Emergency exploratory laparotomy and radical gastrectomy in patients with gastric cancer combined with acute upper gastrointestinal bleeding

BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC.This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB,hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.AIM To investigate the clinical efficacy and safety of exploratory laparotomy^(+)radical gastrectomy and palliative therapy in patients with GC and UGIB combined.METHODS A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study.The 89 patients were divided into two groups:radical resection group(n=46)treated with exploratory laparotomy^(+)radical gastrectomy and Palliative group(n=43)treated with palliative therapy.The study compared several variables between the two groups,including surgical duration,intraoperative blood transfusion volume,postoperative anal exhaust time,off-bed activity time,length of hospitalization,and incidence of complications such as duodenal stump rupture,anastomotic obstruction,and postoperative incision.Additionally,postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and CD3^(+)/HLADR^(+)),immunoglobulin(IgG and IgM),tumor markers(CEA,CA199,and CA125),and inflammatory factors(IL-6,IL-17,and TNF-α)were assessed.The surgical efficacy and postoperative quality of life recovery were also evaluated.The patients were monitored for survival and tumor recurrence at 6 mo,1 year,and 2 years post-surgery.RESULTS The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures.However,patients in the radical resection group exhibited shorter intraoperative blood loss,anus exhaust time,off-bed activity time,and inpatient activity time than those in the Palliative group.Although there was no substantial difference in the occurrence of postoperative complications,such as duodenal stump rupture and anastomotic obstruction,between the radical resection group and Palliative group(P>0.05),the radical resection group exhibited higher postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),etc.)and immunoglobulin levels(IgG,IgM)than the Palliative group,while tumor markers and inflammatory factors levels were lower than those in the radical resection group.Additionally,surgical efficacy,postoperative quality of life,and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy.Moreover,the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group,and these differences were all statistically significant(P<0.05).CONCLUSION Compared to palliative therapy,exploratory laparotomy^(+)radical gastrectomy can improve immune function,reduce the levels of tumor markers and inflammatory factors,improve surgical efficacy,promote postoperative quality of life recovery,enhance survival rates,and attenuate the probability of tumor recurrence.

Social experience promotes the exploratory behaviour in Java Sparrows

Personality widely exists in diverse animal taxa.Such inter-individual variance in behaviour is supposed to be influenced by social context.However,it remains unknown whether the experience of social life has any carryover effects on the subsequent expression of personality.Here,we examined exploratory behaviour in caged Java Sparrows(Lonchura oryzivora)using exploration assays.Birds were assigned to live in either a solitary or a social context for four weeks.We compared the expressions of exploration before and after the treatments,and found that birds showed higher exploration tendencies after than before social life,while the isolated birds were consistent in their exploratory behaviours.Different living experience led to differences in the exploration activities for birds without significant differences in exploration before.Our results indicate that social experience can make birds more proactive.

Uncertainty entropy-based exploratory evaluation method and its applications on missile effectiveness evaluation

Some attributes are uncertain for evaluation work because of incomplete or limited information and knowledge.It leads to uncertainty in evaluation results.To that end,an evaluation method,uncertainty entropy-based exploratory evaluation(UEEE),is proposed to guide the evaluation activities,which can iteratively and gradually reduce uncertainty in evaluation results.Uncertainty entropy(UE)is proposed to measure the extent of uncertainty.First,the belief degree distributions are assumed to characterize the uncertainty in attributes.Then the belief degree distribution of the evaluation result can be calculated by using uncertainty theory.The obtained result is then checked based on UE to see if it could meet the requirements of decision-making.If its uncertainty level is high,more information needs to be introduced to reduce uncertainty.An algorithm based on the UE is proposed to find which attribute can mostly affect the uncertainty in results.Thus,efforts can be invested in key attribute(s),and the evaluation results can be updated accordingly.This update should be repeated until the evaluation result meets the requirements.Finally,as a case study,the effectiveness of ballistic missiles with uncertain attributes is evaluated by UEEE.The evaluation results show that the target is believed to be destroyed.

Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

The Geostatistical Information Method of Exploratory Engineering

The geostatistical information method consists in the use of the principle of quantitative evaluation in exploratory engineering research. The principle of uantitative evaluation is based on the mathematical model of the ore body. The selection of optimal exploratory scheme and optimal engineering positions has been studied in this paper.

Researching Instruction Model of Viewing, Listening ＆ Speaking Class——A Case Study Based on Exploratory Practice

The paper presents a case study on listening-speaking class instruction models based on exploratory practice. Assuming the dual roles of a teacher and a researcher, the writer of this paper has implemented three models of classroom instructions for the Viewing, Listening ＆ Speaking Class. From the students＇ report, teacher＇s log and classroom observation, it is concluded that the three models meet the needs of different students. The key to a successful Viewing, Listening＆ Speaking Class is to set reasonable goals and analyze students＇ needs.

Exploratory and Confirmatory Factor Analyses for Testing Validity and Reliability of the Malay Language Questionnaire for Urinary Incontinence Diagnosis (QUID)

This study examines the construct validity and reliability of the Malay language questionnaire for urinary incontinence diagnosis (QUID) in women. Study Design: Random sampling design was used in this cross-sectional survey. Materials and Methods: The Americanized English language questionnaire was translated to the Malay language and distributed to community-dwelling Malaysian women living in various locations in Selangor. The construct validity was tested using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). The reliability was determined using Cronbach’s α. Results: A total of 111 women completed the Malay language QUID in this pilot study. The Keiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.675 and Bartlett’s test of sphericity (χ2 = 284.633, df = 15, p = 0.001) indicated that the EFA was possible. The total variance and the scree plot identified two factors above the initial eigenvalue of 1 while a third factor was just below it (0.758). The CFA output showed a recursive model with the solution being not admissible because two unobserved and exogenous variables had negative variance estimates. The following values of absolute fit indices showed an acceptable level of fit: 1) Chi-square test with χ2 = 4.997, df = 5, p = 0.416, indicated a smaller difference between the expected and observed covariance matrices;2) GFI = 0.986, AGFI = 0.939, RMR = 0.021 and CMIN/DF = 1.0 indicated acceptable level of fit;3) The baseline comparison values of NFI = 0.983 and CFI = 1.0 also indicated a good fit to the data;4) RMSEA = 0.000 was considered a perfect fit indicating that the hypothesized model was a good fit to the observed data. Under the hypothesis of “close fit”, the probability of getting a sample RMSEA as large as 0.000 was 0.567. The Cronbach’s α coefficient of 0.823 indicated good reliability. Conclusion: The Malay language QUID is a valid and reliable instrument for diagnosing female urinary incontinence in the Malaysian population.

Exploratory Data Analysis Applied in Mapping Multi-element Soil Geochemical Anomalies for Drill Target Definition:A Case Study from the Unpha Layered Non-magmatic Hydrothermal Pb-Zn Deposit,DPR Korea

A factor analysis was applied to soil geochemical data to define anomalies related to buried Pb-Zn mineralization.A favorable main factor with a strong association of the elements Zn,Cu and Pb,related to mineralization,was selected for interpretation.The median+2 MAD(median absolute deviation)method of exploratory data analysis(EDA)and C-A(concentration-area)fractal modeling were then applied to the Mahalanobis distance,as defined by Zn,Cu and Pb from the factor analysis to set the thresholds for defining multi-element anomalies.As a result,the median+2 MAD method more successfully identified the Pb-Zn mineralization than the C-A fractal model.The soil anomaly identified by the median+2 MAD method on the Mahalanobis distances defined by three principal elements(Zn,Cu and Pb)rather than thirteen elements(Co,Zn,Cu,V,Mo,Ni,Cr,Mn,Pb,Ba,Sr,Zr and Ti)was the more favorable reflection of the ore body.The identified soil geochemical anomalies were compared with the in situ economic Pb-Zn ore bodies for validation.The results showed that the median+2 MAD approach is capable of mapping both strong and weak geochemical anomalies related to buried Pb-Zn mineralization,which is therefore useful at the reconnaissance drilling stage.

