清镜系列书法征集活动优秀作品选登

清风渔趣任鱼行,感谢各位钓友挥酒墨宝,与我们共享渔趣。清风雾月,明镜止水,诚邀各位品鉴清镜中的诗情画意!

国企改革的晚清镜鉴

国有企业由国家所有或国家主导,历来是各国稳定和发展经济的重要力量。国有经济应在国民经济中占多大比重,是古今中外各国的共同难题。晚清国有经济的发展历程可为今天的国企改革提供一些借鉴。历史上中国的官府并没有控制大部分国内市场和生产,其中有许多掌握在私人手中。在清代,仅有盐、铜、丝和瓷器由国家垄断,而像茶、糖、谷、棉纺织等则几乎完全被私人拥有和掌握。也正是因此,中国能够在几千年里生生不息,并长期居于世界领先地位。

如何实施小学数学教学的生活化

学生学习数学应该从现实生活中出发,而不是一味地学习书本上的死知识,学习后不会应用。结合生活,学生更容易理解知识,这种模拟生活的实践活动,使学生感到数学的优越性,小学数学生活化是时代发展的必然要求,是我们教师与时俱进的肯定条件。只有小学数学教学生活化了,我们才能更好地运用新课标改革过的课程。新课程改革过的课程知识点比较活跃,更贴近生活。这需要生活实践来解决数学题目。所以小学数学教学生活化是必需的。那么如何实施小学数学的生活化。

镜中人生——评法国短片《镜子》

在人类短暂的一生中,我们总在试图利用各种各样的媒介记录下我们成长的印记。于是我们拍照留念,写日记,拍摄视频,收藏物品。但实际上,默默陪在我们身边的每一件物品,他们看似没有生命,却也见证着我们短暂一生那些每一个再也无法回去的瞬间。法国短片《镜子》从第一人称的视角出发,讲述了一个男人的一生。

样板房的装饰主义空间设计

接到本案的设计任务,针对甲方提出的设计要求：既要满足住宅业主的居住功能需求,又要具备样板房的空间展示功能,同时还要具有住宅空间概念的消费性引导。这些因素就为此案定义了装饰主义的设计概念。装饰是一种生活方式的展现,她是人类文明的开始。举凡庙宇教堂,豪宅简居,乃至于个人服饰穿着皆与装饰息息相关。装饰集中体现了特定历史时期文化与风格,其实,不装饰也是一种天然去雕饰的装饰,问题不在于装饰与否,而在于每个人都要寻求适合自己的得体装饰风格。

明宫裹的侏儒

清饶智元《明宫杂咏》有一首道: 小人嬉笑在深宫,形体么麽顾吩雄。每问左廊邀圣眷,承恩不忍化沙虫。注引《甲申小纪》云:“小人屋在御厕之左廊。人二,夫妇也。长尺许,屋倍之。凡几榻枕席,动用之物,毕具其中,外则绕以栏杆。其声啁哳,亦时作嬉笑怒骂之状。一日,上御厕,出临视焉。二人若甚惊恐,上大笑。”

郑元畅·林依晨真实的故事

早过了疯狂迷恋偶像的年纪,但偶尔看到郑元畅(小综)与林依晨在电视屏幕上亮相,不难理解他俩为何可以迷倒老中青三代。男的完美得像从童话故事中走出来,女的天真娇俏。

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures:A three year prospective study

AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.

Comparative effectiveness of i-SCAN^(TM) and high-definition white light characterizing small colonic polyps

AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative effec- tiveness pilot study. Polyps （n = 103） from 75 average- risk adult outpatients undergoing screening or surveil- lance colonoscopy between December 1, 2010 and April 1, 2011 were evaluated by two participating en- doscopists in an academic outpatient endoscopy center. Polyps were evaluated both with high-definition white light and with/-SCAN to make an/n vivo prediction of adenomatous vs non-adenomatous pathology. We de- termined diagnostic characteristics of/-SCAN and high- definition white light, including sensitivity, specificity, and accuracy, with regards to identifying adenomatous vs non-adenomatous polyps. Histopathologic diagnosis was the gold standard comparison. RESULTS： One hundred and three small polyps, de- tected from forty-three patients, were included in the analysis. The average size of the polyps evaluated in the analysis was 3.7 mm （SD 1.3 mm, range 2 mm to 8 mm）. Formal histopathology revealed that 54/103 （52.4%） were adenomas, 26/103 （25.2%） were hyper- plastic, and 23/103 （22.3%） were other diagnoses in- clude ＂lymphoid aggregates＂, ＂non-specific colitis,＂ and ＂no pathologic diagnosis.＂ Overall, the combined accu- racy of endoscopists for predicting adenomas was iden- tical between/-SCAN （71.8%, 95%CI： 62.1%-80.3%） and high-definition white light （71.8%, 95%CI： 62.1%-80.3%）. However, the accuracy of each endosco- pist differed substantially, where endoscopist A demon- strated 63.0% overall accuracy （95%CI： 50.9%-74.0%） as compared with endoscopist B demonstrating 93.3% overall accuracy （95%CI： 77.9%-99.2%）, irrespective of imaging modality. Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study. Though endoscopist A increased accuracy using/-SCAN from 59% （95%CI： 42.1%-74.4%） in the first half to 67.6% （95%CI： 49.5%-82.6%） in the second half, and endoscopist B decreased accuracy usingi-SCAN from 100% （95%CI： 80.5%-100.0%） in the first half to 84.6% （95%CI： 54.6%-98.1%） in the second half, nei- ther of these differences were statistically significant. CONCLUSION：i-SCAN and high-definition white light had similar efficacy predicting polyp histology. Endosco- pist training likely plays a critical role in diagnostic test characteristics and deserves further study.

