Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Application Effect of External Diaphragm Pacemaker Combined with Active Respiratory Circulation Technology in Pulmonary Rehabilitation of Perioperative Lung Cancer Patients

Aim: To explore the application effect of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients. Methods: A total of 98 lung cancer patients admitted to our hospital from April 2020 to November 2021 were selected as the observation objects, and then divided into a control group and an observation group using the random number table method, with 49 cases in each group. The control group received routine admission guidance and active respiratory circulation training, while the observation group was supplemented with external diaphragm pacemaker on the basis of the control group. The intervention effect was evaluated by blood gas indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators before and after intervention. Results: Before intervention, there were no significant differences in blood gas analysis indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators between the two groups (P > 0.05). After intervention, the improvement degree of the above indicators in the observation group was higher than that in the control group (P < 0.05). Conclusions: The application of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients is significant, which can effectively improve the pulmonary function, blood gas function, and diaphragm function of lung cancer patients after surgery, and improve the activities of daily living and quality of life of patients.

Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.

Theoretical and Experimental Study on the Performance of Hermetic Diaphragm Squeeze Film Dampers for Gas-Lubricated Bearings

Low damping characteristics have always been a key sticking points in the development of gas bearings.The application of squeeze film dampers can significantly improve the damping performance of gas lubricated bearings.This paper proposed a novel hermetic diaphragm squeeze film damper(HDSFD)for oil-free turbomachinery supported by gas lubricated bearings.Several types of HDSFDs with symmetrical structure were proposed for good damping performance.By considering the compressibility of the damper fluid,based on hydraulic fluid mechanics theory,a dynamic model of HDSFDs under medium is proposed,which successfully reflects the frequency dependence of force coefficients.Based on the dynamic model,the effects of damper fluid viscosity,bulk modulus of damper fluid,thickness of damper fluid film and plunger thickness on the dynamic stiffness and damping of HDSFDs were analyzed.An experimental test rig was assembled and series of experimental studies on HDSFDs were conducted.The damper fluid transverse flow is added to the existing HDSFD concept,which aims to make the dynamic force coefficients independent of frequency.Although the force coefficient is still frequency dependent,the damping coefficient at high frequency excitation with damper fluid supply twice as that without damper fluid supply.The results serve as a benchmark for the calibration of analytical tools under development.

Hepatic ectopic pregnancy with hemorrhage secondary diaphragmatic adhesion:A case report

BACKGROUND Primary abdominal pregnancy is an extremely rare form of ectopic pregnancy.Ectopic pregnancies that occur in the liver and diaphragm are even rarer,limited case reports are available in the literature.CASE SUMMARY A woman of childbearing age was transferred to the emergency department due to lumbar and abdominal pain radiating to the back toward the lower right.After a series of physical and auxiliary examinations,she was clinically diagnosed with hepatic ectopic pregnancy.Laparoscopic surgery was performed to remove the pregnancy tissue and achieve hemostasis.After a period of follow-up,the patient was successfully cured.CONCLUSION Paying attention to the patient's signs and utilizing imaging examination methods can help avoid missed diagnoses of liver pregnancy.

Traumatic Diaphragmatic Hernia in Children: A Case Report

Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.

Congenital Diaphragmatic Hernia with Delayed Diagnosis: Report of Two Cases

Introduction: Advances in prenatal imaging studies have allowed early diagnosis of Congenital Diaphragmatic Hernia (CDH), although neonatal mortality remains at high levels (60% survival). Despite advances, this study found delayed diagnosis, demonstrating subdiagnosis, possibly caused by lack of resources and/or prenatal diagnostic failure. Case Report 1: Infant, 4 months and 22 days old, dyspneic, cyanotic, with fever and vomiting for 3 days, treated as pneumonia. After the second chest radiography, a right CDH was revealed. Surgical correction was performed and removal of Meckel’s diverticulum was surgical findings. The patient was discharged on the 10th days after admission. Case Report 2: Infant, 11 months and 3 days old, distended abdomen, with fever and dyspnea for 2 days, treated as pneumonia. After the second chest radiography, a left CDH was revealed. The patient was submitted to surgery, intestinal loop incarceration without necrosis was observed, and the correction of CDH was performed. The patient was discharged on the 7th day after admission. Discussion: Three cases, between July 2012 and July 2013, were diagnosed at Dom Malam Hospital;2 Cases of CDH, with delayed diagnosis, showed incidence of 66.66%. Delayed diagnosis of these patients with initial hypotheses of pneumonia demonstrated high risk, emphasizing the importance of diagnosis research through observation of the clinical course, the correct imaging interpretation, in order to establish early diagnosis and treatment.

