CO_2 insufflation for potentially diffi cult colonoscopies: Effi cacy when used by less experienced colonoscopists

AIM： To clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists. METHODS： One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insuffiation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist （EC） group and a less experienced colonoscopist （LEC） group. Study measurements included a 100-mm visual analogue scale （VAS） for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times. RESULTS： Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group （P〈 0.001, two-way ANOVA） from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group （P = 0.29）, however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group （P = 0.023） immediately after colonoscopies and up to 4 h afterwards. CONCLUSION： CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

Mental Health Problems Experienced by HIV Positive Adolescents;A Case of Choma District, Zambia

Several scholars have reported high mental health problems among adolescents with Human Immunodeficiency Virus (HIV) globally. However, little is known about the mental health of this peculiar group of young people in Choma district. This study aimed to determine the mental health problems experienced by HIV positive adolescents in Choma District. Using the Strengths and Difficulties Questionnaire (SDQ), data were obtained from 103 HIV positive adolescents receiving treatment at Choma General Hospital plus a corresponding number of parents/care givers. Information about mental health services was obtained qualitatively from 10 nurses working in the mental health unit and the Antiretroviral (ART) clinic. The results showed that more than three quarters of the adolescents had mental health problems. Of this number, 57.3 percent had multiple mental health problems: predominantly emotional and peer problems. The study also found a statistically significant relationship between level of stigma and presence of mental health problems (X2 = 1.123, P = 0.003). In conclusion, the study demonstrated that multiple mental health problems particularly emotional and peer problems are prevalent among adolescents with HIV/AIDS yet are most often undiagnosed. In addition, adolescents with high levels of internalized stigma are more likely to have multiple mental health problems. The findings suggest the need to integrate psychiatric services into routine care of HIV infected adolescents, routine screening for mental health problems and provision of continued professional development among nurses managing these patients.

Changes I have Experienced─A Visit to Gyaibo Puncog Cedain

ＣｈａｎｇｅｓＩｈａｖｅＥｘｐｅｒｉｅｎｃｅｄ─ＡＶｉｓｉｔｔｏＧｙａｉｂｏＰｕｎｃｏｇＣｅｄａｉｎＣＨＩＮＡ＇ＳＴＩＢＥＴＲＥＰＯＲＴＥＲＧｙａｉｂｏＰｕｎｃｏｇＣｅｄａｉｎ．ｎｏｗｖｉｃｅ－ｃｈａｉｒｍａｎｏｆｔｈｅｐｅｏｐｌｅ＇ｓｇｏｖｅｒｎｍ...

Intraocular lens exchange or explantation post cataract surgery

AIM:To report incidence,indications,and visual outcomes of intraocular lens(IOL)exchange/explantation surgery.METHODS:Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1^(st) January 2017 and 31^(st) December 2022.The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.RESULTS:Out of 39778 cataract surgeries(with no preexisting ocular co-morbidities)during a six-year period(2017-2022),60(0.15%)needed IOL exchange/explantation.Surgeons-under-training performed 36/60 cases(60%)while 24/60(40%)were by experienced surgeons.The commonest indication was subluxated IOL in 26(43.3%),followed by dislocated IOL in 20(33.3%),postoperative refractive surprise in 7(11.6%),IOL induced uveitis in five and broken haptic in two eyes.Twenty-four(40%)eyes had intraoperative complications during primary surgery.Posterior chamber IOL(PCIOL)was the commonest secondary IOL in 21(35%)eyes,scleral fixated in 20(31.6%),anterior chamber IOL(ACIOL)in 13(21.6%),iris fixated IOL in three(5%)and three eyes(5%)were left aphakic.The mean time between primary and secondary surgery was 168d(168±338.8).Best corrected visual acuity(BCVA)of>20/60 was obtained in 43 eyes(71.66%),20/80-20/200 in 14(23.33%),20/250 in two and hand movements in one.No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons(UCVA 0.45±0.29 vs 0.53±0.32,P=0.20,BCVA 0.34±0.25 vs 0.37±0.26,P=0.69).CONCLUSION:IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor.This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

Feeling the Beauty of Taiji and Sharing the Joy of Being Healthy

From November 26 to December 3,2023,Professor Wu Dong of the International Wushu Development Research Center of the China Wushu School,Beijing Sport University went to Tanzania and Mauritius to give lectures.During the 8-day China Story Taijiquan lecture series,the people of Tanzania and Mauritius have got close to Taijiquan,understood the mystery of Taijiquan and experienced its effects on health.

