Systematic treatment in gastric cancer patients with overt bleeding:A propensity score matching analysis

BACKGROUND Hemorrhage,which is not a rare complication in patients with gastric cancer(GC)/gastroesophageal junction cancer(GEJC),can lead to a poor prognosis.However,no study has examined the effectiveness and safety of chemotherapy as an initial therapy for GC/GEJC patients with overt bleeding(OB).AIM To investigate the impact of OB on the survival and treatment-related adverse events(TRAEs)of GC/GEJC patients.METHODS Patients with advanced or metastatic GC/GEJC who received systematic treatment at Peking University Third Hospital were enrolled in this study.Propensity score matching(PSM)analysis was performed.RESULTS After 1:2 PSM analysis,93 patients were assessed,including 32 patients with OB before treatment(OBBT)and 61 patients without OBBT.The disease control rate was 90.6%in the group with OBBT and 88.5%in the group without OBBT,and this difference was not statistically significant.There was no difference in the incidence of TRAEs between the group with OBBT and the group without OBBT.The median overall survival(mOS)was 15.2 months for patients with OBBT and 23.7 months for those without OBBT[hazard ratio(HR)=1.101,95%confidence interval(CI):0.672-1.804,log rank P=0.701].The mOS was worse for patients with OB after treatment(OBAT)than for those without OBAT(11.4 months vs 23.7 months,HR=1.787,95%CI:1.006-3.175,log rank P=0.044).CONCLUSION The mOS for GC/GEJC patients with OBBT was similar to that for those without OBBT,but the mOS for patients with OBAT was worse than that for those without OBAT.

An Empirical Study on the Differences between Overt Translation and Covert Translation in Legal

Currently,it is key to convey precise meanings to readers for translators.Observing expressing habits between different languages is the precondition to make target texts more readable.It is crucial to ensure the exactness and seriousness of legal texts,but it does not mean that translators have to take machined way to leave out and even give up transmitting in-deep cultural implications for the intention of achieving the all-inclusive integrity of target content.It is a correct choice for translators to take overt translation and covert translation in line with traits of source language and target language and differences between civil law system and common law system.The intention of the article is to make an empirical study between overt translation and covert translation.

Natural history of covert hepatic encephalopathy: An observational study of 366 cirrhotic patients

AIM To explore the natural history of covert hepatic encephalopathy(CHE) in absence of medication intervention.METHODS Consecutive outpatient cirrhotic patients in a Chinese tertiary care hospital were enrolled and evaluated for CHE diagnosis. They were followed up for a mean of 11.2 ± 1.3 mo. Time to the first cirrhosis-related complications requiring hospitalization, including overt HE(OHE), resolution of CHE and death/transplantation, were compared between CHE and no-CHE patients. Predictors for complication(s) and death/transplantation were also analyzed.RESULTS A total of 366 patients(age: 47.2 ± 8.6 years, male: 73.0%) were enrolled. CHE was identified in 131 patients(35.8%). CHE patients had higher rates of death and incidence of complications requiring hospitalization, including OHE, compared to unimpaired patients. Moreover, 17.6% of CHE patients developed OHE, 42.0% suffered persistent CHE, and 19.8% of CHE spontaneously resolved. In CHE patients, serum albumin < 30 g/L(HR = 5.22, P = 0.03) was the sole predictor for developing OHE, and blood creatinine > 133 μmol/L(HR = 4.75, P = 0.036) predicted mortality. Child-Pugh B/C(HR = 0.084, P < 0.001) and OHE history(HR = 0.15, P = 0.014) were predictors of spontaneous resolution of CHE.CONCLUSION CHE exacerbates, persists or resolves without medication intervention in clinically stable cirrhosis. Triage of patients based on these predictors will allow for more cost-effect management of CHE.

