This paper explores the existential problem in Seize the Day-the conflict between individuals and society in modern society.With a brief introduction of Saul Bellow and the novel,the paper emphasizes the analysis of t...This paper explores the existential problem in Seize the Day-the conflict between individuals and society in modern society.With a brief introduction of Saul Bellow and the novel,the paper emphasizes the analysis of the conflict and the sources of the conflict.Besides,Saul Bellow uses many rhetorical devices to intensify the conflict.The analysis of these rhetorical devices is beneficial for us to interpret and understand the true meaning of the novel.Through the study of Bellow’s vision and the novel’s metaphorical meaning,we may find an effective solution to the conflict that our human being is involved in,and realize the social values of this novel.展开更多
Hunger is a physiological need,but the production and consumption of adequate and balanced food is a function of social forces.At every point,social,political,and economic processes intervene,for better or(more common...Hunger is a physiological need,but the production and consumption of adequate and balanced food is a function of social forces.At every point,social,political,and economic processes intervene,for better or(more common)for worse.Food is one fundamental need of human beings for survival.But in Nigeria there is widespread food shortage and hunger.Development scholars have put forward reasons why poverty,hunger persists in the country,from the platitudes about population growth,inadequate implementation of agricultural policies,and neglect of agriculture,bad leadership,corruption,and the issue of distribution.Nigeria is richly blessed with arable land and citizens eager to unlock its food potentials.Unfortunately,this is far from being realized as the country depends on foreign countries for food,a situation that is tragic and sad.She spends about$10 billion a year importing food and agricultural products,the majority of which are wheat,rice,poultry,fish,and consumer-oriented foods.The pressure on the exchange rate results in devaluation-triggered inflation and food costs that fly up beyond the grasp of people at the bottom of the ladder as it is now is one of the negative repercussions of high food importation bills.Examining the effects of hunger is one of this paper’s key concerns and goals,and anger crisis for achieving sustainable development in the country using the Frustration-Aggression Theory,The Relative Deprivation and Political Economy Approach as guide.展开更多
Various transportation systems have been developed in recent years.In this study,an artificial society model is developed to examine the combination of transportation policies in urban areas.In this model,each trip ma...Various transportation systems have been developed in recent years.In this study,an artificial society model is developed to examine the combination of transportation policies in urban areas.In this model,each trip maker selects the primary and terminal transportation modes.An artificial society model is applied to the southeastern region of Osaka City,Japan.The effects of introducing BRT(bus rapid transit,primary transportation)and on-demand buses(terminal transportation)are investigated.The results confirm that BRT is used by a certain number of users.An increase in the use of BRT will increase the amount of walking,thus resulting in a healthy city.However,on-demand buses are rarely used as terminal transportation.Additionally,the development of bicycle parking stations near BRT stops is shown to be effective in the northern section of the BRT route.展开更多
The principle of“school is society”indicates that controlling the environment is the only educational method.By transforming the school into a microcosm of society,we can cultivate individuals who possess a social s...The principle of“school is society”indicates that controlling the environment is the only educational method.By transforming the school into a microcosm of society,we can cultivate individuals who possess a social spirit and adaptability,preparing them to thrive in real-world social situations.By analyzing the social performance of colleges and universities in terms of their training objectives for society,research concepts for the development of society,and service consciousness for the improvement of society,as well as the current demand for a proper connection with society,it can be found that taking“school is society”as the guiding ideology for the construction of the university environment tends to be simplified,purified,balanced,broadened,and provided with practical space.This will be beneficial to the development of higher education.展开更多
