Non-steroidal anti-inflammatory drugs in postoperative hand fracture management:Do they positively or negatively impact recovery?

This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

Hanoi Public TransportmTransformation by Management Using Action Research and Behavior Setting Theory

After the economic reforms in Vietnam, the number of motorbikes surged while public transport lost its passengers. No funds for investment available TRAMOC （Transport Management and Operation Centre）, the Transport Management and Operation Center started the experiment of transforming Hanoi Public Transport by management based on action research, introducing some interventions, which had shown to be effective in Europe. Phase I of the experimental approach was carried out with the smallest company that operated Line 32. The number of daily passengers surged from 1,700 to 8,000. In Phase II, the experiment was extended to the whole net. In 2001, there were 35,000 passengers per day, in 2010, there were 1 million; this is an increase of 3,000%. The result surpassed by far the expectations. The key for understanding the surprising results is the mode choice. 53% of the users are riders by choice; they have access to a car or motorbike. Simulation of the decisions as rational choice based on time needed for trips was proved to be quite accurate. Behavior was analyzed in the frame of behavior setting theory, which brings together urban structure and the design of the transport system. Success with introducing public transport needs a self-reliant leadership, which works with people in their real life situation. An urban transport system is part of the organized behavior of the people, who make use of the technical opportunities offered.

Impacts of Bad Weathers in Growing Season on Apples and Post-disaster Management Measures

Apple cultivation has special requirements for climatic conditions. The period from May to August is a key period for apple growth.During this period,extreme weather occurs frequently,such as extreme high temperature,strong wind,hail,and floods. This paper introduced these extreme weathers and came up with some corresponding management measures.

Influence of Diesel Engine Intake Throttle and Late Post Injection Process on the Rise of Temperature in the Diesel Oxidation Catalyst

In order to effectively implement DPF(Diesel Particulate Filters)regeneration control,thermal management of exhaust products before and inside Diesel Oxidation Catalyst(DOC)is necessary.In the present study,the Influence of the intake throttle valve and late post injection process on temperature rise inside DOC is analyzed through engine bench tests.The steady experiment results show that adjustment of the intake throttle valve can effectively increase exhaust temperature before DOC;in particular,with intake throttle valve opening at 20%,temperature before DOC can be increased by about 170℃ with respect to the full opening.An increase in the late post injection quantity can produce a significant rise of the temperature inside DOC,however its impact on the exhaust temperature before DOC is relatively limited.As the late post injection quantity increases,Hydrocarbon(HC)emissions also grow;in the present work it is shown that with a proper injection quantity,a considerable temperature increase inside the DOC can be obtained with relatively low HC emission.More specifically,with the intake throttle valve at 30%and DOC reaching ignition temperature as the late post injection quantity is increased,the exhaust temperature after DOC can be made larger than 550℃,adequate for DPF active regeneration.

Challenges in the Management of Sepsis in a Resource-Poor Setting

Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in the management of sepsis in a resource limited setting and make appropriate recommendations. Methodology: The data was collected through an online literature search for cases of sepsis managed in resource limited settings from 1990 to 2015. Search terms used included: “sepsis”, “septicaemia”, “incidence”, “prevalence”, “morbidity”, “mortality” and “management challenges” using the English and American spellings. Studies from peer reviewed journals or those presented in professional conferences were selected. Finally, studies with proper definition of sepsis and positive blood cultures were selected. Result: Twenty one studies from eleven resource limited settings were found. A total of 14,862 cases of sepsis were studied with 9260 (62.3%) of neonatal sepsis and 5602 (37.7%) of post neonatal sepsis. Challenges in the management of sepsis that were identified at the community level included: false cultural beliefs and practices, ignorance and poverty, poor health seeking behavior, late presentation, lack of access to skilled care and patronage of unskilled medical practitioners. While challenges identified at the hospital level include: poor knowledge skills of the health workers, delay in making a diagnosis and initiating treatment, poorly equipped laboratory materials and personnel, no protocol for management of sepsis, limited supply of bedside monitoring equipment, poor staffing, repeated industrial actions, use of fake drugs and high cost of care and drugs. Conclusion and recommendation: Management of sepsis in resource limited settings is an uphill task and requires health education and re-orientation of the people. To significantly reduce the mortality associated with sepsis, there is a need to bring health care services to the communities where the people are, improve the management skills of health professionals and translate major components of sepsis management to resource limited settings.

