A two-level supply chain model involving one supplier and one retailer with linear demand is developed, and supply chain coordination mechanisms under asymmetric information （the retailer＇ s cost structure is asymme...A two-level supply chain model involving one supplier and one retailer with linear demand is developed, and supply chain coordination mechanisms under asymmetric information （the retailer＇ s cost structure is asymmetric information） are proposed by employing game theory in two scenarios： coordination mechanisms under asymmetric information in a regular scenario （without disruption）; and coordination mechanisms under asymmetric information in an irregular scenario （ with retailer cost disruptions）. It is optimal for the supply chain to maintain the original production plan and to guarantee a steadily running system if variations of retailer costs are sufficiently low and do not exceed an upper bound. This shows that the original production plan has certain robustness under disruptions. Decisions must be re-made if a retailer＇ s cost change is greater and exceeds an upper bound. Impacts of retailer cost disruptions on the order quantity, the retail price, the wholesale price and each party＇ s as well as the system＇ s expected profits are investigated through numerical analyses.展开更多
The coordinating pricing strategies with asymmetric cost information under disruptions are investigated in a one-supplier-one-retailer supply chain system.While the retailer's cost structure is asymmetric informat...The coordinating pricing strategies with asymmetric cost information under disruptions are investigated in a one-supplier-one-retailer supply chain system.While the retailer's cost structure is asymmetric information,supply chain pricing contract models(a wholesale price contract and an all-unit quantity discount contract)under asymmetric information are proposed by employing the principal-agent principle in a regular scenario.When the retailer's cost distribution is fluctuated by disruptions,we obtain the optimal emergency strategies of the supply chain under asymmetric information by considering deviation costs and show how to effectively handle the cost uncertainty.Using numerical methods,impacts of cost disruptions on the optimal wholesale price,the retailer price,the order quantity and the expected profits of the retailer,the supplier,as well as the total system are analyzed.It is found that the all-unit quantity discount policy can obtain better performance than the wholesale pricing policy.展开更多
Under the threat of bio-terrorism,this paper aims at improving the emergency rescue system's ability of dealing with a public health emergency.Focusing on the demand network,this research establishes the emergency...Under the threat of bio-terrorism,this paper aims at improving the emergency rescue system's ability of dealing with a public health emergency.Focusing on the demand network,this research establishes the emergency rescue supply storage network under a danger diffusion environment.Combined with the infectious disease diffusion model,the traditional set covering model is rebuilt taking the decision optimization of reserve quantity into consideration.Under the premise of a certain emergency service level,the collaborative location optimizing model of an emergency rescue supply storage network is established in order to minimize the sum of the building costs and the preserving costs.The model is proved to be effective through numerical simulation.The collaborative location optimization of the nodes of the emergency rescue supply storage network and the reserve quantity of each storage node is realized.展开更多
Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacte...Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor(PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.展开更多
Water pollution accidents such as chemical spill and toxicants leach have become a serious issue in the world, which brings great threats to the aquatic ecosystem and drinking water safety. To detect unknown pollution...Water pollution accidents such as chemical spill and toxicants leach have become a serious issue in the world, which brings great threats to the aquatic ecosystem and drinking water safety. To detect unknown pollutions in time and take proper emergency actions, this study developed a system which integrated an online intelligent water quality monitoring device with a high efficient water quality model. The device is based on water quality probes and biological sensors which use fish motion as indicator. The numerical model is a combination of Euler and Lagrangian approaches. Finite element method is applied to simulate the flow field in an unstructured grid, and the pollutant be- haviours are traced through particle tracking. Oracle is used to manage the basic and monitoring data, and ArcSDE as well as ArclMS technologies are applied to make the system WebGIS-based so as to improve the data receiving and dispatching efficiency. The developed system has been successfully operated in Douhe Reservoir and Taihu Lake, China, where drinking water intakes are installed. It is seen from the applications that the online intelligent water qual- ity monitoring and emergency support system can be of great support to emergency management.展开更多
