Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.

Circulation of Development Factors Promoted by Innovation of Land Management Under Background of Rural Vitalization:A Case Study of Tengtou Village in Zhejiang Province,China

Land is the space carrier for the existence and flow of other development factors.Activating rural land and promoting the circulation of other development factors through land management innovation is necessary to realize rural vitalization.This paper identifies the connotation of factor flow in the rural vitalization context,the action mechanism of land management innovation to boost the flow of development factors,the issues and obstacles restricting factor circulation,and the realization mechanism of the flow of development factors in rural vitalization.Based on the analytic paradigm constructed in the paper,the successful practice of promoting the flow of development factors through innovative land management in a model village is examined.The results show that:1)the unreasonable systems characterized by the land use system in rural areas are the main obstacles causing circulation issues in development factors.It is essential to engage in comprehensive reform to break down these long-lasting obstacles to the smooth flow of development factors.2)The land should play a leading role in the circulation of development factors in the background of rural vitalization;the main purpose of land management innovation is to activate the land factor,thereby promoting the circulation of other factors.3)The activated land factor will act as a‘trigger’to promote capital and technology in rural settings and use capital and technology to attract the inflow of talents and the return of migrant workers,whereby the population factor will act as a‘catalyst’for the cultivation of rural culture,bringing about the integration of various development factors.4)The innovation of land use and management,increased funding,and new technologies have brought multiple talents to Tengtou Village.The high-frequency mutual feedback between the village’s own and the external development factors resulted in its successful integration of industrial development.

INTEGRATION OF HUMAN FACTORS ENGINEERING AND QUALITY MANAGEMENT

Human factors engineering and quality management are different research branches in the field of industrial engineering.A basis for interaction based on the concepts and techniques of human factors engineering and quality management with some practical examples of cooperative effect is defined in this paper.The specific challenges about the quality management in manufacturing and service are presented to demonstrate that the human factors analysis of quality problems leads to new tends for integrated development.

Predictors and optimal management of tumor necrosis factor antagonist nonresponse in inflammatory bowel disease:A literature review

Tumor necrosis factor-α(TNF-α)antagonists,the first biologics approved for treating patients with inflammatory bowel disease(IBD),are effective for the induction and maintenance of remission and significantly improving prognosis.However,up to one-third of treated patients show primary nonresponse(PNR)to anti-TNF-αtherapies,and 23%-50%of IBD patients experience loss of response(LOR)to these biologics during subsequent treatment.There is still no recognized predictor for evaluating the efficacy of anti-TNF drugs.This review summarizes the existing predictors of PNR and LOR to anti-TNF in IBD patients.Most predictors remain controversial,and only previous surgical history,disease manifestations,drug concentrations,antidrug antibodies,serum albumin,some biologic markers,and some genetic markers may be potentially predictive.In addition,we also discuss the next steps of treatment for patients with PNR or LOR to TNF antagonists.Therapeutic drug monitoring plays an important role in treatment selection.Dose escalation,combination therapy,switching to a different anti-TNF drug,or switching to a biologic with a different mechanism of action can be selected based on the concentration of the drug and/or antidrug antibodies.

Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

A Web-Based Approach for the Efficient Management of Massive Multi-source 3D Models

Effectively managing extensive,multi-source,and multi-level real-scene 3D models for responsive retrieval scheduling and rapid visualization in the Web environment is a significant challenge in the current development of real-scene 3D applications in China.In this paper,we address this challenge by reorganizing spatial and temporal information into a 3D geospatial grid.It introduces the Global 3D Geocoding System(G_(3)DGS),leveraging neighborhood similarity and uniqueness for efficient storage,retrieval,updating,and scheduling of these models.A combination of G_(3)DGS and non-relational databases is implemented,enhancing data storage scalability and flexibility.Additionally,a model detail management scheduling strategy(TLOD)based on G_(3)DGS and an importance factor T is designed.Compared with mainstream commercial and open-source platforms,this method significantly enhances the loadable capacity of massive multi-source real-scene 3D models in the Web environment by 33%,improves browsing efficiency by 48%,and accelerates invocation speed by 40%.

