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
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
Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surg...Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.展开更多
AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who under...AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.展开更多
AIM To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery(ERAS) protocols in elective gastric cancer(GC) surgery.METHODS Pub Med, Medline, EMBASE, World Health Organization Int...AIM To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery(ERAS) protocols in elective gastric cancer(GC) surgery.METHODS Pub Med, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials(RCTs) comparing ERAS protocols and standard care(SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.RESULTS No significant difference was observed between ERAS and control groups regarding total complications(P = 0.88), mortality(P = 0.50) and reoperation(P = 0.49). The incidence of pulmonary infection was significantly reduced(P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS(P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay(P < 0.00001) and medical costs(P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus(P = 0.0004) and the first defecation(P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior shortterm quality of life(QOL).CONCLUSION Collectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.展开更多
AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Tr...AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.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.
文摘Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.
文摘AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.
基金Supported by the National Natural Science Foundation of China,No.81272711 to Shen LZthe Priority Academic Program Development of Jiangsu Higher Education Institutions,No.JX10231801 to Shen LZthe Key Medical Talents Program of Jiangsu Province,No.ZDRCA2016014 to Shen LZ
文摘AIM To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery(ERAS) protocols in elective gastric cancer(GC) surgery.METHODS Pub Med, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials(RCTs) comparing ERAS protocols and standard care(SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.RESULTS No significant difference was observed between ERAS and control groups regarding total complications(P = 0.88), mortality(P = 0.50) and reoperation(P = 0.49). The incidence of pulmonary infection was significantly reduced(P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS(P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay(P < 0.00001) and medical costs(P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus(P = 0.0004) and the first defecation(P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior shortterm quality of life(QOL).CONCLUSION Collectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.
文摘AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.
