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武汉科技大学文法学院-公共管理系
公共管理系•【公共管理系】【行管教研室】【教授】顾杰.2013-12-05•【公共管理系】【行管教研室】【教授】邓泽宏2013-12-05•【公共管理系】【行管教研室】【教授】丁宇2013-12-05•【公共管理系】【行管教研室】【教授】周均旭2013-12-05•【公共管理系】【行管教研室】【教授】何应龙2013-12-05•【公共管理系】【行管教研室】【副教授】魏敏2013-12-05•【公共管理系】【行管教研室】【副教授】雷德明2013-12-05•【公共管理系】【行管教研室】【副教授】李秋容2013-12-05•【公共管理系】【行管教研室】【副教授】吴汉军2013-12-05•【公共管理系】【行管教研室】【副教授】石秀华2013-12-05•【公共管理系】【行管教研室】【副教授】卢珂.2013-12-05•【公共管理系】【行管教研室】【副教授】程红丹2013-12-05•【公共管理系】【行管教研室】【副教授】刘文波2013-12-05•【公共管理系】【行管教研室】【副教授】张彦英2013-12-05•【公共管理系】【行管教研室】【副教授】王哲2013-07-08•【公共管理系】【行管教研室】【讲师】张雅勤2013-07-08•【公共管理系】【行管教研室】【讲师】唐青2013-07-08•【公共管理系】【社保教研室】【教授】董登新2013-07-08•【公共管理系】【社保教研室】【教授】张智勇2013-07-08•【公共管理系】【社保教研室】【教授】熊吉峰2013-07-08•【公共管理系】【社保教研室】【副教授】周云2013-07-08•【公共管理系】【社保教研室】【副教授】王伟2013-07-08•【公共管理系】【社保教研室】【副教授】罗莉2013-07-08•【公共管理系】【社保教研室】【副教授】胡荣芳2013-07-08•【公共管理系】【社保教研室】【副教授】刘珺2013-07-08•【公共管理系】【社保教研室】【讲师】卢敏2013-07-08•【公共管理系】【社保教研室】【讲师】邱莉丽2013-07-08•【公共管理系】【社保教研室】【讲师】程妍2013-07-08•【公共管理系】【社工教研室】【教授】陈秀峰.2013-07-08•【公共管理系】【社工教研室】【教授】彭惠青2013-07-08•【公共管理系】【社工教研室】【教授】张英2013-07-08•【公共管理系】【社工教研室】【副教授】李莉2013-07-08•【公共管理系】【社工教研室】【副教授】柯燕.2013-07-08•【公共管理系】【社工教研室】【讲师】冯晓平2013-07-08教师系统分析与集成社教社社数社社常社。
One-Dimensional Models
Accepted by ASME J. of Biomechanical Engineering on 03/10/2006One-Dimensional Models of the Human Biliary SystemW.G. Li a , X.Y. Luo b, A.G. Johnson c, N.A.Hill b, N. Bird c, & S.B. Chin aa Department of Mechanical Engineering, University of Sheffield, Sheffield, S1 3JD, UKb Department of Mathematics, University of Glasgow, Glasgow, G12 8QW, UKc Academic Surgical Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, UKCorresponding Author:Dr. X.Y. LuoDepartment of Mathematics,University of Glasgow,Glasgow, G12 8QW, UKFax: 0044-141-330 4111E-mail: X.Y.Luo@AbstractThis paper studies two one-dimensional models to estimate the pressure drop in the normal human biliary system for Reynolds number up to 20. Excessive pressure drop during bile emptying and refilling may result in incomplete bile emptying, leading to stasis and subsequent formation of gallbladder stones. The models were developed following the group’s previous work on the cystic duct using numerical simulations. Using these models, the effects of the biliary system geometry, elastic property of the cystic duct, and bile viscosity on the pressure drop can be studied more efficiently than with full numerical approaches. It was found that the maximum pressure drop occurs during bile emptying immediately after a meal, and is greatly influenced by the viscosity of the bile and the geometric configuration of the cystic duct, i.e. patients with more viscous bile or with a cystic duct containing more baffles or a longer length, have the greatest pressure drop. It is found that the most significant parameter is the diameter of the cystic duct; a 1% decrease in the diameter increases the pressure drop by up to 4.3%. The effects of the baffle height ratio and number of baffles on the pressure drop are reflected in the fact that these effectively change the equivalent diameter and length of the cystic duct. The effect of the Young’s modulus on the pressure drop is important only if it is lower than 400Pa; above this value, a rigid-walled model gives a good estimate of the pressure drop in the system for the parameters studied.Keywords: bile flow, cystic duct, gallstone, pressure dropNomenclatureACross-sectional area of collapsed ductm 2 0A Cross-sectional area of duct at zero transmural pressure m 2 1ACross-sectional area of flow at point 1 in Fig. 4 m 2 2A Cross-sectional area of the flow at point 2 in Fig. 4 m 2 1c Sudden contraction head-loss coefficient 2cSudden expansion head-loss coefficient 3c Head loss coefficient in a bend 4cHead loss coefficient in a 90o benddInner diameter of duct mm EYoung’s modulus of materials Pa fDarcy friction factor hThickness of wall or baffle mm HBaffle heightmm j Number of nodeJMaximum number of element p KStiffness of wall Pa LLength of ductm m L Equivalent length due to minor pressure loss m n Number of bafflesc nMaximum number of baffles p Internal duct pressure Pa e p External duct pressure Pa QBile flow rateml/min ReReynolds number, Re ud ν= r Inner radius of duct, πA r =mtTime min uBile velocity in cystic duct, A Q u = m/s V Bile volume in gallbladder ml x Duct centre-line coordinate m α Area ratio, 0A A =αμBile dynamic viscositymPa.s νBile kinematic viscosity, νμρ= mm 2/s θ The half of central angle of baffle cut rad ρDensity of bilekg/m 3 σPoisson’s ratioξBaffle height ratio, CD H d ξ=L Δ Distance between two successive baffles in cystic duct m p ΔPressure dropPa m p Δ Minor pressure drop in cystic ductPa te p Δ Minor pressure drop in T-junction during emptying Pa th p ΔMinor pressure drop in T-junction during refill Pa x ΔInterval of elementm Subscriptsb Baffle CBD Common bile ductCD Cystic duct CHDCommon hepatic ductEM Emptyingeq Equivalent id Ideal, straight and circular pipe inInlet of ductmax Maximum value min Minimum value outOutlet of ductRF Refilling1 IntroductionBiliary diseases such as cholelithiasis and cholecystitis necessitate surgical removal of the gallbladder (GB), which is the most commonly performed abdominal operation in the West. Some 60,000 operations for gallbladder disease are performed in the UK each year [1] at a cost to the National Health Service (NHS) of approximately £60 million per annum [2]. In order to understand the causes of these diseases, it is important to understand the physiological and mechanical functions of the human biliary system. The human biliary system consists of the gallbladder, cystic duct, common hepatic duct and common bile duct (Fig. 1). The human gallbladder is a thin-walled, pear-shaped sac which measures approximately 7-10cm in length and ~3cm in width. Its average storage capacity is 20-30ml. The human cystic duct is approximately 3.5cm long and 3mm wide and merges with the common bile duct. The mucosa of the proximal cystic duct is arranged into 3-7 crescentic folds or valves known as the spiral valves of Heister. The human common duct is normally about 10-15cm long and 5mm wide, in which the hepatic common duct is ~4cm long. The common bile duct merges with the pancreatic duct before entering the duodenum at the ampulla [4].Whilst the anatomical and physiological aspects of the human biliary system have been studied extensively, a little is known about flow mechanics in the system. Torsoli and Ramorino [5] measured pressures in the biliary tree and found them to vary from 0-14cm H2O (1cm H2O=100Pa) in the resting gallbladder to approximately 12-20cm H2O in the common bile duct. Earlier experimental work by Rodkiewcz and Otto [6] showed that bile behaves like a Newtonian fluid, although this has been challenged recently [7, 8, 9]. Kimura [10] found that the relative viscosity of bile is between 1.8-8.0, while Joel [11] found it is between 1.77-2.59. The relative viscosity is defined as the dynamic viscosity of the investigated fluid compared with that of distilled water, both at the same temperature. Tera [12] measured the dynamic viscosity of gallbladder bile by using eight 8cm-long capillary tubes with a diameter of 0.2mm. It was found that the normal gallbladder bile was layered and the relative viscosity of the top, thinnest layer was 2.1 and the bottom thickest layer was 5.1. Bouchier et al [13] also reported that relative viscosity, determined by a capillary flow viscometer, was greater in pathological gallbladder bile than normal gallbladder bile and both were more viscous than hepatic duct bile. Although the concentration of normal gallbladder bile affected the bileviscosity, in pathological and hepatic bile, the content of mucous was the major factor determining viscosity. Cowie et al [14] showed that the mean viscosity of bile from gallbladders containing stones was greater than that from healthy ones. The presence