简介：摘要在硬岩中采用小孔径小间距来保证光面爆破的效果，为了提高光面爆破技术在硬岩施工效率，对大直径轴向不耦合装药光面爆破技术进行试验研究，结果表明在硬岩边坡中采用大直径炮孔小药卷装药结构可以在高效完成爆破作业，提高保护岩体平整美观性。

简介：Inthepresentpaper,theauthorputsforwardsixkeypointsforacupuncturetreatmentofdiseases,namely,①carefulexamination,②definitediagnosis,③preciseandappropriateidentificationofsyndromes,④accuratelocationoftheacupoint,⑤flexibleapplicationofneedlingmanipulations,and⑥“Deqi”.Thefirstthreeaspactsarethefoundation,accuratelocationandflexibleneedlingmanipulationsarealsotheprerequisiteforeffectivetreatmentofdiseases.Inaddition,soundtheoreticalbasicknowledgeofbothtraditionalChinesemedicine(TOM)andmodemmedicine,andflexiblyapplyingsuitableneedlingmaneuvers,stimulatingquantityanddurationofneedleretaininginaccordancewiththeconcretestateofdiseaseandthepatient'sconditionsarealsoveryimportantinclinicalpracticeofacupuncture.

简介：LedbyfourgenerationsofleadershipfromlateProf.JIANGSichang(academician,ChineseAcademyofEngineering),Prof.YANGWeiyan(HonoraryPresident,DivisionofOtolaryngologyHeadandNeckSurgery,ChineseMedicalAssociation),Prof.HANDongyi(PresidentElected,DivisionofOtolaryngologyHeadandNeckSurgery,ChineseMedicalAssociation)tonowProf.YANGShiming(President,DivisionofOtolaryngologists,

简介：将晓莉是一个学习优秀、体态匀称的美丽姑娘。柔和的笑意荡漾着平静。然而生活似乎给她开了个玩笑，她11岁的时候，由于小姨为她掏耳朵不小心将鼓膜弄破，细菌从破裂的鼓膜进到中耳，导致了耳聋。

简介：AbstractMandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons’ preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.

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简介：AbstractMucormycosis is a lethal human disease caused by fungi of the order Mucorales. Mucormycosis is caused by fungi mainly belonging to the genera Mucor, Rhizopus, and Lichtheimia, all of which belong to the order Mucorales. The number of individuals with mucormycosis-causing disorders has increased in recent years, hence, leading to the spread of mucormycosis. Throughout the coronavirus disease 2019 (COVID-19) pandemic, numerous cases of mucormycosis in COVID-19-infected patients have been reported worldwide, and the illness is now recognized as COVID-19-associated mucormycosis, with most of the cases being reported from India. Immunocompromised patients such as those with bone marrow sickness and uncontrolled diabetes are at a greater risk of developing mucormycosis. Genes, pathways, and other mechanisms have been studied in Mucorales, demonstrating a direct link between virulence and prospective therapeutic and diagnostic targets. This review discusses several proteins such as high-affinity iron permease (FTR1), calcineurin, spore coat protein (CotH), and ADP-ribosylation factors involved in the pathogenesis of mucormycosis that might prove to be viable target(s) for the development of novel diagnostic and therapeutic methods.