Clinical and genetic characteristics of a child with Sotos syndrome and attention-deficit/hyperactivity disorder:A case report

BACKGROUND Sotos syndrome is an autosomal dominant disorder,whereas attention-deficit/hyperactivity disorder(ADHD)is a neurodevelopmental condition.This report aimed to summarize the clinical and genetic features of a pediatric case of Soros syndrome and ADHD in a child exhibiting precocious puberty.CASE SUMMARY The patient presented with accelerated growth and advanced skeletal maturation;however,she lacked any distinct facial characteristics related to specific genetic disorders.Genetic analyses revealed a paternally inherited heterozygous synonymous mutation[c.4605C>T(p.Arg1535Arg)].Functional analyses suggested that this mutation may disrupt splicing,and bioinformatics analyses predicted that this mutation was likely pathogenic.After an initial diagnosis of Sotos syndrome,the patient was diagnosed with ADHD during the follow-up period at the age of 8 years and 7 months.CONCLUSION The potential for comorbid ADHD in Sotos syndrome patients should be considered to avoid the risk of a missed diagnosis.

Intensive diabetes management and goal setting are key aspects of improving metabolic control in children and young people with type 1 diabetes mellitus

Diabetes control in children remains poor in spite of advances in treatment for last 10 years. The aim of this review was to look at various aspects of intensive therapy in the management of type 1 diabetes such as insulin regimes, role of target setting, psycho-educational approaches and self-management. To achieve good metabolic control, clear goal setting with adequate support for self-management are essential. Psycho-educational and behavioural interventions aimed at specific areas of management have shown significant improvement in quality of life and diabetes control.

Multimodal Pain Management in the Perioperative Setting

In the context of the current U.S. opioid crisis, there is renewed interest and heightened relevance in the practice of multimodal analgesia for postoperative surgical patients. The goal of this review article is to present an accounting of the available opioid and non-opioid pharmacologic agents, regional analgesia techniques, and complementary modalities that may be considered for optimal pain relief in the perioperative setting. In adhering to the practice of multimodal pain therapy, clinicians improve the quality of pain control and reduce reliance on opioid use. There is strong evidence to support the benefits of multimodal analgesia.

Uterotonic drugs use for post partum hemorrhage: An audit of the third stage of labor management

Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.

Difficulties and Countermeasures of Enterprise＇s Post Internship Management

Relative policies, enterprise＇ s human resources management theories and colleges＇ internship management systems were reviewed, the difficulties of enterprise＇ s post internship management were analyzed and countermeasures were put forward from the perspective of colleges in order to lower enterprise＇ s risk, foster internship work to carry out smoothly and realize the benefits of college, enterprise and students.

The Necessity and Implementation of the Entrepreneurship Management Platform Course Framework under the New Normal

Regardless of economic development,the transformation of marketing methods and the needs of a university’s own development requires the establishment of an Entrepreneurship Management platform course.From the perspective of economic development,after satisfying rigid demands,many people’s needs tend to be niche;from the marketing perspective,the era of e-commerce has arrived;and from the perspective of the university’s own transformation,there is an urgent need to reform economic management majors and improve the quality of teaching.In the construction and implementation of the Entrepreneurship Management platform curriculum framework,the following must be critically considered:the selection of students,the curriculum,the allocation of teachers,the innovation of management systems,the provision of teaching hardware and the support and cooperation of the government and society.

Standardizing Management of Post-Dural Puncture Headache in Obstetric Patients: A Literature Review

Post-dural puncture headache continues to be a significant cause of morbidity in parturients. Despite being a common complication faced by many anesthesiologists, there is a lack of consensus regarding its management. Many still use traditionally taught treatments such as strict bed rest and aggressive hydration despite lack of evidence for their usage. Few are using newly tested treatments such as gabapentin and ACTH despite being proven effective in randomized controlled trials. Furthermore, when and how the epidural blood patch should be used is contentious between different practitioners. This review aims at answering what is the best strategy to manage post-dural puncture headache and proposes an evidence-based practice guideline.

British Tourism Higher Education Curriculum and Education System—Taking the University of Surrey as an Example

A reasonable curriculum system and teaching content can make the talent training of tourism higher education institutions more in line with the needs of the tourism industry.As the birthplace of the world's modern tourism industry,the UK has always been at the forefront of tourism development and has become the pillar of the UK.The industry and the tourism industry have a large number of talents.It can be seen that the tourism higher education in the UK must have certain characteristics and advantages to support the development of its tourism industry.Therefore,this paper takes the comparatively mature university of the University of Surrey in the United Kingdom as an example.Through the analysis of the education system and curriculum of the tourism-related departments,it is found that the curriculum of tourism higher education in British universities and the characteristics of the education system.And through this analysis,it provides a reference for China's tourism higher education.

