The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Ma...The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Many scholars have referred to it as a fuzzy multi-attribute or multi-criteria decision-making problem using various fuzzy set-like approaches because of the inclusion of criteria and anticipated ambiguity.The goal of the current study is to use an innovative methodology to address the expected uncertainties in the problem of solid waste site selection.The characteristics(or sub-attributes)that decision-makers select and the degree of approximation they accept for various options can both be indicators of these uncertainties.To tackle these problems,a novel mathematical structure known as the fuzzy parameterized possibility single valued neutrosophic hypersoft expert set(ρˆ-set),which is initially described,is integrated with a modified version of Sanchez’s method.Following this,an intelligent algorithm is suggested.The steps of the suggested algorithm are explained with an example that explains itself.The compatibility of solid waste management sites and systems is discussed,and rankings are established along with detailed justifications for their viability.This study’s strengths lie in its application of fuzzy parameterization and possibility grading to effectively handle the uncertainties embodied in the parameters’nature and alternative approximations,respectively.It uses specific mathematical formulations to compute the fuzzy parameterized degrees and possibility grades that are missing from the prior literature.It is simpler for the decisionmakers to look at each option separately because the decision is uncertain.Comparing the computed results,it is discovered that they are consistent and dependable because of their preferred properties.展开更多
Ibrutinib,a targeted therapy for B-cell malignancies,has shown remarkable efficacy in treating various hematologic cancers.However,its clinical use has raised concerns regarding cardiovascular complications,notably at...Ibrutinib,a targeted therapy for B-cell malignancies,has shown remarkable efficacy in treating various hematologic cancers.However,its clinical use has raised concerns regarding cardiovascular complications,notably atrial fibrillation(AF).This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence,risk factors,mechanistic links,and management strategies.Through an extensive analysis of original research articles,this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks.Moreover,it highlights the need for personalized treatment approaches,vigilant monitoring,and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy.The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.展开更多
Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care o...Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dys-plasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.展开更多
This paper provides a critical review of some major efforts made by China to manage the fishing capacity of its marine capture fisheries. It begins by reviewing the key concepts and issues closely related to fishing c...This paper provides a critical review of some major efforts made by China to manage the fishing capacity of its marine capture fisheries. It begins by reviewing the key concepts and issues closely related to fishing capacity management. Following on this, a brief introduction to China’s marine capture fisheries is offered, especially the trends of its marine landings and marine fishing fleets and the status of fish stocks in waters under its jurisdiction. Next comes the main concern of the paper, i.e., some major actions recently initiated by China to deal with the overcapacity problem confronting it. The paper ends with conclusions and suggestions.展开更多
Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the m...Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.展开更多
Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett'...Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.展开更多
The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with l- to 3-month treatment delay were...The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with l- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen's duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.展开更多
Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with...Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administration-approved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used off-label. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations.展开更多
BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of ...BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.展开更多
INTRODUCTION: Parkinson’s disease (PD) is a disorder characterized by complex motor and non-motor symptoms that can be difficult for patients to accurately communicate. Wearable technologies portend improvements in a...INTRODUCTION: Parkinson’s disease (PD) is a disorder characterized by complex motor and non-motor symptoms that can be difficult for patients to accurately communicate. Wearable technologies portend improvements in assessment and monitoring of these symptoms, with their clinical utility currently being evaluated in routine clinical care. OBJECTIVE: To evaluate the clinical utility of the Personal KinetiGraph? (PKG?) Movement Recording System in the routine clinical care of persons with PD (PWP). METHODS: Clinically stable, non-demented PWP presented for two routine clinic visits that included: medication review, symptom review, neurological examination including the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III/IV, and completion of a clinical management plan by a movement disorder specialist prior to review of the PKG report. After reviewing the PKG report, the clinician completed a modified clinical management plan taking into consideration the findings of the PKG. This was repeated at a second visit to evaluate various outcome measures following PKG-enhanced management. RESULTS: The PKG improved the assessment of PD symptoms and the response to treatment, while increasing patient activity levels and compliance. Clinical management plans enhanced by PKG led to different recommendations in 29.4% of cases compared with standard of care due to higher rates of bradykinesia, dyskinesia, tremor, and fluctuations identified by PKG. Using the PKG in the clinical management plan led to a change in medications in 75% (21/28) of patients and both a statistically significant difference and a clinically meaningful reduction in MDS-UPDRS III score of 4.8 (p = 0.028). Additionally, positive changes in both the clinician (17/28;61%) and patient-reported (13/24;54%) Global Impression of Improvement were reported. CONCLUSION: The PKG is a valuable tool in augmenting clinical management when utilized along with a clinical assessment.展开更多