Contractor-Related Factors and Performance of Bridge Construction Projects Implemented by Kenya National Highways Authority (KeNHA) Kenya

The performance of bridge projects in Kenya is poor in terms of completion by schedule, cost, and quality (scope). Yet, there is less evidence of empirical research on what factors contribute to this outcome. This study aimed to bridge this gap by examining the effects of contractor-related factors on the performance of bridge construction projects in Kenya through a case study of the Bridge projects Implemented by the Kenya National Highway Agency (KeNHA). The theory of constraints (TOC) was adopted as its theoretical framework. Descriptive research was used, and the target population was 18 bridge construction projects, which were the units of analysis from 2012 to 2022. In each of these projects, 18 respondents, namely clients, consultants, contractors, engineers, environment and social guards, project managers, stakeholders, subcontractors, technical advisors, and inspectors, were included in a target population of 144 respondents. A census was conducted and a structured questionnaire was administered from which a response rate of 68% was achieved. The information was analyzed using descriptive, correlation, and multiple linear regression analysis. The contractor-related factors considered in the study were staff and management factors. The findings indicated that staff and management factors had a positive and significant outcome on performance of bridge construction projects. The study recommends continuous training and a safe learning environment for staff to improve their skills and performance in future projects. The study also recommends that a special category for bridge contractors be created in Kenya’s National Construction Authority rankings to ensure that only qualified contractors implement the Bridge projects.

Colonoscopic perforation:Incidence,risk factors,management and outcome

This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.

Post-pancreaticoduodenectomy hemorrhage:risk factors, managements and outcomes

BACKGROUND： Post-pancreaticoduodenectomy（PD） hemorrhage（PPH） is an uncommon but serious complication. This retrospective study analyzed the risk factors, managements and outcomes of the patients with PPH.METHODS： A total of 840 patients with PD between 2000 and2010 were retrospectively analyzed. Among them, 73 patients had PPH： 19 patients had early PPH and 54 had late PPH.The assessment included the preoperative history of disease,pancreatic status and surgical techniques. Other postoperative complications were also evaluated.RESULTS： The incidence of PPH was 8.7%（73/840）. There were no independent risk factors for early PPH. Male gender（OR=4.40, P0.02）, diameter of pancreatic duct（OR=0.64,P0.01）, end-to-side invagination pancreaticojejunostomy（OR=5.65, P0.01）, pancreatic fistula（OR=2.33, P0.04）and intra-abdominal abscess（OR=12.19, P0.01） were the independent risk factors for late PPH. Four patients with early PPH received conservative treatment and 12 were treated surgically. As for patients with late PPH, the success rate of medical therapy was 27.8%（15/54）. Initial endoscopy was operated in 12 patients（22.2%）, initial angiography in 19（35.2%）,and relaparotomy in 15（27.8%）. Eventually, PPH resulted in 19 deaths. The main causes of death were multiple organ failure,hemorrhagic shock, sepsis and uncontrolled rebleeding.CONCLUSIONS： Careful and ongoing observation of hemorrhagic signs, especially within the first 24 hours after PD or within the course of pancreatic fistula or intra-abdominal abscess, is recommended for patients with PD and a prompt management is necessary. Although endoscopy and angiography are the standard procedures for the management of PPH,surgical approach is still irreplaceable. Aggressive prevention of hemorrhagic shock and re-hemorrhage is the key to treat PPH.

The priority of management factors for reducing the yield gap of summer maize in the north of Huang-Huai-Hai region, China

Understanding yield potential, yield gap and the priority of management factors for reducing the yield gap in current intensive maize production is essential for meeting future food demand with the limited resources. In this study, we conducted field experiments using different planting modes, which were basic productivity(CK), farmer practice(FP), high yield and high efficiency(HH), and super high yield(SH), to estimate the yield gap. Different factorial experiments(fertilizer, planting density, hybrids, and irrigation) were also conducted to evaluate the priority of individual management factors for reducing the yield gap between the different planting modes. We found significant differences between the maize yields of different planting modes. The treatments of CK, FP, HH, and SH achieved 54.26, 58.76, 65.77, and 71.99% of the yield potential, respectively. The yield gaps between three pairs: CK and FP, FP and HH, and HH and SH, were 0.76, 1.23 and 0.85 t ha^(–1), respectively. By further analyzing the priority of management factors for reducing the yield gap between FP and HH, as well as HH and SH, we found that the priorities of the management factors(contribution rates) were plant density(13.29%)>fertilizer(11.95%)>hybrids(8.19%)>irrigation(4%) for FP to HH, and hybrids(8.94%)>plant density(4.84%)>fertilizer(1.91%) for HH to SH. Therefore, increasing the planting density of FP was the key factor for decreasing the yield gap between FP and HH, while choosing hybrids with density and lodging tolerance was the key factor for decreasing the yield gap between HH and SH.

