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Prospective,multicentre study of screening,investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

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Stroke & Vascular Neurology 2023年第3期8卷 207-216,I0028-I0059页

作者： James J M Loan Steven Tominey Kirun Baweja Julie Woodfield Thomas J G chambers Mark Haley Simran S Kundu H Y Josephine Tang Anthony N Wiggins Michael T c Poon Paul M brennan Translational Neurosurgery The University of Edinburgh Centre for Clinical Brain SciencesEdinburghUK Neurosurgery NHS LothianEdinburghUK Neurosurgery Institute of Neurological SciencesGlasgowUK Department of Medicine School of MedicineDentisty and NuringUniversity of GlasgowGlasgowUK Internal Medicine Queen's UniversityKingstonOntarioCanada centre for Discovery Brain Sciences University of EdinburghEdinburghUK Edinburgh centre for Diabetes and Endocrinology NHS LothianEdinburghUK Radiology University Hospitals Plymouth NHS TrustPlymouthUK Department of Medicine Cork University HospitalUniversity College CorkCorkIreland

Background Hyponatraemia often occurs after subarachnoid haemorrhage(SAH).However,its clinical significance and optimal management are *** audited the screening,investigation and management of hyponatraemia after *** We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or *** reviewed medical records daily from admission to discharge,21 days or death and extracted all measurements of serum sodium to identify hyponatraemia(comes were death/dependency at discharge or 21 days and admission duration>10 *** of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission *** assessed hyponatraemia-free survival using multivariable cox *** 175/407(43%)patients admitted to 24 neurosurgical units developed hyponatraemia.5976 serum sodium measurements were *** osmolality,urine osmolality and urine sodium were measured in 30/166(18%)hyponatraemic patients with complete *** most frequently target daily fluid intake was>3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes.26%(n/N=42/164)patients with hyponatraemia received sodium supplementation.133(35%)patients were dead or dependent within the study period and 240(68%)patients had hospital admission for over 10 *** the multivariable analyses,hyponatraemia was associated with less dependency(adjusted OR(aOR)=0.35(95%cI 0.17 to 0.69))but longer admissions(aOR=3.2(1.8 to 5.7)).World Federation of Neurosurgical Societies grade I-III,modified Fisher 2-4 and posterior circulation aneurysms were associated with greater hazards of *** In this comprehensive multicentre prospective-adjusted analysis of patients with SAH,hyponatraemia was investigated inconsistently and,for most patients,was not associated with changes in management or clinical outcome.T

关键词： admitted urine centre

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围术期神经肌肉阻滞的管理:欧洲麻醉和重症监护学会临床指南

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中华麻醉学杂志 2024年第6期44卷 641-656页

作者： Thomas Fuchs-Buder carolina S.Romero Heidrun Lewald Massimo Lamperti Arash Afshari Ana-Marjia Hristovska Denis Schmartz Jochen Hinkelbein Dan Longrois Maria Popp Hans Dde Boer Massimiliano Sorbello Radmilo Jankovic peter Kranke 法国南锡大学医学院附属医院麻醉学、重症监护与围术期医学科法国南锡54000 巴伦西亚大学综合医院麻醉与重症监护科西班牙巴伦西亚46014 慕尼黑工业大学麻醉学与重症监护科德国慕尼黑80333 克利夫兰阿布扎比诊所麻醉学研究所阿联酋阿布扎比31250 哥本哈根大学医院小儿和产科麻醉科丹麦哥本哈根2100 哥本哈根大学医院麻醉学与重症监护科丹麦赫维德2650 布鲁塞尔自由大学Erasme医院麻醉科比利时布鲁塞尔1070 科隆大学医院麻醉学与重症监护科德国科隆50937 巴黎大学附属比查特克劳德伯纳德医院麻醉学与重症监护医学科法国巴黎75018 维尔茨堡大学医院麻醉学、危重病医学、急诊医学和疼痛医学科德国维尔茨堡97080 格罗宁根大学医院麻醉学、疼痛医学与程序性镇静与镇痛科荷兰格罗宁根9713 GZ 卡坦尼亚大学医院麻醉与重症监护科意大利卡坦尼亚95123 尼什大学医学院尼什临床中心麻醉学与重症治疗科塞尔维亚尼什18000