Laparoscopic reduction and repair of acute traumatic diaphragmatic hernia:A video review

Traumatic diaphragmatic hernia is one of the sequela of thoraco-abdominal injury,occurring in about 0.5%-5% of patients presenting post major trauma.Motor vehicle collision is the leading blunt trauma etiology.A high level of suspicion is essential to discover such injuries,as a majority of the patients can be asymptomatic.A case of a successful trans-abdominal laparoscopic reduction and repair of a large acute traumatic diaphragmatic hernia is presented as a video demonstration.We were able to evacuate all intrathoracic air,obliviating the need for a chest tube.Post operatively the patient did well with no complications.If expertise is available,laparoscopic intervention is a feasible option even for large traumatic diaphragmatic hernia preventing the need for a large midline laparotomy incision.

Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm

AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency(RF) ablation vs computed tomography(CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma.Altogether, 24 hemangiomas were ablated via a CTguided percutaneous approach(CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach(laparoscopic ablation group).RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm(range, 6.0-12.0 cm). There was nodifference in the diameter of hemangiomas between the two groups(P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups(P > 0.05). There were 23 thoracic complications in 17 patients: 15(62.5%, 15/24) in the CT-guided ablation group and2(7.4%, 2/27) in the laparoscopic ablation group(P< 0.05). According to the Dindo-Clavien classification,two complications(pleural effusion and diaphragmatic rupture grade Ⅲ) were major in two patients. All others were minor(grade Ⅰ). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7%(22/24) and 96.3%(26/27) in the CT-guided and the laparoscopic ablation groups,respectively(P > 0.05).CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm.It avoids thermal injury to the diaphragm and reduces thoracic complications.

Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm

BACKGROUND It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency(RF) ablation for hepatocellular carcinomas(HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation.AIM To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.METHODS A total of 143 Child-Pugh class A patients who had undergone hepatic resection(n = 80) or percutaneous ultrasound-guided RF ablation(n = 63) for an HCC(≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression(LTP), cumulative intrahepatic distant recurrence(IDR), disease-free survival(DFS), and overall survival(OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated.RESULTS The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were "35.9% vs 65.8%", "64.1% vs 18.3%", and"88.4% vs 68.7%", respectively. Hepatic resection was an independent prognostic factor for DFS(P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups(P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group(1.3% vs 9.5%, P = 0.044).CONCLUSION Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm,DFS was better in the hepatic resection group.

Blunt diaphragmatic lesions: Imaging findings and pitfalls

Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient&#x02019;s collaboration.

Differential uplift and settlement between inner column and diaphragm wall in top-down excavation

