With the development of imaging and localization studies,focused parathyroidectomy with use of intraope-rative parathormone monitoring(IPM)is the mainstay of treatment for primary hyperparathyroidism at many health ca...With the development of imaging and localization studies,focused parathyroidectomy with use of intraope-rative parathormone monitoring(IPM)is the mainstay of treatment for primary hyperparathyroidism at many health care centers both nationally and internationally.Focused parathyroidectomy guided by IPM allows for surgical excision of the offending parathyroid gland through smaller incisions.The Miami criterion is a protocol that uses a">50%parathormone(PTH)drop"from either the greatest pre-incision or pre-excision measurement of PTH in a blood sample taken 10 min following resection of hyperfunctioning glands.Following removal of the hyperfunctioning parathyroid gland,a>50%PTH drop at 10 min indicates completion of parathyroidectomy,and predicts operative success at6 mo.IPM using the Miami criterion has demonstrated equal curative rates of>97%,which is comparable to the traditional bilateral neck exploration.The focused approach,however,is associated with shorter recovery times,improved cosmesis,and lower risk of postoperative hypocalcemia.展开更多
Mianzi is an important and interesting word in Mandarin Chinese which has evolved into a synonym for ＂dignity＂ and even beyond that from its literal meaning. It embodies a significant concept deeply rooted in Chines...Mianzi is an important and interesting word in Mandarin Chinese which has evolved into a synonym for ＂dignity＂ and even beyond that from its literal meaning. It embodies a significant concept deeply rooted in Chinese society. When with others, Chinese people always take to heart their dignity and superiority, which they hope will earn them due respect. Otherwise, they will ＂lose face.＂展开更多
Climate change will profoundly affect hydrological processes at various temporal and spatial scales.This study is focused on assessing the alteration of water resources availability and low flows frequencies driven by...Climate change will profoundly affect hydrological processes at various temporal and spatial scales.This study is focused on assessing the alteration of water resources availability and low flows frequencies driven by changing climates in different time periods of the 21st century.This study evaluates the adaptability of prevailing Global Circulation Models(GCMs)on a particular watershed through streamflow regimes.This analysis was conducted in the Great Miami River Watershed,Ohio by analyzing historical and future simulated streamflow using 10 climate model outputs and the Soil and Water Assessment Tool(SWAT).The climate change scenarios,consisting of ten downscaled Coupled Model Intercomparision Project Phase 5(CMIP5)climate models in combination with two Representative Concentration Pathways(RCP 4.5 and RCP 8.5)were selected based on the correlation between observed records and model outputs.Streamflow for three future periods,2016-2043,2044-2071 and 2072-2099,were independently analyzed and compared with the baseline period(1988-2015).Results from the average of ten models projected that 7-day low flows in the watershed would increase by 19%in the 21st century under both RCPs.This trend was also consistent for both hydrological(7Q10,1Q10)and biological low flow statistics(4B3,1B3).Similarly,average annual flow and monthly flows would also increase in future periods,especially in the summer.The flows simulated by SWAT in response to the majority of climate model projections showed a consistent increase in low flow patterns.However,the flow estimates using the Max-Planck-Institute Earth System Model(MPI-ESM-LR)climate output resulted in the biological based low flows(4B3,1B3)decreasing by 22.5%and 33.4%under RCP 4.5 and 56.9%and 63.7%under RCP 8.5,respectively,in the future when compared to the baseline period.Regardless,the low flow ensemble from the 10 climate models for the 21st century seemed to be slightly higher than that of historical low flows.展开更多
文摘With the development of imaging and localization studies,focused parathyroidectomy with use of intraope-rative parathormone monitoring(IPM)is the mainstay of treatment for primary hyperparathyroidism at many health care centers both nationally and internationally.Focused parathyroidectomy guided by IPM allows for surgical excision of the offending parathyroid gland through smaller incisions.The Miami criterion is a protocol that uses a">50%parathormone(PTH)drop"from either the greatest pre-incision or pre-excision measurement of PTH in a blood sample taken 10 min following resection of hyperfunctioning glands.Following removal of the hyperfunctioning parathyroid gland,a>50%PTH drop at 10 min indicates completion of parathyroidectomy,and predicts operative success at6 mo.IPM using the Miami criterion has demonstrated equal curative rates of>97%,which is comparable to the traditional bilateral neck exploration.The focused approach,however,is associated with shorter recovery times,improved cosmesis,and lower risk of postoperative hypocalcemia.
文摘Mianzi is an important and interesting word in Mandarin Chinese which has evolved into a synonym for ＂dignity＂ and even beyond that from its literal meaning. It embodies a significant concept deeply rooted in Chinese society. When with others, Chinese people always take to heart their dignity and superiority, which they hope will earn them due respect. Otherwise, they will ＂lose face.＂
文摘Climate change will profoundly affect hydrological processes at various temporal and spatial scales.This study is focused on assessing the alteration of water resources availability and low flows frequencies driven by changing climates in different time periods of the 21st century.This study evaluates the adaptability of prevailing Global Circulation Models(GCMs)on a particular watershed through streamflow regimes.This analysis was conducted in the Great Miami River Watershed,Ohio by analyzing historical and future simulated streamflow using 10 climate model outputs and the Soil and Water Assessment Tool(SWAT).The climate change scenarios,consisting of ten downscaled Coupled Model Intercomparision Project Phase 5(CMIP5)climate models in combination with two Representative Concentration Pathways(RCP 4.5 and RCP 8.5)were selected based on the correlation between observed records and model outputs.Streamflow for three future periods,2016-2043,2044-2071 and 2072-2099,were independently analyzed and compared with the baseline period(1988-2015).Results from the average of ten models projected that 7-day low flows in the watershed would increase by 19%in the 21st century under both RCPs.This trend was also consistent for both hydrological(7Q10,1Q10)and biological low flow statistics(4B3,1B3).Similarly,average annual flow and monthly flows would also increase in future periods,especially in the summer.The flows simulated by SWAT in response to the majority of climate model projections showed a consistent increase in low flow patterns.However,the flow estimates using the Max-Planck-Institute Earth System Model(MPI-ESM-LR)climate output resulted in the biological based low flows(4B3,1B3)decreasing by 22.5%and 33.4%under RCP 4.5 and 56.9%and 63.7%under RCP 8.5,respectively,in the future when compared to the baseline period.Regardless,the low flow ensemble from the 10 climate models for the 21st century seemed to be slightly higher than that of historical low flows.
