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简介：AbstractParotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.

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简介：AbstractBackgroud:Aspirin-exacerbated respiratory disease (AERD) is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes.Objective:To characterize the most common timeline for development of the clinical triad [asthma, nasal polyposis, and reactions to nonsteroidal anti-inflammatory drugs (NSAIDs)], identify barriers to prompt diagnosis of AERD, and describe indications for an aspirin challenge to facilitate accurate diagnosis.Methods:Six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women’s Hospital AERD registry. Patient reported age at disease onset of asthma, nasal polyposis, and age of first NSAID reaction were obtained from 2013 to 2019 at enrollment.Results:Of the 697 patients identified, diagnosis of asthma preceded diagnosis of nasal polyposis and first NSAID reaction, although there was considerable variability between patients.Conclusions:Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients. Consider diagnostic aspirin challenge in patients without historical reactions to NSAIDs who have an otherwise compatible clinical history, specifically in patients who take daily low-dose aspirin, leukotriene modifiers, avoid NSAIDs, or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.

简介：Everydaywealluseroads.Wewalkonthem.Wewalkeitheralongthepavement(人行道)oracrosstheroad.Ifwearecareless,wecancauseaccidents.Accidentsoftenhappenwhenpeoplearecrossingtheroad.Hereissomeadvice.

简介：大家对闪电再熟悉不过了。可闪电是怎样形成的呢?当狂风大作、电闪雷鸣时，我们应该注意些什么呢?

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简介：ＰＡＴＩＥＮＴＭＯＮＩＴＯＲＩＮＧＳＹＳＴＥＭＰＡＴＩＥＮＴＭＯＮＩＴＯＲＩＮＧＳＹＳＴＥＭＨａｕＧｕｉｆｅｎ；ＬｉｕＧｕａｎｇｒｏｎｇ（ＣｈｉｎｅｓｅＰＬＡ．ＧｅｎｅｒａｌＨｏｓｐｉｔａｌ１００８５３，Ｂｅｉｊｉｎｇ，Ｃｈｉｎａ）ＳｕｃｈａｓＰａｔ...

简介：Clinicaldecision-makingiswhatallcardiovascularphysiciansdo.Thepurposeofdecision-makingistomakethediagnosis,decideonappropriatetherapyandestimatetheprognosisoftheindividualpatient.Regardingtheprognosis,populationprognosticdataisusedbutthismayormaynotapplytotheindividualpatient.LVfunction,nomatterhowitisdeterminedseemstocorrelatebestwithprognosis.Butweneedtorememberthatprognosticationoftheindividualis,atbest,aneducatedguess.

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简介：Objective:Toevaluatetheauditoryfunctionofanindividualwithgeneticallyconfirmedhemochromatosis.Methods:A57yearoldmalewithmildlyimpairedsounddetectionthresholdsunderwentarangeofbehavioural,electroacousticandelectrophysiologicassessments.Theseincludedtherecordingofotoacousticemissionsandauditorybrainstemresponses,measurementofmonauraltemporalresolutionandevaluationofbinauralspeechprocessing.Findingsforthispatientweresubsequentlycomparedwiththoseof80healthycontrolswithsimilaraudiometricthresholds.Results:Thepatientshowedthethreecardinalfeaturesofauditoryneuropathy,presentingwithevidenceofnormalcochlearouterhaircellfunction,disruptedneuralactivityintheauditorynerve/brainstemandimpairedtemporalprocessing.Hisfunctionalhearingability(speechperception)wassignificantlyaffectedandsuggestedareducedcapacitytouselocalizationcuestosegregatesignalsinthepresenceofbackgroundnoise.Conclusion:Wepresentthefirstcaseofanindividualwithhemochromatosisandauditoryneuropathy.Thefindingsforthispatienthighlighttheneedforcarefulevaluationofauditoryfunctioninindividualswiththedisorder.

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简介：NevergiveoutidentifyingsuchasHomeAddress,SchoolName,orTelephoneberinapublicmessagesuchasatachatName,Num-roomoronbulletinboards.Neversendapersonapic-tureofyouwithoutfirstcheckingwithyourpar-

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简介：Trafficruleisakeyfactoraffectingtrafficflowandsafety.Wedevelopourmodels,includingthecellularautomatatrafficflowmodelaswellasthelinearregressionone,aimingatcalculatingtrafficflowandevaluatingsafetyconditionswithvariedtrafficrules.Then,wethoroughlyinvestigatefourtypesofpathsinafreeway,namelytwostraightlanes,threestraightlanes,ramps,androundaboutsascasestudiesanddiscussthedifferenttrafficrulesascomparison.Theresultsdemonstratethat“Keep-Right-Except-To-Pass”ruleisnotaseffectiveasthefreeruleinpromotingtrafficflow;however,thisruleensuressafetyfordriversbetterthanthefreerule.Additionally,anewtrafficrule,whichsetsdifferentpostedspeedlimitsforadjacentlanes,isproposedtopromotebettertrafficflowwithsafetyrequirementssatisfied.Furthermore,weapplyeffectiverulesandalternatives,leftdrivingnormsaswellasintelligentsystemasextensionandobtainbetterresults.Finally,model’ssensitivityanalysisregardingtoprobabilityofdeceleratingandpostedspeedlimitsprovesthestabilityofourresults.

简介：Inprimarymitralregurgitationthereareanatomicabnormalitiesofthemitralvalvecausingbackwardflow,placingahemodynamicburdenontheleftventricle.Ifthisburdenissevereandprolonged,itleadstoleftventriculardamage,heartfailure,anddeath.Thepreferredtherapyisrestorationofmitralcompetencethroughmitralvalverepair,whichissaferthanmitralvalvereplacement.Whenrepairisperformedinatimelyfashion,lifespancanbereturnedtothatofanormalindividual.Triggersfortimelyrepairincludetheonsetofsymptomsandevidenceofleftventriculardysfunctionasdeterminedbyejectionfractionfallingtoward60%and/orend-systolicdimensionincreasingtoward40mm.

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简介：瞄准：有希望地在年轻病人学习发生和尖锐憩室炎的自然科学。方法：与尖锐憩室炎的诊断在我们在2000年1月之间的医院就医到2005年2月的207个病人的一个总数被包括。他们的人口统计的特征，病历，physical，X光线照相术、内视镜的调查结果以及治疗被记录。病人们被跟随为第一年的每6瞬间并且以后每年。结果：吝啬的病人的年龄是61(范围27-92)年。25个病人(12%)比45年年轻。尖锐憩室炎是显著地，在在年轻年龄组的男性之中流行的更多作为与老年相比组织(19/25，76%对61/182，33%，分别地P=0.0001)。复杂并发症更经常发生在年轻年龄组；32%对13%，(P=0.002)。在后续期间，6个病人(28%)在老年组作为与87个病人(55%)相比在年轻年龄组仍然保持无征状(P=0.024)。作为结果，sigmoidectomies是被执行两次经常在年轻年龄组(38%对13%，P=0.002)。结论：在年轻病人的憩室炎有男优势，有复杂并发症和更高的再发率的更高的率的一堂更好攻击的功课。一条更早外科的途径可能与尖锐憩室炎在年轻病人被考虑。

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