<strong>Introduction:</strong> The periodic management of diabetes improves disease’s prognosis. We aimed to evaluate the quality of diabetes annual management and the effectiveness of its treatment in Ou...<strong>Introduction:</strong> The periodic management of diabetes improves disease’s prognosis. We aimed to evaluate the quality of diabetes annual management and the effectiveness of its treatment in Ouagadougou. <strong>Material and Method:</strong> It was a cross-sectional and descriptive study, from retrospective records in the internal medicine department, Yalgado Ouédraogo Teaching Hospital (CHU-YO). Diabetic patient’s (15 years old and more) files that were registered between January, 2012 and December, 2016 have been analyzed. Files containing less than 80% data were excluded. Data relating to the baseline characteristics of the patients, the therapeutic education dispensation, the clinical and paraclinical assessment of the initial and annual visits at the first year of patient’s follow-up have been collected. The 2007 diabetes management standards of the French “Haute Autorité de Santé” as well as the biological standards of the same instance have been used. The quantitative variables were expressed as means and standard deviations and qualitative variables were expressed as absolute and relative frequencies. <strong>Results:</strong> 317 patients, including 218 women (68.77%) were studied. The mean age of women was 51.67 ± 12.46 years, and that of men 55.71 ± 10.63. Diabetes was type 2 in 302 (95.26%) patients. The mean duration since the diagnosis of diabetes was 2.9 years. The completeness rate of therapeutic education at the annual visit was 10.46%. That of the clinical examinations was at best 38.17% and 44.23% for the measurement of weight and blood pressure;otherwise it was less than 5%. About the paraclinical data, apart from the measurement of the fasting blood glucose which completeness rate was 71.61%, that of the others exams were less than 10%. At the annual visit, the mean value of HbA1C was 7.5%, and the target for HbA1C was achieved in 47.90% patients. <strong>Conclusion:</strong> The quality of diabetes annual management is unsatisfying. A structural improvement and the adaptation of guidelines are needed.展开更多
In many compames, cost management models are abandoned due to their complexity and because of this, the academic literature has experienced a downturn in publications regarding cost management. This paper deepens the ...In many compames, cost management models are abandoned due to their complexity and because of this, the academic literature has experienced a downturn in publications regarding cost management. This paper deepens the understanding regarding the practical usability of cost management models for purchasing decisions, and provides a framework for determining a desired complexity of cost management in different purchasing environments. The complexity is defined along three dimensions identified in literature and the different purchasing environments stem from an adaptation of Kraljic's (1983) matrix.展开更多
Water environment is a part of ecological environment, and conservation of water environment has always been a focus of public attention in China, but water environment management in the vast countryside has been stuc...Water environment is a part of ecological environment, and conservation of water environment has always been a focus of public attention in China, but water environment management in the vast countryside has been stuck in bottleneck. Based on the fi eld investigation in Xianxia Town, Yudu County, Ganzhou City, Jiangxi Province, this paper explored the current situation of local water environment and the management diffi culties, then introduced the holistic view to integrate the linkage of government, market and society, proposed the universality of the individual case, and the new attempt centering on urban-rural integrated water environment management system with public participation mechanism, management subjects' benefit balance and coordination system, marketing operation mechanism and economic incentive mechanism as the extension.展开更多
This paper mainly design B/S system structure and small information management system that often appear some problems of college student information management, combines the actual situation of students and student in...This paper mainly design B/S system structure and small information management system that often appear some problems of college student information management, combines the actual situation of students and student instructor management work. In the process of the development of the whole system, the main use of Microsoft.NET technology as a whole system of compiler environment, SQL Server 2000 is used in the design of backstage supporter' s database, were developed and designed by Visual Studi02005 tool, in exchange for page dynamically selected by the ASP.NET database and system interface between Webpage generation. This system has high reliability, high security, low input, so that the efficiency of information management students to improve.展开更多
Adjustment of Basle Capital Agreement will influence the risk management and capital arrangement demand of the banks with different scales, operation level and environment. It will have widespread and profound effect ...Adjustment of Basle Capital Agreement will influence the risk management and capital arrangement demand of the banks with different scales, operation level and environment. It will have widespread and profound effect on the competition strength of every country's banks in the global market. Starting with illustration of the present cond(tion of risk management in China's banks, the paper analyzes the major problems existing in the risk management system of China's banking industry, then puts forward some clues and suggestions to improve and better the risk management system of China's banking industry.展开更多
