Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Research on Highway Landscape Evaluation System

The paper has selected major evaluation indexes and established an evaluation system for highway landscape by taking Harbin-Daqing Highway for example,introducing the studied road section,using the latest researches on domestic and foreign highway landscape design and evaluation for reference,and based on relevant materials,field survey and opinions of experts,scholars,drivers,passengers,constructors and managers.Through the evaluation by fuzzy math method based on AHP,it has obtained the fuzzy value of each index of Harbin-Daqing Highway landscape system.Furthermore,by combining with the weights of landscape quality indexes,a judgment matrix has been constructed.Then,based on the weight and single factor judgment matrix,the conclusion vector of the first level of evaluation criteria has been obtained,and the conclusion vector of the second level of evaluation criteria obtained,similarly.In line with maximal subordinate degree,a comprehensive judgment has been conducted on landscape quality of Harbin-Daqing Highway,and it is considered that its landscape quality is general.

Effect of hydraulic retention time and pH on oxidation of ferrous iron in simulated ferruginous acid mine drainage treatment with inoculation of iron-oxidizing bacteria

The effect of hydraulic retention time (HRT) and pH on the biooxidation of ferrous iron during simulated acid mine drainage (AMD) treatment was investigated.The simulated AMD was highly acidic (pH 2.5), rich in iron (about 1700 mg/L) and copper (about 200 mg/L), and contained high concentrations of sulfate (about 4700 mg/L).The biooxidation of ferrous iron was studied in a laboratory-scale upflow packed bed bioreactor (PBR).The HRT was shortened stepwise from 40 h to 20 h, 13 h, and 8 h under the acidic environment at a pH value of 2.2.Then, the influent pH value was changed from 2.2 to 1.2 at a constant suitable HRT.Physiochemical and microbial community structure analyses were performed on water samples and stuffing collected from the bioreactor under different conditions.The results indicate that the efficiency of ferrous iron oxidation gradually decreased with the decrease of HRT, and when the HRT exceeded 13 h, ferrous iron in AMD was almost completely oxidized.In addition, the best efficiency of ferrous iron oxidation was achieved at the influent pH value of 1.8.Microbial community structure analyses show that Leptospirillum is the predominant genus attached in the bioreactor, and low influent pH values are suitable for the growth of Leptospirillum.

Hydrogeochemical Assessment of Metals Contamination in an Urban Drainage System: A Case Study of Osogbo Township, SW-Nigeria

With increasing urban population, attention had been focused on environmental degradation of urban drain-age system with respect to trace/heavy metal contaminations. Such concerns underlie the ever-increasing impacts of urbanization and industrial activities on urban watershed in the developing regions of the world, especially in areas with inadequate land-use plan and poor waste disposal and management practices. Hence, this study highlights the hydrogeochemical assessment of surface water and bottom-sediment samples from an urban drainage system in Osogbo Township, SW-Nigeria with respect to trace metals contaminations. The results show that the surface water samples have generally low TDS with average value of 362mg/l, while the average dissolved concentrations of the trace metals (Cu, Pb, Zn, Ni, As and Cr) vary from 0.01 to 0.5mg/l. Cu, Cr and As exhibit concentrations similar to the local background concentrations (LBC) in the pristine stream water with low single metal contamination factor (CF ≈ 1). Pb, Zn and Ni are 5 folds enriched with contamination factor (CF) of >5 indicating moderate to high contamination. For the sediment phase, the adsorbed concentrations of the trace metals (Cu, Pb, Zn, Ni, As, Cr and Co) vary between 0.1 to 3.1mg/kg. These represent about 1 to 3% of the respective total metal concentrations with average values of 18.2– 533.4mg/kg. Also low anthropogenic factor, AF (0.002 to 0.08) and mostly negative values (–5 to –15) of Mueller’s geo-accumulation index (Igeo) for adsorbed metal contents in the sediments suggest dominant geo-genic controls. However, the total metals concentrations in the sediment phase have high estimated AF of 1.1 to 9.3 and positive values of the estimated Igeo (0.9–2.0) and metal contamination index (MCI) of 2.5–8.3. All these suggest a medium to high level enrichment (of 2 to 10 factor) for most of the metals with respect to the local background concentration (LBC) in the basement bedrock units (with the exception of Cr and Ni). This is consistent with the preferential metal enrichment in the sediment phase as indicated by the estimated parti-tioning/distribution coefficient, Kd of >1 exhibited by the total metal concentrations in the stream sediment. Nonetheless, the correlated high peaks of electrical conductivity of the stream water samples and adsorbed concentrations of some trace metals within the urban stretches are indications of point source inputs of un-treated sewage into the drainage system.

