世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来...世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来教授?该标准对现有课程框架的教学内容及教学重点将产生怎样的影响?中国及世界英语教学理论与实践的研究表明,以传播中国,沟通世界为目的的中国外语教学,应该理性地选择世界范围内认可度最高的规范作为教授标准,并与时俱进,更新教学内容;从评价输出角度来说,应转变教学理念,聚焦信息交流的可理解度,将教学重点转向韵律。师生均需拓宽视野,培养世界胸怀,培养国际交流中对待地域及社会变体的积极的语言态度。展开更多
Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates o...Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.展开更多
Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's...The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's day, showing on the one hand the corruption, injustice, ava rice, lust, faction, perfidiousness and cruelty among the ruling classes, and on the other hand the miseries of the oppressed.展开更多
AIM:To study the implementation of an enhanced recovery after surgery(ERAS)program at a large University Hospital from"pilot study"to"standard of care".METHODS:The study was designed as a prospecti...AIM:To study the implementation of an enhanced recovery after surgery(ERAS)program at a large University Hospital from"pilot study"to"standard of care".METHODS:The study was designed as a prospective single centre cohort study.A prospective evaluation of compliance to a protocol based on full application of all ERAS principles,through the progressive steps of its implementation,was performed.Results achieved in the initial pilot study conducted by a dedicated team(n=47)were compared to those achieved in the shared protocol phase(n=143)three years later.Outcomes were length of postoperative hospital stay,readmission rate,compliance to the protocol and morbidity.Primary endpoint was the description of the results and the identification of critical issues of large scale implementation of an ERAS program in colorectal surgery emerged in the experience of a single center.Secondary endpoint was the identification of interventions that have been proven to be effective for facilitating the transition from traditional care pathways to a multimodal management protocol according to ERAS principles in colorectal surgery at a single center.RESULTS:During the initial pilot study(March 2009 to December 2010;47 patients)conducted by a dedicated multidisciplinary team,compliance to the items of ERAS protocol was 93%,with a median length of hospital stay(LOS)of 3 d.Early anastomotic fistulas were observed in 2 cases(4.2%),which required reoperation(Clavien-Dindo gradeⅢb).None of the patients had been discharged before the onset of the complication,which could therefore receive prompt treatment.There were also four(8.5%)minor complications(ClavienDindo gradeⅡ).Thirty days readmission rate was 4%.Perioperative mortality was nil.After implementation of the protocol throughout the Hospital in unselected patients(May 2012 to December 2012;147 patients)compliance was 74%,with a median LOS of 6 d.Early anastomotic fistulas were observed in 11 cases(7.7%),5(3.5%)of which required reoperation(Clavien-Dindo gradeⅢb).Two early anastomotic fistulas were treated by radiologic/endoscopic manoeuvres and 4 were treated conservatively.There were also 36(25.2%)minor complications,21(14.7%)of which were Clavien-Dindo gradeⅡand 15(10.5%)of which were Clavien-Dindo gradeⅠ.Only two patients whose course was adversely affected by the development of an anastomotic leak had been discharged before the onset of the complication itself,requiring readmission.Readmission rate within 30 d was 4%.Perioperative mortality was 1%.CONCLUSION:Our results confirm that introduction of an ERAS protocol for colorectal surgery allows quickerpostoperative recovery and shortens the length of stay compared to historical series.展开更多
AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who under...AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.展开更多
Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surg...Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.展开更多
AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Tr...AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.展开更多
文摘世界英语背景下本族语标准不断受到挑战,一线教学面临诸多迷惑。English After RP:Standard British Pronunciation Today(Lindsey 2019)一书指出RP在英国已经死亡,这要求外语教学界回应语音教学中的两个突出问题:应采用何种语音标准来教授?该标准对现有课程框架的教学内容及教学重点将产生怎样的影响?中国及世界英语教学理论与实践的研究表明,以传播中国,沟通世界为目的的中国外语教学,应该理性地选择世界范围内认可度最高的规范作为教授标准,并与时俱进,更新教学内容;从评价输出角度来说,应转变教学理念,聚焦信息交流的可理解度,将教学重点转向韵律。师生均需拓宽视野,培养世界胸怀,培养国际交流中对待地域及社会变体的积极的语言态度。
文摘Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘The three worlds after the human world in The Journey to the West, in spite of their religious elements, their implicit moralizing, and their involved allegory, hold up a mirror to the social vices of the author's day, showing on the one hand the corruption, injustice, ava rice, lust, faction, perfidiousness and cruelty among the ruling classes, and on the other hand the miseries of the oppressed.
文摘AIM:To study the implementation of an enhanced recovery after surgery(ERAS)program at a large University Hospital from"pilot study"to"standard of care".METHODS:The study was designed as a prospective single centre cohort study.A prospective evaluation of compliance to a protocol based on full application of all ERAS principles,through the progressive steps of its implementation,was performed.Results achieved in the initial pilot study conducted by a dedicated team(n=47)were compared to those achieved in the shared protocol phase(n=143)three years later.Outcomes were length of postoperative hospital stay,readmission rate,compliance to the protocol and morbidity.Primary endpoint was the description of the results and the identification of critical issues of large scale implementation of an ERAS program in colorectal surgery emerged in the experience of a single center.Secondary endpoint was the identification of interventions that have been proven to be effective for facilitating the transition from traditional care pathways to a multimodal management protocol according to ERAS principles in colorectal surgery at a single center.RESULTS:During the initial pilot study(March 2009 to December 2010;47 patients)conducted by a dedicated multidisciplinary team,compliance to the items of ERAS protocol was 93%,with a median length of hospital stay(LOS)of 3 d.Early anastomotic fistulas were observed in 2 cases(4.2%),which required reoperation(Clavien-Dindo gradeⅢb).None of the patients had been discharged before the onset of the complication,which could therefore receive prompt treatment.There were also four(8.5%)minor complications(ClavienDindo gradeⅡ).Thirty days readmission rate was 4%.Perioperative mortality was nil.After implementation of the protocol throughout the Hospital in unselected patients(May 2012 to December 2012;147 patients)compliance was 74%,with a median LOS of 6 d.Early anastomotic fistulas were observed in 11 cases(7.7%),5(3.5%)of which required reoperation(Clavien-Dindo gradeⅢb).Two early anastomotic fistulas were treated by radiologic/endoscopic manoeuvres and 4 were treated conservatively.There were also 36(25.2%)minor complications,21(14.7%)of which were Clavien-Dindo gradeⅡand 15(10.5%)of which were Clavien-Dindo gradeⅠ.Only two patients whose course was adversely affected by the development of an anastomotic leak had been discharged before the onset of the complication itself,requiring readmission.Readmission rate within 30 d was 4%.Perioperative mortality was 1%.CONCLUSION:Our results confirm that introduction of an ERAS protocol for colorectal surgery allows quickerpostoperative recovery and shortens the length of stay compared to historical series.
文摘AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.
文摘Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.
文摘AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.