Digital library is a process of exploiting more scientific methods to construct a social knowledge network. It represents an “extension” from a traditional library. The core and essence is to build a favorable surro...Digital library is a process of exploiting more scientific methods to construct a social knowledge network. It represents an “extension” from a traditional library. The core and essence is to build a favorable surroundings for knowledge accumulation, knowledge transfer and knowledge communication. Management communication covers information transfer and organization cooperation. Compared with traditional library, the management communication in digital library shoulders the commitment to support knowledge innovation. On the basis of analysis of the connotation of digital library, this paper analysed the aspects of management communication, including communicators, communication styles, contents, channels and outer communication, all of which tries to construct an integrated model of management communication in a digital library and turns a library into an actual “knowledge fountain”.展开更多
Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Conventi...Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Because the of the underdeveloped infrastructure and the disorganized layout process,the phenomenon of infection among medical personnel was rampant given the highly contagious nature of the Omicron variant.This paper discusses the effect of 6S management in infection control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Methods:A series of 6S management practices were carried out based on the evaluation of the control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai)during the anti-epidemic period,and the effect of the implementation of 6S management was studied based on the rapport among team members and the overall control system process,the management of wearing and stripping channels,the time of wearing protective articles and the psychological and emotional changes of the team members.Results:After the implementation of 6S management mode,the management of dressing room,epidemic prevention materials,and occupational protection awareness and infection control safety were significantly improved.More than 95.5%of the team members believed that improving the working environment in the shelter increased the confidence of victory in the fight against the epidemic,reduced the preparations before entering and leaving the cabin,improved the work efficiency and ensured occupational safety.It ensures the realization of the goal of“zero infection”and is set as a benchmark of control work of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Conclusion:The application of 6S management mode to the shelter infection control management can create and maintain a good working environment in the shelter,promote the implementation effect of various systems and processes of infection control,reduce the potential infection risk in the shelter and improve the efficiency of infection control management.展开更多
BACKGROUND: Han's acupoint nerve stimulator (HANS) has been frequently used to relieve pain by promoting the central nerve system's release of endogenous opioid peptides through electric stimulation to the body s...BACKGROUND: Han's acupoint nerve stimulator (HANS) has been frequently used to relieve pain by promoting the central nerve system's release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE: To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING: A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College (Ganzhou, Jiangxi Province, China) from January 2005 to February 2006. PARTICIPANTS: Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College (China), were included in this study. METHODS: Forty patients underwent neurosurgery and were randomly divided into two groups: patient-controlled analgesia plus HANS (+HANS, n = 20) and patient-controlled analgesia (-HANS, n = 20). Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. (China). Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing (China), with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE: The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS: Compared with the HANS group, the visual analogue scale scores were remarkably lower in the +HANS group six hours after surgery (P 〈 0.01), and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased (P 〈 0.05).CONCLUSION: The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.展开更多
The methodology of visual simulation for a tunnel engineering construction schedule is presented. Visualization of simulation model, calculation and result of construction schedule simulation is realized, and the cons...The methodology of visual simulation for a tunnel engineering construction schedule is presented. Visualization of simulation model, calculation and result of construction schedule simulation is realized, and the construction simulation and the resource optimization of tunnel engineering are made. A risk analysis and a decision-making method of tunnel engineering construction schedule based on visual simulation are presented. Furthermore, using S curve theory and schedule management method, the real-time management and control method of tunnel engineering construction based on visual simulation is presented. The application to the tunnel engineering construction schedule analysis and management shows the feasibility and effectiveness of the method presented in this paper.展开更多
Aiming at the deficiency of exterminating measures of Chinese firm safety management, a simulation model of Chinese firm's safety management capability based on the organizational learning theory, in which the simula...Aiming at the deficiency of exterminating measures of Chinese firm safety management, a simulation model of Chinese firm's safety management capability based on the organizational learning theory, in which the simulation method of system dynamics is utilized. The level variable and rate variable are designed based on the practical situation and change situation of corresponding variables of firm's safety management ca- pability. Simulation firms are built with accident case groups of the oil industry, chemical industry, machine industry, coal mining industry, and weapon industry. Through analyzing the simulation result, the growth law of Chinese firm's safety management capability is obtained as follows: the accumulating and the coupling of safety knowledge should be emphasized at the same time; the balance of learning behavior of individual, group and organization should be considered together; different types of Chinese firm should take different safety policies according to their practical situations.展开更多
