腹腔手术后重症患者心肌损伤的危险因素

目的探讨腹腔手术后重症患者心肌损伤的发生情况及可能的危险因素。方法回顾性分析北京大学人民医院2017年1月至2019年1月腹腔手术后重症患者的一般临床资料及心肌损伤情况,收集并观察基础病史、术中(手术时间、是否急诊手术、术中出血>800 ml和术中低血压等)及术后指标(改良氧合指数、血乳酸、急性肾损伤和术后24 h内使用升压药情况等)。根据术后是否发生心肌损伤,将患者分为心肌损伤组和非心肌损伤组,采用Logistic回归分析腹腔手术后重症患者心肌损伤的危险因素。结果在纳入的803例腹腔手术后重症患者中,心肌损伤发生率为17. 2%(138/803),而急性心肌梗死发生率仅为0. 9%(7/803)。单因素分析显示,慢性肾功能不全病史、手术时间、急诊手术、术中低血压、术后24 h内使用升压药、高APACHEⅡ评分及术后即刻急性肾损伤与术后重症患者心肌损伤相关(P<0. 05)。多因素回归分析显示,急诊手术(OR=3. 14,95%CI:1. 76～5. 60,P<0. 001)、术后24 h内使用升压药(OR=2. 26,95%CI:1. 23～4. 15,P=0. 008)、APACHEⅡ评分(OR=1. 05,95%CI:1. 01～1. 09,P=0. 008)和术后急性肾损伤(OR=3. 18,95%CI:1. 78～5. 69,P <0. 001)与腹腔手术后重症患者发生心肌损伤独立相关。结论重症患者腹腔手术后心肌损伤发生率高,急诊手术、术后24 h内使用升压药、高APACHEⅡ评分和术后急性肾损伤是导致腹腔手术后重症患者发生心肌损伤的独立危险因素。     

Survey of domestic food purchases and related home handling practices in the Abruzzo region (central Italy): Data collection and analysis through a language-independent classification system

A telephone survey was carried out on 13,486 randomly selected households located in the Abruzzo region (central Italy). Three questionnaires were specifically designed in relation to three different groups of foods (Meat and meat products, Fishery products, Fruit and vegetables). Questions were mainly focused on the amount and number of purchases, type of retailer, and home food handling practices with respect to the week prior to the interview. Data were classified according to a multilingual thesaurus system (LanguaL). Results allowed to estimate domestic purchases (in kg) per capita for different food categories. The category “Red meat/Cattle” accounted for a large part of purchases in the “meat and meat products” group (10.9 kg per capita/year; 32.2% of purchases in the group) while the category “Fish or related organism/Fish” was the most purchased in the “fishery products” group (6.9 kg per capita/year; 63.3%). The aggregation of more detailed characteristics enabled the identification of popular categories of foods, such as “Red meat/Cattle/Divided into pieces” (25% of the “meat and meat products” group). Significant differences (p < 0.05) were found between the four different provinces (L'Aquila, Chieti, Pescara and Teramo) with respect to “Poultry/Chicken” and “Red meat/Cattle” categories. Householders were also asked about post-purchase food handling practices that might be hazardous to food safety. More than 20% of those surveyed stated that they thawed frozen meat at room temperature. The degree of doneness after cooking of different food categories was generally high: over 90% of products purchased in the majority of meat and fish categories were properly cooked. However a noticeable proportion of householders (about 15%) reported medium or rare cooking of “Red meat/Cattle” and “Red meat/Swine”. Differences (p < 0.05) were also found between consumers of different ages, with people over 65 years old being more prone to freeze meat and cook it thoroughly.The survey was carried out in a specific geographic area and on a statistically significant sample of households, thus allowing a collection of data on domestic habits relating to food purchases and home food handling practices. This information should be included in the framework of quantitative microbial risk assessment (QMRA) models as a measure of the actual exposure of consumers to pathogenic microorganism. The LanguaL system also proved to be a practical language-independent method useful not only to identify and describe food items but also to classify them according to specific food safety characteristics.     

