简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

简介：Managementofrheumaticmitralregurgitationinawomancontemplatingpregnancypresentsuniquechallengesfortheclinician.Whentaskedwithtakingcareofthistypeofpatient,attentionneedstobepaidtothepatient’sfunctionalstatustodetermineifsymptomsarepresent.Inadditiontothisclinicalassessment,transthoracicechocardiographyisalsocritical.Itprovidesinsightintotheetiologyofthemitralregurgitation,assessesforthepresenceofconcomitantmitralstenosisorothervalvularabnormalities,characterizestheseverityofmitralregurgitationthroughanintegrativeapproachandidentifieshighriskfindingsincludingprogressiveleftventricular(LV)dilationandLVdysfunction.SurgicalinterventionisrecommendedforsymptomaticpatientsandinasymptomaticpatientswithevidenceofprogressiveLVdilationandaLVejectionfractionoflessthan60%.Whilethepresenceofpulmonaryhypertensionandatrialfibrillationhavebeenshowntoberiskfactorsindegenerativemitralregurgitation,thesamehasnotbeendemonstratedinrheumaticmitralvalvedisease.Whilemitralregurgitationmaybereasonablywelltoleratedduringpregnancy,symptomaticpatientsareathigherriskforadversematernalandfetaloutcomes,andtherefore,itisrecommendedthatmitralvalvesurgerybeperformedpriortopregnancy.Oncethedecisionhasbeenmadetoproceedtosurgery,mitralrepair,performedataHeartValveCenterofExcellenceisrecommendedifpossibleduetoimprovedoutcomes.Mitralvalverepairispossiblein>80%casesofrheumaticmitralregurgitation.Ifrepairisnotpossible,replacementwitheitherabioprostheticormechanicalvalvearereasonableoptions.Thereareadvantagesanddisadvantagestoeachapproachandthechoiceofprosthesisshouldbeashareddecisionbetweenthepatientandhertreatmentteam.

简介：AbstractChronic pruritus is a very common clinical symptom that seriously affects people’s quality of life. Pruritus is associated not only with skin diseases but also with a variety of systemic diseases. It brings great challenges to clinical management. To standardize the management of chronic pruritus, experts of the Allergic Disease Committee of Chinese Dermatologist Association discussed many times and finally formed this guideline to provide reference and guidance for the clinical work of dermatologists and other physicians at all levels.

简介：Engineeringapplicationdomainsneeddatabasemanagementsystemstosupplythemwithagoodmeansofmodeling,ahighdataaccessefficiencyandalanguageinterfacewithstrongfunctionality.Thispaperpresentsasemantichypergraphmodelbasedonrelations,inordertoexpressmany-to-manyrelationsamongobjectsbelongingtodifferentsemanticclassesinengineeringapplications.Amanagementmechanismexpressedbythemodelandthebasicdataofengineeringdatabasesaremanagedinmainmemory.Especially,differentobjectsarelinkedbydifferentkindsofsemanticsdefinedbyusers,thereforethetableswap,therecordswapandsomeunnecessaryexaminationsarreducedandtheaccessefficiencyoftheengineeringdataisincreased.Clanguageinterfacethatincludessomegenericandspecialfunctionalityisproposedforcloserconnectionwithapplicationprograms.

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简介：AbstractSepsis, which is life-threatening organ dysfunction resulting from a dysregulated host response to infection, remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality. The obstetric causes include uterine infection, septic abortion, and wound infection. The non-obstetric causes include pyelonephritis and pneumonia. Maternal sepsis may also be from obstetrical critical illness, such as obstetric severe hemorrhage, obstetric (amniotic fluid/pulmonary) embolism, acute fatty liver of pregnancy, and congestive heart failure, cardiopulmonary arrest, and major trauma. The most commonly reported pathogens in maternal sepsis include Escherichia coli, Streptococcus, Staphylococcus, and other gram-negative bacteria. Maternal sepsis may cause intrauterine infection, which results in (1) preterm premature rupture of membranes or preterm labor or birth, (2) cerebral white matter damage or cerebral palsy or neurodevelopmental delay, (3) stillbirth, (4) early- or late-onset sepsis, and (5) perinatal death. The "Hour-1 bundle" should be initiated within the first hour of the recognition of sepsis. The use of early, appropriate antibiotics is crucial in the management of maternal sepsis. Fetal status should be monitored. Appropriate and early source control should be provided. The decision for delivery is often quite complex and should be individualized to each patient’s clinical scenario while taking into consideration the suspected source of infection, maternal status, fetal well-being, and gestational age. Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.

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简介：ThispaperaddressesamanagementmodelforIPnetworkbasedonNextGenerationOperationSupportSystem(NGOSS).ItmakesthenetworkmanagementonthebaseofalltheoperationactionsofISP,ItprovidesQoStouserservicethroughthewholepathbyprovidingend-to-endServiceLevelAgreements(SLA)managementthroughwholepath.Basedonwebandcoordinationtechnology,thispapergivesanimplementarchitectureofthismodel.

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简介：Ventriculartachycardia(VT)inthepresenceofstructuralheartdiseaseisassociatedwithsuddencardiacdeathandwarrantspromptattention.Implantablecardioverterdefibrillators(ICDs)whilehighlyeffectiveinterminatingsustainedventriculararrhythmiasandreducingmortality,havenoeffectonthearrhythmiasubstrateandrecurrentshocksforVTterminationoccurinapproximately20%ofpatients.Shocksworsenqualityoflifeandareassociatedwithprogressionofheartfailureandincreasedmortality.Antiarrhythmicdrugs,mainlyintheformofbeta-blockersoramiodarone,aremoderatelyeffectiveinreducingICDtherapiesbutdrugintoleranceandserioustoxicitiesofamiodaronenecessitatedrugcessationinaquarterofpatients.CatheterablationhasemergedasaneffectivetreatmentforcontroloffrequentVTepisodesandcanbelifesavingincasesofincessantVTorVTstorm.Asexperienceincreases,itisbeingusedincreasinglyearlier,ratherthanalastresorttherapy.Efficacyvarieswiththenatureoftheunderlyingheartdisease.Intramuralarrhythmiasubstrateandfailuretocreatepermanentablationlesionsremainchallengesandrepeatproceduresarenecessaryinathirdtoahalfofpatients.ForidiopathicVTsorPVCsthataresymptomaticorworsenLVfunction,catheterablationisoftenaneffectivetherapy.

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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.

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简介：人类的飞翔之梦已经延续了千百年，在这期间出现过各式各样的飞行装备。尤其是在近代，随着科学技术的发展，人类探索天空的脚步越来越快，发明家们凭借丰富的想象力，创造出了各种外形怪异的实验性飞机，请看——