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(Europea... 详细信息

近来的研究表明,由于围术期神经肌肉阻滞管理不当,肌肉松弛药(肌松药)残留阻滞及其术后并发症的发生率居高不下。需要重视神经肌肉功能监测仪、肌松药及其拮抗剂的合理应用,以利于改善神经肌肉阻滞管理。欧洲麻醉和重症监护学会(European Society of Anaesthesiology and Intensive care,ESAIc)首次发布围术期神经肌肉阻滞管理临床指南,旨在为临床医生提供最佳医疗管理的循证建议,以提高围术期患者安全。本指南主要聚焦在3个临床问题:肌松药是否有助于成人气管插管?神经肌肉阻滞深度是否影响腹部手术患者的预后?肌松药残留阻滞的诊断和治疗策略有哪些?根据PIcO原则(患者、干预、对照、结局;patient,intervention,comparator,outcome;PIcO)构建临床问题并进行文献检索。初始纳入的临床研究为24 000篇,采用逐步筛选策略,最终临床研究88篇纳入指南分析。应用GRADE方法学(Grading of Recommendations,Assessment,Development and Evaluation,GRADE)对结局指标证据、质量等级进行评价。运用两轮德尔菲法收集专家组建议并形成统一推荐:R1推荐应用肌松药辅助气管插管(1A)。R2推荐应用肌松药以减少气管插管导致的咽部和(或)喉部损伤(1c)。R3推荐在快速顺序诱导插管(rapid sequence induction intubation,RSII)时使用短效肌松药,例如琥珀胆碱1 mg/kg或罗库溴铵0.9~1.2 mg/kg(1B)。R4推荐在需要改善外科手术条件时,加深神经肌肉阻滞深度(1B)。R5尚无足够的证据推荐深度神经肌肉阻滞可减轻术后疼痛或降低围术期并发症的发生率(2c)。R6推荐在拇内收肌处刺激尺神经,定量监测神经肌肉阻滞深度以排除肌松药残留阻滞(1B)。R7推荐应用舒更葡糖钠逆转甾体类肌松药(罗库溴铵、维库溴铵)诱导的深、中及浅度神经肌肉阻滞(1A)。R8推荐在使用新斯的明前,TOFr自行恢复至>0.2,并继续定量监测神经肌肉功能,直至TOFr超过0.9(1c)。

关键词：神经肌肉阻滞神经肌肉功能肌松药临床指南罗库溴铵琥珀胆碱外科手术定量监测

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Performance of identical rockbolts tested on four dynamic testing rigs employing the direct impact method

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Journal of Rock Mechanics and Geotechnical Engineering 2021年第4期13卷 745-754页

作者： charlie c.Li John Hadjigeorgiou peter Mikula Greig Knox Bradley Darlington Renee Royer Andrzej Pytlik Michael Hosp Norwegian University of Science and Technology(NTNU) TrondheimNorway University of Toronto TorontoCanada Mikula Geotechnics Pty.Ltd. KalgoorlieAustralia New concept Mining JohannesburgSouth Africa Sandvik Mining&Rock Technology HeatherbraeAustralia canmetMINING Natural Resources CanadaOttawaCanada central Mining Institute KatowicePoland Minova Innovation and Development Ground SupportFeistritzAustria

Impact drop tests are routinely used to examine the dynamic performance of *** impact tests have been carried out in the past decades on independently designed,constructed and operated testing *** laboratory has developed testing procedures;thus,the results are often reported in different ways by various *** inconsistency in testing procedures and reporting formats presents a challenge when comparing results from different laboratories.A series of impact tests of identical rockbolts was carried out using the direct impact method(*** mass free-fall method)on the rigs in four laboratories in different *** purpose of these tests was to investigate the level of consistency in the results from the four *** rig demonstrated a high level of repeatability,but differences existed between the various *** differences would suggest that there is noticeable equipment-dependent bias when test results obtained from different laboratories are *** was also observed that the energy dissipated for the plastic displacement of the bolt was smaller than the impact energy in the *** average impact load(AIL)and the ultimate plastic displacement(D)of the bolt describe the ultimate dynamic performance of the *** the case where the bolt does not rupture,the specific plastic energy(SPE)is an appropriate parameter in describing the impact performance of the *** other relevant parameters are the first peak load(FPL)and the initial stiffness(K)of the bolt *** information from this test series will guide the formulation of standardised testing procedures for dynamic impact tests of rockbolts.

