氟比洛芬酯复合地佐辛在肝包膜下肿瘤微波消融术中的应用

【摘要】 目的 探讨氟比洛芬酯（凯纷）复合地佐辛对经皮肝癌微波消融（MWA）消融范围累及肝脏包膜的镇痛效果及安全性。方法 选取2017年12月至2018年7月接受局麻下CT引导经皮穿刺肝癌MWA消融范围累及肝包膜的患者40例,随机分为A组（n=20）和B组（n=20）,A组采用氟比洛芬酯（1 mg/kg）术中静脉麻醉镇痛复合地佐辛（0.1 mg/kg）术前肌注镇痛,B组单纯使用地佐辛（0.1 mg/kg）术前肌注。记录两组患者术中不同时间点平均动脉压、呼吸频率、心率以及氧饱和度;观察术中患者不良反应率;记录术后不同时间点疼痛视觉模拟评分（VAS）,采用重复测量方差分析、t检验, χ2检验等分析镇痛效果指标。结果 两组患者性别、年龄、病灶大小及病灶距肝脏包膜的最近距离比较,差异均无统计学意义（P>0.05）,两组患者术中不同时间点呼吸频率、平均动脉压、脉氧饱和度以及心率比较,差异均无统计学意义（P>0.05）,术中两组诸生命体征变化趋势亦均无统计学意义（P>0.05）,A、B两组并发症的发生率分别为15%、45%,差异有统计学意义（P<0.05）,A、B两组患者手术开始后5 min、20 min、2 h疼痛VAS经重复测量的多因素方差分析比较,满足球形条件（P>0.05）,并进行多变量方差分析显示A、B两组患者各时间点的疼痛评分（视觉模拟评分,VAS）的差异有统计学意义（F=31.735,P<0.05）,对A、B两组每个对应时间点患者的疼痛VAS进行比较,发现两组患者手术开始后5 min,20 min疼痛VAS差异无统计学意义（F=0.208、0.483,P>0.05）,手术开始后2 h A组患者疼痛VAS明显低于B组,有统计学意义（F=5.104,P<0.05）。结论 氟比洛芬酯复合地佐辛可以安全有效地控制消融范围累及肝脏包膜的经皮肝癌MWA中的疼痛。
     

肋间神经射频热凝术治疗带状疱疹后神经痛20例疗效观察

【摘要】 目的 观察肋间神经射频热凝治疗带状疱疹后神经痛的疗效和安全性。方法 40例带状疱疹后神经痛患者（VAS ≥ 4.0）,随机分为A、B两组,每组20例:A组使用加巴喷丁、阿米替林、奥施康定等药物治疗;B组在上述药物治疗的基础上,联合肋间神经射频热凝进行治疗。观察患者行肋间神经射频术前,术后第1、7、30、90、180 d的疼痛视觉模拟评分（VAS）、奥施康定使用量、药物不良反应、治疗并发症等情况。结果 A组患者给药前,给药后第1、7、30、90、180 d VAS分别为:（8.2 ± 1.6）、（6.1 ± 1.7）、（4.2 ± 1.4）、（3.6 ± 1.1）、（3.3 ± 1.3）和（2.7 ± 1.2）分。奥施康定使用量分别为:（28.5 ± 5.4）、（35.2 ± 8.5）、（41.6 ± 8.5）、（18.6 ± 4.4）、（10.4 ± 2.3）和（8.4 ± 1.6）mg。B组患者术前,术后第1、7、30、90、180 d VAS分别为:（8.1 ± 1.1）、（4.5 ± 1.2）、（2.7 ± 1.4）、（2.3 ± 1.3）、（1.6 ± 0.9）和（1.3 ± 1.0）分。奥施康定使用量分别为:（28.7 ± 5.8）、（17.3 ± 5.4）、（12.3 ± 3.8）、（5.1 ± 1.7）、（5.6 ± 1.1）和（4.0 ± 1.1）mg,组间比较差异有统计学意义（P ＜ 0.05）,B组药物不良反应轻微,无严重并发症。结论 X线透视下的肋间神经射频热凝术能迅速减轻疼痛,降低镇痛药使用量并减少其相关不良反应,是带状疱疹后神经痛的一种安全、有效的治疗方法。
     

