赓续宋祚抑或绍承元统:明代的元统论争及其嬗变

对元朝正统地位的认同是明朝自建立以来一直思考的大政。明初,在巩固并维护自身政权的目的下,明代帝王认为其正统之位乃是绍元而来。与此同时,士人撰述亦是追忆前朝,奉元为正统。但北部游牧民族的威胁,特别是土木堡之变给明朝带来的震动,导致明代元史观的更张,士人撰述开始斥责元统,明朝廷的态度也一改尊奉元统的基调。由此看来,元朝正统之位经历了由认同到否定的嬗变以及官方与士人之间的纠葛,而这也预示着关于元明鼎革的历史叙述的转变。

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.

Success of photodynamic therapy in palliating patients with nonresectable cholangiocarcinoma: A systematic review and meta-analysis

To perform a systematic review and meta-analysis on clinical outcomes of photodynamic therapy (PDT) in non-resectable cholangiocarcinoma.METHODSIncluded studies compared outcomes with photodynamic therapy and biliary stenting (PDT group) vs biliary stenting only (BS group) in palliation of non-resectable cholangiocarcinoma. Articles were searched in MEDLINE, PubMed, and EMBASE. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.RESULTSTen studies (n = 402) that met inclusion criteria were included in this analysis. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. Pooled odds ratio for successful biliary drainage (decrease in bilirubin level > 50% within 7days after stenting) in PDT vs BS group was 4.39 (95%CI: 2.35-8.19). Survival period in PDT and BS groups were 413.04 d (95%CI: 349.54-476.54) and 183.41 (95%CI: 136.81-230.02) respectively. The change in Karnofsky performance scores after intervention in PDT and BS groups were +6.99 (95%CI: 4.15-9.82) and -3.93 (95%CI: -8.63-0.77) respectively. Odds ratio for post-intervention cholangitis in PDT vs BS group was 0.57 (95%CI: 0.35-0.94). In PDT group, 10.51% (95%CI: 6.94-14.72) had photosensitivity reactions that were self-limiting. Subgroup analysis of prospective studies showed similar results, except the incidence of cholangitis was comparable in both groups.CONCLUSIONIn palliation of unresectable cholangiocarcinoma, PDT seems to be significantly superior to BS alone. PDT should be used as an adjunct to biliary stenting in these patients.

Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and metaanalysis

AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal cancer.METHODS A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, Open Grey and Clinical Trials.gov register for randomized clinical trials(RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooledeffect was considered significant when P < 0.05.RESULTS Overall, 14 RCTs were included. No differences were found in postoperative mortality(P = 0.19) and morbidity(P = 0.75) rates. The mean operative time was 36.67 min longer(95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower(95%CI:-117.25 to-60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller(95%CI:-13.88 to-8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter(95%CI:-2.84 to-0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery(i.e., day of the first bowel movement) was 0.68 d shorter(95%CI:-1.00 to-0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high. CONCLUSION LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality.

Towards a Formal Theory of v-Contradictions

On the basis of differently defined functions- than otherwise - for conjunction, disjunction and implication （＊）, we construct a formal system, as an axiomatic theory, on its three levels： propositional, predicate and arithmetical one, intended to be a formalizaton of identically false formulas. We argue somewhat in favor of such a system from the point of view of its meta theory （it is complete and consistent one）, of properties of duality, symmetry etc., as well as of a logic of a possible world.

Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert pathologists.METHODS Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

Experimental study of fatigue degree quantification for multi-feature fusion identification

A comprehensive quantification method of fatigue degree is proposed concerning subjective and objective quantifications.Using the fatigue degree test software,fatigue degree is objectively quantified by analyzing the reaction and operation abilities of drivers about traffic signals.By comparison experiment with that EEG signal based,multivariate statistical analysis and fusion identification based on BP neural network(BPNN) results show that the experimental procedure is simple and practical,and the proposed method can reveal the correlation between fatigue feature parameters and fatigue degree in theory,and also can achieve accurate and reliable quantification of fatigue degree,especially under the associated action of multiple fatigue feature parameters.

NON-DEGENERATE INVARIANT BILINEAR FORMS ON NONASSOCIATIVE TRIPLE SYSTEMS

A bilinear form f on a nonassociative triple system T is said to be invariant if and only if f( abc ,d) = f(a, dcb ) = f(c, bad ) for all a,b,c,d ∈ T . (T ,f) is called a pseudo-metric triple system if f is non-degenerate and invariant. A decomposition theory for triple systems and pseudo-metric triple systems is established. Moreover, the ?nite-dimensional metric Lie triple systems are characterized in terms of the structure of the non-degenerate, invariant and symmetric bilinear forms on them.

Features analysis of five-element theory and its basal effects on construction of visceral manifestation theory

OBJECTIVE:To study the Chinese ancient five-element theory,one of the philosophical foundations of Traditional Chinese Medicine(TCM)theory construction,from the perspective of comtemporary cognitive science,and to reveal the important functions of five-element theory in the construction of TCM theory.METHODS:The basic effects of five-element theory in the construction of TCM theory are intensively expounded and proved from the following aspects:embodiment of five-element theory in cognizing the world,quasi axiom of five-element theory in essence,classification thery of family resemblance and deductive inference pattern of five-element theory,and the openness and expansibility of five-element theory.RESULTS:If five-element theory is considered acognitive pattern or cognitive system related to culture,then there should be features of cognitive embodiment in the cognitive system.If five-element theory is regarded as a symbolic system,however,then there should be a quasi-axiom for the system,and inferential deduction.If,however,five-element theory is taken as a theoretical constructive metaphor,then there should be features of opening and expansibility for the metaphor.CONCLUSION:Based on five-element theory,this study provides a cognitive frame for the construction of TCM(a medicine that originated in China,and is characterized by holism and treatment based on pattern identification differentiation)theory with the function of constructing a concept base,thereby implying further research strategies.Useful information may be produced from the creative inferences obtained from the incorporation of five-element theory.

A POSTERIORI ERROR ANALYSIS OF NONCONFORMING METHODS FOR THE EIGENVALUE PROBLEM

This paper extends the unifying theory for a posteriori error analysis of the nonconformingfinite element methods to the second order elliptic eigenvalue problem.In particular,the authorproposes the a posteriori error estimator for nonconforming methods of the eigenvalue problems andprove its reliability and efficiency based on two assumptions concerning both the weak continuity andthe weak orthogonality of the nonconforming finite element spaces,respectively.In addition,the authorexamines these two assumptions for those nonconforming methods checked in literature for the Laplace,Stokes,and the linear elasticity problems.

Blinding Effect of Non-penetrating Sham Needle in the Randomized Controlled Trials of Acupuncture:A Systematic Review

The aim of this article was to assess the clinical evidence for or against the blinding effect of non-penetrating sham needle as placebo needle. This systematic review included randomized controlled trials(RCTs) of acupuncture taking non-penetrating sham acupuncture as placebo needle. Systematic searches were conducted in 13 electronic databases up to July 2012: Medline, PubMed, the Cochrane Library, CINAHL, EMBASE, a Chinese medical database. All parallel or cross-over RCTs of acupuncture for the blinding effect of non-penetrating needle were chosen without language restrictions. Finally, totally 7 RCTs met the inclusion criteria. In conclusion, our systematic review and meta-analysis demonstrate that the non-penetrating needle is an effective instrument for placebo control in the acupuncture RCTs.