Performance-based warranties(PBWs)are widely used in industry and manufacturing.Given that PBW can impose financial burdens on manufacturers,rational maintenance decisions are essential for expanding profit margins.Th...Performance-based warranties(PBWs)are widely used in industry and manufacturing.Given that PBW can impose financial burdens on manufacturers,rational maintenance decisions are essential for expanding profit margins.This paper proposes an optimization model for PBW decisions for systems affected by Gamma degradation processes,incorporating periodic inspection.A system performance degradation model is established.Preventive maintenance probability and corrective renewal probability models are developed to calculate expected warranty costs and system availability.A benefits function,which includes incentives,is constructed to optimize the initial and subsequent inspection intervals and preventive maintenance thresholds,thereby maximizing warranty profit.An improved sparrow search algorithm is developed to optimize the model,with a case study on large steam turbine rotor shafts.The results suggest the optimal PBW strategy involves an initial inspection interval of approximately 20 months,with subsequent intervals of about four months,and a preventive maintenance threshold of approximately 37.39 mm wear.When compared to common cost-minimization-based condition maintenance strategies and PBW strategies that do not differentiate between initial and subsequent inspection intervals,the proposed PBW strategy increases the manufacturer’s profit by 1%and 18%,respectively.Sensitivity analyses provide managerial recommendations for PBW implementation.The PBW strategy proposed in this study significantly increases manufacturers’profits by optimizing inspection intervals and preventive maintenance thresholds,and manufacturers should focus on technological improvement in preventive maintenance and cost control to further enhance earnings.展开更多
Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes an...BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes and patients’quality of life.Although the adoption of laparoscopy has lowered their incidence,PPCs remain a frequent and serious concern after hepatobiliary surgery.Existing research on risk factors specific to hepatobiliary surgeries is limited,particularly regarding the epidemiology and risk factors of PPCs in liver and gallbladder surgeries in China.Therefore,this study aimed to investigate the risk factors for PPCs in a large hepatobiliary center.AIM To identify the incidence and risk factors for PPCs following hepatobiliary surgery based on perioperative variables.METHODS Retrospective data were collected from patients who underwent liver,gallbladder,or pancreatic surgery at a hepatobiliary center in China between May 2023 and December 2023.We retrospectively reviewed comprehensive medical records to extract demographic and hospital admission information for determining PPC incidence.Statistically significant variables were initially screened through univariate analysis,followed by binary logistic regression modeling to identify independent predictors of PPCs.Hospitalization expenditures and duration of stay were further contrasted across the study cohorts.RESULTS This study included 1941 patients who underwent liver,gallbladder,or pancreatic surgery,of whom 78 developed PPCs,resulting in an incidence rate of 4.02%.Logistic regression analysis revealed two independent predictors of PPCs in hepatobiliary surgery patients:Age≥75 year(odds ratio=8.350,95%CI:3.521-19.798,P<0.001)and prolonged anesthesia(odds ratio=1.052,95%CI:1.015-1.091,P=0.006).Patients with PPCs had significantly elevated healthcare resource utilization,including higher total hospitalization costs,increased medication expenses,longer hospital stays,and extended postoperative admissions(all P<0.001).CONCLUSION Age≥75 years and prolonged anesthesia emerged as independent predictors of PPCs following hepatobiliary surgery.These complications were correlated with protracted hospitalization and increased healthcare costs.展开更多
Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. ...Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.展开更多
Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive p...Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.展开更多
This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify...This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.展开更多
Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG)...Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG) targets. In Kenya, as the 2030 SDG deadline approaches, the gap in maternal, neonatal, and child health services remains significant. Addressing these challenges is critical to improving Maternal, Neonatal, and Child Health (MNCH) outcomes. Objective: This study explores how integration of digital health innovations into the MNCH chain of service delivery affects the quality of MNCH care within the selected PHC settings in Kajiado, Kisii and Migori Counties in Kenya. Methodology: This Quasi-experimental study was conducted 1-year post-intervention targeting a total of 482 pregnant women from intervention and control sites in Kisii, Kajiado and Migori Counties, Kenya. Data was analysed using Chi-Square test comparing frequencies between intervention and control groups when both variables are categorical. Results: Pre-intervention data revealed an increase in first ANC coverage within first trimester, from 167 to 278 post-intervention (p Linda mama social health insurance registrations increased from 1008 to 1135. At the intervention sites, 938 pregnant women got screened by midwives using portable mobile Obstetric Point-of-Care Ultrasound (OPOCUS) technology compared to the 27 cases that accessed ultrasound services in the noncontiguous control sites. The pilot sites midwives earned themselves an incentive income totaling Ksh 400,000 while the Community Health Promoters (CHPs) who created demand for OPOCUS earned an incentive income totaling Ksh 327,195 from their IGAs that were project supported. There was a significant increase in mobile health application usage and e-resources access for health information in the intervention group (p services and improved adherence to referrals. Conclusion: The success of digital health interventions in improving health-seeking behaviour, knowledge, and service uptake highlights the potential of such innovations to strengthen health systems and achieve universal health coverage. We recommend the intervention for a scale-up in other PHC settings in Kenya.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing...Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.展开更多
Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic...Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.展开更多
Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur si...Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.展开更多
BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development...BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.展开更多
In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA ...In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.展开更多
This paper presents a performance-based methodology for the assessment of seismic vulnerability and capacity of buildings. The vulnerability assessment methodology is based on the HAZUS methodology and the improved ca...This paper presents a performance-based methodology for the assessment of seismic vulnerability and capacity of buildings. The vulnerability assessment methodology is based on the HAZUS methodology and the improved capacity- demand-diagram method. The spectral displacement (Sd) of performance points on a capacity curve is used to estimate the damage level of a building. The relationship between Sd and peak ground acceleration (PGA) is established, and then a new vulnerability function is expressed in terms of PGA. Furthermore, the expected value of the seismic capacity index (SCev) is provided to estimate the seismic capacity of buildings based on the probability distribution of damage levels and the corresponding seismic capacity index. The results indicate that the proposed vulnerability methodology is able to assess seismic damage of a large number of building stock directly and quickly following an earthquake. The SCev provides an effective index to measure the seismic capacity of buildings and illustrate the relationship between the seismic capacity of buildings and seismic action. The estimated result is compared with damage surveys of the cities of Dujiangyan and Jiangyou in the M8.0 Wenchuan earthquake, revealing that the methodology is acceptable for seismic risk assessment and decision making. The primary reasons for discrepancies between the estimated results and the damage surveys are discussed.展开更多
With the development and implementation of performance-based earthquake engineering,harmonization of performance levels between structural and nonstructural components becomes vital. Even if the structural components ...With the development and implementation of performance-based earthquake engineering,harmonization of performance levels between structural and nonstructural components becomes vital. Even if the structural components of a building achieve a continuous or immediate occupancy performance level after a seismic event,failure of architectural,mechanical or electrical components can lower the performance level of the entire building system. This reduction in performance caused by the vulnerability of nonstructural components has been observed during recent earthquakes worldwide. Moreover,nonstructural damage has limited the functionality of critical facilities,such as hospitals,following major seismic events. The investment in nonstructural components and building contents is far greater than that of structural components and framing. Therefore,it is not surprising that in many past earthquakes,losses from damage to nonstructural components have exceeded losses from structural damage. Furthermore,the failure of nonstructural components can become a safety hazard or can hamper the safe movement of occupants evacuating buildings,or of rescue workers entering buildings. In comparison to structural components and systems,there is relatively limited information on the seismic design of nonstructural components. Basic research work in this area has been sparse,and the available codes and guidelines are usually,for the most part,based on past experiences,engineering judgment and intuition,rather than on objective experimental and analytical results. Often,design engineers are forced to start almost from square one after each earthquake event: to observe what went wrong and to try to prevent repetitions. This is a consequence of the empirical nature of current seismic regulations and guidelines for nonstructural components. This review paper summarizes current knowledge on the seismic design and analysis of nonstructural building components,identifying major knowledge gaps that will need to be filled by future research. Furthermore,considering recent trends in earthquake engineering,the paper explores how performance-based seismic design might be conceived for nonstructural components,drawing on recent developments made in the field of seismic design and hinting at the specific considerations required for nonstructural components.展开更多
Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate,...Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.展开更多
In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the mai...In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the main procedures for setting up an EOP course for nurses in Beijing.展开更多
基金supported by the National Natural Science Foundation of China(71871219).
