The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option f...The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option for women who have a second pregnancy after cesarean section, is a major factor in this increase. The trial of labor after cesarean section (TOLAC) is considered to be the best method, and the safety and feasibility of TOLAC have been confirmed by numerous studies, but in clinical practice, there are many factors that make TOLAC unsuccessful. This article reviews the factors that influence the choice of delivery method after cesarean section as follows.展开更多
Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic a...Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.展开更多
Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. Despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuit...Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. Despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. Delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .展开更多
Objective: To evaluate the feasibility and safety of the non-placement of a drainage tube in transvestibular endoscopic thyroid papillary carcinoma surgery by applying the concept of rapid rehabilitation surgery. Meth...Objective: To evaluate the feasibility and safety of the non-placement of a drainage tube in transvestibular endoscopic thyroid papillary carcinoma surgery by applying the concept of rapid rehabilitation surgery. Methods: 106 patients with papillary thyroid carcinoma in the Department of Head and Neck of Affiliated Cancer Hospital of Sun Yat-sen University were retrospectively analyzed, and the observation group (n = 43) 1 who underwent endoscopic surgery without negative pressure drainage tube in the hospital from January 2019 to March 2023 were selected. The control group (n = 63) underwent the same operation at the same time and placed the negative pressure drainage tube. Postoperative hematoma, incision infection, subcutaneous effusion, and use of painkillers were compared between the two groups. Results: There were no statistically significant differences in operation time, intraoperative blood loss, postoperative hospital stay, and number of lymph node dissection between the two groups (P > 0.05). No postoperative hematoma or incision infection occurred between the two groups. There were no statistically significant differences in the incidence of subcutaneous effusion and the use rate of painkillers between the two groups (P > 0.05). Conclusion: No drainage tube in patients undergoing endoscopic thyroid surgery through oral vestibular approach will not increase the probability of complications such as postoperative hematoma, incision infection, subcutaneous effusion, and the use of painkillers, but can improve the comfort of patients in the concept of rapid rehabilitation.展开更多
Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surge...Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.展开更多
AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来...世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来教授?该标准对现有课程框架的教学内容及教学重点将产生怎样的影响?中国及世界英语教学理论与实践的研究表明,以传播中国,沟通世界为目的的中国外语教学,应该理性地选择世界范围内认可度最高的规范作为教授标准,并与时俱进,更新教学内容;从评价输出角度来说,应转变教学理念,聚焦信息交流的可理解度,将教学重点转向韵律。师生均需拓宽视野,培养世界胸怀,培养国际交流中对待地域及社会变体的积极的语言态度。展开更多
In this paper, we take occurrence process of early strong aftershocks of a main after shock type′s earthquake sequence as a complex grey system, and introduce predicting method for its stronger aftershocks by grey p...In this paper, we take occurrence process of early strong aftershocks of a main after shock type′s earthquake sequence as a complex grey system, and introduce predicting method for its stronger aftershocks by grey predicting theory. Through inspection prediction for 1998 Zhangbei M S=6.2 earthquake sequence, it shows that the grey predicting method maybe has active significance for the investigation of quick response prediction problems of stronger aftershocks of an earthquake sequence.展开更多
The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's...The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's day, showing on the one hand the corruption, injustice, ava rice, lust, faction, perfidiousness and cruelty among the ruling classes, and on the other hand the miseries of the oppressed.展开更多
文摘The increasing rate of cesarean delivery has become a widespread concern worldwide, nearly half of which is due to previous cesarean deliveries, and elective repeat cesarean delivery (ERCD), which is the main option for women who have a second pregnancy after cesarean section, is a major factor in this increase. The trial of labor after cesarean section (TOLAC) is considered to be the best method, and the safety and feasibility of TOLAC have been confirmed by numerous studies, but in clinical practice, there are many factors that make TOLAC unsuccessful. This article reviews the factors that influence the choice of delivery method after cesarean section as follows.
文摘Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.
文摘Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. Despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. Delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .
文摘Objective: To evaluate the feasibility and safety of the non-placement of a drainage tube in transvestibular endoscopic thyroid papillary carcinoma surgery by applying the concept of rapid rehabilitation surgery. Methods: 106 patients with papillary thyroid carcinoma in the Department of Head and Neck of Affiliated Cancer Hospital of Sun Yat-sen University were retrospectively analyzed, and the observation group (n = 43) 1 who underwent endoscopic surgery without negative pressure drainage tube in the hospital from January 2019 to March 2023 were selected. The control group (n = 63) underwent the same operation at the same time and placed the negative pressure drainage tube. Postoperative hematoma, incision infection, subcutaneous effusion, and use of painkillers were compared between the two groups. Results: There were no statistically significant differences in operation time, intraoperative blood loss, postoperative hospital stay, and number of lymph node dissection between the two groups (P > 0.05). No postoperative hematoma or incision infection occurred between the two groups. There were no statistically significant differences in the incidence of subcutaneous effusion and the use rate of painkillers between the two groups (P > 0.05). Conclusion: No drainage tube in patients undergoing endoscopic thyroid surgery through oral vestibular approach will not increase the probability of complications such as postoperative hematoma, incision infection, subcutaneous effusion, and the use of painkillers, but can improve the comfort of patients in the concept of rapid rehabilitation.
文摘Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.
文摘AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
文摘世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来教授?该标准对现有课程框架的教学内容及教学重点将产生怎样的影响?中国及世界英语教学理论与实践的研究表明,以传播中国,沟通世界为目的的中国外语教学,应该理性地选择世界范围内认可度最高的规范作为教授标准,并与时俱进,更新教学内容;从评价输出角度来说,应转变教学理念,聚焦信息交流的可理解度,将教学重点转向韵律。师生均需拓宽视野,培养世界胸怀,培养国际交流中对待地域及社会变体的积极的语言态度。
文摘In this paper, we take occurrence process of early strong aftershocks of a main after shock type′s earthquake sequence as a complex grey system, and introduce predicting method for its stronger aftershocks by grey predicting theory. Through inspection prediction for 1998 Zhangbei M S=6.2 earthquake sequence, it shows that the grey predicting method maybe has active significance for the investigation of quick response prediction problems of stronger aftershocks of an earthquake sequence.
文摘The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's day, showing on the one hand the corruption, injustice, ava rice, lust, faction, perfidiousness and cruelty among the ruling classes, and on the other hand the miseries of the oppressed.