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of the-se findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

The lymphatic drainage systems in the brain:a novel target for ischemic stroke?

Recent studies have proposed three lymphatic drainage systems in the brain,that is,the glymphatic system,the intramural periarterial drainage pathway,and meningeal lymphatic vessels,whose roles in various neurological diseases have been widely explored.The glymphatic system is a fluid drainage and waste clearance pathway that utilizes perivascular space and aquaporin-4 protein located in the astrocyte endfeet to provide a space for exchange of cerebrospinal fluid and interstitial fluid.The intramural periarterial drainage pathway drives the flow of interstitial fluid through the capillary basement membrane and the arterial tunica media.Meningeal lymphatic vessels within the dura mater are involved in the removal of cerebral macromolecules and immune responses.After ischemic stroke,impairment of these systems could lead to cerebral edema,accumulation of toxic factors,and activation of neuroinflammation,while restoration of their normal functions can improve neurological outcomes.In this review,we summarize the basic concepts of these drainage systems,including drainage routes,physiological functions,regulatory mechanisms,and detection technologies.We also focus on the roles of lymphatic drainage systems in brain injury after ischemic stroke,as well as recent advances in therapeutic strategies targeting these drainage systems.These findings provide information for potential novel strategies for treatment of stroke.

The optimal drainage line of potted flowers of soilless culture

Water is the source of life. China ranks No.13 among the water shortage countries. The most of the water is utilized in agriculture, while the utilization rate of irrigation water is only 40%, so it is very important to study on the theory and technology on high efficient water utilization. The purpose for this study is to find out the optimal drainage line on potted flowers through the analysis of experimental results of Aglaonema modestum and Rhododendron simsii Planch in different drainage lines.

Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage

AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.

Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on Pub Med, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound(EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.

Endoscopic ultrasound-guided drainage of the biliary system:Techniques,indications and future perspectives

Over the last decade, endoscopic ultrasound-guided biliary drainage(EUS-BD)has evolved into a widely accepted alternative to the percutaneous approach in cases of biliary obstruction with failed endoscopic retrograde cholangiopancreaticography(ERCP). The available evidence suggests that, in experienced hands, EUS-BD might even replace ERCP as the first-line procedure in specific situations such as malignant distal bile duct obstruction. The aim of this review is to summarize the available data on EUS-BD and propose an evidence-based algorithm clarifies the role of the different EUS-BD techniques in the management of benign and malignant biliary obstructive disease.

Comprehensive review on EUS-guided biliary drainage

Feasibility of endoscopic retrograde cholangiopancreatography(ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However,endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree,two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendezvous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However,the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore,trained endoscopists,in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.

Fast prototype and rapid construction of three-dimensional and multi-scaled pitcher for controlled drainage by systematic biomimicry

Biomimetic materials that use natural wisdom to solve practical problems are developing rapidly.The trend for systematic biomimicry is towards in-situ characterization of naturalcreatures with high spatial resolutions.Furthermore,rapid reconstruction of digital twin models with the same complex features as the prototype is indispensable.However,it faces bottlenecks and limits in fast characterization and fabrication,precise parameter optimization,geometricdeviations control,and quality prediction.To solve these challenges,here,we demonstrate astate-of-the-art method taking advantage of micro-computed tomography and three-dimensional printing for the fast characterization of the pitcher plant Nepenthes x ventrata and fabrication of its biomimetic model to obtain a superior drainage controller with multiscale structures withprecise surface morphology optimization and geometric deviation control.Thefilm-rupture-based drainage dynamic and mechanisms are characterized by x-ray and high-speed videography,which determines the crucial structures for unique directionaldrainage.Then the optimized artificial pitchers are further developed into sustained drainage devices with novel applications,such as detection,reaction,and smoke control.

Upper Sun River Drainage Basin Origin Determined by Topographic Map Interpretation Techniques: Lewis and Clark and Teton Counties, Montana, USA

