荷兰城市史研究多散见于经济史和农业史研究之中,专论研究并不多见,集中探讨乡村城镇化历程的更为少见.本文以学者们关注的时代为顺序,结合荷兰城市史相关的研究,对以下问题探讨:罗马文明与公元八世纪之后尼德兰地区城市发展之间的关系,有学者提出了肯定罗马化存在助力尼德兰城市复兴的罗马原因论,而反对此论的学者则提出了"商业推动论";近代早期荷兰城乡关系得到国内外部分学者的关注,丰富了我们对城市发展和乡村经济演化等方面的认识;工业革命时代以来,对荷兰经济做出重要贡献的农业引起部分学者的兴趣,然而城乡关系的研究却有所弱化.荷兰乡村城镇化历程研究无论在整体方面还是在细节方面都有待加强,这方面的工作既有重要的学术价值又有较强的现实意义.

The high-quality development in the Yellow River Basin has to be fostered by the coordination of resources, environment, and economy. Therefore, conducting an analysis on the coupling level of resources, environment, and economy in the Yellow River Basin is of major significance to the research on its high-quality development path. The current study focuses on the coupling coordination in the Yellow River Basin. Based on the data of the nine provinces in the Yellow River Basin from 2004 to 2017, a coupling development model is constructed for an analysis of the coupling level in this area and a modeling prediction. A comprehensive evaluation of the development level of resources-environment-economy system and the subsystems in the Yellow River Basin is performed by combining the range change method and entropy weight method. The result shows that despite the rising coupling level of resources, environment, and economy in the Yellow River Basin, the comprehensive evaluation value of the environment subsystem is low, which was merely 0.109 in 2017 and has remained unchanged between 2009 and 2017, resulting in a low coupling coordination degree of resources, environment, and economy. In 2017, the coupling coordination degree only exceeded 0.4. The development was on the verge of imbalance and the high-quality coordinated development of the Yellow River Basin has been restricted.

目的 探讨胃肠道混合性神经内分泌-非神经内分泌肿瘤(MiNEN)的临床病理特征.方法 回顾性分析2017年1月至2020年6月郑州大学第一附属医院47例胃肠道MiNEN患者的临床病理资料,分析其病理学形态特征及免疫表型.结果 47例胃肠道MiNEN患者中,男34例,女13例,年龄42～81岁,中位年龄59岁.病灶位于胃35例,十二指肠4例,结直肠8例.47例肿瘤组织HE染色镜下表现为由神经内分泌肿瘤与非神经内分泌肿瘤2种成分组成,且每种成分均>30％.其中11例见脉管内癌栓,12例见神经侵犯,18例伴发淋巴结转移.47例肿瘤组织癌成分CK均为弥漫强阳性,神经内分泌肿瘤成分CK均为核旁点状阳性;17例肿瘤组织神经内分泌肿瘤成分同时表达CD56、Syn、CgA;38例肿瘤组织Ki-67阳性率≥50％.结论 胃肠道MiNEN,特别是伴高级别神经内分泌肿瘤成分的MiNEN侵袭性较高,常伴淋巴结转移、神经侵犯与脉管内癌栓.该肿瘤异质性较高,缺乏有效的治疗方案,需要引起重视.

荷兰黄金时代区域经济关系的变化使城市化发展呈现出新动向.一方面,城市的发展出现了沿海城市带动内陆城市的态势,打破以往城市化限于一隅的局域藩篱,城市化发展具有跨区域性.另一方面,荷兰黄金时代的乡村地区生产活动渐趋多元化,这种演变态势有乡村城镇化的旨趣,既造就了城市属性四溢的乡村,也使荷兰黄金时代城市化内涵更趋多元.从地缘视角审视上述城市化的跨区域性和多元性,它们实为荷兰彼时沿海与内陆地区经济关系以及城乡经济关系渐趋改善的产物.荷兰黄金时代乡村经济"异动"的意义在于它为荷兰后续的近代化发展另辟蹊径,使其在产业工业化匮乏的情势中跳出传统经济窠臼,确保荷兰经济能够在此后的欧洲工业化进程中跟队前行.