经同轴套管穿刺活检同步微波消融治疗高度可疑恶性肺结节

【摘要】 目的 评价CT引导下经同轴套管穿刺活检同步微波消融（MWA）治疗高度可疑恶性肺结节的安全性及有效性。方法 回顾性分析2016年9月至2017年11月对57例患者65个高度可疑恶性肺结节行CT引导下穿刺活检及MWA的资料,其中A组23例（29个肺结节）经同轴套管穿刺活检后立即行MWA（同步诊治组）,B组34例（36个肺结节）先行CT引导下经皮穿刺活检术,病理证实为恶性病变后接受MWA（序贯诊治组）。比较两组患者的临床资料、技术成功率、并发症及近期疗效,评价经同轴套管穿刺活检同步MWA的安全性及有效性。结果 两组患者穿刺活检及MWA技术成功率均为100%。气胸发生率A组31.0%,B组58.3%,差异有统计学意义（P=0.028）。咯血及胸腔积液发生率A组均为24.1%（7/29）,B组分别为27.8%（10/36）及22.2%（8/36）,两组差异无统计学意义。随访6个月,两组均无其他并发症,治疗有效率均为100%。结论 CT引导下经同轴套管穿刺活检同步MWA治疗高度可疑恶性肺结节安全有效。
     

超声引导下肩胛上神经脉冲射频与神经阻滞治疗慢性顽固性肩周痛的疗效分析

目的 评估超声引导下肩胛上神经（SSN）脉冲射频（PRF）和神经阻滞治疗慢性顽固性肩周疼痛的疗效。方法 收集80例慢性肩周疼痛患者临床资料，随机分为两组。A组使用超声引导下SSN阻滞（采用类固醇和局麻药的混合物），B组采用超声引导下SSN PRF治疗，每组40例。通过比较治疗前后疼痛视觉模拟量表 （VAS），牛津大学肩关节评分（OSS）评估两种治疗方式的有效率。在治疗前和治疗后3、6个月，收集评价疗效参数。结果 A组平均VAS评分阻滞前为（6.41±1.22），3、6个月的随访分别为（2.07±1.10）和（2.69±1.23）。与治疗前比较差异有显著的统计学意义（P<0.001）。平均OSS评分患者阻滞前为（24.46±7.07），评分在3、6个月的随访分别为（37.48±4.92）和（39.82±5.41）。观察到显著OSS改善（P<0.001）。B组PRF前平均VAS评分为（6.42±1.43），3、6个月的随访评分分别为（0.95±0.14）和（1.25±1.08）。与治疗前比较差异有显著的统计学意义（P<0.001）。平均OSS评分患者PRF前为（23.60±7.69），3、6个月的随访评分分别为（40.83±7.01）和（42.27±6.30）。观察到显著OSS改善（P<0.001）。整个治疗期间未发生严重的治疗相关的并发症。结论 超声引导下SSN的PRF神经调节以及SSN阻滞均是慢性顽固性肩痛的有效治疗方法，相对于SSN阻滞，SSN的PRF可以提供更有效的疗效。
     

MRI引导下肺转移癌微波消融治疗6例

沈晨燕  唐栋梁  王洁  吴斌  徐小青 《工业加热》2019,(8):750-753

经皮椎体成形术治疗脊柱转移瘤疗效的MRI评价

【摘要】 目的 判断MRI检查结果能否为临床脊柱转移瘤患者经皮椎体成形术（PVP）术后疗效客观评价提供可靠的指标。方法 回顾性分析36例患者75节椎体转移瘤采用单纯PVP治疗的临床及医学影像学检查资料。术前及术后进行疼痛视觉模拟评分（VAS）。根据MRI检查显示分为3组:病灶完全消失并持续12周为完全缓解（A组）;病灶出现骨化或肿瘤体积缩小,无新转移灶出现并连续保持12周为部分缓解（B组）;通过测量肿瘤体积反映病灶扩大,表示无效（C组）。然后比较3组术前、术后12周疼痛缓解程度。结果 3组间术前VAS差异无统计学意义（P > 0.05）,术后C组疼痛缓解不明显,A组比B组疼痛缓解程度大,疼痛缓解程度差异有统计学意义（P < 0.05）。表明MRI客观检查结果与临床主观评价一致。结论 PVP是治疗脊柱转移瘤的有效方法,MRI检查能为临床脊柱转移瘤患者PVP术后疗效提供可靠的客观评价。

     

