笑口常开

一吐为快勤务兵喜饶舌，其长宫与宾客谈话时亦无昕忌讳，喋喋不休。长官积怒已久，一日对其严斥，并约法三章：“今后我与客谈话，你再来插嘴，就枪毙你!”

Recent results of laparoscopic surgery in inflammatory bowel disease

Inflammatory bowel diseases are an ideal indication for the laparoscopic surgical approach as they are basically benign diseases not requiring lymphadenectomy and extended mesenteric excision;well-established surgical procedures are available for the conventional approach.Inflammatory alterations and fragility of the bowel and mesentery,however,may demand a high level of laparoscopic experience.A broad spectrum of operations from the rather easy enterostomy formation for anal Crohn’s disease(CD)to restorative proctocolectomies for ulcerative colitis(UC)may be managed laparoscopically.The current evidence base for the use of laparoscopic techniques in the surgical therapy of inflammatory bowel diseases is presented.CD limited to the terminal ileum has become a common indication for laparoscopic surgical therapy.In severe anal CD, laparoscopic stoma formation is a standard procedure with low morbidity and short operative time.Studies comparing conventional and laparoscopic bowel resections,have found shorter times to first postoperative bowel movements and shorter hospital stays as well as lower complication rates in favour of the laparoscopic approach.Even complicated cases with previous surgery,abscess formation and enteric fistulas may be op-erated on laparoscopically with a low morbidity.In UC, restorative proctocolectomy is the standard procedure in elective surgery.The demanding laparoscopic approach is increasingly used,however,mainly in major centers; its feasibility has been proven in various studies.An increased body mass index and acute inflammation of the bowel may be relative contraindications.Short and longterm outcomes like quality of life seem to be equivalent for open and laparoscopic surgery.Multiple studies have proven that the laparoscopic approach to CD and UC is a safe and successful alternative for selected patients. The appropriate selection criteria are still under investigation.Technical considerations are playing an important role for the complexity of both diseases.

Treatment of advanced rectal cancer after renal transplantation

Renal transplantation is a standard procedure for endstage renal disease today. Due to immunosuppressive drugs and increasing survival time after renal transplantation, patients with transplanted kidneys carry an increased risk of developing malignant tumors. In this case report, 3 patients with advanced rectal cancer after renal transplantation for renal failure were treated with anterior resection or abdominoperineal resection plus total mesorectal excision, followed by adjuvant chemotherapy. One patient eventually died of metastasized cancer 31 mo after therapy, although his organ grafts functioned well until his death. The other 2 patients were well during the 8 and 21 mo followup periods after rectal resection. We therefore strongly argue that patients with advanced rectal cancer should receive standard oncology treatment, including operation and adjuvant treatment after renal transplantation. Colorectal cancer screening in such patients appears justified.

The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients

The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.

Comparison of RFFIT Tests with Different Standard Sera and Testing Procedures

The World Health Organization （WHO） standard assay for determining antibody level is the rapid fluorescent focus inhibition test （RFFIT） and is used to determine the degree of immunity after vaccination against rabies. To compare the difference in RFFIT results between the laboratories of The National Institute of Infectious Disease in Japan （NIID） and the Chinese Centre for Disease Control （CCDC） as well the influence of the choice of standard serum （STD） for the detection, the two laboratories detection methods were simultaneously manipulated by RFFIT. The reference serums used in NIID and the WHO standard serum used in CCDC were compared in the same RFFIT detection to determine the titer of four sera samples C1, Sl, S2 and S4 in parallel, and the titers of the detected sera samples were calculated using the standard formula for neutralizing antibody titer. No significant difference was found in RFFIT methods from the two laboratories and the RFFIT testing procedures of the two laboratories have good consistency. However, different titers were obtained with the tentative internal standard serum （TI-STD） produced by adjusting to 2.0 IU of WHO standard serum in NIID and the WHO STD. The titer determined with the TI-STD was higher than that determined with WHO STD, This difference appears to be significant and requires further investigation

International Trade Needs Standardization in China

This article introduces the concepts of international trade procedures simplification and standardization, and illustrates implememt procedures and methods, furthermore, it puts forward proposals for training of international trade procedures simplification and standardization.

