For high reliability and long life systems, system pass/fail data are often rare. Integrating lower-level data, such as data drawn from the subsystem or component pass/fail testing,the Bayesian analysis can improve th...For high reliability and long life systems, system pass/fail data are often rare. Integrating lower-level data, such as data drawn from the subsystem or component pass/fail testing,the Bayesian analysis can improve the precision of the system reliability assessment. If the multi-level pass/fail data are overlapping,one challenging problem for the Bayesian analysis is to develop a likelihood function. Since the computation burden of the existing methods makes them infeasible for multi-component systems, this paper proposes an improved Bayesian approach for the system reliability assessment in light of overlapping data. This approach includes three steps: fristly searching for feasible paths based on the binary decision diagram, then screening feasible points based on space partition and constraint decomposition, and finally simplifying the likelihood function. An example of a satellite rolling control system demonstrates the feasibility and the efficiency of the proposed approach.展开更多
Objective: To investigate the biological basis of qi, blood and vessel in immune thrombocytopenia(ITP) patients with syndrome of qi failing to govern blood(SQFGB) based on traditional Chinese medicine.Methods: A total...Objective: To investigate the biological basis of qi, blood and vessel in immune thrombocytopenia(ITP) patients with syndrome of qi failing to govern blood(SQFGB) based on traditional Chinese medicine.Methods: A total of 52 ITP patients with SQFCB were enrolled and divided into bleeding group(38 cases) and non-bleeding group(14 cases).Bleeding group was further divided into mild qi deficiency group(25 cases) and moderate/severe qi deficiency group(13 cases) based on Chinese Medicine syndrome score.20 healthy volunteer were recruited as control group.The count of platelet(PLT) was taken as the blood related indicator.The expressions of cytokines including IL-1β, IL-17 A, TNF-α, CD40 L, and TGF-β, detected by Aim Plex Multiple Immunoassays for Flow, were taken as the qi related indicators.The expressions of VEGF-A, detected by Aim Plex Multiple Immunoassays for Flow and NO, NOS, and ET-1 detected by ELISA, were taken as the vessel related indicators.Results: As compared to the control group, the count of PLT, taken as the blood related indicator, was significantly lower in ITP group patients with SQFCB(P<0.05).The expression levels of IL-17 A and TNF-α, taken as the qi related indicators, were significantly higher, while those of CD40 L, IL-1β, and TGF-β, also taken as the qi related indicators, were significantly lower in ITP patients with SQFCB, respectively(P<0.05).The expression levels of NO and ET-1, taken as the vessel related indicators, were significantly higher, while the expression levels of NOS and VEGF-A also taken as the vessel related indicators, were significantly lower in ITP patients with SQFCB, respectively(P<0.05).The count of PLT, taken as the blood related indicator, was significantly lower in moderate/severe group than those in mild group(P<0.05).The expression levels of CD40 L and TGF-β, taken as the qi related indicators, were also significantly lower in moderate/severe group than those in mild group, respectively(P<0.05).Conclusion: The count of PLT might be the biological basis of blood.The expressions of NO, NOS, ET-1 and VEGF-A might be the biological basis of vessel.The expressions of IL-1β, IL-17 A, TNF-α, TGF-β, and CD40 L may be the biological basis of qi.The expressions of CD40 L and TGF-β could reflect the degree of qi deficiency in ITP patients based on the theory of qi and blood.展开更多
Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the...Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.展开更多
AIM:To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS: This retrospective study was performed on338 patients with the diagnosis of congenital naso...AIM:To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS: This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS: Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation(P =0.00).In addition,Monoka intubation had better outcomes compared to Masterka technique(P =0.046).No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION: Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.展开更多
AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocysto...AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed Ex-DCR.METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed.The LOS were implanted into the ostium at the end of the revisional surgery.The causes of failed Ex-DCR were analyzed before revisional surgeries.Outcome of revisional surgeries with the new device were evaluated as well.RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed cases.CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery.Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.展开更多
A retrieval control strategy for failed satellite,which is connected to a servicing spacecraft by a tether,is studied.The Lagrange analytical mechanics based dynamics modeling for the system composed of a servicing sp...A retrieval control strategy for failed satellite,which is connected to a servicing spacecraft by a tether,is studied.The Lagrange analytical mechanics based dynamics modeling for the system composed of a servicing spacecraft,a tether and a failed satellite,is presented under the earth center inertia coordinate system,then model simplification is conducted under the assumption that the failed satellite’s mass is far smaller than the servicing spacecraft’s,meanwhile the tether’s length is far smaller than the size of the servicing spacecraft’s orbit.Analysis shows that the retrieval process is intrinsically unstable as the Coriolis force functions is a negative damping.A retrieval strategy based on only the tether’s tension is designed,resulting in the fastest retrieval speed.In the proposed strategy,firstly,the tether’s swing angle amplitude is adjusted to 45?by deploying/retrieving the tether;then the tether swings freely with fixed length until it reaches negative maximum angle–45?;finally,the tether is retrieved by the pre-assigned exponential law.For simplicity,only the coplanar situation,that the tether swings in the plane of the servicing spacecraft’s orbit,is studied.Numerical simulation verifies the effectiveness of the strategy proposed.展开更多