文摘The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Many scholars have referred to it as a fuzzy multi-attribute or multi-criteria decision-making problem using various fuzzy set-like approaches because of the inclusion of criteria and anticipated ambiguity.The goal of the current study is to use an innovative methodology to address the expected uncertainties in the problem of solid waste site selection.The characteristics(or sub-attributes)that decision-makers select and the degree of approximation they accept for various options can both be indicators of these uncertainties.To tackle these problems,a novel mathematical structure known as the fuzzy parameterized possibility single valued neutrosophic hypersoft expert set(ρˆ-set),which is initially described,is integrated with a modified version of Sanchez’s method.Following this,an intelligent algorithm is suggested.The steps of the suggested algorithm are explained with an example that explains itself.The compatibility of solid waste management sites and systems is discussed,and rankings are established along with detailed justifications for their viability.This study’s strengths lie in its application of fuzzy parameterization and possibility grading to effectively handle the uncertainties embodied in the parameters’nature and alternative approximations,respectively.It uses specific mathematical formulations to compute the fuzzy parameterized degrees and possibility grades that are missing from the prior literature.It is simpler for the decisionmakers to look at each option separately because the decision is uncertain.Comparing the computed results,it is discovered that they are consistent and dependable because of their preferred properties.
文摘Ibrutinib,a targeted therapy for B-cell malignancies,has shown remarkable efficacy in treating various hematologic cancers.However,its clinical use has raised concerns regarding cardiovascular complications,notably atrial fibrillation(AF).This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence,risk factors,mechanistic links,and management strategies.Through an extensive analysis of original research articles,this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks.Moreover,it highlights the need for personalized treatment approaches,vigilant monitoring,and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy.The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.
文摘Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dys-plasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.
文摘This paper provides a critical review of some major efforts made by China to manage the fishing capacity of its marine capture fisheries. It begins by reviewing the key concepts and issues closely related to fishing capacity management. Following on this, a brief introduction to China’s marine capture fisheries is offered, especially the trends of its marine landings and marine fishing fleets and the status of fish stocks in waters under its jurisdiction. Next comes the main concern of the paper, i.e., some major actions recently initiated by China to deal with the overcapacity problem confronting it. The paper ends with conclusions and suggestions.
文摘Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.
文摘Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.
基金This project was supported by the National Natural Science Foundation of China (No. 81372879, No. 81672666).
文摘The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with l- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen's duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.
文摘Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administration-approved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used off-label. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations.
文摘BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.
文摘INTRODUCTION: Parkinson’s disease (PD) is a disorder characterized by complex motor and non-motor symptoms that can be difficult for patients to accurately communicate. Wearable technologies portend improvements in assessment and monitoring of these symptoms, with their clinical utility currently being evaluated in routine clinical care. OBJECTIVE: To evaluate the clinical utility of the Personal KinetiGraph? (PKG?) Movement Recording System in the routine clinical care of persons with PD (PWP). METHODS: Clinically stable, non-demented PWP presented for two routine clinic visits that included: medication review, symptom review, neurological examination including the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III/IV, and completion of a clinical management plan by a movement disorder specialist prior to review of the PKG report. After reviewing the PKG report, the clinician completed a modified clinical management plan taking into consideration the findings of the PKG. This was repeated at a second visit to evaluate various outcome measures following PKG-enhanced management. RESULTS: The PKG improved the assessment of PD symptoms and the response to treatment, while increasing patient activity levels and compliance. Clinical management plans enhanced by PKG led to different recommendations in 29.4% of cases compared with standard of care due to higher rates of bradykinesia, dyskinesia, tremor, and fluctuations identified by PKG. Using the PKG in the clinical management plan led to a change in medications in 75% (21/28) of patients and both a statistically significant difference and a clinically meaningful reduction in MDS-UPDRS III score of 4.8 (p = 0.028). Additionally, positive changes in both the clinician (17/28;61%) and patient-reported (13/24;54%) Global Impression of Improvement were reported. CONCLUSION: The PKG is a valuable tool in augmenting clinical management when utilized along with a clinical assessment.