First Exploratory Summary for Four-corresponding and Six-method Massage

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Exploratory Trial to Evaluate the Hydroxyapatite Layer Formed by a New Dental Treatment System

Objective: A powder jet deposition (PJD) process can be used to create a thick hydroxyapatite (HA) layer on the human tooth surface. The purpose of this exploratory trial was to evaluate the safety and efficacy of the hydroxyapatite layer formed by a new dental treatment system for cases of caries, dentin hypersensitivity, or discolored teeth. Methods: A single facility, non-blinded study comparing before and after treatment interventions, without a comparative control, was conducted. A rubber dam was attached to the teeth followed by the application of Vaseline to the gingival margins. Extra- and intra-oral vacuums and a saliva discharge tube were used to spray HA powder over the target site with the PJD equipment. Results: The formation of an HA layer tended to reduce pain on exposure to cold water and air in the cases with caries, and increase brightness and satisfaction in the cases with tooth discoloration. The pain on exposure to air was significantly reduced in the cases with dentin hypersensitivity. PJD was not observed to cause any inflammation of the surrounding gingiva or pulpal symptoms. Conclusions: HA is anticipated to reduce the need for repeat treatment by offering superior compatibility with the tooth substance when compared with other dental materials.

Uncovering and Displaying the Coherent Groups of Rank Data by Exploratory Riffle Shuffling

Let n respondents rank order d items, and suppose that . Our main task is to uncover and display the structure of the observed rank data by an exploratory riffle shuffling procedure which sequentially decomposes the n voters into a finite number of coherent groups plus a noisy group: where the noisy group represents the outlier voters and each coherent group is composed of a finite number of coherent clusters. We consider exploratory riffle shuffling of a set of items to be equivalent to optimal two blocks seriation of the items with crossing of some scores between the two blocks. A riffle shuffled coherent cluster of voters within its coherent group is essentially characterized by the following facts: 1) Voters have identical first TCA factor score, where TCA designates taxicab correspondence analysis, an L1 variant of correspondence analysis;2) Any preference is easily interpreted as riffle shuffling of its items;3) The nature of different riffle shuffling of items can be seen in the structure of the contingency table of the first-order marginals constructed from the Borda scorings of the voters;4) The first TCA factor scores of the items of a coherent cluster are interpreted as Borda scale of the items. We also introduce a crossing index, which measures the extent of crossing of scores of voters between the two blocks seriation of the items. The novel approach is explained on the benchmarking SUSHI data set, where we show that this data set has a very simple structure, which can also be communicated in a tabular form.

Exploratory Practice as a Practitioner Research on LanguageLearning and Teaching

The philosophy of Exploratory Practice is that language classroom learning and teaching practice is a social practice;hence practitioner research on it should pay attention to this socialness rather than only concern the cognitive aspect so that an understanding of quality of classroom life can be achieved before it can possibly lead to the improvement of the practice.The paper introduces the theory of Exploratory Practice in terms of its content spirit,key terms,relationship with other practitioner researches and methodological nature,aiming to help practitioners and classroom-based researchers to understand it.

Postoperative Outcomes in Exploratory Laparotomy and Intestinal Resection in Children: A Secondary Descriptive Observational Analysis

Background: We previously reported independent predictors of intraoperative and postoperative morbidity. These were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of this previous retrospective study in patients who underwent exploratory laparotomy and intestinal resection. Objectives: The objective was to describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to present a research protocol for intraoperative and postoperative optimization. Methods: Secondary analysis of the initial study was used. The Ethics Committee approved the study. Results: There were 54 patients with a median age of 15.5 [0 - 172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus. Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had an intraoperative hemorrhagic shock. Two (3.7%) patients had a postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had an intraoperative transfusion. The in-hospital mortality rate was 3.7% in two patients. Conclusion: The number of patients with postoperative complications in this cohort was not negligible. We, therefore, elaborated a research protocol where intraoperative patient management will be guided with transthoracic echocardiography for fluid and hemodynamic therapy optimization. The objective of this study protocol is to clarify the impact of intraoperative goal-directed fluid and hemodynamic therapy with transthoracic echocardiography on postoperative outcomes in terms of complications in pediatric surgical patients.