太极图是中国传统文化的瑰宝,也是中华民族审美文化的源头,受到国人的尊崇。有研究者发现,太极图与数学、物理学等自然科学有着密不可分的联系。从自然辩证法的角度看,太极图与化学也有相通之处。故太极图也出现在了某些化学类期刊论文...太极图是中国传统文化的瑰宝,也是中华民族审美文化的源头,受到国人的尊崇。有研究者发现,太极图与数学、物理学等自然科学有着密不可分的联系。从自然辩证法的角度看,太极图与化学也有相通之处。故太极图也出现在了某些化学类期刊论文中,用于更直观更艺术地表现化学类论文的主旨思想及化学类期刊的风采。虽然太极图起源于我国并成为我国最优秀传统文化的凝聚,但相对于国内化学期刊,国外化学类期刊似乎更加偏爱太极图,尤其在封面和图形摘要的设计方面,比如国外顶级化学类期刊Chemical Society Review,尤其钟爱太极图,仅2016年出版的24期期刊,在封面和图形摘要中就出现了11次太极图的相关模型。文章着重讨论一下该刊频繁采用太极图的原因及相关设计思路,以期为国内化学期刊的出版提供借鉴。展开更多
Zhang Ailin created so many various kinds of female charaters in her novels;females who own distinct characters and identities just have similar fates and struggles.This paper tries to probe into the similar fates and...Zhang Ailin created so many various kinds of female charaters in her novels;females who own distinct characters and identities just have similar fates and struggles.This paper tries to probe into the similar fates and struggles of two heroines with different identities in the same social background by analysing the novel Gimmal and Crumbs of Agalloch Eaglewood-the First Incense Burner from perspective of feminism.展开更多
Language and society are so closely intertwined.From the sociolinguistic perspective,language not only has denotation functions,but also has a function of signaling the speakers' social and personal backgrounds.Pe...Language and society are so closely intertwined.From the sociolinguistic perspective,language not only has denotation functions,but also has a function of signaling the speakers' social and personal backgrounds.Personal names,as a kind of language use,although vary from country to country and from times to times,they still signal something about people's social identities.Chinese names have very rich connotation.Chinese naming system is a mirror of Chinese society and culture,and personal names have revealed a lot of time features.This study is to examine the change in the choice of words for Chinese given names during the time period of 1940s to the current from the sociolinguistic perspective.It focuses to explore the relations between the change of language use in personal names and the change of society,as well as on the influence of social ideology on the choice of Chinese given names.展开更多
Contents1. Principles of diagnosis and treatment of head and neck cancer2. Diagnosis principles of head and neck cancer2.1 Image diagnosis2.2 Pathological diagnosis2.3 Staging3. Treatment principles of early and local...Contents1. Principles of diagnosis and treatment of head and neck cancer2. Diagnosis principles of head and neck cancer2.1 Image diagnosis2.2 Pathological diagnosis2.3 Staging3. Treatment principles of early and locally advanced head and neck squamous cell carcinoma3.1 Treatment of oral cancer3.1.1 Treatment of early oral cancer3.1.2 Treatment of locally advanced oral cancer.展开更多
Contents1. General guidelines for diagnosis and treatment of colorectal cancer2. Diagnostic principles for colorectal cancer2.1 Colorectal cancer screening of asymptomatic healthy population2.2 Basic diagnostic princi...Contents1. General guidelines for diagnosis and treatment of colorectal cancer2. Diagnostic principles for colorectal cancer2.1 Colorectal cancer screening of asymptomatic healthy population2.2 Basic diagnostic principles2.2.1 Colorectal cancer diagnosis2.2.2 Appendix on colorectal cancer imaging staging and diagnosis2.3 Principles of pathological diagnosis2.4 Staging.展开更多
AIM: To evaluate adherence of primary care physicians(PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy(UGE), evaluate the importance of alarm symptoms and the performance ...AIM: To evaluate adherence of primary care physicians(PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy(UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy(ASGE) guidelines in a Saudi population.METHODS: A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Refer-rals were classified as appropriate or inappropriate according to adherence to ASGE guidelines.RESULTS: Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years(SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level(39%), weight loss(18%), vomiting(16%), loss of appetite(16%), difficulty swallowing(3%), and gastrointestinal bleeding(3%). Abnormal endoscopy findings included gastritis(52%), duodenitis(10%), hiatus hernia(7.8%), features suggestive of celiac disease(6.5%), ulcers(3.9%), malignancy(2.6%) and gastroesophageal reflux disease(GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups(P = 0.639).CONCLUSION: Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormalendoscopic findings.展开更多
