An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture.METHODS: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis.RESULTS: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen.CONCLUSION: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.

Lower Bounds of Decay Rates for Solution to the Single-Layer Quasi-Geostrophic Model

In this paper, we study the long-time behavior of solutions of the single-layer quasi-geostrophic model arising from geophysical fluid dynamics. We obtain the lower bound of the decay estimate of the solution. Utilizing the Fourier splitting method, under suitable assumptions on the initial data, for any multi-index α, we show that the solution Ψ satisfies .

RESEARCH ON IMPERFECTION SENSITIVE REGION OF SINGLE-LAYER LATTICED DOMES

The concept of the imperfection sensitive region is given. The advanced stochastic imperfection method is used to research the imperfection sensitive region of single-layer latticed domes. Taking a K6 single-layer latticed dome with a diameter of 50 m as an example, its imperfection sensitive region is made up of the first 12 kinds of joints. The influence of the imperfections of support joints on the stability of the K6 single-layer latticed dome is negligible. Influences of the joint imperfections of the main rib and the secondary rib on the structural stability are similar. The initial deviations of these joints all greatly lower the critical load of the dome. Results show that the method can analyze the structural imperfection sensitive region quantitatively and accurately.

A new neural-network-based method for structural damage identification in single-layer reticulated shells

Single-layer reticulated shells(SLRSs)find widespread application in the roofs of crucial public structures,such as gymnasiums and exhibition center.In this paper,a new neural-network-based method for structural damage identification in SLRSs is proposed.First,a damage vector index,NDL,that is related only to the damage localization,is proposed for SLRSs,and a damage data set is constructed from NDL data.On the basis of visualization of the NDL damage data set,the structural damaged region locations are identified using convolutional neural networks(CNNs).By cross-dividing the damaged region locations and using parallel CNNs for each regional location,the damaged region locations can be quickly and efficiently identified and the undamaged region locations can be eliminated.Second,a damage vector index,DS,that is related to the damage location and damage degree,is proposed for SLRSs.Based on the damaged region identified previously,a fully connected neural network(FCNN)is constructed to identify the location and damage degree of members.The effectiveness and reliability of the proposed method are verified by considering a numerical case of a spherical SLRS.The calculation results showed that the proposed method can quickly eliminate candidate locations of potential damaged region locations and precisely determine the location and damage degree of members.

Dynamic behavior of single-layer latticed cylindrical shells subjected to seismic loading

The single-layer latticed cylindrical shell is one of the most widely adopted space-fl'amed structures.In this paper,free vibration properties and dynamic response to horizontal and vertical seismic waves of single-layer latticed cylindrical shells are analyzed by the finite element method using ANSYS software.In the numerical study,where hundreds of cases were analyzed,the parameters considered included rise-span ratio,length-span ratio,surface load and member section size.Moreover,to better define the actual behavior of single-layer latticed shells,the study is focused on the dynamic stress response to both axial forces and bending moments.Based on the numerical results,the effects of the parameters considered on the stresses are discussed and a modified seismic force coefficient method is suggested.In addition,some advice based on these research results is presented to help in the future design of such structures.

TREATMENT OF FEMORAL VENOUS INCOMPETENCE BY ENCIRCLING CONSTRICTING SUTURE OF THE FEMORAL VENOUS WALL

Chronic venous incompetence of the lower extramities is a common disease whose etilogy and surgical treatment has been proposed by several authors. Histner (1975) discribed primary valvular incompetency and the effect of valvuloplasty. By the usage of phlebographe, we found that the cause of valvular incompetence was the dilatation of venous lumen, which made the valve relatively smaller. The function of valve may be restored by the circular suture of femoral vein wall below the first valve so as to reduce the dilated venous lumen. during the period from 1984 to 1994, 151 cases have been treated by this new technique. This report presents our experience in using encircling constricting suture method of the femoral venous wall.

Electronic Structures and Optical Properties of Ga Doped Single-Layer Indium Nitride

Electronic structures and optical properties of single-layer In1-xGaxN are studied by employing Heyd-Scuseria-Ernzerh（HSE） method based on the first-principles. The band structure and density of states（DOS） of single-layer In1-xGaxN are calculated, and the band gap ranges from 1.8 eV to 3.8 eV as the ratio x changes, illustrating the potential for the tunability of band gap values via Ga doped. We also have investigated optical properties of single-layer In1-xGaxN such as dielectric function, refractive index and absorption coefficient, the main peak of dielectric function spectrum and the absorption edge are found to have a remarkable blue-shift as the concentration of Ga increases. Furthermore, the optical properties of single-layer In1-xGaxN are analyzed based on the band structures and DOS analysis. Such unique optical properties have profound application in nanoelectronics and optical devices.

