建筑工程技术及施工现场管理问题浅析

我国的建筑工程越来越多,促进了社会经济的进步。为了进一步提高建筑工程的工程质量,需要规范作业实施现场的管治和作业实施技术 。然而,目前建筑工程运营实施现场的治理和技术仍存在一些不足,将对建筑工程的工程质量产生一定影响。

浅析建筑工程技术及施工现场管理

我国建筑项目工程作业实施项目的数量越来越多,促进了社会经济的进步,为了把建筑项目工程品质进一步提高,就应该让作业实施现场的管治与作业实施技术的管治更为标准化,但现阶段建筑项目工程作业实施场地管治和技术当中还是有着一部分不足,会对建筑项目工程品质产生了一定的影响。

Regarding the Regulatory Sandbox Route and Mechanism for Governance of Artificial Intelligence

The main challenge in AI governance today is striking a balance between controlling AI dangers and fostering AI innovation.Regulators in a number of nations have progressively extended the regulatory sandbox,which was first implemented in the banking sector,to AI governance in an effort to reduce the conflict between regulation and innovation.The AI regulatory sandbox is a new and feasible route for AI governance in China that not only helps to manage the risks of technology application but also prevents inhibiting AI innovation.It keeps inventors'trial-and-error tolerance space inside the regulatory purview while offering a controlled setting for the development and testing of novel AI that hasn't yet been put on the market.By providing full-cycle governance of AI with the principles of agility and inclusive prudence,the regulatory sandbox offers an alternative to the conventional top-down hard regulation,expost regulation,and tight regulation.However,the current system also has inherent limitations and practical obstacles that need to be overcome by a more rational and effective approach.To achieve its positive impact on AI governance,the AI regulatory sandbox system should build and improve the access and exit mechanism,the coordination mechanism between the sandbox and personal information protection,and the mechanisms of exemption,disclosure,and communication.

Endoprosthesis implantation at the pharyngo-esophageal level:Problems,limitations and challenges

AIM： To present our experience with endoscopic placement of an esophageal endoprosthesis in 19 patients. METHODS： A retrospective evaluation was made for the use of 19 stents positioned at the level of the cervical esophagus： 11 for malignant tumours （7 causing obstruction, 4 complicated by an esophago -tracheal or -cutaneous fistula）, and 8 for an acquired benign tracheo-esophageal fistula due to prolonged intubation. The covered Ultraflex stent was used in all cases except two. These two patients had an esophagocutaneous fistula following laryngectomy and a Flamingo Wall stent was used. RESULTS： Stent implantation was technically successful in all patients. Dysphagia score was improved from 3 to 2 in stenosis patients, while sealing of the fistula was achieved in all cases. The median hospital stay was 3 d for malignant turnout patients and 13.5 d for esophagocutaneous fistula patients. One Ultraflex stent and two Flamingo Wall stents were easily removed 33 d and 3 months respectively after implantation when the fistulas had totally occluded. CONCLUSION： Endoprosthesis implantation for malignancy and/or fistula of malignant or benign origin at the level of the cervical esophagus is an easy, well tolerated, safe and effective procedure with no complications or mortality.

Cryotherapy in the management of premalignant and malignant conditions of the esophagus

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen(liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett's esophagus(BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.

Angiographic evaluation and management of acute gastrointestinal hemorrhage

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.

Optimizing management of pancreaticopleural fistulas

AIM:To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic duct.METHODS:Eight patients with a spontaneous pancre-aticopleural fistula underwent endoscopic retrograde cholang iopancreatography(ERCP) with an intentionto stent the site of a ductal disruption as the primarytreatment. Imaging features and management were evaluated retrospectively and compared with outcome.RESULTS:In one case,the stent bridged the site of aductal disruption. The fistula in this patient closed with in3 wk. The main pancreatic duct in this case appearednormal,except for a leak located in the body of the pancreas. In another patient,the papilla of Vater couldnot be found and cannulation of the pancreatic ductfailed. This patient underwent surgical treatment. In the remaining 6 cases,it was impossible to insert a stentinto the main pancreatic duct properly so as to coverthe site of leakage or traverse a stenosis situated down-stream to the fistula. The placement of the stent failed because intraductal stones(n = 2) and ductal strictures(n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas(n = 2) . In 3 out of these 6 patients,the pancre-aticopleural fistula closed on further medical treatment.In these cases,the main pancreatic duct was normalor only mildly dilated,and there was a leakage at the body/tail of the pancreas. In one of these 3 patients,additional percutaneous drainage of the peripancre atic fluid collections allowed better control of the leakageand facilitated resolution of the fistula. The remaining3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not beinserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. Aftera failed the rapeutic ERCP,3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of 8 patients in our series required subsequent surgery due to a failed non-operative treat-ment. Distal pancreatectomy with splenectomy was performed in 3 cases. In one case,only external drainage of the pancreatic pseudocyst was done because of diffuse peripancreatic inflammatory infiltration precluding safe dissection. There were no perioperative mortalities.There was no recurrence of a pancreati copleural fistulain any of the patients.CONCLUSION:Optimal management of pancreaticopleural fistulas requires appropriate patient selection that should be based on the underlying pancreatic ductab normalities.

