Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Enhanced Heritage Tourism Management through a Themed Landscape Approach: The Case of Brussels’ Art Nouveau

Besides being known as the birthplace of fries and waffles,Brussels is also referred to as a superlative Art Nouveau Capital.However,it appears that many of its visitors are unfamiliar with this city’s architectural style which is spread throughout the Capital Region.Due to both the specific opportunities and barriers of the Brussels context,an improved valorisation was explored through a themed landscape approach.This innovative tourism approach can enhance both the management and experience of the Art Nouveau patrimony as an entity.Applying a survey and interviews,this research examined the views of two relevant stakeholder groups:policymakers and tourism managers,and visitors.Two main research questions were addressed:whether these groups could identify the Brussels Art Nouveau as a themed landscape;and,in which way a themed landscape approach can overcome fragmented management and weak experience.Confronting both groups revealed interesting discrepancies as hidden hurdles for tourism destination management.

A Virgin Land to be Cultivated:On the Aesthetics of Folk Literature and Art

In terms of the aesthetic of folk literature and art,most researchers explain it drawing on general aesthetic theory,but pay less attention to the specific context and logic of individual cases.Folk aesthetics is deeply rooted in folk life,including local nature,village culture,farming life and folk belief.These folklore factors constitute the“local logic”,which regulates and influences folk aesthetic culture.The hidden“grammar”must be found in the folk life of the masses with a view to explaining the“essence”of folk aesthetics effectively.The concept of folk literature and art is understood in two different ways:One interprets it as“study of art and literature of folks”,regarding folk as a modifier of study of art and literature.Folk literature and art is regarded as the research object and the discipline is defined according to literary standard.This concept is from the perspective of literary studies,emphasizing that“folk literature and art is a special study of literature and art”.The other interprets it as“study of folk literature and art”,treating literature and art among the folks as the research object and defining the discipline in accordance with cultural standard.This concept is from the perspective of cultural studies.

The Current Situation and Counter Measures of Compilation of English Literature Textbooks in the Context of New Liberal Arts

With the promulgation of the“National Quality Standards for Undergraduate Teaching of Foreign Languages and Literatures in General Institutions of Higher Education”and“Teaching Guidelines”in 2018,the humanistic attributes of English majors and the important position of literature in foreign language learning are emphasized.Nowadays,the English literature curriculum is facing the problems of marginalization,reduction of class hours,simplification of curriculum and so on.Then in the context of the new liberal arts,it provides a new way to break through the dilemma of the literature curriculum.The study has collected the use of teaching materials of British and American literature courses in some colleges and universities across the country.Based on the survey results,the compilation of teaching materials in the new era should consider how to adapt to students’deep learning,autonomous learning,cross learning and research-based learning to provide guidance and support.The diversity of learning requires us to break the monotony of textbook compilation,show diversity and complement each other.

Discussion on the Classroom Teaching Management of the Art and Design Major in Higher Vocational Colleges

As a teaching aid, the classroom management model of art and design major courses undoubtedly should follow the rules of art education. Compared with colleges and universities, the teachers in higher vocational colleges often need to educate many students of poor foundation and bad habits, so the management model should be explored more deeply and specifically. Through the depth analysis of the teaching environment, objects, and objectives, a relatively solid, perfect management system including discipline management and system control, mental management and standard attitudes, process management, incentive and interaction, evaluation management, and ability goal is proposed, for the purpose of providing a powerful guarantee for the classroom teaching effect of the an and design major in higher vocational colleges by using reasonable classroom management methods and means. As a result, a solid foundation is laid for the an and design students to become the professionals of the sustainable development.

The Innovative Application of Principal's Leadership Art and Leadership in International School Management

At present,most schools adopt the principal management system.In the International Campus,the principal's leadership has a great impact on the quality of school operation.Headmasters must combine the actual situation and use of international schools,and lead in an innovative way to better promote the development of international schools.Therefore,this paper analyzes the current situation and importance of principal leadership and leadership art in international school management,and discusses the innovative application strategies of principal leadership art and leadership in international school management.

