对“顽固”方言区学生的纠音方法的探讨——以广东潮汕方言区学生为例

纠音是英语语音教学的一个极为烦琐而重要的任务。不同方言对英语语音的负迁移指数不同，有些方言的发音与英语的差异性较大．形成了英语纠音教学上的“顽固”方言。给“顽固”方言区学生纠音，是一项极具挑战性的工程。本文以广东潮汕方言区学生为对象，参考国内纠音教学上的基本方法，探索纠正“顽固”方言区学生英语发音的途径与策略。

巧化“顽固低音” 演绎“课堂之乐”--小学语文教学中常见问题的积极应对

“顽固低音”是指一组在音乐旋律中反复出现的低音组。小学语文教学中也有很多类似的现象。如一错再错的生字词语、无从下手的阅读理解、让学生不知所措的作文等。语文课堂教学应成为激发学生求知欲,开启学生智慧的充满生机活力的课堂教学。语文教师如果能像欣赏音乐一般欣赏这些问题,巧妙化用音乐中的“连音符”“顿音符”“延音线”等,这些问题也会像“顽固低音”一样迎刃而解且充满魅力。

Management of inflammatory bowel disease with Clostridium difficile infection

To address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. METHODSA systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations. RESULTSIn those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not. CONCLUSIONStrong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.

Current knowledge on the laboratory diagnosis of Clostridium difficile infection

Clostridium difficile (C. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. Infection with C. difficile (CDI) is characterized by diarrhea in clinical syndromes that vary from selflimited to mild or severe. Since its initial recognition as the causative agent of pseudomembranous colitis, C. difficile has spread around the world. CDI is one of the most common healthcare-associated infections and a significant cause of morbidity and mortality among older adult hospitalized patients. Due to extensive antibiotic usage, the number of CDIs has increased. Diagnosis of CDI is often difficult and has a substantial impact on the management of patients with the disease, mainly with regards to antibiotic management. The diagnosis of CDI is primarily based on the clinical signs and symptoms and is only confirmed by laboratory testing. Despite the high burden of CDI and the increasing interest in the disease, episodes of CDI are often misdiagnosed. The reasons for misdiagnosis are the lack of clinical suspicion or the use of inappropriate tests. The proper diagnosis of CDI reduces transmission, prevents inadequate or unnecessary treatments, and assures best antibiotic treatment. We review the options for the laboratory diagnosis of CDI within the settings of the most accepted guidelines for CDI diagnosis, treatment, and prevention of CDI.

Evaluation and management of patients with refractory ascites

Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis （LVP） and transjugular intrahepatic portasystemic stent-shunt （TIPS） are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morlJidity and mortality （most surgical options） rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.

Transjugular intrahepatic portosystemic shunt in liver transplant recipients

AIM： To evaluate the efficacy of transjugular intrahepatic portosystemic shunts （TIPSs） after liver transplantation （LT）. METHODS： Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection （n = 4）, ductopenic rejection （n = 5） or portal vein thrombosis （n = 1） were included in this analysis. Eleven TIPSs （one patient underwent two TIPS procedures） were placed for management of therapy-refractory ascites （n = 7）, hydrothorax （n = 2） or bleeding from colonic varices （n = 1）. The median time interval between LT and TIPS placement was 15 （4-158） mo. RESULTS： TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29% of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10 patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 （range 0.4-20） too. The majority of patients died from sepsis with multiorgan failure. CONCLUSION： Indications for TIPS and technical performance in LT patients correspond to those in non-transplanted patients. At least partial control of therapy-refractory ascites and variceal bleeding could be achieved in most patients. Nevertheless, survival rates were disappointing, most probably because of the advanced stages of liver disease at the time of TIPS placement and the high risk of sepsis as a consequence of immunosuppression.

An Analysis on the Therapeutic Effects of Auriculo-Acupuncture in 38 Obstinate Hiccup Cases of Different Races

The author of this article has treated 38 cases of obstinate hiccup from different countries by using the auriculo-acupuncture therapy, and obtained satisfactory therapeutic results as reported in the following.

Enterovesical fistula caused by a bladder squamous cell carcinoma

Enterovesical fistulas are not uncommon in patients with inflammatory or malignant colonic disease, however, fistulas secondary to primary bladder carcinomas are extremely rare. We herein reported a patient presenting with intractable urinary tract infection due to enterovesical fistula formation caused by a squamous cell carcinoma of the urinary bladder. This patient underwent en bloc resection of the bladder dome and involved ileum, and recovered uneventfully without urinary complaint. To the best of our knowledge, this is the first case reported in the literature.