文摘<strong>Introduction:</strong> The periodic management of diabetes improves disease’s prognosis. We aimed to evaluate the quality of diabetes annual management and the effectiveness of its treatment in Ouagadougou. <strong>Material and Method:</strong> It was a cross-sectional and descriptive study, from retrospective records in the internal medicine department, Yalgado Ouédraogo Teaching Hospital (CHU-YO). Diabetic patient’s (15 years old and more) files that were registered between January, 2012 and December, 2016 have been analyzed. Files containing less than 80% data were excluded. Data relating to the baseline characteristics of the patients, the therapeutic education dispensation, the clinical and paraclinical assessment of the initial and annual visits at the first year of patient’s follow-up have been collected. The 2007 diabetes management standards of the French “Haute Autorité de Santé” as well as the biological standards of the same instance have been used. The quantitative variables were expressed as means and standard deviations and qualitative variables were expressed as absolute and relative frequencies. <strong>Results:</strong> 317 patients, including 218 women (68.77%) were studied. The mean age of women was 51.67 ± 12.46 years, and that of men 55.71 ± 10.63. Diabetes was type 2 in 302 (95.26%) patients. The mean duration since the diagnosis of diabetes was 2.9 years. The completeness rate of therapeutic education at the annual visit was 10.46%. That of the clinical examinations was at best 38.17% and 44.23% for the measurement of weight and blood pressure;otherwise it was less than 5%. About the paraclinical data, apart from the measurement of the fasting blood glucose which completeness rate was 71.61%, that of the others exams were less than 10%. At the annual visit, the mean value of HbA1C was 7.5%, and the target for HbA1C was achieved in 47.90% patients. <strong>Conclusion:</strong> The quality of diabetes annual management is unsatisfying. A structural improvement and the adaptation of guidelines are needed.
文摘In many compames, cost management models are abandoned due to their complexity and because of this, the academic literature has experienced a downturn in publications regarding cost management. This paper deepens the understanding regarding the practical usability of cost management models for purchasing decisions, and provides a framework for determining a desired complexity of cost management in different purchasing environments. The complexity is defined along three dimensions identified in literature and the different purchasing environments stem from an adaptation of Kraljic's (1983) matrix.
文摘Water environment is a part of ecological environment, and conservation of water environment has always been a focus of public attention in China, but water environment management in the vast countryside has been stuck in bottleneck. Based on the fi eld investigation in Xianxia Town, Yudu County, Ganzhou City, Jiangxi Province, this paper explored the current situation of local water environment and the management diffi culties, then introduced the holistic view to integrate the linkage of government, market and society, proposed the universality of the individual case, and the new attempt centering on urban-rural integrated water environment management system with public participation mechanism, management subjects' benefit balance and coordination system, marketing operation mechanism and economic incentive mechanism as the extension.
文摘This paper mainly design B/S system structure and small information management system that often appear some problems of college student information management, combines the actual situation of students and student instructor management work. In the process of the development of the whole system, the main use of Microsoft.NET technology as a whole system of compiler environment, SQL Server 2000 is used in the design of backstage supporter' s database, were developed and designed by Visual Studi02005 tool, in exchange for page dynamically selected by the ASP.NET database and system interface between Webpage generation. This system has high reliability, high security, low input, so that the efficiency of information management students to improve.
文摘Adjustment of Basle Capital Agreement will influence the risk management and capital arrangement demand of the banks with different scales, operation level and environment. It will have widespread and profound effect on the competition strength of every country's banks in the global market. Starting with illustration of the present cond(tion of risk management in China's banks, the paper analyzes the major problems existing in the risk management system of China's banking industry, then puts forward some clues and suggestions to improve and better the risk management system of China's banking industry.
