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Evolution of surgical skills training

World journal of Gastroenterology 2006年第20期12卷 3219-3224页

作者： Kurt E roberts robert L Bell Andrew j Duffy Department of Surgery Yale University School of Medicine 40 Temple StreetSuite 3ANew HavenCT 06510United Staets

Surgical training is changing： one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated ＂tissue＂ in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education＇s （ACGME） has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

关键词： Surgery Training Certification Skills Simulation Curriculum

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Crop Epigenomics： Identifying, Unlocking, and Harnessing Cryptic Variation in Crop Genomes

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Molecular Plant 2015年第6期8卷 860-870页

作者： Lexiang ji Drexel A. Neumann robert j. Schmitz Department of Genetics University of Georgia Athens GA 30602 USA Institute of Bioinformatics University of Georgia Athens GA 30602 USA These authors contributed equally to this article.

DNA methylation is a key chromatin modification in plant genomes that is meiotically and mitotically her- itable, and at times is associated with gene expression and morphological variation. Benefiting from the increased availability of high-quality reference genome assemblies and methods to profile single-base res- olution DNA methylation states, DNA methylomes for many crop species are available. These efforts are making it possible to begin answering crucial questions, including understanding the role of DNA methyl- ation in developmental processes, its role in crop species evolution, and whether DNA methylation is dynamically altered and heritable in response to changes in the environment. These genome-wide maps provide evidence for the existence of silent epialleles in plant genomes which, once identified, can be tar- geted for reactivation leading to phenotypic variation.

关键词： epigenomics DNA methylation whole-genome bisulfite sequencing (WGBS) crops comparativegenomics

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Controversies in the treatment of gastroesophageal reflux and achalasia

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World journal of Gastroenterology 2006年第20期12卷 3155-3161页

作者： Kurt E roberts Andrew j Duffy robert L Bell Department of Surgery Yale University School of Medicine 40 Temple St. Suite 3 ANew HavenCT 06510United States

The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease （GERD） and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery （LAP, S） as the preferred treatmerit for Barrett＇s esophagus and the procedure＇s potential to reduce the risk of adenocarcinoma of the esophagus. GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed： radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter. Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia： medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LAPS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective nonsurgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concer

关键词： Gastroesophageal reflux disease Nissen Toupet Fundoplication Achalasia Heller myotomy

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Assessment of mercury(II) bioavailability using a bioluminescent bacterial biosensor: Practical and theoretical challenges

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journal of Environmental Sciences 2010年第8期22卷 1137-1143页

作者： Paulo R G Barrocas William M Landing robert j M Hudson Department of Sanitation and Environmental Health National School of Public Health Oswaldo Cruz Foundation Department of Oceanography Florida State University. Tallahassee Department of Natural Resources and Environmental Sciences University of Illinois

Critical methodological challenges in the microbial biosensor approach to assessing Hg（II） bioavailability were evaluated from the perspective of analytical chemists. The main challenge stems from the fact that the chemical speciation of Hg（II） in natural waters exerts a major control on its bioavailability, yet its natural complexation equilibria are extensively altered during conventional bioassays. New data, obtained using a bioluminescent Hg（II）-biosensor, that illustrate these challenges are presented and potential solutions proposed.

关键词： mercury bioavailability biosensor chemical speciation bioluminescent

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Ethnic and Religious Violence in South China： The Hakka-Tiandihui Uprising of 1802

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Frontiers of History in China 2016年第4期11卷 532-562页

作者： robert j. Antony Canton's Thirteen Hongs Research Center Guangzhou University Guangzhou 510006 China

In 1802 the second major Tiandihui （Heaven and Earth Society） uprising erupted in the mountains of Huizhou prefecture near Canton. Before it was suppressed over a year later, the disturbances came to involve several tens of thousands of people and nearly a quarter of Guangdong province. This study, which is based on extant historical sources and fieldwork, takes an interdisciplinary approach, combining the methodologies of history, anthropology, and folklore. The areas where the uprising occurred were predominantly Hakka, an ethnic Chinese minority who came into conflict with the earlier settlers, known as the Punti. As violence escalated, both sides organized their own paramilitary units： Hakka formed Tiandihui groups and Punti formed Ox Head Societies. Significantly too, the Tiandihui groups in Huizhou belonged to a much wider network of secret society and sectarian organizations that spread across the Hakka heartland on the jiangxi, Fujian, and Guangdong border. This article addresses key issues concerning the social, political, and religious contexts and motivations of this Hakka-led uprising.

