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1挪威海底隧道经验显示文摘海底隧道深埋于海水以下,因而在勘探、设计、施工和运行方面都比陆地隧道更困难。挪威在近30a来修建了40条海底隧道,积累了丰富的经验,形成了被称为“挪威海底隧道概念”的一整套技术。规划设计阶段要采用各种可能方法进行尽可能详细的地质勘探,尤其是海洋折射地震波探测,以提供基岩表面深度、基岩地质剖面等重要资料。影响隧道的稳定主要为断层和软弱带,因此,在地质勘探中确认断层和软弱带是极为重要的。施工时需采用精心设计的方法,包括减少每轮爆破的进尺及采用喷射混凝土拱肋、密集长锚桩等。典型的挪威海底隧道衬砌由作为支护的喷锚结构和自立的防水防冻的内衬砌组成。挪威海底隧道的衬砌都按排水结构设计,而不承受外水压力。渗水是海底隧道的最大威胁,施工期应随时了解掌子面前的地质和水文地质条件,超前探测孔和预灌浆是控制渗流的最佳方法,同时必须时刻准备处理可能发生的紧急情况。最小岩石覆盖厚度影响隧道安全和造价,必须慎重考虑,根据岩石条件、稳定要求、渗水量充分论证,大部分挪威海底隧道的最小岩石覆盖厚度都小于50m。海水的腐蚀性给海底隧道带来一系列的特殊问题,须认真对待。吕明 Grφv E Nilsen B Melby K 2005岩石力学与工程学报2005,24,23:106
2Sedation in gastrointestinal endoscopy: Current issues显示文摘Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate(conscious) sedation.Moderate sedation,using midazolam and an opioid,is the standard method of sedation,although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation.Moreover,the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and,consequently,its low risk of inducing hepatic encephalopathy.In the future,propofol could become the preferred sedation agent,especially for routine colonoscopy.Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam.Among opioids,pethidine and fentanyl are the most popular.A number of other substances have been tested in several clinical trials with promising results.Among them,newer opioids,such as remifentanil,enable a faster recovery.The controversy regarding the administration of sedation by an endoscopist or an experienced nurse,as well as the optimal staffing of en-doscopy units,continues to be a matter of discussion.Safe sedation in special clinical circumstances,such as in the cases of obese,pregnant,and elderly individuals,as well as patients with chronic lung,renal or liver disease,requires modification of the dose of the drugs used for sedation.In the great majority of patients,sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide.In this review,an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.John K Triantafillidis Emmanuel Merikas Dimitrios Nikolakis Apostolos E Papalois 2013World Journal of Gastroenterology2013,19,4:35
3AGNP精神科治疗药物监测共识指南:2011显示文摘治疗药物监测(Therapeutic drug monitoring,TDM),如通过定量测定血清或血浆药物浓度指导用药剂量优化,已经成为对患者进行精神药物治疗的很有价值的工具。在患者用药依从性难以判断、药物耐受性不佳、治疗剂量下无效以及可能存在药代动力学药物-药物相互作用等情况下,测定药物浓度是很有用的。在精神科,有可能明显获益于TDM的主要患者群体包括儿童、孕妇、老年患者、智力障碍患者、涉及司法的患者、已知或怀疑携带药代动力学相关基因变异的患者,以及合并躯体疾病影响药代动力学的患者。然而,只有将TDM充分整合到临床治疗过程中去,才能发挥其优化药物治疗的潜在优势。为了促进TDM的合理应用,神经精神药理学与药物精神病学协会(Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie,AGNP)的TDM专家组在2004年发表了精神药物治疗药物监测指南。之后,随着知识不断更新,又有许多可能需要进行TDM的新药上市。因此,本次更新将神经精神药物的种类扩展到了128种,并将其TDM必要性划分为从'强烈推荐'到'可能有用'的四个等级。经过大量细致且全面的文献检索与分门别类的汇总整理,将基于循证医学理念的'治疗参考浓度范围'和'剂量相关参考浓度范围'呈现给大家。本共识指南引入了'实验室警戒浓度'的新概念,即实验室需要马上告知治疗医生的药物浓度上限。本共识指南还给出了诸如药物作为细胞色素P450酶的底物和抑制剂的性质,代谢物与母药浓度比值的常见范围,以及与结果解释相关的内容,还提供了何时将TDM与遗传药理学检测相结合的建议。遵循本指南,有助于改善许多患者精神药物治疗的效果,特别是那些存在药代动力学异常的患者。TDM是一门交叉学科,有时针对看起来不一致的数据,需要多学科坦诚地讨论,只有这样,患者才能从这种合作中获益。Hiemke C Baumann P Bergemann N Conca A Dietmaier O Egberts K Fric M Gerlach M Greiner C Gründer G Haen E Havemann-Reinecke U Jaquenoud Sirot E Kirchherr H Laux G Lutz UC Messer T Müller MJ Pfuhlmann B Rambeck B Riederer P Schoppek B Stingl J Uhr M Ulrich S Waschgler R Zernig G 李文标(译) 果伟(译) 阮灿军(译) 贺静(译) 汤宜朗(审校) 王传跃(审校) 2016实用药物与临床2016,19,10:37
