnant,or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma(HCC).Liver transplantation can cure some patients with poor liver function,but few patients are eligible because of scarcity of donors.Without specific anti-cancer treatment,the prognosis of HCC is poor.Various locoregional therapies are used to treat patients who are not candidates for surgery,and have emerged as tools for palliation,tumor downstaging,and bridging therapy prior to liver transplantation.Currently,local ablative therapy even competes with partial hepatectomy and liver transplantation as a primary treatment for small HCC.HCC is well suited to treatment with loco-regional therapy because it has a tendency to stay within the liver,with distant metastasis generally occurring late in the course of disease.This suggests that an effective local-regional therapy can have a great impact on HCC patients who are not candidates for surgical treatment.Loco-regional therapy can further be justified because patients with HCC usually die of liver failure consequent to intrahepatic growth resulting in liver tissue destruction,rather than extrahepatic metastases.展开更多
BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic pa...BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had less blood loss and liver ischemic injury than P展开更多
BACKGROUND: Following curative treatment for hepatocellular carcinoma (HCC), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any ne...BACKGROUND: Following curative treatment for hepatocellular carcinoma (HCC), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any neoadjuvant or adjuvant therapy, which can decrease or delay the incidence of intra-hepatic recurrence, or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant, will improve the results of liver resection. This article systematically reviewed the current evidence of neoadjuvant, adjuvant, and chemoprevention in partial hepatectomy of HCC. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'adjuvant therapy', 'neoadjuvant therapy', and 'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with (131)I-lipiodol and adjuvant systemic interferon showed promising results. However, there were only a limited number of such studies. CONCLUSIONS: Further randomized controlled studies need to be carried out. Currently, there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC.展开更多
BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile...BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.展开更多
BACKGROUND: Pancreatic cancer is an aggressive malignancy with a dismal prognosis. Radical surgery provides the only chance for a cure with a 5-year survival rate of 7%-25%. An effective adjuvant therapy is urgently n...BACKGROUND: Pancreatic cancer is an aggressive malignancy with a dismal prognosis. Radical surgery provides the only chance for a cure with a 5-year survival rate of 7%-25%. An effective adjuvant therapy is urgently needed to improve the surgical outcome. This review describes the current status of adjuvant therapy for pancreatic cancer, and highlights its controversies. DATA SOURCES: A Medline database search was performed to identify relevant articles using the keywords 'pancreatic neoplasm', and 'adjuvant therapy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Eight prospective randomized controlled trials (RCTs) on the use of adjuvant chemotherapy and chemoradiation for pancreatic cancer could be identified. The results for adjuvant regimens based on systemic 5-fluorouracil with or without external radiotherapy were conflicting. The recent two RCTs on gemcitabine based regimen gave promising results. CONCLUSIONS: Based on the available data, no standard adjuvant therapy for pancreatic cancer can be established yet. The best adjuvant regimen remains to be determined in large-scale RCTs. Future trials should use a gemcitabine based regimen.展开更多
目的:A型肉毒杆菌毒素(Botox)联合眼睑手术治疗面肌痉挛(HFS)疗效观察。方法:回顾性分析患者的影像和医疗记录,并对注射Botox的患者治疗效果和并发症进行分析。结果:共纳入76例(女性58例)HFS患者至少接受4次Botox注射。平均随访时间为83...目的:A型肉毒杆菌毒素(Botox)联合眼睑手术治疗面肌痉挛(HFS)疗效观察。方法:回顾性分析患者的影像和医疗记录,并对注射Botox的患者治疗效果和并发症进行分析。结果:共纳入76例(女性58例)HFS患者至少接受4次Botox注射。平均随访时间为83±50(20~112)mo,平均注射16±10(4~34)次。发病高峰年龄为55~64a,平均发病年龄为66±11(32~85)a。多达23%的面肌痉挛患者存在与面神经关系密切的异常血管结构(右侧8例,左侧7例)(MRI=14,CT=1),其中以椎动脉累及最多(n=6),其次是小脑前下动脉(n=5)。原发性HFS患者的有效期间较继发性HFS患者短(2.5 vs 3.1mo,P<0.05),发病时间较继发性HFS患者长(4.1 vs 3.8d,P=0.739),SSAs较继发性HFS患者低(1.7 vs 1.9,P=0.179)。19例先前存在眼睑疾病的患者中有12例接受了手术矫正,包括上睑成形术(n=12)、肌肉切除(7例)、眉成形术(7例)和提上睑肌腱膜修复术(5例)。5例(41.7%)接受手术矫正和对肉毒杆菌素反应不佳的患者术后6mo症状改善(发病时间:P=0.0256,有效期间:P=0.374,SSAs:P=0.0161)。12例行眼睑手术患者术后并发症发生率低于未行眼睑手术患者(23%vs 42%,P≤0.05)。结论:Botox对于治疗HFS是一种安全有效的方法。继发性HFS患者使用肉毒杆菌毒素的治疗效果优于原发性HFS患者。对于并发眼睑疾病的患者而言,眼睑手术可提高患者满意度,降低并发症发生率,从而提高后续Botox注射的效果。展开更多
I read with great interest the consensus and guideline of laparoscopic hepatectomy,which was originated from the experts in China[1].This is a significant step forward in minimally invasive liver surgery.The developme...I read with great interest the consensus and guideline of laparoscopic hepatectomy,which was originated from the experts in China[1].This is a significant step forward in minimally invasive liver surgery.The development of minimally invasive liver surgery over the last 2 decades has a great impact on the surgical practice in China,and the other parts of the world.The potential advantages of laparoscopic hepatectomy are those of minimal access surgery(Table 1).展开更多