of mucous in gallbladders with stones was likely to account for the differences in viscosity based on the viscosity results using a Cannon-Fiske capillary viscometer at room temperature.The complicated geometry of the biliary tree makes it difficult to estimate the pressure drop during bile emptying using the Poiseuille formula. Rodkiewiz et al [15] found that flow of bile in the extrahepatic biliary tree of dog was related to the associated pressure drop by a power law and differed from that for laminar flow in a rigid tube. Dodds et al [16] calculated the volume variations of the gallbladder during emptying using the ellipsoid and sum-of-cylinders methods from the gallbladder images. Jazrawi et al [17] performed simultaneous scintigraphy and ultrasonography for 14 patients with gallstones and 11 healthy controls and studied the postprandial refilling, turnover of bile, and turnover index. They found that in postprandial healthy controls, the gallbladder handles up to six times its basal volume within 90min, but this turnover of bile is markedly reduced in cholelithiasis causing a reduced washout effect of the gallbladder contents, including cholesterol crystals (They didn’t actually measure the cholesterol crystals). Deenitchin [18] investigated the relationships between a complex cystic duct and cholelithiasis in 250 patients with cholelithiasis and 250 healthy controls. It was found that the patients with gallstones had significantly longer and narrower cystic ducts than those without stones. The results suggested that complex geometry of the cystic ducts may play an important role in cholelithiasis. An increase in the cystic duct resistance has been shown to result in sludge formation and eventually stones in the gallbladder [19, 20, 21, 22, 23]. Recently, Bird et al [24] have investigated the effects of different geometries and their anatomical functions of the cystic ducts.It is now generally accepted that prolonged stasis of bile in the gallbladder is a significant contributing factor to gallstone formation, suggesting that fluid mechanics, in particular, the pressure drop which is required to overcome the resistance of bile flow during emptying, may play an important role in gallstone formation. Unusually high gallbladder pressures could be a cause of acute pain observed in vivo, and also indicate that the gallbladder could not empty satisfactorily, increasing the likelihood of forming cholesterol crystals.Ooi et al [25] performed a detailed numerical study on flow in two- and three-dimensional cystic duct models. The cystic duct models were generated from patients’ operative cholangiograms and acrylic casts. The pressure drops in these models were compared with that of an idealised straight duct with regular baffles or spiral structures. The influences of different baffle heights, numbers, and Reynolds numbers on the pressure drop were investigated. They found that an idealised duct model, such as a straight duct with baffles, gives qualitative measurements that agree with the realistic cast models from two different patients. Experimental work has also been carried out to validate the CFD predictions in the simplified ducts [26]. Thus the simplified models can be used to provide some physical insights into the general influence of cystic duct geometry on the pressure drop [25]. However, their CFD modelling was limited to rigid cystic duct models only, an extending it to compliant model will be very much time consuming.In this paper, in order to obtain a global view of the total pressure drop in the whole biliary system and to consider the importance of the effects of fluid-structure interaction in the human cystic duct, we propose two one-dimensional models of the human biliary system, one with a rigid wall and one with an elastic wall. These models are based on the three-dimensional straight duct with regular baffles used by Ooi et al [25]. The rigid model is validated against the three-dimensional simulations, and the differences between the elastic and rigid models are discussed. Using these models, the effects of physical parameters such as the cystic duct length, diameter, baffle height ratio, number of baffles, the Young’s modulus, and the bile viscosity, on the pressure drop are studied in detail. Both refilling and emptying processes are modelled, and the bile flow in the hepatic and common bile ducts is also taken into consideration. It is hoped that these models can be further developed to provide some fast, qualitative estimates of pressure drop based on real time in vivo data of patients’ biliary systems and therefore be used to aid clinical diagnosis in the longer term.The remainder of the paper is organized as follows. The characteristics of geometry and flow are described in Section 2, and the one-dimensional models are introduced in Section 3. The results and discussion are given in Section 4, followed by the conclusions.2 Characteristics of Geometry and FlowAnatomical descriptions of the biliary system date back to the 18th century when Heister [4] reported spiralling features in the lumen of the cystic duct and called them “valves”. Although later researchers doubted the valvular function, the term “valves of Heister” is still in use. The gross anatomy of the biliary system shown in Fig.1 begins from the gallbladder neck which funnels into a cystic duct. Spiralling mucous membranes are generally prominent in the proximal part of the cystic duct (pars spiralis or pars convoluta ) which then smoothes out to form a circular lumen at the distal end (pars glabra ). Although the actual geometry of the cystic, common hepatic and bile ducts is very complicated and subject dependent, and the ducts are all curved, to obtain a system view we can schematically represent the human biliary system as in Fig. 2.The flow directions of the bile during gallbladder emptying immediately after meal, and during refilling are also shown in Fig. 2. Usually, it takes about half an hour for emptying and several hours (until the next meal) for refilling. The gallbladder volume variation with time in both emptying and refilling is shown in Fig. 3 [4]. From this figure, we can derive the corresponding flow rate (or volume flux) Q (=dV dt ). For a healthy person, the average bile density ρ is about 1000kg/m 3, the same as water, and the range of diameter of the cystic duct is about CD d =1-4mm [24]. The temporal acceleration of bile (u t ρ∂) is approximately 10-3 m/s 2 in the emptying phase and 10-5 m/s 2 in the refilling, and can therefore be ignored in our model. In addition, the maximum Reynolds number (Re =4CD Q d πν) estimated for a cystic duct with diameter of 1mm and bile kinematical viscosity ν=1.275 mm 2/s is about 20 duringnormal emptying, and even smaller during refilling. Hence the flow is laminar. Finally, for a healthy person without gallstones, the bile can be reasonably considered as a Newtonian fluid [27].3 The One-Dimensional ModelsThe pressure drop during emptying is believed to have a link with the stone formation in gallbladder [18]. Our primary aim, therefore, is to predict this pressure drop in a mathematical model of the human biliary system. It is noted that the key structure contributing to the pressure drop is the cystic duct, while the hepatic and common bile ducts offer little resistance or geometric changes during emptying and refilling. Therefore to simplify the pressure dropprediction, the modelling focuses on the non-linear flow features in the cystic duct, while Poiseuille flow is assumed in the other two biliary ducts. In the following, the effects of the baffles in the cystic duct are considered in order to determine the equivalent diameter and length. The effects of the elastic wall are then considered on a straight model of the cystic duct using the concept of equivalent diameter and length.3.1 The Rigid Wall ModelFor a given