Acute lower gastrointestinal bleeding （LGIB） is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures ar...Acute lower gastrointestinal bleeding （LGIB） is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy, colonoscopy, angiography, radionuclide scintigraphy and multi detector row computed tomography. Although no modality has emerged as the gold standard in the management of LGIB, colonoscopy is the current preferred initial test for the majority of the patients presenting with hema- tochezia felt to be from a colon source. Colonoscopy has the ability to diagnose all sources of bleeding from the colon and, unlike the radiologic modalities, does not require active bleeding at the time of the examination. In addition, therapeutic interventions such as cautery and endoclips can be applied to achieve hemoo stasis and prevent recurrent bleeding. Studies suggest that colonoscopy, particularly when performed earlyin the hospitalization, can decrease hospital length of stay, rebleeding and the need for surgery. However, results from available small trials are conflicting and larger, multicenter studies are needed. Compared to other management options, colonoscopy is a safe procedure with complications reported in less than 2% of patients, including those undergoing urgent examinations. The requirement of bowel preparation （typically 4 or more liters of polyethylene glycol）, the logistical complexity of coordinating after hours colonoscopy, and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB, particularly in urgent situations. This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.展开更多
Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require e...Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.展开更多
To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD).METHODSThis was a randomised controlled open-label trial of patients wit...To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD).METHODSThis was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life.RESULTSEighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P < 0.01). At week 6, the LFD group showed a significantly lower median IBS-SSS (median 115; inter-quartile range [IQR] 33-169) than ND group (median 170, IQR 91-288), P = 0.02. Furthermore, the LFD group had a significantly greater increase in SIBDQ (median 60, IQR 51-65) than the ND group (median 50, IQR 39-60), P < 0.01.CONCLUSIONIn a prospective study, a low-FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.展开更多
AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between J...AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.展开更多
AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT dur...AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.展开更多
MM： Persistent cholestasis is a rare complication of severe trauma or infections. Little is known about the possible pathomechanisms and the clinical course.METHODS： Secondary sclerosing cholangitis was diagnosed in...MM： Persistent cholestasis is a rare complication of severe trauma or infections. Little is known about the possible pathomechanisms and the clinical course.METHODS： Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma （one burn injury, three accidents, one power current injury）. Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS： Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis （PSC）-Iike destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up 〉2 years. Therapeutic possibilities were limited.CONCLUSION： Posttraumatic sderosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension.Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.展开更多
The process of decision making and risk analysis are essential tasks along the construction project cycle. Over the years, construction practitioners and researchers have used various methods, tools and techniques to ...The process of decision making and risk analysis are essential tasks along the construction project cycle. Over the years, construction practitioners and researchers have used various methods, tools and techniques to evaluate risk and assist in making more concise decisions. Most practitioners, however, rely on their expert judgment, past experience, intuition, acquired and accumulated knowledge and gut feelings to make decisions. Aleatory （natural, heterogeneity and stochasticity） and epistemic （subjective, ignorance） are the two major types of uncertainties observed in natural sciences. Practitioners traditionally deal with aleatory uncertainty through probabilistic analysis based on historical data （frequentist approach）; and epistemic uncertainty, on the other hand, handled through the Bayesian approach which has limitations since it requires a priori assumption. This paper reports the application of the DST （Dempster Shafer Theory） of evidence to determine the most critical risk factors affecting project cost contingencies using their epistemic probabilities of occurrence. The paper further discuses how these factors can be managed to enhance successful delivery of infrastructural projects. It uses the mixed methodology, with data gathered through structured questionnaires distributed to construction clients, contractors, professionals and experts in the built environment. The research revealed that design risk, financial risk and economic risk were most important cost risk categorizations. In particular, scope changes, incomplete scope definition, incomplete design, changes in specification, micro and macroeconomic indicators and delayed payment problems were identified as the most important risk factors to be considered during the cost contingency estimation process, hence successful delivery of infrastructural projects. The paper concludes by recommending modalities for managing the contingency evolution process of risk estimation to enhance successful delivery and management of infrastructural projects.展开更多
