简介：Thereisgrowingevidencesuggeststhatnoise-inducedcochleardamagemayleadtohyperexcitabilityinthecentralauditorysystem(CAS)whichmaygiverisetotinnitus.However,thecorrelationbetweentheonsetoftheneurophysiologicalchangesintheCASandtheonsetoftinnitushasnotbeenwellstudied.Toinvestigatethisrelationship,chronicelectrodeswereimplantedintotheauditorycortex(AC)andsoundevokedactivitiesweremeasuredfromawakeratsbeforeandafternoiseexposure.Theauditorybrainstemresponse(ABR)wasusedtoassessthedegreeofnoise-inducedhearingloss.Tinnituswasevaluatedbymeasuringgap-inducedprepulseinhibition(gap-PPI).Ratswereexposedmonaurallytoahigh-intensitynarrowbandnoisecenteredat12kHzatalevelof120dBSPLfor1h.Afterthenoiseexposure,alltheratsdevelopedeitherpermanent(>2weeks)ortemporary(<3days)hearinglossintheexposedear(s).TheACamplitudesincreasedsignificantly4hafterthenoiseexposure.Mostoftheexposedratsalsoshoweddecreasedgap-PPI.Thepost-exposureACenhancementshowedapositivecorrelationwiththeamountofhearingloss.Theonsetoftinnitus-likebehaviorwashappenedaftertheonsetofACenhancement.

简介：根据文学，仅仅关于渗透胸的主动脉的损伤的出现的一个小比例能成功地被对待。此处，我们报导我们缺乏的一所农村医院里的如此的一个病人的最近的营救的经验推进了仪器为心肺绕过操作。20岁的男性在在无名的动脉和左普通颈动脉动脉之间的大动脉的拱门上和1.5厘米的撕裂与破坏无名的静脉和恰好普通的颈动脉动脉为渗透的损害被招收。没有实现，病人成功地被救心肺绕过。在这种情况中的表示和管理被讨论。

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简介：Wearingaheavyovercoat,TangJincheng,amanalwaysbusyasdirec-torofacoachstationinHangzhouCity,eastChina,wasevenbusierduringtheSpringFestivalwhenmigrantworkersandstudentsleftforfamilyreunions.For2009,theannual'peakofSpringFestivaltravels'began

简介：TheissueofhealthstatusandcarefortheelderlyinurbanandruralareasisbecomingincreasinglyseriousintherapidcontextofpopulationaginginChina.ThepaperanalyzedthehealthstatusofurbanandruralelderlyinChinainthetwo-weekmorbidityrate,prevalencerateofchronicdiseases,disabilitystatus,self-ratedhealthandhealthylifeexpectancyoftheelderlyusingthedatafromthe2006SamplingSurveyontheStatusofUrban/RuralAgedPopulationinChina,theFourthNationalHealthServiceSurveyandthe2006SecondChinaNationalSampleSurveyonDisability,toexplorethecurrentprovisionofsourcesofcarefortheelderlyandtrytomakesomepolicyrecommendationsabouttoimprovethehealthandcarefortheelderlypopulationfacingthecrisisofpopulationaging.

简介：Therehasbeenaparadigmshiftinmedicineawayfromtradition,anecdoteandtheoreticalreasoningfromthebasicsciencestowardsevidence-basedmedicine(EBM).Inpalliativecarehowever,statisticallysignificantbenefitsmaybemarginalandmaynotberelatedtoclinicalmeaningfulness.Thetypicaltreatmentvs.placebocomparisonnecessitatedby‘goldstandard'randomisedcontrolledtrials(RCTs)isnotnecessarilyapplicable.Thecomplexmultimorbidityofendoflifecareinvolvesconsiderationsofthepatient'sphysical,psychological,socialandspiritualneeds.Inaddition,thefieldofpalliativecarecoversaheterogeneousgroupofchronicandincurablediseasesnolongerlimitedtocancer.Adequatesamplesizescanbedifficulttoachieve,reducingthepowerofstudiesandhighattritionratescanresultininadequatefollowupperiods.Thisreviewusesexamplesofthemanagementofcancer-relatedfatigueanddeathrattle(noisybreathing)todemonstratethecurrentstateofEBMinpalliativecare.ThefutureofEBMinpalliativecareneedstobeasdiverseasthepatientswhoultimatelyderivebenefit.Non-RCTmethodologiesofequivalentquality,validityandsizeconductedbycollaborativeresearchnetworksusinga‘mixedmethodsapproach'arelikelytoposethecorrectclinicalquestionsandderiveevidencebasedyetclinicallyrelevantoutcomes.

