简介：AbstractEnhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

简介：OnthehistoricdayofSeptember9,1993,IsraeliPrimeMinisterYitzhakRabinandPLOChairmanYasserAraratdeclaredrecognitionofeachotherbyanex-changeofletters.Fourdayslater,onSeptember13,thetwosidessignedthe"DeclarationofPrinciplesonInterimSelf-governmentArrangements"inWashing-tonatameetingpresidedoverbyAmericanPresidentBillClinton.ThenewaccordisanothersignificantbreakthroughintheMiddleEastpeaceprocessaftertheCampDavidAgreementreachedbetweenIsraelandEgyptin1978.Inviewofthefact

简介：ObjectivesTostudythemonitoringofrejectionafterorthotopicheartthansplantation.MethodsFrom1998to2005,10othotopicheartthansplanswereperformed,andacuterejectionwasmonitoredbyendomyocardialbiopsyaswellasbyclinicalfeatures,ECG,ultrasonocardiographyandbloodserumdeterminationofTropinI,andbythecombinationofthesemethods,weanalysedthemonitoringofacuterejectionafterthehearttransplantation.ResultsWiththecombinationofclinicalfeatures,ECG,ultrasonocardiographyandbloodserumtest,5occurencesofacuterejectionwerejudgedinthepostoperativecourse,whichwerecomfirmedbyendomyocardialbiopsytobe2acuterejectionsinⅠbdegree,3acuterejectionsinⅢadegree.Endomyocardialbiopsywereroutinelyperformed21timespostoperativelyinwhichtherewere1acuterejectioninⅠadegreeand5acuterejectionsinⅠbdegree.ConclusionsAcuterejectionisanimportantfactorinfluencingthepostoperativecourseofhearttransplantation,soitisimperativetohaveanin-time,effectiveandplannedmonitoringprocedureforacuterejection.Endomyocardialbiopsyisasensitiveandreliablemethodindiagnosisofacuterejection,butitisinvasiveandprobableforsomecomplications.Thenoninvasivemethodsuchasclinicalfeatures,ECG,ultrasonocardiographyandbloodserumtestcanbeusedasadditivemeansinthediagnosisofacuterejection.Endomyocardialbiopsyshouldbecombinedwithsomenoninvasivemethodsinmonitoringacuterejectionafterthehearttransplantation.

简介：AbstractBlunt traumatic aortic injury is the second leading cause of death after motor vehicle accidents. The most frequent localisation of aortic lesion is the isthmus, especially in those who survived the accident. Here we report a case of blunt traumatic aortic injury with unusual localisation and modality. A 31 years old man sustained a motorcycle accident, being run over by a car. Computed tomography scan showed an atypical ascending aorta lesion, confirmed by intraoperative finding. The patient underwent emergency ascending aorta replacement with Dacron tubular graft. The patient was discharged uneventfully on 35th postoperative day, after multiple maxillofacial surgeries for concomitant injuries.

简介：一个计划被开发计算在电子影响刺激以后射出的放射的极化。充分相对论的弄歪波浪的方法是使用的品种内异系交配体节计算。计划被用于象他一样和象Li一样离子。线极化的计算价值与另外的理论结果和试验性的价值相比。象ForHe一样U在更低的事件精力，，现在的极化在更高的精力在1%以内同意另外的理论的，差别增加直到大约10%。为象他一样Fe和Ti，为大多数线的极化度的现在的结果在试验性的错误酒吧以内同意试验性的数据。为象Li一样Ti线q(1s2s2p(2)P(3/2)到1s(2)2s)，极化的现在的值与另一理论一个，和两个最优地同意值与在试验性的错误工具条以内的测量数据一致。

简介：AbstractBackground:Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches.Methods:A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model.Results:Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS.Conclusions:Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.

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简介：Eightyearshavepassedsincetheeruptionof'ColorRevolution'.Duringthisperiodoftime,WesternNGOswhichoncetrainedpro-Westernpoliticalforcesinthenameofhumanrightsanddemocracyseemtohavevanished.Nevertheless,theyhavenotstoppedtheiractivitiesinCISstatesinreality.Itisjustthattheyhavechangedtheirusualpracticesofpreaching