4Advances in prognostic factors in acute pancreatitis:a mini-review显示文摘BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson's or Glasgow's criteria ≥3,the APACHE II classification system ≥8,and the Balthazar's criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis 2010Hepatobiliary & Pancreatic Diseases International2010,9,5:25
5美国国立老化研究所与阿尔茨海默病协会诊断指南写作组:阿尔茨海默病临床前阶段的定义显示文摘阿尔茨海默病(AD)的病理生理过程在痴呆诊断的多年前就开始了。这一长期的AD“临床前”阶段是治疗干预的关键机会,但需进一步阐明AD的病理级联过程和临床症状出现之间的联系。美国国立老化研究所和AD协会召集了一个国际工作组对AD生物标志物、流行病学和神经心理学的证据进行综述并提出建议,以确定能够预测由“正常”认知到轻度认知功能障碍(MCI)及AD痴呆的最佳预测指标。根据目前已有的主要科学证据,我们提出了一个概念性的框架和用于操作的研究标准,以通过纵向临床研究来验证和改进这些模型。这些建议仅用于研究目的,目前不涉及临床应用。我们希望这些建议能提供一个共识,以推进临床前AD的研究,最终推动更早期治疗干预的进展,使得一些疾病减缓药物的疗效发挥最大。Sperling RA Aisen PS Beckett LA Bennett DA Craft S Fagan AM Iwatsubo T Jack CR Jr Kaye J Montine TJ Park DC Reiman EM Rowe CC Siemers E Stern Y Yaffe K Carrillo MC Thies B Morrison-Bogorad M Wagster MV Phelps CH 贾建平(译) 郭起浩(译) 黄丽(译) 陆璐(译) 张逸驰(译) 邢怡(译) 2012中华神经科杂志2012,45,5:22
6Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis显示文摘AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral head.METHODS: The porous tantalum rod was combined with endoscopy,curettage,autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients(58 hips) with a mean age of 38 years.The majority of the patients had idiopathic osteonecrosis,followed by corticosteroid-induced osteonecrosis.Thirtyeight hips were of Steinberg stage Ⅱ disease and 20 hips were of stage Ⅲ disease.Patients were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and radiologically.The primary outcome of the study was survival based on the conversion to total hip arthroplasty(THA).Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with survival.The Kaplan-Meier survival analysis was performed to evaluate the survivorship ofthe prosthesis,and the Fisher exact test was performed to test associations between various parameters with survival.RESULTS: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site morbidity.During the 5-year follow up,1 patient died,7 patients had disease progression and 4 hips were converted to THA.The 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%.Stage Ⅱ disease was associated with statistically significant better survival rates compared to stage Ⅲ disease(P = 0.04).The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival rates.The clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the preoperative period(P < 