简介：AbstractBackground:The End Tuberculosis (TB) Strategy of the World Health Organization highlights the need for patient-centered care and social protection measures that alleviate the financial hardships faced by many TB patients. In China, TB treatments are paid for by earmarked government funds, social health insurance, medical assistance for the poor, and out-of-pocket payments from patients. As part of Phase III of the China-Gates TB project, this paper introduces multi-source financing of TB treatment in the three provinces of China and analyzes the challenges of moving towards universal coverage and its implications of multi-sectoral engagement for TB care.Main text:The new financing policies for TB treatment in the three provinces include increased reimbursement for TB outpatient care, linkage of TB treatment with local poverty alleviation programs, and use of local government funds to cover some costs to reduce out-of-pocket expenses. However, there are several challenges in reducing the financial burdens faced by TB patients. First, medical costs must be contained by reducing the profit-maximizing behaviors of hospitals. Second, treatment for TB and multi-drug resistant TB (MDR-TB) is only available at county hospitals and city or provincial hospitals, respectively, and these hospitals have low reimbursement rates and high co-payments. Third, many patients with TB and MDR-TB are at the edge of poverty, and therefore ineligible for medical assistance, which targets extremely poor individuals. In addition, the local governments of less developed provinces often face fiscal difficulties, making it challenging to use of local government funds to provide financial support for TB patients. We suggest that stakeholders at multiple sectors should engage in transparent and responsive communications, coordinate policy developments, and integrate resources to improve the integration of social protection schemes.Conclusions:The Chinese government is examining the establishment of multi-source financing for TB treatment by mobilization of funds from the government and social protection schemes. These efforts require strengthening the cooperation of multiple sectors and improving the accountability of different government agencies. All key stakeholders must take concrete actions in the near future to assure significant progress toward the goal of alleviating the financial burden faced by TB and MDR-TB patients.

简介：Historically,mastcellswereknownasakeycelltypeinvolvedintypeIhypersensitivity.Untillasttwodecades,thiscelltypewasrecognizedtobewidelyinvolvedinanumberofnon-allergicdiseasesincludinginflammatoryboweldisease(IBD).MarkedlyincreasednumbersofmastcellswereobservedinthemucosaoftheileumandcolonofpatientswithIBD,whichwasaccompaniedbygreatchangesofthecontentinmastcellssuchasdramaticallyincreasedexpressionofTNFα,IL-16andsubstanceP.TheevidenceofmastcelldegranulationwasfoundinthewallofintestinefrompatientswithIBDwithimmunohistochemistrytechnique.ThehighlyelevatedhistamineandtryptaselevelsweredetectedinmucosaofpatientswithIBD,stronglysuggestingthatmastcelldegranulationisinvolvedinthepathogenesisofIBD.However,littleisknownoftheactionsofhistamine,tryptase,chymaseandcarboxypeptidaseinIBD.Overthelastdecade,heparinhasbeenusedtotreatIBDinclinicalpractice.Thelowmolecularweightheparin(LMWH)waseffectiveasadjuvanttherapy,andthepatientsshowedgoodclinicalandlaboratoryresponsewithnoseriousadverseeffects.TherolesofPGD2,LTC4,PAFandmastcellcytokinesinIBDwerealsodiscussed.Recently,aseriesofexperimentswithdispersedcolonmastcellssuggestedthereshouldbeatleasttwopathwaysinmanformastcellstoamplifytheirownactivation-degranulationsignalsinanautocrineorparacrinemanner.Thehypothesisisthatmastcellsecretogoguesinducemastcelldegranulation,releasehistamine,thenstimulatetheadjacentmastcellsorpositivelyfeedbacktofurtherstimulateitshostmastcellsthroughH1receptor.Whereasreleasedtryptaseactssimilarlytohistamine,butactivatesmastcellsthroughitsreceptorPAR-2.Theconnectionsbetweencurrentanti-IBDtherapiesorpotentialtherapiesforIBDwithmastcellswerediscussed,implicatingfurtherthatmastcellisakeycelltypethatisinvolvedinthepathogenesisofIBD.Inconclusion,whilepathoge

简介：LongbeforethediscoveryofHelicobacterpylori,thereweremanyexcellentobservationalstudiesthatdocumenteddifferencesinthepatternsofgastroduodenaldisease.Itwasclearthatinthedevelopingworld,gastriculcerandgastriccancerweremorecommonthaninthedevelopedworldwhereduodenalulcerpredominated.Thiscorrelatedwiththedistributionofgastritisinduodenalulcerpatientswheretheinflammationwasantralpredominantwhileingastriculcerpatientsthegastritiswasmoreevenlydistributedthroughthestomach.Gastriculcersusuallyappearedinafairlyrestricteddistributioninthestomachneartheangulusandclosetothetransitionalzonebetweenantrumandbodymucosa.Asasocietydevelopedsothesepatternsofdiseasechanged.