关键词： Dynamic test Drop test Impact test Rockbolt Rock reinforcement Ground support

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State of Science:Why Does Rework Occur in construction?What Are Its consequences?And What can be Done to Mitigate Its Occurrence?

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Engineering 2022年第11期18卷 246-258页

作者： peter E.D.Love Jane Matthews Michael c.P.Sing Stuart R.Porter Weili Fang School of civil and Mechanical Engineering Curtin UniversityPerthWA 6845Australia School of Architecture and Built Environment Deakin University Geelong Waterfront CampusGeelongVIC 3220Australia School of Architecture and Built Environment The University of NewcastleCallaghanNSW 2308Australia Department of civil and Building Systems Technische Universität BerlinBerlin 13156Germany

There has been a wealth of research that has examined the nature of rework in *** toward addressing the rework problem has been limited-it still plagues practice,adversely impacting a project’s *** all rework studies have focused on determining its proximal or root causes and therefore have overlooked the conditions that result from its *** filling this void,this paper draws upon our previous empirical studies,amongst others,to provide a much-needed theoretical framing to understand better why rework occurs,what its consequences are,and how it can be mitigated during *** theoretical framing we derive from our review provides construction organizations and their projects with a realization that the journey to mitigating rework begins with creating an error-mastery culture comprising authentic leadership,psychological safety,an errormanagement orientation,and *** suggest that,once an error-mastery culture is established within construction organizations and their projects,they will be better positioned to realize the benefits of the techniques,tools,and technologies espoused to address rework,such as the Last Planner® and building information *** also provide directions for future research and identify implications for practice so that strides toward rework mitigation in construction can be made.

关键词： construction Errors Error-mastery culture Pathogens Rework Violations

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canopy gap size influences niche partitioning of the ground-layer plant community in a northern temperate forest

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Journal of Plant Ecology 2013年第1期6卷 92-100页

作者： christel c.Kern Rebecca A.Montgomery peter B.Reich Terry F.Strong USDA Forest Service Northern Research Station1831 Hwy 169 EastGrand RapidsMN 55744USA Department of Forest Resources University of Minnesota-Twin Cities1530 North Cleveland AvenueSaint PaulMN 55108USA Hawkesbury Institute for the Environment University of Western SydneyLocked Bag 1797Penrith NSW 2751Australia USDA Forest Service USARetired

Aims The Gap Partitioning Hypothesis(GPH)posits that gaps create heterogeneity in resources crucial for tree regeneration in closed-canopy forests,allowing trees with contrasting strategies to coexist along resource *** studies have examined gap partitioning of temperate,ground-layer vascular *** used a ground-layer plant community of a temperate deciduous forest in northern Wisconsin,USA,as a model system to test whether the GPH extends to the relatively species-rich ground *** We used a well-replicated experimental approach that included a gap opening gradient(five gap sizes,6,10,20,30 and 46 m diameter,and undisturbed reference areas),a within-gap location gradient(gap edge to center),and a temporal gradient(0,2,6 and 13 years after gap creation).The data were observations of ground-layer plant abundance,published plant traits,and a modeled index of understory light *** ordinated the plant abundance data and evaluated the relationships of composition,traits and light environment by gap size,location along the forest-gap transect and time,with several approaches such as correlations,descriptive statistics,non-parametric tests of group differences and indicator species importance *** Findings Ground-layer plant composition and traits differed across gap sizes,within-gap locations and over *** of all sizes differed in composition from undisturbed areas,and all pair-wise combinations of gap size also differed in composition,except the 6 m from the 10-m *** gaps(46 m)also displayed within-gap compositional gradients from gap edge to center *** differences in gap size were evident 2 years after gap creation and,contrary to our hypotheses,remained different over the 13-year period,even in gaps with crown *** contrast to the neutral theory,species functional traits and microenvironmental conditions were related to variation in ground-layer *** with smaller seeds,low

关键词： herbaceous layer experimental gaps proximity to edge functional diversity plant traits

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Nucleoporin 88 expression in hepatitis B and c virus-related liver diseases

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World Journal of Gastroenterology 2006年第36期12卷 5870-5874页

