Levosimendan, as a new calcium sensitizer and KATP channel opener, is widely used in the research and treatment of heart failure and cardiomyopathy. There is a lack of effective treatment for brain injury caused by many kinds of nervous system diseases in the clinic. Presently, domestic and foreign studies show that levosimendan may reduce damage to the nervous system by antagonizing inflammatory reactions, oxidative stress reactions, and vasodilator mechanisms in hemorrhagic brain injury and ischemic brain injury. Levosimendan has also received attention as a potential therapeutic agent for neurological disorders. Therefore, this article reviews the neuroprotective effects and mechanisms of levosimendan on nervous system diseases.

背景与目的:胰腺淋巴上皮囊肿(PLEC)是一种罕见的胰腺囊性病变,其临床表现无明显特异性,术前影像学诊断较为困难,与其他胰腺良恶性病变鉴别有一定难度,其确诊仍然依赖术后病理组织学检查.迄今为止,PLEC作为胰腺良性肿瘤,未出现临床症状的患者多建议保守治疗,出现明显临床症状或与恶性肿瘤鉴别不清者需行外科手术治疗.本文介绍1例PLEC的临床表现、诊断及鉴别诊断要点、临床治疗路径和病理组织学特征;并通过国内外相关文献阅读,总结其临床特征,以期为提高PLEC的诊疗水平提供借鉴和参考.方法:回顾性分析了 2021年7月大连医科大学附属大连市中心医院肝胆外科诊治的1例PLEC临床资料.结果:患者为59岁男性,因体检意外发现胰腺肿物入院,增强核磁共振扫描可见胰腺颈部大小为2.6 cm×4.3 cm椭圆形异常信号.通过讨论分析患者临床表现、影像学特征、实验室检查结果等方面资料,认为有手术指征和条件,遂行胰十二指肠切除.手术时间360min,术中出血50mL.术后病理组织学检查确诊为PLEC.术后患者未出现出血、胰瘘、感染、胃排空障碍等并发症.术后10d拔除引流管,术后12d出院.结论:PLEC是一种罕见的胰腺囊性良性病变,由于其临床表现不典型,术前诊断较为困难.有症状的胰腺囊性病患者通常需要行外科手术完整切除病变组织,对于无法明确PLEC诊断的患者,建议行外科手术治疗,患者术后通常预后良好;无症状者可考虑保守治疗和随访观察.

"新工科"建设开启了高等工程教育人才培养的新篇章,为高等工程教育的改革和发展提供了一个全新的视角.随着便携式电子设备的广泛应用,我国对电子封装技术专业人才的需求愈加迫切.在"新工科"建设的背景下,针对当前电子封装专业实验环节缺乏关联性以及知识框架完整性偏弱的问题,以电子产品的研发流程为参考,设计了电子封装专业创新实验.教学实践表明,该套教学体系能有效提高学生的科研兴趣和积极性,锻炼学生运用所学知识解决实际问题的能力,对学生自主学习能力、科研能力以及创新能力的培养具有重要意义.

随着《中国制造2025》的贯彻落实’我国对电子封装技术人才的需求愈加旺盛. "电子封装技术"被国防科技工业局和教育部列为目录外紧缺专业.文章针对电子封装实验教学现状’通过分析基于微课的翻转课堂教学模式的特点’提出将"课前知识学习+课堂知识内化+课后知识巩固"的教学手段引入电子封装实验教学.通过课前实验教学资源构建﹑学生线上自主学习﹑课堂协同实践和课后知识巩固等阶段的学习及全面的评价体系’有效提高了实验教学的效率和质量’增强了学生自主学习能力和创新思维能力.

Objective:To investigate the effect of different postoperative nutritional support on the gastrointestinal function and nutritional status in acute colon peforation patients.Methods:60 cases of acute emergency operation patients with perforation of the colon,according to the given nutritional support treatment of the different ways,were divided into enteral parenteral joint nutrition (EN + PN) group and total parenteral nutrition (TPN) group.Clinical therapeutic effects of two groups were compared.Results:The results of EN + PN group were significantly better than the those in TPN group (P ＜ 0.05).Conclusion:EN + PN model can improve the postoperative nutritional status and accelerate the recovery of patients with acute colonic perforation.

