The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was p...The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.展开更多
The pun becomes the most popular language strategy for advertisers as a broadly used rhetorical device. Using pun words felicitously not only makes advertising language more humorous, implicative, and vivid but also l...The pun becomes the most popular language strategy for advertisers as a broadly used rhetorical device. Using pun words felicitously not only makes advertising language more humorous, implicative, and vivid but also leaves the audience a room to imagine and enjoy. The author summarizes pun's definitions, features, classifications, and how the pun procures a successful communicative activity in English advertisements based on Sperber and Wilson's Relevance Theory. At last, the pun's pragmatic functions are concluded.展开更多
SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using sur...SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using surgical mesh products 1970s, gynecologists began to indicate the repair of pelvic organ prolapse (POP), and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food andDrug Administration (FDA) approved the first surgical mesh product specifically for use in POP.展开更多
Objective: The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor. Methods: Anterolateral thigh flap with the descending branch of th...Objective: The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor. Methods: Anterolateral thigh flap with the descending branch of the lateral circumflex femoral artery and the pedicle of anterolaterat thigh cutaneous nerve was used in primary repairing of the defect from postoperative vulva tumor, the sizes of the flaps ranged from 10 cm ×14 cm-14 cm× 20 cm. Results: All flaps survived, during a follow-up of 2 to 12 months, the appearance of the flaps was satisfactory with sensitive function without local recurrences. Conclusion: Anterelateral thigh flap has fairly long vessel pedicle, wider vessel diameter, and is in the covert area. Anterolateral thigh flap with sensory nerve is the ideal choice for postoperative repairing of vulva tumor.展开更多
A multi-sensory five-fingered prosthetic hand has been designed on the basis of underactuated mechanism and coupling principle. The hand is much similar to the adult hand. Three motors actuate the thumb, the index fin...A multi-sensory five-fingered prosthetic hand has been designed on the basis of underactuated mechanism and coupling principle. The hand is much similar to the adult hand. Three motors actuate the thumb, the index finger and the other three fingers each. The hand comprises 13 joints. Actuated by a motor, the thumb can move along a conic surface, which is superior in appearance. Driven by another motor with springs as transmission elements, the mid finger, ring finger and little finger can envelop objects with complex shape. The sensory system and the appearance design are introduced. It was verified by experiments that the hand has strong capacity of self adaptation and can accomplish accurate and powerful grasp for objects with complex shape.展开更多
By means of experiments of C02 miscibility with crude oil, four nonpolar chemicals were evaluated in order to enhance the miscibility of C02 with crude oil. Through pre-slug injection and joint injection of toluene in...By means of experiments of C02 miscibility with crude oil, four nonpolar chemicals were evaluated in order to enhance the miscibility of C02 with crude oil. Through pre-slug injection and joint injection of toluene in CO2, crude oil displacement experiments in the slim-tube were conducted to investigate effects of the toluene- enhanced C02 flooding under simulated subterranean reservoir conditions. Experimental results showed that toluene can enhance extraction of oil into C02 and dissolution of C02 into oil with the increment of 251% and 64% respectively. Addition of toluene can obviously improve the oil recovery in either pre-slug injection or joint injection, and the crude oil recovery increased with the increase of the toluene concentration. The oil recov- ery can increase by 22.5% in pre-slug injection with the high toluene concentration. Pre-slug injection was recom- mended because it can consume less toluene than joint injection. This work could be useful to development and application of the CO) flooding in the oil recoverv as well as CO2 emission reduction.展开更多
