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简介：ObjectiveTostudyclinicalcharacteristicsofendolymphaticsactumor(ELST)anditsdiagnosisandtreatment.MethodsELSTwasdiagnosedin6casesbasedonsurgicalandhistologicalfindings.Thesecaseswerereviewedfortheirclinicalmanifestations,differentialdiagnosisandsurgicaltreatmenttechniques.ResultsTherewere1maleand5femalesinthisgroup,agedfrom28to59years(meanage=38.7years).Thetumorwasinleftearin4casesandinrightearintheother2cases.Diseasecoursesrangedfrom5to30years(meanduration=12.6years).Clinicalpresentationsincludedsensorineuralhearingloss(n=4),otorrheaandtinnitus(n=2),tinnitusandfacialspasm(n=1),otorrheawithfacialparalysis(n=1),andhearinglosswithtinnitus(n=2).NoneofthecaseswasdiagnosedasELSTpreoperatively.Twocasesweremisdiagnosedasglomusjugularetumor,2aschronicsuppurativeotitismedia,1assweatglandadenomaonbiopsyand1astemporalbonetumor.Tumorsweresurgicallyresectedinall6casesviathemastoidectomy(n=2)orcombinedoto-cervicalorcranio-oto-cervicalapproaches(n=4).Postoperativecerebrospinalfluidotorrheaoccurredin1case.Thetumorswereconfirmedonhistologicalexaminationtobealow-gradeadenocarcinoma.Allpatientshavesurvivedatthetimeofthispaper.ConclusionELSTisrareandcommonlymisdiagnosedandinadequatelytreated.Itsprognosisisrelativelyfavorablebecauseofitsslowgrowthrate.

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简介：ObjectiveToevaluateefficacyofsurgicaltreatmentintraumaticfacialparalysis.Methods:Thirty-threecaseswerereviewed,includingtemporalbonefractureandiatrogenicfacialnerveinjury.Allthepatientsweretreatedwithvarioussurgicalmethodsaccordingtotheirpathogeny.ResultsThemeanpercentagefacialfunctionimprovement(House-BrackmannGradeⅠ-Ⅱ)was86%intemporalbonefractureandfunctionwasimprovedafterproperoperationtoiatrogenicfacialnerveinjury.ConclusionsPatientswithtraumaticfacialparalysisreceiveprovedoutcomesitreaedwithpropersurgicalmethodsaccordingtotheirparticularconditionofnerveinjury.

简介：AbstractThe ongoing coronavirus disease 2019 (COVID-19) pandemic has put a strain on health systems globally. Although Africa is the least affected region to date, it has the weakest health systems and an exponential rise in cases as has been observed in other regions, is bound to overwhelm its health systems. Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic. The World Health Organization (WHO) recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility; however, where this is not possible due to the health system capacity, patients can be isolated in re-purposed facilities or at home. An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases, given the already limited health infrastructure and health workforce, and the risk of nosocomial transmission. Use of repurposed facilities requires additional resources, including health workers. Home isolation, on the other hand, would be a challenge given the poor housing, overcrowding, inadequate access to water and sanitation, and stigma related to infectious disease that is prevalent in many African societies. Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited. These unique cultural, social, economic and developmental differences on the continent, call for a tailored approach to COVID-19 case management strategies. This article proposes three broad case management strategies based on the transmission scenarios defined by WHO, and the criteria and package of care for each option, for consideration by policy makers and governments in African countries. Moving forward, African countries should generate local evidence to guide the development of realistic home-grown strategies, protocol and equipment for the management of COVID-19 cases on the continent.

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简介：Thisarticleelaboratestheviewpointthathowtostrengthenqualitymanagementofcasetogivefullplaytoitsvalue,thepointsthattheauthorurgedareinfollowingaspects,includingraisingqualityconsciousnessofcasewriting,upgradingthewritingqualityofcase,payingattentiontothevalueofcaseandensuringthequalityofcase.1.Trainingdoctor's“basicskill”.2.Trainingsystemofdoctor,a.Inthefirstmonthaftercheck-in,arrangetwolecturesaboutwritingofcasetounifytherequirementandinformthemhowtowriteit.b.Givethemthewritingstandardofanamnesis,whichtheycanrefertowhenwriting.3.Thesystemthatthedirectorsspot-checktheanamnesis.TheAmericanqaulityadministrativepower,world-famousDoctorMilanprophesiedthat“21centuryiscenturyofquality”,havingentered21century,factsalsofurtherprovedthefacticityofthisprophesy.Thenewerainwhichthequalityissupreme,qualitydirectlyinfluenceswhetherthecasecanfullyplayitsvalue.

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简介：AbstractCholedochal cysts is a rare congenital cystic dilatation of common biliary duct. The most common prenatal diagnosed form type- I (85%-90%), consists of fusiform dilation of the common bile duct. There is communication between the bile duct and the cyst. In antenatal period diagnosis may be made by the presence of a cyst in the upper right side of the fetal abdomen on ultrasound. To differentiate it with other cystic lesions prenatal ultrasonography (USG), three-dimensional USG and magnetic resonance imaging may be helpful. By early diagnosis and prompt removal of cyst in postnatal period long term complications like development of biliary cirrhosis, portal hypertension, calculi formation or adenocarcinoma can be avoided in later life. The operative mortality is about 10%. We are reporting a case of antenatal diagnosis type I congenital choledochal cysts at 21 weeks, its follow up and successful postnatal management.