作者： Martina Knoess Anna Kordelia Kurz Olga Goreva Nuran Bektas Kai Breuhahn Magarethe Odenthal peter Schirmacher Hans peter Dienes c Thomas Bock Hanswalter Zentgraf Axel zur Hausen Institute of Pathology University Hospital Cologne Cologne Germany Department of Hematology/Oncology Freiburg University Medical Center Freiburg Germany Institute of Pathology University of Heidelberg Heidelberg Germany Department of Molecular Pathology University Hospital Tübingen Germany German cancer Research center DKFZ Applied Tumor Virology Heidelberg Germany Institute of Pathology University Hospital Freiburg Freiburg Germany

AIM: To investigate the expression of nucleoporin 88 (Nup88) in hepatitis B virus (HBV) and c virus (HcV)-related liver diseases. METHODS: We generated a new monoclonal Nup88 antibody to investigate the Nup88 protein expression by immunohistochemistry (IHc) in 294 paraffin-embedded liver specimens comprising all stages of hepatocellular carcinogenesis. In addition, in cell culture experiments HBV-positive (HepG2.2.15 and HB611) and HBV-negative (HepG2) hepatoma cell lines were tested for the Nup88 expression by Western-immunoblotting to test data obtained by ***: Specific Nup88 expression was found in chronic HcV hepatitis and unspecific chronic hepatitis, whereas no or very weak Nup88 expression was detected in normal liver. The Nup88 expression was markedly reduced or missing in mild chronic HBV infection and inversely correlated with HBcAg expression. Irrespective of the HBV- or HcV-status, increasing Nup88 expression was observed in cirrhosis and dysplastic nodules, and Nup88 was highly expressed in hepatocellular carcinomas. The intensity of Nup88 expression significantly increased during carcinogenesis (P correlated with dedifferentiation (P cantly downregulated in HBV-positive HepG2.2.15 (P cell lines as compared to HBV-negative HepG2 cells. cONcLUSION: Based on our immunohistochemical data, HBV and HcV are unlikely to influence the expression of Nup88 in cirrhotic and neoplastic liver tissue, but point to an interaction of HBV with the nuclear pore in chronic hepatitis. The expression of Nup88 in nonneoplastic liver tissue might reflect enhanced metabolic activity of the liver tissue. Our data strongly indicate a dichotomous role for Nup88 in non-neoplastic and neoplastic conditions of the liver.

关键词： Nucleoporin 88 Hepatitis B and c virus Hepatocellular carcinogenesis

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阿多诺对利盖蒂的影响——对二者通信的考察兼论歌剧《伟大的死亡》

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中央音乐学院学报 2024年第1期174卷 58-68,142页

作者： [德]约恩·彼得·希克尔孙冰洁(译) 班丽霞(校) 德国德累斯顿卡尔·玛利亚·冯·韦伯音乐学院新音乐学系中央音乐学院中央音乐学院音乐学系

作曲家利盖蒂长期以来与哲学家阿多诺保持着通信联系,而且利盖蒂对20世纪后半叶的新音乐发展也具有重要的参照作用,但这些方面一直被人们所忽视。作者在考证大量史料的基础上,以开放的“音乐现代主义”概念为前提,结合对《伟大的死亡》... 详细信息

作曲家利盖蒂长期以来与哲学家阿多诺保持着通信联系,而且利盖蒂对20世纪后半叶的新音乐发展也具有重要的参照作用,但这些方面一直被人们所忽视。作者在考证大量史料的基础上,以开放的“音乐现代主义”概念为前提,结合对《伟大的死亡》①等作品的分析与阐释,剖析了利盖蒂与阿多诺之间的理念关联,特别是阿多诺《困境》一文对利盖蒂的影响,重新审视了作曲家在现代主义中的地位与立场。本文最终认为,利盖蒂深受阿多诺的“否定性”与“非形象音乐”等理念的影响,以具有表现性与意象性的音乐瞬间来表达死亡等方式,瓦解了“保守”与“先锋”之间的二元对立,展现出“主观性”与“客观性”相结合的悖论美学。

关键词：利盖蒂阿多诺《伟大的死亡》音乐现代主义

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cerebellar pathology in motor neuron disease:neuroplasticity and neurodegeneration

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Neural Regeneration Research 2022年第11期17卷 2335-2341页