0.001).The mean preoperative Merle d'Aubigne score was 13.0(SD: 1.8).The respective score at 12 mo improved to 17.0(SD: 2.0).The 12-mo mean score was retained at 5 years.CONCLUSION: The modified porous tantalum rod technique presented here showed encouraging outcomes.The survival rates based on conversion to THA are the lowest reported in the published literature.Emilios E Pakos Panayiotis Megas Nikolaos K Paschos Spyridon A Syggelos Antonios Kouzelis Georgios Georgiadis Theodoros A Xenakis 2015World Journal of Orthopedics2015,6,10:20
7世界卫生组织(WHO)造血与淋巴组织肿瘤分类方案:临床顾问委员会会议报告显示文摘引言 :从 1995年开始 ,欧洲病理学工作者协会和血液病理学会一直致力于制定一个新的世界卫生组织 (WHO)血液恶性肿瘤分类方案 ,该分类方案包括淋巴系肿瘤、髓系肿瘤、组织细胞肿瘤和肥大细胞肿瘤。 材料与方法 :此项 WHO计划共组成十个病理学工作者委员会 ,负责确定病种和作出定义。另外还成立一个由国际血液学家和肿瘤学家组成的临床顾问委员会 (CAC)以保证该分类的临床实用性。 1997年 11月召开会议讨论了与该分类有关的临床问题。 结果 :WHO采纳了 1994年国际淋巴瘤研究组 (IL SG)报告的修订欧美淋巴系肿瘤分类 (REAL)方案作为淋巴系肿瘤的分类方案。该方案的分类方法遵循以下原则 :分类应是联合应用形态学、免疫表型、遗传特征及临床特征能够清楚界定的“真实存在”(“real”)病种的名录 ,上述各项特征的相对重要性因病种不同而异 ,不存在任何“金标准”。 WHO将 REAL分类原则延用于髓系肿瘤和组织细胞肿瘤 ,髓系肿瘤的分类包括联合应用细胞形态学和细胞遗传学异常能够界定的各个病种。围绕一系列临床问题召集的这次 CAC会议 ,就提交的大多数问题达成共识 ,这些问题及共识将详述于下。对于另外一些问题 ,CAC认为淋巴系肿瘤临床分组既无必要也不必需 ,患者的治疗取决于淋巴瘤的具体类型 ,如有?N L Harris E S Jaffe J Diebold G Flandrin H K Muller-Hermelink J Vardiman T A Lister C D Bloomfield 张凤奎 郝玉书 2001白血病.淋巴瘤2001,10,3:20
8Akt inhibitor shows anticancer and radiosensitizing effects in malignant glioma cells by inducing autophagy显示文摘Fujiwara K Iwado E Mills GB Sawaya R Kondo S Kondo Y 2007中国神经肿瘤杂志2007,5,4:20
9Pancreatic regenerating protein (regⅠ) and regⅠreceptor mRNA are upregulated in rat pancreas after induction of acute pancreatitis显示文摘AIM: Pancreatic regenerating protein (regⅠ) stimulates pancreatic regeneration after pancreatectomy and is mitogenic to ductal andβ-cells. This suggests that regⅠand its receptor may play a role in recovery after pancreatic injury. We hypothesized that regⅠand its receptor are induced in acute pancreatitis. METHODS: Acute pancreatitis was induced in male Wistar rats by retrograde injection of 3% sodium taurocholate into the pancreatic duct. Pancreata and serum were collected 12, 24, and 36 hours after injection and from normal controls (4 rats/group). RegⅠreceptor mRNA, serum regⅠprotein, and tissue regⅠprotein levels were determined by Northern analysis, enzyme-linked immunosorbent assay (ELISA), and Western analysis, respectively. Immunohistochemistry was used to localize changes in regⅠand its receptor. RESULTS: Serum amylase levels and histology confirmed necrotizing pancreatitis in taurocholate treated rats. There was no statistically significant change in serum regⅠconcentrations from controls. However, Western blot demonstrated increased tissue levels of regⅠat 24 and 36 h. This increase was localized primarily to the acinar cells and the ductal cells by immunohistochemistry. Northern blot demonstrated a significant increase in regⅠreceptor