AIM: To compare the postoperative visual acuity among eyes with proliferative diabetic retinopathy(PDR) of different stages after pars plana vitrectomy(PPV) in type 2 diabetic patients. METHODS: A retrospective study ...AIM: To compare the postoperative visual acuity among eyes with proliferative diabetic retinopathy(PDR) of different stages after pars plana vitrectomy(PPV) in type 2 diabetic patients. METHODS: A retrospective study was conducted for PDR eyes undergoing PPV in type 2 diabetic patients. All patients were divided into three groups based on Chinese Ocular Fundus Diseases Society(COFDS) classification for PDR: Group A(primary vitreous hemorrhage), Group B(primary fibrovascular proliferation) and Group C(primary vitreous hemorrhage and/or fibrovascular proliferative combined with retinal detachment). The postoperative visual acuity and the change between postoperative and preoperative visual acuity were compared among three groups. The associated risk factors for postoperative visual acuity were analyzed in the univariate and multiple linear aggression. RESULTS: In total, 195 eyes of 195 patients were collected in this study, including 71 eyes of 71 patients in Group A, 75 eyes of 75 patients in Group B and 49 eyes of 49 patients in Group C. The eyes in Group A got better postoperative best-corrected visual acuity(BCVA) compared to the eyes in Group B and C(0.48±0.48 vs 0.89±0.63, P<0.001;0.48±0.48 vs 1.04±0.67, P<0.001;respectively). The eyes in Group A got more improvement of BCVA compared to the eyes in Group B and C(1.07±0.70 vs 0.73±0.68, P=0.004;1.07±0.70 vs 0.77±0.78, P=0.024;respectively). In the multiple linear regression analysis, primary fibro-proliferative type(β=0.194, 95%CI=0.060-0.447, P=0.01), retinal detachment type(β=0.244, 95%CI=0.132-0.579, P=0.02), baseline log MAR BCVA(β=0.192, 95%CI=0.068-0.345, P=0.004), silicone oil tamponade(β=0.272, 95%CI=0.173-0.528, P<0.001) was positively correlated with postoperative log MAR BCVA. Eyes undergoing phacovitrectomy had better postoperative BCVA(β=-0.144, 95%CI=-0.389 to-0.027, P=0.025). CONCLUSION: PDR eyes of primary vitreous hemorrhage type usually have better visual acuity prognosis compared to primary fibrovascular proliferation type and retinal detachment type. COFDS classification for PDR may have a high prognostic value for postoperative visual outcome and surgical management indications.展开更多
Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease(STD) caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with ...Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease(STD) caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with men(MSM) and people infected with human immunodeficiency virus(HIV)^([1]). Reports of the condition from Asian countries remains limited.展开更多
The problem of China’s uneven and insufficient development is the most striking in the countryside. Countryside rejuvenation is of historical significance to building a moderately prosperous society in all respects a...The problem of China’s uneven and insufficient development is the most striking in the countryside. Countryside rejuvenation is of historical significance to building a moderately prosperous society in all respects and turning China into a modernized socialist country. The reform of rural land system is vital to integrating urban and rural development. We must allow farmers to gain their due share of value-added revenues from land, and share in the dividends of urbanization. Based on household operations, we should enhance the basic rural operation system, foster new agricultural operators, and develop modern agriculture as the foundation for revitalizing countryside industries. We must deepen agricultural supply-side structural reforms to ensure sufficient supply and security of main agricultural products. We must reform the rural collective ownership system to implement property rights to farmers and protect their interests in the context of urban and rural integration. We must promote green development and revitalize countryside ecological environment. We must enhance rural governance to revitalize rural organizations.展开更多
BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gast...BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures.展开更多
