Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.

Diet fortification for mild and moderate picky eating in typically developed children:Opinion review of Middle East consensus

BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.

An efficient conversion model between acceleration and pseudo-acceleration response spectra considering effects of magnitude,distance,and site class

Both acceleration and pseudo-acceleration response spectra play important roles in structural seismic design.However,only one of them is generally provided in most seismic codes.Therefore,many studies have attempted to develop conversion models between the acceleration response spectrum(SA)and the pseudo-acceleration response spectrum(PSA).Our previous studies found that the relationship between SA and PSA is affected by magnitude,distance,and site class.Subsequently,we developed an SA/PSA model incorporating these effects.However,this model is suitable for cases with small and moderate magnitudes and its accuracy is not good enough for cases with large magnitudes.This paper aims to develop an efficient SA/PSA model by considering influences of magnitude,distance,and site class,which can be applied to cases not only with small or moderate magnitudes but also with large ones.For this purpose,regression analyses were conducted using 16,660 horizontal seismic records with a wider range of magnitude.The magnitude of these seismic records varies from 4 to 9 and the distances vary from 10 to 200 km.These ground motions were recorded at 338 stations covering four site classes.By comparing them with existing models,it was found that the proposed model shows better accuracy for cases with any magnitudes,distances,and site classes considered in this study.

Changes in River Cross-section Morphology and Response to Streamflow and Sediment Processes in Middle Reaches of Yellow River,China

Changes in river cross-section morphology have decisive influences on the flood discharge and sand transport capacity of rivers;thus,these changes strongly reflect the vitality of a river.In this paper,based on the river cross-section and water and sediment data of two different periods(1974−1987 and 2007−2021),the trend analysis,change-point analysis and sediment rating curve method were used to analyze the change process of river cross-section morphology and its response to streamflow and sediment changes in the main river stream of the Yellow River at the Longmen hydrological station.From 1974 to 1987(except in 1977),the riverbed experi-enced siltation,and the riverbed elevation rose.Conversely,from 2007 to 2021,the riverbed experienced scouring,and the riverbed el-evation gradually decreased.The cross-section shape changed from rectangular to U-shaped(deeper on the right side)at the Longmen cross-section.The changes in streamflow and sediment processes significantly impacted the evolution of river cross-section.Stream-flow(P<0.05),sediment discharge(P<0.01),and the sediment load coefficients(P<0.01)decreased significantly.The relationship between the water depth and sediment load coefficients followed a power function.The decreasing trend in sediment discharge was sig-nificantly stronger than that in streamflow.Suspended sediment particles tended to become finer.The sediment rating curve indicates that the sediment supply from upstream decreased while the erosive power in the river channel increased,leading to a gradual decline in riverbed elevation at the Longmen cross-section from 2007 to 2021.These findings help us better understand the impacts of ecological restoration on changes in river streamflow and sediment during river evolution.

Improved super-elastic Ti-Ni alloy wire for the angle class III patient with anterior open bite:A case report

BACKGROUND Orthodontic treatment for open bite and crossbite cases is always challenging.In this paper,we demonstrate a skeletal class III patient with anterior open bite and crossbite whose problem was successfully corrected with improved super-elastic Ti-Ni alloy wire(ISW).CASE SUMMARY A 19 years old male came to our clinic with a chief complaint of anterior open bite and crossbite and not able to chew food well.Clinical examination revealed an angle class III malocclusion with anterior open bite,crossbite and spaced arch.Ra-diographic and clinical examination showed a skeletal class III pattern.We used ISW to level the upper and lower arch and to correct the anterior open bite and crossbite.Intermaxillary elastics were also used to achieve a better interdigitation.Finally,adequate overbite,overjet and a desirable occlusion were achieved.The active treatment time took 2 years and 2 months.CONCLUSION In a case of class III angular malocclusion with open bite and crossbite in the ante-rior teeth,ideal results were achieved using the ISW technique and the patient was satisfied with the outcome.