Intrahepatic transplantation of hepatic oval cells for fulminant hepatic failure in rats

AIM： To evaluate the effect of intrahepatic transplantation of hepatic oval cells （HOC） on fulminant hepatic failure （FHF） in rats.METHODS： HOC obtained from rats were labeled with green fluocescent protein （GFP） or 5, 6- carboxyfluorescein diacetate succinmidyl ester （CFDASE）. Cell fluorescence was observed under fluorescent microscope at 6, 24, 48 and 72 h after labeling. CFDA- SE labeled HOC （5 × 10^6 cells each rat） were injected into livers of rats with FHF induced by D-galactosamine. Serum albumin （ALB）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBil） levels were measured at different time points. Liver function of rats was examined on days 3, 7, 14 and 21 after HOC transplantation.RESULTS： The positive rate of GFP and CFDA-SE labeled HOC was 10% and 90%, respectively, with no significant change in cell viabilities. The survival rate was higher in HOC transplantation group than in control group, especially 48 （9/15 vs 6/15） and 72 h （9/15 vs 4/15） after HOC transplantation. The serum ALT, AST and TBil levels were decreased while the serum AIb level was increased after HOC transplantation. Fluorescence became faded and diffused in liver tissues, suggesting that proliferation and differentiation occur in transplanted HOC.CONCLUSION： CFDA-SE is superior to GFP in labeling HOC, although fluorescence intensity is decreased progressively with cell division. HOC transplantation can improve the liver function and increase the survival rate of recipients.

Helpfulness of the combination of acetic acid and FICE in the detection of Barrett's epithelium and Barrett's associated neoplasias

AIM:To investigate the mucosal morphology in Barrett's oesophagus by chromo and magnifying endoscopy.METHODS:A prospective pilot study at a tertiary medical centre was conducted to evaluate the use of acetic acid pulverisation combined with virtual chromoendoscopy using Fujinon intelligent chromoendoscopy(FICE) for semiological characterization of the mucosal morphology in Barrett's oesophagus and its neoplastic complications.Upper endoscopy using high definition whitelight,2% acid acetic pulverisation and FICE with high definition videoendoscopy were performed in 20 patients including 18 patients who presented with aspects of Barrett's oesophagus at endoscopy examination.Two patients used as controls had normal endoscopy and histological results.Prospectively,videos were watched blind from histological results by three trained FICE technique endoscopists.RESULTS:The videos of patients with high-grade dysplasia showed an irregular mucosal pattern in 14% using high definition white light endoscopy and in 100% using acid acetic-FICE combined.Videos did not identify irregular vascular patterns using high definition white light endoscopy,while acid acetic-FICE combined visualised one in 86% of cases.CONCLUSION:Combined acetic acid and FICE is a promising method for screening high-grade dysplasia and early cancer in Barrett's oesophagus.

Endoscopic removal and trimming of distal self-expandable metallic biliary stents

AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary strictures.Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS(one uncovered and 18 covered) removal had been attempted,and 8 patients in whom stent trimming using argon plasma coagulation(APC) had been attempted at Tokyo Medical University Hospital.The APC settings were:voltage 60-80 W and gas flow at 1.5 L/min.RESULTS:The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d(range,8-280 d).Of the 19 patients in whom removal of the SEMS had been attempted,the procedure was successful in 14(73.7%) without procedure-related adverse events.The indwelling period in the stent removable group was shorter than that in the unremovable group(94.9 ± 71.5 d vs 166.2 ± 76.2 d,P = 0.08).Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage.Trimming time ranged from 11 to 16 min.CONCLUSION:Although further investigations on larger numbers of cases are necessary to accumulate evidence,the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.

Effect of double-balloon enteroscopy on pancreas:An experimental porcine model

AIM： To evaluate the effect of double-balloon enteros- copy （DBE） on pancreas histology and levels of pancre- atic enzymes. METHODS： Conventional upper gastrointestinal endos- copy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups （10 pigs each） were defined according to DBE duration： 90 rain for Group 1 and 140 min for Group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amy- lase, lipase and C-reactive protein （CRP） levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of de- creased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was per- formed on day 7. RESULTS： All animals tolerated DBE without clini- cal manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic lev- els had returned to baseline. No differences between Groups 1 and 2 were found for any enzyme and sam- pling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspec- tion of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from Groups 1 and 2 re- vealed the existence of focal areas （0.14-0.26 mm2） of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe （tail） was always affected. However, this only happened in 83.3% of the samples from the right lobe （head） and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe （tail） and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe （tail）. The presence of the lesions was not related to the ex- ploration length.CONCLUSION： The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.

study to determine guidelines for pediatric colonoscopy

To investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy. METHODSThe present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon. RESULTSHematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis. CONCLUSIONColonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.