[目的]对儿童股骨远端骨肉瘤(San-Julian分型Ⅲ型)行关节囊外整块切除联合使用保留胫骨骨骺可延长肿瘤型人工关节假体重建术的早期临床研究.[方法] 2017年10月～2018年10月,共6例患儿在本院行穿刺活检病理学证实为骨肉瘤,影像学分型,均为San-Julian分型Ⅲ型,其中男2例,女4例;年龄7～ 12岁;左侧3例,右侧3例.均在本科接受关节囊外整块切除联合保留胫骨骨骺可延长肿瘤型人工假体重建术,术后指导患儿进行功能锻炼,伤口2周后拆线,再过1周后即给予术后的规范化化疗,并进行随访.[结果]6例患儿手术时间分别为2.5 h、3h、3h、3.2 h、3.5 h和4h,平均(3.20±1.14)h;术中出血量600～1 200ml,平均(850.00±484.77) ml.6例患儿均获随访9～21个月,平均(15.17±9.53)个月.根据美国骨肿瘤学会评分系统(Musculoskeletal Tumor Society,MSTS),术后3个月功能评分18～27分,平均(22.83±7.67)分,患儿肢体功能达到良好标准.末次随访,患肢膝关节屈曲角度90°～110°共4例,110°～130°共2例,伸直均能达到180°;共5例患儿双下肢长度相差＜1.5 cm,1例患儿双下肢长度差异约为2.5 cm.随访期间所有患儿均未出现局部复发及肺部转移.[结论]通过严格把握手术适应证,对于股骨远端骨肉瘤San-Julian分型中的Ⅲ型的患儿,关节囊外切除联合使用保留胫骨骨骺可延长肿瘤型人工关节假体重建术提供了一种安全有效的手术方式.

Objective To observe the clinical and magnetic resonance changes of acute mild toluene poisoning en-cephalopathy. Methods The clinical data of 3 patients with acute mild toluene poisoning encephalopathy were retrospec-tively analyzed. The cognitive function was evaluated by ( MMSE),Montreal Cognitive Assessment scale ( MoCA) on 7 days,1 month ± 3 days and 3 months ± 5 days after onset. Results All the 3 patients had dizziness and headache at admis-sion,symptoms were relieved at 1 month after onset,and many dreams appeared at 3 months after onset,and the symptoms of head discomfort were easy to be found in closed and crowded space. The first time MRI showed extensive involvement of white matter in both hemispheres,involving bilateral deep nuclei,internal and external bursa,dentate nucleus of cerebellum, T1 WI in 2 cases,low signal in 1 case,high signal in T2 WI and DWI,FLAIR,and isointense in ADC. No enhancement was found in 1 case. At 1 month,the MRI of all the 3 patients had no obvious change,and the MRI of 3 cases showed that the original lesion disappeared,and the brain atrophy appeared in 1 case. There was no significant difference in MMSE,MoCA scores between 7 days,1 month and 3 months after onset of the disease in one patient with cognitive impairment. Conclu-sion The main characteristics of occupational acute mild toluene poisoning encephalopathy are abnormal brain MRI and a-typical clinical manifestations,and long-term exposure to toluene may lead to brain atrophy and impairment of cognitive function.