Objective:This study proposed a modified Blumgart anastomosis(m-BA)that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the ...Objective:This study proposed a modified Blumgart anastomosis(m-BA)that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the aim of simplifying the complicated steps of the conventional BA(c-BA).Thus,we observe if a difference in the risk of postoperative pancreatic fistula(POPF)exists between the two methods.Methods:The m-BA anastomosis method has been used since 2010.From October 2011 to October 2015,147 patients who underwent pancreatoduodenectomy(PD)using BA in Tianjin Medical University Cancer Institute and Hospital were enrolled in this study.According to the type of pancreatojejunostomy(PJ),50 patients underwent m-BA and 97 received c-BA.The two patient cohorts were compared prospectively to some extent but not randomized,and the evaluated variables were operation time,the incidence rate of POPF,and other perioperative complications.Results:The operation time showed no significant difference(P〉0.05)between the two groups,but the time of duct-to-mucosa anastomosis in the m-BA group was much shorter than that in the c-BA group(P〈0.001).The incidence rate of clinically relevant POPF was 12.0%(6/50)in the modified group and 10.3%(10/97)in the conventional group(P〉0.05),which means that the modified anastomosis method did not cause additional pancreatic leakage.The mean length of postoperative hospital stay of the m-BA group was 23 days,and that of the c-BA group was 22 days(P〉0.05).Conclusions:Compared with the conventional BA,we suggest that the modified BA is a feasible,safe,and effective operation method for P J of PD with no sacrifice of surgical quality.In the multivariate analysis,we also found that body mass index(≥25展开更多
Teaching English composition has long been recognized as one of the most daunting tasks of college education in China. So this thesis is intended to investigate the applicability of the audience-oriented rhetorical ap...Teaching English composition has long been recognized as one of the most daunting tasks of college education in China. So this thesis is intended to investigate the applicability of the audience-oriented rhetorical appeals to the teaching of English composition.展开更多
This paper argues for an overt innovational shift in praxis, as well as classroom configuration in the ESOL writing class by calling for a move away from the current foci on process-based pedagogies for newcomer popul...This paper argues for an overt innovational shift in praxis, as well as classroom configuration in the ESOL writing class by calling for a move away from the current foci on process-based pedagogies for newcomer populations, to an explicit teaching of modeling strategies with concomitant practice opportunities provided in the ESOL writing class. It is argued that explicit, sequenced instruction in the domains of rhetorical structure as well as grammatical accuracy provide ESOL (English for Speakers of Other Languages) learners in the emerging stages of language learning with a more concrete grasp of meaning, structure and grammar in rhetorical construction. The modeling strategies proposed in the paper focus on a simultaneous building of rhetorical fluency and grammatical accuracy via spotlighted and sequenced strategies which afford learners practice in smaller chunks of composition including but not limited to thesis statement writing, varied paragraph organization, multiple modes of exposition, and grammatical complexity all in a bid to generate rhetorical depth and grammatical detail in writing. In short, both form and function need to be explicitly taught in the ESOL writing class with adequate opportunities provided for rhetorical practice. Using a meticulous blend of meaningful, authentic and purposeful tasks combined with one-on-one instruction which incorporates a variety of visual and rhetorical modeling strategies, emerging writers, it is argued a move from controlled to automatic writing fluency within a short time span. The pedagogy proposed in the current paper spotlights the specific learner, rather than the writing process and entails a move away from traditional, teacher-fronted classrooms to targeted, workshop-centered configurations which permit for one-on-one conferencing in the ESOL writing class. The visually rendered modeling strategies proposed in this paper argue for writing instruction for ESOL students which is learner responsive, relevant and practical.展开更多
To see what lacks representation on stage is a fully creative act that the spectator performs thanks to his or her imagination, as (s)he is called to retrieve via memory what is objectively absent from the scene. Th...To see what lacks representation on stage is a fully creative act that the spectator performs thanks to his or her imagination, as (s)he is called to retrieve via memory what is objectively absent from the scene. The Renaissance audience accomplished such a creative act by making use of rhetoric and figurative arts. However, it is pre-eminently words that trigger and support the imagination, as Shakespeare's drama best exemplifies. Both in the Elizabethan drama and in the Italian Renaissance theatre, with its perspectival vision, the spectator's creative act takes place in an ideal space where the stage space turns into the locus of stereoscopic vision. Consequently, the creation and consumption of the vision originates first and foremost in drama (comedy and tragedy). The psychological, aesthetic, and anthropological mechanisms at the heart of vision, and the fruition of the images deriving from words, can be found as operating within the dramatic text, from the point of view of both the playwright and of the spectator/listener, in a direct relationship of cause and effect. Religious and especially Jesuitical drama, whose theatrical experience aims at discovering a correspondence between words and images, testifies to the visual power of the theatre.展开更多