Development of Elementary School Teachers＇ Self-Regulated Learning Exploratory Factor Scale

Self-regulated learning （SRL） is one of the precious ways in teachers＇ professional development, and its operation level includes different factors. With studies abroad and our preliminary investigation as base, this study developed a scale to test the factors SRL includes. According to the result of 905 teachers working in elementary school by exploratory factor analysis, the SRL for elementary teachers is consisted of its sociality （it included selecting leads and seeking for instructing）, its motivation（it included self-improvement and self-excelling）, its methods（it included strategy use and habitual behavior）, and its outcomes（it included extensive reading and teachers＇ professional development）. All the result indicated Teachers＇ SRL Scale had clear factor structure, good reliability and validity. It can be used to test the current operating situation of SRL for teachers working in elementary school.

Inter-Organizational Conflict (IOC) in Building Refurbishment Projects;an Exploratory Factor Analysis (EFA) approach

Over the past years,there has been an expanding intrigued in building refurbishment projects because of the alter in financial conditions and the accentuation on sustainable development.Increasing demand for building refurbishment projects will lead to an increase in organizational interactions in the construction works as building refurbishment works involve interactions among many different organizations and it can cause Inter-Organizational conflict(IOC)among organizations involved in projects.This paper adopted an Exploratory Factor Analysis(EFA)approach to analyses IOC in building refurbishment projects.For this study,a fivepoint Likert Scale was adopted to ensure the instruments of the study are reliable.The researcher ultimately sent questionnaires as a web-link and email invitation to 1050 construction firms and 733 architectural firms.The questionnaire sent to managers and professionals from construction and architectural firms in Malaysia.Finally,one-hundred-seventy-nine(179)refurbishment projects formed a database for this paper.The finding of this paper shows the IOC factors that contribute to the improve the performance of building refurbishment project can be conflict during the construction stage,conflict between the client and the consultant,task expectations,basic responsibilities,final duration,project’s goals,conflict between the client and the contractor,final cost,final quality,standards of behaviors,conflict between the contractor and the consultant,interference and conflict during the design stage.

Android Oriented Image Visualization Exploratory Search

When using traditional image search engines, smartphone users often complain about their poor user interface including poor user experience, and weak interaction. Moreover, users are unable to find a desired picture partly due to the unclear key words. This paper proposes the word-bag co-occurrence scheme by defining the correlation between images. Through exploratory search, the search range can be expanded and help users refine retrieval of the expected images. Firstly, the proposed scheme applied the bag of visual words (BoVW) vector by processing images on Hadoop. Secondly, similarity matrix was constructed to organize the image data. Finally, the images in which users were interested was visually displayed on the android mobile phone via exploratory search. Comparing the proposed method to current methods by testing with image data sets on ImageNet, the experimental results show that the former is superior to the latter on visual representation, and the proposed scheme can provide a better user experience.

A preliminary study on exploratory search behavior of undergraduate students in China

Purpose: This study attempts to investigate how a user's search behavior changes in the exploratory search process in order to understand the characteristics of the user's search behavior and build a behavioral model.Design/methodology/approach: Forty-two matriculated full-time senior college students with a female-to-male ratio of 1 to 1 who majored in medical science in Jilin University participated in our experiment. The task of the experiment was to search for information about 'the influence of environmental pollution on daily life' in order to write a report about this topic. The research methods include concept map, query log analysis and questionnaire survey.Findings: The results indicate that exploratory search can significantly change the knowledge structure of searchers. As searchers were moving through different stages of the exploratory search process, they experienced cognitive changes, and their search behaviors were characterized by quick browsing, careful browsing and focused searching.Research limitations: The study used only one search topic, and there is no comparision or control group. Although we took search habits, personal thinking habits, personality characteristics and professional background into account, a more detailed study to analyze the effects of these factors on exploratory search behavior is needed in our further research.Practical implications: This study can serve as a reference for other researchers engaged in the same effort to construct the supporting system of exploratory search.Originality/value: Three methods are used to investigate the behavior characteristics during exploratory search.