文摘Performance-based warranties(PBWs)are widely used in industry and manufacturing.Given that PBW can impose financial burdens on manufacturers,rational maintenance decisions are essential for expanding profit margins.This paper proposes an optimization model for PBW decisions for systems affected by Gamma degradation processes,incorporating periodic inspection.A system performance degradation model is established.Preventive maintenance probability and corrective renewal probability models are developed to calculate expected warranty costs and system availability.A benefits function,which includes incentives,is constructed to optimize the initial and subsequent inspection intervals and preventive maintenance thresholds,thereby maximizing warranty profit.An improved sparrow search algorithm is developed to optimize the model,with a case study on large steam turbine rotor shafts.The results suggest the optimal PBW strategy involves an initial inspection interval of approximately 20 months,with subsequent intervals of about four months,and a preventive maintenance threshold of approximately 37.39 mm wear.When compared to common cost-minimization-based condition maintenance strategies and PBW strategies that do not differentiate between initial and subsequent inspection intervals,the proposed PBW strategy increases the manufacturer’s profit by 1%and 18%,respectively.Sensitivity analyses provide managerial recommendations for PBW implementation.The PBW strategy proposed in this study significantly increases manufacturers’profits by optimizing inspection intervals and preventive maintenance thresholds,and manufacturers should focus on technological improvement in preventive maintenance and cost control to further enhance earnings.
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金Supported by the Beijing Tsinghua Changgung Hospital Fund,China,No.12023C01005.
文摘BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes and patients’quality of life.Although the adoption of laparoscopy has lowered their incidence,PPCs remain a frequent and serious concern after hepatobiliary surgery.Existing research on risk factors specific to hepatobiliary surgeries is limited,particularly regarding the epidemiology and risk factors of PPCs in liver and gallbladder surgeries in China.Therefore,this study aimed to investigate the risk factors for PPCs in a large hepatobiliary center.AIM To identify the incidence and risk factors for PPCs following hepatobiliary surgery based on perioperative variables.METHODS Retrospective data were collected from patients who underwent liver,gallbladder,or pancreatic surgery at a hepatobiliary center in China between May 2023 and December 2023.We retrospectively reviewed comprehensive medical records to extract demographic and hospital admission information for determining PPC incidence.Statistically significant variables were initially screened through univariate analysis,followed by binary logistic regression modeling to identify independent predictors of PPCs.Hospitalization expenditures and duration of stay were further contrasted across the study cohorts.RESULTS This study included 1941 patients who underwent liver,gallbladder,or pancreatic surgery,of whom 78 developed PPCs,resulting in an incidence rate of 4.02%.Logistic regression analysis revealed two independent predictors of PPCs in hepatobiliary surgery patients:Age≥75 year(odds ratio=8.350,95%CI:3.521-19.798,P<0.001)and prolonged anesthesia(odds ratio=1.052,95%CI:1.015-1.091,P=0.006).Patients with PPCs had significantly elevated healthcare resource utilization,including higher total hospitalization costs,increased medication expenses,longer hospital stays,and extended postoperative admissions(all P<0.001).CONCLUSION Age≥75 years and prolonged anesthesia emerged as independent predictors of PPCs following hepatobiliary surgery.These complications were correlated with protracted hospitalization and increased healthcare costs.
文摘Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.
文摘Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.
文摘This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.
文摘Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG) targets. In Kenya, as the 2030 SDG deadline approaches, the gap in maternal, neonatal, and child health services remains significant. Addressing these challenges is critical to improving Maternal, Neonatal, and Child Health (MNCH) outcomes. Objective: This study explores how integration of digital health innovations into the MNCH chain of service delivery affects the quality of MNCH care within the selected PHC settings in Kajiado, Kisii and Migori Counties in Kenya. Methodology: This Quasi-experimental study was conducted 1-year post-intervention targeting a total of 482 pregnant women from intervention and control sites in Kisii, Kajiado and Migori Counties, Kenya. Data was analysed using Chi-Square test comparing frequencies between intervention and control groups when both variables are categorical. Results: Pre-intervention data revealed an increase in first ANC coverage within first trimester, from 167 to 278 post-intervention (p Linda mama social health insurance registrations increased from 1008 to 1135. At the intervention sites, 938 pregnant women got screened by midwives using portable mobile Obstetric Point-of-Care Ultrasound (OPOCUS) technology compared to the 27 cases that accessed ultrasound services in the noncontiguous control sites. The pilot sites midwives earned themselves an incentive income totaling Ksh 400,000 while the Community Health Promoters (CHPs) who created demand for OPOCUS earned an incentive income totaling Ksh 327,195 from their IGAs that were project supported. There was a significant increase in mobile health application usage and e-resources access for health information in the intervention group (p services and improved adherence to referrals. Conclusion: The success of digital health interventions in improving health-seeking behaviour, knowledge, and service uptake highlights the potential of such innovations to strengthen health systems and achieve universal health coverage. We recommend the intervention for a scale-up in other PHC settings in Kenya.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
文摘Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.