目的 探讨种植体周围龈沟液(PICF)中miR-23a、miR-146a水平与种植体周围炎的关系.方法 选取行牙种植修复,并进行术后12个月复查的189例患者为研究对象,根据临床指标将患者分为:健康种植体组87例、炎症种植体组102例,同期选取参与体检者78例作为对照组,检测并记录牙种植修复患者及正常人探针深度(PD)、龈沟出血指数(SBI)、龈沟液量(GCF)的值,采用qRT-PCR法检测龈沟液中miR-23a、miR-146a水平,采用Pearson相关性分析检测龈沟液中miR-23a、miR-146a水平与各临床指标的关系.结果 炎症种植体组PD、GCF、SBI均显著高于对照组和健康种植体组(P＜0.05);炎症种植体组患者龈沟液中miR-23a、miR-146a水平显著高于对照组和健康种植体组(P＜0.05),健康种植体组患者龈沟液中miR-23a、miR-146a水平显著高于对照组(P＜0.05);不同性别患者种植体周围龈沟液中miR-23a、miR-146a水平差异无统计学意义(P＞0.05);＞60岁组患者种植体周围龈沟液中miR-23a、miR-146a水平显著高于＜40岁组和40～60岁组;龈沟液中miR-23a、miR-146a水平均与患者PD、SBI呈正相关(P＜0.05).结论 种植体周围龈沟液中miR-23a、miR-146a水平与种植体周围炎患者临床指标有关,可能成为反映种植体周围炎症进展及牙周组织损伤程度的生物标志物.

目的 探讨右美托咪定对乳腺癌手术老年患者细胞免疫功能和术后恢复的影响.方法 117例拟行乳腺癌根治术老年女性患者随机分为3组(n=39),对照组(C组)、Dex1组(D1组)和Dex2组(D2组).分别于麻醉前(T0)、术毕(T1)、术后24小时(T2)、术后48小时(T3)时点测定T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及NK细胞百分比,记录患者术后恢复情况.结果 与T0比较,3组患者CD3+、CD4+、CD4+/CD8+及NK细胞百分比在T1明显降低(P<0.05),后逐渐回升,CD8+在T1明显升高(P<0.05),后逐渐回落;D1和D2组在T1及T2与C组比较,CD3+、CD4+、CD4+/CD8+及NK细胞百分比显著增高,CD8+细胞百分比显著降低(P<0.05);D1、D2组患者术后呕吐及患者满意度均明显优于C组(P<0.05).结论 右美托咪定对乳腺癌手术老年患者细胞免疫功能的抑制较小,术后恢复快,有益于患者的康复.

目的 观察腹腔镜下全结肠系膜切除术治疗结肠癌的临床效果.方法 采用随机数表法将2017年1月至2018年6月在西峡县人民医院行外科手术治疗的74例结肠癌患者分为对照组和观察组,每组37例.对照组接受开腹手术治疗,观察组接受腹腔镜手术治疗.记录两组患者手术时间、术中失血量、清扫淋巴结数目、术后引流时间、术后排气时间、术后首次进食时间、住院天数等围手术期指标,统计两组患者术后并发症发生率.结果 观察组患者术中出血量少于对照组,术后引流时间、术后排气时间、术后首次进食时间、住院天数均短于对照组,差异有统计学意义(均P＜0.05).观察组患者清扫淋巴结数目多于对照组,差异有统计学意义(P＜0.01).两组患者手术时间比较,差异无统计学意义(P＞0.05).对照组术后并发症发生率为32.43％(12/37),观察组术后并发症发生率为10.81％(4/37).观察组患者术后并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 腹腔镜下全结肠系膜切除术治疗结肠癌的临床效果更佳,术后并发症发生率较低.

考察荷兰近现代城市化,无法绕开对前近代尼德兰地区城市发展的梳理.罗马化的存在与前近代尼德兰城市化关系密切.古罗马时期构建的交通网以及罗马聚落所在区位大都为日后尼德兰城市化所用.在罗马统治时期,当时人们不自觉地准备着一些利于城市化的基本要素.西罗马帝国灭亡后至10世纪末,尼德兰地区虽然遭遇了诸多困难,但具备一定城市属性的聚落还是得以形成.从11世纪开始到中世纪结束,聚落城市化依赖工商业者努力、土地贵族的扶持以及尼德兰有利的地理地貌最终得以实现,尼德兰前工业革命时期城市的基本格局在前近代确立起来.

