重症胃肠功能障碍中西医结合集束化防治管理优化方案研究

目的 观察3个不同的集束化防治管理方案对重症胃肠功能障碍（急性胃肠损伤）患者关键预后指标的影响,筛选优化的集束化防治管理方案。方法 将180例ICU患者随机分为3组,实施3种不同的治疗方案（方案1是尽早限制性给予肠内营养,以及早期给予肠外营养和中药;方案2是尽早给予合理性肠内营养和中药,3 d后肠内营养不足目标热量60%时加肠外营养;方案3是方案2减去中药）,疗程为7 d,比较3种方案对患者腹腔内压（intra abdominal pressure,IAP）、腹腔灌注压（abdominal perfusion pressure, APP）、胃肠功能、病情严重程度、ICU住院时间、28 d存活率、ICU病死率等的影响。结果 治疗后方案2组患者IAP显著降低,APP显著升高,病情严重程度减轻,28 d存活率显著增高（P<0.05）。结论 方案2能改善重症胃肠功能障碍患者的IAP、APP和病情,提高患者28 d存活率,显著优于方案1和方案3。     

肝豆汤合驱铜疗法对肝豆状核变性患者生活质量影响的前瞻性研究

目的观察肝豆汤合驱铜疗法对Wilson病(Wilsons disease,WD)患者生活质量的影响。方法共纳入135例WD患者,在二巯基丙磺酸钠强力驱铜治疗及青霉胺和二巯基丁二酸维持驱铜治疗的基础上,口服肝豆片。治疗前及治疗1年后分别采用WHO生活质量简表评价患者的生活质量,并观察总体疗效。结果与治疗前比较,135例WD患者治疗后WHO生活质量简表的生理领域、心理领域、社会领域、环境领域得分均显著提高(P0.01)。135例WD患者中,临床痊愈5例,显效33例,有效88例,无效7例,恶化2例,无死亡病例,总有效率达93.3%。结论肝豆汤口服合驱铜治疗可以明显改善WD患者的生活质量。     

手术序贯应用十二味疏肝利胆颗粒治疗肝胆管结石临床研究

目的 观察手术序贯应用十二味疏肝利胆颗粒治疗肝胆管结石的临床疗效.方法 将确诊为肝胆管结石并接受手术治疗的134例患者分为对照组(66例)与观察组(68例).对照组患者手术治疗后常规予以抗感染、护肝、补液等治疗;观察组在对照组治疗方法的基础上,手术后第1天予以口服十二味疏肝利胆颗粒;比较两组患者治疗前后C反应蛋白(C-reaction protein,CRP)水平、肝功能相应指标,以及手术后胆汁颜色、胆汁细菌培养结果、T管引流量和结石累计复发率.结果 手术后3、7 d,观察组患者CRP水平显著低于对照组(P<0.05).手术后7 d,观察组患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶、血清总胆红素、结合胆红素水平显著低于对照组(P<0.05),前清蛋白水平显著高于对照组(P<0.05).手术后7 d,观察组患者胆汁颜色复常率、T管引流量显著高于对照组(P<0.05).手术后25个月内进行随访,观察组结石累计复发率显著低于对照组(8.82％vs 21.21％,P<0.05).结论 手术序贯应用十二味疏肝利胆颗粒有利于控制术后胆管炎症,促进术后肝功能恢复和残余结石排出,防止结石再生.     

政府与自然的和谐是建设节约型政府的核心理念

建设节约型政府理念的核心意蕴就是政府与自然的和谐。广义的和谐社会也就是一种政府与自然和谐的社会,既包括政府如何引导社会改造与利用自然以实现自身存在与发展的需要,也包括政府如何引导社会改造和完善自身以遵循和顺应自然的需要。构建政府与自然和谐的路径主要在于强化政府的节约意识和建立健全政府的节约制度。     

Policy Monitoring and Ministerial Survival: Evidence from Multiparty Presidentialism

Studies on policy monitoring and ministerial survival within coalition governments are usually conducted separately. In this study, we bring these topics together and argue that the strategy of coalition partners to oversee the implementation of one another's policies has surprising consequences on the duration of office-holding ministers. Our main theoretical insight suggests that the degree to which ministers behave as faithful agents of the government depends on their expectations about their partners' monitoring behavior, such that when they expect to be under high scrutiny, they moderate their drifting behavior. Using evidence from legislative information requests on the activities of individual ministers over all multiparty cabinets formed in Brazil between 1995 and 2014, we demonstrate that: (1) greater policy monitoring by coalition partners is observed under more ideologically heterogeneous cabinets, and (2) more frequent policy-monitoring efforts by coalition partners lead to a lower ministerial replacement within the government term.     