Carbon Footprint Analysis for Baby Strollers

The increasing awareness of climate change has led organizations to demand a standard procedure to measure and communicate greenhouse gas(GHG) emissions linked to their products or services.The publicly available specification PAS 2050 has been developed in response to broad community and industry desire for a consistent method-carbon footprint for assessing the life cycle GHG emissions of goods and services.Specifically,this paper illustrates the implementation of carbon footprint for a baby stroller in accordance with PAS 2050.A fial value of 321 kg per one stroller including package was calculated.Moreover,the study led to identify raw materials production of the stroller as the main source of GHS emissions where efforts need to focus for emission reduction opportunities.This case study is hoped to be a starting point for organizations to benefit from the increasing application of carbon footprint assessment.

Surgical techniques for improving hemostasis during Bentall procedure

Objective:To evaluate the effect of modified surgical techniques on hemostasis used in aortic root replacement with a composite graft(Bentall procedure).Methods:Data on 15 patients who underwent Bentall procedure during 2005 to 2007 were analyzed.The first 5 patients(Group 1) received the standard procedure.Then next 10 patients(Group 2) received the modified procedure.Techniques including "tandem suture line","endo-button buttress","sandwich anastomosis" and "left ventricle filling" were added to the standard procedure.Perioperative bleeding and the volume of blood transfusion required were compared to estimate hemostasis in different groups.Results:Between groups 1 and 2,a significant difference was found in postoperative bleeding [(2193±383) ml vs(1012±258) ml,respectively;P<0.05] and in volume of blood transfusion required [(7242±1416) ml vs(2520±708) ml,respectively;P<0.05].Conclusion:The modified surgical techniques used in our study are effective in the improvement of the hemostasis in Bentall procedure.

An Overview of the Analytic Hierarchy Process （AHP） and Its Applications to Determine Benchmarking Criteria in Industrial Companies

This paper determines benchmarking criteria from the actors＇ point of view, who are involved in benchmarking processes within four Libyan industrial companies （LICs）. It also describes an application of the analytic hierarchy process （AHP）, which can help an organization to determine its benchmarking criteria. It presents a structured hierarchy for assessing the key capabilities using the AHP. The hierarchy is illustrated using the four main criteria that manufacturing companies will consider when carrying out benchmarking. AHP and benchmarking techniques make the implementation and analysis studies more effective, easy, and applicable to companies. Further, AHP is used to calculate the relative weights of criteria, sub-criteria, and specific sub-criteria, to prioritize them, and finally to select the important benchmarking criteria within each of the four companies investigated. The overall findings suggest that quality control is the most important criterion considered to be benchmarked in companies Q and R. Meanwhile, cost control is considered as the most important criterion to be benchmarked in companies S and T1.

Practice on bilingual education and exam reform of vocational computer programming

The application of bilingual teaching in vocational colleges is necessary choice of acting on international standards, promoting education reform, improving the competitive advantage of profession. As computer programming languages are developed in America with native English, it is of great significance for vocational college to promote bilingual education in computer programming courses. This paper analyzes the current teaching situation in vocational programming courses, describes the practice of bilingual teaching vocational programming from three aspects such as teaching resources, teaching methods and assessment methods to improve students＇ programming ability, and to promote development of bilingual education on vocational programming courses.

Comparison of Minimum Energy Performance Standards (MEPS) Programs in the USA and China

Abstract： Nowadays energy saving and environmental protection are crucial issues in the international society. One of the best solutions for both issues is to improve energy efficiency. To improve energy efficiency, it is commonly recognized by both standards and energy sectors that Minimum Energy Performance Standards （MEPS） could play an important role . China and the USA, the top two energy consumption countries in the world, both have adopted MEPS program to address the problem of energy conservation and environmental protection. This paper analyzes and compares the two countries＇ MEPS programs from a historical and legal context, examining the role of different stakeholders in the process,the process, the outcomes by standards,and then makes some recommendations for both sides.

