Ibrutinib and atrial fibrillation:An in-depth review of clinical implications and management strategies

Ibrutinib,a targeted therapy for B-cell malignancies,has shown remarkable efficacy in treating various hematologic cancers.However,its clinical use has raised concerns regarding cardiovascular complications,notably atrial fibrillation(AF).This comprehensive review critically evaluates the association between ibrutinib and AF by examining incidence,risk factors,mechanistic links,and management strategies.Through an extensive analysis of original research articles,this review elucidates the complex interplay between ibrutinib’s therapeutic benefits and cardiovascular risks.Moreover,it highlights the need for personalized treatment approaches,vigilant monitoring,and interdisciplinary collaboration to optimize patient outcomes and safety in the context of ibrutinib therapy.The review provides a valuable resource for healthcare professionals aiming to navigate the intricacies of ibrutinib’s therapeutic landscape while prioritizing patient well-being.

Expansion and Management Implications of Invasive Alien Spartina alterniflora in Yancheng Salt Marshes, China

Improved understanding of the spatial dynamics of invasive plant species is critical for effective land management and control of future invasion. The Yancheng National Nature Reserve (YNNR), an internationally important wetland, has the largest distribution of alien Spartina alterniflora in China. This alien plant was intentionally introduced for erosion prevention and dike protection in China. However, it became an aggressive competitor with native salt marsh plants in the coastal regions in China. High resolution imagery, SPOT-5, was used to map plant communities including invasive species in the south core zone of YNNR with the natural ecosystem of salt marshes in 2003, 2005 and 2008. The fuzzy set assessment method significantly improved the classification accuracies over the conventional error matrix, i.e., from 73.8%, 73.5% and 81.4% to 91.5%, 91.6% and 93.4% in 2003, 2005 and 2008, respectively. It shows a great potential for mapping invasive plant species. Phragmites australis and S. alterniflora were the most accurately mapped classes, and sparse and dense Suaeda glauca were the least accurately mapped. From 2003 to 2008, S. alterniflora increased 28.8% from 1664.1 to 2142.6 ha in area size, and more than 2.5 times from 742 to 2608 patches. The highest increase in patch number occurred within the interval between 2001 and 3000 m from the eastern baseline. This increase was dominated by small patches with area less than 200 m2. During the study period, the mean spread width was 405 ± 80.7 m in the original large patch of area over 200 ha. The eastward/seaward spread was distinctively larger than the westward/landward. The results enhance the understanding of alien plant’s invasion patterns and help improve conservation efforts.

Preoperative Laboratory Testing by Surgeons: Implication on Anaesthetic Management

Background: Request for preoperative laboratory investigations is usually done by surgeons. On some occasions, the patient may come with laboratory investigations that have been requested by the primary physician. This occurs in situations where the primary physician saw the patient first and referred to the surgeon. There is usually no indications based on history or physical examination before these laboratory request is done but rather on speculations that the “anaesthetist may require them”. This is done in order to avoid cancellation or delay of cases. The aim of this study was to find out how tests ordered in Komfo Anokye Teaching Hospital (K.A.T.H.) by the surgeons affected the decisions of the anaesthetists in the perioperative management of the patients. Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K.A.T.H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. A close and open-ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Abnormal test results did not influence the anaesthetic management in 70.5% of cases but led to either delay or cancelation of cases or requirement for transfusion of blood or blood products in 29.5% of cases. Conclusion: Preoperative laboratory tests ordered by Surgeons in KomfoAnokye Teaching Hospital do not significantly influence the anaesthetic managements of patients.

Recreational Attractiveness of Urban Parks and Implications for Their Management:A Case Study in Changchun,China

Urban parks are an important part of urban ecosystems and also provide recreational services for urban residents.However,it is still unclear how the recreational attractiveness of urban parks can be evaluated.In this study,12 typical parks in Changchun,China were selected for evaluation of their recreational attractiveness.We built a recreational attractiveness evaluation system based on the analytical hierarchy process(AHP)to produce a composite evaluation index.This method included:1)the landscape quality of the parks;2)the recreational facilities;3)the conditions of the area;and 4)the accessibility of the parks.Our results showed that Nanhu Park,Children’s Park,Shengli Park,and Jingyuetan Forest Park had high recreational attractiveness,whereas Linyuan Park had the lowest attractiveness among the 12 parks.These results agreed with the information obtained from a field survey of the actual recreational and revisit rates,which showed that the evaluation index is reliable.Correlation analysis showed that the landscape quality and recreational facilities of parks had a direct effect on their recreational attractiveness.A negative correlation was found between the accessibility of a park and its recreational attractiveness.We conclude that if the scenery and facilities are not as good as a visitor expects,then they may choose to visit a different park,even if it takes a longer time to reach.