flow rate, the flow resistance is defined as the pressure drop required to drive the flow along the duct. This pressure drop generally includes viscous losses and any local flow separation or vortex loss.3.1.1 Equivalent diameter and lengthIt is assumed that the common bile duct and the common hepatic duct are straight tubes and join at a T-junction (Fig. 2). To model the effects of the cystic duct baffles on the flow, following Ooi et al [25], the baffles are arranged in the simplified manner, shown in Fig. 4. Unlike in the straight tube, the flow in the cystic duct needs to negotiate its way around the baffles and the worst scenario is shown by the arrow in Fig. 4. Thus the key problem is to estimate the equivalent length L eq , and the equivalent diameter, d eq , treating the cystic duct as an “equivalent straight pipe”. Once this is done, it is straightforward to calculate the pressure drop in the cystic duct assuming Poiseuille flow.The equivalent diameter for the cystic duct, CD d , is dependent on the number of baffles, as well as the baffle height. From Fig. 4 we can see that the bile flow travels twice the distance from points 1 to 2 between any two baffles in the duct, and 1A and 2A are the corresponding cross-sectional areas at points 1 and 2. The sector area 1A can be easily calculated from)212CD CD A d H d θ=− , (1)where θ is half of the centre angle of the baffle cut, and is written as))))11tan 22tan CDCD H d H d θππ−−⎧−⎪⎪=⎨⎪+−⎪⎩222CD CD CD H d H d H d >=< , (2)for a given tube with fixed values of CD L and CD d , 1A depends on the baffle height H only.The maximum diameter of the flow passage is equal to the diameter of cystic duct CD d without baffles, i.e.,max eq CD d d = , (3)It is shown in the Appendix that for the range of parameters in which we are interested, 1A is always smaller than 2A. Therefore the minimum diameter of the flow passage is associated with 1A , i.e.,min eq d = , (4)We now assume that the equivalent diameter of cystic duct varies linearly with the number of baffles between min ,eq d and max ,eq d , i.e.(),min ,max ,min 1eq eq eq eq c n d d d d n ⎛⎞=+−−⎜⎟⎝⎠, (5)where n c is the maximum number of baffles considered. For the parameters we considered, n c =18 (for details, see Appendix).The equivalent length of the cystic duct is determined from the actual length of the flow passage along the duct plus an extra length due to the complicated flow pattern, i.e.()1eq CD m L H n L L =−++, (6)where m L denotes the extra length corresponding to the minor pressure drop due to local vortices from the cross-section area expansion, contraction and the flow path bending in the baffle zone. It can be estimated from [28] that4128eq mm d p L QπμΔ=, (7) where m p Δ is the local pressure drop predicted by Bober and Kenyon [29], i.e.()2212324241616(1)m eq eqQ Q p n c c c n d d ρρππΔ=++− . (8)Here the sudden contraction head-loss coefficient is 110.42(1)CD c A A =−, and the sudden expansion head-loss coefficient is ()2211CD c A A =− [28]. The coefficient 3c is the head-lossdue to the flow bending around the baffles and it is a function of the bending angle. For a 90o bend, 3c has been measured to be 0.75 [29]. In our model, the angle through which the flowbends around a baffle should largely depend on the baffle height ratio, ξ, and to a lesser extent, on the number of baffles too. For simplicity, however, we assume that the angle is a linear function of ξ: 3c k ξ=, where k is chosen to be 0.85. Thus, for ξ=0 (straight tubeflow), 3c =0, and for ξ = 0.9, where 3D simulations typically show that the flow turningthrough 90o around the baffles, 3c =0.75.3.1.2 The Emptying PhaseThe pressure drop in the cystic duct in the emptying phase for a given number of baffles can now be estimated for Poiseuille flow [28]4128CD eq eqQ p L d μπΔ= . (9) For the common bile duct, in the emptying phase, the pressure drop can be written as4128CBD CBD te CBDQ p L p d μπΔ=+Δ , (10) where te p Δ accounts for the pressure drop owing to the T-junction which consists of one 90o bend and one expansion, given224224241616te CD CDQ Q p c c d d ρρππΔ=+ , (11) The coefficients 4c =0.75 for 90o bend and 2c may be treated in the same manner as those for Eq. (8). Thus the total pressure drop in the biliary system during the emptying phase is44128128EM eq CBD te eq CBDQ Q p L L p d d μμππΔ=++Δ . (12)3.1.3 The Refilling PhaseLikewise, during refilling, the pressure drop in the common bile duct is expressed by Eq. (10), and the pressure drop in the common hepatic duct is4128CHD CHD th CHDQ p L p d μπΔ=+Δ , (13) where224124241616th CHD CHD Q Q p c c d d ρρππΔ=+ , (14) and the total pressure drop during refilling is44128128RF eq CHD th eq CHDQ Q p L L p d d μμππΔ=++Δ . (15)3.2 The Elastic Wall ModelIn order to obtain a more realistic description for the pressure drop in the human biliarysystem, an elastic wall model is now considered. In reality, the ducts are soft tissues made of non-linear material, i.e. the Young’s modulus varies with the internal pressure [30, 31]. However, in the first instance, it is assumed that the cystic duct is a linear, isotropic elastic material with a uniform wall thickness. The hepatic and common bile ducts are still assumed to be rigid for two reasons: one is that the Young’s modulus of these ducts is greater than that of the cystic duct [30]; the other is that the pressure variations in these two ducts are much smaller (less than 1 Pa) than in the cystic duct and, therefore, the deformation of the ducts is also much smaller.For simplicity, we model the elastic behavior of the cystic duct as an “equivalent pipe” with an equivalent length L=L eq , and a diameter d eq . In other words, the effects of baffles on the flow come implicitly through L eq and d eq (or area A eq , which varies with the transmuralpressure, i.e. internal minus external). We assume that the cystic duct is initially circular and the duodenal valve opens during emptying, which reduces the pressure in the common bile duct. This, together with the rise in the gallbladder pressure, will initiate the bile flow out of the gallbladder, which further decreases the pressure downstream in the cystic duct. Thus the transmural pressure in the downstream part of the cystic duct during emptying will become negative. As a result, the cystic duct becomes partially collapsed towards the downstream end. This fluid-structure behavior is modeled following well-known work on collapsible flows [32,33, 34].3.2.1 The elastic wall modelThe Emptying Phase The partially collapsed cystic duct is shown schematically in Fig. 5, where p e is the external pressure, and equals to the pressure in the chest, e p =1.5kPa [4](above atmospheric pressure ). We introduce a one-dimensional coordinate system originating from point ‘O’. As the bile flows down the cystic duct, the internal pressure decreases due to viscous losses, causing a decrease in transmural pressure, e p p −, from the inlet (in A ) to theoutlet (out A ). The governing equations for the flow in the elastic cystic duct are [32]Au Q = , (16)28du dp Q u dx dx Aπμρ=−− . (17) The pressure at the inlet is chosen as the reference pressure. For a given flow rate, the corresponding pressure in the duct is derived by integrating Eq. (17)2222011118'(')2xin in p p Q dx Q A x A A πμρ⎛⎞=−+−⎜⎟⎝⎠∫. (18) The constitutive equation for the duct with an elastic wall obeys the ‘tube law’ forhomogeneous elastic materials [33],()αF K p p p e =− , (19)where()323121p Eh K rσ=− , (20) and 0A A α=, ()αF is usually determined by experiments. For veins, the tube law can be expressed as [32, 34]()1032F ααα−=−. (21)Since there is no experimental data for the cystic duct, here we assume that it obeys Eq. (21). The fluid pressure estimated using Eq.(19) is ()3231032232121e Eh p p Aπαασ−=+−⎡⎤⎣⎦− . (22) Combining Eq.(18) and Eq.