“十字”缝合法在腹腔镜APR会阴部切口重建中的应用

目的:探讨“十字”缝合法在腹腔镜腹会阴联合切除术(abdominoperineal resection,APR)会阴部切口重建中的应用。方法:选取2017年1月—2022年12月钦州市第一人民医院胃肠外科收治的60例低位直肠癌患者。随机将其分为试验组和对照组,各30例。两组均给予腹腔镜APR,试验组腹腔镜APR会阴部切口重建应用“十字”缝合法,对照组腹腔镜APR会阴部切口重建应用常规间断缝合法。比较两组围手术期指标,术后7 d切口愈合情况,并发症。结果:试验组手术时间、住院时间均短于对照组,术中出血量及引流量均少于对照组,正常饮食时间、腹腔引流管拔管时间均早于对照组,差异有统计学意义(P<0.05)。试验组切口愈合情况优于对照组,差异有统计学意义(P<0.05)。试验组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:“十字”缝合法用于腹腔镜APR会阴部切口重建,能够降低切口张力,促进伤口愈合,住院时间短。

贯穿连续缝合法用于鼻中隔偏曲矫正手术的价值分析

目的 观察在鼻中隔偏曲矫正手术实施贯穿连续缝合法的效果。方法 选取中国人民解放军联勤保障部队第九八一医院于2021年2月—2023年8月收治的60例接受鼻中隔偏曲矫正手术治疗的患者作为研究对象,用随机数表法分为研究组和对照组,各30例。研究组采用贯穿连续缝合法,对照组采用鼻腔填塞法。比较两组患者的病情程度、主观症状、并发症发生率。结果 治疗后,研究组的病情程度评分、主观症状评分、并发症发生率低于对照组,差异有统计学意义(P均<0.05)。结论 在鼻中隔偏曲矫正手术中采取贯穿连续缝合法,可以改善病情程度,缓解主观症状,降低并发症发生风险。

腹腔镜子宫肌瘤剥除术中不同缝合方法对子宫肌瘤患者应激反应和术后并发症的影响

目的探讨腹腔镜子宫肌瘤剥除术(LM)中不同缝合方法对子宫肌瘤(UF)患者应激反应和术后并发症的影响。方法回顾性分析2019年12月至2021年12月吉安市中心人民医院收治的70例UF患者的临床资料,均行LM,根据缝合方式的不同分为传统缝合组(n=34,采用传统缝合法)和棒球缝合组(n=36,采用棒球缝合法)。比较两组围手术期指标、手术后恢复情况、应激反应指标[甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、促肾上腺皮质激素释放激素(CRH)]及手术后并发症的情况。结果棒球缝合组手术时间、切口缝合时间均短于传统缝合组,术中出血量少于传统缝合组,差异有统计学意义(P<0.05);两组术后引流量比较差异无统计学意义。棒球缝合组下地活动时间、住院时间、术后排气时间均短于传统缝合组,差异有统计学意义(P<0.05)。术后,棒球缝合组NE、Cor、AngⅡ及CRH水平均低于传统缝合组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。结论LM术中采用棒球缝合法能缩短UF患者的手术时间、住院时间、切口缝合时间,减少术中出血,改善术后恢复情况,减少应激反应,值得临床推广应用。

2D multi-scale hybrid optimization method for geophysical inversion and its application

Local and global optimization methods are widely used in geophysical inversion but each has its own advantages and disadvantages. The combination of the two methods will make it possible to overcome their weaknesses. Based on the simulated annealing genetic algorithm （SAGA） and the simplex algorithm, an efficient and robust 2-D nonlinear method for seismic travel-time inversion is presented in this paper. First we do a global search over a large range by SAGA and then do a rapid local search using the simplex method. A multi-scale tomography method is adopted in order to reduce non-uniqueness. The velocity field is divided into different spatial scales and velocities at the grid nodes are taken as unknown parameters. The model is parameterized by a bi-cubic spline function. The finite-difference method is used to solve the forward problem while the hybrid method combining multi-scale SAGA and simplex algorithms is applied to the inverse problem. The algorithm has been applied to a numerical test and a travel-time perturbation test using an anomalous low-velocity body. For a practical example, it is used in the study of upper crustal velocity structure of the A＇nyemaqen suture zone at the north-east edge of the Qinghai-Tibet Plateau. The model test and practical application both prove that the method is effective and robust.