The Dilemmas of Using Covert and Overt Participant Observation in Qualitative Research: Effects and Strategies

Participant observation is often applied in qualitative research to help researchers obtain the overall,useful data,which will lead researchers to gain the knowledge that the academia tries to.However,different levels of participant observation,mainly the covert and overt participant observation,have aroused heated discussions among scholars.Field researchers are faced with many problems when doing research,such as whether they should be a covert participant observer or an overt one;what the research will get when they are in different roles and etc.In order to solve those problems,this article tries to provide some effective methods to field researchers,especially to the new ones.This article mainly talks about two types of participant observation:covert and overt participant observation;tries to explore the issues caused by them and the strategies to help researchers deal with such issues.Finally,in qualitative research,when faced with different fieldworks,researchers should adapt themselves to choosing participant roles flexibly and appropriately.

Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding

AIM: To investigate the difference in long-term outcomes between gastric cancer patients with and without a primary symptom of overt bleeding(OB).METHODS: Consecutive patients between January 1, 2007 and March 1, 2012 were identified retrospectively by reviewing a gastric cancer database at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. A follow-up examination was performed on patients who underwent a radical gastrectomy. OB due to gastric cancer included hematemesis, melena or hematochezia, and gastric cancer was confirmed as the source of bleeding by endoscopy. Patients without OB were defined as cases with occult bleeding and those with other initial presentations, including epigastric pain, weakness, weight loss and obstruction. The 3-year overall survival(OS) rate, age, gender, AJCC T stage, AJCC N stage, overall AJCC stage, tumor size, histological type, macroscopic(Borrmann) type, lymphovascular invasion and R status were compared between patients with and without OB. Moreover, we carried out a subgroup analysis based on tumor location(upper, middle and lower).RESULTS: We identified 939 patients. Of these, 695(74.0%) were hospitalized for potential radical gastrectomy and another 244 received palliative resection, rerouting of the gastrointestinal tract, chemotherapy, radiotherapy or no treatment due to the presence of unresectable tumors. Notably, there was no significant difference in the percentage of OB patients between resectable cases and unresectable cases(20.3 % vs 22.1 %, P = 0.541). Fo l l o w- u p examination was performed on 653 patients(94%) who underwent radical gastrectomy. We found no significant difference in 3-year OS rate(68.2% vs 61.2%, P = 0.143) or clinicopathological characteristics(P > 0.05) between these patients with and without OB. Subgroup analysis based on tumor location showed that the 3-year OS rate of upper gastric cancer was significantly higher in patients with OB(84.6%) than in those without OB(48.1%, P < 0.01) and that AJCC stagesⅠ-Ⅱ(56.4% vs 35.1%, P = 0.017) and T1-T2 category tumors(30.8% vs 13%, P = 0.010) were more frequent in patients with OB than in those without OB. There was no significant difference in 3-year OS rate or clinicopathological characteristics between patients with and without OB(P > 0.05) for middle or lower gastric cancer.CONCLUSION: Upper gastric cancer patients with OB exhibited tumors at less advanced pathological stages and had a better prognosis than upper gastric cancer patients without OB.

Overt gastrointestinal bleeding because of hookworm infection

Hookworm infection is a relatively common cause of anemia in endemic areas.The most common hookworm species are Ancylostoma duodenale and Necator americanus.In this report we present a case of overt gastrointestinal bleeding Wause of hookworm infection.Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.

Comparative Study on Clinical Characteristics and Outcomes of Overt Diabetes Mellitus and Gestational Diabetes Mellitus in Late Pregnancy