(22), we have()3321032222321111821210in e in x Eh p Q dx Q p A A A A ππμραασ−⎛⎞′⎡⎤−+−=+−⎜⎟⎣⎦−⎝⎠∫, (23) Equation (23) represents a one-dimensional boundary value problem, which is solved using a finite difference method. The duct is divided into J elements (J is chosen to be > 300); a typical element extending from node j to j+1 is illustrated in Fig. 5. At the (j+1)th node, ()1032323112222232121001111182121j j j j e j j j j A A Eh p Q Q x p A A A A A A πρπμσ−+++++⎡⎤⎛⎞⎛⎞⎛⎞⎛⎞+−−Δ=+−⎢⎥⎜⎟⎜⎟⎜⎟⎜⎟⎜⎟−⎝⎠⎢⎥⎝⎠⎝⎠⎝⎠⎣⎦, (24) where222202221212122212111118,21111,211118,2j x j in in j j jj j j j j j j p p Q dx Q A A A A A A p p Q Q x A A A πμρρπμ+++++⎛⎞=−+−⎜⎟⎜⎟⎝⎠⎛⎞⎛⎞=+⎜⎟⎜⎟⎜⎟⎝⎠⎝⎠⎛⎞⎛⎞=+−−Δ⎜⎟⎜⎟⎜⎟⎝⎠⎝⎠∫and j p is known. Expressing ()2121j A + in terms of A j and A j+1, Eq. (24) can also be written as ()10323231122222232110011111142121j j j j e j j j j j A A Eh p Q Q x p A A A A A A A πρπμσ−+++++⎡⎤⎛⎞⎛⎞⎛⎞⎛⎞+−−+Δ=+−⎢⎥⎜⎟⎜⎟⎜⎟⎜⎟⎜⎟⎜⎟−⎢⎥⎝⎠⎝⎠⎝⎠⎝⎠⎣⎦. (25) We employ the bisection method to solve Eq.(25) to find unknown 1j A + in region[]1000.1,2j A A A +∈ in an iterative manner.The boundary conditions are applied at the inlet (node 1) ()()0331032232121in in in e in in in A A Eh p p A απαασ−=⎧⎪⎨=+−⎪−⎩, (26) If in α=1, then in e p p =; else if 1in α>, then in e p p >. The maximum pressure drop in the cysticduct is thus CD in out p p p Δ=−, and the total pressure drop occurring during emptying is4128EM CD CBD te CBDQ p p L p d μπΔ=Δ++Δ . (27) The Refilling Phase Because the bile flow rate is very small during refilling and the refill time is at least 3 times longer than the emptying time, the cystic duct wall can be regarded asrigid during this phase. Equations (13)-(15) in the rigid model are applied to calculate the pressure drop.4 Results and Discussion4.1 ParametersThe parameters used in the models are listed in Table 1. Most of these are taken from the statistics of human ducts given by Deenitchin et al [18]. The range of values for ξ, n and CD d are chosen to be the same as in the 3D models by Ooi [25]. The gallbladder flow rate isderived from the volume-time curve in Fig. 3, which lies between 0.49 and 1.23 ml/min. The range of the Young’s modulus used for this model is based on the measurements of [30], where bile ducts from 16 healthy adult dogs were tested with a pressure ranging from 4.7kPa to 8kPa. In fact, the physiological internal pressure is normally around 1.5kPa in the human biliary system, which is outside the pressure range used by Jian and Wang [30]. In order to obtain meaningful results, we estimate the Young’s modulus for the pressure around 1.5kPa from the extrapolation of the best curve fitting from the data of [30]. The Young’s modulus chosen for the models is therefore in the range of 100Pa and 1000Pa, which corresponds to the internal pressure varying from 1.03kPa to 1.9kPa.4.2 One-Dimensional Model ValidationAs several assumptions are used in deriving the equivalent diameter and length of the one-dimensional (1D) model, here we compare our 1D model with the three-dimensional (3D) rigid cystic duct models solved with the numerical methods. Fig. 6 illustrates the pressure drop variations with Reynolds number using the rigid model for the cystic duct only, with and without baffles. The geometry and bile parameters are CD L =50mm, CD d =5mm, n =0, 2, 6,10and 14, b h h ==1mm, ρ=1000kg/m 3, ν=1mm 2/s, respectively. These results are comparedwith the corresponding 3D cystic duct CFD results provided by [25], which was quantitatively validated by experiments [26] for higher Reynolds numbers. It can be seen that the agreement between the rigid model and 3D CFD results is consistently good for all values of parameters. This suggests that we have captured the main features of the flow in the rigid cystic duct. Theelastic model is derived for a straight pipe with equivalent diameter and length to the duct with baffles, and is based on the experimental curve for a straight rubber tube [32]. Therefore, if the rigid model with the correct equivalent diameter and length is accepted as satisfactory, then the elastic model is likely to be satisfactory.4.3 Pressure Drop for the Reference Parameter SetThere are many parameters present in the model, and each can vary within its ownphysiological range. In order to isolate the effect of each individual parameter, we introduce a Reference Parameter Set (henceforth referred to as the Reference Set), which is based on averaged values of a normal human cystic duct. The Reference Set is: n =7, ξ=0.5, ν=1.275 mm 2/s, CD d =1 mm, CD L =40 mm, E =300 Pa, in α=1, and Q =1 ml/min. The effect of anyparticular parameter on the pressure drop is determined by varying this parameter while keeping all the other parameters fixed. For the rigid tube, all parameters are the same except that Young’s modulus does apply.The predicted pressure drops in the human biliary system for the Reference Set using the rigid and elastic models in the emptying and refill phases are shown in Fig. 7. Two cases are considered: in α =1 and 1.2. in α =1 is the case when the inlet of the cystic duct is notexpanded, while in α=1.2 indicates a duct expansion because this has been observed clinically.It can be seen that for in α=1 the elastic model predicts a greater pressure drop in the emptyingphase, due to the collapse of the cystic duct. It is also noted that the maximum value of the pressure drop agrees with the typical physiological observation of 20Pa to 100Pa [4, 35].The ratio of total pressure drop in the common bile duct or common hepatic duct to the total pressure drop in the cystic duct, can illustrate the importance of the pressure drop across the cystic duct in the human biliary system. The results demonstrate that the pressure drop in the common duct is less than 1.5%, and in the common hepatic duct less than 0.15% only, compared to that in the cystic duct. This justifies estimating the pressure drop in the human biliary system from the cystic duct model only, as was done by Ooi et al [25].。
期货必看20本书籍
7、系统交易方法
交易系统、数学模型设计系列最为推荐的是原任国内股票市场管理“泰和基金”的嘉实基金公司的投资总监留美金融博士波涛写的，书中介绍电脑程序交易系统由理论向实战转变过程的心得及国际上五位著名大师的交易系统。
8、操盘建议—全球顶尖交易员的成功实践和心路历程
（英）阿尔佩西·帕特尔著 内容简介： 成功的秘诀在于一种心智结构、看待事物的方法。这是一段艰难的旅程，你应该吸取成功者的经验和教训，避免亲自经历亏损。 本书探索全球顶尖交易员的操作哲学、行为和战术，找出在市场中成功的策略及制胜的方法。本书把所有的操作策略都摆在心智架构中讨论，通过顶尖交易员的经验展现出来，并进入这些交易员的内心深处，探究他们如何执行获胜的策略，以及究竟是什么不寻常的心智结构，使得这些交易员能够稳定获利。
17.驾驭市场优秀交易商是如何造就的
[美]詹姆斯·道顿 艾立克·琼斯 罗伯特·道顿 本书是一部关于期货市场、外汇市场以及证券市场的交易理念和操作技巧的专著；同时，又是一部完事地介绍四度空间理论和应用的经典著作。
四度空间理论是近年来在国际金融市场中崛起的、发展前景非常广阔的新型技术分析理论。与传统的以蜡烛图等为基础的技术批示和形态分析相比，四度空间图无论从分析观察市场角度上，还是实战效果（尢其是短线操作）上，都独具魅力。自20世纪80年代问世以来，迅速吸引了越来越多市场专业人士和广大投资者的目光。
19、期货决胜108篇
作者：[香港]刘梦雄 简介：国内最好的期货入门书籍，内容深入浅出、图文并茂 .介绍了经纪人开发客户和客户刚入门的不少的故事。（是早几年一本很流行的读物。现在这本书在大陆已几成绝版，身价翻了好几倍。
20.原版海龟交易法则
9 .期货交易策略
作者：STANLEY KROLL 斯坦利.克罗(美国9大期货大师之一来华讲座时的著作） 内容简介 「经历这些年，我仍关心从市场上获利─获取暴利。但在衡量巨大的财务风险、紧张情绪、寂寞、孤立、自我怀疑，甚至莫名的恐惧，自然这全是期货操作者的经常伴侣，你不应该只以获利为满足。暴利必须成为你的目标。」──Stanley Kroll
HKCS Council Members 2008-2009
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2009中国猎头行业10位专家级顾问情况一、王保光（北京柏卓人力资源顾问有限公司总经理）王保光,FESCO、PERSON、IBM、LUCENT、PANASONIC、CNC、OLYMPUS、RISING、HITACHI、TCL、北京柏卓人力资源开发咨询有限公司执行董事、总经理。
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中国电信BPR项目
工业经济时代->知识经济时代 IT应用 IT黑洞 管理变革 变革的反弹
管理变革与IT技术的结合
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一 个 一 一 一 一 一 很 一 一 一 一 一 一 未 未 一 一 一 一 149个 个 个 ， 可可一一可可可个可可未未可可。
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BPR是一套管理体系 BPR是一套管理体系（理念、方法、技术、工具）
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关于BPR的一些基本概念 关于BPR的一些基本概念 BPR关注的是什么？
Introduction1