mRNA expression with pancreatitis. Immunohistochemistry localized this increase to the ductal cells, islets, and acinar cells. CONCLUSION: Acute pancreatitis results in increased tissue regⅠprotein levels localized to the acinar and ductal cells, and a parallel threefold induction of regⅠreceptor in the ductal cells, islets, and acinar cells. These changes suggest that induction of reg I and its receptor may be important for recovery from acute pancreatitis.Martin H Bluth Sameer A Patel Brian K Dieckgraefe Hiroshi Okamoto Michael E Zenilman 2006World Journal of Gastroenterology2006,12,28:19
10HPV阴性胃型子宫颈原位腺癌:一种具有胃和肠分化的罕见病变谱系显示文摘作者报道9例罕见的具有胃和肠分化且与人类乳头瘤病毒(HPV)感染无关的子宫颈原位腺癌(AIS)。患者年龄25~73岁(平均51岁),所有病例均位于子宫颈鳞一柱交界区(或邻近),其中有3例延伸子宫下段,2例累及子宫内膜。所有病例均大部分保留正常子宫颈腺体结构,其中5例有轻度腺体复杂性增生。腺上皮从几乎为纯胃型(4例)至混合不同比例杯状细胞的胃肠型(5例)。与正常的子宫颈腺体嗜碱性细胞质不同,胃型上皮通常由明显嗜酸性或浅粉色胞质的细胞组成,但在某些病例中胞质呈明显的泡沫状或透明胞质。所有病例均有核非典型性,Talia K L Stewart C J R Howitt B E 黄爱清(摘译) 余英豪(审校) 2017临床与实验病理学杂志2017,33,11:19
11Long acting octreotide in the treatment of advanced hepatocellular cancer and overexpression of somatostatin receptors: Randomized placebo-controlled trial显示文摘AIM: To estimate if and to what extent long acting octreotide (LAR) improves survival and quality of life in patients with advanced hepatocellular carcinoma (HCC). METHODS: A total of 127 cirrhotics, stages A-B, due to chronic viral infections and with advanced HCC, were enrolled in the study. Scintigraphy with 111Indium labeled octreotide was performed in all cases. The patients with increased accumulation of radionuclear compound were randomized to receive either oral placebo only or octreotide/octreotide LAR only as follows: octreotide 0.5mg s.c. every 8 h for 6 wk, at the end of wk 4-8 octreotide LAR 20 mg i.m. and at the end of wk 12 and every 4 wk octreotide LAR 30mg i.m.. Follow-up was worked out monthly as well as the estimation of quality of life (QLQ-C30 questionnaire). Patients with negative somatostatin receptors (SSTR) detection were followed up in the same manner. RESULTS: Scintigraphy demonstrated SSTR in 61 patients. Thirty were randomized to receive only placebo and 31 only octreotide. A significantly higher survival time was observed for the octreotide group (49 ± 6 wk) as compared to the control group (28 ± 1 wk) and to the SSTR negative group (28 ± 2 wk), LR = 20.39, df = 2, P < 0.01. The octreotide group presented 68.5% lower hazard ratio [95% CI (47.4%-81.2%)]. During the f irst year, a 22%, 39% and 43% decrease in the QLQ-C30 score was observed in each group respectively.CONCLUSION: The proposed therapeutic approach has shown to improve the survival and quality of life in SSTR positive patients with advanced HCC.D Dimitroulopoulos D Xinopoulos K Tsamakidis A Zisimopoulos E Andriotis D Panagiotakos A Fotopoulou C Chrysohoou A Bazinis D Daskalopoulou E Paraskevas 2007World Journal of Gastroenterology2007,13,23:18