The Awakening is about the heroine Edna Pontellier awakes and tries to reset her relation with the world in New Orleans,a place the family chose to spend the summer, where there also are influences working their way t...The Awakening is about the heroine Edna Pontellier awakes and tries to reset her relation with the world in New Orleans,a place the family chose to spend the summer, where there also are influences working their way to awake Edna. Among them, theeffects from Madame Ratignolle and Madame Reisz are of great importance in the process of Edna's awakening and to her final sui-cide. This dissertation will see how Edna is affected by and distinguished from them, and get the conclusion that Edna fails being alife mediator by contrasting with the two women.展开更多
The Narrow Road to the Deep North,a novel composed by Richard Flanagan,a well-known Australian contemporary nov⁃elist,depicts a grand political picture of Australia,from the lens of individual’s psyche.The domination...The Narrow Road to the Deep North,a novel composed by Richard Flanagan,a well-known Australian contemporary nov⁃elist,depicts a grand political picture of Australia,from the lens of individual’s psyche.The domination of the official history en⁃courages forgetting as a way to deal with the painful history,the Burma camp in the novel,while the minorities,who rise up,fighting against the imposed official history by constructing the counter memory,are trapped in the identity confusion.Literature is used by both the perpetrators and the survivors as means to pursuing for reconciliation but both failed for the perpetrators use it as a way of forgetting which contributes to the prevailing unforgiveness in the novel,and further contributes the victims’failed reconciliation.展开更多
Compound Danshen Dripping Pill (CDDP) is the traditional Chinese medicine that has been widely used in China for the treatment of diseases such as coronary heart disease, stenocardia, and myocardial ischemia. The appl...Compound Danshen Dripping Pill (CDDP) is the traditional Chinese medicine that has been widely used in China for the treatment of diseases such as coronary heart disease, stenocardia, and myocardial ischemia. The application of the pills was submitted to the USA Food and Drug Administration (FDA) in 1997. It was also the first TCM to enter phase III clinical trials by the FDA. However, news about the failure of the phase III clinical trials of CDDP was recently reported.展开更多
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
In ST-segment elevation myocardial infarction (STEMI), acute reperfusion of the infarct-related artery (IRA)is the main goal in the early minutes after the patient seeks medical attention. Fibrinolytic therapy (FT) an...In ST-segment elevation myocardial infarction (STEMI), acute reperfusion of the infarct-related artery (IRA)is the main goal in the early minutes after the patient seeks medical attention. Fibrinolytic therapy (FT) and/or primary coronary intervention (PCI) were proven to be effective in opening the IRA.展开更多
Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt on...Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.展开更多
Emergency physicians are often the first providersto encounter patients with complications in earlypregnancy. Point-of-care (POC) pelvic ultrasound isbeing increasingly used in the evaluation of emergencydepartment ...Emergency physicians are often the first providersto encounter patients with complications in earlypregnancy. Point-of-care (POC) pelvic ultrasound isbeing increasingly used in the evaluation of emergencydepartment (ED) patients with first trimester symptoms.[1]While the initial aim of POC ultrasound in this settingis to confirm an intrauterine pregnancy, a secondarygoal is to differentiate between a normal and abnormalpregnancy. There exist a number of sonographic featuresto suggest a pregnancy is non-viable.展开更多
This article provides a snapshot of pass/fail and discretionary grading approaches, highlighting the advantages and disadvantages of each. Norm-referenced and criterion-referenced grading practices and their associati...This article provides a snapshot of pass/fail and discretionary grading approaches, highlighting the advantages and disadvantages of each. Norm-referenced and criterion-referenced grading practices and their associations with learning are identified. A brief historical backdrop illustrates how grading practices have evolved. The inherent subjectivity of grading is emphasized. Pass/fail grading supports intrinsic motivation and self-direction, but limits opportunities for recognizing excelling students. Discretionary grading, which includes letter (F- to A+) and numeric (0% to 100%) representations, supports extrinsic motivation and self-improvement, but promotes unhealthy competition. Both approaches have merit and can effectively measure student achievement in nursing education programs.展开更多
Preclinical stroke research has introduced a number of potential interventions that can be utilized to enhance recovery after stroke(Lo and Rosenberg,2009).