In the course of creating immense wealth, manufacturing industry has excessively consumed the resources and energy in the earth, and seriously polluted the environment. To take progress as the sustainable development ...In the course of creating immense wealth, manufacturing industry has excessively consumed the resources and energy in the earth, and seriously polluted the environment. To take progress as the sustainable development way, save resource and improve environment, our nation has been advocating to construct the cycle economy and saving-oriented society. Taking the remanufacturing engineering as the representative, the “4R” rule (Reduce, Reuse, Recycle and Remanufacture) is the important measure to get the goal. Remanufacturing engineering is the industrialization of high-tech maintenance of the waste and worn productions, and is one of the most active factors in “4R”. The development of high and new technology takes the important effect to promote the remanufacturing engineering.展开更多
文摘This paper explores the existential problem in Seize the Day-the conflict between individuals and society in modern society.With a brief introduction of Saul Bellow and the novel,the paper emphasizes the analysis of the conflict and the sources of the conflict.Besides,Saul Bellow uses many rhetorical devices to intensify the conflict.The analysis of these rhetorical devices is beneficial for us to interpret and understand the true meaning of the novel.Through the study of Bellow’s vision and the novel’s metaphorical meaning,we may find an effective solution to the conflict that our human being is involved in,and realize the social values of this novel.
文摘Hunger is a physiological need,but the production and consumption of adequate and balanced food is a function of social forces.At every point,social,political,and economic processes intervene,for better or(more common)for worse.Food is one fundamental need of human beings for survival.But in Nigeria there is widespread food shortage and hunger.Development scholars have put forward reasons why poverty,hunger persists in the country,from the platitudes about population growth,inadequate implementation of agricultural policies,and neglect of agriculture,bad leadership,corruption,and the issue of distribution.Nigeria is richly blessed with arable land and citizens eager to unlock its food potentials.Unfortunately,this is far from being realized as the country depends on foreign countries for food,a situation that is tragic and sad.She spends about$10 billion a year importing food and agricultural products,the majority of which are wheat,rice,poultry,fish,and consumer-oriented foods.The pressure on the exchange rate results in devaluation-triggered inflation and food costs that fly up beyond the grasp of people at the bottom of the ladder as it is now is one of the negative repercussions of high food importation bills.Examining the effects of hunger is one of this paper’s key concerns and goals,and anger crisis for achieving sustainable development in the country using the Frustration-Aggression Theory,The Relative Deprivation and Political Economy Approach as guide.
基金supported by JSPS KAKENHI(grant number:21K04307).
文摘Various transportation systems have been developed in recent years.In this study,an artificial society model is developed to examine the combination of transportation policies in urban areas.In this model,each trip maker selects the primary and terminal transportation modes.An artificial society model is applied to the southeastern region of Osaka City,Japan.The effects of introducing BRT(bus rapid transit,primary transportation)and on-demand buses(terminal transportation)are investigated.The results confirm that BRT is used by a certain number of users.An increase in the use of BRT will increase the amount of walking,thus resulting in a healthy city.However,on-demand buses are rarely used as terminal transportation.Additionally,the development of bicycle parking stations near BRT stops is shown to be effective in the northern section of the BRT route.
文摘The principle of“school is society”indicates that controlling the environment is the only educational method.By transforming the school into a microcosm of society,we can cultivate individuals who possess a social spirit and adaptability,preparing them to thrive in real-world social situations.By analyzing the social performance of colleges and universities in terms of their training objectives for society,research concepts for the development of society,and service consciousness for the improvement of society,as well as the current demand for a proper connection with society,it can be found that taking“school is society”as the guiding ideology for the construction of the university environment tends to be simplified,purified,balanced,broadened,and provided with practical space.This will be beneficial to the development of higher education.