12PD-L1在不同乳腺癌亚型及分期病例中的表达及其肿瘤内异质性:245例原发和40例转移癌的研究显示文摘肿瘤组织中PD—L1表达与多种恶性肿瘤免疫逃逸有关,包括三阴型乳腺癌,通过PD—L1标记有助于选择适合于PD—I/PD—L1抑制剂治疗患者。作者采用组织芯片技术对各种组织学形态的乳腺癌进行PD—L1表达和研究,以探讨其在原发和转移性乳腺癌中的异质性,研究病例包括245例原发性乳腺癌和40例转移性乳腺癌(淋巴结转移及远处转移各20例),瘤细胞PD—L1膜着色细胞≥1%定义为阳性。Dill E A Gru A A Atkins K A.Atkins 王婷 余英豪 2017临床与实验病理学杂志2017,33,10:17
13在血压控制不良的高血压患者中使用数字化干预的家庭和在线血压管理:随机对照试验显示文摘HOME BP试验(The home and online management and evaluation of blood pressure)的目的是评估在初级预防中结合自我监测和自我管理的数字化干预在高血压管理中的作用。研究者纳入英国76个治疗中心经过治疗但血压控制不好(>140/90 mm Hg, 1 mm Hg=0.133 kPa)并能上网的患者622例,进行自动确定主要终点的公开随机对照试验。McMa-nus RJ Little P Stuart B Morton K Raftery J Kelly J Bradbury K Zhang J Zhu S Murray E May CR Mair FS Michie S Smith P Band R Ogburn E AllenJ Rice C Nut-tall J Williams B Yardley L 陈嘉睿(译) 叶鹏(审校) 2021中华高血压杂志2021,29,5:15
14有效的继续医学教育活动:提高医生实践水平改善患者临床疗效显示文摘政府、公众和医疗机构都认为,医疗卫生人员有义务和责任保持自己的医疗水平,提高患者的医疗保健服务质量。美国国家医学研究所(the Institute of Medicine)、美国毕业后医学教育认证委员会(the Accreditation Council for Graduate Medical Education)和美国医学专科委员会(the American Board of Medical Specialties)规定了医疗卫生人员的必备技能,如患者诊疗、医学知识、以实践为基础的学习、改善人际交往和沟通能力、专业性和以系统为基础的实践等。并建议各医学院校的教学课程、医院的住院医师培训项目以及继续医学教育活动都应围绕医疗卫生人员的这些必备技能来设计教学内容。Regnier K Kopelow M Lane D Alden E 2012中国继续医学教育2012,4,2:15
15内脏脂肪组织通过产生骨桥蛋白调控成纤维细胞衰老促进心脏衰老显示文摘老化通过增加包括骨桥蛋白(osteopontin,OPN)在内的细胞外基质(extracellular matrix,ECM)蛋白的沉积引起心脏结构和功能改变进而导致进行性间质纤维化。虽然已知OPN参与各种病理状况,但其在心肌衰老中的作用仍不清楚。Sawaki D Czibik G Pini M Ternacle J Suffee N Mercedes R Marcelin G Surenaud M Marcos E Gual P Clément K Hue S Adnot S Hatem SN Tsuchimochi I Yoshimitsu T Hénégar C Derumeaux G 刘青 叶鹏 2018中华高血压杂志2018,26,3:14
16Hepatocellular carcinoma: Review of disease and tumor biomarkers显示文摘Hepatocellular carcinoma(HCC) is a common malignancy and now the second commonest global cause of cancer death. HCC tumorigenesis is relatively silent and patients experience late symptomatic presentation. As the option for curative treatments is limited to early stage cancers, diagnosis in non-symptomatic individuals is crucial. International guidelines advise regular surveillance of high-risk populations but the current tools lack sufficient sensitivity for early stage tumors on the background of a cirrhotic nodular liver. A number of novel biomarkers have now been suggested in the literature, which may reinforce the current surveillance methods. In addition, recent metabonomic and proteomic discoveries have established specific metabolite expressions in HCC, according to Warburg's phenomenon of altered energy metabolism. With clinical validation, a simple and non-invasive test from the serum or urine may be performed to diagnose HCC, particularly benefiting low resource regions where the burden of HCC is highest.Jin Un Kim Mohamed I F Shariff Mary M E Crossey Maria Gomez-Romero Elaine Holmes I Jane Cox Haddy K S Fye Ramou Njie Simon D Taylor-Robinson 2016World Journal of Hepatology2016,8,10:13