Robert Frost is skillful at adopting symbolism and images in his poems. "Mending Wall", one of Frost's well-known poems, had been analyzed in different approaches, such as psychoanalytical approach, social approach...Robert Frost is skillful at adopting symbolism and images in his poems. "Mending Wall", one of Frost's well-known poems, had been analyzed in different approaches, such as psychoanalytical approach, social approach and structural approaches, etc. By exploring the symbol and images applied in "Mending Wall", it draws the conclusion that "the wall", symbolizing convention, is set as a barrier in human communication.展开更多
This paper demonstrates the rhetoric technique, narrative function and sign decoding of Nabokocian otherworld in LoBta and Pale Fire to detect not only the presence of the metaphysical otherworld, but also the faint i...This paper demonstrates the rhetoric technique, narrative function and sign decoding of Nabokocian otherworld in LoBta and Pale Fire to detect not only the presence of the metaphysical otherworld, but also the faint influence upon the living. Under the narrative strategies of the otherworld lies Nabokov's aesthetic ethics, which make those who label Nabokov pessimistic and indifferent to be aware of his persistent attempt to push beyond the boundaries of human consciousness and his sincere concern and deep sympathy for the misery of men.展开更多
Restorative proctocolectomy(RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous polyposis.Surgery in elective settings is often performed in 2 stages,fashioni...Restorative proctocolectomy(RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous polyposis.Surgery in elective settings is often performed in 2 stages,fashioning an ileostomy which is closed 2-3-mo later.It is still debated whether omitting ileostomy could offer advantages in the management of patients undergoing RP.展开更多
This paper aims at showing how rhetoric and meaning in Zambian poetry interact. The work analyses the definition of poetry and gives the understanding that poetry is an artistic use of language that employs figurative...This paper aims at showing how rhetoric and meaning in Zambian poetry interact. The work analyses the definition of poetry and gives the understanding that poetry is an artistic use of language that employs figurative language for maximum effect. The work also analyses rhetoric and concludes that the sole aim of rhetoric is to persuade the audience. The use of this rhetoric is later identified as a preoccupation of most poets. After studying a number of rhetorical devices used in poetry, the work has studied selected Zambian poems and focussed on the use of rhyme and alliteration in the poems. It has been shown that there is much use of rhyme but with limited use of alliteration. In both cases, the use is not so much to the contribution to the meaning in the poetry. The poets usually use these devices for the sake of beauty and not meaning. The paper therefore suggests that poets could undergo some formal training in composition while the art is also taught to the young while in their early years in schools.展开更多
Objective To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS). Methods Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively e...Objective To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS). Methods Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.展开更多
文摘The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.
文摘The pun becomes the most popular language strategy for advertisers as a broadly used rhetorical device. Using pun words felicitously not only makes advertising language more humorous, implicative, and vivid but also leaves the audience a room to imagine and enjoy. The author summarizes pun's definitions, features, classifications, and how the pun procures a successful communicative activity in English advertisements based on Sperber and Wilson's Relevance Theory. At last, the pun's pragmatic functions are concluded.
文摘SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using surgical mesh products 1970s, gynecologists began to indicate the repair of pelvic organ prolapse (POP), and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food andDrug Administration (FDA) approved the first surgical mesh product specifically for use in POP.
文摘Objective: The aim of this study was to evaluate the value of the application of anterolateral thigh flap in postoperative repairing of vulva tumor. Methods: Anterolateral thigh flap with the descending branch of the lateral circumflex femoral artery and the pedicle of anterolaterat thigh cutaneous nerve was used in primary repairing of the defect from postoperative vulva tumor, the sizes of the flaps ranged from 10 cm ×14 cm-14 cm× 20 cm. Results: All flaps survived, during a follow-up of 2 to 12 months, the appearance of the flaps was satisfactory with sensitive function without local recurrences. Conclusion: Anterelateral thigh flap has fairly long vessel pedicle, wider vessel diameter, and is in the covert area. Anterolateral thigh flap with sensory nerve is the ideal choice for postoperative repairing of vulva tumor.
