Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.

Congenital penile curvature: long-term results of operative treatment using the plication procedure

Aim: To determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea. Methods: From January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients. Results: Penile straightening was excellent in 62 patients (91 %) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-Five patients (51 %) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied. Conclusion: Corporeal plication is an effective and durable procedure with a high rate of patient satisfaction.

Long-term Safety Observations on Side Effects and Com -plications of Non-surgical Sterilization by Chem ical In-stillation of the Fallopian Tubal

The present objective is to observe the side effects and complications of fem ale tubalsterilization by phenol-atabrinepaste (PAP) and phenolm ucilage (PM). 1 705 eligible w om en w ere divided random ly into tw o groups, 871 usinig PAP and 834 w om en using PM. Results: Thefeverratesw ere8.0and 4.4( P< 0.01 ) respec- tively in group PAP and group PM. Infection rates of the appendages w ere 2.3 and 1.2 respectively. The incidence of chem ical peritonitis, w ithin the lim its of pelvic cavity, w ere 1.1and 2.4respectively. Perforation of uterus, pelvic ab- scessand ectopicpregnancy w ere notfound during thisobservation. Slightabdom inal pain after the proceduresw ere 33.6and 30.8respectively. Slightvaginalbleed- ing after the procedure w as 23.2 and 18.0 respectively. Menstruation of the w om en w as not affected by the instillation. This five-year follow -up study neither show ed a positivePap testnor a potentialdeseasecaused by thesterilizing agents. This technique isa safe and efficientm ethod for fem ale sterilization.

Diaphragmatic Plication: Retrospective Study with 54 Patients

Objective: This study seeks to evaluate the results of surgery performed according to the etiological causes of diaphragmatic eventration or paralysis. Method: Files of 54 patients (35 males, 19 females;mean age: 39.1 ± 3.01 years) who had undergone diaphragm plication between January 2005 and June 2011 in two clinics located in Istanbul were studied in terms of pulmonary spirometry, applied surgical procedure, duration of hospitalization, morbidity, and mortality. Results: In diaphragm plications, observed etiologies were isolated diaphragmatic eventration without phrenic nerve injury (Group 1) in 20 (37%) patients due to blunt thoracic trauma;Group 2 (thymoma in 19 (35.2%) patients;lung cancer in 7 (12.9%) patients;mediastinal tumor in 3 (5.6%) patients) and congenital heart surgery (Group 3) in 5 (9.3%) patients. The mean time to plication was 7.4 months in Group 1. The mean duration of hospitalization was 4 days in Group 1, 6.2 days in Group 2, 11.8 days in Group 3. Mean forced vital capacity, forced expiratory volume at 1 second improved by 17%, 20.3%, respectively (p In Group 1, mean dyspnea-related hospital admission before plication was 2.4 times. At the end of 6 months after plication mean dyspnea-related hospital admission was 0 time. All of them returned to daily activities or their job within 6 months in Group 1. Postoperative mortality was observed in 2 (3.7%) patients in Group 3 while the overall complication rates were 24%. The morbidity rates were 8%, 27.5%, 60%, respectively;and the mortality rates were 0%, 0%, 40%, respectively. Conclusion: As a result, it could be suggested that early and timely performed plications for diaphragmatic eventration improves functional status and assesses a shorter lenght of stay. On the other hand,simultaneously performed plications in intraoperative phrenic nerve resections can be performed with acceptable morbidity and no mortality. In diaphragmatic paralysis due to congenital heart surgery, morbidity and mortality rate is still high.

CLINICAL APPLICATION OF POINT-THROUGH-POINT ACUPUNCTURE

Point-through-point acupuncture is atechnique in which a long needle is insertedin various directions and depths and acts ontwo or more points in treating disease.It iscommonly used in clinical practice.The ap-plication of point-through-point acupunc-ture and its effects are summarized as fol-lows.

Laparoscopic Diaphragmatic Plication in Patients with Unilateral Diaphragm Paralysis with Thoracoscopic Verification

Diaphragm eventration or paralysis causes elevation of the ipsilateral diaphragm. Some patients have symptoms. The most common symptom is dyspnea. In symptomatic patients with unilateral diaphragm paralysis and dyspnea disproportionate to the degree of physical activity, diaphragm plication is the treatment of choice to relieve dyspnea. We report on our experience with laparoscopic plication of a paralysed hemidiaphragm. The laparoscopic approach is an attractive surgical alternative for the treatment of phrenic nerve palsy. This technique combines the advantage of an excellent field of vision during surgery with a fast postoperative recovery and early discharge from hospital. In accordance to recent literature, we have successfully applied the laparoscopic approach to treat our patients who suffered from a unilateral paralysis of the diaphragm. Preoperative symptoms of exertional dyspnea and orthopnea were significantly reduced.