A case of hypereosinophilic syndrome presenting with intractable gastric ulcers

We report a rare case of hypereosinophilic syndrome （HES） presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacterpylori （Hpylon） eradication therapy followed by proton pump inhibitor （PPI） therapy. However, follow- up endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% （total count： 7903/mm3）. Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylon eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered.

A Dynamic Job Shop Scheduling Method Based on Ant Colony Coordination System

Due to the stubborn nature of dynamic job shop scheduling problem,a novel ant colony coordination mechanism is proposed in this paper to search for an optimal schedule in dynamic environment.In ant colony coordination mechanism,the dynamic job shop is composed of several autonomous ants.These ants coordinate with each other by simulating the ant foraging behavior of spreading pheromone on the trails,by which they can make information available globally,and further more guide ants make optimal decisions.The proposed mechanism is tested by several instances and the results confirm the validity of it.

Analysis of Efficacy of DICE(Dexamethasone,Ifosfamide,Cisplatin and Etoposide)Regimen on Recurrent and Refractory Intermediate and High Grade Non-Hodgkin's Lymphoma

OBJECTIVE Thus far there is no standard salvage regimenfor patients with recurrent and refractory intermediate and highgrade non-Hodgkin's lymphoma (NHL). This study intends toinvestigate the therapeutic efficacy of the DICE (dexamethasone,isofosfamide, cisplatin and etoposide) regimen on the recurrentand refractory NHL, and to observe the related adverse effects.METHODS Clinical records of 22 patients with recurrent andrefractory NHL, who failed to achieve a remission from theCHOP [cyclophosphamide, hydroxydaunomycin/doxorubicin(adriamycin), oncovin, prednisone] regimen within 2 to 6 cyclesof treatment, were reviewed. DICE, as a salvage regimen with amedian course of treatment of 4 cycles (ranging from 2 to 7 cycles),was now used, and evaluation of the therapeutic efficacy andadverse effect of DICE was conducted in all the patients. Of the 22NHL cases, 8 were of T-cell origin and the other 14 B-cell origin.Salvage treatment was performed in the patients, with appraisal,prevention and treatment of the toxic reactions.RESULTS Following DICE treatment in the 22 patients, thetotal effective rate of the regimen was 63.6%, and the completeremission (CR) rate was 40.9%. The effective rates of DICE onthe T and B-cell sourced NHL were 75.0% and 57.1%, and the CRrate were 37.5%, 42.9%, respectively (P >0.05). An increase of thelactate dehydrogenase (LDH) level accompanied by a giant lumpwas the short-term effect on patients with recurrence (mean P <0.05) who were drug resistant. Myelosuppression, digestive systemreaction and alopecia were the commonly-seen complications inthe patients who received DICE regimen. All patients recoveredafter treatment, and no chemotherapy-related death occurred.CONCLUSION DICE regimen is effective in treating refractoryand recurrent NHL.

Clinical Application of the Du Channel

The authors have, in recent years, obtained quite good therapeutic results in their acupuncture treatment of mental diseases, heat syndromes and cerebrovascular diseases through treating mainly the Du Channel with the methods of resuscitating and regulating the mind, and clearing and activating the channels and collaterals. The illustrative cases are reported below.

STUDY ON ACUPUNCTURE AND MOXIBUSTION THERAPY FOR FEMALE URETHRAL SYNDROME

Among 180 patients with female urethral syndrome, 128 were treated by acupuncture and moxibustion and 52 by western medicine as controls. The short-term effective rate in the acupuncture and moxibustion group was 90.6% and the long-term effective rate, 80.4%; whereas the short-term effective rate of the control group was 26.9% (P 0.05). Sixty-nine cases from the acupuncture and moxibustion group and 39 from the control group were subjected before and after treatment to determinations of the maximal bladder pressure, maximal abdominal pressure, bladder-neck pressure, and maximal urethral closure pressure during urination. All these indexes were decreased remarkably in the acupuncture and moxibustion group, while no changes were observed in the control group.

Treatment of 30 patients with intractable facial paralysis by warming-needle moxibustion at B?ihuì(百会 GV 20)combined with penetration needling

Objective To observe the clinical efficacy of moxibustion at B ihuì（百会 GV 20） combined with penetration needling in treatment of intractable facial paralysis. Methods Sixty patients with intractable facial paralysis included in the study were divided into two groups according to the random number table, with 30 patients in observation group（group A）, and 30 patients in control group（group B）. Moxibustion at GV 20 combined with penetration needling were adopted in group A, and simple penetration needling was applied in group B. Once daily, thirty days of treatment were required. The House Brackmann（H-B） facial nerve function grading and improvement of clinical symptoms were observed. Results The H-B function grading and improvement of clinical symptoms in group A were superior to group B, and the difference was statistically significant（P〈0.05）. Conclusion The clinical efficacy of moxibustion at GV 20 combined with penetration needling in treatment of intractable facial paralysis is definite, and the treatment method is deserving of clinical promotion.

