简介：BackgroundDuringprimarypercutaneouscoronaryintervention(PCI),manualthrombectomymayreducedistalembolizationandthusimprovemicrovascularperfusion.Smalltrialshavesuggestedthatthrombectomyimprovessurrogateandclinicaloutcomes,butalargertrialhasreportedconflictingresults.MethodsWerandomlyassigned10,732patientswithST-segmentelevationmyocardialinfarction(STEMI)undergoingprimaryPCItoastrategyofroutineupfrontmanualthrombectomyversusPCIalone.Theprimaryoutcomewasacompositeofdeathfromcardiovascularcauses,recurrentmyocardialinfarction,cardiogenicshock,orNewYorkHeartAssociation(NYHA)classIVheartfailurewithin180days.Thekeysafetyoutcomewasstrokewithin30days.ResultsTheprimaryoutcomeoccurredin347of5033patients(6.9%)inthethrombectomygroupversus351of5030patients(7.0%)inthePCI-alonegroup(hazardratiointhethrombectomygroup,0.99;95%confidenceinterval[CI],0.85to1.15;P=0.86).Theratesofcardiovasculardeath(3.1%withthrombectomyvs.3.5%withPCIalone;hazardratio,0.90;95%CI,0.73to1.12;P=0.34)andtheprimaryoutcomeplusstentthrombosisortarget-vesselrevascularization(9.9%vs.9.8%;hazardratio,1.00;95%CI,0.89to1.14;P=0.95)werealsosimilar.Strokewithin30daysoccurredin33patients(0.7%)inthethrombectomygroupversus16patients(0.3%)inthePCI-alonegroup(hazardratio,2.06;95%CI,1.13to3.75;P=0.02).ConclusionsInpatientswithSTEMIwhowereundergoingprimaryPCI,routinemanualthrombectomy,ascomparedwithPCIalone,didnotreducetheriskofcardiovasculardeath,recurrentmyocardialinfarction,cardiogenicshock,orNYHAclassIVheartfailurewithin180daysbutwasassociatedwithanincreasedrateofstrokewithin30days.

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简介：Canprogesteronebeabetteralternativetodexamethasoneforuseinroutinebrainsurgery?Surgicalbraininjury(SBI)isaformofbraintraumacausedbyvariousformsofneurosurgicalinterventionsincludingbraintumorexcision,evacuationofintracerebralhemorrhageandbrainlobectomy(e.g.,inepilepsysurgery).CerebraledemaandbrainswellingtypicallyoccurssoonafterSBIandcommonlypeaksonpost-operativedays3to7.SBImaycause

简介：Todeterminethevalueofdissectingtherecurrentlaryngealnerveduringthyroidsurgerywithrespecttopreventingrecurrentlaryngealnerveinjury,weretrospectivelyanalyzedclinicaldatafrom5344patientsundergoingthyroidectomy.Amongthesecases,548underwentdissectionoftherecurrentlaryngealnerve,while4796didnot.Therewere12casesofrecurrentlaryngealnerveinjuryfollowingrecurrentlaryngealnervedissection(injuryrateof2.2%)and512casesofrecurrentlaryngealnerveinjuryinthosenotundergoingnervedissection(injuryrateof10.7%).Thisdifferenceremainedstatisticallysignificantbetweenthetwogroupsintermsoftypeofthyroiddisease,typeofsurgery,andnumberofsurgeries.Amongthe548casesundergoingrecurrentlaryngealnervedissection,128developedanatomicalvariationsoftherecurrentlaryngealnerve(incidencerateof23.4%),butnorecurrentlaryngealnerveinjurywasfound.Inaddition,theincidenceofrecurrentlaryngealnerveinjurywassignificantlylowerinpatientswiththeinferiorparathyroidglandandmiddlethyroidveinsusedaslandmarksforlocatingtherecurrentlaryngealnervecomparedwiththosewiththeentryoftherecurrentlaryngealnerveintothelarynxasalandmark.Thesefindingsindicatethatanatomicalvariationsoftherecurrentlaryngealnervearecommon,andthatdissectingtherecurrentlaryngealnerveduringthyroidsurgeryisaneffectivemeansofpreventingnerveinjury.

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简介：ConstraintsfromP-Tpseudosections(MnNCKFMASHsystem),foliationintersection/inflectionaxespreservedinporphyroblasts(FIAs),mineralassemblagesandtexturalrelationshipsforrockscontainingallthreeAl2SiO5polymorphsindicateakyanite→andalusite→sillimanitesequentialformationatdifferenttimesratherthanstablecoexistenceattheAl2SiO5triplepoint.AllthreeAl2SiO5polymorphsgrewintheChl,Bt,Ms,Grt,St,PlandCrdbearingOrdovicianClayholeSchistinBalcooma,northeasternAustraliaseparatelyalongaloopedP-T-t-Dpaththatswapsfromclockwisetoanticlockwiseinthetectono-metamorphichistoryoftheregion.KyanitegrewduringcrustalthickeninginanEarlySilurianOrogeniceventfollowedbydecompression/heating,andalusiteandfibroliticsillimanitegrowthduringEarlyDevonianexhumation.

简介：Objectives:TocharacterizethedistributionpatternofbiovarsandserotypesofUreaplasmaurealyticuminnormalhealthywomen,sexuallytransmittedinfectionsclinicclients,andinsexworkers.Methods:Weculturedcervicalswabstakenfrom261physicalcheck-upclients,599STIclinicoutpatientsand98sexworkersusingcommercialselectivemedium.SomepositivecultureswerefurtherbiotypedandserotypedbyPCR.Results:(1)U.urealyticumismorecommonlyisolatedinsexworkers(90.8%)thaninthephysicalcheck-upgroup(60.9%)ortheSTIoutpatientgroup(61.3%)(P<0.001).(2)Biovar1ofU.urealyticum(95.0%),especiallysingleinfectionofserotype1,3,and6ofbiovar1,iscommonlyfoundinhealthywomen.(3)Biovar2infectionofU.urealyticumismoreprevalentinsexworkers(28.1%)andSTIoutpatientsgroup(26.6%)thanthatinthephysicalcheck-upgroup(4.9%)(P<0.001).(4)MixedinfectioncausedbymorethanoneserotypeofU.urealyticumincreasedfromphysicalcheck-upgroup(8.6%)toSTIoutpatients(12.4%)tosexworkers(23.9%)(P<0.01).(5)Thereisnostatisticallysignificantdifferenceinthedistributionofserotype1,3,and6ofbiovar1amongthesethreegroups(P=0.763).(6)ThePCRmethoddescribedhereisrelativelysimple,rapidandspecificforthebiotypingandserotypingofbiovar1ofU.urealyticum.Conclusion:Weshouldpaymoreattentiontobiovar2andmixedinfectionsofU.urealyticumthansingleinfectionofbiovar1inclinicpractice.PCRisagoodmethodforbiotypingandserotyping.

简介：摘要：本文探讨了在小学英语中，如何以核心素养为导向，进行整体作业设计的方法和实践。首先，明确了方法论的五个关键步骤，包括明确核心素养目标、具体化目标、创设作业情境、制定评分标准，以及诊断和优化作业。然后，通过以“Daily routine”为例的实际单元，详细展示了如何在作业设计中培养学生的语言能力、文化意识、思维品质和学习能力。通过分层次的作业设计，学生能够从多个角度深入学习“日常作息”话题，促进了他们对语言和文化的全面理解和应用，以提升学生的核心素养。