Informing regional taphonomy research using retrospective forensic anthropology cases in the Western Cape,South Africa

The post-mortem interval (PMI) is important in death investigations as it can assist in reconstructing the context of the case and the identification of the unknown individual. However, in some instances the PMI is challenging to estimate due to the absence of regional taphonomy standards. To conduct accurate and locally relevant forensic taphonomy research, investigators require insight into the regional hotspot recovery areas. Thus, forensic cases examined by the Forensic Anthropology Cape Town (FACT) in the Western Cape (WC) province of South Africa between 2006 and 2018 (n = 172 cases; n = 174 individuals) were retrospectively reviewed. In our study, a considerable number of individuals did not have the PMI estimations (31 %; 54/174) and the ability to estimate a PMI was significantly associated with skeletal completeness, unburnt remains, absence of clothing and the absence of entomological evidence (p < 0.05 for each). Significantly fewer cases had the PMI estimated after FACT was formalised in 2014 (p < 0.0001). One third of cases with PMI estimations were made with large open-ended ranges, making them less informative. Factors significantly associated with these broad PMI ranges were fragmented remains, absence of clothing and absence of entomological evidence (p < 0.05 for each). Most decedents (51 %; 87/174) were discovered in police precincts from high crime areas, yet a considerable number (47 %; 81/174) were also found in low crime and sparsely populated areas regularly used for recreational activities. Common sites of body discovery were vegetated areas (23 %; 40/174), followed by the roadside (15 %; 29/174), aquatic environments (11 %; 20/174) and farms (11 %; 19/174). Decedents were discovered exposed (35 %; 62/174), covered with items such as bedding or shrubs (14 %; 25/174) or buried (10 %; 17/174). Our data highlight gaps in forensic taphonomy studies and clearly informs what regional research is needed. Overall, our study demonstrates how forensic case information can inform regional forensic taphonomy studies to locate common areas and contexts for the discovery of decomposed bodies and encourages similar studies in other areas of the world.     

Right-wing populism against diploma democracy. The evolution of parliamentary elites in Austria,Italy, and Switzerland

Are the sociological profiles of radical right-wing populist parties' (RRPPs) representatives really unlike those of their counterparts in mainstream parties? Once RRPPs occupy positions of legislative power for an extended period, do their MPs' profiles increasingly converge with those of more mainstream parties? This paper examines three right-wing parties in Austria, Italy, and Switzerland (FPÖ, LEGA, and SVP), and shows how RRPPs' MPs persistently contrast the “diploma democracy”, that is the increasingly dominant high-educated trend in political representation. Inspired by the current scholarship's diachronic and comparative perspectives of political elites and MPs, the analysis focuses trends since the 1980s.     

中西医结合治疗慢性盆腔炎湿热瘀结型78例

目的 观察中西医结合治疗慢性盆腔炎湿热瘀结型的临床疗效。方法 78例慢性盆腔炎湿热瘀结型患者月经期采用静脉滴注奥硝唑及左氧氟沙星，共7 d；经后期采用清热利湿化瘀的中药内服、外敷、灌肠综合治疗，14 d为1个疗程。共治疗3个疗程。结果 78例患者中，治愈、好转、无效分别为58、13、7例，总有效率为91.03%。结论 中西医结合治疗慢性盆腔炎湿热瘀结型疗效显著。     

中西医学思维模式探析

中医西医的差异源于其思维模式的不同，形成过程各有其深刻的哲学背景。中医强调整体性，着眼于你体综合功能状态以及各种因素的关联，而综合功能状态的变化可以在多空间中表示出来，因此，中医可称为多维医学。