关键词： Hakka Punti Tiandihui ethnic feuds violence Buddhist lay sects Dachengjiao

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Economic Growth and Convergence, Applied to China

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China & World Economy 2016年第5期24卷 5-19页

作者： robert j. Barro Warburg Professor of Economics Economics Department Harvard UniversityUSA

From the perspective of conditional convergence, China＇s GDP growth rate since 1990 has been surprisingly high. However, China cannot deviate forever from the global historical experience, and the per capita growth rate is likely to fall soon from around 8 percent per year to a range of 3-4 percent. China can be viewed as a middle-income convergence success story, grouped with Costa Rica, Indonesia, Peru, Thailand and Uruguay. Upper-income convergence successes （toward which China is likely heading） include Chile, Hong Kong, Ireland, Malaysia, Poland, Singapore, South Korea and Taiwan.

关键词： China convergence dispersion economic growth

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Global Educational Research in Western Times:The Rise and Plight of Chinese Educational Research

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Frontiers of Education in China 2018年第2期13卷 163-192页

作者： robert j.TIERNEY Faculty of Education The University of British ColumbiaVancouverBC V6T 1Z2Canada Advanced Innovation Center for Future Education Beijing Normal UniversityBeijing 100875China

The paper offers a critical appraisal of the global knowledge developments in education using China’s contributions in a fashion similar to a case *** paper scrutinizes the complicity of Western educational research to euro-centric biases and discusses the pursuit of a global epistemological *** support this claim,the magnitude of the global knowledge economy,including country-by-country comparisons,is explored together with data pertaining to the success rate of submissions and *** data are used as the basis for arguments that the dominant research practices and developmental work serve Western interests,Western thought and a Western economy tied to standardization rather than eastern epistemological interests.

关键词： Chinese educational research globalization Westernization

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Treatment of recurrent Clostridium difficile colitis:a narrative review

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Gastroenterology Report 2018年第1期6卷 21-28,I0001页

作者： Roy j.Hopkins robert B.Wilson Department of Upper GI Surgery Liverpool HospitalSydneyNew South WalesAustralia

Clostridium difficile is a gram-positive,spore-forming,obligate anaerobic bacillus that was originally isolated from the stool of a healthy neonate in *** high-income countries,*** is the most common cause of infectious diarrhoea in hospitalized *** incidence of *** infection in the USA has increased markedly since 2000,with hospitalizations for *** infections in non-pregnant adults doubling between 2000 and *** 20%and 35%of patients with *** infection will fail initial antibiotic treatment and,of these,40–60%will have a second *** of *** infection after initial treatment causes substantial morbidity and is a major burden on health care *** this article,current treatments for recurrent *** infection are reviewed and future directions *** include the use of antibiotics,probiotics,donor faecal transplants,anion resins,secondary bile acids or anti-toxin antibodies.

关键词： Clostridium difficile recurrent infection faecal microbiota transplant anion-binding resins monoclonal antibodies secondary bile acid

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The variable codons of H5N1 avian influenza A virus haemagglutinin genes

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Science China(Life Sciences) 2008年第11期51卷 987-993页

作者： Mark j.GIBBS robert W.MURPHY School of Botany and Zoology Faculty of ScienceAustralian National UniversityACT 0200Australia Department of Natural History Royal Ontario MuseumTorontoON M5S 2C6Canada

We investigated the selection pressures on the haemagglutinin genes of H5N1 avian influenza viruses using fixed effects likelihood models. We found evidence of positive selection in the sequences from isolates from 1997 to 2007, except viruses from 2000. The haemagglutinin sequences of viruses from southeast Asia, Hong Kong and China's Mainland were the most polymorphic and had similar nonsyn-onymous profiles. Some sites were positively selected in viruses from most regions and a few of these sites displayed different amino acid patterns. Selection appeared to produce different outcomes in vi-ruses from Europe, Africa and Russia and from different host types. One position was found to be positively selected for human isolates only. Although the functions of some positively selected posi-tions are unknown, our analysis provided evidence of different temporal, spatial and host adaptations for H5N1 avian influenza viruses.

关键词： positive selection pressure H5N1 avian influenza virus HA codon

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Steroid responsive eosinophilic gastric outlet obstruction in a child

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World journal of Gastroenterology 2008年第14期14卷 2270-2271页

作者： Richard Kellermayer Nina Tatevian William Klish robert j Shulman Section of Gastroenterology Hepatology and Nutrition Department of Pediatrics Baylor College of Medicine One Baylor Plaza Houston TX 77030 United States Department of Pathology Baylor College of Medicine One Baylor Plaza Houston TX 77030 United States Section of Gastroenterology Hepatology and Nutrition Department of Pediatrics Baylor College of Medicine One Baylor Plaza Houston TX 77030 United States Children’s Nutrition Research Center Department of Pediatrics Baylor College of Medicine One Baylor Plaza Houston TX 77030 United States

Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservativ... 详细信息

关键词： Eosinophilic gastroenteritis Pylorus Gastric outlet obstruction Steroids

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