简介：AbstractBackground:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion. Gunshot wounds to the head are the deadliest of all gun injuries. According to literature statistics, the survival rate of patients with gunshot wounds to the head is only 9%. Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost entirely based on military experience, and there are few related reports, especially of the head, in which an individual suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances. On initial presentation, the patient had a Glasgow Coma Scale score of 6, was unable to communicate, and had loss of consciousness. The first bullet penetrated the right frontal area and finally reached the right occipital lobe. When the patient reflexively shielded his head with his hand, the second bullet passed through the patient’s right palm bone, entered the right frontotemporal area, and came to rest deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan. After two foreign body removals and skull repair, the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital, followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is usually necessary, and its key points include the timing, method, and scope of the operation.

简介：客观Tracheobronchial损害被定义为从延长直到支气管的部门的环状的软骨的水平包含气管或支气管的损害。我们在场有大多数tracheobronchial损害的一个盒子系列发现了在渗透损伤以后被支撑。回顾的评论在统帅中亚细亚大学被执行的方法，喀拉蚩，巴基斯坦。从2004年1月到2009年12月，有胸的损伤的168个病人被对待，谁15被认出有主要tracheobronchial和肺的损害。结果平均年龄是与大多数是男性的病人(14:1)一起的31年。在他们之中，11个病人让了作为损害的主要原因渗透损伤，有的3个病人从道路交通事故弄钝损伤，仅仅1个病人联合了损伤(钝、渗透的损伤)。八个病人基于放射学的调查结果被诊断。所有病人通过手术被对待。叶切除术是在7个病人执行的最普通的干预。死亡率是7%(1个病人)。当5与残疾幸存时，大多数病人没有sequelae(10个病人)幸存。我们发现渗透损伤是在我们的系列的损害的领先的原因。损害的严厉取决于引起损伤的武器。在我们的系列的病人有多重损害并且要求了外科的管理。结论Tracheobronchial损害是稀罕的但是潜在地威胁的生活。他们要求快诊断和管理。自从没有目前可得到的专业化诊断形式，诊断趋于困难。

简介：AbstractPregnancy is rare and difficult in Sheehan syndrome patients. With the help of assisted reproductive technology, the patients even with panhypopituitarism can get pregnant again. Moreover, women with hypopituitarism have increased risk of pregnancy complications. Here we report a patient who suffered acute and severe Sheehan syndrome with panhypopituitarism and central diabetes insipidus got pregnant again by in vitro fertilization and embryo transfer. A regular and careful antenatal care was given by the cooperation between obstetricians and endocrinologists. Finally, she delivered a healthy female baby at 37+6weeks of gestation with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively. The patient and her baby were doing well at postpartum follow-up. The related articles were also reviewed. This case report is aimed to help clinical practitioners to make better decisions on the management of Sheehan syndrome or other type of hypopituitarism during pregnancy.

简介：WeusedagoalprogrammingtechniquetodeterminetheoptimalharvestvolumefortheIranianCaspianforest.Wecollecteddataincludingvolume,growth,woodpriceatforestroadside,andvariableharvestingcosts.Theallometricmethodwasusedtoquantifysequestratedcarbon.Regressionanalysiswasusedtoderivegrowthmodels.Expectedmeanpricewasestimatedusingwoodpriceandvariableharvestingcosts.Questionnairewasusedtodeterminetheconstraintsandtheequationcoefficientsofthegoalprogrammingmodel.Theoptimalvolumewasdeterminedusingthegoalprogrammingmethodaccordingtomultipurposeforestmanagement.LINGOsoftwarewasusedforanalysis.Resultsindicatedthattheoptimumvolumesofspecieswere250.25m3?ha-1forbeech,59m3?ha-1forhornbeam,73m3?ha-1foroak,41m3?ha-1foralder,and32m3?ha-1forotherspecies.Thetotaloptimumvolumeis455.25m3?ha-1.

简介：ThispaperpresentsanopportunityforenergymanagementwithanintegratedphotovoltaicandwindfarmfortheenergyandeconomicaspectsofthecommercialarealocatedinPutrajaya.Theenergyeconomyaccessionconformingtothewindspeed,temperature,solarirradiation,andenergyconsumptiononadailybasisistakenintoconsideration.Designanalysisisdonethroughtheindustrystandardnumericaltool.Fromtheresultanalysis,therecommendedratioofrenewableshareminimizingstresstotheelectricgridisproposed.Accordingtothesolutionsobtainedfromthenumericaldesigntool,photovoltaicisrecommendedtobemoreenergyefficientandeconomicallyviableincomparisonofthefullycrowdedwindfarm.Fromtheproposedsolutions,thephotovoltaicisabletoprovide51%oftheenergyconsumedanditcostsRM0.365perkW/h.

简介：Companiesthatnotonlyabidebyenvironmentalregulations,butalsodiscovernewtechniquesandadoptnewmanagementmethodstoreducenegativeenvironmentalimpactsoftenhavepositiveeffectsoncorporateprofitability.Inordertomeettheneedsofsustainabilityofenterprisesandprotectenvironment,theconceptofgreenmanagementisdevelopedandregardedasanimportantdirectionofmanagementtheoryofthe21stcentury.Thoughtherearemanytheoriesandpracticesaboutgreenmanagementinwesterncountries,theyarebuiltbasedonthedevelopedmarketeconomy,whicharenotsuitableforChineseenterprisesabsolutely.Byanalyzingtheviewpointsandmodelsoftheoverseasanddomesticexpertsandscholars,combiningcharacteristicofChina’smarketeconomy,thispaperpointsouttherealconnotationofenterprisegreenmanagement-thecombinationofecologicalharmony(harmonybetweenhumanandnature)withhumanharmony(harmonyamongpeople),establishesa3Dtheoreticalmodel,pointsoutthedefectsofenterprise’sgreenmanagementinChina,reanalyzesandredesignedenterprisegreenmanagement,whichpavesthewayforthedeeperandbroaderdevelopmentofgreenmanagement.

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