BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence ...In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.展开更多
Undoubtedly as a master of short stories, Raymond Carver's second collection of short stories invites the reader to reconsider about the topic of minimalism. In this sense, through a detailed analysis of the stori...Undoubtedly as a master of short stories, Raymond Carver's second collection of short stories invites the reader to reconsider about the topic of minimalism. In this sense, through a detailed analysis of the stories collected in What We Talk about When We Talk about Love, the reader will have explicit understanding of the definition of minimalism in literature, the purposes of Carver's application of it and the efficacy brought to the work itself by adopting minimalism.展开更多
Minimalism has become a new consumer trend that can guide low-carbon innovation behaviors.This study uses two experiments and one survey to explore the mechanisms underlying the relationships among minimalism,quantita...Minimalism has become a new consumer trend that can guide low-carbon innovation behaviors.This study uses two experiments and one survey to explore the mechanisms underlying the relationships among minimalism,quantitative behavior,and low-carbon innovation behavior.The results show that(1)minimalism can positively influence consumers’low-carbon innovation behavior;(2)the interactive effect of minimalist and quantitative behavior on low-carbon innovation behavior is significant;and(3)meaning in life can play a significant mediating role in the relationship between minimalism and low-carbon innovation behavior.Finally,corresponding strategies for theory and management practices are proposed.展开更多
Taking religious buildings as the object of study and the Korean architect Kim Young-Sub's art of church design as a sample, the paper attempts to discuss the pronounced effects that minimalist design methods have...Taking religious buildings as the object of study and the Korean architect Kim Young-Sub's art of church design as a sample, the paper attempts to discuss the pronounced effects that minimalist design methods have for building up religious environment from the perspective of space, details, decoration and lighting.展开更多
Raymond Carver, American short story writer and poet is a major force in the revitalization of the short story in the ! 980s. Carver＇s writing permeates idiographic techniques and evocative insights into reality. ＂C...Raymond Carver, American short story writer and poet is a major force in the revitalization of the short story in the ! 980s. Carver＇s writing permeates idiographic techniques and evocative insights into reality. ＂Cathedral＂ is the title story of Carver＇s outstanding collection Cathedral. The story relates that the narrator through the visit of his wife＇s blind friend eliminates the prejudice and goes out of shell of closed-off ignorance. Carver employs precise and concise language to develop plot and reveal characters＇ mind and sets tensions leading to character＇s epiphany. Through the setting of tensions, the achievement of epiphany, and the precise and concise narrative language, Carver makes fullness out of a minimalist style of writing.展开更多
This paper, through the investigation and analysis of economic status, fashion art and consumption psychology in modem society, makes a research of formation background, style features and fashion reflection from mult...This paper, through the investigation and analysis of economic status, fashion art and consumption psychology in modem society, makes a research of formation background, style features and fashion reflection from multiple aspects. And from the perspective of artistic style and garment innovation design, it analyzes the artistic feature of new minimalism culture and style types of garment interlining art, forming systematic theoretical statement.展开更多
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
文摘In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.
文摘Undoubtedly as a master of short stories, Raymond Carver's second collection of short stories invites the reader to reconsider about the topic of minimalism. In this sense, through a detailed analysis of the stories collected in What We Talk about When We Talk about Love, the reader will have explicit understanding of the definition of minimalism in literature, the purposes of Carver's application of it and the efficacy brought to the work itself by adopting minimalism.
基金This research was supported by Zhejiang Provincial Social Science Foundation of China[Grant number.22LLXC017YB]。
文摘Minimalism has become a new consumer trend that can guide low-carbon innovation behaviors.This study uses two experiments and one survey to explore the mechanisms underlying the relationships among minimalism,quantitative behavior,and low-carbon innovation behavior.The results show that(1)minimalism can positively influence consumers’low-carbon innovation behavior;(2)the interactive effect of minimalist and quantitative behavior on low-carbon innovation behavior is significant;and(3)meaning in life can play a significant mediating role in the relationship between minimalism and low-carbon innovation behavior.Finally,corresponding strategies for theory and management practices are proposed.
文摘Taking religious buildings as the object of study and the Korean architect Kim Young-Sub's art of church design as a sample, the paper attempts to discuss the pronounced effects that minimalist design methods have for building up religious environment from the perspective of space, details, decoration and lighting.
文摘Raymond Carver, American short story writer and poet is a major force in the revitalization of the short story in the ! 980s. Carver＇s writing permeates idiographic techniques and evocative insights into reality. ＂Cathedral＂ is the title story of Carver＇s outstanding collection Cathedral. The story relates that the narrator through the visit of his wife＇s blind friend eliminates the prejudice and goes out of shell of closed-off ignorance. Carver employs precise and concise language to develop plot and reveal characters＇ mind and sets tensions leading to character＇s epiphany. Through the setting of tensions, the achievement of epiphany, and the precise and concise narrative language, Carver makes fullness out of a minimalist style of writing.
文摘This paper, through the investigation and analysis of economic status, fashion art and consumption psychology in modem society, makes a research of formation background, style features and fashion reflection from multiple aspects. And from the perspective of artistic style and garment innovation design, it analyzes the artistic feature of new minimalism culture and style types of garment interlining art, forming systematic theoretical statement.