Chapter 1: IntroductionRegional anaesthesia has increased in popularity in recent years (Clergue et al., 1999). This was prompted by two significant events. Firstly, the realisation that children do feel pain and require pain relief like adults; and secondly, that avoiding general anaesthesia in premature babies may have major advantages.With the increased survival of premature infants in recent years, the number of premature neonates presenting for surgery has increased. These premature neonates present with either chronic or acute defects that urgently need to be corrected. The risk of general anaesthesia is significant in these patients as they are at a greater risk of developing respiratory failure and postoperative apnoea compared to term infants of the same age (Welborn et al., 1986). Recent concerns regarding the deleterious effects of general anaesthesia on the developing brain further justifies the use of regional anaesthesia in this vulnerable age group (Sun et al. 2008).The use of regional anaesthesia therefore may have considerable advantages not only in premature neonates but also in infants, children and adults. The stages of development can be classified as follows: Stage 1: Neonate or newborn (0-30 days), Stage 2: Infant or baby (1 month-1 year), Stage 3: Toddler (1-4 years), Stage 4: Childhood (prepubescence) (4-12 years), Stage 5: Adolescence and puberty (12-20 years), and Stage 6: Adulthood (21 years - death), which can be subdivided into early adulthood (21-39 years), middle adulthood (40-59 years) and advanced adults/senior citizen (older than 60 years) (Jones, 1946).1.1) A brief history of paediatric regional anaesthesiaThe 19th century was a time when fundamental changes were made in the concepts regarding medicine. This is especially true for the speciality of regional anaesthesia. It is also the period regarded as the birth of modern regional anaesthesia (Bonica, 1984; Dalens, 1995). The thought that the heart is the centre for pain reception was discounted and Bell in 1811 andMagendie in 1822 showed that both motor and sensory impulses were relayed by the nerve tracts. By 1840, Muller established that the brain is the centre for perception and received all sensory information, including pain stimuli (Dalens, 1995).August Bier is commonly regarded as the “father of regional anaesthesia” and discovered the “cocainization of the spinal cord”, using a spinal anaesthetic technique (Fortuna & de Oliveira Fortuna, 2000). Since then, the regional anaesthetic techniques of the time included spinal, caudal epidural and supraclavicular brachial plexus blocks. These procedures gained enthusiastic acceptance by the anaesthesiologists of the time (Bainbridge, 1901; Farr, 1920; Campbell, 1933). However, these procedures gradually fell into disuse and almost came to a complete halt after the Second World War. This was mainly due to the development of new anaesthetic agents and improved techniques for general anaesthesia, which were safer and more reliable to use.The nineteen seventies saw a re-emergence of paediatric regional anaesthesia. Studies conducted by Lourey and McDonald (1973), Kay (1974) and Melman et al. (1975) caused a resurgence in the popularity of paediatric regional anaesthesia. The concept that regional and general anaesthesia can be used in a complimentary fashion, rather than being in contention with each other, also gained increasing acceptance (Dalens, 1995).This increase in regional anaesthesia could be attributed to the constant refinement, and/or development of new techniques. Research into newer, safer and better local anaesthetic solutions, as well as the use of continuous infusions through pumps, has offered new ways of providing pre- and post-operative analgesia to patients scheduled for paediatric surgery (Cook et al., 1995). With the above-mentioned advances in the field of anaesthesiology, the need for a strict protocol for administration, with reliable equipment, well-trained and alert personnel, become even more important (Fortuna & de Oliveira Fortuna, 2000).1.2) The importance of clinical anatomy in regional anaesthesiaDespite all the opportunities in medical research today, as well as the advances made in medical technology, the effective performance of clinical procedures still rests on a solid anatomical basis. This is even more important for medical practitioners in developing countries where technology is often lacking and they are dependent on their anatomical knowledge for the successful performance of clinical procedures (AACA, EAC, 1999).The practice of regional nerve blocks relies heavily on a sound knowledge of clinical anatomy (Winnie et al., 1975). This is especially true for anaesthesiologists who perform these blocks on paediatric patients (Bosenberg et al., 2002). Clinical procedures, such as regional nerve blocks, which either fail to achieve their objective or that result in complications, can often be linked to a lack of understanding, or even misunderstanding, of the anatomy relevant to the specific procedure (Ger, 1996; AACA, EAC, 1999).Winnie and co-workers (Winnie et al., 1973) states that no technique could truly be called simple, safe and consistent until the anatomy has been closely examined. This is quite apparent when looking at the literature where many anatomically based studies regarding regional techniques have resulted in the improvement of the technique, as well as the development of safer and more efficient methods. Anaesthesiologists performing these procedures should have a clear understanding of (a) the anatomy, (b) the influence of age and size, and (c) the potential complications and hazards of each procedure to ensure good results (Brown, 1985). Ellis and Feldman (1993) stated that anaesthesiologists required a particularly specialised knowledge of anatomy, which in some cases should even rival that of a surgeon. There is however a distinct lack of studies focusing on the anatomy of a paediatric population and relating it to a clinical setting (van Schoor et al., 2005). The anatomy described for paediatric patients are in most instances, obtained from adults and could be flawed (see Table 3.1 for an example).Performing regional anaesthetic procedures on paediatric patients have some additional complications and problems associated with it. Many anaesthesiologists may not be comfortable with working on a dose/weight basis. Most importantly, many anaesthesiologists not used to working with paediatric patients may lack the knowledge of the relative depths or position of certain key anatomical structures, as it is known that the anatomy of children of different ages may differ to a greater or lesser degree from that of adults (Bosenberg et al., 2002, Brown, 1985, Brown & Schulte-Steinberg, 1988, Katz, 1993). A thorough knowledge of the anatomy in children is therefore essential for successful nerve blocks and it cannot be substituted by probing the patient with a needle attached to a nerve stimulator, while the effective use of ultrasound requires a sound knowledge of the anatomy of the specific region. The anatomy described in adults is not always, and in most instances not applicable, to children of different ages as anatomical landmarks in children vary with growth. Bony landmarks (e.g. the greater trochanter of the femur) are poorly developed in infants prior to weight bearing. Muscular and tendinous landmarks commonly used in adults, tend to lack definition in young children partly because of poorer muscle development (Bosenberg et al., 2002), but also because they require patient cooperation to locate them. Most children are under sedation or general anaesthesia when the nerve block is being performed (Bosenberg et al., 2002, Armitage, 1985). Finally, classical anatomical landmarks may be absent or difficult to define in children with congenital deformities (Bosenberg et al., 2002).1.3) Indications and limitations of paediatric regional anaesthesiaRegional anaesthesia has advantages over general anaesthesia since it covers not only the intra-operative but also the postoperative period. Regional anaesthesia can be used to treat both acute and chronic pain and, in addition, it also provides both sympathetic and motor blockades (Saint-Maurice, 1995). Like all clinical procedures, the