Actual Aspects of Rural Development Strategy and Policy in the European Union

The objective of the work is to define and evaluate the normative approach in the programming and implementation of rural development in the European Union countries. Main focus is to determine the objectives and methods of implementation and achieve these objectives in various ideological documents, strategies, programs, and development policies. The present work was created on the basis of documents and publications by community bodies and institutions as well as open literature on this subject. The study presents ways of defining rural areas, strategies, and development programs in Europe （Lisbon Strategy, Europe 2020 Strategy）, tasks of major Community policies towards rural areas （common agricultural policy, cohesion policy）, Cork ideological declarations, multifunctional development concepts and smart development. Innovative approaches include the concept of smart city, smart village, smart specializations of regions, and the urban-rural partnerships.

An Appropriate Unidirectional Wave Spectrum Model for the Strait of Hormuz

The objective of this paper is to introduce an appropriate unidirectional wave spectrum model for the Strait of Hormuz. The research is focused on assessing performance of standard wave spectrum models in the region. By evaluating such models based on valuable measurement data recently published, the calibration procedure has been conducted on such standard models to reach a better concordance between a modified standard spectral model and observed field spectra. The calibration is performed initially with respect to four distinct directions related to four available measurement stations. So, it results in four sets of coefficients for a nominated model. Next, it is continued to reach just one model insensitive to directions. Results clearly showed that the International Towing Tank Conference （ITTC） model is more appropriate than Joint North Sea Wave Project （JONSWAP） and Pierson and Moskowitz （PM） models in this area, even without any calibration. However, modifications have been successful on improving the conformity of the model.

Underwater Recording and 3D Modeling during a Dive Training Course： A Case Study at Panormos, Skopelos, Greece

In the field of underwater survey, there is a variety of methods which differ from each other in terms of the operating environment and the purpose that each method is used. Hence, some of the state-of-the-art methods, that have many applications in the various scientific fields nowadays, are introduced in this paper. Additionally, the application of the procedures for an underwater survey in shallow depths is analyzed in accordance with the training standards of the PADI Underwater Survey Diver distinctive specialty. The main goal is to demonstrate not only the theoretical background of underwater surveys but also their operational issues, in order to facilitate the development of knowledge and skills during a training course. Finally, a case study for the recording and 3D modeling of the seabeds＇ morphology in shallow water is presented as it has been organized and accomplished by the participants of such a training course. By this way, it is expected that the reader will understand explicitly the application of the procedures prior, during and after the dive for an underwater survey in shallow depths.

Complex Standardization as the Factor of Flexibility and Competitive Ability

Research, performed by the authors proved that one of the most significant factors affecting the increase in flexibility and competitive ability of a firm is the conceptual, complex intra-plant standardization. The enterprise implementing the standardization is capable of flexible responding to customer＇s demands for the assortment, accelerates considerably research, and offers satisfactory delivery terms. That means the selection of types of the input factors and the method how to use them, the selection of working procedures and procedures of intermediary consumption, definition of the relations in the process of control, rational structure of the final products etc.. The permanent innovative atmosphere is presupposed.

Research on the Educational Evaluation Standard Value based on the Normative Perspective

This paper conducts analysis on the educational evaluation standard value based on the normative perspective. Systematic evaluation refers to the determination of the nature and state of a system by means of an effective standard, based on the clear system objective, structure, and system properties, and then compares it with a set of evaluation criteria and makes a judgment. The evaluation result is also the interaction of the product. The education evaluation which is constructed with the dialogue thinking is democratic, friendly, open, win-win, and the evaluation of creation. Educational evaluation is not a party to the other party as superior, judgment, conclusion, one-way row order, but both sides of the equality. Under this basis, this paper proposes the educational evaluation standard value based on the normative perspective. In the future, we will apply proposed method into the general applications to verify the effectiveness and systematic effectiveness.

