primary

摘要： BACKGROUND Dedifferentiated liposarcoma(DDLPS)is an extremely rare neoplasm that exhibits various morphologies.The tumor is characterized by immunoreactivity to MDM2 and CDK4 and can be confirmed by detecting MDM2 amplification via fluorescence in situ hybridization(FISH).Herein,we report an unusual case of DDLPS arising from the duodenum.CASE SUMMARY A 64-year-old man presented with repeated abdominal pain and weight loss.Radiologic studies revealed a mass of the duodenum involving the pancreas.The patient was treated with pylorus-preserving pancreaticoduodenectomy.Histologically,the tumor showed a high-grade sarcoma.Immunohistochemistry demonstrated that the tumor cells were positive for MDM2 and CDK4 expression.MDM2 amplification was detected via FISH,leading to the final diagnosis of DDLPS.Following surgery,the patient was treated in the intensive care unit due to peritonitis,and died 60 d after surgery.CONCLUSION To the best of the authors’knowledge,this is the first case of primary duodenal DDLPS in Korea and the third case in the English-language literature.Care must be taken not to misdiagnose DDLPS as another high-grade tumor.Liposarcoma should be in the differential diagnosis list.

摘要： Objective:To compare the clinical effectiveness of gamma knife radiosugery combined with acupuncture therapy and microvascular decompression in the treatment of idiopathic trigeminal neuralgia.Methods:A total of 93 patients with primary trigeminal neuralgia added to Nanchang University Hospital from November 2016 to October 2018 were selected,it was divided randomly into the control group(45 cases)and the study group(48 cases).The control group was treated with microvascular decompression and the study group used gamma knife radiosurgery combined with acupuncture therapy.The study compared the immediate pain relief rate,Visual Analogue Scale(VAS)scores,completion rate,recurrence rate,hospitalization days,total treatment duration,total treatment cost and total effective rate of treatment in 2 groups.Results:Comparison of the same group after treatment:the VAS score with 24 hours of treatment in the control group was(5.33±0.49),with a significant difference from the pre-treatment VAS score(8.62±0.13);The VAS score with 24 hours of treatment in the study group was(5.96±0.58),with a significant difference from the pre-treatment VAS score(8.54±0.25).After treatment,immediate effect,parent effect,acute and chronic complements of the control group was 25,5,2 and 7 cases,and the study group was 6,25,7 and 1,respectively.There were significant differences between the two groups;The comparison of hospitalization days,total treatment duration,total treatment cost was statistically significant(P0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safe and effective treatment idiopathic trigeminal neuralgia patients,and for patients with good health,can tolerance all-hemp surgery,there are contraindicaindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerante all-hemp surgery or resist surgery,economic difficulties,and can choose gamma knife radiosurgery combined with acupuncture therapy treatment.

摘要： Primary malignant giant cell tumor of bone is clinically rare,lack of specificity,and often misdiagnosed.Currently,related literature about this tumor remains scarce.One case of primary malignant giant cell tumor of bone was diagnosed and treated in our hospital,and the treatment effect was satisfactory.There was no recurrence or metastasis in 2 years of followup.The report is as follows.

摘要： The thesis aims to discuss the application of Chaoxing-based flipped classroom in the teaching of integrated practical activity design for primary school.The undergraduate students who learn this curriculum from Primary Education Classes 1 and 2 of Class 2017 of Nanchang Normal University are taken as the research subjects,of which Class 1 is regarded as the control group and Class 2 is considered the experimental group.The control group adopts the traditional teaching method while the experimental group applies the teaching method of Chaoxing-based flipped classroom.The result shows that the average point of the total grade of the experimental group is 86.2,which is significantly higher than 73.68 of the control group(p<0.05,which indicates that there is a significant difference in the total grades between the two groups).Consequently,applying the Chaoxing-based flipped classroom into the undergraduate teaching of integrated practical activity design for primary education enables students to enhance their performances,especially for the improvement of the class teaching capability by using what they have acquired in the flipped classroom.

摘要： With the continuous attention of the physical education curriculum,the mainland of China and Hong Kong,China is making continuous progress in the exploration of physical education curriculum standards.Through the comparison of the framework,content,and evaluation of curriculum standards,the two curriculum standards have their own similarities and characteristics.This paper compares the primary school physical education curriculum standards between Mainland China and Hong Kong to provide a reference for the further improvement of primary school physical education and health curriculum standards in mainland China.

