梦里动静两相宜——元杂剧涉梦戏梦景小议

元杂剧涉梦戏的梦景表现为静视与动视基本两种审美状态,这种角色的美学态势与艺术构思传达着剧作家独具匠心的思维脉络和时代思潮,尤其是道教对文学的精神冲刷。

Direct pre-stack depth migration on rugged topography

Engineering seismic exploration aims at shallow imaging which is confused by statics if the surface is uneven. Direct pre-stack depth migration （DPDM） is based on accurate elevations of sources and receivers, by which static correction is completely abandoned before migration and surely the imaging quality is remarkably improved. To obtain some artificial shot gathers, high-order staggered-grid finite-difference （FD） method is adapted to model acoustic wave propagation. Since the shot gathers are always disturbed by regular interferences, the statics still must be applied to supporting the interference elimination by apparent velocity filtering method. Then all the shot gathers should be removed back to their original positions by reverse statics. Finally, they are migrated by pre-stack reverse-time depth migration and imaged. The numerical experiments show that the DPDM can ideally avoid the mistakes caused by statics and increase imaging precision.

Role of combined propofol and sufentanil anesthesia in endoscopic injection sclerotherapy for esophageal varices

AIM To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy(EIS) for esophageal varices(EVs). METHODS Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists(ASA) physical status, Child-Turcotte-Pugh(CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.RESULTS Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1± 11.7 years(range, 25-83 years). The patients weighed 71.4 ± 10.7 kg(range, 45-95 kg) and had ASA physical status classifications of Ⅱ(79 patients) or Ⅲ(103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients(1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient(0.5%, 1/182), and hypoxia occurred in one patient(0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.CONCLUSION The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.

How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

Visual improvement in an adult amblyopic eye following branch retinal vein occlusion in non-amblyopic eye

Objective:To report a case of anisometropic amblyopia reversal as a result of branch retinal vein occlusion (BRVO) occurring in the sound fellow eye.Methods:An adult patient with childhood anisometropic amblyopia was found to exhibit gradually visual acuity improvement in the amblyopic eye as the result of decreased visual acuity in the sound fellow eye.Results:Four years after the BRVO,the patient subsequently regained normal vision in the previously amblyopic eye.Conclusion:Visual plasticity is preserved in adults but may require special or stronger stimulation and possibly longer treatment time than during childhood.

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxide) and a control group(inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram(ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients(P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group(P < 0.05).CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.

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.

Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.

High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

Branch retinal vein thrombosis and visual loss probably associated with pegylated interferon therapy of chronic hepatitis C

Ophthalmological complications with interferon therapy are usually mild and reversible, not requiring the withdrawal of the treatment. We report a case of a patient who had visual loss probably associated with interferon therapy. Chronic hepatitis C virus infection （genotype la） was diagnosed in a 33-year old asymptomatic man. His past medical history was unremarkable and previous routine ophthalmologic check-up was normal. Pegylated interferon alpha and ribavirin were started. Three weeks later he reported painless reduction of vision. Ophthalmologic examination showed extensive intraretinal hemorrhages and cottonwool spots, associated with inferior branch retinal vein thrombosis. Antiviral therapy was immediately discontinued, but one year later he persists with severely decreased visual acuity. This case illustrates the possibility of unpredictable and severe complications during pegylated interferon therapy.

Investigating Iranian Test-takers＇ Performance Over Taking Different Modalities of Listening Comprehension Test

Visual and pictorial materials are extensively used in teaching listening comprehension textbooks. Although the use of still image is currently implemented in some distinguished testing systems, video test is not a popular modality due to the fact that this kind of test may result in test-takers＇ confusion during the test. In the present study, a sample of 80 Iranian EFL （English as a Foreign Language） students was selected to compare their performance on three different modalities of listening test： audio-only test, pictorial （listening with still image test）, and visual （video） listening test. The analysis of one-way repeated measure ANOVA （Analysis of Variance） was used to compare the students＇ scores. The results of Bonferroni Post Hoc Test confirm that there were significant differences in scores among audio-only, pictorial, and visual tests. The results of this study highlight the greater performance of students in pictorial listening test which is statistically significant.

Tunneling Radiation of Massive Vector Bosons from Dilaton Black Holes

It is well known that Hawking radiation can be treated as a quantum tunneling process of particles from the event horizon of black hole. In this paper, we attempt to apply the massive vector bosons tunneling method to study the Hawking radiation from the non-rotating and rotating dilaton black holes. Starting with the Proca field equation that govern the dynamics of massive vector bosons, we derive the tunneling probabilities and radiation spectrums of the emitted vector bosons from the static spherical symmetric dilatonic black hole, the rotating Kaluza–Klein black hole,and the rotating Kerr–Sen black hole. Comparing the results with the blackbody spectrum, we satisfactorily reproduce the Hawking temperatures of these dilaton black holes, which are consistent with the previous results in the literature.

Mathematical analysis of an HIV infection model including quiescent cells and periodic antiviral therapy

In this paper, we revisit the model by Guedj et al. [J. Guedj, R. Thibaut and D. Commenges, Maximum likelihood estimation in dynamical models of HIV, Biometrics 63 （2007） 198-206; J. Guedj, R. Thibaut and D. Commenges, Practical identifiability of HIV dynamics models, Bull. Math. Biol. 69 （2007） 2493 2513] which describes the effect of treatment with reverse transcriptase （RT） inhibitors and incorporates the class of quiescent cells. We prove that there is a threshold value 7 of drug efficiency η such that if η 〉 7, the basic reproduction number R0 〈 1 and the infection is cleared and if η〈 η^-, the infectious equilibrium is globally asymptotically stable. When the drug efficiency function η（t） is periodic and of the bang-bang type we establish a threshold, in terms of spectral radius of some matrix, between the clearance and the persistence of the disease. As stated in related works [L. Rong, Z. Feng and A. Perelson, Emergence of HIV-1 drug resistance during antiretroviral treatment, Bull. Math. Biol. 69 （2007） 2027-2060; P. De Leenheer, Within-host virus models with periodic antiviral therapy, Bull. Math. Biol. 71 （2009） 189-210.], we prove that the increase of the drug efficiency or the active duration of drug must clear the infection more quickly. We illustrate our results by some numerical simulations.