The history of the formation and development of Chinese civilization is also a civilization history of water conservancy. Water not only gives birth to Chinese civilization but also gives birth to the unique regional ...The history of the formation and development of Chinese civilization is also a civilization history of water conservancy. Water not only gives birth to Chinese civilization but also gives birth to the unique regional culture in Lingnan. In the past thousands of year, from the ancient myths and legends of Lingnan water conservancy culture to the digging of efficacious Canal＇s integration of the nationalities in Lingnan, to the blending of water and culture of the Xijiang River and the North River of the Zhujiang water system and the formation of urban river culture, development of its generation, deduction and inheritance has the mutual penetration with the formation of water system and the variation of water conservancy which mutually influence the historical evolvement of Lingnan regional culture.展开更多
In this paper, we apply the tunneling of massive particle through the quantum horizon of a Schwarzschild black hole in noncommutative spaeetime. The tunneling effects lead to modified Hawking radiation due to inclusio...In this paper, we apply the tunneling of massive particle through the quantum horizon of a Schwarzschild black hole in noncommutative spaeetime. The tunneling effects lead to modified Hawking radiation due to inclusion of back-reaction effects. Our calculations show also that noncommutativity effects cause the further modifications to the thermodynamical relations in black hole. We calculate the emission rate of the massive particles＇ tunneling from a Schwarzschild black hole which is modified on account of noncommutativity influences. The issues of information loss and possible correlations between emitted particles are discussed. Unfortunately even by considering noneommutativity view point, there is no correlation between different modes of evaporation at least at late-time. Nevertheless, as a result of spacetime noncommutativity, information may be conserved by a stable black hole remnant.展开更多
Inflammatory bowel diseases(IBD),including ulcerative colitis(UC) and Crohn's disease(CD),are chronic,progressive and disabling disorders.Over the last few decades,new therapeutic approaches have been introduced w...Inflammatory bowel diseases(IBD),including ulcerative colitis(UC) and Crohn's disease(CD),are chronic,progressive and disabling disorders.Over the last few decades,new therapeutic approaches have been introduced which have led not only to a reduction in the mortality rate but also offered the possibility of a favorable modification in the natural history of IBD.The identification of clinical,genetic and serological prognostic factors has permitted a better stratification of the disease,thus allowing the opportunity to indicate the most appropriate therapy.Early treatment with immunosuppressive drugs and biologics has offered the opportunity to change,at least in the short term,the course of the disease by reducing,in a subset of patients with IBD,hospitalization and the need for surgery.In this review,the crucial steps in the natural history of both UC and CD will be discussed,as well as the factors that may change their clinical course.The methodological requirements for high quality studies on the course and prognosis of IBD,the true impact of environmental and dietary factors on the clinical course of IBD,the clinical,serological and genetic predictors of the IBD course(in particular,which of these are rel-evant and appropriate for use in clinical practice),the impact of the various forms of medical treatment on the IBD complication rate,the role of surgery for IBD in the biologic era,the true magnitude of risk of colorectal cancer associated with IBD,as well as the mortality rate related to IBD will be stressed;all topics that are extensively discussed in separate reviews included in this issue of World Journal of Gastroenterology.展开更多
In this paper, the author examines the possibilities of leisure （studies） in Mozambique. First, the author suggests that leisure can he looked at as a social construct which resulted from the colonial regulation of ...In this paper, the author examines the possibilities of leisure （studies） in Mozambique. First, the author suggests that leisure can he looked at as a social construct which resulted from the colonial regulation of native labour, particularly between 1890s and 1974. Secondly, the author proposes that people look at the conditions of possibility of leisure in a context dominated by the new moral code of conduct, a cathartic purification of the colonial mentality, introduced through the ideology of the ＂New Man＂ created by the ruling party, Frelimo. Thirdly, the author examines the possibility of leisure in the context of Mozambique＇s adherence to neo-liberalism and market-driven economy after the collapse of socialism. The author concludes by providing the ground to establish lines of inquiry for an eventual field of leisure studies.展开更多