Background: With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes. Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus (ODM) and gestational diabetes mellitus (GDM) at the late pregnancy. Methods: From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study. Patients were classified into two groups. 31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group. Clinical characteristics and outcomes were compared between ODM and GDM. We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use, blood pressure, clinical nutrition indexes, blood pressure. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total protein (TP), albumin (ALB), prealbumin (PALB), hemoglobin (HGB), urea nitrogen (BUN), serum creatinine (CREA), and dynamic blood glucose monitoring were measured. And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. Results: In the ODM group, HbA1c, FBG, average blood glucose, two-hour postprandial blood glucose (2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than those of GDM and two groups compared with statistical significance (P < 0.05). The number of patients treated with insulin (10/31) in ODM is significantly more than that in GDM (1/32) (P < 0.05). 45% (14/31) of ODM have a family history of diabetes patients. The ratio is significantly higher than 13% (4/32) of GDM (P < 0.05). There was significant difference in urinary ketone positive rate between the two groups (P < 0.05), but there was no significant difference in urinary microalbumin abnormal rate between them (P > 0.05). The number of preeclampsia in ODM (8/31) is significantly higher than that of GDM (P < 0.05). The level of HGB in ODM is lower than that of GDM (P < 0.05). There was no difference in the pregnancy outcomes between the two groups. Conclusion: Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner, higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher risk of preeclampsia, lower HGB level than GDM, while GDM has higher positive rate of urine ketone than ODM.

Short-term overt hypothyroidism affect on lipids after thyroxine-withdrawal in patients with differentiated thyroid carcinoma

Objective: The aim of the study was to investigate the effects of short-term overt hypothyroidism on lipids after thyroxine-withdrawal in patients with iatrogenically induced hypothyroidism before radioiodine treatment for differentiated thyroid carcinoma (DTC). Methods: Thirty patients with a history of differentiated thyroid carcinoma on thyroid-stimulating hormone (TSH)-suppressive thyroxine replacement therapy were studied. Blood sample were taken before and 4 weeks after withdrawal of thyroxine substitution. Venous blood was drawn after an overnight fast and analyzed for serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB). Fifty healthy people matched for age and gender were controls. Their blood samples were taken only once. Results: After thyroxine-withdrawal, the patients presented with increased serum TSH and low serum FT4 and FT3 levels compared with controls. Serum TG, TC, LDL, HDL, ApoB and Lp(a) increased after thyroxine withdrawal, reaching statistical significant differences with previous evaluation. However, when compared to euthyroid controls, only TC, LDL and ApoB were increased when patients were hypothyroidism. No changes were observed in ApoA1 in patients during thyroxine withdrawal, or when comparing the values observed in patients to those of euthyroid controls. Conclusion: TG, TC, LDL, HDL, ApoB and Lp(a) were increased during short-term overt hypothyroidism.

The Acquisition Phenomenon of Null and Overt Subjects in the Early Speech of Arabic-Speaking Children

This paper examines the early acquisition of null subjects and overt subjects and how they are distributed and realized in the early speech of Arabic dialect-speaking children.①The study accounts for the phenomenon of subjects by examining a longitudinal corpus of two children,Wala and Ibraheem,who were around two years old,speaking Yemeni Ibbi Arabic(YIA)dialect.The production and elicited production data collection methods were used in the study to collect the corpus during five months.The results of the study showed that null-subjects appear with a high proportion compared to the overt subjects.It was found that null subjects and overt subjects in the speech of Ibraheem and Wala had a similar distribution in the imperfective and the perfective,of which 86-87%are null subjects and 12-14%are overt subjects.The paper examined the widespread linguistic phenomenon of Null Subject Parameter acquisition,(Rizzi,1982;Hyams,1986,1989)that is emergence of null subjects in line with overt subjects.The paper supports Hyam’s(1982)argument on the acquisition of Null Subject Parameter where we can find children acquire null subjects early around 2 years of age.In contrast to non-null subject languages(like English),Null Subject Languages(NSLs)like Arabic happen to have null subjects appear more frequently and this is due to the rich inflectional morphology of NSLs.

Does Charity Need Overt Publicity?

CHEN Guangbiao,President of Jiangsu Huangpu Renewable Resources,made headlines in January 2011 when he gave out red envelopes stuffed with money to those in need in Taiwan, and again in March when he handed out cash to survivors of earthquake-stricken Yingjiang County,Yunnan Province.The posed photos of Chen along with earthquake survivors holding

Optimizing care for gastric cancer with overt bleeding:Is systemic therapy a valid option?

Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.

