There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between ...There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.展开更多
AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed us...AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.展开更多
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rat...Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.展开更多
BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operati...BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operative management in adhesive SBO.METHODS A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018.Data collated included basic demographics,clinical presentation,biochemistry and imaging results and management outcomes.The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes.The patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for analysis.RESULTS Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both groups.Laboratory tests of inflammatory markers and lactate levels were similar in both groups.From the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical intervention.In patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.展开更多
Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligamen...Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.展开更多
In the process of patriotism education for primary school students,educational drama can play a very important role.However,the premise is that educational drama should be successfully integrated into the process of p...In the process of patriotism education for primary school students,educational drama can play a very important role.However,the premise is that educational drama should be successfully integrated into the process of patriotism education of primary school students,instead of simply and mechanically stuffing educational drama into patriotism education of primary school students.As far as the integration mode of educational drama is concerned,educational drama can be divided into three kinds,namely,discipline-oriented drama education,infiltration-oriented drama education and activity-oriented drama.Therefore,the integration methods are also divided into three categories,namely,setting up educational drama courses,using educational drama to infiltrate patriotic education into other disciplines and carrying out activity-oriented drama education.展开更多
Western legal scholars learn from China’s approach to justice at a seminar held at Oxford University.Mediation can work better than prosecution and prison.
Traditional pre-stack depth migration can only provide subsurface structural information. However, simple structure information is insufficient for petroleum exploration which also needs amplitude information proporti...Traditional pre-stack depth migration can only provide subsurface structural information. However, simple structure information is insufficient for petroleum exploration which also needs amplitude information proportional to reflection coefficients. In recent years, pre-stack depth migration algorithms which preserve amplitudes and based on the one- way wave equation have been developed. Using the method in the shot domain requires a deconvolution imaging condition which produces some instability in areas with complicated structure and dramatic lateral variation in velocity. Depth migration with preserved amplitude based on the angle domain can overcome the instability of the one-way wave migration imaging condition with preserved amplitude. It can also offer provide velocity analysis in the angle domain of common imaging point gathers. In this paper, based on the foundation of the one-way wave continuation operator with preserved amplitude, we realized the preserved amplitude prestack depth migration in the angle domain. Models and real data validate the accuracy of the method.展开更多
Referring to corn breeding literature at home and abroad,the possible ways to improve the efficiency of maize breeding were discussed.The results showed that through the summary and reflection on breeding objectives a...Referring to corn breeding literature at home and abroad,the possible ways to improve the efficiency of maize breeding were discussed.The results showed that through the summary and reflection on breeding objectives and strategies,and improvement and optimization of breeding techniques and methods,as well as adjustment and simplification of experimental design and implementation,the breeding cost would be greatly reduced,and the breeding efficiency would be improved.展开更多
According to the analysis and statistics of relevant institution, it is a prominent problem that CSR reports generally become a mere formality. Through the analysis on the causes, it finds that it is inevitable for th...According to the analysis and statistics of relevant institution, it is a prominent problem that CSR reports generally become a mere formality. Through the analysis on the causes, it finds that it is inevitable for the phenomenon. Thus, we proposed to improve the cultivation mechanism of corporate responsibility by ex- panding and advancing the subject and the object, as well as the contents, of fi- nancial analysis in order to push ahead with CSR report in China.展开更多
It is necessary for precise measurement to estimate the uncertainty of measurement result. When measuring flatness error in close way by pitch, usually the uncertainty of measurement result is independently estimated ...It is necessary for precise measurement to estimate the uncertainty of measurement result. When measuring flatness error in close way by pitch, usually the uncertainty of measurement result is independently estimated according to pitch points. By analyzing a concrete example, this paper proposed that the uncertainty should be evaluated by the correlation calculating method. This approach greatly improved the deficiencies of the assessment method according to independent measurement and enhanced measurement precision. It provides a reference value for uncertainty assessment in leveling a flat.展开更多
文摘There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to follow.This is clearly shown by the discordance between various national and international guidelines on NOM of rectal cancer.The main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical interventions.In many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is achieved.However,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.
基金Supported by In part by a Canada Research Chair to Dr.Bhandariin part by the Canadian Institutes of Health Research and Vancouver Coastal Health Research Institute to Dr.Slobogean
文摘AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.