A new and fundamentally different regional geomorphology paradigm in which massive south- and southeast-oriented meltwater floods flowed across the entire Missouri River drainage basin is tested by interpreting detailed topographic maps of the Montana upper Sun River drainage basin region by trying to explain origins of previously unexplained or poorly explained erosional landforms located upstream from Sun River Canyon (which cuts across Montana’s north-to-south oriented Sawtooth Range). Mountain passes, through valleys, and other drainage divide low points along what are today high mountain ridges, including the North American east-west continental divide, are interpreted to be evidence of drainage routes that once crossed the region. These drainage divide crossings suggest that prior to erosion of present-day upper Sun River drainage basin valleys, massive floods moved in south directions across what are today the north-oriented Middle and South Fork Flathead River drainage basins into today’s upper Sun River drainage basin area and carved a complex of diverging and converging channels into what was probably a low relief surface now represented by the crests of the region’s highest mountain ridges. Further, the map evidence shows how a diverging complex of south- and southeast-oriented upstream Sun River drainage basin flood flow channels changed flow direction to cross the Sawtooth Range in a northeast direction before converging on the Montana plains at a location downstream from Sun River Canyon. The observed upper Sun River drainage basin area topographic map evidence is consistent with the new geomorphology paradigm predictions, in which massive south-oriented meltwater floods flowing across the rising rim of a continental ice sheet created deep “hole” (created by deep ice sheet erosion and ice sheet weight caused crustal warping) are diverted to flow in northeast and north directions into and across deep “hole” space being opened up by ice sheet melting.

A SYSTEMATIC STUDY ON LAND AND REGIONAL DEVELOPMENT OF THE TARIM RIVER DRAINAGE BASIN,XINJIANG PROVINCE,CHINA

A Systematic Study on Land (SSL), aiming at the investigation of the land complex, isone of the important parts of integrated physical geography. With systematic theory as guid-ance, the dissertaton carries out the comprehensive and systematic study of a series ofsubsystems like land classification, land structure analysis, comprehensive physicalregionalization, land evaluation, reasonable planning of land utilization as well as popula-

Endoscopic ultrasound-guided biliary drainage after failed endoscopic retrograde cholangiopancreatography: The road is open for almighty biliopancreatic endoscopists!

Commentary on the article written and published by Peng et al,investigating the role of endoscopic ultrasound(EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiopan-creatography(ERCP).For 40 years endoscopic biliary drainage was synonymous with ERCP,and EUS was used mainly for diagnostic purposes.The advent of therapeutic EUS has revolutionized the field,especially with the development of a novel device such as electrocautery-enhanced lumen-apposing metal stents.Complete biliopancreatic endoscopists with both skills in ERCP and in interven-tional EUS,would be ideally suited to ensure patients the best drainage technique according to each individual situation.

Investigation of a Flow Modulation System for Siphonic Roof Drainage Systems

Siphonic roof drainage systems (SRDS’s) have been widespread used now for approximately 40 years and are an efficient method of removing rainwater rapidly from roofs. SRDS’s are designed to run full-bore, resulting in sub-atmospheric system pressures with high hydraulic driving heads and higher system flow velocities than conventionally guttered systems. Hence, SRDS’s normally require far fewer downpipes, and the depressurised conditions also mean that much of the collection pipework can be routed at a high level, thus reducing the extent of any underground pipework. But, they work properly at only one roof run-off rate and therefore suffer from sizing and operational problems including noise and vibration which limit their performance and adoption rate. Climate change is creating situations where normal ranges of rainfall intensity are being frequently exceeded, so the typical:storm ratios (rTS) are large increasing. Current SRDS’s typically operate within a small rTS range of 2. This may have an impact on the future uptake of SRDS’s. This paper describes the development of a novel SRDS which includes a small mobile cap at the roof of outlet appears to offer benefits and avoids sizing problems associated with current SRDS’s. The cap has the potential to avoid noise associated with making and breaking siphonic action through flow modulation. Laboratory scale tests demonstrate the basic feasibility of the cap system and indicate that the cap functions reliably. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Basic on sizing and design optimiza-tion factors are suggested. The rTS range is increased from approximately 2 to approximately 6.

Electrothermal Bipolar Vessel Sealing System Dissection Reduces Drainage Fluid Output or Time to Drain Removal Following Axillary and Ilio-Inguinal Node Dissection in Melanoma Patients: A Pilot Study

Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound healing. The aim of this study was to evaluate the use of the LigaSureTM Small Jaw (LSJ) on postoperative drainage fluid volume and drainage permanence in patients undergoing RLND. Study design: This was a prospective single-center study in which consecutive melanoma patients underwent nodal dissection using the LSJ. Daily drainage volume and duration of drainage were recorded in post-operative course on days 3, 10 or 15 and day 20. Results: A total of 70 patients were included. Mean postoperative drainage volume was lower. Around two-thirds of patients had a drainage fluid volume of less than 50cc at 10 days. Mean time to drainage removal was 14.5 days. Conclusions: This is the first report of nodal dissection in patients with cutaneous melanoma using an electrothermal bipolar vessel sealing system. The technique was feasible, safe, and effective and resulted in reduced drainage fluid volume and drainage permanence.