文摘Digital library is a process of exploiting more scientific methods to construct a social knowledge network. It represents an “extension” from a traditional library. The core and essence is to build a favorable surroundings for knowledge accumulation, knowledge transfer and knowledge communication. Management communication covers information transfer and organization cooperation. Compared with traditional library, the management communication in digital library shoulders the commitment to support knowledge innovation. On the basis of analysis of the connotation of digital library, this paper analysed the aspects of management communication, including communicators, communication styles, contents, channels and outer communication, all of which tries to construct an integrated model of management communication in a digital library and turns a library into an actual “knowledge fountain”.
文摘Objective:In 2022,a pneumonia caused by novel coronavirus broke out in Shanghai.A large number of medical personnel were deployed nationwide to support the Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Because the of the underdeveloped infrastructure and the disorganized layout process,the phenomenon of infection among medical personnel was rampant given the highly contagious nature of the Omicron variant.This paper discusses the effect of 6S management in infection control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Methods:A series of 6S management practices were carried out based on the evaluation of the control management of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai)during the anti-epidemic period,and the effect of the implementation of 6S management was studied based on the rapport among team members and the overall control system process,the management of wearing and stripping channels,the time of wearing protective articles and the psychological and emotional changes of the team members.Results:After the implementation of 6S management mode,the management of dressing room,epidemic prevention materials,and occupational protection awareness and infection control safety were significantly improved.More than 95.5%of the team members believed that improving the working environment in the shelter increased the confidence of victory in the fight against the epidemic,reduced the preparations before entering and leaving the cabin,improved the work efficiency and ensured occupational safety.It ensures the realization of the goal of“zero infection”and is set as a benchmark of control work of Fangcang Shelter Hospital of National Exhibition and Convention Center(Shanghai).Conclusion:The application of 6S management mode to the shelter infection control management can create and maintain a good working environment in the shelter,promote the implementation effect of various systems and processes of infection control,reduce the potential infection risk in the shelter and improve the efficiency of infection control management.
文摘BACKGROUND: Han's acupoint nerve stimulator (HANS) has been frequently used to relieve pain by promoting the central nerve system's release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE: To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING: A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College (Ganzhou, Jiangxi Province, China) from January 2005 to February 2006. PARTICIPANTS: Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College (China), were included in this study. METHODS: Forty patients underwent neurosurgery and were randomly divided into two groups: patient-controlled analgesia plus HANS (+HANS, n = 20) and patient-controlled analgesia (-HANS, n = 20). Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. (China). Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing (China), with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE: The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS: Compared with the HANS group, the visual analogue scale scores were remarkably lower in the +HANS group six hours after surgery (P 〈 0.01), and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased (P 〈 0.05).CONCLUSION: The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.
基金Supported by National Natural Science Foundation of China (No.50539120)Natural Fund for Distinguished Young Scholars of China(No.50525927)
文摘The methodology of visual simulation for a tunnel engineering construction schedule is presented. Visualization of simulation model, calculation and result of construction schedule simulation is realized, and the construction simulation and the resource optimization of tunnel engineering are made. A risk analysis and a decision-making method of tunnel engineering construction schedule based on visual simulation are presented. Furthermore, using S curve theory and schedule management method, the real-time management and control method of tunnel engineering construction based on visual simulation is presented. The application to the tunnel engineering construction schedule analysis and management shows the feasibility and effectiveness of the method presented in this paper.
基金the National Social Science Foundation of China (07BJY080)
文摘Aiming at the deficiency of exterminating measures of Chinese firm safety management, a simulation model of Chinese firm's safety management capability based on the organizational learning theory, in which the simulation method of system dynamics is utilized. The level variable and rate variable are designed based on the practical situation and change situation of corresponding variables of firm's safety management ca- pability. Simulation firms are built with accident case groups of the oil industry, chemical industry, machine industry, coal mining industry, and weapon industry. Through analyzing the simulation result, the growth law of Chinese firm's safety management capability is obtained as follows: the accumulating and the coupling of safety knowledge should be emphasized at the same time; the balance of learning behavior of individual, group and organization should be considered together; different types of Chinese firm should take different safety policies according to their practical situations.