Endoventricular Spiral Plication for Ischemic Dilated Cardiomyopathy

Surgical ventricular restoration (SVR) procedures have been developed;however, their long-term effectiveness remains controversial. Although a series of endoventricular spiral plication (ESP) has been rarely reported and its long prognosis is still unknown;this method has a unique concept of left ventricular (LV) restoration without artificial patch materials. Here, we describe the case of a patient with ischemic cardiomyopathy and ischemic mitral regurgitation who successfully underwent ESP, mitral valve repair, and coronary artery bypass grafting. ESP was effective in papillary muscle approximation for avoiding heart failure;however, the noted improvement of LV wall thickening might be temporary.

Diaphragmatic Plication for Patients with Acute Phase Phrenic Nerve Paralysis Following Lung Transplantation: A Case Report

Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarterial extracorporeal membrane oxygenation and was unable to be weaned from ventilatory support with nitric oxide. Although enhanced CT scanning showed stenotic anastomosis of the right pulmonary artery (PA), pulmonary angiograph findings revealed that PA flow was normal under sedation and considerably decreased with spontaneous breathing. Fluoroscopy showed that the right diaphragm moved inversely to the position of the left diaphragm, indicating that the right phrenic nerve was paralytic. We performed diaphragmatic plication 7 days after lung transplantation and weaning from ventilator support was accomplished soon thereafter. Phrenic nerve dysfunction is an important clinical problem following lung transplantation. In the present case, diaphragmatic plication was effective for treatment of circulatory failure due to phrenic nerve paralysis even in acute phase after lung transplantation.

Deep Unity of Classic and Quantum Physics at the Space Thermostat Presence with Technical Applications

The paper demonstrates deep unity of classic and quantum physics at the space thermostat (ST) presence, which fulfilled all space by the temperature T0 = 2.73 K. The ST presents itself the Cosmic Microwave Background (CMB). From the main quantum position we consider the ST/CMB as the wave function carrier (“quantum background”). The paper is devoted to ST/CMB medium the classic conservation laws of mass, momentum and energy. We show the soliton like solutions of our classic model correspond to Schrodinger’s quantum solutions, demonstrate the atom hydrogen specter and other quantum peculiarities. The paper contains typical technical examples classic/ quantum simulation at the ST presence.

SHER Grade IIIb Placenta Abruptio Complicating Severe Superimposed Pre-Eclampsia at 19 WA: A Case Report

The placenta abruptio is an extremely serious pathology which involves the maternal-fetal prognosis. We report the case of a 19-year-old patient who consulted for abdominopelvic pain associated with heavy vaginal bleeding on 19SA in a context of arterial hypertension. The symptomatology suddenly worsened with the onset of hemorrhagic shock, which prompted an emergency hysterotomy. The diagnosis of placenta abruptio grade III b of SHER was evoked. Uterine atony was objectified intraoperatively and uterine compression by the B-Lynch technique was performed. The evolution of the patient was favorable after a stay of 5 days in intensive care.

域外管辖论纲

近年来,域外管辖和域外适用问题成为中国统筹推进国内法治和涉外法治工作的重要议题,但学界对于域外管辖及有关概念尚存争议,实务界在立法、执法和司法实践中也呈现出不同理解。从本质上说,域外管辖权属于国家管辖权范畴,是国家的固有权利。域外管辖指的是国家在本国领土范围内针对境外的人、物或行为确立和行使管辖权,域外管辖包括域外适用,但不等于长臂管辖,也不能等同于经济制裁。国家行使域外管辖权是国际关系中的正常现象,国家往往会在属地管辖权的基础上,依托相关连接点扩张域外管辖权,但这种扩张需要符合“真实合理联系”要求,否则便涉嫌违反国际法,损害国际社会正常秩序。

逻辑思维在工程制图组合体识图中的应用

逻辑思维能力是创新及实践能力的基础。读图过程是多种思维的综合应用,但逻辑思维能力不可替代。阐述了图学思维方法、逻辑思维在组合体读图过程中的重要性,并通过实例揭示出组合体读图时的逻辑思维方法,为工程制图的教学提供教学法,以便促使传统教学打开新局面,对提升学生逻辑思维及分析问题、解决问题的能力有积极作用,能更好地适应新时代对创新思维的开拓型人才的需求。