文摘Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.
文摘Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.
基金Supported by 2023 Key R&D Projects of Tongji University,No.150029607160-24323Industrial Key Program Foundation of Guangdong Province:R&D of Natural Novel Anticancer Drugs,No.2004B10401033。
文摘BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.
基金supported by the Russian Science Foundation,Russia(Grant No.24-24-00031).
文摘In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.
基金National Natural Science Foundation of China Under Grant No.50908216Postdoctoral Science Foundation of China Under Grant No.20070420878
文摘This paper presents a performance-based methodology for the assessment of seismic vulnerability and capacity of buildings. The vulnerability assessment methodology is based on the HAZUS methodology and the improved capacity- demand-diagram method. The spectral displacement (Sd) of performance points on a capacity curve is used to estimate the damage level of a building. The relationship between Sd and peak ground acceleration (PGA) is established, and then a new vulnerability function is expressed in terms of PGA. Furthermore, the expected value of the seismic capacity index (SCev) is provided to estimate the seismic capacity of buildings based on the probability distribution of damage levels and the corresponding seismic capacity index. The results indicate that the proposed vulnerability methodology is able to assess seismic damage of a large number of building stock directly and quickly following an earthquake. The SCev provides an effective index to measure the seismic capacity of buildings and illustrate the relationship between the seismic capacity of buildings and seismic action. The estimated result is compared with damage surveys of the cities of Dujiangyan and Jiangyou in the M8.0 Wenchuan earthquake, revealing that the methodology is acceptable for seismic risk assessment and decision making. The primary reasons for discrepancies between the estimated results and the damage surveys are discussed.
文摘With the development and implementation of performance-based earthquake engineering,harmonization of performance levels between structural and nonstructural components becomes vital. Even if the structural components of a building achieve a continuous or immediate occupancy performance level after a seismic event,failure of architectural,mechanical or electrical components can lower the performance level of the entire building system. This reduction in performance caused by the vulnerability of nonstructural components has been observed during recent earthquakes worldwide. Moreover,nonstructural damage has limited the functionality of critical facilities,such as hospitals,following major seismic events. The investment in nonstructural components and building contents is far greater than that of structural components and framing. Therefore,it is not surprising that in many past earthquakes,losses from damage to nonstructural components have exceeded losses from structural damage. Furthermore,the failure of nonstructural components can become a safety hazard or can hamper the safe movement of occupants evacuating buildings,or of rescue workers entering buildings. In comparison to structural components and systems,there is relatively limited information on the seismic design of nonstructural components. Basic research work in this area has been sparse,and the available codes and guidelines are usually,for the most part,based on past experiences,engineering judgment and intuition,rather than on objective experimental and analytical results. Often,design engineers are forced to start almost from square one after each earthquake event: to observe what went wrong and to try to prevent repetitions. This is a consequence of the empirical nature of current seismic regulations and guidelines for nonstructural components. This review paper summarizes current knowledge on the seismic design and analysis of nonstructural building components,identifying major knowledge gaps that will need to be filled by future research. Furthermore,considering recent trends in earthquake engineering,the paper explores how performance-based seismic design might be conceived for nonstructural components,drawing on recent developments made in the field of seismic design and hinting at the specific considerations required for nonstructural components.
文摘Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.
文摘In order to promote efficient communication between nurses in Beijing hospitals and foreign patients, EOP (English for Occupational Purposes) courses specifically for nurses are demanded. This paper introduces the main procedures for setting up an EOP course for nurses in Beijing.
