鼻内窥镜下经钩突径路和鼻丘径路开放额窦手术的探讨

探索改良的经鼻内窥镜鼻丘径路治疗慢性额窦炎的手术方法。对安徽省合肥市第二人民医院2014年1月~2015年9月的61例慢性额窦炎的患者分为两组,观察组31例行鼻内窥镜下改良的鼻丘径路额窦开放术,对照组30例行鼻内窥镜下钩突径路额窦开放术,术后随访6月~12月,收集资料,比较两组疗效及并发症。鼻内窥镜下改良的鼻丘径路额窦开放术的疗效和并发症发生率均优于钩突径路额窦开放术(P0.05)。鼻内窥镜下改良的鼻丘径路额窦开放术对额隐窝和额窦的暴露较好,术中视野开阔,术后粘连较少,额窦和额隐窝引流通畅,手术效果好。     

全结肠切除加回肠造口术对特发型巨结肠性便秘的疗效分析

探讨全结肠切除加回肠造口术治疗特发型巨结肠性便秘的疗效。回顾性分析2005年1月~2013年12月在笔者医院接受手术治疗的35例特发型巨结肠性便秘患者的临床资料,其中结肠次全切除加回肠-乙状结肠侧侧吻合/升结肠-直肠端端吻合术患者13例和全结肠切除加回肠造口术患者22例,观察对比两组患者术后并发症及随访资料。在术后并发症指标观察中,发现全结肠切除术组的术后腹腔内感染率和术后炎性肠梗阻发生率明显少于结肠次全切除术组,其差异有统计学意义(P0.05)。在随访指标观察中,发现全结肠切除术组术后再手术干预率显著低于结肠次全切除术组,并全结肠切除术组无一例术后复发而再次手术的患者(P0.05)。特发型巨结肠性便秘更加适合行全结肠切除加回肠造口术。     

原发性肝癌术后肝内复发:再手术还是射频消融

观察射频消融治疗原发性肝癌术后肝内复发的临床疗效.选取我院确诊为原发性肝癌行根治性手术治疗后肝内复发且没有肝外转移的患者168例,其中99例患者行射频消融术治疗,69例行再手术治疗.观察两组患者的临床疗效、术后并发症、生存率.结果射频消融及再次手术治疗均能明显消除肝内复发病灶,射频消融治疗组未出现严重并发症,而再手术组1例患者因术后肝功能衰竭死亡.射频消融组和再手术组的1年、2年生存情况差异无统计学意义(P>0.05).应用射频消融治疗原发性肝癌术后肝内复发的临床疗效及预后与再手术治疗类似,但射频消融治疗方法的适应证更宽、术后并发症更少、更易于被患者和家属接受,可推广临床应用.     

微创引流术治疗高血压脑出血的疗效观察

观察微创引流术治疗高血压脑出血的疗效,比较开颅术与微创术的手术效果。回顾分析笔者所在医院422例高血压脑出血患者临床资料,135例行常规开颅术治疗的患者为对照组,287例行微创引流术治疗的患者为观察组,比较两组患者的术后神经损伤程度评分、生活能力和运动障碍等级。术后7d对照组的神经损伤程度评分为(21.5±1.3)分,观察组为(15.1±1.4)分,差异有统计学意义(P0.05);术后1个月,观察组患者生活自理能力和运动协调性强于对照组(P0.05)。高血压脑出血患者采用微创引流术治疗后神经损伤程度小,并发症少,临床效果显著。     

对膝下段股-腘动脉人工血管移植术后患者疗效影响的比较分析

观察苏合香丸对膝下段股-腘动脉人工血管移植术后患者疗效的影响.共34例患者,随机分为苏合香丸组及对照组,两组均采用常规术后处理,苏合香丸组加用苏合香丸口服.观察术后第1、2年的疗效评价、踝/肱指数及彩超检查通畅率.两组患者术后第1、2年总有效率中药组较对照组均明显提高(P<0.05),中药组ABI显著高于对照组(P<0.05);术后2年中药组人工血管通畅率(58.82%)较对照组(31.25%)显著提高(P<0.05).应用苏合香丸对降低手术并发症、稳定踝/肱指数、提高人工血管通畅率.     