Human Factors/Ergonomics (HFE) in Leadership and Management: Organizational Interventions to Reduce Stress in Healthcare Delivery

Clinician Burnout is a personal and public health issue. Most occupational stressors contributing to clinician burnout are systemic. The combination of organizational interventions along with individual interventions is necessary to make significant lasting difference in reducing burnout, improving clinician and patient satisfaction and reducing latent error in healthcare delivery. Application of Human Factors/Ergonomics (HFE) science in healthcare leadership and management is a gap in current training for leaders. HFE uses concepts from organizational, educational and cognitive science, systems science and industrial engineering. HFE application is especially necessary in a fast changing highly stressful healthcare environment which impacts the wellbeing of clinicians and the safety of patients under care. Practical suggestions for working with various healthcare leadership styles and organizational dynamics, while aligning wellness efforts with institutional mission are discussed. Concrete examples of decreasing extraneous mental load on clinicians to preserve their brainpower to achieve quality patient care are illustrated. Organizational interventions in combination with individual interventions to reduce and manage burnout have enormous potential to improve clinician wellbeing and satisfaction in taking care of patients, reduce costs, risk of error and create the safe working environment needed to sustainably give high quality care to patients.

Prognostic Factors of Gastrointestinal Stromal Tumors： A Single Institutional Retrospective Experience with Surgical Management over 20 Years

OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor （GIST） after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients with GISTs who underwent surgery between 1988 and 2007 were retrospectively reviewed. The predic-tive factors for the survival of these patients were identi. ed using multivariate analysis. RESULTS In the 327 tumors, 152 （46.5%） were located in the stomach, 89 （27.2%） in the small intestine, 33 （10.1%） in the colon and rectum, and 43 （13.1%） in other sites including the omentum and mesentery. The 3-year and 5-year overall survival rates of the 327 GIST patients were 74.4% and 62.7%, respectively, and univariate survival analysis demonstrated that factors, such as tumor size, mitotic index, NIH categories, Ki-67 index, tumor location, surgical margins, tumor bleeding, and tumor necrosis have significant effect on survival of the patients （P 〈 0.05）. Multivariate analysis demonstrated that the NIH categories, surgical margins, and Ki-67 index were independent prognostic factors for the survival rate. In the group of patients with postoperative recurrence or metastasis, the median survival time of patients who did not receive imatinib treatment was 30 months and that of patients who received imatinib treatment was 59 months. Their 5-year survival rates were 16.4% and 39.4%, respectively, and the difference was statistically significant （P = 0.017）. CONCLUSION Complete resection is the .rst choice of treat-ment for GISTs. It is reasonable to evaluate the prognosis of resect-able GISTs and guide the adjunctive therapy with NIH categories and Ki-67 index. Imatinib treatment can signi.cantly increase the survival rate of patients with recurrent and metastatic GISTs.

Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus:A narrative review

Type 1 diabetes(T1D)is one of the most common chronic diseases in children and adolescents worldwide.Its etiopathogenesis results from the interplay of genetic and environmental variables.Among the latter,psychological stress has been implicated in disease onset as well as disease management.Various studies,including large population-based studies,have highlighted the role of stressful life events in the etiopathogenesis of T1D.In this article,we also emphasize the importance of attachment in the early child-caregiver relationship,which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation.It serves as a model for all subsequent relationships in one’s life.We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management.T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications.In addition to psychological stress,psychological factors such as family functioning,developmental adjustment,autonomy,mental health problems and other factors have been found to relate to metabolic control.Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi-or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.

A survey of the influencing factors and models for resident＇s household waste management behavior

The problem of household solid waste has been concerned and researched on by municipalities and researchers.At present, household solid waste has been changed to management problem from technical one. From the point view ofmanagement, the research on household solid waste is to study the factors which influence resident’s behavior ofmanaging their waste. Based on the literature review, firstly, this paper summarizes those factors which have alreadybeen identified to have impact on resident’s behavior of managing their waste. They are social-demographic variables,knowledge, environmental values, psychological factors, publicity and system design. Secondly, three typical models ofthe relationship between factors and behavior, which are factors determining task performance in waste management,conceptualization of waste management behavior and the theoretical model of repeated behavior on household wastemanagement, are analyzed and the deficiencies of these models are also analyzed. Finally, according to the currentsituation in household waste management and the culture and resident’s habits in China, this paper puts forward aresearch focus and suggestions about resident’s behavior of household solid waste management.