Acupuncture combined with herb decoction for intractable hiccup

Objective To observe the efficacy of scalp acupuncture combined with oral administration of ènì Tāng（呃逆汤, Hiccup Decoction） for treatment of intractable hiccup. Methods One hundred patients with intractable hiccup were divided into treatment group（acupuncture combined with herb decoction group） and control group（western medicine group） according to the random number table method with 50 patients in each group. In treatment group, scalp acupuncture was conducted in the gastric area and thoracic area of patients, and Hiccup Decoction was taken orally. In control group, anisodamine（654-2） was injected intramuscularly in the dosage of l0 mg. The treatment was conducted for once a day in each group, and treatment for three consecutive times was needed. The number of times and the frequency of hiccup were observed after each treatment, and the results were compared. The standard of therapeutic effectiveness was evaluated by the number of hiccups decreased. Results In treatment group, the total cure rate was 54%, and the total effective rate was 84%, in control group, the total cure rate was 32%, and the total effective rate was 66%. According to the comparison between the two groups in the cure rate and total effective rate, the differences were statistically significant（both P〈0.05）. After the first treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, after the second treatment, the differences were statistically significant according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）, and the efficacy in treatment group was obviously superior to that in control group, after the third treatment, there was no statistical difference according to the comparison between the two groups in the cure rate and total effective rate（both P〈0.05）. Conclusion In the one course of treatment, the efficacy of acupuncture combined with herb decoction for treatment of intractable hiccup was obviously superior to that of intramuscular injection with anisodamine. The therapeutic effect of intramuscular injection with anisodamine for treatment of intractable hiccup was the best at the first treatment, and the therapeutic effect of acupuncture combined with herb decoction was the best at the second treatment.

Acupuncture combined with cupping therapy for 30 cases of intractable hiccup

Objective： To observe the clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup.Methods： Thirty patients with intractable hiccup were treated by adopting acupuncture combined with cupping therapy. Acupuncture was performed at Cuánzhú（攒竹BL 2）. Nèiguān（内关PC 6）. Zhōngwǎn（中脘CV 12） and Zúsānlǐ（足三里ST 36）, with the time of needle retention for 30 min. Flash cupping was carried out on Fèishū（肺俞BL 13）, Géshū（膈俞BL 17） and Wèishū（胃俞BL 21）, with the time of cup retention for 8-10 min. The treatment was conducted once a day. and 10 treatments were considered as one course of treatment. Clinical efficacy was observed after one course treatment.Results： Among the 30 patients, 22 cases were cured, accounting for 73.33%（22/30）, effective relief was found in 5 cases, accounting for 16.67%（5/30）, and 3 cases had no improvement, accounting for 10.00%（3/30）. The total effective rate was 90.00%（27/30）.Conclusion： The clinical efficacy of acupuncture combined with cupping therapy for intractable hiccup is satisfactory, which is worthy of clinical promotion and application.

Clinical observation on 35 cases of intractable cough treated by long snake moxibustion

Objective To observe the clinical efficacy of long snake moxibustion on the intractable cough. Methods The moxa and the semen brassicae were laid from ＂Dazhui＇ （大椎 GV 24） to ＂Yaoshu＂ （腰俞 GV 2） along the Governor Vessel on the patient＇s back. Moxibustion was repeated continuously for three times as a treatment, two treatments a week, two weeks as a therapeutic course, and then the efficacy was assessed after 2 courses. Results Twenty-eight cases were cured accounting to 80.0% （28/35）; 6 cases were improved accounting to 17.1% （6/35）. The total effective rate was 97.1% （34/35）. Conclusion The effect of the long snake moxibustion was significant on the treatment of intractable cough.

Clinical Observation on Acupuncture Treatment of Intractable Insomnia

Objective:To observe the effects of acupuncture for treatment of intractable insomnia.Methods:Totally 90 patients were randomly divided into a treatment group(50 cases) ,treated by the body acupuncture plus auricular-plaster therapy,and a control group(40 cases) ,the Baihui(GV 20) -through-Sishencong(EX-HN1) puncture,auricular-plaster therapy and moxibustion on the back-shu points were not used in the control group.The clinical effects were observed.Results:The total effective rate was 98.0%in the treatment group and 77.5%in the control group.The therapeutic effect in the treatment group was much better than that in the control group(P<0.01) .Conclusion:The body acupuncture plus auricular-plaster therapy may show better effect for intractable insomnia.