早期宫颈癌术式选择的比较研究

根治性子宫切除术与保留生育功能的根治性宫颈切除术均可用于早期宫颈癌患者的手术治疗。根据生物-心理-社会医学模式的要求,本文采用比较治疗学的方法,对这两种手术方式,从适应证、手术方式、并发症、疗效等方面进行比较,为宫颈癌临床科学决策提供借鉴。     

早期宫颈癌术式选择的比较研究

根治性子宫切除术与保留生育功能的根治性宫颈切除术均可用于早期宫颈癌患者的手术治疗.根据生物-心理-社会医学模式的要求,本文采用比较治疗学的方法,对这两种手术方式,从适应证、手术方式、并发症、疗效等方面进行比较,为宫颈癌临床科学决策提供借鉴.     

微创经皮钢板固定术与交锁髓内钉治疗胫骨远端关节外骨折疗效差异

观察分析微创经皮钢板固定术(MIPPO)与交锁髓内钉(IMN)治疗胫骨远端关节外骨折的临床疗效。以2011年2月~2015年12月期间笔者所在医院骨科收治的134例符合胫骨远端关节外骨折诊断标准的患者作为研究对象,随机分为MIPPO组(n=67)和IMN组(n=67),MIPPO组给予MIPPO治疗,IMN组给予IMN治疗;观察两组患者术中治疗情况、术后临床疗效和并发症等。结果,MIPPO组患者手术时间、住院时间较IMN组均显著缩短,住院费用较高(P0.05)。两组术中出血量、愈合时间无明显差异(P0.05)。MIPPO组患者和IMN组患者治疗有效率均能达到90%以上,治愈率高,能够有效减轻患者痛苦;MIPPO组患者并发症发生率低(9.0%),无愈合延期、畸形等并发症,预后情况较佳,优于IMN组(P0.05)。MIPPO疗效突出,并发症少,能有效缩短手术时间并降低对骨组织的损伤,IMN法治疗费用低,不易感染,均对临床具有重要的意义。     

老年早期结直肠癌患者内镜下黏膜剥离术安全性、疗效及术后整体生活质量调查

针对内镜下黏膜剥离术(ESD)对老年患者早期结直肠癌治疗的安全性、疗效及术后整体生活质量加以评价。68例病例组(老年组)和同时期52例对照组(非老年组)纳入研究。结果显示两组患者在性别比例、体质量指数、病变部位、内镜分型、病理类型、病变大小、手术操作时间、住院天数、完整切除和整块切除率上差异均无统计学意义(P0.05)。两组患者在"术中出血"、"迟发性术后出血"、"穿孔"这三项并发症上差异无统计学意义(P0.05)。在生活质量指数量表(QL-Index)评分上,两组差异无统计学意义。在欧洲肿瘤研究和治疗联盟关于癌症患者生活质量调查评分30(QLQ-C30)评分上,除去"失眠"项目老年组患者得分显著高于非老年组患者(P=0.028),其他各项目上两组得分差异无统计学意义。因此,老年早期结直肠癌患者ESD手术治疗是相对安全和有效的。     

甲状旁腺全切除术在继发性甲状旁腺功能亢进患者中的疗效评估

评估继发性甲状旁腺功能亢进患者行甲状旁腺全切除术或甲状旁腺次全切除术的临床疗效。选取继发性甲状旁腺功能亢进患者40例,随机分为对照组和研究组,其中16例对照组行甲状旁腺次全切除术,其余24例研究组行甲状旁腺全切除术。观察两组患者围手术期临床参数,并随访观察其疗效。研究组症状缓解时间、iPTH、血磷及血钙恢复正常时间明显短于对照组,但术后泵钙时间与对照组相比相对长,其差异有统计学意义(P0.05)。Kaplan-Meier法生存分析,发现研究组累计未复发率明显优于对照组,其差异有统计学意义(P0.05)。甲状旁腺全切除术治疗继发性甲状旁腺功能亢进是一种安全有效的方法,建议选择积极的甲状旁腺全切除术。     