简介：Themolecularstructureofpolyethylene（PE）sampleswithvariouscomonomersincludingpropylene,1-buteneand1-hexenewasinvestigatedbyDSCand13C-NMRtechniques.Thedensityofthesamplesvariesfrom0.948g/cm3to0.917g/cm3,andthemolecularweightdeterminedbytheGPCmethodisintherangeof1～2×105.Thebranchpointcontentofthesampleswasdeterminedby13C-NMRmeasurementsandwasfoundtobelessthan20per1000Catomsalongthemainchain.CrystallizationsegregationDSCtechnique（CSDSC）wasusedtocharacterizethebranchpointdistributionorthesegmentlengthdistributionofPEs.Thecrystallizationsegregationwasperformedinasuccessiveannealingprocessatdecreasingtemperatures.Theintervaloftwosuccessiveannealingtemperatureswas6K,andthetimelengthofeachannealingstepwas2.5h.TheCSDSCresultsclearlyindicatethatallthePEsamplesused,includingsomemetallocenePEs,moreorlessexhibittheirnon-uniformityinsegmentlengthdistribution,andbimodalormultimodalCSDSCcurveswereusuallyobserved.ForquantitativecharacterizationoftheCSDSCcurvesandthesegmentlengthdistributiontwoparameters,theaveragemeltingpoint,TmAV,andtheroot-mean-squaredeviationofmeltingtemperature,(ΔTmAV2)1/2,wereproposed.TmAViscorrespondingtotheaveragesegmentlengthduetobranchingand(ΔTmAV2)1/2givesinformationaboutthewidthofthesegmentlengthdistribution.Experimentalresultsshowthatboththedegreeofaveragemeltingtemperaturedepressionandthewidthofthedistributionseemtoincreasewithincreasingthebranchingcontentandaredependentonthetypeofcomonomers.VerygoodreproducibilityandadditivityoftheCSDSCmethodwereevidencedexperimentally.ItwasconcludedthattheCSDSCtechniqueisasensitiveandconvenientmethodforcharacterizingthesegmentlengthdistributionofbr

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简介：ＴＨＥＤＹＮＡＭＩＣＳＯＦＭＡＩＮＴＡＩＮＩＮＧＴＨＥＴＲＯＰＩＣＡＬＣＹＣＬＯＮＥ９０１２ＡＦＴＥＲＩＴＳＬＡＮＤＩＮＧ￥ＬｉａｎｇＬｉ，ＷｕＺｈｉｗｅｉ（ＭｅｔｅｏｒｏｌｏｇｉｃａｌＩｎｓｔｉｔｕｔｅｏｆＦｕｊｉａｎＰｒｏｖｉｎｃｅ，Ｆｕｚｈｏｕ...

简介：OjbectiveTofindtheindependentpredictorsforrestenosisaftercoronarystenting.MethodsQuantitativeangiographywasperformedon60cases(67successfullydilatedlesions)afterangio-plastyover6-monthsfollow-up,andbothunivariateandmultivariatelogisticregressionanalysisweredonetoi-dentifythecorrelationsofrestenosiswithclinicalfactors.ResultsThetotalrestenosisratewas31.3%(21of67lesions),andaccordingtounivariateanalysisthepatientswhounderwentcoronarystenting≥3.5mmhadalowerrateofrestenosis(P<0.01).Collateralcirculationtotheobstructionsite,highmaximalinflationpressure,smokingandthelessminimallumendiameterafterPTCAmadetherateofrestenosishigherower(P<0.05).Multivariatelogisticregressionanalysisshowedthatcoronarystenting≥3.5mmhadalowrateofrestenosis,buthighmaximalinflationpressureandsmokingmadetherestenosisratehigher.ConclusionCoronarystentsize,maximalinflationpressureand.smokin

简介：AbstractLeopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.

简介：在过去几年，乍见陆地并且轨道，紧张，支撑热带气旋的机制(此后TC)并且联系天气变化变得加热了研究的话题。从精力转变，潮湿转移，中间纬度的baroclinicfrontal地区和周围的风领域的观点，陈等。Le等。并且Zengetal。学习了乍见陆地做了的TC的支撑的机制。李等。另外指出TCsduring转变的增强与骚乱并且向下被联系在TC附近的high-levelpotential旋涡，低级锋带和低压的循环的交通，在解释以后，在TC的差别转移跟随湿潜在的旋涡的理论。

简介：AbstractNearly one-fourth of the world’s population is infected with Mycobacterium tuberculosis (MTB). Female genital tuberculosis (TB) is a common cause of infertility in both developing and undeveloped countries. Furthermore, assisted reproduction treatments and pregnancy potentially increase the risk of TB infection and reactivation. In this study, we present the case of a 28-year-old infertile female without a history of TB who developed an acute miliary TB and pelvic TB after in vitro fertilization-embryo transfer (IVF-ET). Elevated serum estrogen levels during controlled ovarian hyperstimulation and T-lymphocyte function inhibition during pregnancy are the risk factors for MTB infection and reactivation. In her 7th week of gestation, the patient developed fever and spontaneously aborted. Her chest computed tomography images revealed classical miliary TB. Uterine curettage tissue and vaginal secretion samples as well as Gene X-pert MTB/rifampicin (RIF) and TB-RNA test results were positive for MTB. Histological examination of the uterine curettage tissue confirmed the diagnosis of endometrial TB. Treatment with isoniazid, RIF, pyrazinamide, amikacin, and levofloxacin was selected based on the patient’s diagnosis, complications, and test results. Currently, the patient is undergoing anti-TB treatment, and her condition is stable. It is important to rule out the presence of TB in infertile patients before performing IVF-ET to avoid TB dissemination during pregnancy.