成人ICU患者显性误吸影响因素分析

目的探讨成人ICU患者发生显性误吸的影响因素,为识别高危人群、降低显性误吸发生率提供参考。方法选取成人ICU患者798例,利用单因素分析和logistic回归分析探讨显性误吸的影响因素。结果成人ICU患者显性误吸发生率为16.9%,机械通气、胃残余量、腹腔内压力、误吸史、呕吐是危险因素(均P<0.05)。结论成人ICU患者有发生显性误吸的风险,需重点关注机械通气、有误吸史及呕吐的患者,减少胃残余量和降低腹腔内压力,以减少显性误吸。

《山海经》名物书写的基本样式和运思机制

《山海经》之中的名物数量众多,种类繁富,是构成全书的基本骨架。其中名物的含义有显豁与隐晦之分,还有的则介于二者之间。造成含义隐晦的原因,是名物所用词语往往取其原始本义、特殊义,而不是常见用法;还有的文字属于多音、多义词。名物指称对象有的是一种物,有的则是一个类别,后者运用的是综合思维。《山海经》以各个条目为相对独立的结构单元,各条目之间不存在意义的直接关联,呈现的是间断性。而在条目内部出现的名物,往往存在意义上的关联,是以条目标题名物所承载的理念统辖其他名物,连续出现的名物呈链状或网状。中国古代神话的片断性特征,很大程度上是由这种书写方式造成的。

基于“隐性-韧性-显性”的技能人才协同发展理论构建研究

技能人才协同发展是实现职业教育一体化、技能人才高质量发展的必然要求。引入“隐性—韧性—显性”的研究新视角,以技能人才规划协同实施带动、市场协同共建推进和开发协同共治驱动为内生保障机制,以城市—产业—技能人才融合互动、技能人才发展治理制度体系健全完善、资源培育整合提升和服务质量优化改善为运行调控条件,以技能人才服务与保障供给体系建设能力有效改善、开发效益持续增强、培育结构不断优化、发展治理效能显著提升为外部支持系统,构建基于“隐性—韧性—显性”的技能人才协同发展的理论框架,为其整体性研究提供理论支撑与分析路径。

航空犯罪的共谋犯研究

2010年通过的《北京公约》和《北京议定书》新增了共谋实施国际航空犯罪的规定。在英美刑法中,共谋罪是一项独立的罪名,对共谋实施航空犯罪的行为予以处罚。德国《刑法典》中的“重罪约定”和日本刑法中的“共谋罪”也均适用于共谋实施航空犯罪的情形。在英美和德日刑法理论中,共谋罪处罚的依据都是复数主体协议实施犯罪的危险性。在我国刑法理论中,共谋被认为是一种非物质性预备行为,属于制造犯罪条件的行为。我国刑法并没有将犯罪协议明确规定为一种犯罪预备的行为方式,建议最高司法机关将“共谋行为”解释为犯罪预备中的“制造条件”行为,并将共谋犯的适用范围限定为法定刑三年以上有期徒刑的严重犯罪。

法家治国的主要方式、路径转变及现代启示

法、术、势是法家治国的主要方式。法、术、势三种方式的综合运用,标志着一种有别于“礼治”的新型“法治”治国模式的生成,体现着古代君主治国方式从阴谋到阳谋的转变,具体而言,就是法从秘密的“刑不可知、威不可测”迈向公开的“布之于百姓”;术从驾驭群臣的诡诈手段变为选任考核官员的公开之举;势从非人力所控的“自然之势”转向“抱法处势”的“人设之势”。法家法、术、势思想构建起一种公开透明的“阳谋”治理方式,为今天全面推进依法治国提供了文化传承与价值支撑。

OVERT MANIFESTATIONS OF CONSCIOUSNESS OF TARGET LANGUAGE FORMS IN OUTPUT PROCESSING

Ever since Schmidt proposed the noticing hypothesis in 1990, the role of consciousness in second language input and output processing has attracted increasing attention from various researchers. In many studies, whether or not consciousness is used is deemed as an important factor leading to changes in language learners performance. Current research procedures on measuring consciousness in second language acquisition field are not very satisfactory. The present study, by making use of Levelt s L1 speech pr...