膝关节镜辅助下内侧髌股韧带重建与开放性内侧支持带紧缩治疗青少年复发性髌骨脱位疗效及并发症分析

目的观察膝关节镜辅助下内侧髌股韧带(MPFL)重建与开放性内侧支持带紧缩治疗青少年复发性髌骨脱位疗效及分析并发症。方法回顾性分析2020年9月—2022年1月我院收治的复发性髌骨脱位的58例患者。根据治疗方式分为支持带紧缩组(n=31)和韧带重建组(n=27),支持带紧缩组行开放性内侧支持带紧缩术,韧带重建组行膝关节镜辅助下MPFL重建术。分析比较两组患者髌骨恐惧试验、影像学检查结果[髌骨移动度及髌骨外侧角、髌骨适合角、髌骨倾斜角]、疼痛情况[视觉疼痛评分(VAS)]及膝关节功能评分[Lysholm膝关节功能评分量表评分(LKSS)]、[Kujala髌股关节功能评分(KPS)]及并发症。结果治疗后,两组髌骨移动度及髌骨外侧角、髌骨适合角、髌骨倾斜角均有所降低,且韧带重建组均小于支持带紧缩组(P<0.05);术后末次随访,韧带重建组髌骨恐惧试验均为阴性,支持带紧缩组阳性率9.68%,两组阳性率比较差异无统计学意义(P>0.05);治疗后3 d,两组VAS评分均有所升高,但韧带重建组低于支持带紧缩组(P<0.05);治疗后,两组LKSS评分和KPS评分均有所增加,且韧带重建组评分均高于支持带紧缩组(P<0.05);治疗后,韧带重建组并发症发生率7.41%低于支持带紧缩组29.03%(P<0.05)。结论膝关节镜辅助下内侧MPFL韧带重建治疗青少年复发性髌骨脱位具有良好的治疗效果,能够促进膝关节功能恢复,降低术后疼痛度,减少并发症发生率。

工程结构三维重建中数字影像采集基站布设优化

为优化无人机影像采集基站布设方式,以提高工程结构三维逆向建模效率。提出了控制参数BHR(breadth height ratio),设置了总计25组对比分析工况;然后设计了一个能够有效模拟实际工程结构三维重建情景的实验,对比了各工况在点定位,移动轨迹和线形变化3类特征测量的误差,从工作效率和模型精度两方面对基站的合理布设方式进行了评估;最后对一个装配式钢框架结构进行三维重建,以验证提出的最优布设方法在工程应用中的有效性。结果表明,25组工况在3类特征测量中表现出相似的规律,即误差随着BHR和拍摄距的下降而减小;25组工况的误差变化率有显著差异,其中拍摄距离>0.8 m的工况绝大多数表现出了负贡献;结合建模时间,综合评估最合理的布设方式为BHR=0.18,H=H_(eff)/2的工况,将其应用到实际工程中得到了良好的效果。所提出的无人机基站布设方式可以在保证三维重建精度的前提下大幅缩减建模时长。

胸腔镜膈肌折叠术治疗小儿膈膨升2种不同缝线缝合打结法的比较

目的探讨改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法在胸腔镜膈肌折叠术治疗小儿膈膨升中应用的可行性、安全性及手术效果。方法回顾性分析我院2010年5月~2022年5月70例膈膨升行胸腔镜膈肌折叠术的临床资料,根据缝合打结方法的不同分为改良组(改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法,n=30)和常规组(腔内缝合打结法,n=40),比较2组患儿围术期指标及有无线结松开或膈膨升复发等。结果70例手术均顺利完成,无中转开放手术。改良组手术时间明显短于常规组[(35.3±7.4)min vs.(64.7±10.8)min,t=13.521,P=0.000]。2组术中出血量、留置胸腔引流管时间、术后住院时间、术前术中和术后动脉血气pH值、PO_(2)、PCO_(2)和术后术侧膈肌轻微上升等差异无统计学意义(P>0.05)。70例术后随访6~24个月,中位随访时间12个月,均无线结松开和膈膨升复发,无死亡。结论胸腔镜膈肌折叠术治疗小儿膈膨升采用改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法安全可行、疗效确切,且简单易操作,具有一定腔镜手术基础的医生可快速掌握,适宜有条件的医院推广开展。

基于图像处理的烟草甲自动监测系统设计与应用

根据烟草仓储及卷烟生产车间的烟草甲自动监测需求,结合烟草甲[Lasioderma serricorne(Fabricius)]实际图像特征,在基于标记分水岭算法的基础上叠加分割图像算法,设计了基于图像处理的烟草甲自动监测系统,通过全自动拍照设备定时采集相应诱捕器图像,利用有线网络将图像传输至服务器,在服务器端完成图像识别与计数、实时展示、超标报警、历史曲线查看等功能,解决了烟草甲实际监测过程中虫板烟尘、虫体重合、光线等诸多干扰因素,实现了烟草甲精准的自动图像识别及计数功能。实际应用表明,该系统工作稳定,计数平均准确率大于94.00%,在卷烟生产车间烟虫监测上具有较好的应用前景。