文摘Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, nonoperative management（NOM） is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma.Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2%（70/72）. The success rates of NOM in the patients with grade I-III, IV and V liver trauma were100%, 94.4% and 83.3%. The complication rates were 10.0%and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived.NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
文摘BACKGROUND Majority of adhesive small bowel obstruction(SBO)cases can be managed nonoperatively.However,a proportion of patients failed non-operative management.AIM To evaluate the predictors of successful non-operative management in adhesive SBO.METHODS A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018.Data collated included basic demographics,clinical presentation,biochemistry and imaging results and management outcomes.The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes.The patients were divided into group A operative(including those that failed initial non-operative management)and group B non-operative for analysis.RESULTS Of 252 patients were included in the final analysis;group A(n=90)(35.7%)and group B(n=162)(64.3%).There were no differences in the clinical features between both groups.Laboratory tests of inflammatory markers and lactate levels were similar in both groups.From the imaging findings,the presence of a definitive transition point[odds ratio(OR)=2.67,95%confidence interval(CI):0.98-7.32,P=0.048],presence of free fluid(OR=2.11,95%CI:1.15-3.89,P=0.015)and absence of small bowel faecal signs(OR=1.70,95%CI:1.01-2.88,P=0.047)were predictive of the need of surgical intervention.In patients that received water soluble contrast medium,the evidence of contrast in colon was 3.83 times predictive of successful non-operative management(95%CI:1.79-8.21,P=0.001).CONCLUSION The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
文摘Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.
基金Supported by National Social Science Foundation (20XZX020).
文摘In the process of patriotism education for primary school students,educational drama can play a very important role.However,the premise is that educational drama should be successfully integrated into the process of patriotism education of primary school students,instead of simply and mechanically stuffing educational drama into patriotism education of primary school students.As far as the integration mode of educational drama is concerned,educational drama can be divided into three kinds,namely,discipline-oriented drama education,infiltration-oriented drama education and activity-oriented drama.Therefore,the integration methods are also divided into three categories,namely,setting up educational drama courses,using educational drama to infiltrate patriotic education into other disciplines and carrying out activity-oriented drama education.
文摘Western legal scholars learn from China’s approach to justice at a seminar held at Oxford University.Mediation can work better than prosecution and prison.
基金supported by the National 863 Program(Grant No.2006AA06Z206)the National 973 Program(Grant No.2007CB209605)CNPC geophysical laboratories and Ph.D innovative funding in China University of Petroleum(East China)
文摘Traditional pre-stack depth migration can only provide subsurface structural information. However, simple structure information is insufficient for petroleum exploration which also needs amplitude information proportional to reflection coefficients. In recent years, pre-stack depth migration algorithms which preserve amplitudes and based on the one- way wave equation have been developed. Using the method in the shot domain requires a deconvolution imaging condition which produces some instability in areas with complicated structure and dramatic lateral variation in velocity. Depth migration with preserved amplitude based on the angle domain can overcome the instability of the one-way wave migration imaging condition with preserved amplitude. It can also offer provide velocity analysis in the angle domain of common imaging point gathers. In this paper, based on the foundation of the one-way wave continuation operator with preserved amplitude, we realized the preserved amplitude prestack depth migration in the angle domain. Models and real data validate the accuracy of the method.
基金Supported by National Science and Technology Support Program(2007BAD69B05)~~
文摘Referring to corn breeding literature at home and abroad,the possible ways to improve the efficiency of maize breeding were discussed.The results showed that through the summary and reflection on breeding objectives and strategies,and improvement and optimization of breeding techniques and methods,as well as adjustment and simplification of experimental design and implementation,the breeding cost would be greatly reduced,and the breeding efficiency would be improved.
文摘According to the analysis and statistics of relevant institution, it is a prominent problem that CSR reports generally become a mere formality. Through the analysis on the causes, it finds that it is inevitable for the phenomenon. Thus, we proposed to improve the cultivation mechanism of corporate responsibility by ex- panding and advancing the subject and the object, as well as the contents, of fi- nancial analysis in order to push ahead with CSR report in China.
文摘It is necessary for precise measurement to estimate the uncertainty of measurement result. When measuring flatness error in close way by pitch, usually the uncertainty of measurement result is independently estimated according to pitch points. By analyzing a concrete example, this paper proposed that the uncertainty should be evaluated by the correlation calculating method. This approach greatly improved the deficiencies of the assessment method according to independent measurement and enhanced measurement precision. It provides a reference value for uncertainty assessment in leveling a flat.