Objective:To investigate the effscts of different anesthetic and postoperative analgesic methods on cel-lular immune function and postoperative recovery in patients with cervical cancer.Methods:Seventy-eight patients scheduled for laparoscopic radical hysterectomy were randomly divided into 3 groups(26 in each group):GroupⅠ:Total intravenous anesthesia with patient-controlled intravenous analgesia(PCIA),group Ⅱ:Epidural combined in-travenous anesthesia with PCEA and groupⅢ:Epidural combined intravenous-inhalational anesthesia with patient-controlled epidural analgesia(PCEA).The change of T-lymphocyte subsets and NK cells were observated at before anesthesia(T0),the end of operation(T1),24 hours after operation(T2)and 48 hours after operation(T3)time point.First remedy analgesic time,gastrointestinal recovery time,postoperative activity time,postoperative vomiting and satisfaction of patients were recorded.Results:Compared with T0,the percentage of CD3 +,CD4 +,NK cells and CD4 +/CD8 +were significantly decreased and the percentage of CD8 +cells was significantly increased at T1and T2in all groups(P<0.05).Compared with groupⅠ,the percentage of CD3 +,CD4 +,NK cells and CD4 +/CD8 +were sig-nificantly increased and the percentage of CD8 +cells was significantly decreased at T2,T3in groupⅡand groupⅢ(P<0.05).Postoperative recovery in groupⅡand group Ⅲ was better than groupⅠ(P<0.05).Conclusion:Intrave-nous anesthesia with epidural anesthesia and postoperative epidural analgesia for patients with cervical cancer,has quick recovery after operation.

目的 探讨不同麻醉深度对宫颈癌手术老年患者术后早期认知功能的影响.方法 拟行腹腔镜下宫颈癌根治术ASAⅡ～Ⅲ级患者78例,分为3组(每组26例),Ⅰ组:BIS=30～39,Ⅱ组:BIS=40～49,Ⅲ组:BIS=50～59.所有患者采用全凭静脉麻醉复合硬膜外神经阻滞.测定患者术前及术毕血清S100β蛋白的浓度,计算Da-jvO2,CjvO2及CERO2,统计术后7天内POCD发生率.结果 三组患者Da-jvO2,CjvO2及CERO2术前与术毕均无明显差别(P>0.05);三组患者S100β蛋白术毕较术前含量明显增加(P<0.05),且Ⅰ组含量明显小于Ⅱ组和Ⅲ组(P<0.05);三组患者术后7天内POCD发生率比较,差异无统计学意义(P>0.05).结论 不同麻醉深度对宫颈癌手术老年患者术后早期认知功能无影响,深麻醉状态可以减轻患者脑损伤.

Objective To optimize establishment of the model of colorectal cancer patient-derived xenografis tumor.Methods The fresh tumor tissues were selected from 86 patients not given radiation and chemotherapy,and transplanted to the subcutaneous part of the neck of immunodeficiency mice by puncturing mice skin with 18 G needle and expanding the needle hole without suturing after embedding tumors.The tumor size and duration time of tumor formation were regularly monitored,the best time for next passage was explored,and tumor pathology and protein expression of each passage were compared by hematoxylin and eosin (HE) staining and immunohistochemistry respectively.Results The average time of model establishment for primary tumors was (16.5 ±2.8) min.The success rate of transplantation for original generation was 79％.For the following passage it was 100％.The success rate of transplantation for original generation was not related to tumor type,tumor differentiation or clinical stage.Offspring tumors shared similar pathological structure and protein expression with primary tumors.Conclusion This study optimizes the establishment of colorectal cancer patient-derived xenografts tumor,simplifies process and shortens time with high success rate.Meanwhile this model shows stable pathological and histological features between primary tumors and offspring tumors.

世界近代史承上启下,相当重要.如何授课以凸显高等教育之意义,关乎学科延续和发展,更关乎人才的培养.从以下三个方面开展教学有事半功倍之效:重视史实的讲解;以中立的态度将学界在该时段关键节点上的学术争论引入,并间或提醒学生要依据相关事实独立思考相关学术争论,以便形成自己的认识;设定若干讨论话题,引导学生阅读并鼓励他们积极介入讨论之中.史实与学术争论相伴行实乃学与思的结合,如此方能呈现高等史学教育之意义.