Perceived value of microfinance and SME performance: The role of exploratory innovation

This study examines how perceived value of microfinance and exploratory innovation affect small and medium-sized enterprises(SME)performance in the context of a developing nation.Drawing on the strategic innovation and microfinance literature,we hypothesize that(1)perceived value of microfinance affects exploratory innovation and SME performance,and(2)exploratory innovation serves as an effective mechanism through which microfinance enhances SME per-formance.We employ partial least squares structural equation modeling(PLS-SEM)to test our hypotheses.Using a sample of 581 Ghanaian SMEs with microfinance,the results of the PLS SEM support our hypotheses.We further conducted a qualitative analysis of comments provided by the SMEs(n=144)to gain a deeper understanding of exploratory innovation in developing econo-mies.Our findings show that SMEs purposefully attempt to strengthen their exploratory inno-vation in microfinance.We discuss the theoretical and practical implications of these findings as well as future research avenues.

Evaluation of ICUs and weight of quality control indicators:an exploratory study based on Chinese ICU quality data from 2015 to 2020

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit(ICU)patients in Chinese mainland over six years(2015–2020).The data for this study were from 31 provincial and municipal hospitals(3425 hospital ICUs)and included 2110685 ICU patients,for a total of 27607376 ICU hospitalization days.We found that 15 initially established quality control indicators were good predictors of patient prognosis,including percentage of ICU patients out of all inpatients(%),percentage of ICU bed occupancy of total inpatient bed occupancy(%),percentage of all ICU inpatients with an APACHE II score≥15(%),three-hour(surviving sepsis campaign)SSC bundle compliance(%),six-hour SSC bundle compliance(%),rate of microbe detection before antibiotics(%),percentage of drug deep venous thrombosis(DVT)prophylaxis(%),percentage of unplanned endotracheal extubations(%),percentage of patients reintubated within 48 hours(%),unplanned transfers to the ICU(%),48-h ICU readmission rate(%),ventilator associated pneumonia(VAP)(per 1000 ventilator days),catheter related blood stream infection(CRBSI)(per 1000 catheter days),catheter-associated urinary tract infections(CAUTI)(per 1000 catheter days),in-hospital mortality(%).When exploratory factor analysis was applied,the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation:nosocomial infection management(21.35%),compliance with the Surviving Sepsis Campaign guidelines(17.97%),ICU resources(17.46%),airway management(15.53%),prevention of deep-vein thrombosis(14.07%),and severity of patient condition(13.61%).Based on the different weights of the core elements associated with the 15 indicators,we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management+17.97%xcompliance with SSC guidelines+17.46%×ICU resources+15.53%×airway management+14.07%×DVT prevention+13.61%×severity of patient condition.This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

Spatiotemporal evolution and influencing factors of urban resilience in the Yellow River Basin,China

The Yellow River Basin of China is a key region that contains myriad interactions between human activities and natural environment.Industrialization and urbanization promote social-economic development,but they also have generated a series of environmental and ecological issues in this basin.Previous researches have evaluated urban resilience at the national,regional,urban agglomeration,city,and prefecture levels,but not at the watershed level.To address this research gap and elevate the Yellow River Basin’s urban resilience level,we constructed an urban resilience evaluation index system from five dimensions:industrial resilience,social resilience,environmental resilience,technological resilience,and organizational resilience.The entropy weight method was used to comprehensively evaluate urban resilience in the Yellow River Basin.The exploratory spatial data analysis method was employed to study the spatiotemporal differences in urban resilience in the Yellow River Basin in 2010,2015,and 2020.Furthermore,the grey correlation analysis method was utilized to explore the influencing factors of these differences.The results of this study are as follows:(1)the overall level of urban resilience in the Yellow River Basin was relatively low but showed an increasing trend during 2010–2015,and significant spatial distribution differences were observed,with a higher resilience level in the eastern region and a low-medium resilience level in the western region;(2)the differences in urban resilience were noticeable,with industrial resilience and social resilience being relatively highly developed,whereas organizational resilience and environmental resilience were relatively weak;and(3)the correlation ranking of resilience influencing factors was as follows:science and technology level>administrative power>openness>market forces.This research can provide a basis for improving the resilience level of cities in the Yellow River Basin and contribute to the high-quality development of the region.