Top structure and basement will confront the risk of being damaged on account of large stress and strain fields incurred by differential uplift and settlement between inner column and diaphragm wall in top-down method. Top-down excavation of the Metro Line 10 in Shanghai was modeled with finite element analysis software ABAQUS and parameters of subsoil were obtained by inverse analysis. Based on the finite element model and parameters, changes in the following factors were made to find more effective methods to restrain differential uplift and settlement: length of diaphragm wall, thickness of jet-grouting reinforcement layer, ways of subsoil reinforcement, sequence of pit excavation, connection between slabs and diaphragm wall or column and width of pit. Several significant results are acquired. The longer the diaphragm wall is, the greater the differential uplift between column and diaphragm wall is. Rigidity of roof slab is in general not strong enough to keep diaphragm wall and column undergoing the same uplift during excavation; Uplift at head of column and differential uplift between column and diaphragm wall decrease when subsoil from-16.6 to-43 m in pit is reinforced through jet-grouting. But, as excavation proceeds to a lower level, benefit from soil reinforcement diminishes. During the process applying vertical load, the larger the depth of diaphragm wall is, the smaller the settlement is at head of column and diaphragm wall, and the greater the differential settlement is between column and diaphragm wall. When friction connection is implemented between column, diaphragm wall and floor slabs, uplifts at head of column and diaphragm wall are larger than those of the case when tie connection is implemented, and so does differential uplift between column and diaphragm wall. The maximum deflection of diaphragm wall decreases by 58% on account of soil reinforcement in pit. The maximum deflection of diaphragm wall decreases by 61.2% when friction connection is implemented instead of tie connection.

Mechanism study of electrochemical oxidation in the terylene diaphragm cell

By using a self-made carbon/polytetrafluoroethylene （C/PTFE） O2-fed as cathode and Ti/IrO2/RuO2 as anode, the effects of electrochemical oxidation of phenol and the coal-gas wastewater containing phenol were studied. The terylene diaphragm which kept pH〉12 in cathodic compartment and pH〈1 in the anodic compartment was selected in the experiment in comparison with the other types of diaphragm. Furthermore, hydroxyl radical （HO·） was determined in the cathodic compartment of the diaphragm cell by electron spin resonance spectrum（ESR） and the fluorescence spectra. Compared with pH, the accumulated HzO2 and the COD removal of the no-diaphragm cell, the mechanism of electrochemical oxidation in the terylene diaphragm cell was supposed. The degradation of phenol was supposed to be cooperative oxidation by direct or indirect electrochemical oxidation at the anode and H2O2, HO· produced by oxygen reduction at the cathode. The mineralization of phenol in the diaphragm cell was better than that in the no-diaphragm cell. When the coal-gas wastewater was treated by the electrolysis system with terylene diaphragm, the average removal efficiency of the volatile phenol and COD were 100% and 79.6%, respectively.

Strictures, diaphragms, erosions or ulcerations of ischemic type in the colon should always prompt consideration of nonsteroidal anti-inflammatory drug-induced lesions

AIM： To investigate whether NSAIDs/ASA lesions in the colon can histologically be diagnosed on the basis of ischemic necrosis similar to biopsy-based diagnosis of NSAIDs/ASA- induced erosions and ulcers of the stomach. METHODS： In the period between 1997 and 2002, we investigated biopsy materials obtained from 611 patients （415 women, 196 men, average age 60.5 years） with endoscopic focal erosions, ulcerations, strictures or diaphragms in the colon. In the biopsies obtained from these lesions, we always established the suspected diagnosis of NSA/D-inducecl lesions whenever necroses of the ischemic type were found. Together with the histological report, we enclosed a questionnaire to investigate the use of medication. The data provided by the questionnaire were then correlated with the endoscopic findings, the location, number and nature of the lesions, and the histological findings. RESULTS： At the time of their colonoscopy, 86.1% of the patients had indeed been taking NSAID/ASA medication for years （43.9%） or months （29.5%）. The most common indication for the use of these drugs was pain （64.3%）, and the most common indication for colonoscopy was bleeding （55.5%）. Endoscopic inspection revealed multiple erosions and/or ulcers in 60.6%, strictures in 15.8%, and diaphragms in 3.0% of the patients. The lesions were located mainly in the right colon including the transverse colon （79.9%）. A separate analysis of age and sex distribution, endoscopic and histological findings for NSAIDs alone, ASA alone, combined NSAID/ASA, and for patients denying the use of such drugs, revealed no significant differences among the groups. CONCLUSION： This uncontrolled retrospective study based on the histological finding of an ischemic necrosis shows that the histologically suspected diagnosis of NSAID-induced lesions in the colon is often correct. The true diagnostic validity of this finding and the differentiation from ischemic colitis should, however, be investigated in a prospective controlled study.