简介：WiththeagingofChina'spopulation,old-agecareserviceraisedmoreandmoreconcerns.Firstly,thepaperstudiedpopulationageingwithChinesecharacteristics.Secondly,macroandmicroanalysiswasperformedontheproblemsofserviceforagedwithrapidageingspeed.Atlast,thepaperraisedtoconstructold-agecareservicepatternswithChinesecharacteristics,whicharegovernmentguidance,community-support,publicwelfare-basisandcognitionchangepremise.

简介：Thispaperdealswiththeissueofprioritysettinginhealthcareunderuncertaintiesabouttheseverityoftheillnessandtheeffectivenessofmedicaltreatment.Weexaminetheeffectofadiseaseuncertainty(atreatmentuncertainty)ontheallocationofhealthcareresourcesinthepresenceofatreatmentrisk(adiseaserisk)andidentifypreferenceconditionsunderwhichthesocialplannerallocatesmoreresourcestohigherriskpopulation.Weallowforthesimultaneouspresenceoftworisksandinvestigatethejointeffectoftwo-sourceuncertaintiesonhealthcareallocationwhenthetworisksareeithersmallorpositivelyquadrantdependent.Theeffectofinequalityaversiononhealthcareallocationisalsoanalyzedbyintroducinganequityweightingfunction.Ourworkextendsthepreviousmodelofhealthcareprioritytotwo-riskframeworkandprovidesnewinsightsintotheproblemofhealthcaredecisionmakingunderuncertainty.

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简介：AbstractPropose:In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.Methods:All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID- 19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.Results:In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p= 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.Conclusion:We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

简介：BelovedisoneofToniMorrison’smostfamousnovelsandattractsmuchattentionfromthepublic.ThisessayaimstoanalyzethehealingprocessofSethe’straumafromtheperspectiveofpsychologicalanalysis.Therearefourparts.First,itintroducestheplotofthestoryandthetheory.ThesecondpartanalyzestheformingofSethe’straumaandthethirdpartdiscussesthehealingprocess.Thelastpartreachestheconclusion.ByanalyzingSethe’straumafrompsychoanalysis,thispaperaimstohelptheseblackpeopletoreconstructtheiridentityandachieverenascence.

简介：Objective:Toobservetheocularhistopathologicalchangesaftereyeballenucleationinducedbycornealtrauma.Methods:Lightmicroscopicexaminationwasdoneon117eyeballspecimensenucleatedaftercornealtrauma(18withcornealfissureand99withcornealperforatingtrauma).Results:Acute,subacuteorchronicinflammatorychanges,andfibrousmembraneformationwereobservedinwell-closedcornealwounds,whereasinflammation,atrophyandscarwereobservedinthefocaltissues.Butatthelateperiod,secondaryglaucoma,retinaldetachment,endophthalmitisandeyeballatrophyresultedinblindness.Cornealfistulawasobservedinthosewithinadequatecureofwoundscausedbyingrowthofcornealepithelium,embedmentofirisandvitreousbody,andlargeareaofcentrallylocatedtissuedeficiencyofthecorneal.Ahighincidenceofendophthalmitiswasnotedduetothepresenceofcornealfistula.Severeinflammationwasobservedintheanteriorsegmentaltissueswithfibrousinfiltrationintheanteriorchamber,whichmightresultinrapiddestructionoftheeyeballs.Conclusions:Ocularpathologyvarieswiththedifferenceoftheposition,form,sizeandclosingconditionsofthecorneallacerationaftertrauma.