Fixed-time control of traffic signals pursues the regulation of phases based on historical data of traffic demand, in this way, neglecting of the random arrival rates of traffic flow on different intersection streams ...Fixed-time control of traffic signals pursues the regulation of phases based on historical data of traffic demand, in this way, neglecting of the random arrival rates of traffic flow on different intersection streams causes increasing of the stops and delays and fuel consumption at the same time. Coordinated semi-actuated control due to ability to respond traffic demands on both main and secondary directions, based on road detector registration saves the coordinated features, serving the unused time to the main road, while the secondary clears early. In this paper, the authors analyzed and explained comparatively the results of LOS （level of service） parameters of the current state of control （fixed-time） with the proposed control （semi-actuated coordinated） of the artery of length 2,348 km consisted of four signalized T intersections. Highway Capacity Manual and Synchro/Sim Traffic software are used for analysis and optimization of parameters in this paper.展开更多
Human experience can best be understood in the framework of collective social relations. Like any other tie, the mother-daughter relationship is forged not in isolation but informed by cultural, historical, and social...Human experience can best be understood in the framework of collective social relations. Like any other tie, the mother-daughter relationship is forged not in isolation but informed by cultural, historical, and social values, circumstances, and practices. The twentieth century has witnessed the greatest changes in world history. As an outcome of the noticeable shift in gender ideologies in the last half of that century, modern mothers and daughters struggled to experience a union, a bond, an understanding of themselves and the world around them. Clash of tradition and modernity in ideals and mores can be held accountable for the consequential neurotic development of the psyche in twentieth century mothers and daughters. Doris Lessing＇s writings reflect the way in which these complex changes in society affect family relationships. Her first novel of the Children of Violence series, Martha Quest, is an apt study of a mother and her daughter＇s struggle with their newly defined roles in society. This paper will seek to examine the conflicts that are encountered in the wake of such adjustments by contemporary mothers and daughters. In order to do so, the study will focus on an exploration of the kind of issues that Martha Quest and May Quest experience in Lessing＇s Martha Quest through approaches available in works by Carl Jung on his theory of the ＂mother complex＂.展开更多
AFuller makes the morality be divided into two groups of morality in the book ＂The Morality of Law＂ . One group is the desiderative morality and compulsory morality, and other group is innernal and external morality...AFuller makes the morality be divided into two groups of morality in the book ＂The Morality of Law＂ . One group is the desiderative morality and compulsory morality, and other group is innernal and external morality of law. The desiderative morality is the good morality with life, excellent morality and the morality which can make human＇ s power be fully realized. The author makes the interactive relationship between innernal morality and external morality be explained that there is experience contact about innernal and external morality of law. The explanation about this kind of experience relationship conforms with the position of the sociology of law which is definited by Fuller in law. In addition, seen from the practical experience and historical experience of human, this kind of explanation not only conforms with the demand of human practice but also conforms with the reality at the same time. There is also some significance which can be reference for us to discuss how to conduct the law practice.展开更多
We examined IgE levels in 4,312 samples of umbilical blood taken from children born into families with a positive history of allergy in one or both parents from 1998-2015. At the age often days, those with high IgE we...We examined IgE levels in 4,312 samples of umbilical blood taken from children born into families with a positive history of allergy in one or both parents from 1998-2015. At the age often days, those with high IgE were given Colinfant Newborn （a lyophilized non-pathogenic strain of E. coli） for one month, three times weekly. At 15 months and three years we investigated the levels of IgE, IgA and IgG, and the incidence of illness and allergy. The results revealed that allergy and high umbilical IgE is strongly linked with family history （p 〈 0.001）. We also detected differences in seasonality, especially with regards to pollen allergies. About 80% of children treated with Colinfant had significantly reduced IgE and morbidity at 13-15 months and 3 years, and furthermore without any clinical signs of allergy. Surprisingly 20% of treated children did not have reduced IgE, and yet they did not have any clinical signs of allergy. Normalization of IgA and IgG was seen in 90% of treated subjects （p 〈 0.001）. These levels significantly are correlated with an almost negligible morbidity up to 4 years of life. Our study strongly suggests a positive effect of physiological E. coli on the microbiome of children as evidenced by a significantly reduced incidence of allergy and morbidity when applied early in life.展开更多