On the basis of the initial definition of Enterprise Emergency Management Capacity（EEMC）, the paper has established evaluation index system of EEMC, and provided a method to calculate index weight, with the regard t...On the basis of the initial definition of Enterprise Emergency Management Capacity（EEMC）, the paper has established evaluation index system of EEMC, and provided a method to calculate index weight, with the regard to subjectivity existing in the comprehensive evaluation of EEMC multi-indicators, in accordance with the principle of Variable weight Gray Cluster, which makes the weight of indicators generate automatically in the evaluation process and not judged by human, thus decreasing subjective factors during the evaluation.展开更多
基金The National Natural Science Foundation of China(No70671021)Jiangsu Postdoctoral Foundation (No0601015C)
文摘A two-level supply chain model involving one supplier and one retailer with linear demand is developed, and supply chain coordination mechanisms under asymmetric information （the retailer＇ s cost structure is asymmetric information） are proposed by employing game theory in two scenarios： coordination mechanisms under asymmetric information in a regular scenario （without disruption）; and coordination mechanisms under asymmetric information in an irregular scenario （ with retailer cost disruptions）. It is optimal for the supply chain to maintain the original production plan and to guarantee a steadily running system if variations of retailer costs are sufficiently low and do not exceed an upper bound. This shows that the original production plan has certain robustness under disruptions. Decisions must be re-made if a retailer＇ s cost change is greater and exceeds an upper bound. Impacts of retailer cost disruptions on the order quantity, the retail price, the wholesale price and each party＇ s as well as the system＇ s expected profits are investigated through numerical analyses.
基金The National Key Technology R&D Program of China during the11th Five-Year Plan Period(No.2006BAH02A06)Jiangsu Postdoctoral Foundation(No.0601015C)
文摘The coordinating pricing strategies with asymmetric cost information under disruptions are investigated in a one-supplier-one-retailer supply chain system.While the retailer's cost structure is asymmetric information,supply chain pricing contract models(a wholesale price contract and an all-unit quantity discount contract)under asymmetric information are proposed by employing the principal-agent principle in a regular scenario.When the retailer's cost distribution is fluctuated by disruptions,we obtain the optimal emergency strategies of the supply chain under asymmetric information by considering deviation costs and show how to effectively handle the cost uncertainty.Using numerical methods,impacts of cost disruptions on the optimal wholesale price,the retailer price,the order quantity and the expected profits of the retailer,the supplier,as well as the total system are analyzed.It is found that the all-unit quantity discount policy can obtain better performance than the wholesale pricing policy.
基金The National Natural Science Foundation of China(No.70671021)the National Key Technology R&D Program of China during the11th Five-Year Plan Period(No.2006BAH02A06)
文摘Under the threat of bio-terrorism,this paper aims at improving the emergency rescue system's ability of dealing with a public health emergency.Focusing on the demand network,this research establishes the emergency rescue supply storage network under a danger diffusion environment.Combined with the infectious disease diffusion model,the traditional set covering model is rebuilt taking the decision optimization of reserve quantity into consideration.Under the premise of a certain emergency service level,the collaborative location optimizing model of an emergency rescue supply storage network is established in order to minimize the sum of the building costs and the preserving costs.The model is proved to be effective through numerical simulation.The collaborative location optimization of the nodes of the emergency rescue supply storage network and the reserve quantity of each storage node is realized.
文摘Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor(PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.
基金National High-Tech R&D Program of China ("863" Program,No.2009AA06A418)
文摘Water pollution accidents such as chemical spill and toxicants leach have become a serious issue in the world, which brings great threats to the aquatic ecosystem and drinking water safety. To detect unknown pollutions in time and take proper emergency actions, this study developed a system which integrated an online intelligent water quality monitoring device with a high efficient water quality model. The device is based on water quality probes and biological sensors which use fish motion as indicator. The numerical model is a combination of Euler and Lagrangian approaches. Finite element method is applied to simulate the flow field in an unstructured grid, and the pollutant be- haviours are traced through particle tracking. Oracle is used to manage the basic and monitoring data, and ArcSDE as well as ArclMS technologies are applied to make the system WebGIS-based so as to improve the data receiving and dispatching efficiency. The developed system has been successfully operated in Douhe Reservoir and Taihu Lake, China, where drinking water intakes are installed. It is seen from the applications that the online intelligent water qual- ity monitoring and emergency support system can be of great support to emergency management.