基金Supported by the National Natural Science Foundation of China (No.50435040).
文摘A multi-sensory five-fingered prosthetic hand has been designed on the basis of underactuated mechanism and coupling principle. The hand is much similar to the adult hand. Three motors actuate the thumb, the index finger and the other three fingers each. The hand comprises 13 joints. Actuated by a motor, the thumb can move along a conic surface, which is superior in appearance. Driven by another motor with springs as transmission elements, the mid finger, ring finger and little finger can envelop objects with complex shape. The sensory system and the appearance design are introduced. It was verified by experiments that the hand has strong capacity of self adaptation and can accomplish accurate and powerful grasp for objects with complex shape.
基金Supported by the National Science&Technology Pillar Program(2012BAC24B03)
文摘By means of experiments of C02 miscibility with crude oil, four nonpolar chemicals were evaluated in order to enhance the miscibility of C02 with crude oil. Through pre-slug injection and joint injection of toluene in CO2, crude oil displacement experiments in the slim-tube were conducted to investigate effects of the toluene- enhanced C02 flooding under simulated subterranean reservoir conditions. Experimental results showed that toluene can enhance extraction of oil into C02 and dissolution of C02 into oil with the increment of 251% and 64% respectively. Addition of toluene can obviously improve the oil recovery in either pre-slug injection or joint injection, and the crude oil recovery increased with the increase of the toluene concentration. The oil recov- ery can increase by 22.5% in pre-slug injection with the high toluene concentration. Pre-slug injection was recom- mended because it can consume less toluene than joint injection. This work could be useful to development and application of the CO) flooding in the oil recoverv as well as CO2 emission reduction.
文摘Objective:This study proposed a modified Blumgart anastomosis(m-BA)that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the aim of simplifying the complicated steps of the conventional BA(c-BA).Thus,we observe if a difference in the risk of postoperative pancreatic fistula(POPF)exists between the two methods.Methods:The m-BA anastomosis method has been used since 2010.From October 2011 to October 2015,147 patients who underwent pancreatoduodenectomy(PD)using BA in Tianjin Medical University Cancer Institute and Hospital were enrolled in this study.According to the type of pancreatojejunostomy(PJ),50 patients underwent m-BA and 97 received c-BA.The two patient cohorts were compared prospectively to some extent but not randomized,and the evaluated variables were operation time,the incidence rate of POPF,and other perioperative complications.Results:The operation time showed no significant difference(P〉0.05)between the two groups,but the time of duct-to-mucosa anastomosis in the m-BA group was much shorter than that in the c-BA group(P〈0.001).The incidence rate of clinically relevant POPF was 12.0%(6/50)in the modified group and 10.3%(10/97)in the conventional group(P〉0.05),which means that the modified anastomosis method did not cause additional pancreatic leakage.The mean length of postoperative hospital stay of the m-BA group was 23 days,and that of the c-BA group was 22 days(P〉0.05).Conclusions:Compared with the conventional BA,we suggest that the modified BA is a feasible,safe,and effective operation method for P J of PD with no sacrifice of surgical quality.In the multivariate analysis,we also found that body mass index(≥25
文摘Teaching English composition has long been recognized as one of the most daunting tasks of college education in China. So this thesis is intended to investigate the applicability of the audience-oriented rhetorical appeals to the teaching of English composition.