The Chinese road has deep historical roots. Its most striking feature is that it is marked by historical continuity rather than rupture, and the main force behind this continuity is its intrinsic dynamism and vitality...The Chinese road has deep historical roots. Its most striking feature is that it is marked by historical continuity rather than rupture, and the main force behind this continuity is its intrinsic dynamism and vitality. Unlike the paradigm of Eurocentrism or ＂Discovering History in China,＂ the comparative analytical paradigm discovers China through long-term comparisons with corresponding countries in the same time and space in an effort to find positive elements in the history of the Chinese road and to refute the long prevalent theory of Chinese stagnation. Seen over the course of world history, the impetus for the creation of the world＇s most brilliant agrarian civilization was endogenous. This impetus was not a momentary ＂explosive force＂ but a sustainable institutional drive whose main constituents were the independent farming household, endogenous government capacity and adaptive national governance. In addition to the main theme of ＂permanent change,＂ Chinese development had a secondary theme of ＂cyclical change＂ which cannot be ignored. The roots of Chinese development are buried deep in the genes of this agrarian nation in the form of sticky institutions, bureaucratic inertia, arbitrary power, etc. Historical continuity provided a foundation for China＇s creative revolution and development in modern times, ultimately laying down a socialist development road with Chinese characteristics, although this remains an unfinished relay process.展开更多
Primates have been found to differ widely in their taste perception and studies suggest that a coevolution between plant species bearing a certain taste substance and primate species feeding on these plants may contri...Primates have been found to differ widely in their taste perception and studies suggest that a coevolution between plant species bearing a certain taste substance and primate species feeding on these plants may contribute to such between-species differences. Considering that only platyrrhine primates, but not catarrhine or prosimian primates, share an evolutionary history with the neotrop- ical plant Stevia rebaudiana, we assessed whether members of these three primate taxa differ in their ability to perceive and/or in their sensitivity to its two quantitatively predominant sweet- tasting substances. We found that not only neotropical black-handed spider monkeys, but also paleotropical black-and-white ruffed lemurs and Western chimpanzees are clearly able to perceive stevioside and rebaudioside A. Using a two-bottle preference test of short duration, we found that Ateles geoffroyi preferred concentrations as low as 0.05 mM stevioside and 0.01 mM rebaudioside A over tap water. Taste preference thresholds of Pan troglodytes were similar to those of the spider monkeys, with 0.05 mM for stevioside and 0.03 mM for rebaudioside A, whereas Varecia variegata was slightly less sensitive with a threshold value of 0.1 mM for both substances. Thus, all three primate species are, similar to human subjects, clearly more sensitive to both steviol glycosides compared to sucrose. Only the spider monkeys displayed concentration-response curves with both stevioside and rebaudioside A which can best be described as an inverted U-shaped function sug- gesting that Ateles geoffroyi, similar to human subjects, may perceive a bitter side taste at higher concentrations of these substances. Taken together, the results of the present study do not support the notion that a co-evolution between plant and primate species may account for between-species differences in taste perception of steviol glycosides.展开更多
The historical records of astronomical phenomena may play a significant role in comet identification.Getting an accurate result is based on many factors,of which the calculation of orbital elements is the most importa...The historical records of astronomical phenomena may play a significant role in comet identification.Getting an accurate result is based on many factors,of which the calculation of orbital elements is the most important.This paper presents a "Cross Reference" method in which the perturbation of Jupiter is the only considered factor used to attempt an efficient way of comet identification with ancient Chinese historical records.In this method,the records before and after the calculated result from orbital determination within the error range are compared with the historical records to find the correlated perihelion time,and then,with five other orbital elements at the perihelion time,the ephemeris is calculated.If the calculated ephemeris matches the historical records,it is concluded that the comet determined by orbital calculation is the same as the one recorded in history.With this method,three comets with four historical records have already been found.展开更多