Personalized Management of Anastomotic Leak after Surgery for Esophageal Carcinoma

Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. Results A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0±31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. Conclusions Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method.The efficacy of stent implantation needs further investigation to confirm.

Hemorrhoids:From basic pathophysiology to clinical management

This review discusses the pathophysiology,epidemiology,risk factors,classification,clinical evaluation,and current non-operative and operative treatment of hemorrhoids.Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions.The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement.The abnormal dilatation and distortion of the vascular channel,together with destructive changes in the supporting connective tissue within the anal cushion,is a paramount finding of hemorrhoids.It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development,and could be a potential target for medical treatment.In most instances,hemorrhoids are treated conservatively,using many methods such as lifestyle modification,fiber supplement,suppositorydelivered anti-inflammatory drugs,and administration of venotonic drugs.Non-operative approaches include sclerotherapy and,preferably,rubber band ligation.An operation is indicated when non-operative approaches have failed or complications have occurred.Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy,but postoperative pain is invariable.Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence.The applications and outcomes of each treatment are thoroughly discussed.

Governance Logic and Basic Systems of the New “Food Safety Law of the People's Republic of China”: a Focus on Social Co-Governance

To modernize food safety governance, we must carry out basic restructuring of its internal logic at the national level to reflect the features of contemporary Chinese society that shape food safety. This will entail establishing an overarching, macro-level conception of food safety that integrates ＂baseline safety＂, ＂hub safety＂, ＂co-constructed safety＂ and ＂endogenous safety＂. These four dimensions of safety represent four fundamental requirements of food safety governance in modern Chinese society, which is a ＂risk society＂（Beck 1992） and one that is also complex, open and pluralist. These requirements are： maximum legal liability, a unified, authoritative and efficient supervision system, a concept of social co-governance, and enterprises being the primary entities accountable for food safety. This article uses this analytical framework to interpret the basic contents of the newly revised Food Safety Law of the People’s Republic of China, and uses a focus on social co-governance to present the institutional highlights of this law and the transformation of the internal logic of food safety governance.

New Opportunity and Challenges on Integrated Water Supply and Water Demand Managements

在未来10年以及更长的一段时间,全球和中国的水资源管理面临着紧迫的挑战,这些挑战包括水管控、水与食物、水与自然、水与能源、水与健康以及与气候变化相适应的与水相关的跨国合作,所有这些都与区域和全球尺度水安全相关。为了应对这些挑战,无论在中国还是世界范围,水资源管理战略必须解决需水管理(WDM)和供水管理(WSM)这两个重要问题,以及需水管理和供水管理的联合管理问题。本文将站在一个全球高度上研讨这一紧迫问题。通过分析,建议如下:在地方一级进行关于供水和需水管理的知识转让和经验交流和实践;在国家一级制定完善促进供需水管理的指导方针,最终发展到流域和区域级别。由于大陆或次大陆存在很大的差异,具体的区域指导报告是必要的,其中包括:专门针对现有可利用水资源和水需求的评估(通过使用水文方法进行水资源的评估以及需水调查和预测);关于组织、机构、税收、培训和教育的供需水的联合管理,在全球范围起草一个联合国公约草案。并在联合国会议上强调跨国界流域管理和/或竞争用水情况下的管理和/或水匮乏的供水需水联合管理的重要性。参照上述列举的目标,这些目标可能侧重于4个方面:在地方和国家一级(短期)供水管理;在地方和国家一级(短期)需水管理;在国家一级(中期和长期)供水管理和需水管理联合管理:在国际/区域一级(中期和长期)供水管理和需水管理联合管理。