indications of regional anaesthetic techniques is based on well-established criteria, such as patient safety, quality of analgesia, duration of surgery, and whether it is a minor ormajor surgical procedure (Melman et al., 1975; Armitage, 1985; Saint-Maurice, 1995, Markakis, 2000, Wilder, 2000).Indications should not be decided by the subjective preferences of the anaesthesiologist or on the basis of mastery of the specific technique (although this is vital when the procedure is actually performed), but solely on whether the technique is required by careful examination of the indications (Saint-Maurice 1995). In order to select the best anaesthetic technique available, the benefits and risks of the regional nerve block should first be weighed against the advantages and disadvantages of all other available techniques of analgesia (Dalens & Mansoor, 1994).1.3.1 General indications of regional anaesthesiaPatients often have certain medical conditions, where the use of regional nerve blocks would be an advantage, these include:1.3.1.1 Disorders of the respiratory tractThe presence of respiratory diseases is in most cases (except the interscalene block, which has a high incidence of blocking the phrenic nerve) an indication for the use of regional anaesthesia. A regional nerve block can safely be performed on paediatric patients with respiratory distress, provided that the needle insertion, as well as the surgical site, is easily accessible. In certain cases, regional anaesthesia can be performed under mild general anaesthesia, after the patient has been intubated. In these situations, peripheral nerve blocks may be more preferable than central blocks. The advantages of combining both regional and general anaesthesia include reducing the requirements for intravenous and inhalational agents, thereby decreasing the risk of complications and also decreasing the recovery time. The patient should be extubated only when fully conscious and with the effect of anaesthetic inhalant worn off. This will allow the anaesthesiologist to effectively avoid aspiration (Saint-Maurice, 1995).1.3.1.2 Disorders of the central nervous systemThis is often considered to be a contraindication for performing regional nerve blocks. It is however more likely that an anaesthesiologist would refrain from performing regional nerve blocks on these patients more from the fact that there is a concern that the regional nerve block might worsen the disease state. The only true contraindications for performing regional nerve blocks on these patients are mechanical (neuropathy) and infectious conditions (infections in the vicinity of the block). Nevertheless, all children with disorders of the central nervous system should undergo careful evaluation before performing any regional nerve block on them. A neurologist should preferably do the evaluation and, as always, the risk versus benefit ratio should be carefully examined. (Saint-Maurice 1995)myastheniaand1.3.1.3 MyopathyRegional anaesthesia is especially indicated for patients with muscular dystrophy because it avoids the complications associated with general anaesthesia, particularly malignant hyperthermia. Unfortunately, due to the various anatomical deformities often found in these patients, certain regional nerve blocks might be more difficult to perform (Saint-Maurice 1995).1.3.2 General contraindications or limitations of regional anaesthesiaRegional anaesthesia has a very important place in children. Like any technique, it has its distinct advantages and specific indications. However, it also has limitations, disadvantages and contraindications that should be taken into account when performing regional blocks. Although contraindications are block dependant and should be known before attempting any regional nerveblock, general contraindications for regional anaesthesia include:1.3.2.1 Patient refusalPatient refusal is an absolute contraindication to regional anaesthesia. Appropriate information should be given to the patient regarding the technique, its advantages, disadvantages and potential complications. Informed consent must be obtained (Eledjam et al., 200).1.3.2.2 Local infections at the needle insertion siteSkin infections at the needle insertion site are an absolute contraindication to regional anaesthesia(Ecoffey & McIlvaine, 1991). This is also true for inflammation of the lymph nodes near the site of needle insertion.1.3.2.3 Septicaemia(presence of pathogens in the blood)1.3.2.4 Coagulation disordersCoagulation disorders, as well as patients who are undergoing antithrombotic or anticoagulant treatment are contraindications to a regional block because of the potential risk of haematoma formation (Dalens, 1995; Ecoffey & McIlvaine, 1991). Most of the complications have been described with epidural anaesthesia due to multiple traumatic vascular punctures and needle placement difficulties (Dalens, 1995).involving the peripheral nerves 1.3.2.5 Neurologicaldiseases(neuropathy)Although neuropathy (due to neurological or metabolic diseases) is not an absolute contraindication to perform a regional block, a clear benefit over general anaesthesia should be made (Ecoffey & McIlvaine, 1991).1.3.2.6 Allergy to the local anaesthetic solutionLess then 1% of all adverse reactions to local anaesthetics are due to patient allergy to the solution (Ramamurthi & Krane, 2007). Ester-linked local anaesthetics which are metabolized to para-amino benzoic acid (PABA) are far more likely to be associated with allergic reactions compared to amide local anaesthetics. Allergic reactions with amide local anaesthetics have yet to be reported in medical literature, although preservatives like methylparaben, present in many commercial preparations of amide local anaesthetics, are responsible for occasional allergic reactions (Naguib et al., 1998). Ester local anaesthetic allergies are true anaphylactic IgE-mediated allergies and not anaphylactoid reactions more commonly associated with other drugs used in the practice of anaesthesia (Ramamurthi & Krane, 2007).1.3.2.7 Lack of trainingAdequate skills regarding a specific technique are essential for a successful procedure to avoid complications and malpractice claims. Skills and expertise are key points to success in regional anaesthesia (Eledjam et al., 2000).1.4) Equipment used for paediatric regional anaesthesiaThe importance of selecting the appropriate devices and have them readily available when performing a regional block in children has long been underestimated and virtually all types of needles have been used for almost all types of block procedures (Dalens, 1999). Specifically designed needles and catheters are currently available for paediatric regional anaesthesia and it is now well established that a significant proportion of complications are directly related to the use of the wrong device (Giaufre et al., 1996). The importance of the correct equipment for a successful block was further confirmed in a survey of South African paediatric anaesthesia (van Schoor, 2004).Dalens (1999) stated that in addition to skin preparation solutions and sterile drapes to protect the site of puncture from bacterial contamination, the materials required to perform local or regional anaesthesia are rather simple but, nevertheless, specific. Sterile needles specifically designed to perform the relevant technique have to be used in children. He summarised the relevant equipment in a table (see Appendix A).An intravenous cannula should always be inserted in either the upper or lower limb in case of local anaesthetic toxicity caused by an accidental intravenous injection, or profound sympathetic blockade from a high epidural block. Light general anaesthesia is normally given to the paediatric patient. The procedure must be carried out with a strict aseptic technique. The skin should be thoroughly prepared and sterile gloves must be worn