BRIEFS

CHINA Promising Drone Industry China’s drone industry has experienced rapid development,with a massive surge in the number of newly registered unmanned aerial vehicles(UAVs)in H1 of 2024.

Patterns of Herbal Combination for the Treatment of Insomnia Commonly Employed by Highly Experienced Chinese Medicine Physicians

Objective：To explore the most effective herbal combinations commonly used by highly experienced Chinese medicine（CM） physicians for the treatment of insomnia.Methods：We collected and analyzed data related to insomnia treatment from the clinics of 7 highly experienced CM physicians in Beijing.The sample included 162 patients and 460 consultations in total.Patient outcomes,such as sleep quality and sleep time per day,were manually collected from the medical records by trained CM clinicians.Three data mining methods,support vector machine（SVM）,logistic regression and decision tree,and multifactor dimensionality reduction（MDR）,were used to determine and confirm the herbal combinations that resulted in positive outcomes in patients suffering from insomnia.Results：Results show that MDR is the most efficient method to predict the effective herbal combinations.Using the MDR model,we identified several combinations of herbs with 100%positive outcomes,such as stir-fried spine date seed,Szechwan lovage rhizome,and prepared thinleaf milkwort root;white peony root,golden thread,and stir-fried spine date seed;and Asiatic cornelian cherry fruit with fresh rehmannia.Conclusions：Results indicate that herbal combinations are effective treatments for patients with insomnia compared with individual herbs.It is also shown that MDR is a potent data mining method to identify the herbal combination with high rates of positive outcome.

The Confucian Educational Philosophy and Experienced Teachers’Resistance:A Narrative Study in Macao

This study investigates experienced teachers’resistance in an era of neoliberalism in Macao.The narratives of three experienced teachers are examined under a post-structuralist framework.The findings indicate that the traditional Chinese Confucian ideology of education guides the experienced teachers’professional practice and offers them an alternative subject position to inhabit that makes it possible for them to establish a critical distance from the prevailing norms imposed by the hegemony of neoliberalism.Such a distance allows the experienced teachers to observe,to think otherwise and consequently to live out a different teaching life and to reassemble their identity around an empowered notion of self.The study concludes that the Confucian ideology of education has contributed to the transformation of the contemporary discursive context of Macao by promising a future for education,a future with a revisioned future rather than a neoliberal incorporation of the past.

China's Auto Parts Industry Has Experienced 3 Periods Over The Past 30 Years

The following was a keynote speech of the CAAM at an annual conference on the auto parts industry. 1.The first stage:to introduce the advanced technologies to localize car parts. In the mid 1980's,the auto industry began introducing the car and

Geographic Distribution of Coal Enterprises and Workers Exposed to Coal Dust in China in 2020

Prolonged exposure to coal dust may lead to various lung diseases, especially coal workers’ pneumoconiosis(CWP)[1]. Developed countries such as the United States experienced a resurgence of pneumoconiosis in the early 20t h century[2], and this phenomenon has become even more critical in developing countries[3]such as China and India.

Analysis of rear-end risk for driver using vehicle trajectory data

To explore the relationship between rear-end crash risk and its influencing factors, on-road experiments were conducted for measuring the individual vehicle trajectory data associated with novice and experienced drivers. The rear-end crash potential probability based on the time to collision was proposed to represent the interpretation of rear-end crash risk.One-way analysis of variance was applied to compare the rearend crash risks for novice and experienced drivers. The rearend crash risk models for novice and experienced drivers were respectively developed to identify the effects of contributing factors on the driver rear-end crash risk. Also, the cumulative residual method was used to examine the goodness-of-fit of models. The results show that there is a significant difference in rear-end risk between the novice and experienced drivers.For the novice drivers, three risk factors including the traffic volume, the number of lanes and gender are found to significantly impact on the rear-end crash risk, while significant impact factors for experienced drivers are the vehicle speed and traffic volume. The rear-end crash risk models perform well based on the existing limited data samples.