Optimized functional linked neural network for predicting diaphragm wall deflection induced by braced excavations in clays

Deep excavation during the construction of underground systems can cause movement on the ground,especially in soft clay layers.At high levels,excessive ground movements can lead to severe damage to adjacent structures.In this study,finite element analyses(FEM)and the hardening small strain(HSS)model were performed to investigate the deflection of the diaphragm wall in the soft clay layer induced by braced excavations.Different geometric and mechanical properties of the wall were investigated to study the deflection behavior of the wall in soft clays.Accordingly,1090 hypothetical cases were surveyed and simulated based on the HSS model and FEM to evaluate the wall deflection behavior.The results were then used to develop an intelligent model for predicting wall deflection using the functional linked neural network(FLNN)with different functional expansions and activation functions.Although the FLNN is a novel approach to predict wall deflection;however,in order to improve the accuracy of the FLNN model in predicting wall deflection,three swarm-based optimization algorithms,such as artificial bee colony(ABC),Harris’s hawk’s optimization(HHO),and hunger games search(HGS),were hybridized to the FLNN model to generate three novel intelligent models,namely ABC-FLNN,HHO-FLNN,HGS-FLNN.The results of the hybrid models were then compared with the basic FLNN and MLP models.They revealed that FLNN is a good solution for predicting wall deflection,and the application of different functional expansions and activation functions has a significant effect on the outcome predictions of the wall deflection.It is remarkably interesting that the performance of the FLNN model was better than the MLP model with a mean absolute error(MAE)of 19.971,root-mean-squared error(RMSE)of 24.574,and determination coefficient(R^(2))of 0.878.Meanwhile,the performance of the MLP model only obtained an MAE of 20.321,RMSE of 27.091,and R^(2)of 0.851.Furthermore,the results also indicated that the proposed hybrid models,i.e.,ABC-FLNN,HHO-FLNN,HGS-FLNN,yielded more superior performances than those of the FLNN and MLP models in terms of the prediction of deflection behavior of diaphragm walls with an MAE in the range of 11.877 to 12.239,RMSE in the range of 15.821 to 16.045,and R^(2)in the range of 0.949 to 0.951.They can be used as an alternative tool to simulate diaphragm wall deflections under different conditions with a high degree of accuracy.

Therapeutic target for nephrotic syndrome: Identification of novel slit diaphragm associated molecules

The slit diaphragm bridging the neighboring foot pro-cesses functions as a fnal barrier of glomerular capil-lary wall for preventing the leak of plasma proteins into primary urine. It is now accepted that the dysfunction of the sit diaphragm contributes to the development of proteinuria in several glomerular diseases. Neph-rin, a gene product of NPHS1, a gene for a congenital nephrotic syndrome of Finnish type, constitutes an ex-tracellular domain of the slit diaphragm. Podocin was identified as a gene product of NPHS2 , a gene for a familial steroid-resistant nephrotic syndrome of French. Podocin binds the cytoplasmic domain of nephrin. After then, CD2 associated protein, NEPH1 and transient re-ceptor potential-6 were also found as crucial molecules of the slit diaphragm. In order to explore other novel molecules contributing to the development of protein-uria, we performed a subtraction hybridization assay with a normal rat glomerular RNA and a glomerular RNA of rats with a puromycin aminonucleoside ne-phropathy, a mimic of a human minimal change type nephrotic syndrome. Then we have found that synaptic vesicle protein 2B, ephrin-B1 and neurexin were already downregulated at the early stage of puromycin aminonucleoside nephropathy, and that these molecules were localized close to nephrin. It is conceivable that these molecules are the slit diaphragm associated molecules, which participate in the regulation of the barrier func-tion. These molecules could be targets to establish a novel therapy for nephrotic syndrome.