管道风险管理方法研究

按照管道风险管理的流程分别对管道风险评价、风险控制和决策支持、效能测试和响应进行了论述。针对目前国内管道行业的情况，提出了进行管道风险评价的有效方法及维护措施。着重介绍了国外管道风险可接受标准的情况，作为国内制定管道风险评价标准的参考。     

信息安全风险评估的模糊多准则决策方法

基于ISO/IEC17799标准建立了一个综合的信息系统风险分析框架,并运用模糊多准则决策(FMCDM)方法计算信息安全风险,根据风险等级矩阵(RLM)对信息资产风险进行级别划分,最终建立评估信息资产相关风险的完整模型。     

企业中层管理人员培训的思考

以分析企业中层管理人员培训的现状为突破口,阐述了中层管理人员培训需求分析的思路和方法。在此基础上对培训内容进行整体设计,指出针对此类培训应采用的培训方式和评估方法。以期对企业中层管理人员的培训起到一些启发和借鉴作用。     

自适应阵对角线加载研究

本文分析了对角线加载对自适应阵性能的影响，提出了加载门限的概念，以及加载门限的计算公式，为加载量的选取提供了方法和依据，并将加载研究的结果加以推广，提出了有效的ＬＳ自适应波束形成算法的非零初始化方法。     

三峡水库减淤增容调度方式研究——多汛限水位调度方案

本文建议在汛期中小流量时（Q<35000m3/s），将坝前水位维持在148～151m；出现汛情且流量更较大后，将坝前水位降低到143m；入库流量大于35000m3/s且短期预报将出现大于十年一遇洪水时，预泄洪水到135m.按这一调度，汛期约80％时间可以维持在较高水位，一般洪水期。汛限水位143m不影响坝区通航，135m水位迎洪可大量增加防洪库客。到100年后可减淤30亿m3，增加防洪库容约40亿m3.变动回水区减淤40%，优化了坝区水沙搭配，可改善通航条件。降低库区洪水位，缓解防洪与移民的矛盾。可对发电带来较大好处：提高发电效益，减少粗沙过机。初期水库排沙比大于原方案，可减轻下游冲刷。同时，可减小三峡汛初泄水与鄱阳湖防洪的矛盾。     

浅谈如何搞好加油站的风险评价

阐述了加油站实施HSE管理，进行加油站风险评价的必要性，介绍了评价方法及其应用范围，评价组织的建立和工作流程及注意事项，指出：进行加油站风险评价，在选择评估方法时应从加油站的生产实际出发，针对不同的区域，采用适当的，可操作的方法；找出身边存在的危害因素，采取适当的措施来控制和化解风险，提高加油站安全管理水平，才能适应加入WTO后所面临的挑战。     

长江螺山站高水位流量关系和城陵矶（莲花塘）控制水位的研究

螺山站高水位流量关系是确定长江城陵矶（莲花糖）控制水位的基本依据，从基本的河道水力学规律出发，考虑涨落率修正、瞬时比降修正，计算各时段点的代表性比降，和相应糙率，求出均值，根据断面资料，得出高水位的稳定流曲线，并以各日流量转化的稳定流点，进行验证，精度很好，分析了河段区间流量对螺山站稳定流量的影响。阐明了螺山站稳定流量的变化情况和趋势，推求了各次大洪水的超额洪量，计算出莲花糖以上的总入流，根据现今的湖区及槽蓄容积进行洪水演进，计算1954年特大洪水的超额洪量，并分析节三峡水库拦洪后对长江中下游超额水量的影响；对莲花塘不同防洪控制水位进行了技术经济分析和评价，提出了抬高控制水位的具体建议。     

变差函数在地下水位估值中的应用研究

用数值方法进行地下水水资源评价时 ,需要给出每个节点上的初始地下水位值。本文着重阐述了区域化变量和变差函数及其计算步骤 ,指出变差函数在分析地下水位的空间变异的重要性