Purpose： Flail chest （FC） injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being chall...Purpose： Flail chest （FC） injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre （MTC）. Methods： A retrospective cohort analysis has been conducted at an MTC with full trauma service. All patients （age 〉 16 years） sustaining FC were included. Patient demographics, injury characteristics and inpatient stay information were extracted. Results： Two hundred and ninety-three patients were identified, with a mean injury severity score （ISS） of 28.9 （range 9-75）, average age of 56.1 years （range of 16-100）, and a male predominance （78%）. Road traffic accidents accounted for 45% （n = 132） of injuries, whilst 44% were fall or jump from height （n = 129）. Associated lung contusion was present in 133 patients （45%） while 76% of patients were found to have 5 or more ribs involved in the flail segment （n = 223） with 96% （n = 281 ） having a unilateral FC. Inpatient treatment was required 19.9 days （range 0-150 days） with 59% of patients （n = 173） requiring intensive care unit （ICU） level care for 8.4 days （range 1-63） with 61.8% requiring mechanical ventilation （n = 107） for 10.5 days （range 1-54）, and Z8g underwent rib fixation with rib plates （n = 23）. The mortality rate was found to be 14% （n = 42）. A non-significant trend towards improved outcomes in the conservative group was found when compared with the fixation group; ventilation days （6.94 vs 10.06, p = 0.18） intensive treatment unit （ITU） length of stay （LOS） （12.56 vs 15.53, p = 0.28） and hospital LOS （32.62 vs 35.24, p = 0.69）. Conclusion： This study has successfully described the natural history of flail chest injuries, and has found a nonsignificant trend towards better outcomes with conservative management. With the cohort and management challenges now defined, work on outcome improvement can be targeted. In addition the comnarahility of results to other studies makes collaboration with other MTCs a realistic vrovosal.展开更多
China is now in an era of multiple values. While there is some virtue in previous theories on the history of literature based on the theory of evolution, class struggle and the enlightenment, when it comes to the twen...China is now in an era of multiple values. While there is some virtue in previous theories on the history of literature based on the theory of evolution, class struggle and the enlightenment, when it comes to the twenty-first century, the histories of modem Chinese literature used in teaching are farfrom adequate for meeting the developmental needs of the times, society and literature. This is especially so in view of the putting forward of the goals of ＂putting people first＂ and ＂the harmonious society,＂ and the great changes taking place in time and space, the function of literature and aesthetic taste. Hence there is an urgent need to restructure this history and establish a more fair, equal and reasonable system of evaluation. Such a system would have humanism as its highest principle, and truth, goodness and beauty as its three virtues. Its great superiority would be its functional characteristics of universality, transcendence, fairness, and human-centeredness.展开更多
文摘The history of the formation and development of Chinese civilization is also a civilization history of water conservancy. Water not only gives birth to Chinese civilization but also gives birth to the unique regional culture in Lingnan. In the past thousands of year, from the ancient myths and legends of Lingnan water conservancy culture to the digging of efficacious Canal＇s integration of the nationalities in Lingnan, to the blending of water and culture of the Xijiang River and the North River of the Zhujiang water system and the formation of urban river culture, development of its generation, deduction and inheritance has the mutual penetration with the formation of water system and the variation of water conservancy which mutually influence the historical evolvement of Lingnan regional culture.
文摘In this paper, we apply the tunneling of massive particle through the quantum horizon of a Schwarzschild black hole in noncommutative spaeetime. The tunneling effects lead to modified Hawking radiation due to inclusion of back-reaction effects. Our calculations show also that noncommutativity effects cause the further modifications to the thermodynamical relations in black hole. We calculate the emission rate of the massive particles＇ tunneling from a Schwarzschild black hole which is modified on account of noncommutativity influences. The issues of information loss and possible correlations between emitted particles are discussed. Unfortunately even by considering noneommutativity view point, there is no correlation between different modes of evaporation at least at late-time. Nevertheless, as a result of spacetime noncommutativity, information may be conserved by a stable black hole remnant.