影像引导下腰脊神经内侧支脉冲射频治疗腰椎小关节综合征

【摘要】 目的 评估脉冲射频刺激脊神经后内侧支治疗腰椎小关节综合征的疗效。方法 48例诊断为腰椎小关节综合征的患者随机分为消炎镇痛药组（A组＝26例）和脉冲射频组（B 组＝22例）。A组患者口服美洛昔康分散片;B组患者行射频脉冲刺激脊神经后内侧支所对应小关节。采用视觉模拟评分（VAS）,分别测评入院时、出院时及出院后6个月的VAS评分,并根据VAS改善程度统计疗效。结果 出院时及出院后6个月时,A、B两组的VAS评分均较入院时有显著降低（P<0.01）;两组间VAS评分比较,出院时B组较A组降低,差异有统计学意义（P<0.05）。出院后6个月时B组较A组显著降低,差异有统计学意义（P<0.05）。治疗后6个月总有效率A组为46.5%,B组为87.6%;显效率B组为76.2%,A组为26.4%。B组的总有效率和显效率均显著高于A组（P＜0.01）。结论 影像引导脊神经后内侧支脉冲射频术能有效缓解腰椎小关节综合征所致慢性腰痛,疗效优于口服药物治疗。     

超声引导下肩胛上神经阻滞治疗脑卒中后肩关节疼痛的疗效分析

【摘要】 目的 探讨超声引导下肩胛上神经阻滞治疗脑卒中后肩关节疼痛的有效性。方法 2017年6月至2018年6月收治92例脑卒中后肩关节疼痛（发病时间＜1年）,患者随机分为两组,每组46例。干预组使用超声引导下肩胛上神经阻滞,对照组采用超声引导下肩胛上神经注射0.9%NaCl溶液。比较治疗前后疼痛评分（视觉模拟量表,VAS）,残疾指数（改良Rankin量表）和生活质量（EuroQol健康问卷）的变化。 所有参与者在随机化之前以及干预后第1周、1个月和3个月进行评估。随访期间两组患者均继续接受脑卒中康复的常规治疗。结果 干预组和对照组均显示随着时间的疼痛评分降低,干预组与对照组相比,干预组的患者显示出显著的疼痛减轻（P＜0.05）。残疾指数和生活质量方面两组未观察到显著差异。两组患者均无不良事件发生。结论 超声引导下肩胛上神经阻滞是治疗偏瘫肩痛患者安全有效的方法。

     

经皮微波消融与胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌的疗效

【摘要】 目的 探究CT引导下经皮微波消融（MWA）与胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌（NSCLC）的疗效及预后。方法 选取2015年3月至2017年2月139例NSCLC患者作为研究对象。根据治疗方案将139例NSCLC患者分为两组,MWA组（n=65）和胸腔镜组（n=74）。比较两组患者手术疗效、术后并发症发生情况、手术相关指标及生存情况。结果 两组患者肿瘤清除率比较,差异无统计学意义（P＞0.05）。两组患者治疗期间均未出现死亡病例。两组患者并发症发生率比较,胸腔镜组和MWA组分别为20/74和14/65,差异无统计学意义。胸腔镜组肿瘤100%切除,MWA组肿瘤完全消融,两组差异无统计学意义（P＞0.05）。MWA组患者手术时间、术后住院时间及住院费用均低于胸腔镜组,差异有统计学意义（P＜0.05）。MWA组患者1、2年总生存率（OS）和无瘤生存率（DFS）与胸腔镜组比较,差异均无统计学意义（P＞0.05）。MWA组患者平均总生存时间及平均DFS与胸腔镜组比较,差异无统计学意义（P＞0.05）。结论 MWA与胸腔镜肺叶切除术治疗Ⅰ期NSCLC疗效相当,且较为安全。MWA治疗Ⅰ期NSCLC的手术时间、术后住院时间及费用均低于胸腔镜肺叶切除术。

     

In-situ Kelvin probe and ellipsometry study of the doping of a-Si : H and a-SiC : H layers:: Correlation with solar cell parameters

To underscore the effects of boron doping on the photovoltaic characteristics of a-Si : H based p–i–n solar cells we used the in-situ Kelvin probe technique to determine the evolution of the contact potential at the SnO₂/p interface in two series of solar cells: one with a p(a-Si : H) layer and another with a p(a-SiC : H) layer plus a buffer a-SiC : H layer. In each series, the flow of diborane was varied between 0.5 and 7 sccm. The in-situ Kelvin probe measurements on thick layers indicate that the doping efficiency is higher in a-Si : H than in a-SiC : H layers. In the case of cells with a p(a-Si : H) layer we observe an optimum in V_oc as a function of the diborane flow rate. Below this optimum the increase in V_oc is correlated to the increase of the contact potential measured by the Kelvin probe. Above the optimum value of the diborane flow, the further increase of the contact potential contrasts with the decrease of V_oc. Moreover, we found that V_oc of the cells with a p(a-SiC : H) is independent of the diborane flow rate. This unexpected behaviour is interpreted in terms of the diffusion of impurities and changes in the p-layer induced by boron atoms; it is supported by secondary-ion mass spectrometry and in-situ spectroscopic ellipsometry measurements.     