文摘This paper argues for an overt innovational shift in praxis, as well as classroom configuration in the ESOL writing class by calling for a move away from the current foci on process-based pedagogies for newcomer populations, to an explicit teaching of modeling strategies with concomitant practice opportunities provided in the ESOL writing class. It is argued that explicit, sequenced instruction in the domains of rhetorical structure as well as grammatical accuracy provide ESOL (English for Speakers of Other Languages) learners in the emerging stages of language learning with a more concrete grasp of meaning, structure and grammar in rhetorical construction. The modeling strategies proposed in the paper focus on a simultaneous building of rhetorical fluency and grammatical accuracy via spotlighted and sequenced strategies which afford learners practice in smaller chunks of composition including but not limited to thesis statement writing, varied paragraph organization, multiple modes of exposition, and grammatical complexity all in a bid to generate rhetorical depth and grammatical detail in writing. In short, both form and function need to be explicitly taught in the ESOL writing class with adequate opportunities provided for rhetorical practice. Using a meticulous blend of meaningful, authentic and purposeful tasks combined with one-on-one instruction which incorporates a variety of visual and rhetorical modeling strategies, emerging writers, it is argued a move from controlled to automatic writing fluency within a short time span. The pedagogy proposed in the current paper spotlights the specific learner, rather than the writing process and entails a move away from traditional, teacher-fronted classrooms to targeted, workshop-centered configurations which permit for one-on-one conferencing in the ESOL writing class. The visually rendered modeling strategies proposed in this paper argue for writing instruction for ESOL students which is learner responsive, relevant and practical.
文摘To see what lacks representation on stage is a fully creative act that the spectator performs thanks to his or her imagination, as (s)he is called to retrieve via memory what is objectively absent from the scene. The Renaissance audience accomplished such a creative act by making use of rhetoric and figurative arts. However, it is pre-eminently words that trigger and support the imagination, as Shakespeare's drama best exemplifies. Both in the Elizabethan drama and in the Italian Renaissance theatre, with its perspectival vision, the spectator's creative act takes place in an ideal space where the stage space turns into the locus of stereoscopic vision. Consequently, the creation and consumption of the vision originates first and foremost in drama (comedy and tragedy). The psychological, aesthetic, and anthropological mechanisms at the heart of vision, and the fruition of the images deriving from words, can be found as operating within the dramatic text, from the point of view of both the playwright and of the spectator/listener, in a direct relationship of cause and effect. Religious and especially Jesuitical drama, whose theatrical experience aims at discovering a correspondence between words and images, testifies to the visual power of the theatre.
文摘Robert Frost is skillful at adopting symbolism and images in his poems. "Mending Wall", one of Frost's well-known poems, had been analyzed in different approaches, such as psychoanalytical approach, social approach and structural approaches, etc. By exploring the symbol and images applied in "Mending Wall", it draws the conclusion that "the wall", symbolizing convention, is set as a barrier in human communication.
文摘This paper demonstrates the rhetoric technique, narrative function and sign decoding of Nabokocian otherworld in LoBta and Pale Fire to detect not only the presence of the metaphysical otherworld, but also the faint influence upon the living. Under the narrative strategies of the otherworld lies Nabokov's aesthetic ethics, which make those who label Nabokov pessimistic and indifferent to be aware of his persistent attempt to push beyond the boundaries of human consciousness and his sincere concern and deep sympathy for the misery of men.
文摘Restorative proctocolectomy(RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous polyposis.Surgery in elective settings is often performed in 2 stages,fashioning an ileostomy which is closed 2-3-mo later.It is still debated whether omitting ileostomy could offer advantages in the management of patients undergoing RP.
文摘This paper aims at showing how rhetoric and meaning in Zambian poetry interact. The work analyses the definition of poetry and gives the understanding that poetry is an artistic use of language that employs figurative language for maximum effect. The work also analyses rhetoric and concludes that the sole aim of rhetoric is to persuade the audience. The use of this rhetoric is later identified as a preoccupation of most poets. After studying a number of rhetorical devices used in poetry, the work has studied selected Zambian poems and focussed on the use of rhyme and alliteration in the poems. It has been shown that there is much use of rhyme but with limited use of alliteration. In both cases, the use is not so much to the contribution to the meaning in the poetry. The poets usually use these devices for the sake of beauty and not meaning. The paper therefore suggests that poets could undergo some formal training in composition while the art is also taught to the young while in their early years in schools.
文摘Objective To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS). Methods Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.