文摘Inflammatory bowel diseases(IBD),including ulcerative colitis(UC) and Crohn's disease(CD),are chronic,progressive and disabling disorders.Over the last few decades,new therapeutic approaches have been introduced which have led not only to a reduction in the mortality rate but also offered the possibility of a favorable modification in the natural history of IBD.The identification of clinical,genetic and serological prognostic factors has permitted a better stratification of the disease,thus allowing the opportunity to indicate the most appropriate therapy.Early treatment with immunosuppressive drugs and biologics has offered the opportunity to change,at least in the short term,the course of the disease by reducing,in a subset of patients with IBD,hospitalization and the need for surgery.In this review,the crucial steps in the natural history of both UC and CD will be discussed,as well as the factors that may change their clinical course.The methodological requirements for high quality studies on the course and prognosis of IBD,the true impact of environmental and dietary factors on the clinical course of IBD,the clinical,serological and genetic predictors of the IBD course(in particular,which of these are rel-evant and appropriate for use in clinical practice),the impact of the various forms of medical treatment on the IBD complication rate,the role of surgery for IBD in the biologic era,the true magnitude of risk of colorectal cancer associated with IBD,as well as the mortality rate related to IBD will be stressed;all topics that are extensively discussed in separate reviews included in this issue of World Journal of Gastroenterology.
文摘In this paper, the author examines the possibilities of leisure （studies） in Mozambique. First, the author suggests that leisure can he looked at as a social construct which resulted from the colonial regulation of native labour, particularly between 1890s and 1974. Secondly, the author proposes that people look at the conditions of possibility of leisure in a context dominated by the new moral code of conduct, a cathartic purification of the colonial mentality, introduced through the ideology of the ＂New Man＂ created by the ruling party, Frelimo. Thirdly, the author examines the possibility of leisure in the context of Mozambique＇s adherence to neo-liberalism and market-driven economy after the collapse of socialism. The author concludes by providing the ground to establish lines of inquiry for an eventual field of leisure studies.
文摘Fixed-time control of traffic signals pursues the regulation of phases based on historical data of traffic demand, in this way, neglecting of the random arrival rates of traffic flow on different intersection streams causes increasing of the stops and delays and fuel consumption at the same time. Coordinated semi-actuated control due to ability to respond traffic demands on both main and secondary directions, based on road detector registration saves the coordinated features, serving the unused time to the main road, while the secondary clears early. In this paper, the authors analyzed and explained comparatively the results of LOS （level of service） parameters of the current state of control （fixed-time） with the proposed control （semi-actuated coordinated） of the artery of length 2,348 km consisted of four signalized T intersections. Highway Capacity Manual and Synchro/Sim Traffic software are used for analysis and optimization of parameters in this paper.
文摘Human experience can best be understood in the framework of collective social relations. Like any other tie, the mother-daughter relationship is forged not in isolation but informed by cultural, historical, and social values, circumstances, and practices. The twentieth century has witnessed the greatest changes in world history. As an outcome of the noticeable shift in gender ideologies in the last half of that century, modern mothers and daughters struggled to experience a union, a bond, an understanding of themselves and the world around them. Clash of tradition and modernity in ideals and mores can be held accountable for the consequential neurotic development of the psyche in twentieth century mothers and daughters. Doris Lessing＇s writings reflect the way in which these complex changes in society affect family relationships. Her first novel of the Children of Violence series, Martha Quest, is an apt study of a mother and her daughter＇s struggle with their newly defined roles in society. This paper will seek to examine the conflicts that are encountered in the wake of such adjustments by contemporary mothers and daughters. In order to do so, the study will focus on an exploration of the kind of issues that Martha Quest and May Quest experience in Lessing＇s Martha Quest through approaches available in works by Carl Jung on his theory of the ＂mother complex＂.