The robotic surgical system was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed at reviewing robotic partial ...The robotic surgical system was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed at reviewing robotic partial hepatectomy to conventional laparoscopic or open partial hepatectomy in terms of perioperative, oncologic, and healthcare costs for hepatocellular carcinoma (HCC). Studies were identified by searching MEDLINE and PubMed databases for articles from January 2004 to June 2017 using the keywords 'laparoscopic hepatectomy', 'robotic surgery','robotic hepatectomy', and 'hepatocellular carcinoma'. Case reports were not included. The open conversion rate, overall morbidity rate, and mortality rate of robotic partial hepatectomy were reported as 0-14.3%, 0-27%, and 0-3%, respectively. Although little data regarding robotic approach for HCC have been reported, it appears to be better than open approach, particularly blood loss and hospital stay, and similar to conventional laparoscopic approach in terms of short term outcomes. The oncological outcomes were comparable to open or laparoscopic approach. Well-known advantages of the robotic system allow resection of tumor location over posterior and superior segments or major hepatectomy with more ease. The main disadvantage of robotic approach was its high cost. In conclusion, oncological data from homogenous series of HCC after robotic partial hepatectomy was needed. Robotic approach was safe to be an alternative option of minimallyinvasivehepatectomyforHCC.Itsfutureimplementationwilldependontheadvantages that it can provide over open or conventional laparoscopy approach.展开更多
This paper is concerned with the pattern dynamics of the generalized nonlinear Schrodinger equations(NSEs)relatedwith various nonlinear physical problems in plasmas.Our theoretical and numerical results show that the ...This paper is concerned with the pattern dynamics of the generalized nonlinear Schrodinger equations(NSEs)relatedwith various nonlinear physical problems in plasmas.Our theoretical and numerical results show that the higher-order nonlinear effects,acting as a Hamiltonian perturbation,break down the NSE integrability and lead to chaotic behaviors.Correspondingly,coherent structures are destroyed and replaced by complex patterns.Homoclinic orbit crossings in the phase space and stochastic partition of energy in Fourier modes show typical characteristics of the stochastic motion.Our investigations show that nonlinear phenomena,such as wave turbulence and laser filamentation,are associated with the homoclinic chaos.In particular,we found that the unstable manifolds W(u)possessing the hyperbolic fixed point correspond to an initial phase θ=45° and 225° ,and the stable manifolds W(s)correspond toθ=135° and 315° .展开更多
文摘With the rise of populist leaders over the last 20 years,this paper examines whether we have seen a corresponding increase in the distribution of nationalist sentiments in a country,a strengthening of the effect of those sentiments on attitudes toward free trade,cooperation,and immigration,and nationalism conditioning the effect of education on those three attitudes.Using data from the ISSP,we show that while the distribution of nationalist attitudes in countries has not changed much and the effect of nationalism on those three attitudes has not changed,nationalism conditions the effect of education on trade and immigration and that effect is increasing over time.
基金the Government of Malaysia for the financial support from University of Malaya through the UMRG grant no. RP008B-13SUSMinistry of Higher Education (MOHE) through the FRGS grant no. FP028-2012A
文摘The effects of particle size, impeller clearance and impeller speed are assessed to show how condition variations influence power consumption in the water-solid slurry suspension in an agitated tank. The energy efficiency of slurry height variation, impeller type and diameter, and solid movement speed has been investigated with six soil series stirred in a soil-water slurry. Coarser sand particles are observed to significantly increase power consumption, while finer particles, for instance clay, decrease the stirring power requirement. The 3-blade HR100 SUPERMIX? impeller manufactured by SATAKE generally performs more efficiently than a conventional4-pitched blade turbine. The impeller's geometric design, including diameter and number of blades influences the impeller's energy efficiency, and HR100 impellers with greater diameters remarkably reduce power consumption. The tests demonstrated that the power required to provide off-bottom solid suspension and solid dispersion can be reduced dramatically by increasing the slurry height rather than by accelerating the impeller, if this option is possible.