作者： Rangariroyashe H.chipika Grainne Mulkerrin Pierre-François Pradat Aizuri Murad Fabrice Ango cédric Raoul peter Bede computational Neuroimaging Group Biomedical Sciences InstituteTrinity College DublinDublinIreland Pitié-Salpêtrière University Hospital Sorbonne UniversityParisFrance The Neuroscience Institute of Montpellier(INM) INSERMCNRSMontpellierFrance

Amyotrophic lateral sclerosis is a relentlessly progressive multi-system *** clinical picture is dominated by upper and lower motor neuron degeneration,but extra-motor pathology is increasingly recognized,including cerebellar ***-mortem and neuroimaging studies primarily focus on the chara cterization of supratentorial disease,des pite emerging evidence of cerebellar degeneration in amyotrophic lateral *** clinical features of amyotrophic lateral sclerosis,such as dysarthria,dysphagia,cognitive and behavioral deficits,saccade abnormalities,gait impairment,respiratory weakness and pseudobulbar affect are likely to be exacerbated by co-existing cerebellar *** review summarizes in vivo and post mortem evidence for cerebellar degeneration in amyotrophic lateral scle *** imaging studies consistently capture cerebellar grey matter volume reductions,diffusivity studies readily detect both intra-cerebellar and cerebellar peduncle white matter alte rations and functional imaging studies commonly report increased functional connectivity with supratentorial *** functional connectivity is commonly interpreted as evidence of neuro plasticity representing compensatory processes despite the lack of post-mortem *** is a scarcity of post-mortem studies focusing on cerebellar alte rations,but these detect pTDP-43 in cerebellar *** rebellar pathology is an overloo ked facet of neurodegeneration in amyotrophic lateral sclerosis despite its contribution to a multitude of clinical symptoms,wides p read connectivity to spinal and supratentorial regions and putative role in compensating for the degeneration of primary motor regions.

关键词： amyotrophic lateral sclerosis ataxia cerebellum magnetic resonance imaging motor neuron disease neuroimaging neuroplasticity pathology primary lateral sclerosis pseudobulbar affect

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Operational Wave Now- and Forecast in the German Bight as a Basis for the Assessment of Wave-Induced Hydrodynamic Loads on coastal Dikes

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Journal of Ocean University of china 2017年第6期16卷 991-997页

作者： DREIER Norman FROHLE peter Institute of River and coastal Engineering Hamburg University of Technology Hamburg Germany

The knowledge of the wave-induced hydrodynamic loads on coastal dikes including their temporal and spatial resolution on the dike in combination with actual water levels is of crucial importance of any risk-based early warning system. As a basis for the assessment of the wave-induced hydrodynamic loads, an operational wave now-and forecast system is set up that consists of i) available field measurements from the federal and local authorities and ii) data from numerical simulation of waves in the German Bight using the SWAN wave model. In this study, results of the hindcast of deep water wave conditions during the winter storm on 5–6 December, 2013(German name ‘Xaver') are shown and compared with available measurements. Moreover field measurements of wave run-up from the local authorities at a sea dike on the German North Sea Island of Pellworm are presented and compared against calculated wave run-up using the Eur Otop(2016) approach.

关键词： German Bight North Sea wave forecast cosmo-Model SWAN hydrodynamic loads wave run-up EurOtop

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Links between global cO_2 variability and climate anomalies of biomes

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Science china Earth Sciences 2008年第5期51卷 740-747页

作者： peter S. BAKWIN School of Earth and Environmental Sciences Queens College City University of New York New York 11367 USA

The global rate of fossil fuel combustion continues to rise, but the amount of cO2 accumulating in the atmosphere has not increased accordingly. The causes for this discrepancy are widely debated. Par- ticularly, the location and drivers for the interannual variability of atmospheric cO2 are highly uncertain. Here we examine links between global atmospheric cO2 growth rate (cGR) and the climate anomalies of biomes based on (1986―1995) global climate data of ten years and accompanying satellite data sets. Our results show that four biomes, the tropical rainforest, tropical savanna, c4 grassland and boreal forest, and their responses to climate anomalies, are the major climate-sensitive cO2 sinks/sources that control the cGR. The nature and magnitude by which these biomes respond to climate anomalies are generally not the same. However, one common influence did emerge from our analysis; the ex- tremely high cGR observed for the one extreme El Nio year was caused by the response of the tropical biomes (rainforest, savanna and c4 grassland) to temperature.

关键词： biomes carbon cycle climate anomaly NDVI El Nio

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