文摘AFuller makes the morality be divided into two groups of morality in the book ＂The Morality of Law＂ . One group is the desiderative morality and compulsory morality, and other group is innernal and external morality of law. The desiderative morality is the good morality with life, excellent morality and the morality which can make human＇ s power be fully realized. The author makes the interactive relationship between innernal morality and external morality be explained that there is experience contact about innernal and external morality of law. The explanation about this kind of experience relationship conforms with the position of the sociology of law which is definited by Fuller in law. In addition, seen from the practical experience and historical experience of human, this kind of explanation not only conforms with the demand of human practice but also conforms with the reality at the same time. There is also some significance which can be reference for us to discuss how to conduct the law practice.
文摘We examined IgE levels in 4,312 samples of umbilical blood taken from children born into families with a positive history of allergy in one or both parents from 1998-2015. At the age often days, those with high IgE were given Colinfant Newborn （a lyophilized non-pathogenic strain of E. coli） for one month, three times weekly. At 15 months and three years we investigated the levels of IgE, IgA and IgG, and the incidence of illness and allergy. The results revealed that allergy and high umbilical IgE is strongly linked with family history （p 〈 0.001）. We also detected differences in seasonality, especially with regards to pollen allergies. About 80% of children treated with Colinfant had significantly reduced IgE and morbidity at 13-15 months and 3 years, and furthermore without any clinical signs of allergy. Surprisingly 20% of treated children did not have reduced IgE, and yet they did not have any clinical signs of allergy. Normalization of IgA and IgG was seen in 90% of treated subjects （p 〈 0.001）. These levels significantly are correlated with an almost negligible morbidity up to 4 years of life. Our study strongly suggests a positive effect of physiological E. coli on the microbiome of children as evidenced by a significantly reduced incidence of allergy and morbidity when applied early in life.
文摘The Chinese road has deep historical roots. Its most striking feature is that it is marked by historical continuity rather than rupture, and the main force behind this continuity is its intrinsic dynamism and vitality. Unlike the paradigm of Eurocentrism or ＂Discovering History in China,＂ the comparative analytical paradigm discovers China through long-term comparisons with corresponding countries in the same time and space in an effort to find positive elements in the history of the Chinese road and to refute the long prevalent theory of Chinese stagnation. Seen over the course of world history, the impetus for the creation of the world＇s most brilliant agrarian civilization was endogenous. This impetus was not a momentary ＂explosive force＂ but a sustainable institutional drive whose main constituents were the independent farming household, endogenous government capacity and adaptive national governance. In addition to the main theme of ＂permanent change,＂ Chinese development had a secondary theme of ＂cyclical change＂ which cannot be ignored. The roots of Chinese development are buried deep in the genes of this agrarian nation in the form of sticky institutions, bureaucratic inertia, arbitrary power, etc. Historical continuity provided a foundation for China＇s creative revolution and development in modern times, ultimately laying down a socialist development road with Chinese characteristics, although this remains an unfinished relay process.
文摘Primates have been found to differ widely in their taste perception and studies suggest that a coevolution between plant species bearing a certain taste substance and primate species feeding on these plants may contribute to such between-species differences. Considering that only platyrrhine primates, but not catarrhine or prosimian primates, share an evolutionary history with the neotrop- ical plant Stevia rebaudiana, we assessed whether members of these three primate taxa differ in their ability to perceive and/or in their sensitivity to its two quantitatively predominant sweet- tasting substances. We found that not only neotropical black-handed spider monkeys, but also paleotropical black-and-white ruffed lemurs and Western chimpanzees are clearly able to perceive stevioside and rebaudioside A. Using a two-bottle preference test of short duration, we found that Ateles geoffroyi preferred concentrations as low as 0.05 mM stevioside and 0.01 mM rebaudioside A over tap water. Taste preference thresholds of Pan troglodytes were similar to those of the spider monkeys, with 0.05 mM for stevioside and 0.03 mM for rebaudioside A, whereas Varecia variegata was slightly less sensitive with a threshold value of 0.1 mM for both substances. Thus, all three primate species are, similar to human subjects, clearly more sensitive to both steviol glycosides compared to sucrose. Only the spider monkeys displayed concentration-response curves with both stevioside and rebaudioside A which can best be described as an inverted U-shaped function sug- gesting that Ateles geoffroyi, similar to human subjects, may perceive a bitter side taste at higher concentrations of these substances. Taken together, the results of the present study do not support the notion that a co-evolution between plant and primate species may account for between-species differences in taste perception of steviol glycosides.
