Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction:A case report and review of literature

BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.

Unveiling hidden outcomes in malignant gastric outlet obstruction research–insights from a"Pancreas 2000"review

Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.

Attack-Resilient Distributed Cooperative Control of Virtually Coupled High-Speed Trains via Topology Reconfiguration

Dear Editor,This letter addresses the resilient distributed cooperative control problem of a virtually coupled train convoy under stochastic disturbances and cyber attacks.The main purpose is to achieve distributed coordination of virtually coupled high-speed trains with the prescribed inter-train distance and same cruise velocity.

Speed limit effect during lane change in a two-lane lattice model under V2X environment

Speed limit measures are ubiquitous due to the complexity of the road environment,which can be supplied with the help of vehicle to everything(V2X)communication technology.Therefore,the influence of speed limit on traffic system will be investigated to construct a two-lane lattice model accounting for the speed limit effect during the lane change process under V2X environment.Accordingly,the stability condition and the mKdV equation are closely associated with the speed limit effect through theory analysis.Moreover,the evolution of density and hysteresis loop is simulated to demonstrate the positive role of the speed limit effect on traffic stability in the cases of strong reaction intensity and high limited speed.

Effect of speed humps on instantaneous traffic emissions in a microscopic model with limited deceleration capacity

As a common transportation facility, speed humps can control the speed of vehicles on special road sections to reduce traffic risks. At the same time, they also cause instantaneous traffic emissions. Based on the classic instantaneous traffic emission model and the limited deceleration capacity microscopic traffic flow model with slow-to-start rules, this paper has investigated the impact of speed humps on traffic flow and the instantaneous emissions of vehicle pollutants in a single lane situation. The numerical simulation results have shown that speed humps have significant effects on traffic flow and traffic emissions. In a free-flow region, the increase of speed humps leads to the continuous rise of CO_(2), NO_(X) and PM emissions. Within some density ranges, one finds that these pollutant emissions can evolve into some higher values under some random seeds. Under other random seeds, they can evolve into some lower values. In a wide moving jam region, the emission values of these pollutants sometimes appear as continuous or intermittent phenomenon. Compared to the refined Na Sch model, the present model has lower instantaneous emissions such as CO_(2), NO_(X) and PM and higher volatile organic components(VOC) emissions. Compared to the limited deceleration capacity model without slow-to-start rules, the present model also has lower instantaneous emissions such as CO_(2), NO_(X) and PM and higher VOC emissions in a wide moving jam region. These results can also be confirmed or explained by the statistical values of vehicle velocity and acceleration.

Navigating Market Choices: Understanding Carrot Market Outlet Selection among Smallholder Farmers in Kenya

This research delves into the hurdles and strategies aimed at augmenting the market involvement of smallholder carrot farmers in Nakuru County, Kenya. Employing a Multinomial Logit (MNL) model, it scrutinizes the factors influencing the selection of marketing outlets among carrot farmers. The findings unveil that a significant majority (81%) of surveyed farmers actively participate in diverse market outlets, encompassing the farm gate, cleaning point, local market, external market, and export market. Notably, pivotal buyers include aggregators, brokers, wholesalers, retailers, and consumers, with transactions predominantly occurring at the farm level. Additionally, the analysis discerns substantial influences of socio-economic characteristics, experiential factors, and geographical proximity on farmers’ choices of market outlets. Specifically, gender, age, land size, farming experience, and distance to markets emerge as critical determinants. Moreover, the study delves into the examination of market margins along the carrot value chain, shedding light on the potential profitability of carrot farming in the region. Remarkably, higher average gross margins are identified in export and external markets, signaling lucrative prospects for farmers targeting these segments. However, disparities in profit distribution between farmers and traders underscore the necessity for interventions to ensure equitable value distribution throughout the value chain. These findings underscore the imperative for tailored interventions to tackle challenges and foster inclusive agricultural development. Strategies such as farmer organizations, contracting, and vertical integration are advocated to enhance market access and profitability for smallholder carrot farmers. Thus, this study enriches our comprehension of the dynamics within carrot value chains and provides valuable insights for policymakers and development practitioners aiming to uplift rural livelihoods and bolster food security.

