简介:Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.
简介:Chronicpancreatitisisanongoingdiseasecharacterizedbypersistentinflammationofpancreatictissues.Withdiseaseprogression,patientswithchronicpancreatitismaydeveloptroublesomecomplicationsinadditiontoexocrineandendocrinepancreaticfunctionalloss.Amongthem,apseudoaneurysm,mainlyinducedbydigestiveenzymeerosionofvesselsinproximitytothepancreas,isarareandlife-threateningcomplicationifbleedingofthepseudoaneurysmoccurs.Atpresent,noprospectiverandomizedtrialshaveinvestigatedthetherapeuticstrategyforthisrarebutcriticalsituation.Theroleofarterialembolization,thetimingofsurgicalinterventionandevensurgicalproceduresarestillcontroversial.Inthisreview,wesuggestthatdynamicabdominalcomputedtomographyandangiographyshouldbeperformedfirsttolocalizethebleedersandtoevaluatetheassociatedcomplicationssuchaspseudocystformation,followedbyarterialembolizationtostopthebleedingandtoachieveearlystabilizationofthepatient’scondition.Withadvancesandimprovementsinendoscopicdevicesandtechniques,therapeuticendoscopyforpancreaticpseudocystsistechnicallyfeasible,safeandeffective.Surgicalinterventionisrecommendedforableedingpseudoaneurysminpatientswithchronicpancreatitiswhoareinanunstablecondition,forthoseinwhomarterialembolizationofthebleedingpseudoaneurysmfails,andwhenendoscopicmanagementofthepseudocystisunsuccessful.Ifableedingpseudoaneurysmislocatedoverthetailofthepancreas,resectionisapreferentialprocedure,whereasifthelesionissituatedovertheheadorbodyofthepancreas,relativelyconservativesurgicalproceduresarerecommended.
简介:Basedonthemeaningofeconomictheoryaswellasanalysisofrelevantcharacteristicsofwatershedenvironmentalmanagement,awatershedenvironmentalmanagementframeworkwillbecreated,withbuildingsystemsoftheory,principles,methods,andsupportingmeasures.Throughthegeneralstructure,thewatershedenvironmentalmanagementsystemdesigncanbeexploredtooptimizetheallocationofresourcesandachievecoordinateddevelopmentofwatershedeconomicgrowthandenvironmentalprotection.
简介:BasedonthecurrentsituationofChinaConstructionBIMtechnology,thisarticlediscussedtherequirementofBIMapplicationsinconstructionphase.BytheintroductionofPKPMBIM-basedConstructionManagementPlatform,themeaningoftheplatformapplicationwasrevealed.Finally,twoapplicationcaseswereshowntoexplainplatform’svalueandprospect.
简介:Tosolvethedatapersistenceprobleminthemanagementsystem,thispaperusedthepopularobject-relationalmappingframeworkHibernatetoachievethepersistencelayerwhichinamedicinesinventorymanagementsystem.ThispaperdescribedtheadvantagesandprinciplesoftheHibernate,andthenshowedthewrittenworkoftheconfigurationfiles,mappingfiles,persistentclasses,etc.Finally,thepapershowedhowtodisplaythespecificdatainformationintheTableViewerbasedontheEclipseRCPframework.Itisobservedthat,operatingtheobjectsintheHibernateframeworkismoreflexibleandefficientthanusingJDBCdirectly.Adinaddition,theapplicationbasedonEclipseRCPframeworkcantakeovermanyexcellentfeaturesofEclipse,andthedeveloperscanimprovetheirefficiencybythesefeatures.
简介:TofurtherimplementthespiritoftheThirdPlenarySessionoftheEighteenthPartyCentralCommittee,conscientiouslysumupcomprehensivemanagementofsexratioatbirthin2013andfullyarrangethetasksin2014,onDecember20,2013,NationalMeetingonComprehensiveManagementofSexRatioatBirthwasheldinFuzhou
简介:Communicativelanguageteachingapproachiseffectiveincultivatingstudents’communicativecompetence.Ithaschangedthewayofteachingaswellaslearning.Thispaper,basedonclassobservationofonesemester’s'management'course,reflectsontheteachingapproachemployedbytheteacher,discussesitsbenefitsandproblemswithintheclass,andexplorestheunderlyingprinciplesoftheapproachadopted.更多还原
简介:ObjectiveToreportoutcomesofnonsurgicalandsurgicalmanagementofMenière’sdiseaseatBeijingTiantanHospital.MethodsPatientswithMenière’sdiseasewerecategorizedintogroupsbasedonhearingandqualityoflife.Individualizedmanagementwasprovided,includinglifestylemodification,drugtherapies,endolymphaticsacdecompressionandlabyrinthectomy.Treatmentoutcomeswereevaluatedduringupto24monthsfollowup.ResultsEightysevenpatientsunderwentlifestylemodificationanddrugtherapies.ThevertigocontrolrateofGradeAandBwas76.9%and83.8%respectively.Sixpatientsreceivedsurgicalmanagement,includingendolymphaticsacdecompression(n=5)andlabyrinthectomy(n=1).Forthesepatients,thevertigocontrolrateofGradeAandBwas80%and100%,respectively.ConcluIsionsManagementofMenière’sdiseasedependsonseveralfactors,i.e.severitiesofvertigoandhearingloss,qualityoflife,surgicalcontraindicationsandpatientsubjectivedesire.Thetreatmentisdrugtherapiesforthemajorityofpatients,aswellaslifestylemodification.Surgicalindicationsarerareandtheleastinvasiveproceduresshouldbeconsideredfirst.Theresultsofsurgeryaregenerallysatisfying.