Political Implications of Emergency Management

This paper will review three broad types of political implications of emergency management, since historically emergency management was considered only a function of law enforcement and fire departments, with the support in the event of a major catastrophe from public health and civil defense organizations. The issue is not whether governments will be required to respond to emergencies but rather when and how frequently. The time to think about emergencies is before they happen. Despite some significant weakness in the overall approach, political implications offer many benefits and provide various options for CDCs （community development corporations） to get involved in disaster recovery and emergency management. Based upon a generally positive evaluation, the paper concludes that emergency management must become a central activity, whether at the federal, state, or local or as an intergovernmental activity. Hopefully for the future the government does not have to wait for a disaster to strike for one to put a policy into place, since they have had several to occur over decades. The government should be ready to take on any disaster if it occurs with the following policies and procedures that are in place.

Common eye drops and their implications for p H measurements in the management of chemical eye injuries

Dear Sir,Eye drops(single use)commonly used in clinics do have varying pH values.The use of such drops in the initial management of chemical eye injury may influence the accuracy of pH measurement of the eye,and subsequently influence its management.Chemical eye injury is an ophthalmic emergency,which may be caused by exposure to an acidic(pH【4)or an alkali(pH】10)solution to the eye.Rinsing the eye decreases the concentration of these solutions on ocular surface.The initial management would be copious irrigation with clean or sterile water or Ringer’s solution(pH 7.3-7.4)or its equivalent,of a

Introduction of PIC/S Accession Procedure and Suggestions for Establishing a Unified Quality Management System in China

Objective To introduce the accession procedure and evaluation of PIC/S,and help relevant departments in China to understand the requirements of PIC/S in detail,and to promote the process of China’s entry into PIC/S.Methods The procedures and steps of joining PIC/S,the evaluation process of PIC/S,and the experience of several countries in joining PIC/S were introduced and analyzed,which could help the relevant personnel in China understand the specific contents.Results and Conclusion According to the requirements of PIC/S,it is necessary to establish a unified GMP quality management system.

Managing Variation and Resolving the Trade-off Implications of Global Supply

The reduction of wasteful variation within the supp ly chain is naturally suited to high and stable volumes, as epitomised in the lean practices of the automotive industry. However, with the growth of innovative pr oducts, typically characterised by lower volumes and uncertain demand, it is als o important to develop strategies to effectively manage the externally imposed v ariation resulting from volatile market demand. Such strategies often come under the banner of quick response or agile supply. System variation is the common denominator, for whereas lean strategies emphasis e the need for stability and the reduction of wasteful supply chain variation, a gile emphasises the need to respond to externally imposed demand variation. Simi larly, lean supply is closely associated with level scheduling and investing in inventory to decouple demand variation from the supply chain, whereas, agile sup ply is associated with investing in responsive capacity as inventory requirement s cannot be effectively predicted. This distinction between lean and agile supply, highlights a trade-off between investing in responsive capacity and decoupling inventory, which is closely related to the conflicting manufacturing tasks of fast response and low cost. The implications of this conflict have been more widely felt in recent years, as companies have opted to outsource manufacture to low cost overseas suppliers. T he rationale is to reduce manufacturing costs, but the trade-off is a dramatic loss of responsive capacity with higher dependency on decoupling inventory. As with lean and agile supply, the trade-off implications of such choices need to be acknowledged, conceptually understood and then separate out or otherwise r esolved. This paper introduces the business need before exploring the significance of var iation and the concept of managing variation in a delivery system using responsi ve capacity and decoupling inventory. These concepts will then be used to unpack the lean and agile paradigms before applying the thinking to a more detailed in dustrial case concerning offshore supply decisions. The paper concludes with som e reflections.

基于C/S架构和物联网技术的可移动医疗设备共享调配系统的设计与应用

目的 设计一个可移动医疗设备高效管理与临床科室共享调配相结合的医疗设备共享管理平台,实现可移动医疗设备使用的全过程管理。方法 基于C/S架构,利用物联网技术优化整合现有医疗设备大数据资源,结合医院需求,构建可移动医疗设备共享调配系统,实现医疗设备共享管理、预约借用、统计分析等核心功能。通过比较系统上线前后呼吸机调配次数、平均调配时间、呼吸机使用率、单台呼吸机日均收入4个指标,分析系统应用效果。结果 系统上线后,呼吸机调配次数明显增加、平均调配时间明显降低,呼吸机使用率、单台呼吸机日均收入明显升高,且差异均有统计学意义(P﹤0.05),表明系统对提高呼吸机调配效率与使用效率有促进作用。结论 可移动医疗设备共享调配系统优化了医院设备管理流程,实现了医疗资源的统一调配,有效满足临床紧急抢救时医疗设备调配使用的相关需求,提高了医疗设备周转率以及设备管理人员的工作效率,有助于医院节约人员成本、降低采购费用,为医院管理者制定相关决策提供数据支撑。