浅筋膜折叠减张缝合技术在环乳晕法乳房固定术中的应用

目的:讨论一种浅筋膜折叠减张缝合技术在环乳晕法乳房固定术中的临床效果。方法:选取2019年10月-2020年10月笔者科室诊治的26例中度乳房下垂就医者为研究对象,依据术中切口缝合关闭方法的不同,将其分为传统组(n=13)和改良组(n=13)。传统组就医者采用传统交锁荷包缝合法,改良组就医者采用浅筋膜折叠减张技术联合交锁荷包缝合法。统计比较两组术后即刻切口满意度、瘢痕情况[温哥华瘢痕量表(Vancouver scar scale,VSS)]及术后12个月与术后即刻乳晕直径差值。结果:术后即刻,就医者对改良组切口的满意度高于传统组(P<0.05);术后12个月,改良组VSS评分低于传统组(P<0.05),改良组乳晕增大程度低于传统组(P<0.05)。结论:本研究提出的浅筋膜折叠减张缝合技术在环乳晕法乳房固定术中应用,可获得更加平整、美观的切口对合的同时,能一定程度上减轻术后瘢痕及乳晕扩大的程度,具有良好的临床效果。

颌面部创伤清创缝合术后患儿照护者居家照护知识需求量表的构建及应用

目的:构建及验证颌面部创伤清创缝合术后患儿照护者居家照护知识需求量表。方法:通过文献回顾、医护临床经验总结、病人开放式调查表调查,编制颌面部创伤清创缝合术后病人照护者居家护理知识需求调查表。采用便利抽样法于2022年12月—2023年4月抽取四川省某三级口腔专科医院急诊科就诊的行清创缝合术的115名颌面部创伤患儿的主要照护者进行横断面调查。结果:最终形成包括4个维度(伤口常规护理知识、伤口并发症防治、用药及二期治疗、瘢痕及其他管理)、20个条目的颌面部创伤清创缝合术后患儿照护者居家照护知识需求量表。量表及各维度Cronbach'sα系数为0.860~0.960,折半信度为0.743~0.948。横断面调查结果显示,主要照护者的各维度知识需求得分均较高,伤口常规护理知识需求最高。结论:构建的颌面部创伤清创缝合术后患儿照护者居家照护知识需求量表具有良好的科学性和可靠性,可为评估颌面部创伤清创缝合术后患儿照护者的居家照护知识需求提供参考。

改良Hayman缝合法与荷包式缝合法在宫缩乏力性产后出血患者中的应用对比

目的比较改良Hayman缝合法与荷包式缝合法在宫缩乏力性产后出血患者中的应用效果。方法采用回顾性研究,选择2020年6月至2022年6月漯河市召陵区人民医院收治的80例宫缩乏力性产后出血患者的病历资料,根据手术方式分组,将采用荷包式缝合法的38例患者资料纳入对照组,将采用改良Hayman缝合法的42例患者资料纳入观察组。比较两组手术疗效、围手术期指标、不同时点血红蛋白水平以及术后并发症情况。结果观察组总有效率(97.62%)高于对照组(81.58%),差异有统计学意义(P<0.05)。观察组手术时间、术中出血量、术后2 h出血量、术后24 h出血量均少于对照组,差异有统计学意义(P<0.05);两组术后住院时间、恶露持续时间、月经复潮时间比较,差异无统计学意义(P>0.05)。术前两组患者血红蛋白水平比较,差异无统计学意义(P>0.05);术后2、24 h,两组患者血红蛋白水平比较,差异有统计学意义(P<0.05);组内各时点血红蛋白水平比较,差异有统计学意义(P<0.05)。观察组并发症发生率(4.76%)与对照组并发症发生率(15.79%)差异无统计学意义(P>0.05)。结论与荷包式缝合法相比,改良Hayman缝合法止血效果更好,可以减少宫缩乏力性产后出血患者手术时间及出血量。

缝线牵引悬吊法在胸乳入路腔镜甲状腺癌根治术中的应用

目的探讨缝线牵引悬吊法在胸乳入路腔镜甲状腺手术中的应用价值。方法回顾性分析2020年1月~2022年12月108例甲状腺乳头状癌行胸乳入路腔镜单侧腺叶切除、同侧中央区淋巴结清扫的资料。2021年5月后逐步开展用2-0聚丙烯缝线牵引悬吊带状肌、气管及甲状腺腺叶的缝线牵引悬吊法。缝线牵引悬吊组51例,常规腔镜组57例。比较2组术中及术后指标。结果2组均顺利完成手术。缝线牵引悬吊组较常规腔镜组的腺叶切除手术时间短[(35.3±7.3)min vs.(43.4±8.4)min,t=-5.342,P<0.001],中央区淋巴结清扫手术时间短[(20.1±3.5)min vs.(27.7±4.9)min,t=-9.271,P<0.001],术中出血量少[10(5~15)ml vs.15(5~30)ml,Z=-6.250,P<0.001],清扫中央区淋巴结数量多[8(3~13)个vs.6(4~10)个,Z=3.272,P=0.001],术后一过性喉返神经损伤少,但差异无统计学意义(1例vs.8例,χ^(2)=3.678,P=0.055]。2组术后住院时间、淋巴漏、标本发现甲状旁腺、甲状旁腺功能减退、疼痛评分及美容效果评分差异无统计学意义(P>0.05)。结论缝线牵引悬吊法可缩短手术时间,减少术中出血,减少喉返神经损伤的发生,增加中央区淋巴结清扫数目。