Future perspective of China's feed demand and supply during its fast transition period of food consumption

China has experienced dramatic changes in food consumption patterns over the last three decades. However, there are different opinions regarding the future trends in consumption. By adopting the well-developed partial equilibrium model-China Agricultural Policy Simulation Model（CAPSi M）, the demand for livestock products and the main feed crops over 2011–2030 is predicted and analyzed. It is found that China＇s per capita consumption of livestock products will continue to rise during this period, even though its growth rate will slow down gradually. Meanwhile, the expansion of livestock production will pose great challenges for feed supply in China. More accurately, China will be confronted with feed security rather than grain security in the future.

CLINICAL OBSERVATION ON 80 CHILDREN WITH PEPTIC ULCER TREATED PRIMARILY BY TRADITIONAL CHINESE MEDICINE

Using the empirical recipe of Wang Pengfei (a very experienced TCM doctor) as the main treatment, the authors treated 80 children with peptic ulcer by means of promoting blood circulation, removing blood stasis as well as regulating the flow of qi, alleviating pain, tonify-ing the stomach and reinforcing the spleen. Measures for hemostasis, correction of anemia and other general treatment were also taken. After 8 weeks of treatment, a total effective rate of 92.5% was obtained.

Cyclic load testing of pre-stressed rock anchors for slope stabilization

The objective of this research was to assess the characteristics of seismic induced damage and the deformation patterns of pre-stressed cement-grouted cables that are used for rock slope stabilization projects subjected to quasi-static cyclic loading.The experimental configuration includes the installation of 15 pre-stressed cables in a slope model made of concrete blocks(theoretically rigid rock mass) on top of a pre-existing sliding surface.The study showed that:(i) The pre-stressed cables exhibited great seismic performance.Rapid displacement of the model blocks was observed after the complete loss of the initial pre-stress load under continued applied cyclic loads and exceedance of the state of equilibrium,which implies the higher the initial pre-stress load,the better the seismic performance of the rock anchor;(ii) The failure of the pre-stressed cables was due to fracture at the connection of the tendons and cable heads under cyclic loading.The sequence of failure had a distinct pattern.Failure was first observed at the upper row of cables,which experienced the most severe damage,including the ejection of cable heads.No evidence of de-bonding was observed during the cyclic loading;(iii) The stress distribution of the bond length for pre-stressed cables was highly non-uniform.High stress concentrations were observed at both the fixed end and the free end of the bond length both before and immediately after the state of equilibrium is exceeded.The results obtained can be used to evaluate the overall performance of pre-stressed rock anchors subject to seismic loading and their potential as rockfall prevention and stabilization measures.

Minimally Invasive Percutaneous Catheter Drainage versus Open Laparotomy with Temporary Closure for Treatment of Abdominal Compartment Syndrome in Patients with Early-stage Severe Acute Pancreatitis

This study aimed to examine the clinical efficacy of minimally invasive percutaneous catheter drainage（PCD） versus open laparotomy with temporary closure in the treatment of abdominal compartment syndrome（ACS） in patients with early-stage severe acute pancreatitis（SAP）. Clinical data of 212 patients who underwent PCD and 61 patients who were given open laparotomy with temporary closure in our hospital over the last 10-year period were retrospectively analyzed, and outcomes were compared, including total and post-decompression intensive care unit（ICU） and hospital stays, physiological data, organ dysfunction, complications, and mortality. The results showed that the organ dysfunction scores were similar between the PCD and open laparotomy groups 72 h after decompression. In the PCD group, 134 of 212（63.2%） patients required postoperative ICU support versus 60 of 61（98.4%） in the open laparotomy group（P〈0.001）. Additionally, 87（41.0%） PCD patients experienced complications as compared to 49 of 61（80.3%） in the open laparotomy group（P〈0.001）. There were 40（18.9%） and 32（52.5%） deaths, respectively, in the PCD and open laparotomy groups（P〈0.001）. In conclusion, minimally invasive PCD is superior to open laparotomy with temporary closure, with fewer complications and deaths occurring in PCD group.