Using composite filler is a very potential way to braze dissimilar material,especially braze metals with ceramics.The composite filler which is added varieties of high temperature alloy,carbon fiber and ceramic particles has a suitable coefficient of thermal expansion.The application of composite filler can release the residual stress caused by mismatch of thermal expansion coefficient in the brazing joints and improve the overall performance significantly.According to the traditional classification method of composite materials,the composite filler is divided into micron-reinforced composite filler and nano-reinforced composite filler,of which the feature and research status are discussed in this text.According to the influence of different size reinforced phases on microstructure and mechanical property of the brazing joints,nano-reinforced composite filler has more uniform and better structure compared with micron-reinforced composite filler,and higher joint strengh can be obtained by using it.However,the reinforced mechanism is still an open question,and will become the key area of the future research work.

目的:探讨胃小弯侧异位胰腺的临床及病理特点和诊治方法。方法:分析2009年10月—2009年12月大连市中心医院普通外科收治的3例胃小弯侧异位胰腺的临床资料。结果:3例均为非特异性消化系统疾病症状入院,行胃镜、超声胃镜、上腹部CT等检查,均诊断为胃小弯侧黏膜下肿物,均行小弯侧胃壁部分切除术。1例为腹腔镜手术,1例腹腔镜中转开腹,1例为开腹手术。手术中切除肿物及其周围1.0~2.0 cm正常胃壁组织,术中冷冻病理和术后病理报告均为异位胰腺。术后2例出现消化不良、胃排空障碍。结论:胃小弯侧异位胰腺无特异性临床表现,胃镜、超声胃镜是其诊断的主要手段,小弯侧胃壁部分切除术是其治疗的首选术式,术中冷冻病理检查是必要的,局部切除术后应注意消化功能异常和胃排空障碍等并发症的发生。

Objective To discuss the feasibility and effect of spleen -preserving distal pancreatectomy in treatment of pancreatic body and tail tumors. Methods A retrospective analysis was performed tof 49 cases of pancreatic body and tail tumors treated by surgery in our hospital from January 1999 to Decmber 2010. Eighteen cases were treated by spleen-preserving distal pancreatectomy including 7 cases with pancreatic adenocarcinoma, 9 cases with cystadenoma of pancreas tail, 2 case with insulinoma. Among them, three patients underwent laparoscopic distal pancreatectomy with preservation of the spleen. The clinical symptoms, preoperative examination, postoperative complications were analyzed retrospectively, and the follow -up observation was conducted. Results The open and laparoscopic spleen-preserving distal pancreatectomy were performed in all cases successfully. Spleen-preserving distal pancreatectomy made patients with well tolerated and fewer postoperative complications. Most patients receive long-term survival. Conclusions Preoperative imaging studies and tumor markers inspection is reliable methods to diagnose in early stage. CTA and DSA are the main methods to determine operation methods. Spleen -preserving distal pancreatectomy is the optimal choice because of the importance of spleen in immune function. With the advantages of reduced injury, earlier recovery and less complication, laparoscopic distal pancreatectomy with preservation of the spleen is safe and feasible.

急腹症患者在症状与体征不符、急诊化验和常规检查又没有明确提示诊断的情况下,应该如何考虑疾病诊断的可能性是普外科医师的难题.如何从已有的线索准确地推测可能的诊断并迅速地明确诊断对此类患者的治疗及预后起着决定性作用.大连市中心医院2006年至2010年此类急腹症中以肠系膜上动脉栓塞及肾动脉栓塞患者为主,其中肠系膜上动脉栓塞患者12例,肾动脉栓塞患者7例,现就其各自特点报道如下。

Objective To summarize the operative experience of transumbilical single-port laparoscopic cholecystectomy. Method The clinical data of 15 patients underwent transumbilical singleport laparoscopic cholecystectomy between May to October in 2010 was reviewed. Results The operative time was 30-85(45±16) min,hospitalization time was (2.5 ± 1.1 ) d. No surgical complications such as bile leak or uncontrolled hemorrhage occurred postoperatively. All the incision were healed well and the surgical scar was virtually concealed whithin the umbilicus. Conclusions Transumbilical single-port laparoscopic cholecystectomy is feasible and safe when patients are well selected. Comparing with conventional laparoscopic cholecystectomy, it's more manipulatively difficult.