Addition of senna improves quality of colonoscopy preparation with magnesium citrate

AIM: To prospectively investigate the effectiveness and patient’s tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. METHODS: A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone (n = 160) or magnesium citrate and senna granules (n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. RESULTS: The percentage of procedures rescheduled because ofinsufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group (P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen (P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or headache.However, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). CONCLUSION: The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome.

Catalytic ozonation of phenol and oxalic acid with copper-loaded activated carbon

A novel heterogeneous catalytic ozonation process in water treatment was studied, with a copper-loaded activated carbon （Cu/AC） that was prepared by an incipient wetness impregnation method at low temperature and tested as a catalyst in the ozonation of phenol and oxalic acid. Cu/AC was characterized using XRD, BET and SEM techniques. Compared with ozonation alone, the presence of Cu/AC in the ozonation processes significantly improves the degradation of phenol or oxalic acid. With the introduction of the hydroxyl radical scavenger, i.e., turt-butanol alcohol （t-BuOH）, the degradation efficiency of both phenol and oxalic acid in the Cu/AC catalyzed ozonation process decreases by 22% at 30 min. This indicates that Cu/AC accelerates ozone decomposition into certain concentration of hydroxyl radicals. The amount of Cu（II ） produced during the reaction of Cu/AC-catalyzed ozonation of phenol or oxalic acid is very small, which shows that the two processes are both heterogeneous catalytic ozonation reactions.

Arthroscopic Debridement and Synovium Resection for Inflammatory Hip Arthritis

Objective To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis.Methods A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis.There were 17 cases of ankylosing spondylitis,11 cases of rheumatoid arthritis,and 8 cases of psoriatic arthritis.The joints were irrigated and the inflamed tissues were debrided with anthroscopy.The patients were followed up with Harris hip score,Oxford hip score,Visual Analog Scale(VAS),and magnetic resonance imaging(MRI).Statistical analysis was performed using Student t test.Results All of the 36 cases were followed up for 46-103 months,averaging 67.2±8.4 months.Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation,respectively(P<0.05).VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5(P<0.05).All the patients showed improved joint range of motion.MRI revealed alleviation of hip synovitis.The results were classified as excellent in 8 patients,good in 17 patients,fair in 8 patient,and poor in 3 according to Harris hip score.Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities.Conclusions Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis.The inflammatory lesion might be thereby controlled and the symptoms be relieved.

Increased tumor necrosis factor receptor 1 expression in human colorectal adenomas

AIM: To determine the expression statuses of tumor necrosis factor (TNF)-α, its receptors (TNF-R) and downstream effector molecules in human colorectal adenomas. METHODS: We measured the serum concentrations of TNF-α and its receptors in 62 colorectal adenoma patients and 34 healthy controls. The protein expression of TNF-α, TNF-R1, TNF-R2 and downstream signals of the TNF receptors, such as c-Jun N-terminal kinase (JNK), nuclear factor-κ B and caspase-3, were also investigated in human colorectal adenomas and in normal colorectal mucosal tissues by immunohistochemistry. Immunofluorescence confocal microscopy was used to investigate the consistency of expression of TNF-R1 and phospho-JNK (p-JNK). RESULTS: The serum levels of soluble TNF-R1 (sTNF-R1) in adenoma patients were significantly higher than in the control group (3.67 ± 0.86 ng/mL vs 1.57 ± 0.72 ng/mL, P < 0.001). Receiver operating characteristic analysis revealed the high diagnostic sensitivity of TNF-R1 measurements (AUC was 0.928) for the diagnosis of adenoma, and the best cut-off level of TNF-R1 was 2.08 ng/mL, with a sensitivity of 93.4% and a specificity of 82.4%. There were no significant differences in the serum levels of TNF-α or sTNF-R2 between the two groups. Immunohistochemistry showed high levels of TNF-R1 and p-JNK expression in the epithelial cells of adenomas. Furthermore, a high incidence of co-localization of TNF-R1 and p-JNK was identified in adenoma tissue. CONCLUSION: TNF-R1 may be a promising biomarker of colorectal adenoma, and it may also play an important role in the very early stages of colorectal carcinogenesis.

Microscopic Inspection on Developmental Process of Myeloma Cells

The developmental process of Myeloma cells under a digital optical microscope has been inspected and monitored by using time-lapsed recording technique. Myeloma cells were cultured in medium contained 20% and 50% of Fetal Bovine Serum （FBS）, respectively. Inspection and monitoring for 6 hours showed the effect of the FBS to mobility, proliferation rate, and development of cell cycle phases of Myeloma cells. Using time-lapsed data, the speed of cells was 3.5-6.0 pm/s when using FBS 20% and increased to 5.0-8.0 p.m/s when using FBS 50%. The rate of cells decreases from 2 cells/hr when using FBS 20% to 1/6 cells/br when using FBS 50%. The cells division process is signified by the change in gray level and it took every 50-70 minutes.