Consumption and Culture： Understanding the Shaping of the New Brazilian Middle Class

In a recent historical process of economic stabilization and of social policies focused on the disadvantaged, major changes in the composition of the Brazilian social pyramid are happening. Driven by the increase of employment and income, in conditions of low inflation and abundant credit, millions of Brazilians have increased in recent years their purchasing power and started to acquire their own home and car--gaudiest symbols of joining the middle class--as well as a wide range of consumer goods. It appears that this set of transformations profoundly altered the perceptions and strategies of social mobility. So this phenomenon is being called the shaping of the new Brazilian middle class. The fact is that there is a group growing, sustained mainly by a decrease in income inequality. In this study, we attempted to draw a clear overview and some disagreements about the emergence of a new Brazilian middle class. On the topic of the emergence of a new Brazilian middle class, one can say that it is not a completely true fact, and that there was actually an expansion of the income of families who still harbor extreme ties with the working classes and why not, popular classes. What to some scholars would be the emergence of a new working class, whose average income is approaching the middle income of what is considered as the lower middle class？

PAD Class教学模式对英语专业学生写作焦虑影响的实证研究

本研究以英语专业大一120名学生为实验对象,进行了为期16周的实证研究,以探讨PAD class教学模式对英语专业学生写作焦虑的影响。基于《二语写作焦虑量表》调查问卷结果表明:英语专业学生总体焦虑处于中等焦虑水平,PAD Class能有效降低学生的写作总体焦虑,其中课堂焦虑、构思焦虑、自信焦虑明显降低,但回避焦虑没有达到显著水平;PAD Class模式对高中低不同写作水平学生的写作焦虑都有影响,对中、低水平学生的写作焦虑缓解比对高水平学生的影响效果更明显。

A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma.We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma.Middle ear cholesteatoma surgeries were divided into four types and two special types as follows:type I,attic retraction pocket,which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction;typeⅡ,cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions,including type Ⅱa,requiring only use of a curette,and type Ⅱ b,requiring use of an electric drill or chisel;type Ⅲ,cholesteatoma not limited to the attic,in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions,requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and"Canal Wall Up"mastoidectomy;type Ⅳ,extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications,removal of which can only be performed under a microscope for"Canal Wall Down"mastoidectomy.In addition,there were two special types:"difficult external auditory canal"and congenital cholesteatoma in children.In our system,type I and type U middle ear cholesteatoma surgery was completely performed under an endoscope alone.However,estimating the extent of the lesions,determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma.The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.

Classification of facial nerve aberration in congenital malformation of middle ear:Implications for surgery of hearing restoration

Objectives: Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear.The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.Methods: A retrospective study involving review of clinical data of 227 patients(256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography(CT) data, surgical records and videos.Results: Aberration involving intratemporal facial nerve was found in 82/256 ears(32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window(50/82 ears, 60.98%), bifurcation(3/82 ears, 3.66%) and transverse over the promontory(3/82 ears, 3.66%), counting for 68.29%(56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears(92.68%) and atresia or stenosis of the oval window in 27/82 ears(32.93%). In 9/82 ears(10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis(TORP) implantation and Vibrant Soundbridge(VSB) implantation.Conclusion: The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.

The Consumption Practices and Identity Formation of the Chinese Middle Class in the Media Era

During the past 40 years following the reform and opening-up policy of 1978,China’s social structure has seen great changes,which include the birth and rapid development of the Chinese middle class as a derivative and consequence of modernization.They are the main source of consumption in contemporary China and display unique characteristics in their consumption practices.Consumption is not only a daily practice,but also a means of demonstrating and forming identity.In this media era,media play an important role in people’s consumption practices and identity formation.In this study,semi-structured interviews were carried out with members of the Chinese middle class to study the relationship between consumption,identity,and media through their oral accounts.Moreover,problems,including the characteristics of middle-class consumption practices and how they use consumption to form identity,were analyzed.This study not only complements studies on the sociology of consumption of the Chinese middle class,but also is of great practical significance for deepening our understanding of the behavioral and ideological characteristics of the Chinese middle class.

Biden Administration’s Foreign Policy for the Middle Class

The Biden administration’s political platform,set during the 2020 US presidential campaign,called for"a foreign policy for the middle class"and this has subsequently been instituted as a policy commitment.The new administration’s economic and trade policy targets enhancing US competitiveness,setting rules for economic globalization and keeping good relations with democratic states.Security policy emphasizes diplomatic means over military practices.The foreign policy for the middle class aims to resolve differences in the Democratic Party between traditional Democrats and progressives.It is also crafted to solve domestic and international problems and burnish America’s international image,but it faces an uphill battle if it wishes to restructure foreign policy to serve the needs of the American middle class.

The Critical Significance of Middle Class America for a Collective U.S. Prosperity and Socioeconomic Sustainability

The shrinking size of middle class in the U.S. has motivated this research work. The focus of this research has been on sustainability of society through middle-class promoting public policy. We have estimated three various regression equations to test the significance of several socio-economic variables on what would define some desirable indices of healthier nations such as mean years of schooling, human development, and quality of life. Quality of life in certain countries such as Norway, Denmark, etc., is highlighted as best, compared to many other nations of the world. We have introduced a better measure of quality of life and estimated the empirical impacts of some explanatory variables, such as healthcare, property price to income ratio, and pollution on that index of life quality. An implication of this study for public policy would be revealed in clear needs for reducing pollution, more income creating innovative objectives, while healthcare accessibility and the corresponding costs to citizens must be brought down.