高中英语第三册教学参考书(以下简称《教参》)p.117讲到 fail 用法时说:表示“没有能够”的意思时,“用作 vt.(及物动词),后面跟不定式”,并举如下两例:I failed to see him.He was out.我没有见到他。他出去了。He didvery well,but fa...高中英语第三册教学参考书(以下简称《教参》)p.117讲到 fail 用法时说:表示“没有能够”的意思时,“用作 vt.(及物动词),后面跟不定式”,并举如下两例:I failed to see him.He was out.我没有见到他。他出去了。He didvery well,but failed to break the record.他跑(跳,游,滑)得很好,但未能打破记录。展开更多
Background: With the increasing number of laparoscopic fundoplications, many more patients with a failed primary antireflux operation are being referred for complex redo procedures. The objective of this study was to ...Background: With the increasing number of laparoscopic fundoplications, many more patients with a failed primary antireflux operation are being referred for complex redo procedures. The objective of this study was to evaluate our results of redo antireflux surgery using the Belsey Mark IV (BMIV) Repair. Methods: A retrospective analysis of the patients who underwent BMIV repair following a failed fundoplication was performed. The primary endpoint was failure of the redo procedure and recurrent hiatal hernia. Secondary endpoints were assessment of the functional results of the redo fundoplication and quality of life with a Dysphagia Score, and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) questionnaire. Results: 206 patients underwent surgery for failed primary fundoplication. Most patients had one prior antireflux surgery 148/206 (71.8%). The most common primary failed fundoplication was the Nissen procedure (189/206, 91.7%). The median time from the prior operation to the redo operation was 34 months. Median follow-up was 25.6 months. The Dysphagia score decreased from 3.6 ± 0.5 preoperatively to 1.0 ± 0.4 postoperatively (p < 0.0001). At the time of follow-up, the Median GERD-HRQL score was 4 (range 0 - 9), classified as excellent, compared to a preoperative Median GERD-HRQL score of 43 (range 41 - 50) which was classified as poor. (p < 0.0001). There was no recurrence of the hiatal hernia. Conclusion: Complete takedown and reestablishment of the normal anatomy, recognition of a short esophagus, and proper placement of the wrap are essential components of a redo antireflux procedure. The BMIV repair as the choice of reopertaive procedure results in excellent symptom relief, significant improvement in quality of life, and is associated with excellent medium-term durability in terms of recurrence of the hiatal hernia.展开更多
基金supported by the National Natural Science Foundation of China(61304218)
文摘For high reliability and long life systems, system pass/fail data are often rare. Integrating lower-level data, such as data drawn from the subsystem or component pass/fail testing,the Bayesian analysis can improve the precision of the system reliability assessment. If the multi-level pass/fail data are overlapping,one challenging problem for the Bayesian analysis is to develop a likelihood function. Since the computation burden of the existing methods makes them infeasible for multi-component systems, this paper proposes an improved Bayesian approach for the system reliability assessment in light of overlapping data. This approach includes three steps: fristly searching for feasible paths based on the binary decision diagram, then screening feasible points based on space partition and constraint decomposition, and finally simplifying the likelihood function. An example of a satellite rolling control system demonstrates the feasibility and the efficiency of the proposed approach.