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。

两种4股交叉屈肌腱缝合方法的生物力学比较

目的探究运用Mclarney与Adelaide缝合法在猪趾屈肌腱生物力学中的性能。方法取新鲜冷冻猪前蹄趾深屈肌腱40条,按随机数表法分为两组。A组采用Adelaide法缝合肌腱,B组采用McLarney法缝合肌腱。在生物力学机上拉伸肌腱,记录肌腱2 mm间隙时的负荷与肌腱断裂时最大拉伸负荷,检查记录肌腱失效模式。结果两组2 mm间隙负荷分别为(50.06±4.47)N、(31.26±2.67)N,最大负荷分别为(69.09±5.11)N、(48.58±4.41)N;两组2 mm间隙负荷、最大负荷之间差异有统计学意义(P=0.001,P<0.05);A组有17例缝线断裂、3例肌腱撕脱;B组有4例缝线断裂、16例肌腱撕脱。结论Adelaide缝合法比Mclarney缝合法有更好的力学性能,可以提供更大的抗张强度,能够为患者术后早期主动功能锻炼提供安全保障。

改良四段法含硅胶垫圈包皮环切缝合器的应用

目的观察改良四段法硅胶垫圈包皮环切缝合器行包皮环切术的临床效果。方法回顾性分析2020年8月至2023年8月216例本院就诊并行包皮环切术患者的临床资料。根据使用包皮环切缝合器不同分成两组,观察组(改良四段法含硅胶垫圈包皮环切缝合器)112例,对照组(不含硅胶垫圈包皮环切缝合器)104例,比较两组的安全、有效性及手术并发症。结果两组患者包皮手术出血、迟发血肿发生率、手术后1 d、3 d和7 d包皮换药时疼痛率、术后4周缝合钉脱钉率和手工拆钉率比较,差异有统计学意义(P<0.05)。结论相对于不含硅胶垫圈一次性包皮环切缝合器,改良四段法含硅胶垫圈一次性包皮环切缝合器具有手术出血少、迟发血肿发生率低,术后包皮疼痛轻,术后4周硅胶垫圈脱钉率高和手工拆钉率低等优点,值得临床推广应用。

预置缝线的间断缝合法改进腹腔镜下T管缝合的效果

目的比较腹腔镜下T管缝合时预置缝线法与传统缝合方法的效果差异。方法回顾性分析2020年6月至2023年9月间空军特色医学中心行腹腔镜T管缝合的患者的临床资料,对照组采用传统的T管缝合方法,研究组采用预置缝线的T管缝合方法:间断缝合,进针和出针时前一针的缝线不打紧,每组24例。比较两组患者T管缝合时间和注水试验阳性率。结果研究组术中T管缝合时间少于对照组[(12.61±0.88)min vs(17.62±0.58)min,t=-23.34,P<0.001],注水试验阳性率低于对照组[0 vs 25%(6/24),P=0.029],差异均有统计学意义。结论应用预置缝线的间断缝合法可提高腹腔镜下T管缝合速度,使缝合更确切,较传统方法有明显优势。

单排再改良Mason-Allen术与双排缝合桥术治疗中型肩袖损伤的临床效果

目的比较肩关节镜下单排再改良Mason-Allen术与双排缝合桥术治疗中型肩袖损伤的临床效果。方法回顾性分析2021年2月至2022年6月期间连云港市第一人民医院收治的48例行关节镜手术治疗中型肩袖损伤患者的临床资料。根据所采用的治疗方式分为2组:单排再改良组(25例)和双排缝合桥组(23例)。采用美国肩肘外科协会评分(ASES)、Constant-Murley评分、视觉模拟评分(VAS)以及肩关节活动度评分(前屈、外展、内旋、外旋)对2组患者的肩关节功能恢复情况进行比较。结果48例患者术后均获得随访,时间为6~24个月。2组间术前和末次随访ASES、Constant-Murley、VAS评分和肩关节活动度(前屈、外展、内旋、外旋)评分比较,差异均无统计学意义(P>0.05);组内比较:末次随访ASES、Constant-Murley评分和肩关节活动度(前屈、外展、内旋、外旋)评分明显高于术前,VAS评分低于术前,差异有统计学意义(P<0.05);两种手术方式均显著改善肩关节功能。结论对于中型肩袖损伤,单排再改良Mason-Allen术与双排缝合桥术均显著有效,强调了选择适合患者具体情况的手术方法的重要性。这一策略将有助于优化术后恢复,提升患者生活质量。