A Cross-Cultural Initiative： Engaging China＇s Middle Class

This study provides an evaluation of China＇s growing middle class, the new consumers for world economies and estimated to be 300-500 million people. By using internal analysis of market and nonmarket variables, we detail how the future growth rate of the middle class is dependent on three issues： domestic consumption trends of Generation Y in China, the valued opportunity of the science and technology industry, and the importance of maintaining a strong work force able to increase productivity. In particular, we discuss market demands from Generation Y, products best suited for Chinese consumers, and the effect social-economic inequalities in Western China will have on development measures of the middle class. Based on data collection, interviews, library research and econometric analyses, we show how these above issues will continue to influence consumer behavior, reform policies, and the growth of the middle class in China. It is important to note that economic growth and prosperity in China will only continue if the national government and private institutions, along with the international agendas of other countries, are in balance, and not excess, of the resources and capabilities available for desired growth levels.

Marketing Factors Affecting Middle Class Consumer’s Buying Decision in Housing Market in Nanning City

It is important to study the relationship between marketing factors and purchase decisions of middle-class consumers in Nanning housing market.This study will investigate the factors influencing people decision to purchase houses in Nanning City.The extrinsic housing attributes at this study consist of environmental attributes and location attributes.I have a limited understanding of the purchase behavior of Nanning home buyers in Nanning City.This study adopts the data collection methods of e-mail and field survey.Based on 509 questionnaires,the data were analyzed using descriptive statistics analysis and logistic regression.The results show that location attributes,such as school districts,positively influence housing purchase decisions in Nanning City.This study contributes to an improved understanding of home buyers’decision making in Nanning City.The beneficiaries of this study include home buyers and marketers and academic institutions.To better meet home buyers’needs and achieve a competitive advantage,marketers can use the research outcomes to focus more on those housing purchase factors that significantly influence house buyers’purchase decision making.

A Study of the Differences Between China and UK Classroom Teaching in Middle Schools Based on a BBC Documentary

This paper aims to analyze the differences between China and UK classroom teaching in middle school based on a case study ofa BBC documentary, Are Our Kids Tough Enough-Chinese School. The author found that there were many significant differences between the two countries in terms of the relationship between teacher and student, classroom teaching style and teaching methods.

A Study On the Structural Dimension of Middle Class Relational Identification in Chinese Context

Through in-depth interviews,this study makes an exploratory study on the dimension of the middle class relational identification in Chinese context by using the grounded theory.It is mainly composed of 4 dimensions:relational orientation,relational adaptation,relational evaluation and relational development.According to the four dimension model of middle class relational identification,the middle class relational identification in China is the cognitive and behavioral orientation that in the action of achieving a certain purpose,because of the perception of consistence with each other in role cognition and personal cognition,the middle class is willing to unite and trust,respect and understand and coordinate the conflict to adapt to this relationship,and then to form a positive evaluation of the relationship and a sense of belonging and commitment to this relationship.The construction of the structural dimension of middle class relational identification in China is conducive to explaining the endemic phenomena of Chinese middle class.

White Collar:The Middle Classes

White Collar:The American Middle Classes is a famous book written by Mills,C.Wright.In this book,Mills gave a description of the emergence of a"new class",the white-collar workers,during that age in US.He also mentioned about their life styles and their political consciousness.This thesis is to compare the different definitions of middle class in China and in US,and comment on the life styles and the political consciousness of the white collars in China.

Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Multimedia Used for English Class in Middle School

The multimedia application got involved in middle school teaching.It is not only supporting the teaching information but also developing and optimizing the traditional language teaching ways.This paper discusses the application of the multimedia and in the multimedia' s audio-visual environment,how to utilize the multimedia skills to strengthen the teachers' hand、students' listening ability、visual acuity and imaginative power;Meanwhile,it points out some problems existing in multimedia teaching.

The Application of Situational Teaching Approach in Senior Middle School English Class

With the rapid advancing of the new English curriculum reform, English teaching has also been enriched constantlyand many teaching approaches have sprung up. Situational teaching is one of them, as one of the most popularteaching approaches, playing a crucial role in English classroom teaching. This paper is mainly devoted toexploring the origins and development of situational teaching approach, functions as well as ways to apply it tosenior middle school English classes. Moreover, it presents a teaching case of the author in the end. Finally, thispaper tries to seek for feasible and practical ways to improve the teaching efficiency.