17Current opinion on lymphadenectomy in pancreatic cancer surgery显示文摘BACKGROUND:Adenocarcinoma of the pancreas exhibits aggressive behavior in growth,inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%.Curative resection is the only potential therapeutic opportunity. DATA SOURCES:A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma. RESULTS:Despite recent advances in chemotherapy,radio-therapy or even immunotherapy,surgery still remains the major factor that affects the outcome.The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial.Four prospective,randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection.The exact lymph node status,including malignant spread and the total number retrieved as well as the lymph node ratio,is the most important prognostic factor.Positive lymph nodes after pancreatectomy are present in 70%.Paraaortic lymph node spread indicates poor prognosis. CONCLUSIONS:Undoubtedly,a standard lymphadenectomy including>15 lymph nodes must be no longer preferred in patients with the usual head location.The extended lymphadenectomy does not have any place,unless in randomized trials.In cases with body or tail location,the radical antegrade modular pancreatosplenectomy gives promising results.Nevertheless,accurate localization and detailed examination of the resected specimen are required for better staging.Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis 2011Hepatobiliary & Pancreatic Diseases International2011,10,1:12
18Liver iron transport显示文摘肝在铁新陈代谢起一个中央作用。它是为铁的主要存储地点并且也表示涉及铁运输和铁动态平衡的规定的分子的一个复杂范围。与肝的铁运输或规定联系的越来越多的基因被识别了。这些包括转铁蛋白受体(TFR1 并且 2 ) , ferrireductase (STEAP3 ) ,运输 ers 二价的金属 transporter-1 (DMT1 ) 和象 haemochromatosis 蛋白质, HFE 和 haemojuvelin (HJV ) 一样的 ferroportin (FPN ) ,它正在表明分子。许多也这些基因参予铁集中于肝的肽 hepcidin 的规章的小径。然而,我们开始仍然仅仅正在理解在肝之间的复杂相互作用熨运输和铁动态平衡。这评论在铁运输和铁动态平衡的规定构画出我们铁新陈代谢和他们的角色的分子的当前的知识。Ross M Graham Anita CG Chua Carly E Herbison John K Olynyk Debbie Trinder 2007World Journal of Gastroenterology2007,13,35:12
19消毒副产物三氯甲烷与膀胱癌的关系显示文摘氯化消毒(chlorination)是饮用水加工过程中使用最广泛的消毒方式。然而,氯化消毒过程中可产生对健康有害的物质一消毒副产物(disinfection byproducs,DBPs)。消毒副产物主要包括三卤甲烷(trihalomethanes,THMs)、卤代乙酸(haloacefic acids,HAAs)、卤代乙腈(haloaceton itriles,HAN)等。毒理学研究显示DBPs具有遗传毒性、致突变性、细胞毒性、生殖发育毒性和致癌性。膀胱癌是指发生在膀胱黏膜上的恶性肿瘤。李园园 Beane Freeman L E Cantor K P Baris D 2017环境卫生学杂志2017,7,5:10
20疝修补术:寻找理想的网片显示文摘要做到有效的网片修补是困难的。在过去的50年中,疝修补技术有了长足的进步,但仍然需要一些新的观念和方法来巩固疝修补术已经取得的成绩。在欧洲疝学会第30次国际大会上,疝修补术及网片试验评估领域的9名专家共同参加了一次圆桌会议,讨论当今疝修补术中亟待解决的问题;内容包括'理想'网片的定义及'理想'的网片材料。讨论的其他内容还包括轻量型网片的特点,网片替代物,外科医生在疝修补术中的作用,当今疝修补术中亟待解决的问题,以及最佳的动物试验模型。尽管人们对于理想网片的构成还没有定论,但对其重要的特点却有了更深的理解。希望这些建议可以促进疝治疗的发展,并催生出最为有效的疝修补网片材料。Bringman S Conze J Cuccumllo D Deprest j Junge K Klosterhalfen B Parra-Davila E Ramshaw B Schumpelick V 2010中国实用外科杂志2010,30,12:10
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