Numerical analysis of effect of friction between diaphragm wall and soil on braced excavation

A plane strain finite element model was established to investigate the effect of friction between diaphragm wall and soil on braced excavation. The behavior of interface between diaphragm wall and soil was simulated with the interface model of ABAQUS. Parametric studies were conducted with different diaphragm wall external friction angles δ. The results show that deflection of diaphragm wall and ground surface settlement decrease with the decrease of δ. However, the reduction effect on diaphragm wall deflection is the most significant at the depth where the maximum wall deflection occurs and can be neglected at the wall base. The ratio between wall deep inward component and wall cantilever component reaches its peak value 2.7 when δ=5°. The ratio of the maximum ground surface settlement to the maximum wall lateral deflection decreases at a reduced rate with the increase of δ. For excavation with braced diaphragm wall, the effect of friction between diaphragm and soil on the deflection of diaphragm wall and ground settlement, especially the distribution of ground surface settlement behind diaphragm, should be taken into account.

NONLINEAR BENDING OF CORRUGATED DIAPHRAGM WITH LARGE BOUNDARY CORRUGATION UNDER COMPOUND LOAD

By using the simplified Reissner's equation of axisymmetric shells of revolution, the nonlinear bending of a corrugated annular plate with a large boundary corrugation and a nondeformable rigid body at the center under compound load are investigated. The nonlinear boundary value problem of the corrugated diaphragm reduces to the nonlinear integral equations by applying the method of Green's function. To solve the integral equations, a so_called interpolated parameter important to prevent divergence is introduced into the iterative format. Computation shows that when loads are small, any value of interpolated parameter can assure the convergence of iteration. Interpolated parameter equal or almost equal to 1 yields a faster convergence rate; when loads are large, interpolated parameter cannot be taken too large in order to assure convergence. The characteristic curves of the corrugated diaphragm for different load combinations are given. The obtained characteristic curves are available for reference to design. It can be concluded that the deflection is larger when the diaphragm is acted by both uniform load and concentrated load than when it is acted only by uniform load. The solution method can be applied to corrugated shells of arbitrary diametral sections.

Flexural Capacity Formula of Diaphragm-Through Joints of Concrete-Filled Square Steel Tubular Columns

Finite element analysis and parametric studies were performed to investigate the flexural capacity of the panel zone of diaphragm-through joints between concrete-filled square steel tubular columns and H-shaped steel beams. Through the comparisons of failure modes, load–displacement curves, and bearing capacity, it was found that the flexural capacity of the panel zone of diaphragm-through joints was determined by the tensile action and influence of the web of H-shaped steel beams, and the axial load should be taken into account. The steel tube and the diaphragm were the major parts of the joint that resisted the bending moment. The contribution of in-filled concrete had little influence on the flexural capacity of the panel zone of the joint and could be neglected. According to the results of these numerical studies, a formula that considered the influence of the web of H-shaped steel beams and the axial load was developed based on the yield lines in the diaphragm and the steel tube. The results of the proposed formula were in good agreement with the numerical data of this investigation. © 2017, Tianjin University and Springer-Verlag Berlin Heidelberg.

Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs

AIM:To summarize clinical,endoscopic,radiologic and pathologic features of special diaphragm-like strictures found in small bowel,with no patient use of nonsteroidal anti-inflammatory drugs(NSAIDs).METHODS:From January 2000 to fecember 2009,5 cases(2 men and 3 women,with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging,,operation and pathology.All the patients denied the use of NSAIDs.The clinical,endoscopic,radiologic and pathologic findings in these 5 patients were retrospectively reviewedfrom the hospital database.Images of capsule endoscopy(CE) and small bowel follow-through(SBFT) obtained in 3 and 3 patients,respectively,and images of double-balloon enteroscopy and computed tomography enterography(CTE) obtained in all 5 patients were available for review.RESULTS:All patients presented with long-term(2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia.There was only one stricture in ?our cases and three lesions in one case,and all the lesions were located in the middle or distal segment of ileum.Circumferential stricture was shown in the small bowel in three cases in the CE image,but the capsule was retained in the small bowel of 2 patients.Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient.The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE(in all 5 cases),SBFT(in 2 cases) and double-balloon enteroscopy(in all cases).On microscopy,a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions.CONCLUSION:fiaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine,having similar clinical,endoscopic,radiologic and pathologic features.