甲状旁腺全切联合自体前臂移植术治疗终末期肾病继发性甲状旁腺功能亢进症的临床分析

目的分析甲状旁腺全切联合自体前臂移植术对终末期肾病继发性甲状旁腺功能亢进症(SHPT)的疗效。方法选取2015年5月—2019年6月在湖南省人民医院乳甲外科接受甲状旁腺全切联合前臂自体移植术的33例终末期肾病合并SHPT的患者,分析其预后、并发症、甲状旁腺激素(PTH)和电解质的变化。结果所有患者手术成功,共取得甲状旁腺结节130枚,其中甲状旁腺腺瘤结节40枚,甲状旁腺组织增生结节82枚,余8枚为腺瘤与增生组织混合结节。甲状旁腺全切5 min、20 min后PTH值均较术前下降80%以上,33例患者的骨痛和其中20例患者合并存在的皮肤瘙痒症状在术后1个月内缓解,9例患者的骨折或畸形情况在术后6个月得到了不同程度的缓解,患者PTH、钙磷水平和钙磷乘积较术前明显下降,29例患者出现术后低钙血症,经1~14 d对症治疗后血钙值恢复正常。结论甲状旁腺全切联合自体前臂移植术能有效改善终末期肾病SHPT的症状。

Management of granulomatous lobular mastitis: an international multidisciplinary consensus(2021 edition)

Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Teeming stream protection using an argon shroud during casting of steel ingots

Two kinds of argon shroud protection devices with two different basic structures were designed and investigated. Industrial experiments and numerical simulations were used to examine the protection effect, and the mechanism of air entrapment during the casting of steel ingots was analyzed. The influence of the structure of the argon shroud protection device on the protection effect was investigated. An argon shroud protection device mounted to the nozzle holder on the bottom of the ladle does not provide a good protection effect because air can easily flow into the teeming system and cause reoxidation of molten steel during teeming. By contrast, an argon shroud protection device seated on the top of the central trumpet provides an excellent protection effect, where air has little chance of flowing into the teeming system during casting. The feasibilities of the argon shroud protection devices are discussed.

Uniformity evaluation and optimization of fluid flow characteristics in a seven-strand tundish

The effect of flow control devices（FCDs） on the uniformity of flow characteristics in a seven-strand symmetrical trapezoidal tundish was studied using both an experimental 1：2.5 hydraulic model and a numerical simulation of a 1：1 geometric model.The variation coefficient（CV） was defined to evaluate the flow uniformity of the seven-strand tundish.An optimized FCD configuration was proposed on the basis of the evaluation of experimental results.It is concluded that a turbulence inhibitor（TI） and U-type dam are essential to improve the uniformity of fluid flow in the seven-strand tundish.In addition,the configuration of inclination T-type dams with a height of 200 mm between the second and third strands and with a height of 300 mm between the third and fourth strands can minimize the proportion of dead zone.After optimizing the configuration of FCDs,the variation coefficient reduces below 20%of the mean value,and the average proportion of dead zone is just 14.6%;in addition,the temperature fluctuation between the strands could be controlled within 0.6 K.In summary,the uniformity of flow and temperature in the seven-strand tundish is greatly improved.

Variation and optimization of acid-dissolved aluminum content in stainless steel

As a key step in secondary refining, the deoxidation process in clean stainless steel production is widely researched by many scholars. In this study, vacuum oxygen decarburization（VOD） deoxidation refining in a 40-t electric arc furnace ＋ VOD ＋ ingot casting process was analyzed and optimized on the basis of Al deoxidation of stainless steel and thermodynamic equilibrium reactions between the slag and steel. Under good stirring conditions in VOD, the deoxidation reaction reaches equilibrium rapidly, and the oxygen activity in the bulk steel is controlled by the slag composition and Al content. A basicity of 3–5 and an Al content greater than 0.015wt% in the melt resulted in an oxygen content less than 0.0006wt%. In addition, the dissolved oxygen content decreased slightly when the Al content in the steel was greater than 0.02wt%. Because of the equilibrium of the Si–O reaction between the slag and steel, the activity of SiO2 will increase while the Si content increases; thus, the Si content should be lowered to enable the formation of a high-basicity slag. A high-basicity, low-Al2O3 slag and an increased Si content will reduce the Al consumption caused by SiO2 reduction.