Digital Twins for Engineering Asset Management:Synthesis,Analytical Framework,and Future Directions

Effective engineering asset management(EAM)is critical to economic development and improving livability in society,but its complexity often impedes optimal asset functionalities.Digital twins(DTs)could revolutionize the EAM paradigm by bidirectionally linking the physical and digital worlds in real time.There is great industrial and academic interest in DTs for EAM.However,previous review studies have predominately focused on technical aspects using limited life-cycle perspectives,failing to holistically synthesize DTs for EAM from the managerial point of view.Based on a systematic literature review,we introduce an analytical framework for describing DTs for EAM,which encompasses three levels:DT 1.0 for technical EAM,DT 2.0 for technical-human EAM,and DT 3.0 for technical-environmental EAM.Using this framework,we identify what is known,what is unknown,and future directions at each level.DT 1.0 addresses issues of asset quality,progress,and cost management,generating technical value.It lacks multi-objective self-adaptive EAM,however,and suffers from high application cost.It is imperative to enable closed-loop EAM in order to provide various functional services with affordable DT 1.0.DT 2.0 accommodates issues of human-machine symbiosis,safety,and flexibility management,generating managerial value beyond the technical performance improvement of engineering assets.However,DT 2.0 currently lacks the automation and security of human-machine interactions and the managerial value related to humans is not prominent enough.Future research needs to align technical and managerial value with highly automated and secure DT 2.0.DT 3.0 covers issues of participatory governance,organization management,sustainable development,and resilience enhancement,generating macro social value.Yet it suffers from organizational fragmentation and can only address limited social governance issues.Numerous research opportunities exist to coordinate different stakeholders.Similarly,future research opportunities exist to develop DT 3.0 in a more open and complex system.

Analysis of the management and therapeutic performance of diabetes mellitus employing special target

Diabetes mellitus (DM) is a chronic metabolic condition characterized predominantlyby hyperglycemia. The most common causes contributing to the pathophysiologyof diabetes are insufficient insulin secretion, resistance to insulin’stissue-acting effects, or a combination of both. Over the last 30 years, the globalprevalence of diabetes increased from 4% to 6.4%. If no better treatment or cure isfound, this amount might climb to 430 million in the coming years. The major fact-ors of the disease’s deterioration include age, obesity, and a sedentary lifestyle.Finding new therapies to manage diabetes safely and effectively without jeopardizingpatient compliance has always been essential. Among the medicationsavailable to manage DM on this journey are glucagon-like peptide-1 agonists,thiazolidinediones, sulphonyl urease, glinides, biguanides, and insulin-targetingreceptors discovered more than 10 years ago. Despite the extensive preliminarystudies, a few clinical observations suggest this process is still in its early stages.The present review focuses on targets that contribute to insulin regulation andmay be employed as targets in treating diabetes since they may be more efficientand secure than current and traditional treatments.

Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review

Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using 'ketamine', 'pain or analgesia', and'intranasal' as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1204 papers extracted via primary search, 1088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.

An Analysis of the Current Situation of Art Education Management in the Education of Chinese Middle School Students

This article analyzes the current domestic middle school art education and education management.Today,with great efforts to improve the quality of education,our domestic art education has been included in the education sequence of the compulsory education system,but there are still some shortcomings in middle school art education.Combining with the current conditions of my country’s middle school art education,through investigation and analysis,it points out the key issues in the quality of middle school art education,and the universality of middle school art education,and finally implements reasonable improvements.