文摘太极图是中国传统文化的瑰宝,也是中华民族审美文化的源头,受到国人的尊崇。有研究者发现,太极图与数学、物理学等自然科学有着密不可分的联系。从自然辩证法的角度看,太极图与化学也有相通之处。故太极图也出现在了某些化学类期刊论文中,用于更直观更艺术地表现化学类论文的主旨思想及化学类期刊的风采。虽然太极图起源于我国并成为我国最优秀传统文化的凝聚,但相对于国内化学期刊,国外化学类期刊似乎更加偏爱太极图,尤其在封面和图形摘要的设计方面,比如国外顶级化学类期刊Chemical Society Review,尤其钟爱太极图,仅2016年出版的24期期刊,在封面和图形摘要中就出现了11次太极图的相关模型。文章着重讨论一下该刊频繁采用太极图的原因及相关设计思路,以期为国内化学期刊的出版提供借鉴。
文摘Zhang Ailin created so many various kinds of female charaters in her novels;females who own distinct characters and identities just have similar fates and struggles.This paper tries to probe into the similar fates and struggles of two heroines with different identities in the same social background by analysing the novel Gimmal and Crumbs of Agalloch Eaglewood-the First Incense Burner from perspective of feminism.
文摘Language and society are so closely intertwined.From the sociolinguistic perspective,language not only has denotation functions,but also has a function of signaling the speakers' social and personal backgrounds.Personal names,as a kind of language use,although vary from country to country and from times to times,they still signal something about people's social identities.Chinese names have very rich connotation.Chinese naming system is a mirror of Chinese society and culture,and personal names have revealed a lot of time features.This study is to examine the change in the choice of words for Chinese given names during the time period of 1940s to the current from the sociolinguistic perspective.It focuses to explore the relations between the change of language use in personal names and the change of society,as well as on the influence of social ideology on the choice of Chinese given names.
文摘Contents1. Principles of diagnosis and treatment of head and neck cancer2. Diagnosis principles of head and neck cancer2.1 Image diagnosis2.2 Pathological diagnosis2.3 Staging3. Treatment principles of early and locally advanced head and neck squamous cell carcinoma3.1 Treatment of oral cancer3.1.1 Treatment of early oral cancer3.1.2 Treatment of locally advanced oral cancer.
文摘Contents1. General guidelines for diagnosis and treatment of colorectal cancer2. Diagnostic principles for colorectal cancer2.1 Colorectal cancer screening of asymptomatic healthy population2.2 Basic diagnostic principles2.2.1 Colorectal cancer diagnosis2.2.2 Appendix on colorectal cancer imaging staging and diagnosis2.3 Principles of pathological diagnosis2.4 Staging.
基金Supported by The Deanship of Scientific Research at King Saud University for funding this Research group number RGP-VPP-279
文摘AIM: To evaluate adherence of primary care physicians(PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy(UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy(ASGE) guidelines in a Saudi population.METHODS: A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Refer-rals were classified as appropriate or inappropriate according to adherence to ASGE guidelines.RESULTS: Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years(SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level(39%), weight loss(18%), vomiting(16%), loss of appetite(16%), difficulty swallowing(3%), and gastrointestinal bleeding(3%). Abnormal endoscopy findings included gastritis(52%), duodenitis(10%), hiatus hernia(7.8%), features suggestive of celiac disease(6.5%), ulcers(3.9%), malignancy(2.6%) and gastroesophageal reflux disease(GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups(P = 0.639).CONCLUSION: Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormalendoscopic findings.