Systematic review and meta-analysis of prophylactic abdominal drainage after pancreatic resection

AIM: To investigate whether prophylactic abdominal drainage is necessary after pancreatic resection. METHODS: Pub Med, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published before January 2014. Publications were retrieved if they met the selection criteria. The outcomes of interest included: mortality, morbidity, postoperative pancreatic fistula(POPF), clinically relevant pancreatic fistula(CRPF), abdominal abscess, reoperation rate, the rate of interventional radiology drainage, and the length of hospital stay. Subgroup analyses were also performed for pancreaticoduodenectomy(PD) and for distal pancreatectomy. Begg's funnel plot and the Egger regression test were employed to assess potential publication bias.RESULTS: Nine eligible studies involving a total of 2794 patients were identified and included in this meta-analysis. Of the included patients, 1373 received prophylactic abdominal drainage. A fixedeffects model meta-analysis showed that placement of prophylactic drainage did not have beneficial effects on clinical outcomes, including morbidity, POPF, CRPF, reoperation, interventional radiology drainage, and length of hospital stay(Ps > 0.05). In addition, prophylactic drainage did not significantly increase the risk of abdominal abscess. Overall analysis showed that omitting prophylactic abdominal drainage resulted in higher mortality after pancreatectomy(OR = 1.56; 95%CI: 0.93-2.92). Subgroup analysis of PD showed similar results to those in the overall analysis. Elimination of prophylactic abdominal drainage after PD led to a significant increase in mortality(OR = 2.39; 95%CI: 1.22-4.69; P = 0.01).CONCLUSION: Prophylactic abdominal drainage after pancreatic resection is still necessary, though more evidence from randomized controlled trials assessing prophylactic drainage after PD and distal pancreatectomy are needed.

Spontaneous combustion influenced by surface methane drainage and its prediction by rescaled range analysis

This study established numerical modeling using COMSOLTMto examine the influence of horizontal location and drainage ability of surface borehole on spontaneous combustion in longwall working face gob. Rescaled Range Analysis(R/S analysis) was employed to investigate the chaos characteristic of N_2/O_2 ratio from a surface borehole in 10416 working face gob, Yangliu Colliery, China. The simulation results show that there is always a circular ‘‘dissipation zone" around the drainage borehole and an elliptic ‘‘spontaneous combustion zone" in deep gob. Little influence was found on spontaneous combustion zone on the intake side of the gob but the width of spontaneous combustion zone in middle gob is enlarged, while the depth of spontaneous combustion zone near the return side is reduced. The R/S analysis indicates that the influence of surface borehole on spontaneous combustion can be divided into two stages by the chaos feature of N_2/O_2: safety drainage stage and spontaneous combustion initiating stage. It can be concluded that the methane drainage from gob through surface borehole can intervene in the distribution of spontaneous combustion zone in gob and the chaos feature of N_2/O_2 from surface borehole can effectively reflect coal spontaneous combustion condition in gob.

Origin of Mountain Passes across Continental Divide Segments Surrounding the Southwest Montana Big Hole and Beaverhead River Drainage Basins, USA

The evolution of southwest Montana’s Big Hole and Beaverhead River drainage basins is determined from topographic map evidence related to mountain passes crossing what are today high altitude drainage divides including North America’s east-west Continental Divide. Map evidence, such as orientations of valleys leading away from mountain passes (and saddles) and barbed tributaries found along the downstream drainage routes, is used to reconstruct flow directions of streams and rivers that once crossed the present-day high mountain divides. Large south-oriented anastomosing complexes of diverging and converging channels are interpreted to have eroded what are today closely spaced passes and saddles now notched into high mountain ridges. Water in those south-oriented channels is interpreted to have flowed across emerging mountains and subsiding basins. Headward erosion of deeper southeast-oriented valleys, assisted by crustal warping, concentrated south-oriented water in fewer and deeper valleys as the water flowed from southwest Montana into what are today Idaho and the Snake River drainage basin. Headward erosion of the Big Hole River valley between the emerging Anaconda and Pioneer Mountains, also assisted by crustal warping, reversed all Big Hole Basin drainage so as to create the north-, east-, and south-oriented Big Hole River drainage route. A final and even more major reversal of flow in the present-day north-oriented Montana Missouri River valley, with the assistance of additional crustal warping, next ended all remaining flow to Idaho and the Snake River drainage basin and reversed and captured all drainage in the present-day north-oriented Big Hole, Beaverhead, and Red Rock River drainage basins. The observed map evidence indicates that prior to the final flow reversal events, large volumes of south-oriented water flowed across southwest Montana’s Big Hole and Beaverhead River drainage basins.