简介：AIM:Toinvestigatewhetherphotoreceptornecroptosisinducedbyz-VAD-FMK(pancaspaseinhibitor)wasinvolvedtheactivationofautophagyandwhetherNecrostatin-1,aspecificnecroptosisinhibitor,couldinhibitthisinductionofautophagyafterexperimentalretinaldetachment.METHODS:ExperimentalretinaldetachmentmodelswerecreatedinSprague-Dawleyratsbysubretinalinjectionofsodiumhyaluronateandsubretinalinjectionsofz-VAD-FMK,vehicleorz-VAD-FMKplusNecrostatin-1.Threedaysafterretinaldetachment,morphologicchangeswereobservedbytransmissionelectronmicroscopy.Inotheranimals,retinasweresubjectedtoimmunoprecipitationandWesternBlotting,thenprobedwithanti-RIP1,phosphoserine,LC-3IIorcaspase8antibody.RESULTS:Itwasprovedbyimmunoprecipitationandwesternblotting,thatphotoreceptornecroptosiswasmediatedbycaspase-8inhibitionandreceptorinteractingproteinkinase(RIP1)phosphorylationactivation.TransmissionelectronmicroscopeandwesternblottingresultsindicatedthatphotoreceptornecroptosiswasinvolvedtheLC-3IIandautophagosomesinduction.WealsodiscoveredNecrostatin-1couldinhibitRIP1phosphorylationandLC-3IIinduction.CONCLUSION:Thesedatafirstlyindicatephotoreceptornecroptosisisassociatedwiththeactivationofautophagy.Necrostatin-1protectsphotoreceptorsfromnecroptosisandautophagybydown-regulationofRIP1phosphorylationandLC-3II.

简介：AIM:Todiscusstheclinicalsignificanceofpostoperativegastrointestinaldecompressioninoperationonlowerdigestivetract.METHODS:Threehundredandsixty-eightpatientswithexcisionandanastomosisoflowerdigestivetractweredividedintotwogroups,i.e.thegroupwithpostoperativegastrointestinaldecompressionandthegroupwithoutpostoperativegastrointestinaldecompression.Clinicaltherapeuticoutcomeandincidenceofcomplicationwerecomparedbetweentwogroups.Furthermore,aninvestigationonapplicationofgastrointestinaldecompressionwascarriedoutamong200generalsurgeons.RESULTS:Thevolumeofgastricjuiceindecompressiongroupwasabout200mLeverydayafteroperation.Bothgroupshadalowergirthbeforeoperationthaneverydayafteroperation.Nodifferenceinlengthofthefirstpassageofgasbyanusanddefecationafteroperationwasfoundbetweentwogroups.Theoverallincidenceofcomplicationswasobviouslyhigherindecompressiongroupthaninnon-decompressiongroup(28%vs8.2%,P<0.001).Theincidenceofpharyngolaryngitiswasupto23.1%.Therewasalsonodifferencebetweentwogroupsregardingthelengthofhospitalizationafteroperation.Themajority(97.5%)ofgeneralsurgeonsheldthatgastrointestinaldecompressionshouldbeplacedtillpassageofgasbyanus,andonly2.5%ofsurgeonsthoughtthatgastrointestinaldecompressionshouldbeplacedfor2-3dbeforepassageofgasbyanus.Nobody(0%)deemeditunnecessaryforplacinggastrointestinalcompressionafteroperation.CONCLUSION:Applicationofgastrointestinaldecompressionafterexcisionandanastomosisoflowerdigestivetractcannoteffectivelyreducegastrointestinaltractpressureandhasnoobviouseffectonpreventingpostoperativecomplications.Onthecontrary,itmayincreasetheincidenceofpharyngolaryngitisandothercomplications.Therefore,itismorebeneficialtotherecoveryofpatientswithoutundergoinggastrointestinaldecompression.

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简介：为了比较在在medication.METHODSA上有选择激光trabeculoplasty(SLT)和那些的病人之间的生活和治疗满足的质量，收到了SLT和用反绿内障药继续的一个控制组的143个绿内障病人上的未来的临床的试用被进行。眼泪分散时间(，但是)，标点角膜炎，对帮助的需要，人工的眼泪的使用和intraocular压力(IOP)的治疗满足调查在基线被测量，6并且12mo.RESULTSSLT能减少从1.56需要的药的吝啬的数字