妊娠期显性糖尿病与不良妊娠结局的研究

目的:探讨妊娠期显性糖尿病(ODM)孕妇不良妊娠结局。方法:回顾性分析北京大学国际医院分娩的孕妇1321例,分为血糖正常(NGDM)组、妊娠期糖尿病(GDM)组和ODM组,比较母体和新生儿不良结局。结果:ODM组妇女年龄、妊娠早期糖化血红蛋白、尿酸、甘油三酯、妊娠晚期糖化血红蛋白水平显著高于NGDM组,差异有统计学意义(P<0.01)。ODM组发生妊娠期高血压(OR 6.32,P<0.01)、剖宫产(OR 1.87,P<0.05)、早产(OR 2.73,P<0.05)、巨大儿(OR 3.45,P<0.01)风险显著高于NGDM组。与GDM相比,ODM组未增加妊娠期高血压、子痫或子痫前期、肩难产、胎盘早破、剖宫产、早产、巨大儿、低体质量儿的发生风险(P>0.05)。结论:ODM增加妊娠期高血压、剖宫产、新生儿早产和巨大儿的发生风险,需要积极对ODM妇女进行管理。

年龄联合白蛋白-胆红素评分对经颈静脉肝内门体分流术后显性肝性脑病的预测价值

目的探讨年龄联合白蛋白-胆红素(ALBI)评分对肝硬化伴食管胃底静脉曲张破裂出血(EGVB)患者经颈静脉肝内门体分流术(TIPS)治疗后显性肝性脑病(OHE)的预测价值。方法回顾性分析87例接受TIPS治疗的肝硬化伴EGVB患者的临床资料,术后随访6个月,根据是否发生OHE将患者分为OHE组27例和非OHE组60例。通过单因素分析筛选出2组间差异有统计学意义的指标,对其进行二元Logistic回归分析,明确OHE发生的独立影响因素。绘制受试者工作特征(ROC)曲线,评估各独立影响因素单独及联合预测OHE的效能,应用MedCalc软件比较不同曲线下面积(AUC)的差异。结果87例患者中,27例患者术后6个月内发生OHE,发病率为31.03%。单因素分析结果显示,OHE组年龄、白蛋白、血钠、ALBI评分与非OHE组比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,年龄(OR=1.08,95%CI:1.02~1.14,P=0.01)、ALBI评分(OR=13.68,95%CI:3.00~62.44,P<0.01)均为肝硬化伴EGVB患者TIPS治疗后发生OHE的独立影响因素。ROC曲线分析结果显示,年龄、ALBI评分预测OHE的AUC分别为0.67(95%CI:0.55~0.79,P=0.01)、0.72(95%CI:0.60~0.85,P<0.01);年龄联合ALBI评分预测OHE的AUC为0.80(95%CI:0.70~0.91,P<0.01),敏感度为77.8%,特异度为75.0%。年龄、ALBI评分单独预测的AUC比较,差异无统计学意义(P>0.05);年龄联合ALBI评分预测的AUC大于年龄、ALBI评分单独预测的AUC,差异有统计学意义(P<0.05)。结论年龄、ALBI评分为肝硬化伴EGVB患者TIPS治疗后发生OHE的独立影响因素,两者联用对OHE具有较高的预测效能。

深度翻译的分类再思考

目前学界尚未就深度翻译的分类达成共识。本研究在厘清深度翻译的内涵与外延的基础上,从形式和内容两个维度,提出4种分类标准,对其进行重新分类:依据分布位置,深度翻译可分为译本内和译本外两类,译本内又分为译文内和译文外两类,译文内又分为句内和句外两类;依据呈现方式,可分为隐性和显性两类;依据内容性质,可分为语义和文化两类;依据内容来源,可分为导引和评价两类。精细化分类对深入理解深度翻译概念的实质、拓宽深度翻译的研究视野具有一定的理论参考价值。