Objective To investigate the effects of dexmedetomidine on intestinal mucosa in patients undergoing laparoscopic radical hysterectomy.Methods Eighty-one patients scheduled for laparoscopic radical hysterectomy were randomly divided into three groups (27 cases in each group):control group (group C),dexmedetomidine group one (group D1) and dexmedetomidine group two (group D2).The same standard anesthesia protocol was used for induction in all groups.After induction,group C received total intravenous anesthesia,group Dt and group D2 received dexmedetomidine combined with total intravenous anesthesia and with intravenous-inhalational anesthesia respectively.Before opening pneumoperitoneum (T1),at the end of operation (T2) and 24 hours after operation (T3),the serum levels of intestinal fatty acid binding protein (Ⅰ-FABP),diamine oxidase (DAO) and 8-iso-prostaglandin F2α (8-isoPGF2α) were measured.Results Compared with T1,the serum levels of Ⅰ-FABP,DAO and 8-iso-PGF2α in all groups were significantly increased at T2 (P ＜ 0.05),but there was no significant differences in the indexes in group D1 or group D2 between T3 and T1 (P ＞ 0.05).Compared with group C,the serum levels of Ⅰ-FABP,DAO and 8-iso-PGF2α were significantly decreased at T2 and T3 in group D1 and group D2 (P ＜ 0.05),but there was no significant difference in the indexes between group D1 and group D2 at each time point (P ＞ 0.05).Conclusion Dexmedetomidine can relieve oxidative stress response in patients undergoing laparoscopic radical hysterectomy and protect intestinal mucosa.

当今新媒体在中国迅猛发展,微信、微博作为依托自身资源、平台等,在各自发展战略的指引下呈现出了不同的特点:微信依托社会化关系网络,关系为王;微博依托社会化信息网络,内容为王.本文从关系类型、对于产品的延伸等多角度呈现微信、微博各自的特性,以及在构建各自传播生态上所展现的殊异.

Aim:To study the biomechanical characteristics of different part and size of the adult proximal tibia bone defect,and to provide the basis for clinical practice.Methods:A total of 21 fresh adult cadaver tibial specimens were se-lected,including 12 males and 9 females.Forty-two tibial specimens made from tibia platform weight-bearing area bone de-fect model were randomly divided into 7 groups:group A1,A2,A3,B1,B2,B3 and group C.6 specimens in each group. group A1, A2, and A3 were made of proximal medial tibial bone defect with diameter of 10, 15, and 20 mm.Group B1, B2, and B3 were made of proximal lateral tibial bone defect with diameter of 10, 15, 20 mm.Tibial specimens from group C were not treated as normal control group.Axial compression test, three point bending test and torsion test were performed. Results:The tibial plateau of group A1, A2, B1, B2, and C were not collapsed, and the tibial plateau in one specimen of group A3, and B3 was collapsed,respectively.There were no significant differences in the physical characteristics of the tibial specimens among the groups(P>0.05).Compared with group C,the axial compression stiffness, three point bending stiffness and torsion stiffness of group A2 ,A3 and B3 decreased(P<0.05).Compared with group A2,the axial compres-sion stiffness, three point bending stiffness and torsion stiffness of group A3 decreased(P<0.05).Conclusion: Clinical treatment of bone defects need auxiliary fixed materials,when proximal tibia of adult medial cortical defect is ≥15 mm or lateral cortical bone defect is≥20 mm.