HIV Drug Resistance Profiles and Clinical Outcomes in Patients with Viremia Maintained at Very Low Levels

We describe an observational study of clinical, virologic and drug resistance profiles in HIV-positive antiretroviral adherent subjects with stable low level viremia (LLV) 50 - 1000 copies/mL for more than 12 months. Subjects were followed from time of first detectable viral load (VL). In total, 102 episodes of LLV were detected among 80 individuals. The median (mean, range) HIV copy number at genotyping was 250 (486, - 3900) copies/mL after 14 (17.9, 0 - 58) months of LLV. Few patients maintained LLV for the entire 9 years period of observation, with half (52%) experiencing viremic progression following a stable period of LLV either spontaneously or after treatment interruption or failed regimen intensification. In the setting of prolonged periods of sustained LLV, mean duration 22 (range 8 - 106) months, drug resistance (DR) was almost universal. Resistance to ≥1 on-treatment drugs was defined in 97% of specimens and DR to all drugs in the treatment regimen in over half of all patients. Evolution of DR mutations during the period of LLV was observed in 20/28 (71%) subjects with specimens available for follow-up testing. This evolution was associated with viremic progression to levels >1000 copies/mL (p = 0.03). Our data suggest that DR present in patients with LLV is likely to impact long term clinical outcomes, highlighting the importance of optimizing techniques to detect the presence of drug resistant HIV in the setting of LLV and the need for larger prospective studies to assess the emergence of DR in the setting of sustained LLV and the impact of this DR on treatment outcomes.

幕墙“事故”

这个幕墙很有难度。我们邀请了当时最棒的幕墙团队＂晶艺＂来做设计,他们在国家大剧院和？台大剧院项目中都有做的很好。对于幕墙的构造、具体怎么实施等这些我们产生疑问的地方,他们都给予了比较实在的回答。从方案确定,我们就非常关注这个外墙,专门立项去研究讨论,开了很多次专门的幕墙评审会和论证会。最终发生问题,我们觉得首先还是材料选择的问题。建筑外墙顶部难度最大双曲面部分,即使我们先在工厂排序预拼接,到现场后还是有问题。

一项历时20年的研究表明:常蒸桑拿可预防痴呆症（英文）

Visiting the sauna regularly could reduce the risk of dementia,a new study has found.Scientists at the University of East Finland followed more than 2,000middle-aged men for 20 years to find out what factors influenced how many developed cognitive^1 problems in later life.

TREATMENT WITH ACUPUNCTURE AT ZUSANLI (St 36) FOR EPIGASTRIC PAIN IN THE ELDERLY

Acupuncture at a single point is a spe-cial feature in the treatment of acute symp-toms for its simplicity and effectiveness.Theauthor experienced many cases of acuteepigastric pain treated with acupuncture at asingle acupoint with satisfactory results.Pain in the elderly is most often of

A DISCUSSION ON THE DEVELOPMENT HISTORY OF TROPICAL KARST AND ITS PALEOENVIRONMENT IN GUILIN, CHINA

The development of tropical karst in Guilin could be dated back to middle Triassic, i.e. up to 240 million years, and the incipient karst landform was formed from the middle Triassic to the early Jurassic, a period with intensive karstification. Later, the karst in the area has experienced three major periods, that is, the weak period from the middle Jurassic to the late Cretaceous; the intensive period in the Tertiary which was significant to the formation of the old Li River; and the third period lasts the Quaternary period which has completed the typical tropical karst landform. Some ideas about the effect of paleo lake water to the formation of the tropical karst and the ages of caves on different levels in Guilin have been put forward.