Cervicofacial Cystic Lymphangiomas and Review of the Literature: About 2 Cases at Donka National Hospital

In this retrospective study, conducted over 7 years (2009-2016) at the ENT and Head and Neck Surgery Department of the Donka National Hospital, we report 2 cases of cervicofacial cystic lymphangiomas. They were a 28-month-old girl and a 2-year-old boy. The symptomatology was noted after their birth. Dyspnea and dysphagia were found in the boy. They had a satisfactory general condition. ENT examination noted a cystic-like tumor syndrome. Imaging showed evidence of a cystic lymphangioma of the cervicofacial region. Pathological examination confirmed the diagnosis. All patients underwent exeresis cervicotomy. We found adhesion of the lymphangioma cyst to the internal jugular vein in the children. The boy presented a paralysis of the chin branch of the facial nerve after the surgery. We did not find any tumor recurrence. However, cystic cervicofacial lymphangiomas are a particular aspect of surgical pathology in children in Africa. In spite of the advent of sclerosing products, surgery remains for us the treatment of choice.

Research on the Construction of Public Management Discipline Under the Background of New Liberal Arts

Under the background of new liberal arts,the construction of public management discipline should be based on the social times,the goal of talent cultivation,and the characteristics of the discipline itself so as to meet the requirements of new liberal arts.In terms of social background,the public management discipline should not only respond to the new problems arising from the technological revolution,but also to the problems of national governance in the new era.In terms of the goal of talent cultivation,the public management discipline should not only cultivate public management professionals but also undertake the basic task of establishing virtue and cultivating talents.In terms of the characteristics of the discipline itself,the public management discipline should highlight the functional advantages of humanistic education,comprehensive discipline,and social service.

Review Article: Herbal Approach for Obesity Management

Obesity, a complex interplay between environmental and genetic factors and is associated with significant morbidity and mortality. Usage of herbs for the management of obesity in the recent times is attracting attention. A web and manual based literature survey was conducted to assess the amount of information available on the herbal products for weight management. Traditional literature, PubMed, Scopus, Google scholar databases were screened up to February 2012. The search words were “obesity', 'herbal medicine/products/extracts”, 'medicinal plants', 'traditional medicine', 'Ayurvedic medicine' without narrowing/limiting searching words or elements. Publications only with abstracts/full articles and books were reviewed in the search. Based on the available literature, for many of the herbal and weight loss products, there is little published information and there have been no clinical trials or the level of evidence is limited. Our literature survey also indicated that these herbal products fall under an acceptable level of evidence or with no scientific background at all, or they have a scientific rational but not to an acceptance level. Attempts were made in the review to define the features of possible herbal weight loss product. An ideal herbal anti obesity product should reduce the weight by 10% over placebo of treatment by showing an evidence of improvement of bio markers like blood pressure, lipids and glycemia without any side effects.

Disability management and rehabilitation for persons with multiple sclerosis

Multiple sclerosis is the commonest cause of chronic neurological disability in young adults. Patients typically have a normal life span, though with accrued time multiple disabilities with a significant impact on quality of life. This article presents the current literature on symptomatic treatment and rehabilitation for persons with multiple sclerosis. A comprehensive multidisciplinary approach addresses the acute, intermediate and long-term medical, psychological and social issues faced by these individuals. Prevention of medical complications, maintenance and restoration of functional independence, addressing psychosocial factors and issues relating to quality of life are integral to the rehabilitation processes.

Poetizing Art of Enframed Scenery

Enframed scenery was classified into 4 categories:door and window enframed scenery,railing and column enframed scenery,tree enframed scenery,cave and crack enframed scenery.Demonstration of poetizing art in such 4 categories of enframed scenery was analyzed,application of enframed scenery in modern landscape architecture was introduced,and cultural connotations of enframed scenery were further explored.