目的 评价氟尿嘧啶缓释剂腹腔化疗预防中晚期直肠癌术后复发的效果.方法 收集中晚期直肠癌行根治手术患者并分为两组.对照组96例,术中均未使用氟尿嘧啶腹腔化疗;治疗组107例,术中均使用氟尿嘧啶腹腔化疗.对两组患者术后吻合口瘘、腹腔感染、白细胞下降等不良反应及术后6个月、12个月、24个月的肿瘤局部复发率进行比较.结果 两组术后吻合口瘘、腹腔感染、白细胞下降等不良反较差异无统计学意义;治疗组术后6个月、12个月、24个月的肿瘤局部复发率分别为0.93%、6.54%、13.08%,对照组分别为7.29%、15.63%、29.17%,两组差异有统计学意义(P<0.05).结论 氟尿嘧啶术中腹腔化疗对预防中晚期直肠癌根治术复发有一定作用,且不增加吻合口瘘、腹腔感染、白细胞下降等不良反应发生的风险.

[Objective] To investigate the safety, efficacy and feasibility of laparoscopic Miles operation for the low rectal cancer. [Methods] The clinical data of 36 patients with low rectal cancer were reviewed retrospectively. Sixteen of these patients received laparoscopic Miles operation and 20 received open resection surgery. The clinical data include the hospital stay, operation time, blood loss, cleared lymph nodes and time of the bowel function recovery. [Results] The average blood loss(235.2 ± 81.9) mL in the operation and the gastrointestinal function recovery time (44.1 ± 7.8) h after operation of laparoscopic Miles surgery were less than those (428.7 ± 75.6) mL and (82.5 ± 114) h of the open procedure(P <0.05). But the number of lymph nodes clearance (15.7 ± 8.3) and hospitalization (11.9 ± 4.2) d of laparoscopic Miles surgery had no significant difference from those (16.2 ± 7.1) and (14.3 ± 6.4) d of the open procedure(P >0.05). [Conclusion] Compared with the open procedure, the laparoscopic Miles surgery had less trauma, less blood loss and quicker recovery. So it is safe, efficient and feasible treatment for the low rectal cancer.

Springback is one of the key defects in plate forming,which must be solved in stamping because it affects forming quality.The springback matter during the processes of force-displacement separate control multi-point forming are simulated and studied based on explicit-implicit algorithm,taking the spherical workpiece as an example.Dynamic-explicit formulation is employed to anlyze the forming processes and the implicit algorithm formulation is used to analyze unloading processes.Simulate the springback processes with different parameters and analyze the factors which have effect on the springback.

Objective:To analyze the therapeutic efficacy and adverse reaction induced by Kanglaite injection(KLT) combined with CEF regimen (cyclophosphamide+epirubicin+5-fluorouracil) in the neoadjuvant chemotherapy of breast cancer. Methods: Seventy seven patients who had stages Ⅰ to Ⅱ breast cancer were divided into 2 groups randomly: the Kanglaite injection combined with neoadjuvant chemotherapy group (the KLT group, n=37) and the conventional neoadjuvant chemotherapy group (the control group, n=40). The chemotherapy cycle was equally 21 d. Evaluations about therapeutic effects were made after three cycles of neo-adjuvant chemotherapy and consequent operation. Results:The effective powers (complete response+partial response) of the KLT group and the control group were 81.08% (30/37 cases) and 47.5% (19/40 cases), respectively. The difference was statistically significant (P0.05). The main adverse effects were grade Ⅱ to Ⅲ gastrointestinal tract indisposition and myelosuppression. The WBC decrease and the incidence rate of nausea and vomiting were obviously lower in the KLT group than those in the control group (P0.05). The life quality of patients in the KLT group was greatly improved than that in the control group (P0.05). Conclusion: The application of KLT combined with the neoadjuvant chemotherapy can improve the therapeutic efficacy, reduce the poisonous side effects of chemotherapy, and therefore improving the life quality of the patients.