基金Supported by the Ministry of Science and Technology of Chinathe United States Department of Energy+15 种基金the Chinese Academy of Sciencesthe National Natural Science Foundation of Chinathe Guangdong provincial governmentthe Shenzhen municipal governmentthe China Guangdong Nuclear Power GroupShanghai Laboratory for Particle Physics and Cosmologythe Research Grants Council of the Hong Kong Special Administrative Region of ChinaUniversity Development Fund of The University of Hong Kongthe MOE program for Research of Excellence at NTU, NCTUNSC fund support from Taipeithe U.S. National Science Foundationthe Alfred P. Sloan Foundationthe Ministry of EducationYouth and Sports of the Czech Republicthe Czech Science Foundationthe Joint Institute of Nuclear Research in Dubna,Russia
文摘We report an improved measurement of the neutrino mixing angle θ13 from the Daya Bay Reactor Neutrino Experiment. We exclude a zero value for sin22θ13 with a significance of 7.7 standard deviations. Electron antineutrinos from six reactors of 2.9 GWm th were detected in six antineutrino detectors deployed in two near （flux-weighted baselines of 470 m and 576 m） and one far （1648 m） underground experimental halls. Using 139 days of data, 28909 （205308） electron antineutrino candidates were detected at the far hall （near halls）. The ratio of the observed to the expected number of antineutrinos assuming no oscillations at the far hall is 0.944± 0.007（stat.） ± 0.003（syst.）. An analysis of the relative rates in six detectors finds sin22θ13=0.089± 0.010（stat.）±0.005（syst.） in a three-neutrino framework.
文摘Anatomic location/size and number of lesions,inadequate volume of future liver remnant,or poor coexisting premorbid conditions preclude surgery in the majority of patients with hepatocellular carcinoma(HCC).Liver transplantation can cure some patients with poor liver function,but few patients are eligible because of scarcity of donors.Without specific anti-cancer treatment,the prognosis of HCC is poor.Various locoregional therapies are used to treat patients who are not candidates for surgery,and have emerged as tools for palliation,tumor downstaging,and bridging therapy prior to liver transplantation.Currently,local ablative therapy even competes with partial hepatectomy and liver transplantation as a primary treatment for small HCC.HCC is well suited to treatment with loco-regional therapy because it has a tendency to stay within the liver,with distant metastasis generally occurring late in the course of disease.This suggests that an effective local-regional therapy can have a great impact on HCC patients who are not candidates for surgical treatment.Loco-regional therapy can further be justified because patients with HCC usually die of liver failure consequent to intrahepatic growth resulting in liver tissue destruction,rather than extrahepatic metastases.
文摘BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had less blood loss and liver ischemic injury than P
文摘BACKGROUND: Following curative treatment for hepatocellular carcinoma (HCC), 50%-90% of postoperative death is due to recurrent disease. Intra-hepatic recurrence is frequently the only site of recurrence. Thus, any neoadjuvant or adjuvant therapy, which can decrease or delay the incidence of intra-hepatic recurrence, or any cancer chemoprevention which can prevent a new HCC from developing in the liver remnant, will improve the results of liver resection. This article systematically reviewed the current evidence of neoadjuvant, adjuvant, and chemoprevention in partial hepatectomy of HCC. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed databases for articles from January 1990 to November 2008 using the keywords 'hepatocellular carcinoma', 'hepatectomy', 'adjuvant therapy', 'neoadjuvant therapy', and 'regional therapy'. Additional papers and book chapters were identified by a manual search of the references from the key articles. RESULTS: Neoadjuvant transarterial chemoembolization or adjuvant regional transarterial chemotherapy embolization+systemic chemotherapy did not add benefit. Both adjuvant transarterial radioembolization with (131)I-lipiodol and adjuvant systemic interferon showed promising results. However, there were only a limited number of such studies. CONCLUSIONS: Further randomized controlled studies need to be carried out. Currently, there is no consensus on a standard neoadjuvant/adjuvant/chemoprevention therapy in partial hepatectomy for HCC.
文摘BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.
文摘BACKGROUND: Pancreatic cancer is an aggressive malignancy with a dismal prognosis. Radical surgery provides the only chance for a cure with a 5-year survival rate of 7%-25%. An effective adjuvant therapy is urgently needed to improve the surgical outcome. This review describes the current status of adjuvant therapy for pancreatic cancer, and highlights its controversies. DATA SOURCES: A Medline database search was performed to identify relevant articles using the keywords 'pancreatic neoplasm', and 'adjuvant therapy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Eight prospective randomized controlled trials (RCTs) on the use of adjuvant chemotherapy and chemoradiation for pancreatic cancer could be identified. The results for adjuvant regimens based on systemic 5-fluorouracil with or without external radiotherapy were conflicting. The recent two RCTs on gemcitabine based regimen gave promising results. CONCLUSIONS: Based on the available data, no standard adjuvant therapy for pancreatic cancer can be established yet. The best adjuvant regimen remains to be determined in large-scale RCTs. Future trials should use a gemcitabine based regimen.