基金supported by theNational Natural Science Foundation of China (Grant No.10821061)the National Basic Research Program of China (Grant No.2007CB815103)
文摘The historical records of astronomical phenomena may play a significant role in comet identification.Getting an accurate result is based on many factors,of which the calculation of orbital elements is the most important.This paper presents a "Cross Reference" method in which the perturbation of Jupiter is the only considered factor used to attempt an efficient way of comet identification with ancient Chinese historical records.In this method,the records before and after the calculated result from orbital determination within the error range are compared with the historical records to find the correlated perihelion time,and then,with five other orbital elements at the perihelion time,the ephemeris is calculated.If the calculated ephemeris matches the historical records,it is concluded that the comet determined by orbital calculation is the same as the one recorded in history.With this method,three comets with four historical records have already been found.
文摘Purpose： Flail chest （FC） injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre （MTC）. Methods： A retrospective cohort analysis has been conducted at an MTC with full trauma service. All patients （age 〉 16 years） sustaining FC were included. Patient demographics, injury characteristics and inpatient stay information were extracted. Results： Two hundred and ninety-three patients were identified, with a mean injury severity score （ISS） of 28.9 （range 9-75）, average age of 56.1 years （range of 16-100）, and a male predominance （78%）. Road traffic accidents accounted for 45% （n = 132） of injuries, whilst 44% were fall or jump from height （n = 129）. Associated lung contusion was present in 133 patients （45%） while 76% of patients were found to have 5 or more ribs involved in the flail segment （n = 223） with 96% （n = 281 ） having a unilateral FC. Inpatient treatment was required 19.9 days （range 0-150 days） with 59% of patients （n = 173） requiring intensive care unit （ICU） level care for 8.4 days （range 1-63） with 61.8% requiring mechanical ventilation （n = 107） for 10.5 days （range 1-54）, and Z8g underwent rib fixation with rib plates （n = 23）. The mortality rate was found to be 14% （n = 42）. A non-significant trend towards improved outcomes in the conservative group was found when compared with the fixation group; ventilation days （6.94 vs 10.06, p = 0.18） intensive treatment unit （ITU） length of stay （LOS） （12.56 vs 15.53, p = 0.28） and hospital LOS （32.62 vs 35.24, p = 0.69）. Conclusion： This study has successfully described the natural history of flail chest injuries, and has found a nonsignificant trend towards better outcomes with conservative management. With the cohort and management challenges now defined, work on outcome improvement can be targeted. In addition the comnarahility of results to other studies makes collaboration with other MTCs a realistic vrovosal.
文摘China is now in an era of multiple values. While there is some virtue in previous theories on the history of literature based on the theory of evolution, class struggle and the enlightenment, when it comes to the twenty-first century, the histories of modem Chinese literature used in teaching are farfrom adequate for meeting the developmental needs of the times, society and literature. This is especially so in view of the putting forward of the goals of ＂putting people first＂ and ＂the harmonious society,＂ and the great changes taking place in time and space, the function of literature and aesthetic taste. Hence there is an urgent need to restructure this history and establish a more fair, equal and reasonable system of evaluation. Such a system would have humanism as its highest principle, and truth, goodness and beauty as its three virtues. Its great superiority would be its functional characteristics of universality, transcendence, fairness, and human-centeredness.