Suggestion of Criteria and Certification Process to Secure the Safety of Railway Software

One of the significant differences between the digital system and the analog system is software. The software takes charge of the functions and the management of the digital system. Nowadays railway equipment has begun to be designed and implemented based on digital technology with online and real time performance to achieve high speed and high density operation. The software is designed, coded and implemented into the system, and controls hardware components in order to satisfy the functional requirements of the system. As the functions that are implemented by software are increased, it becomes very difficult to predict the soil-ware failures because of its complexity. Therefore, it has become one of the key issues how to assure that the sottware is reliable, safe and secure. In this paper, the safety criteria are suggested to secure the software safety for the field of railway system. Characteristic of railway software and review safety related standards are analyzed. The authors also suggest development methodology and certification procedure for the developer and assessor to easily make safety critical railway software with following the safety criteria.

Program for Solar Water Heating Systems Based on the F-Chart Method

This paper aims at presenting an application developed in Java for optimizing the design of centralized solar water heating systems with forced circulation, based on the f-chart method. The program uses data from the Brazilian Solar Atlas, performance data of flat plate collectors and thermal reservoirs from the standardized tests run within the Brazilian Labeling Program, and values of water consumption of appliances defined by the ABNT. The program finds the inclination of the collector that maximizes the annual solar fraction, or for the winter, and enables the use of arrays in series and parallel collectors. From the investment costs and O ＆ M （operations and maintenance） of solar heating systems, the program carries out economical analysis using classical parameters as net present value, discounted payback and internal rate of return. The program was validated through examples from the book of Duffle ＆ Beckman and also by comparison with the results from a project developed at UFRGS, having obtained good agreement.

Definition of Stationarity Based on Monitoring the Uncertainty at Real Measurement Conditions

In the statistical standard literature the stationarity of a time dependent process generally is defined by the invariance in time of the distribution of the variable, like a SPL （sound pressure level） fluctuating in time. However in reality there cannot exist constant distribution, respectively characteristics, in time in the strict mathematical sense because the time intervals of observation only can be finite due to practical reasons. Hence on every distribution and characteristics based on it a certain, but evaluable uncertainty is imposed. For monitoring these uncertainties the online-measurement technique, i.e. primarily appropriate software, is already available, also for customers. According to this state of the art the following expanded definition of the stationarity is proposed： Stationarity during a quality controlled measurement process becomes established, when the upper confidence limit of the interesting specific characteristic has no positive slope in time and correspondingly the lower confidence limit of the specific characteristic no negative slope and, as a third, a common condition, the interesting specific characteristic has adjusted itself to a constant position in time. From this a systematic criteria scheme is established and in examples applied on different in- and outdoor situations of sound impact.

Full process of recommendation formulation for clinical practice guidelines:Taking World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis as an example

The formulation of recommendations is a crucial step in the development of clinical practice guidelines,which requires tools provided by the GRADE methodology.These tools include the evidence quality assessment tool,the evidence summary tool,and the evidence-to-decision(EtD)framework.Although there is a methodologically guided standard pathway for formulating recommendations in clinical practice guidelines,it remains unclear how to translate this theoretical pathway into the practical process for formulating recommendations and what the specific steps in this process entail.Therefore,this paper takes the World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guidelines on Acupuncture and Moxibustion:Allergic Rhinitis as an example to detail the full process of formulating recommendations and summaries it into a three-step method.Step one:Collect original materials from different sources to create EtD table.Step two:Distribute and collect EtD table,and preliminarily gather the recommendation voting results.Step three:Organize"salami-slicing pattern"guideline development group consensus meeting to formulate recommendations.The three-step method for formulating recommendations in clinical practice guidelines fully utilizes the GRADE EtD table to provide guideline development group with decision-making foundation and reference from multiple dimensions,including the importance of clinical questions,balance of benefits and harms,quality of evidence,resource required,values and preferences,health equity,acceptability,and feasibility.This approach enhances the scientific and practical nature of guideline recommendations.This paper provides a standard operating procedure to formulate recommendations for the incoming clinical practice guidelines,which aims to establish a standard pathway for the formulation of acupuncture clinical practice guideline recommendations.