Agri-food Supply Chain Management: Literature Review

The purpose of this paper is to present a critical review of prior literature relating to agri-food supply chain management. An in-depth analysis has been carried out to identify the influential information from the literature. This paper has identified gaps to be explored about agricultural supply chain management (SCM) practices which may be used by researchers to enrich theory construction and practitioners may concentrate on establishing the extent and frontiers of agri-food SCM. This research work is the first attempt to make a critical literature review of available literature on agri-food SCM practices for developing countries like India. The research articles and other materials related to the agri-food supply chain management were collected from online data bases like Scopus, EBSCO and Google Scholar for the period of 10 years (2006-2016). The study performs content analysis and is followed by descriptive analysis. In the next phase, the literature in the field of agri-food supply chain management is classified into four broad categories viz. general literature review of agri-food supply chain, policies affecting the segments of agri-food supply chain, individual segments of agri-food SCM (structure of supply chain segments and conduct of supply chain segments) and performance of supply chain segments. These four categories are comprehensively reviewed and elaborated the research gap in the literature based on agri-food supply chain management. Finally, potato supply chain of India is considered as a case example for comprehensive analysis and elaborated in detail.

Incidence of Nephropathy in HIV Infected Patients Receiving Highly Active Antiretroviral Therapy at Newlands Clinic: A Retrospective Study

Introduction: HIV infected patients on antiretroviral therapy (ART) are at risk of developing nephropathy and therefore require monitoring of renal function. Some medications used in the management of HIV, opportunistic infections (OIs) and other comorbidities are nephrotoxic and may further compromise renal function, underlining the importance of regular monitoring of renal function. This study was designed to determine the incidence of nephropathy in HIV infected patients on antiretroviral therapy (ART) at Newlands Clinic and to determine the associated risk factors. Methodology: A retrospective cohort study was conducted involving 1986 HIV-1 infected participants who were commenced on ART between January 2007 and December 2013 at Newlands Clinic. The majority of participants were female (1340 (67.5%)). All participants were aged 18 or older at ART commencement. Participants with pre-existing nephropathy at baseline were excluded. Nephropathy was defined as two consecutive calculated creatinine clearances (CrCl) less than 60 ml/min by the Cockcroft-Gault equation, or two consecutive urine dipsticks positive for protein (≥30 g/L albumin). Data collected during routine patient visits were exported from the clinic’s database and analysed for incidence of nephropathy and risk factors. Results: During the follow-up period, 93 of the 1986 participants (4.7%) developed nephropathy. The estimated incidence rate (IR) of nephropathy was 1.45/100 person years (CI: 1.17 - 1.78). In the multivariate analysis, statistically significant risk factors were baseline age > 45 (HR 2.30, CI: 1.50 - 3.55), diabetes mellitus (HR 4.12, CI: 1.75 - 9.69), pulmonary tuberculosis (HR 2.00, CI: 1.28 - 3.12), and HIV wasting syndrome (HR 2.72, CI: 1.30 - 5.68). Conclusion: The incidence of nephropathy was low in this cohort. The traditional risk factors for renal disease;older age and diabetes mellitus were significant, as well as HIV wasting syndrome and pulmonary tuberculosis. HIV care should be complimented with proper diabetic care and patients that develop pulmonary tuberculosis, HIV wasting syndrome or are initiated on ART above 45 years require regular monitoring for early detection of nephropathy.

Exploring Students Engagement Towards the Learning Management System (LMS) Using Learning Analytics

Learning analytics is a rapidly evolving research discipline that uses theinsights generated from data analysis to support learners as well as optimize boththe learning process and environment. This paper studied students’ engagementlevel of the Learning Management System (LMS) via a learning analytics tool,student’s approach in managing their studies and possible learning analytic methods to analyze student data. Moreover, extensive systematic literature review(SLR) was employed for the selection, sorting and exclusion of articles fromdiverse renowned sources. The findings show that most of the engagement inLMS are driven by educators. Additionally, we have discussed the factors inLMS, causes of low engagement and ways of increasing engagement factorsvia the Learning Analytics approach. Nevertheless, apart from recognizing theLearning Analytics approach as being a successful method and technique for analyzing the LMS data, this research further highlighted the possibility of mergingthe learning analytics technique with the LMS engagement in every institution asbeing a direction for future research.