基于B/S的高校实验室预约管理系统设计与实现

为了实现实验室管理信息化,更好地为师生服务,文章设计并开发一套高校实验室预约管理系统。该系统是基于B/S结构,采用Vue视图框架、Nginx服务器及MySQL数据库构建而成的;支持专业实验室、教室和会议室的预约管理;入口对接华中科技大学统一身份认证系统,在校师生可直接使用已有的统一身份认证系统账号密码登录系统。用户可通过浏览器完成在线预约、预约查询、预约管理和数据统计等功能。该系统的应用提高了实验室管理的规范性和信息化程度。

基于三层B/S架构的企业信息化管理系统的设计

为解决企业管理系统中存在的数据冗余、不一致、数据同步效率低等问题,文章通过引入三层浏览器/服务器(B/S)架构模式,实现了对企业信息化管理系统的研究。该系统的设计主要包含数据库设计、系统管理、生产管理、统计报表等主要功能模块的设计。系统由浏览器向服务器发送请求,服务器接收请求并处理,然后将结果返回给浏览器。系统采用了MVC设计模式,将数据层、业务层和表示层分离开来,提高了可维护性、可扩展性和可重用性。该系统的应用不仅达到了数据远程共享的目的,还实现了对现骨干数据及报表的查询功能,可充分满足企业的信息化管理需求。

Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment

Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dys-plasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.

A Qualitative Appraisal of China’s Efforts in Fishing Capacity Management

This paper provides a critical review of some major efforts made by China to manage the fishing capacity of its marine capture fisheries. It begins by reviewing the key concepts and issues closely related to fishing capacity management. Following on this, a brief introduction to China’s marine capture fisheries is offered, especially the trends of its marine landings and marine fishing fleets and the status of fish stocks in waters under its jurisdiction. Next comes the main concern of the paper, i.e., some major actions recently initiated by China to deal with the overcapacity problem confronting it. The paper ends with conclusions and suggestions.

Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease

Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.

Management strategies of Barrett's esophagus

Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.

Application of Delayed Surgical Managements in Patients with Stensen＇s Duct Injury

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with l- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen＇s duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Pharmacological management of behavioral symptoms associated with dementia

Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administration-approved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used off-label. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations.

Determination of the Neoproterozoic Shicaogou Syn-collisional Granite in the Eastern Qinling Mountains and Its Geological Implications

The Shicaogou granite has been identified as a magnesian (Fe-number=0.71-0.76), calcic to calc-alkalic (MALI=3.84-5.76) and peraluminous (ASI=1.06-1.13) granite of the syn-collisional S-type, with high SiO2(>71%), A12O3 (>13%) and Na2O+K2O (6.28%-7.33%, equal for NaO2 and K2O). Trace element and REE analyses show that the granite is rich in LILE such as of Rb, Sr, Ba and Th, and poor in HFSE like Yb, Y, Zr and Hf. Its Rb/Sr ratio is greater than 1; the contents of Nb and Ta, and the ratio of Nb/Ta as well as the REE geochemical features (e.g. REE abundance, visible fractionation of LREE and HREE and medium to pronounced negative Eu anomalies) are all similar to those of crust-origin, continent-continent syn-collisional granite. Moreover, the granite exhibits almost the same pattern as that of the typical continent-continent syn-collisional granite on the spider diagram and all samples fall within the syn-collisional granite field.The cathodoluminescence (CL) investigations have revealed that the zircon from the Shicaogou granite represents a typical magmatic product characterized by its colorless, transparent and euhedral crystals, and distinct zoning of oscillatory bands. Residual cores of irregular zircon can be found in a few enhedral grains. Trace element studies of the zircon grains, with high contents of P, Y, Hf, Th, U and REE and high ratios of Th/U, obviously positive Ce anomalies and HREE enrichment compared to LREE, also result in the same conclusion.The LA-ICP-MS U-Pb isotopic data from 24 spots of 21 zircon grains demonstrate that 20 spots in the oscillatory zone yield an average weighted 206Pb/238U age of 925±11 Ma, indicating that the Shicaogou granite was formed in the Neoproterozoic. Combined with other Neoproterozoic syn-collisional granites found in the study area, the present geochronological determination can further reveal that collision-amalgamation events could have occurred among some continental blocks in the Qinling orogenic belt during the Neoproterozoic. This in turn provides an accurate chronological constraint on the Neoproterozoic break-up and convergence in the belt.

Cholinergic input from the pedunculopontine nucleus to the cerebellum: implications for deep brain stimulation in Parkinson's disease

Deep brain stimulation（DBS）is a well established electrophysiological treatment initially applied to treat medication-refractory motor symptoms in Parkinson＇s disease（PD）,and is now being explored for several neurological and psychiatric disorders.The specific physiological mechanisms underlying the effectiveness of DBS are not fully understood.

Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic:A case report

BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.