基金the National Program on Key Basic Research Project(2015CB554403)
文摘Objective: To investigate the biological basis of qi, blood and vessel in immune thrombocytopenia(ITP) patients with syndrome of qi failing to govern blood(SQFGB) based on traditional Chinese medicine.Methods: A total of 52 ITP patients with SQFCB were enrolled and divided into bleeding group(38 cases) and non-bleeding group(14 cases).Bleeding group was further divided into mild qi deficiency group(25 cases) and moderate/severe qi deficiency group(13 cases) based on Chinese Medicine syndrome score.20 healthy volunteer were recruited as control group.The count of platelet(PLT) was taken as the blood related indicator.The expressions of cytokines including IL-1β, IL-17 A, TNF-α, CD40 L, and TGF-β, detected by Aim Plex Multiple Immunoassays for Flow, were taken as the qi related indicators.The expressions of VEGF-A, detected by Aim Plex Multiple Immunoassays for Flow and NO, NOS, and ET-1 detected by ELISA, were taken as the vessel related indicators.Results: As compared to the control group, the count of PLT, taken as the blood related indicator, was significantly lower in ITP group patients with SQFCB(P<0.05).The expression levels of IL-17 A and TNF-α, taken as the qi related indicators, were significantly higher, while those of CD40 L, IL-1β, and TGF-β, also taken as the qi related indicators, were significantly lower in ITP patients with SQFCB, respectively(P<0.05).The expression levels of NO and ET-1, taken as the vessel related indicators, were significantly higher, while the expression levels of NOS and VEGF-A also taken as the vessel related indicators, were significantly lower in ITP patients with SQFCB, respectively(P<0.05).The count of PLT, taken as the blood related indicator, was significantly lower in moderate/severe group than those in mild group(P<0.05).The expression levels of CD40 L and TGF-β, taken as the qi related indicators, were also significantly lower in moderate/severe group than those in mild group, respectively(P<0.05).Conclusion: The count of PLT might be the biological basis of blood.The expressions of NO, NOS, ET-1 and VEGF-A might be the biological basis of vessel.The expressions of IL-1β, IL-17 A, TNF-α, TGF-β, and CD40 L may be the biological basis of qi.The expressions of CD40 L and TGF-β could reflect the degree of qi deficiency in ITP patients based on the theory of qi and blood.
文摘Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.
文摘AIM:To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS: This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS: Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation(P =0.00).In addition,Monoka intubation had better outcomes compared to Masterka technique(P =0.046).No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION: Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.
基金Supported by Wenzhou Science and Technology Bureau Program (No.Y2020362)。
文摘AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed Ex-DCR.METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed.The LOS were implanted into the ostium at the end of the revisional surgery.The causes of failed Ex-DCR were analyzed before revisional surgeries.Outcome of revisional surgeries with the new device were evaluated as well.RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed cases.CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery.Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.
基金supported by the Fundamental Research Funds for the Central Universities(NUAA-NS2016082)
文摘A retrieval control strategy for failed satellite,which is connected to a servicing spacecraft by a tether,is studied.The Lagrange analytical mechanics based dynamics modeling for the system composed of a servicing spacecraft,a tether and a failed satellite,is presented under the earth center inertia coordinate system,then model simplification is conducted under the assumption that the failed satellite’s mass is far smaller than the servicing spacecraft’s,meanwhile the tether’s length is far smaller than the size of the servicing spacecraft’s orbit.Analysis shows that the retrieval process is intrinsically unstable as the Coriolis force functions is a negative damping.A retrieval strategy based on only the tether’s tension is designed,resulting in the fastest retrieval speed.In the proposed strategy,firstly,the tether’s swing angle amplitude is adjusted to 45?by deploying/retrieving the tether;then the tether swings freely with fixed length until it reaches negative maximum angle–45?;finally,the tether is retrieved by the pre-assigned exponential law.For simplicity,only the coplanar situation,that the tether swings in the plane of the servicing spacecraft’s orbit,is studied.Numerical simulation verifies the effectiveness of the strategy proposed.
文摘The Awakening is about the heroine Edna Pontellier awakes and tries to reset her relation with the world in New Orleans,a place the family chose to spend the summer, where there also are influences working their way to awake Edna. Among them, theeffects from Madame Ratignolle and Madame Reisz are of great importance in the process of Edna's awakening and to her final sui-cide. This dissertation will see how Edna is affected by and distinguished from them, and get the conclusion that Edna fails being alife mediator by contrasting with the two women.
文摘The Narrow Road to the Deep North,a novel composed by Richard Flanagan,a well-known Australian contemporary nov⁃elist,depicts a grand political picture of Australia,from the lens of individual’s psyche.The domination of the official history en⁃courages forgetting as a way to deal with the painful history,the Burma camp in the novel,while the minorities,who rise up,fighting against the imposed official history by constructing the counter memory,are trapped in the identity confusion.Literature is used by both the perpetrators and the survivors as means to pursuing for reconciliation but both failed for the perpetrators use it as a way of forgetting which contributes to the prevailing unforgiveness in the novel,and further contributes the victims’failed reconciliation.