基金Supported in part by the National Science Foundation of Liaoning Province,China(No.2020-MS-360)Shenyang Science and Technology Bureau(No.RC210267)。
文摘AIM: To compare the postoperative visual acuity among eyes with proliferative diabetic retinopathy(PDR) of different stages after pars plana vitrectomy(PPV) in type 2 diabetic patients. METHODS: A retrospective study was conducted for PDR eyes undergoing PPV in type 2 diabetic patients. All patients were divided into three groups based on Chinese Ocular Fundus Diseases Society(COFDS) classification for PDR: Group A(primary vitreous hemorrhage), Group B(primary fibrovascular proliferation) and Group C(primary vitreous hemorrhage and/or fibrovascular proliferative combined with retinal detachment). The postoperative visual acuity and the change between postoperative and preoperative visual acuity were compared among three groups. The associated risk factors for postoperative visual acuity were analyzed in the univariate and multiple linear aggression. RESULTS: In total, 195 eyes of 195 patients were collected in this study, including 71 eyes of 71 patients in Group A, 75 eyes of 75 patients in Group B and 49 eyes of 49 patients in Group C. The eyes in Group A got better postoperative best-corrected visual acuity(BCVA) compared to the eyes in Group B and C(0.48±0.48 vs 0.89±0.63, P<0.001;0.48±0.48 vs 1.04±0.67, P<0.001;respectively). The eyes in Group A got more improvement of BCVA compared to the eyes in Group B and C(1.07±0.70 vs 0.73±0.68, P=0.004;1.07±0.70 vs 0.77±0.78, P=0.024;respectively). In the multiple linear regression analysis, primary fibro-proliferative type(β=0.194, 95%CI=0.060-0.447, P=0.01), retinal detachment type(β=0.244, 95%CI=0.132-0.579, P=0.02), baseline log MAR BCVA(β=0.192, 95%CI=0.068-0.345, P=0.004), silicone oil tamponade(β=0.272, 95%CI=0.173-0.528, P<0.001) was positively correlated with postoperative log MAR BCVA. Eyes undergoing phacovitrectomy had better postoperative BCVA(β=-0.144, 95%CI=-0.389 to-0.027, P=0.025). CONCLUSION: PDR eyes of primary vitreous hemorrhage type usually have better visual acuity prognosis compared to primary fibrovascular proliferation type and retinal detachment type. COFDS classification for PDR may have a high prognostic value for postoperative visual outcome and surgical management indications.
文摘Dear Editor,Syphilis is a spirochaetal bacterial sexually transmitted disease(STD) caused by Treponema pallidum. Outbreaks of syphilis have been described in Western communities, especially in men who have sex with men(MSM) and people infected with human immunodeficiency virus(HIV)^([1]). Reports of the condition from Asian countries remains limited.
文摘The problem of China’s uneven and insufficient development is the most striking in the countryside. Countryside rejuvenation is of historical significance to building a moderately prosperous society in all respects and turning China into a modernized socialist country. The reform of rural land system is vital to integrating urban and rural development. We must allow farmers to gain their due share of value-added revenues from land, and share in the dividends of urbanization. Based on household operations, we should enhance the basic rural operation system, foster new agricultural operators, and develop modern agriculture as the foundation for revitalizing countryside industries. We must deepen agricultural supply-side structural reforms to ensure sufficient supply and security of main agricultural products. We must reform the rural collective ownership system to implement property rights to farmers and protect their interests in the context of urban and rural integration. We must promote green development and revitalize countryside ecological environment. We must enhance rural governance to revitalize rural organizations.
文摘BACKGROUND Acute gallstone pancreatitis(AGP) is the most common cause of acute pancreatitis(AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy(ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography(ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography(MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54(68%) underwent MRCP first whereas 25 patients(32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay(5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients(83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients(17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.RESULTS Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis(79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines(kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings(without a preceding MRCP).CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures.
文摘In the course of creating immense wealth, manufacturing industry has excessively consumed the resources and energy in the earth, and seriously polluted the environment. To take progress as the sustainable development way, save resource and improve environment, our nation has been advocating to construct the cycle economy and saving-oriented society. Taking the remanufacturing engineering as the representative, the “4R” rule (Reduce, Reuse, Recycle and Remanufacture) is the important measure to get the goal. Remanufacturing engineering is the industrialization of high-tech maintenance of the waste and worn productions, and is one of the most active factors in “4R”. The development of high and new technology takes the important effect to promote the remanufacturing engineering.