as infection in the caudal space is extremely serious (Jankovic & Wells, 2001).1.5) Imaging techniques used to aid in regional anaesthesia1.5.1 Nerve stimulators and regional anaesthesiaThe idea of stimulating a motor nerve in order to determine the ideal injection site for regional anaesthesia was first suggested by Von Perthes in 1912. Although, only within the past twenty years, have peripheral nerve stimulators (see Figure 1.1) become popular as clinical and teaching tools in regional anaesthesia practice (Visan et al., 2002). Nerve stimulators enable confirmation of the correct needle placement without inducing paraesthesia (Vloka et al., 1999) and, in turn, allow anaesthesiologists to perform the block in sedated or anaesthetised patients (Brown, 1993).Figure 1.1: Some commercially available peripheral nerve stimulators(Vloka et al., 1999).Since Pither et al. (1985) made recommendations on the use of nerve stimulators in regional anaesthesia; there has been an explosion of new and varied nerve stimulators available on the market. Although the advances in the technology surrounding nerve stimulators have made their use to localise the desired nerve(s) much easier, the wide variety of functions and features can be confusing for first-time users. This could in turn leave anaesthesiologists with an insufficient understanding of the basic principles behind nerve stimulation.principles of nerve stimulation1.5.1.1 BasicNerve stimulation techniques rely on the elicitation of appropriate motor responses to electrical current to confirm the proximity of the needle or catheter to the target nerve structure. Typically, nerve stimulation involves application of electrical current once the needle/catheter has penetrated the subcutaneous tissue, although surface mapping by transcutaneous electrical stimulation of peripheral nerves in children has been described (Bosenberg et al., 2002).The relationship between the strength and duration of the current and the polarity of the stimulus is of particular importance to nerve stimulation (Pither et al., 1985). To propagate a nerve impulse, a certain threshold level ofstimulus must be applied to the nerve. Below this threshold, no impulse ispropagated. Any increase of the stimulus above this threshold results in a corresponding increase in the intensity of the impulse (Tsui, 2007).It is also possible to estimate needle-to-nerve distance by using a stimulus of known intensity and pulse duration. A clear motor response achieved at 0.2 to 0.5 mA indicates an appropriate needle-to-nerve relationship. The tip of the needle is therefore close enough to the desired nerve to cause an effective block if the anaesthetic solution is administered. Nerve stimulation at <0.1 mA may indicate intraneural placement of the needle. This should be avoided as it may lead to nerve injury if the local anaesthetic is injected (Visan et al., 2002).Another important aspect to remember is that the cathode can be up to four times more effective at nerve depolarization than the anode, and thus it is the preferred stimulating electrode. Some problems may arise when nerve stimulators are not made to connect properly for other manufacturers’ stimulating needles and an adapter would therefore be required. It is best to use similarly manufactured stimulators and needles if possible (Tsui, 2007).A surface electrode is required to complete the electrical circuit and the optimal position to place the electrode on the patient’s body during peripheral nerve blocks is controversial (Tsui, 2007). According to Hadzic and co-workers (2004), this is less critical than was previously thought due to the introduction of constant-current nerve stimulators.features of nerve stimulators1.5.1.2 EssentialAccording to Visan et al. (2002), the essential features of the nerve stimulator include:•Constant current output: This assures automatic compensation for changes in tissue or connection impedance during nerve stimulation, inturn, assuring accurate delivery of the specified.•Current display: The ability to read the current being delivered is of utmost importance because the current intensity at which the nerve is stimulated gives the operator an approximation of the needle-to-nerve distance.•Current intensity control: Current can be controlled using either digital means or an analogue dial. Alternatively, current intensity can be controlled using a remote controller, such as a foot pedal, which allowsa single operator to perform the procedure and control the currentoutput (Hadzig & Vloka, 1996)•Short pulse width: Many peripheral nerve stimulators lack the ability for the user to control pulse width.•Stimulating frequency: Nerve stimulators with a 1 Hertz (Hz) stimulation frequency (1 pulse per second) are the norm. A model with a 2 Hz stimulation frequency may prove to be more clinically advantageous because it allows faster manipulation of the needle.•Malfunction indicator: This is a necessary feature because the operator should know when the stimulus is not being delivered because of malfunctions such as poor electrical connection and/or battery failure.A study conducted by Bosenberg (1995) revealed that a relatively cheap, unsheathed needle could be successfully used to locate peripheral nerves with the aid of a nerve stimulator in anaesthetised children. Although a slightly larger current is required to produce a motor response when compared to sheathed needles, a success rate of greater than 98% underlines its value as a cost-effective teaching tool, and the ease with which a technique can be mastered when using a nerve stimulator.Surface nerve mapping or transdermal nerve stimulation is a modification of the standard nerve stimulator technique and can be used to trace the path of a nerve prior to skin penetration. Surface nerve mapping could prove to be most useful in paediatric patients since anatomical landmarks are less precisely defined (Bosenberg et al., 2002), and paediatric patients are at the greatest risk for complications of regional anaesthesia.(Giaufre et al.,1996) Nerve mapping offers a further dimension for localisation of superficial peripheral nerves prior to skin penetration in both infants and children (Bosenberg et al.,2002).For locating superficial nerves, in patients of normal weight or paediatric patients, a special device can be used together with the nerve stimulator to trigger a transdermal response from the target muscle. The pulse duration of the device is set to 1 millisecond (ms) and the current range to 5 mA. In this way, it is possible to get a better fix on the puncture site or even correct the puncture direction. This also serves as an invaluable training tool for anaesthesiologists. Not only can the correct stimulus response be demonstrated but needle localisation and direction can be practiced before the needle is inserted (, 2009)Bosenberg and co-workers (2002) stated that peripheral nerve stimulation should not be a substitute for sound anatomical knowledge and careful technique. In a study, they did however show that using a nerve stimulator does provide a greater degree of reliability and accuracy in finding the correct needle insertion site, compared to using only anatomical landmarks or paraesthesias to perform nerve blocks. It is also a safer technique for attaining close proximity to the actual nerve.A combination of using a nerve stimulator/surface nerve mapping device and anatomical landmarks seem to be the best method for accurate, safe and successful blockade (Bosenberg, 1995).1.5.2 Ultrasound guidance and regional anaesthesia1.5.2.1 Advantages of ultrasound guidance during regional anaesthesiaThe use of ultrasound guided techniques for performing regional anaesthesia has greatly increased within the past decade. Recent studies show that ultrasound guided nerve blocks may have many advantages over traditional techniques. These