简介：AbstractOutbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

简介：客观：与严重煽动性的反应症候群(先生)在创伤的病人调查甲状腺荷尔蒙的引申。方法：有严重先生的五十个创伤的病人被注册并且根据他们是否介绍了multiorgandysfunction症候群(MODS)把组划分了成二。甲状腺荷尔蒙大小被拿，包括totaltriiodothyronine(TT3)，全部的甲状腺素(TT4)，免费triiodothyronine(FT3)，免费甲状腺素(FT4)和甲状腺刺激荷尔蒙(TSH)。尖锐生理学和长期的健康评估Ⅱ(APACHEⅡ)20根据临床的数据被计算。恢复或恶化的结果被记录，以及从到时间甲状腺荷尔蒙的先生的发作的时间的长度被测量。结果：Euthyroid病了的症候群(S字)在45cases.TT3水平被介绍否定地与APACHEH分数被相关(r=-0.330,P<0。05)，并且TT3/TT4value否定地与先生的持续时间被相关(r=-0.316,P<0.05)。没有MODS，在MODS病人的TT3，TT4和FT3levels是比那些显著地低的(P<0.05)。没有MODS，给低TT4或FT4的MODS病人比那些经常铺平更多(P<0.05)。与在正常TSH组的病人相比，有有的减少的TSH的病人降低T3，T4，恢复率和更高的APACHEⅡ分数，MODS发生，但是二个组之间没有差别(P>0.05).Conclusions：有严重先生的损伤病人有高可能性得到S字，它更经常并且严重地发生在MODS病人。它在甲状腺轴上显示出先生的影响。Withthe坚持和先生的恶化，有甲状腺荷尔蒙的进步减小。

简介：ThispaperpointsouttheproblemsexistingintheIntensiveReadingCourseclassroomsconductedundertheteacher-centredpedagogyandproposesthatvariedwarm-upactivitiesbeappliedatthebeginningofeveryclass.Thepurposeistomotivatethestudentstobeactiveparticipantsinclass,provokecommunicationatdifferentlevels,andfosterthetop-downreadingschema,allofwhichservetoenablethestudentstobecomeeffectivereaders.Thetheoreticalandapplicativeconsiderationsofthewarm-upactivitiesarediscussedindetailinthepaper.

简介：AbstractImportance:In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.Objective:To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis; to assess the outcome; and to evaluate the risk factors associated with the mortality in these patients.Methods:During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.Results:Out of 88 documented episodes of intestinal complications from 77 patients; 58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness (OR 4.529, 95%CI 1.062-19.317, P = 0.041); a longer duration of neutropenia (OR 1.215, 95%CI 1.030-1.434, P = 0.021); and hemodynamic instability (OR 17.023, 95%CI 4.095-70.772, P < 0.001), were found to be independently associated with worse outcome.Interpretation:In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.

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简介：AbstractNeurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.

简介：HealthCareResourcesTotalNumberofMedicalandHealthInstitutionsAttheendof2011,thenumberofmedicalandhealthinstitutionstotaled954,389,anincreaseof17,462comparedwiththatoflastyear.Ofwhich,therewere21,979hospitals,918,003grassrootshealthcareinstitutionsand11,926specializedpublichealthinstitutions.Comparedwithlastyear,thenumberofhospitalincreasedby1,061,thatofgrassrootshealthcareinstitutionsincreasedby16,294;andthatofspecializedpublichealthinstitutionsincreasedby91(seeTable1).Amongthehospitals,13,542werepublichospitalsand8,437wereprivatehospitals.Categorizedbyclasses,therewere1,399first-classhospitals'ofwhich,881wereupperfirst-classhospitals',6,468second-classhospitals,5,636third-classhospitalsand8,476unclassifiedhospitals.Categorizedbythenumberofbedsahospitalpossessed,therewere13,136