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简介：摘要目的探讨对肿瘤专科120项肿瘤手术的护理配合难度进行评价，为临床手术护理工作量化考核提供依据。方法采用Delphi调查法，所有的手术名称来源于HIS系统的手术收费名称，以120项肿瘤手术配合难度系数为主体，形成专家函询表，选取山东省几家肿瘤专科医院手术室相关研究领域的专家17人，通过由一人进行发放、讲解和回收的方式，对专家进行了两轮咨询，同时专家之间不能进行任何的沟通。两轮调查后综合分析专家意见，对变异较大的项目，进行第2次专家函询，直至得到满意的结果。结果专家函询，第1轮调查中10名专家均参与，回收10份问卷，回收率为100%，有效率为100%。第2轮调查中17名专家参与，回收17份，回收率为100%，有效率为100%。专家最小权威系数为0.9。两轮函询中，函询的变异系数均<0.35，协调系数为0.821和0.953，结果可靠。结论通过对肿瘤手术难度系数的调整和排序，护士可以参照难度系数值对自己的收费项目进行核对，减少差错；同时，可以加快手术的衔接，促进医院手术台次的周转，促进手术护理管理和护理教学的发展。

简介：冬天来了，这给服装商们带来了好运，各式的冬装立即走俏起来。母亲在商场给我选了件羽绒服，穿上的感觉很好，暖和得似乎可以催眠，最后我说不行，太暖和了。我的这个理由让卖服装的营业员笑了起来。是啊，冬衣就是要暖和，越暖和越好，我却嫌太暖和？

简介：妻子是长女，从小家住农村，兄妹多，家务重。于是插秧种菜出苦力，烧茶煮饭带弟妹，艰苦的劳作便落在她的身上。于是便养成了风风火火的性格，粗嗓门说话，命令式叫人，不知温柔为何物，更不知世上有幽默二字。婚后从她那里领略到的爱都是辛辣的。

简介：AbstractBackground:The global prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The pathogenesis of NAFLD is multifaceted, and the underlying mechanisms are elusive. We conducted data mining analysis to gain a better insight into the disease and to identify the hub genes associated with the progression of NAFLD.Methods:The dataset GSE49541, containing the profile of 40 samples representing mild stages of NAFLD and 32 samples representing advanced stages of NAFLD, was acquired from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using the R programming language. The Database for Annotation, Visualization and Integrated Discovery (DAVID) online tool and Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database were used to perform the enrichment analysis and construct protein-protein interaction (PPI) networks, respectively. Subsequently, transcription factor networks and key modules were identified. The hub genes were validated in a mice model of high fat diet (HFD)-induced NAFLD and in cultured HepG2 cells by real-time quantitative PCR.Results:Based on the GSE49541 dataset, 57 DEGs were selected and enriched in chemokine activity and cellular component, including the extracellular region. Twelve transcription factors associated with DEGs were indicated from PPI analysis. Upregulated expression of five hub genes (SOX9, CCL20, CXCL1, CD24, and CHST4), which were identified from the dataset, was also observed in the livers of HFD-induced NAFLD mice and in HepG2 cells exposed to palmitic acid or advanced glycation end products.Conclusion:The hub genes SOX9, CCL20, CXCL1, CD24, and CHST4 are involved in the aggravation of NAFLD. Our results offer new insights into the underlying mechanism of NAFLD progression.

简介：<正>InstituteofOtolaryngologyofChinesePLA(KeyLaboratoryforthePreventionofAcousticTrauma,PLA)KeyLaboratoryofHearingImpairmentScience(ChinesePLAMedicalSchool)MinistryofEducationLedbyfourgenerationsofleadershipfromlateProf.JIANGSichang(academician,ChineseAcademyofEngineering),Prof.YANGWeiyan(HonoraryPresident,DivisionofOtolaryngology

简介：摘要骨不连为骨治疗的严重晚期并发症，凡骨折后6个月骨折两端未达到骨性连接为骨不连，骨折后一旦发生骨不连将对患肢的功能康复有着极大的影响，而骨不连术后骨仍不愈合对患者的身心产生极其严重的影响。这类病例原因很多，其治疗的要求很缜密。