目的 探讨颈椎前路椎间盘摘除植骨融合术(anterior cervical discectomy and fusion,ACDF)中应用新型脱细胞同种异体骨的临床效果.方法 回顾性分析2009年1月-2013年12月收治的73例行ACDF的单节段颈椎病患者临床资料.根据术中所用植骨材料将患者分为3组,其中A组22例取自体髂骨移植,B组27例使用新型脱细胞同种异体骨——拜欧金移植,C组24例使用普通同种异体骨——鑫康晨移植.3组患者性别、年龄、颈椎病分型、病程、病变节段等一般资料比较差异无统计学意义(P＞0.05),有可比性.比较3组患者手术时间、术中出血量、并发症发生情况;摄X线片及CT扫描观察植骨融合情况;采用日本骨科协会(JOA)评分评价患者疼痛缓解情况并计算改善率.结果 A组手术时间及术中出血量显著多于B、C组(P＜0.05),B、C组间差异无统计学意义(P＞0.05).A组出现供骨区疼痛、麻木12例,伤口愈合不良1例;B、C组术后分别出现伤口红肿渗液1例和6例;3组并发症发生率比较差异有统计学意义(x2=18.82,P=0.00).所有患者均获随访,随访时间6～54个月,平均30个月.术后6个月A、B组患者均达骨性融合(100％),C组23例达骨性融合(95.8％),3组融合率比较差异无统计学意义(x2=2.04,P=0.36).术后6个月3组患者JOA评分均较术前显著改善(P＜0.05);但术前及术后6个月3组间比较JOA评分,差异均无统计学意义(P＞0.05).A、B、C组JOA评分优良率分别为90.9％、88.9％、87.5％,3组比较差异无统计学意义(x2=0.14,P=0.93).结论 新型脱细胞同种异体骨用于ACDF具有手术时间短、出血少、早期临床效果满意等优点,但仍需进一步研究其是否存在慢性排斥反应和延迟排斥反应.

BACKGROUND:Conventional therapies for lumbar spondylolisthesis can result in trauma,bleeding and low back pain.With the vigorous development of spinal biomechanics and novel spinal fixation systems,we have more understanding on the reduction and fusion after spondylolisthesis.OBJECTIVE:To observe the clinical effects of transforaminal lumbar interbody fusionvia the quadrant system on lumbar spondylolisthesis and related biomechanical changes.METHODS:A retrospective analysis was done in 23 patients with lumbar spondylolisthesis undergoing transforaminal lumbar interbody fusionviathe quadrant system admitted from June 2012 to September 2013.Oswestry disability index and visual analog scale score were detected at 3 months and 1 year after treatment,as wel as fusion conditions and internal fixation with or without loosening or breakage.RESULTS AND CONCLUSION:Al patients were successfuly treated,with no cerebrospinal fluid leakage and nerve injury.Incisions were healed wel in al cases except one case suffered from incision infection that wascontroled after 10 days of antibiotic treatment.Al the patients were folowed up.The Oswestry disability indexes and visual analog scale scores were significantly improved at 3 months and 1 year after treatment (P ＜0.05),but there was no difference in these two scores at 3 months and 1 year after treatment (P＞0.05).The improvement rates of Oswestry disability index and visual analog scale score were (65.3±14.8)％and (58.2±12.0)％,respectively.These findings indicate that the transforaminal lumbar interbody fusionvia the quadrant system is safe and effective to correct lumbar spondylolisthesis,maintains the biomechanical stability,improves patient's symptoms,reduces the incidence of low back pain and improves the quality of life.

Objective Discussion of advanced gastric cancer patients perioperative intraperitoneal hyperthermic perfusion chemotherapy combined treatment with adjuvant chemotherapy. Methods The selected 150 cases of patients with advanced gastric cancer, both in our hospital from May 2012 to May 2013 were treated underwent D2 + radical treatment, randomized, on gastric cancer chemotherapy (control group,n=70) and perioperative chemotherapy was cavity perfusion chemotherapy (observation group, n=80) to start contrast effect. Results Toxicities and complications groups had no significant difference (P>0.05), the observation group 2-year recurrence rate was significantly lower than the control group, the 3-year survival rate was significantly higher, were statistically significant (P < 0.05). Conclusion Advanced gastric perioperative intraperitoneal chemotherapy plus adjuvant chemotherapy can significantly reduce the recurrence rate and improve long-term survival.