studies reported less vascular puncture, highersuccess rates, and a reduced dose of local anaesthetic required in order to obtain a successful block (Marhofer et al., 2004; Sandhu et al., 2004; Bigeleisen, 2007).1.5.2.2 Basic principles of ultrasoundUltrasound machines can typically deliver sound waves of 2–15 MHz. Characteristically, the higher the frequency, the less the penetration depth but the better the resolution and vice versa. In the paediatric population, a high frequency linear probe is usually sufficient as the anatomy is much smaller and most structures being blocked are reasonably superficial. Sound waves propagate through the body and the amplitude of the reflected signals is based on different acoustic impedance of human tissue and fluids. Signals of least intensity appear dark (hypoechoic) or black as with body fluids, while signals of greatest intensity appear white (hyperechoic) as with bones and with intermediate intensities appearing as shades of gray. A common artefact is anisotropy, which is caused by an incidence angle of less than 90o between the probe and the structure being imaged. This results in poor or no reflection of the ultrasound beam from the tissue and, consequently, an inability to visualise it. The ultrasound beam must be oriented perpendicularly on the nerve axis to be able to visualise it (Marhofer et al. 2005; Brain et al., 2007).regional anaesthesia:1.5.2.3 UltrasoundguidedThe success of ultrasound guided nerve blocks relies on several aspects (Perlas & Chan, 2008):•Quality of image: This depends on the quality of the ultrasound machine and transducers, proper transducer selection (e.g., frequency) for each nerve location, sonographic anatomy knowledge pertinent to the block, and good hand-eye coordination to track needle movementduring advancement.•Patient position and technique: Optimal patient positioning and sterile technique is essential. This is particularly important for the continuouscatheter technique when it is necessary to use sterile conducting geland a sterile plastic sheath to fully cover the entire transducer.•Nerve stimulation: Nerve localisation by ultrasound can be combined with nerve stimulation. Both tools are valuable and complementary andnot mutually exclusive. Ultrasonography provides anatomical information, while a motor response to nerve stimulation provides functional information about the nerve in question.•Spread of anaesthetic solution: Ultrasound allows the anaesthesiologist to observe the spread of the local anaesthetic solution as well as real-time visual guidance to navigate the needle toward the target nerve.Two approaches are generally available to block peripheral nerves. The first approach aims to align and move the block needle inline with the long axis of the ultrasound transducer, so that the needle stays within the path of the ultrasound beam (see Figure 1.2a). In this manner, the needle shaft and tip can be clearly visualized. This approach is preferred when it is important to track the needle tip at all times (e.g., during a supraclavicular block to minimize inadvertent pleural puncture). The second approach places the needle perpendicular to the probe (see Figure 1.2b). In this case, the ultrasound image captures a transverse view of the needle, which is visible as a hyperechoic "dot" on the screen. Accurate moment-to-moment tracking of the needle tip location can be difficult, and needle tip position is often inferred indirectly by tissue movement. This approach is particularly useful for continuous catheter placement along the long axis of the nerve.。
“史上最牛散户”回国领刑
法治在线·案件聚焦“最牛散户”让一些股民损失惨重“史上最牛散户”回国领刑 文·图/永剑唐汉博，这个股票圈的风云人物曾因操纵股价多次被证监会点名、处罚，后逃往国外。
2018年6月，他回国投案。
2020年3月30日，上海市第一中级人民法院对唐汉博等三名被告人进行了判决。
违法操盘1973年出生的唐汉博是湖南省绥宁县人，大学毕业后投身深圳证券机构，先后担任过联合证券有限责任公司基金经理助理、深圳宝盈基金管理公司行业研究员、深圳国诚投资咨询公司研发总监等职务。
多年的证券领域从业经历，让唐汉博深刻感悟到资本的诱惑和魅力。
2012年3月下旬，他被一个大老板请到大户室看K线图，觉察到后续卖盘压力较大。
唐汉博让这个资金雄厚的大老板追加了一笔巨资。
在操作的过程中，这个大老板做了撤单处理，但股价已经大水漫灌般上了一个涨停板。
唐汉博反复琢磨，发现了窍门，即通过先垫单后撤单的方式可以拉升股价，然后再进行反向交易出货，打好这个“时间差”，既能带来巨额利润，又能做到神不知鬼不觉。
但是，如此操作需要多个股票账户联动。
作为证券从业人员，他深知不得从事与履行职责相冲突的业务，也不得参与股票买卖。
他所在的公司甚至规定员工不准持有个人名下的股票账户。
于是，他想到了胞弟唐力勤和表弟张晋，他们都热衷于炒股票。
唐力勤有广泛的人脉关系，能借到巨额资金，还能找朋友帮助开设股票账户；张晋自称“操盘手”，只恨手里没有资金，没事时就“模拟炒股”。
唐汉博找他们商量，共谋“发财之道”。
三人很快达成共识，按照唐汉博的授意，唐力勤找了30多人开设股票账户，张晋负责接受指令下单。
2012年5月7日，唐汉博盯上了“XX 实业”的股票。
他和唐力勤利用手里控制的多个自然人账户低位建仓，在下午两点后的一个小时内合计买入845万股，代表股票成交量的柱状线在尾盘突然一飞冲天。
第二天，唐汉博利用资金优势，高价位挂单买入“XX实业”1799万股，这次不但成交量暴涨，日K线也到了涨停板，股票价位向上猛蹿。
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许国庆教你写英文简历
许国庆教你写英文简历（1）[ 2007-07-13 10:54 ]许国庆，1986年毕业于北京大学，获国际经济学士学位。
1986年至1991年在美国第四大商业银行汉华银行(Manufacturers Hanover，现合并为摩根大通银行)北京代表处工作，任北京代表。
1991年至1993年在哈佛商学院就读MBA。
1993年至1997年在华尔街六大证券公司之一的美国雷曼兄弟公司(Lehman Brothers)纽约及香港债券部工作，任副总裁。
1997年至1998年在香港最大的“人”字猎头公司(Executive Access)任高级顾问。
1998年8月回北京创立诚迅联丰咨询公司，任董事长。
诚迅联丰咨询公司(Chainshine Consulting)主要业务是专业金融培训，及校园招聘咨询的季节性服务，为国际金融机构、咨询公司及跨国公司在北大、清华提供招聘服务，为毕业生开办求职讲座和辅导，并为到外企就业的学生进行商务礼仪与外企文化的培训。
许先生自1998年以来连续5年应邀到清华、北大、复旦和上海交大等知名高校举办讲座，其内容和风格深受广大学子欢迎。
以下内容是根据许国庆老师在一次人才招聘会上的讲座整理而成，我们将分十个部分呈献给大家。
虽然文章篇幅过长，但是对你写英文简历还是非常有帮助。
一份高质量的英文简历，起码要花30多个小时，这当中包括3次以上的大改及多于10次的小改。
认真阅读此文将会使你受益不少哦！第一部分英文简历种类1．中式英文简历中式简历中，常包括政治面貌、性格及身高体重等。
如果中英文简历一起递交，建议中文不写政治面貌，因为如果去外企工作，背景中的政治色彩越少越好，起码没有必要让老外知道。
性格是一个主观的东西，有经验的招聘人员从来不相信任何人自己写的性格，因为它不是一个硬性的东西，不像学历、技能。
有些人如果认为公司要招聘一个比较活跃一点的，便会在简历中写性格开朗，有的是真相信自己性格开朗，有的是觉得写上开朗更好，其实没必要。
李亚明
李亚明，北京汉博商业管理股份有限公司副总裁，二十余年房地产开发与运营管理经验，使其熟知中国房地产各大分支行业的发展脉络，对中国房地产的宏观发
展方向有着精准和独到的见解。
作为房地产行业的市场战略及研究专家，李亚明曾先后荣获商业地产开发、定位、招商、运营各流程。
操作并参与商业项目近千万平米，在房地产开发管理、商业策划、建筑规划、招商推广、运营管理各方面拥有丰富经验和实际操作能力。
时任北京汉博商业管理股份有限公司副总裁。
教育改变未来
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家长正确了
孩子才能正确
王辰 2009.11
《好孩子的成长99％靠妈妈》 《好孩子的成功来自妈妈1%的改变》 作者和作品的关系
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左右孩子百年人生的九种基本力
1.失败力 2.哲学力 3.幸福力
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《大 学》
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先决定要什么（目的） 再决定做什么（手段） 1. 想健康长寿（晨练后乱穿马路） 2.爱孩子（孩子打碎饭碗被打） 3.节约（逼老公吃剩饭剩菜） 4.爱老公（不愿意给公婆养老的钱） 5.担心风险（把钱全存银行）
家书（训）的意义——观念不对，终身受罪，甚至影响好几辈
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袁 世 凯 的 子 孙 们
•袁克定（长子）：留学德国，其 独子袁家融留学美国，工程师， 曾任教北大、北师大。 •袁克文（次子）：擅长书法、诗 词文章。有4子3女，子家嘏、家 彰，家骝、家骥，女家华、家宜、 家藏，皆为知识分子。其中家彰、 家骝留学美国，皆学有所成，且 均加入美籍并定居 。 •袁家骝：著名物理学家，物理 学博士，其妻吴健雄号称东方居 里夫人。
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/wcth 芬兰，其人口也是500万，到处是森 林、湖泊，非常美丽。但60年代的芬兰 却是北欧最贫穷的国家。在寒冷的首都 (气温达零下30摄氏度)，室内的供暖常 常不足。当时谁也不知在一个叫诺基亚 的小镇里还有一家百年老厂：诺基亚公 司。但到了90年代，谁都知道诺基亚公 司了。公司的总部搬到了大学旁边，并 把主要业务方向对准知识经济时代的龙 头：信息。从而使公司长了翅膀，飞跃 发展。现在，该公司对全国国民生产总 值贡献20％，生产的移动电话数名列世 界第一。近几年，它连续被列为世界500 强之列，利润超过我国进入500强的三个 公司的总和。
本院资讯业务络人第
一、報告事項
(一)處長: 1. 94 年下半年計中主任由本人兼代，然而處長本身業務量就不少，經常有分身 乏術的情況。12 月下旬，好不容易找到資訊所廖弘源研究員擔任新主任，他 是資訊專業，可以進一步的協助大家。但是，今天的會議，因為廖主任先前 就已安排其他會議，故不克前來參加。 2. 總辦事處是服務單位，過去大家對計中的服務不太滿意，現在也見到逐步的 改進，各位有任何意見均請提出，本人可督促計中提供符合所需的服務。 3. 本人等一下還需外出開會，請何惠安副主任代理主持會議。 (二)何惠安副主任： 1. 各「分組資訊業務連絡人會議」相關議案後續處理說明。 (1)資訊業務連絡人分組會議議案說明及問卷調查結果報告。 (2)94 年度資訊業務連絡人滿意度問卷調查結果報告。 2. 計算中心 95 年度主要工作摘要報告。
本院資訊業務連絡人第 3 次聯席會議紀錄
一、日期：95 年 1 月 4 日(星期三)下午 2 時至 4 時 40 分 二、地點：本院學術活動中心第一會議室 三、出(列)席人員： 數理科學組： 數學所－周謀鴻先生(林玉端女士代) 物理所－余海禮先生(請假)、簡明宏先生 化學所－許昭萍女士(請假)、聞昱生先生 地科所－李建成先生(請假)、王品秀女士，天文所籌備處－曾耀寰先生 資訊所－王秋鳳女士，統計所－鄭少為先生(請假)、劉益順先生 原分所－宋克嘉先生、林許成先生，環境變遷中心－陸又壬先生 應用科學研究中心－陳培菱先生(請假)、邱香蘭女士 生命科學組： 植微所－羅文春先生，細生所－廖永豐先生、黃杏治女士 生化所－邱繼輝先生，分生所－孫以翰先生（陳南君先生代） 生醫所－林文昌先生，基因體研究中心－劉小燕女士、蔡宗儒先生 生農所籌備處－黃培瑛女士（陳怡安先生代） 、林國俊先生 生物多樣性研究中心－詹榮桂先生(王明智先生代) 人文社會科學組： 史語所－陳熙遠先生（劉舒文先生代） 、張俊傑先生 民族所－郭佩宜女士(請假)、王鈞先生，近史所－胡國台先生、謝慶盈先生 經濟所－簡錦漢先生(請假)、陳端君女士 歐美所－蘇宏達先生、蘇文廣先生，台史所－劉士永先生(江聖忱先生代) 社會所－張茂桂先生(陳依宏先生代) 文哲所－廖肇亨先生(請假)、高偉騰先生(請假) 政治所籌備處－林繼文先生(羅任媛女士代) 語言所－孫天心先生(請假)、劉慧瑜女士，法律所籌備處－許雅雯小姐 人文社會科學研究中心－高明瑞先生(蕭炳南先生代) 總辦事處： 葉義雄處長，秘書組－陳彥銘先生，學術事務組－莊素芬女士(請假) 總務組－陳麗玲女士，公共事務組－張震宇先生，會計室－何子倩女士 人事室－曾惠卿女士，政風室－連榮先生，儀器服務中心－邱文棋先生 計算中心－何惠安副主任、曾士熊高級分析師、林 晰科長、劉忠全科長 丁之侃科長(張錦堂先生代)、許翠娥女士、陳亞寧先生、周獻彬先生 嚴漢偉先生(葉大葉先生代)、曹仲明先生、徐建華先生、洪紹雄先生 郭桂月女士、林俊吉先生、袁天竑先生、周哲儀先生、黃瓊瑤女士 廖泫銘先生(白璧玲女士代)、陸維肇先生、尤凱婷女士 四、主席：葉義雄 處長 記錄：顧秋芬 女士