文摘Acute lower gastrointestinal bleeding （LGIB） is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy, colonoscopy, angiography, radionuclide scintigraphy and multi detector row computed tomography. Although no modality has emerged as the gold standard in the management of LGIB, colonoscopy is the current preferred initial test for the majority of the patients presenting with hema- tochezia felt to be from a colon source. Colonoscopy has the ability to diagnose all sources of bleeding from the colon and, unlike the radiologic modalities, does not require active bleeding at the time of the examination. In addition, therapeutic interventions such as cautery and endoclips can be applied to achieve hemoo stasis and prevent recurrent bleeding. Studies suggest that colonoscopy, particularly when performed earlyin the hospitalization, can decrease hospital length of stay, rebleeding and the need for surgery. However, results from available small trials are conflicting and larger, multicenter studies are needed. Compared to other management options, colonoscopy is a safe procedure with complications reported in less than 2% of patients, including those undergoing urgent examinations. The requirement of bowel preparation （typically 4 or more liters of polyethylene glycol）, the logistical complexity of coordinating after hours colonoscopy, and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB, particularly in urgent situations. This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.
文摘Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.
文摘To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD).METHODSThis was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life.RESULTSEighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P < 0.01). At week 6, the LFD group showed a significantly lower median IBS-SSS (median 115; inter-quartile range [IQR] 33-169) than ND group (median 170, IQR 91-288), P = 0.02. Furthermore, the LFD group had a significantly greater increase in SIBDQ (median 60, IQR 51-65) than the ND group (median 50, IQR 39-60), P < 0.01.CONCLUSIONIn a prospective study, a low-FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.
文摘AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
文摘AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.
文摘MM： Persistent cholestasis is a rare complication of severe trauma or infections. Little is known about the possible pathomechanisms and the clinical course.METHODS： Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma （one burn injury, three accidents, one power current injury）. Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS： Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis （PSC）-Iike destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up 〉2 years. Therapeutic possibilities were limited.CONCLUSION： Posttraumatic sderosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension.Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.
文摘The process of decision making and risk analysis are essential tasks along the construction project cycle. Over the years, construction practitioners and researchers have used various methods, tools and techniques to evaluate risk and assist in making more concise decisions. Most practitioners, however, rely on their expert judgment, past experience, intuition, acquired and accumulated knowledge and gut feelings to make decisions. Aleatory （natural, heterogeneity and stochasticity） and epistemic （subjective, ignorance） are the two major types of uncertainties observed in natural sciences. Practitioners traditionally deal with aleatory uncertainty through probabilistic analysis based on historical data （frequentist approach）; and epistemic uncertainty, on the other hand, handled through the Bayesian approach which has limitations since it requires a priori assumption. This paper reports the application of the DST （Dempster Shafer Theory） of evidence to determine the most critical risk factors affecting project cost contingencies using their epistemic probabilities of occurrence. The paper further discuses how these factors can be managed to enhance successful delivery of infrastructural projects. It uses the mixed methodology, with data gathered through structured questionnaires distributed to construction clients, contractors, professionals and experts in the built environment. The research revealed that design risk, financial risk and economic risk were most important cost risk categorizations. In particular, scope changes, incomplete scope definition, incomplete design, changes in specification, micro and macroeconomic indicators and delayed payment problems were identified as the most important risk factors to be considered during the cost contingency estimation process, hence successful delivery of infrastructural projects. The paper concludes by recommending modalities for managing the contingency evolution process of risk estimation to enhance successful delivery and management of infrastructural projects.
文摘On the basis of the initial definition of Enterprise Emergency Management Capacity（EEMC）, the paper has established evaluation index system of EEMC, and provided a method to calculate index weight, with the regard to subjectivity existing in the comprehensive evaluation of EEMC multi-indicators, in accordance with the principle of Variable weight Gray Cluster, which makes the weight of indicators generate automatically in the evaluation process and not judged by human, thus decreasing subjective factors during the evaluation.