Objective To explore the diagnosis and treatment of the acute abdomen caused by renal artery embolism(RAE)at the early stage.Methods The 3 cases with RAE were analysed,all of them were complicated by atrial fibrillation.Two were diagnosed as the embolism at the main trunk of the renal artery by digital subtraction angiography,and then were treated by thrombolysis,anticoagulation and transcatheter thrombus aspiration.One case complicated by intestinal obstruction and peritonitis accepted exploratory laparotomy,and we found during the operation the embolism was localized at the branch of renal artery,and was treated by thrombolysis and anticoagulation.Results All of the three cases were diagnosed within 12 hours after the occurrence of abdominal pain.After effective treatments,the abdominal pain disappeared and renal function recovered.Conclusions Digital subtraction angiography of renal artery is the most direct method to diagnose RAE early.Local perfusion therapy,thrombolysis,anticoagulation and transcatheter thrombus aspiration as early as possible are effective method for the recovery of renal perfusion.

目的通过与不保留肋间臂神经(ICBN)的病例患肢前臂内侧皮肤感觉障碍、肩关节活动范围及心理创伤的严重程度进行比较,评价乳癌手术中保留ICBN的疗效。方法2005年共行乳癌手术113例,其中保留ICBN的有21例,均为Ⅰ～Ⅱ期乳癌,在同期中67例Ⅰ～Ⅱ期不保留ICBN的乳癌病例中随机抽取21例,比较2组患肢前臂内侧皮肤感觉障碍范围、肩关节活动范围及心理创伤程度。结果保留ICBN的病例皮肤感觉障碍发生率及发生范围明显低于不保留ICBN者,两者比较有显著差异性(P<0.05);患肢肩关节活动稍好于不保留ICBN者,但无统计学差异(P>0.05),抑郁发生率低于不保留者(P<0.05)。结论乳癌手术保留ICBN的疗效优于不保留ICBN者。

急性肠系膜缺血性疾病(AMI)临床并非少见,由于该病起病急,临床无特异性表现,易与其他急腹症相混淆,常常误诊.我院从1991-06～2006-05收治本病32例,其中误诊24例,误诊率75%.分析如下.

Objective: To discuss the method of decreasing the risk of the injury on laryngeal nerve in the thyroid gland operation.Methods:We could get the conclusion from the analysis of the reason why the patients' recurrent laryngeal nerve get injured. In the analysis the 375 cases were picked among the patients undergone the thyroid gland operation from Sep.2005 to Jan.2007. Results:Among the 375 cases there were 5 patients whose recurrent laryngeal nerve was injured,among which there are three thyroidectomies,one Hashimoto thyroiditis and one thyrocarcinoma. In all these five cases,the injuries were all on the site of abduction when they were observed seen through the laryngoscope. After fifteen days to three months' hormonal and neurotrophic treatment,the patients could recover completely and the vocal cord could also got over which could be examined through the laryngoscope. Conclusions:The majority of the recurrent laryngeal nerve’s injuries can be avoided,it is important to know the nerves anatomical structure and its variation well for the operators,the operators should firstly understand the visual field and the histiostructure of the operation region especially of the recurrent laryngeal nerve.

目的观察当归对博莱霉素所致的肺间质纤维化大鼠的肺形态学及胶原的影响,探讨其作用机制.方法 36只大鼠随机分为对照组、模型组及当归组.气管内注入博莱霉素复制大鼠肺间质纤维化模型,次日当归组每日腹腔内注射当归注射液150mg/kg,于第7及第28天每组分别处死6只大鼠,观察肺间质纤维化形成的病理变化及血清Ⅰ型胶原的含量.结果当归能明显减轻肺泡炎和肺纤维化程度,与模型组比较,当归组血清Ⅰ型胶原含量于第7、28天明显降低(P均＜0.05).结论当归能减慢肺间质纤维化的进程,对肺间质纤维化有一定的保护作用.

目的通过对24例病例的诊治结果分析,探讨先天性胆总管囊肿的术式;方法本组病例6例行囊肿十二指肠吻合,2例行囊肿空肠吻合术,16例行囊肿切除,胆总管空肠Roux-Y吻合术;结果内引流术后并发症有胆道感染,胆道结石囊肿癌变,吻合口狭窄,需二次手术;囊肿切除,胆总管空肠Roux-Y吻合术效果较好.结论先天性胆总管囊肿以切除囊肿,Roux-Y吻合术及胆肠重建为宜.