The Partial Identity Account of Partial Similarity Revisited

This paper provides a defence of the account of partial resemblances between properties according to which such resemblances are due to partial identities of constituent properties. It is argued, first of all, that the account is not only required by realists about universals à la Armstrong, but also useful (of course, in an appropriately re-formulated form) for those who prefer a nominalistic ontology for material objects. For this reason, the paper only briefly considers the problem of how to conceive of the structural universals first posited by Armstrong in order to explain partial resemblances, and focuses instead on criticisms that have been levelled against the theory (by Pautz, Eddon, Denkel and Gibb) and that apply regardless of one’s preferred ontological framework. The partial identity account is defended from these objections and, in doing so, a hitherto quite neglected connection—between the debate about partial similarity as partial identity and that concerning ontological finitism versus infinitism—is looked at in some detail.     

Partial Monotonic Protothetics

This paper has four parts. In the first part, I present Leniewski's protothetics and the complete system provided for that logic by Henkin. The second part presents a generalized notion of partial functions in propositional type theory. In the third part, these partial functions are used to define partial interpretations for protothetics. Finally, I present in the fourth part a complete system for partial protothetics. Completeness is proved by Henkin's method [4] using saturated sets instead of maximally saturated sets. This technique provides a canonical representation of a partial semantic space and it is suggested that this space can be interpreted as an epistemic state of a non-omniscient agent.     

Partial avoidance contingencies

Rats were trained in a discrete-trial paradigm with no intertrial interval. The first response changed an auditory stimulus for the remainder of the trial. Shocks were delivered only at the end of the trial cycle. Avoidance contingencies were defined by the conditional probability of shock, given no response (P₀), and the conditional probability of shock given a response (P₁). The maximal avoidance contingency was P₀=1.0, P₁=0, and noncontingent conditions were those for which P₀=P₁. In Experiment I, after training on the maximal contingency, three groups of subjects experienced either P₀=P₁=0, P₀=P₁=0.5, or P₀=P₁=1.0. Eight of 10 subjects stopped responding under the noncontingent conditions. Experiment II studied partial contingencies by varying P₀ and P₁. For one group, P₀ was reduced holding P₁=0. Responding decreased to zero as P₀ approached zero. A second group was studied under P₁>0, holding P₀=1.0. For three of the six rats in this group, responding decreased to zero with increasing P₁. The other three maintained responding as P₁ was increased up to the noncontingent, P₁=P₀=1.0 value. The P₀ group was also studied with P₀=P₁>0, and half of these subjects responded. The results demonstrated two modes of response to weakening or eliminating the avoidance contingency. Some subjects were sensitive to contingency only, and insensitive to changes in shock density. Approximately one half of the subjects were sensitive to both contingency and shock density. This shared control was observed only when P₁> 0.     

Partial assessment of technologies

Trade‐Offs: Imperatives of Choice in a High‐Tech World, by Ed Wenk, Baltimore, MD: Johns Hopkins University Press, 1986, 238 pages, hb $20     

Partial worlds and paradox

Since universal language systems are confronted with serious paradoxical consequences, a semantic approach is developed in whichpartial worlds form the ontological basis. This approach shares withsituation semantics the basic idea that statements always refer to certain partial worlds, and it agrees with the extensional and model-theoretic character ofpossible worlds semantics. Within the framework of the partial worlds conception a satisfactory solution to theLiar paradox can be formulated. In particular, one advantage of this approach over those theories that are based on the totality of possible worlds semantics can be found in the fact that the so-called Strengthened Liar problem is avoided.I would like to thank Dirk Koppelberg for helpful remarks on an earlier draft of this paper. Special thanks to an anonymous referee for detailed comments.