文摘Compound Danshen Dripping Pill (CDDP) is the traditional Chinese medicine that has been widely used in China for the treatment of diseases such as coronary heart disease, stenocardia, and myocardial ischemia. The application of the pills was submitted to the USA Food and Drug Administration (FDA) in 1997. It was also the first TCM to enter phase III clinical trials by the FDA. However, news about the failure of the phase III clinical trials of CDDP was recently reported.
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
文摘In ST-segment elevation myocardial infarction (STEMI), acute reperfusion of the infarct-related artery (IRA)is the main goal in the early minutes after the patient seeks medical attention. Fibrinolytic therapy (FT) and/or primary coronary intervention (PCI) were proven to be effective in opening the IRA.
文摘Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.
文摘Emergency physicians are often the first providersto encounter patients with complications in earlypregnancy. Point-of-care (POC) pelvic ultrasound isbeing increasingly used in the evaluation of emergencydepartment (ED) patients with first trimester symptoms.[1]While the initial aim of POC ultrasound in this settingis to confirm an intrauterine pregnancy, a secondarygoal is to differentiate between a normal and abnormalpregnancy. There exist a number of sonographic featuresto suggest a pregnancy is non-viable.
文摘This article provides a snapshot of pass/fail and discretionary grading approaches, highlighting the advantages and disadvantages of each. Norm-referenced and criterion-referenced grading practices and their associations with learning are identified. A brief historical backdrop illustrates how grading practices have evolved. The inherent subjectivity of grading is emphasized. Pass/fail grading supports intrinsic motivation and self-direction, but limits opportunities for recognizing excelling students. Discretionary grading, which includes letter (F- to A+) and numeric (0% to 100%) representations, supports extrinsic motivation and self-improvement, but promotes unhealthy competition. Both approaches have merit and can effectively measure student achievement in nursing education programs.
基金supported by RO1-NS063965R21-NS088016+1 种基金VA Merit Review-BX000891Jowdy Professorship to SCF
文摘Preclinical stroke research has introduced a number of potential interventions that can be utilized to enhance recovery after stroke(Lo and Rosenberg,2009).
文摘高中英语第三册教学参考书(以下简称《教参》)p.117讲到 fail 用法时说:表示“没有能够”的意思时,“用作 vt.(及物动词),后面跟不定式”,并举如下两例:I failed to see him.He was out.我没有见到他。他出去了。He didvery well,but failed to break the record.他跑(跳,游,滑)得很好,但未能打破记录。
文摘Background: With the increasing number of laparoscopic fundoplications, many more patients with a failed primary antireflux operation are being referred for complex redo procedures. The objective of this study was to evaluate our results of redo antireflux surgery using the Belsey Mark IV (BMIV) Repair. Methods: A retrospective analysis of the patients who underwent BMIV repair following a failed fundoplication was performed. The primary endpoint was failure of the redo procedure and recurrent hiatal hernia. Secondary endpoints were assessment of the functional results of the redo fundoplication and quality of life with a Dysphagia Score, and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) questionnaire. Results: 206 patients underwent surgery for failed primary fundoplication. Most patients had one prior antireflux surgery 148/206 (71.8%). The most common primary failed fundoplication was the Nissen procedure (189/206, 91.7%). The median time from the prior operation to the redo operation was 34 months. Median follow-up was 25.6 months. The Dysphagia score decreased from 3.6 ± 0.5 preoperatively to 1.0 ± 0.4 postoperatively (p < 0.0001). At the time of follow-up, the Median GERD-HRQL score was 4 (range 0 - 9), classified as excellent, compared to a preoperative Median GERD-HRQL score of 43 (range 41 - 50) which was classified as poor. (p < 0.0001). There was no recurrence of the hiatal hernia. Conclusion: Complete takedown and reestablishment of the normal anatomy, recognition of a short esophagus, and proper placement of the wrap are essential components of a redo antireflux procedure. The BMIV repair as the choice of reopertaive procedure results in excellent symptom relief, significant improvement in quality of life, and is associated with excellent medium-term durability in terms of recurrence of the hiatal hernia.