Effect of hydrogen on the properties of amorphous alloys finemet type:: PEN-X effect

Elastic properties of the amorphous metallic alloys based on iron and cobalt were found to decrease after hydro-genation, and to recover upon subsequent storage at 295 K. The possible causes for this unusual behaviour are discussed on the basis of measurements of electrical resistance and magnetic susceptibility, as well as X-ray diffraction data. 1999 International Association for Hydrogen Energy. Published by Elsevier Science Ltd. All rights reserved.     

The minimum complexity of endogenous growth models:: the role of physical resource flows

Conventional economic growth theory assumes that technological progress is exogenous and that resource consumption is a consequence, not a cause, of growth. This assumption is built into most, if not all, of the large-scale models used for policy guidance by governments. The reality is probably more complex. A ‘growth engine’ is a positive feedback loop involving declining costs and increasing demand. The neoclassical theory was based on population growth and the traditional savings–investment–capital accumulation mechanism. Solow added an exogenous residual called ‘technical progress’. However, based on both qualitative and quantitative evidence, physical resource flows have been, and still remain, a major factor of production. Yet doubts remain because of the small share of direct payments to energy (and other natural resource) suppliers in the national accounts. This paper shows that the apparent inconsistency between (small) factor payments and the high correlation between physical resource (energy) inputs and outputs can be traced to an often forgotten simplification. The standard neoclassical growth model produces final products directly from labor and capital without allowing any role for consumable intermediates. Correcting for the omission of intermediates by introducing a two-sector or multi-sector production process multiplies the impact of primary resource inputs and accounts for the apparent inconsistency.     

Review: Sustainable production of hydroxymethylfurfural and levulinic acid: Challenges and opportunities

Hydroxymethylfurfural (HMF) and levulinic acid (LA) are two of the most promising chemicals derived from biomass owing to their convertibility into a large number of chemicals having applications in diverse industries. Their transition from niche products to mass-produced chemicals, however, requires their production from sustainable biomass feedstocks at low costs using environment-friendly techniques. In this review, the numerous reaction systems that have been developed to produce HMF and LA from various substrates have been looked at and their merits, demerits and requirements for commercialisation outlined. Special attention has been paid to microwave irradiation-heated systems due to their dual advantages of high product yields and low environmental footprint.     

Algebraic solution of capillary tube flows: Part I: Adiabatic capillary tubes

Capillary tube flows have been solved through both numerical and analytical approaches. The former requires a reasonable understanding of the governing equations of heat and fluid flow, thermodynamic relations, numerical methods, and computer programming, and therefore are not the suitable approach for most refrigeration and air-conditioning practitioners. Some simpler procedures based on different strategies for analytically solving the capillary tube flow have been proposed in the literature, although iterative loops for calculating the mass flow rate are still required. The aim of this work is to advance a semi-empirical algebraic model to solve adiabatic capillary tube flows using a relatively simple set of thermodynamic relations and being explicit for the mass flow rate calculation. Comparisons with a comprehensive experimental data set, taken with the refrigerants HFC-134a and HC-600a, has shown that the model predicts more than 90% and nearly 100% of all data within ±10% and ±15% error bands, respectively.     

Development of biodiesel: Current scenario

Fuels are inevitable for industrial development and growth of any country. The life span of fossil fuel resources has always been terrifying. Biodiesel, a renewable source of energy seems to be an ideal solution for global energy demands including India as well. The current review is addressed to various aspects of biodiesel production. Latest literature has been critically reviewed and consulted.     

The thermal springs of Bockfjorden, Svalbard: II: selected aspects of trace element hydrochemistry

Waters from the Trollkjeldene (Troll springs) and Jotunkjeldene (Jotun springs) thermal springs on northern Svalbard have been analysed by ICP-AES, ICP-MS and IC techniques for a wide range of major and trace elements. Although it is plausible that the thermal waters originate from a deep reservoir in siliceous rocks, it appears that a significant component of their hydrochemical signature is derived from dissolution of higher-level Hecla Hoek marbles. Rare earth elements (REEs) show some degree of enrichment of heavy REEs in the water phase, relative to the marbles and to the travertines that precipitate from the waters. A strong positive Eu anomaly is also observed in the waters, suggesting preferential mobilisation of Eu under reducing conditions. The ratio Nb/Ta is rather well-preserved between the marbles, the waters and the travertines.