基于家属支持的心理-行为-认知干预在舌癌根治术患者中的应用效果

目的探讨基于家属支持的心理-行为-认知干预在舌癌根治术患者中的应用效果。方法根据干预方式的不同将116例舌癌根治术患者分为对照组(n=60)和研究组(n=56),对照组患者给予常规干预,研究组患者给予家属支持的心理-行为-认知干预。比较两组患者的负性情绪[抑郁自评量表(SDS)、焦虑自评量表(SAS)]、生活质量[华盛顿大学生存质量问卷(UW-QOL)]、希望水平[Herth希望量表(HHI)]、术后并发症发生情况、依从性和满意情况。结果干预后,两组患者SDS、SAS评分均低于本组干预前,UW-QOL、HHI各维度评分均高于本组干预前,研究组患者SDS、SAS评分均低于对照组,UW-QOL、HHI各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。研究组患者的术后并发症总发生率低于对照组,总依从率和总满意度均高于对照组,差异均有统计学意义(P﹤0.05)。结论基于家属支持的心理-认知-行为干预能改善舌癌根治术患者的负性情绪、生活质量及希望水平,降低并发症发生率,并且提高患者的依从率和满意度。

折叠缝合法预防子宫下段瘢痕薄弱处切口憩室的效果

目的:探究因多次剖宫产所致的瘢痕子宫产妇子宫下段瘢痕薄弱处采取折叠缝合法对预防子宫切口憩室的影响。方法:选取德兴市人民医院2023年1—12月因多次剖宫产所致的瘢痕子宫产妇80例,以随机数字表法分为对照组与观察组,每组40例。对照组采用传统的连续单纯双层缝合技术进行处理,观察组在对照组基础上对子宫下段的瘢痕薄弱区域引入折叠缝合法进行加强处理。观察两组手术情况,比较两组子宫切口愈合情况及C反应蛋白(CRP)。结果:观察组手术时间、血性恶露持续时间、住院时间均短于对照组,肛门排气时间早于对照组,术后出血量少于对照组,差异均有统计学意义(P<0.05)。术后42 d,两组切口瘢痕憩室发生率比较,差异无统计学意义(P>0.05);术后42 d,观察组子宫下段肌层厚度优于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组和对照组月经复潮各15例,差异无统计学意义(P>0.05)。术后3个月,观察组切口瘢痕憩室发生率低于对照组,差异有统计学意义(P<0.05);观察组子宫下段肌层厚度大于对照组,差异有统计学意义(P<0.05)。术后第3天,观察组CRP显著低于对照组,差异有统计学意义(P<0.05)。结论:针对多次剖宫产的瘢痕子宫,采用折叠缝合法对子宫下段薄弱部位进行修补能有效预防子宫切口憩室形成,可缩短手术时间,改善手术情况,且术后恢复快,能减轻炎症反应。

先天性轻度上睑下垂患者眶隔后壁-上睑提肌复合体折叠术后矫正及美学效果分析

目的:探讨先天性轻度上睑下垂患者眶隔后壁-上睑提肌复合体折叠术后矫正效果及美学效果。方法:选取2020年4月-2023年4月在笔者医院诊治的84例先天性轻度单侧上睑下垂患者为研究对象,根据手术方式分为对照组(上睑提肌缩短术)和观察组(眶隔后壁-上睑提肌复合体折叠术),各42例。比较两组矫正效果、眼睑生理功能、美学评分、上睑回缩量及术后并发症发生情况。结果:观察组总有效率90.48%(38/42),高于对照组73.81%(31/42)(P<0.05)。两组上睑活动度均高于术前,且观察组高于对照组(P<0.05)。观察组术后3个月美学评分高于对照组(P<0.05)。观察组术后3个月的眼睑自然闭合状态下的睑裂高度低于对照组(P<0.05)。两组上睑回缩量的组间、时间及交互作用差异有统计学意义(P<0.05);两组术后1周、术后1、3个月的上睑回缩量依次增加,观察组术后1、3个月的上睑回缩量均低于对照组(P<0.05)。观察组术后并发症总发生率4.76%(2/42),低于对照组21.43%(9/42)(P<0.05)。结论:眶隔后壁-上睑提肌复合体折叠术可有效改善先天性轻度上睑下垂患者的眼睑生理功能,矫正效果和美学效果均优于上睑提肌缩短术,且安全性良好。

生物制药技术原理及应用领域分析研究

为了进一步提高生物制药技术水平,深入探索生物制药领域,充分发挥生物制药能动性,分别从基因工程、细胞培养、蛋白质纯化、生物反应器、基因组学、蛋白质组学及生物信息学等多个方面对生物制药技术内涵、主要类型进行阐述,对生物制药技术原理进行分析,这对当前生物制药技术中单克隆抗体疗法、基因治疗、细胞治疗、生物仿制药、合成生物学和疫苗技术创新等领域的发展尤为显著,并在冠心病药物、抗肿瘤药物、免疫药物、神经类药物、人源化小鼠、细胞工程及生物酶催化中被广泛应用取得了显著的成果,为生物医药产业的发展提供了新的方向和可能性。