Quantification of the effects of management factors on maize (Zea mays L.) and cotton(Gossypium hirsutum L.) residues decomposition rate

Efforts to quantify management effects on decomposition rate of added substrates to the soil is important especially where such information is to be used for prediction in mathematical or simulation models. Using data from a short term (60 days) greenhouse simulation study, a procedure for quantifying effects of management on SOM and substrate decomposition is presented. Using microbial growth rate u (q), microbial efficiency in substrate utilization e (q), specific decomposition rates for added plant residues to two contrasting soils, red earth (Ferrasol) and black earth (Acrisol) were estimated. The treatments included straw addition + buried, (T1); straw addition + mineral N (T2); and straw addition + tillage, (T3). Sampling was done every 15 days. Straw decomposition rate was affected by external mineral N sources (Urea 46% N). Addition of an external N source significantly increased decomposition rates. The study could not, however, fully account for the effect of tillage on residues because of the limited effect of the tillage method due to the artificial barrier to mechanical interference supplied by the mesh bags. It is concluded that using few decomposer parameters, decomposition rates and consequently SOM trends in a soil system can be monitored and quantification of the influence of perturbations on decomposition rate of added substrates possible.

Study on Factors Influencing the Reliability of the Organization Management Chain of the Large and Medium-Sized Project in the Construction Period

On the basis of analyzing the reliability of the organization’ management chain of the large and medium- sized project in the construction period, the paper studies the factors influencing the reliability of the organi-zation management chain, which, corresponding to four elements of management chain – “Management Loop”, “Management Link”, “Management Chain”, and “Management Network”, can be summarized as project main body, interface management, connection sequence and management model. The paper then re-searches on the specific influencing factors from the above-mentioned four aspects.

Extrauterine pregnancies-risk factors and management

Objective: To study the clinical progress, risk factors, management, and outcomes of suspected ectopic pregnancy (EP). Design: Retrospective clinical case study. Population: All 184 patients hospitalized for suspected EP during the period 1.1.2008-31.12.2011. Setting: Oulu University Hospital, Finland. Methods: The clinical progress, risk factors, management, complications and outcomes were based on studies of hospital records. Main outcome measures: Symptoms, serum quantitative human chorionic gonadotropin (hCG) levels, management, complications and outcome of patients. Results: At least one of the risk factors was found in 117 women (66%). There were 11 patients without symptoms. In the initial visit, the median hCG concentration was 1915 (20 - 73,000) IU/l. The most common treatment was surgical, 137/181 (76%), followed with medical treatment, 22/181 (12%) and expectant management, 22/181 (12%). Conclusions: Surgery was the most widely used treatment for EP. We might thus draw attention to more conservative management.

Solanum lycopersicum: Novelties for Climate Factors and Its Agronomic Management for High Yields

The intensive production of vegetables such as tomatoes depends on various strategies to achieve high yields.Purpose of this manuscript is to provide scientific and technological strategies for the intensive production of tomato or other vegetables in mega-production factories. However, with the advancement of knowledge, new improvements in the strategies will be incorporated. We have carried out research related to growth and yield variables in S. Lycopersicum. From this research we have worked on the intensive production of this noble vegetable at an industrial level. The results obtained are improvements in the production system. The improvements include the selection of the appropriate variety, germination and development of seedlings in a certified nursery. Trans-plantation in soil or hydroponics. The conditions of nutrient applications from the irrigation head system. The ventilation system and monitoring of climatic factors both day and night (temperature and relative humidity). Monitoring of macro- and micronutrients in the plant system, including Ca, K, Fe, and Zn. Soil fertility analyzes should include: primary and secondary macronutrients (ppm), organic matter (OM), EC, pH, bulk density (BD), and cation exchange capacity (CEC). The nutritional diagnosis to confirm ranges of sufficiency. As a tool in plant nutrition programs, foliar application can include biostimulants and growth regulators. The foregoing can be considered strategies for the integral management of the tomato crop.