Based on the construction project of the Changjiashan tunnel of the freeway,the variety rule of surrounding rock masses of the tunnel through the gob of coalmine wasstudied by using of finite element methed(FEM).The s...Based on the construction project of the Changjiashan tunnel of the freeway,the variety rule of surrounding rock masses of the tunnel through the gob of coalmine wasstudied by using of finite element methed(FEM).The status of the stress and strain,thevariety of the plastic area were simulated in the whole rock mass before and after thetunnel was excavated.The characters of stress and deformation of surrounding rockmasses were analyzed when the tunnel was built.It concluded from the numerical simula-tion that the influence on the tunneling is great when the tunnel passing through the gob ofcoalmine is excavated,and the relative measures should be taken.展开更多
AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty s...AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.展开更多
Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterol...Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum endpoints in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce welltrained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal ofthese programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.展开更多
Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in we...Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.展开更多
文摘Based on the construction project of the Changjiashan tunnel of the freeway,the variety rule of surrounding rock masses of the tunnel through the gob of coalmine wasstudied by using of finite element methed(FEM).The status of the stress and strain,thevariety of the plastic area were simulated in the whole rock mass before and after thetunnel was excavated.The characters of stress and deformation of surrounding rockmasses were analyzed when the tunnel was built.It concluded from the numerical simula-tion that the influence on the tunneling is great when the tunnel passing through the gob ofcoalmine is excavated,and the relative measures should be taken.
文摘AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.
文摘Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum endpoints in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce welltrained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal ofthese programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.
基金Supported by Food Standards Agency, N12105Northumbria Colorectal Research Funds
文摘Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.