摘要： BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease(SVD).AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease(MVD).METHODS The retrospective cohort of patients were divided into two groups:SVD and MVD group.The study population consisted of both male and female young(≤45 years)patients presented with ST-elevation myocardial infarction(STEMI)at the National Institute of Cardiovascular Disease,Karachi,Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018.Pre and postprocedure management of the patients was as per the guidelines and institutional protocols.RESULTS A total of 571 patients with STEMI,≤45 years were stratified into two groups by the number of vessels involved,342(59.9%)with SVD and 229(40.1%)with MVD.The average age of these patients was 39.04±4.86 years.A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group(25.1%vs 38%,P<0.01;11.7%vs 27.5%,P<0.001)respectively.While,smoking was more prevalent among the SVD group as compare to MVD group(36.3%vs 28.4%,P=0.05).The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group(48.8%vs 39.2%,P=0.021).Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98%vs 96.5%of the patients is SVD vs MVD group.CONCLUSION The MVD comprised of around 40%of the young patients presented with STEMI.Also,this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases,therefore,preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

摘要： BACKGROUND Although surgical resection is associated with the best long-term outcomes for neuroendocrine liver metastases(NELM),the current indications for and outcomes of surgery for NELM from a population perspective are not well understood.AIM To determine the current indications for and outcomes of liver resection(LR)for NELM using a population-based cohort.METHODS A retrospective review of the 2014-2017 American College of Surgeons National Surgical Quality Improvement Program and targeted hepatectomy databases was performed to identify patients who underwent LR for NELM.Perioperative characteristics and 30-d morbidity and mortality were analyzed.RESULTS Among 669 patients who underwent LR for NELM,the median age was 60(interquartile range:51-67)and 51%were male.While the number of metastases resected ranged from 1 to 9,the most common(45%)number of tumors resected was one.The majority(68%)of patients had a largest tumor size of230 min(OR=1.731,95%CI:1.168-2.565)were associated with higher 30-d morbidity while intraoperative ablation and concomitant procedures were not.CONCLUSION LR for NELM was performed with relatively low postoperative morbidity and mortality.Concomitant procedures performed at the time of LR did not increase morbidity.

摘要： Background: Serum uric acid (SUA) has been correlated with cardiac morbidity and mortality. However, its prognostic value in acute ST-segment elevation myocardial infarction (STEMI) is still uncertain. The aim of this study was to evaluate the prognostic value of SUA on admission in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods: We prospectively enrolled 150 STEMI patients underwent PPCI. The mean age of the studied population was 56.1 years, 78%?were males?while 22% were females. Patients were divided into tertiles based on the basal serum uric acid level. Patients with high SUA (n = 72) was defined as a value in the third tertile (>6.4 mg/dl), and a low SUA group (n = 78) was set as a value in the lower two tertiles ( Results: SUA level on admission carried prognostic value in patients with STEMI undergoing PPCI where the low uric acid group had better KILLIP class (P =0.001), better TIMI flow (P = 0.001), higher ejection fraction (49.53 ± 8.75 versus 39.95 ± 7.06;P =0.001), better survival and lower incidence of other major adverse cardiac events (MACE) (P = 0.01) during the hospital stay and three months follow up?than the high uric acid group. Age, SUA > 6 mg/dl, TIMI flow, Killip class and EF 40% were independent predictors for MACE in such patients. Conclusions: High SUA level on admission was associated with higher frequency of in-hospital and three months follow up MACE in patients with acute STEMI undergoing PPCI.

摘要： Background: Conclusive evidence has yet to emerge regarding the effectiveness and applicability of the Mediterranean diet on middle-aged Hispanic women, the largest female minority group in the United States who is at-risk of metabolic disorders. Objective: The aim of this study is to evaluate the effect of the Mediterranean diet (MED) on the BMI in middle-aged Hispanic women with pre-obesity and obesity in Central Washington State. Design: A prospective study was performed to determine the effect of Mediterranean diet on the BMI of 67 Hispanic women with pre-obesity and obesity between 45 to 65 years of age in Central Washington State. The study was carried out for eight weeks. Dietary adherence was monitored to ensure consistent results. Results: The proportion of Hispanic women who reported a reduction in BMI was 94%, with a decrease in mean BMI after eight weeks of 2.8 (95% CI: 2.5 to 3.0) and P = 0.02, with an odds ratio of 2.6. Multiple linear regression analysis was used to adjust for age, education, physical activity, and smoking. Conclusion: The reduction in BMI demonstrates that the Mediterranean diet can be a promising, culturally appropriate therapy to address the obesity epidemic that is prevalent among Hispanic women.