文摘目的:A型肉毒杆菌毒素(Botox)联合眼睑手术治疗面肌痉挛(HFS)疗效观察。方法:回顾性分析患者的影像和医疗记录,并对注射Botox的患者治疗效果和并发症进行分析。结果:共纳入76例(女性58例)HFS患者至少接受4次Botox注射。平均随访时间为83±50(20~112)mo,平均注射16±10(4~34)次。发病高峰年龄为55~64a,平均发病年龄为66±11(32~85)a。多达23%的面肌痉挛患者存在与面神经关系密切的异常血管结构(右侧8例,左侧7例)(MRI=14,CT=1),其中以椎动脉累及最多(n=6),其次是小脑前下动脉(n=5)。原发性HFS患者的有效期间较继发性HFS患者短(2.5 vs 3.1mo,P<0.05),发病时间较继发性HFS患者长(4.1 vs 3.8d,P=0.739),SSAs较继发性HFS患者低(1.7 vs 1.9,P=0.179)。19例先前存在眼睑疾病的患者中有12例接受了手术矫正,包括上睑成形术(n=12)、肌肉切除(7例)、眉成形术(7例)和提上睑肌腱膜修复术(5例)。5例(41.7%)接受手术矫正和对肉毒杆菌素反应不佳的患者术后6mo症状改善(发病时间:P=0.0256,有效期间:P=0.374,SSAs:P=0.0161)。12例行眼睑手术患者术后并发症发生率低于未行眼睑手术患者(23%vs 42%,P≤0.05)。结论:Botox对于治疗HFS是一种安全有效的方法。继发性HFS患者使用肉毒杆菌毒素的治疗效果优于原发性HFS患者。对于并发眼睑疾病的患者而言,眼睑手术可提高患者满意度,降低并发症发生率,从而提高后续Botox注射的效果。
文摘I read with great interest the consensus and guideline of laparoscopic hepatectomy,which was originated from the experts in China[1].This is a significant step forward in minimally invasive liver surgery.The development of minimally invasive liver surgery over the last 2 decades has a great impact on the surgical practice in China,and the other parts of the world.The potential advantages of laparoscopic hepatectomy are those of minimal access surgery(Table 1).
文摘The robotic surgical system was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed at reviewing robotic partial hepatectomy to conventional laparoscopic or open partial hepatectomy in terms of perioperative, oncologic, and healthcare costs for hepatocellular carcinoma (HCC). Studies were identified by searching MEDLINE and PubMed databases for articles from January 2004 to June 2017 using the keywords 'laparoscopic hepatectomy', 'robotic surgery','robotic hepatectomy', and 'hepatocellular carcinoma'. Case reports were not included. The open conversion rate, overall morbidity rate, and mortality rate of robotic partial hepatectomy were reported as 0-14.3%, 0-27%, and 0-3%, respectively. Although little data regarding robotic approach for HCC have been reported, it appears to be better than open approach, particularly blood loss and hospital stay, and similar to conventional laparoscopic approach in terms of short term outcomes. The oncological outcomes were comparable to open or laparoscopic approach. Well-known advantages of the robotic system allow resection of tumor location over posterior and superior segments or major hepatectomy with more ease. The main disadvantage of robotic approach was its high cost. In conclusion, oncological data from homogenous series of HCC after robotic partial hepatectomy was needed. Robotic approach was safe to be an alternative option of minimallyinvasivehepatectomyforHCC.Itsfutureimplementationwilldependontheadvantages that it can provide over open or conventional laparoscopy approach.
基金This work is also supported by the National Natural Science Foundation of China grant Nos.10575013 and 10576007partially by the National Basic Research Program of China(973)(2007CB814802 and 2007CB815101).
文摘This paper is concerned with the pattern dynamics of the generalized nonlinear Schrodinger equations(NSEs)relatedwith various nonlinear physical problems in plasmas.Our theoretical and numerical results show that the higher-order nonlinear effects,acting as a Hamiltonian perturbation,break down the NSE integrability and lead to chaotic behaviors.Correspondingly,coherent structures are destroyed and replaced by complex patterns.Homoclinic orbit crossings in the phase space and stochastic partition of energy in Fourier modes show typical characteristics of the stochastic motion.Our investigations show that nonlinear phenomena,such as wave turbulence and laser filamentation,are associated with the homoclinic chaos.In particular,we found that the unstable manifolds W(u)possessing the hyperbolic fixed point correspond to an initial phase θ=45° and 225° ,and the stable manifolds W(s)correspond toθ=135° and 315° .