Evaluation of the post-fire erosion and flood control works in the area of Cassandra(Chalkidiki, North Greece)

We quantified morphological and hydrographical characteristics of two drainage basins（Chanioti and N. Skioni） on Cassandra peninsula of Chalkidiki（North Greece）, and evaluated the effectiveness of post-fire flood and erosion control works. The drainage basins were chosen because of their severe damage by fire, post-fire potential for erosion and flood due to the steep relief, and the importance of the area for residential and tourism development. The first measures taken in the area after the fire were salvage cutting of burned trees, a total ban on grazing, and construction of three types of works, log erosion barriers（LEBs）, log check dams and contour branch barriers. Almost all necessary post-fire works were completed in both catchments but many construction failures were recorded. Approximately 75 % of the LEBs and45 % of the contour branch barriers functioned properly,while the remainder failed. Nearly 80 % of the log dams were sedimented to 0–20 % of the dam height, 14.3 %were 20–40 % filled and 5.9 % collapsed. Despite these failures, peak discharge declined by 10.5 % in Chanioti and 20.4 % in N. Skioni catchment. The main reasons for works failures were the rush of construction and the limited supervision of workers, which resulted in floods during the years that followed.

System for the Management of the Continuity of Use of Medical Devices in Hospitals

The Technical Services and the Medical Administration of the Hospitals of Trieste have been working for years to ensure the optimal functioning of the Surgery, Intensive Care, Diagnostics and Research Services offered to the Patients and to the University in an 800-bed hospital complex, transforming and innovating the buildings and support installations. We have dedicated special attention to the technologies necessary to guarantee the continuity of the power supply to the electromedical devices, increasingly numerous in highly specialized hospitals. We report the power of the generator sets and the UPS and our opinion that their power must be related to the overall consumption of the hospital, with a reserve margin.

Study on Designing Standards System Framework of Hainan National Breeding and Multiplication

A preliminary feasibility study was set up for the HNBM standard system. By introducing the set theory and basic methods of the solid geometry and adopting the Verman three-dimensional structure ideology innovatively, the standards system of Hainan National Breeding and Multiplication (HNBM) was studied with the four-dimensional structure and integration by combining with the time dimension. The four-dimensional structure standards system will be useful for guiding the construction of the HNBM standards system, carrying on the division of labor and realizing the dynamic development of the standards system. The standards set of HNBM helps to computer programming and information management.

Major gastrointestinal bleeding and antithrombotics: Characteristics and management

BACKGROUND There are few reports on major gastrointestinal(GI)bleeding among patients receiving an antithrombotic.AIM To describe clinical characteristics,bleeding locations,management and inhospital mortality related to these events.METHODS Over a three-year period,we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1,2013 and December 31,2015 for major GI bleeding while receiving an antithrombotic.The bleeding events were medically validated.Clinical characteristics,causative lesions,management and fatalities were described.The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding.No cause was identified for 383(35.5%)patients.Gastro-duodenal ulcer was the first causative lesion in the upper tract(209 out of 408)and colonic diverticulum the first causative lesion in the lower tract(120 out of 289).There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations(P=0.03).There was an independent association between gastro-duodenal ulcer and antithrombotic use(P=0.03),taking account of confounders and proton pump inhibitor coprescription.Pair wise comparisons pointed to a difference between vitamin K antagonist,direct oral anticoagulants,and antiplatelet agents in monotherapy vs dual antiplatelet agents.CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding.Management was similar across antithrombotics and in-hospital mortality was low(5.95%).

Conservative approach to the acute management of a large mesenteric cyst

Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large(21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

Ontology mapping approach based on set & relation theory and OCL

An ontology mapping approach based on set & relation theory and OCL is introduced,then an ontology mapping meta-model is established which is composed of ontology related elements,mapping related elements and definition rule related elements.This ontology mapping meta-model can be regarded as a unified mechanism to realize different kinds of ontology mappings.The powerful computation capability of set and relation theory and the flexible expressive capability of OCL can be used in the computation of ontology mapping meta-model to realize the unified mapping among different ontology models.Based on the mapping meta-model,a general mapping management framework is developed to provide a common mapping storage mechanism,some mapping APIs and mapping rule APIs.