中日文化交流史迹考察四篇

第一篇圆觉寺位于鎌仓北部的圆觉寺以无学祖元为开山,以北条时宗为开基,建于1282年,全名为'瑞鹿山圆觉兴圣禅寺'。'瑞鹿山'三字缘自释迦初转法轮处为鹿野苑;'兴圣'二字缘自中国径山兴圣万寿禅寺。圆觉寺初建时仿照径山寺以中轴贯穿、左右排列的布局,建有山门、佛殿、法堂、僧堂、库院、东司、浴室等禅寺典型的七大伽蓝,后增建方丈舍利殿、藏经楼、御影堂、华严塔等。经数次水灾地震后的重建,今仍为拥有诸多庄严伽蓝和16塔院的一大禅林。

Healthcare utilization and costs associated with gastroparesis

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill. Further research on cost-effective evaluation and management of gastroparesis is required.

National trends in resection of the distal pancreas

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care databases.METHODS:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal pancreatectomy.Utilization of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology codes.In SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure codes.We analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative resection.RESULTS:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,respectively.Overall,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the study.Resection was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open groups.Overall complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was utilized.One and two year survival after resection for malignancy were unchanged over the course of the study(ductal adenocarinoma 1-year 63.6% and 2-year 35.1%,P = 0.53;intraductal papillary mucinous neoplasm and nueroendocrine 1-year 90% and 2-year 84%,P = 0.25).The majority of resections were performed in teaching hospitals(77% NIS and 85% NSQIP),but minimally invasive surgery(MIS) was not more likely to be used in teaching hospitals(15% vs 14%,P = 0.26).Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles(88% vs 43%,P < 0.001),but were no more likely to utilize MIS at resection.Complication rate in teaching and the top decile hospitals was not significantly decreased when compared to non-teaching(15% vs 14%,P = 0.72) and lower volume hospitals(14% vs 15%,P = 0.99).No difference was seen in the median number of lymph nodes and lymph node ratio in N1 disease when compared by year(P = 0.17 and P = 0.96,respectively).CONCLUSION:There appears to be an overall underutilization of laparoscopy for DP.Centralization does not appear to be occurring.Survival and lymph node harvest have not changed.

Strategy Research on Improving Performance Appraisal of Human Resource in Technical School

The 21 st century is an era of knowledge-based economy. With more high-quality talents, the technical schools can achieve sustainable development, making contributions due to the field of vocational education. Under this background, how to develop and manage human resources has become an important topic in the management of technical schools in our country. Management believes that there are many ways to develop and manage human resources, and the key problem is to find specific ways to solve problems. It is a feasible strategy to stimulate the enthusiasm of human resources through performance appraisal.

Discussion on the Teaching Reform of Course Warehouse Management in Higher Vocational Colleges --,The Construction of Theory and Practice Courses Integrated Teaching Mode

Warehouse management, as a higher vocational course integrating theory and practice, is of extreme importance to training the professional personnel logistics management. In this paper, under the premise of the teaching objective of course Warehouse Management, and based on analyzing the disadvantages in the current teaching of the course, the teaching mode integrating theory and practice courses, and teaching and learning is discussed, so this paper is of great significance to the design of the course teaching modes in higher vocational colleges.

Analysis of injuries and treatment of 3401 inpatients in 2008 Wenchuan earthquakembased on Chinese Trauma Databank

Objective： A catastrophic earthquake struck Wenchuan region of West China on May 12, 2008 and caused more than 69 225 deaths. This study was to analyze injury characteristics and treatment of the seismic patients based on Chinese Trauma Databank, which will be helpful for improvement of future medical rescue in potential disasters. Methods： Based on inpatients＇ medical records of seismic patients admitted into 11 hospitals, data were registered with Trauma Database System Version 3.0. Patients＇ general information, causes, clinical characteristics and treatment of injuries were studied. Results： Main causes for seismic injuries were blunt strike （68.2%）, crush/burying 08.7%） and slip/falling （11.5%）. Slip/falling was the main cause for spinal injuries and accounted for 19. 1%, which was higher than the percentage for other body part. Extremity injuries accounted for 54.8% of all injuries. Fractures accounted for 53.1%. Lower extrem-ity fracture accounted for 70.1% of lower extremity injury and spinal fracture accounted for 85.9% of spinal injury. The proportion of spinal injuries with AIS ≥4 was higher than that of other injured locations except for the abdomen. Debridement and suturation for single injury and multiple injury patients accounted for 64.7% and 42.9% of their operations respectively. Conclusions： Blunt strike, crush/burying and slip/ falling are the main causes for seismic injuries. The most frequently injured site is extremity. The main injury type is fracture, especially for the lower extremities and the spine. Multiple injury patients were mainly treated by operation, including debridement and suturation, closed reduction and external fixation, etc.

苏联准备评选列宁奖金今年获奖作品

据“苏维埃文化报”2月14日发表的苏联部长会议附设文学艺术列宁奖金委员会通报,从申请颁发1959年列宁奖金的所有作品中,经过小组和全会的研究,已初步选出一批作品,提供进一步的讨论。造型艺术部分初步选出的有; 1.E·符切提奇——在莫斯科的捷尔任斯基纪念碑。