Complementary-Label Adversarial Domain Adaptation Fault Diagnosis Network under Time-Varying Rotational Speed and Weakly-Supervised Conditions

Recent research in cross-domain intelligence fault diagnosis of machinery still has some problems,such as relatively ideal speed conditions and sample conditions.In engineering practice,the rotational speed of the machine is often transient and time-varying,which makes the sample annotation increasingly expensive.Meanwhile,the number of samples collected from different health states is often unbalanced.To deal with the above challenges,a complementary-label(CL)adversarial domain adaptation fault diagnosis network(CLADAN)is proposed under time-varying rotational speed and weakly-supervised conditions.In the weakly supervised learning condition,machine prior information is used for sample annotation via cost-friendly complementary label learning.A diagnosticmodel learning strategywith discretized category probabilities is designed to avoidmulti-peak distribution of prediction results.In adversarial training process,we developed virtual adversarial regularization(VAR)strategy,which further enhances the robustness of the model by adding adversarial perturbations in the target domain.Comparative experiments on two case studies validated the superior performance of the proposed method.

Energy harvesting and speed sensing with a hybrid rotary generator for self-powered wireless monitoring

Real-time onboard health monitoring systems are critical for the railway industry to maintain high service quality and operational safety.However,the issue with power supplies for monitoring sensors persists,especially for freight trains that lack onboard power.Here,we propose a hybrid piezoelectric-triboelectric rotary generator(HPT-RG)for energy harvesting and vehicle speed sensing.The HPT-RG incorporates a rotational self-adaptive technique that softens the equivalent stiffness,enabling the piezoelectric non-resonant beam to surpass resonance limitations in a low-frequency region.The experiments demonstrate the feasibility of using the HPT-RG as an energy harvesting module to collect the rotational energy of the freight rail transport and power the wireless temperature sensors.To allow multiple monitoring in confined spaces on trains,a triboelectric sensing module is added to the HPT-RG to sense the operation speed and mileage of vehicles.Furthermore,the generator exhibits favorable mechanical durability under more than 600 h of official testing on the train bogie axle.The proposed HPT-RG is essential for creating a truly self-powered,maintenance-free,and zero-carbon onboard wireless monitoring system on freight railways.

Relationships between Terrain Features and Forecasting Errors of Surface Wind Speeds in a Mesoscale Numerical Weather Prediction Model

Numerical weather prediction(NWP)models have always presented large forecasting errors of surface wind speeds over regions with complex terrain.In this study,surface wind forecasts from an operational NWP model,the SMS-WARR(Shanghai Meteorological Service-WRF ADAS Rapid Refresh System),are analyzed to quantitatively reveal the relationships between the forecasted surface wind speed errors and terrain features,with the intent of providing clues to better apply the NWP model to complex terrain regions.The terrain features are described by three parameters:the standard deviation of the model grid-scale orography,terrain height error of the model,and slope angle.The results show that the forecast bias has a unimodal distribution with a change in the standard deviation of orography.The minimum ME(the mean value of bias)is 1.2 m s^(-1) when the standard deviation is between 60 and 70 m.A positive correlation exists between bias and terrain height error,with the ME increasing by 10%−30%for every 200 m increase in terrain height error.The ME decreases by 65.6%when slope angle increases from(0.5°−1.5°)to larger than 3.5°for uphill winds but increases by 35.4%when the absolute value of slope angle increases from(0.5°−1.5°)to(2.5°−3.5°)for downhill winds.Several sensitivity experiments are carried out with a model output statistical(MOS)calibration model for surface wind speeds and ME(RMSE)has been reduced by 90%(30%)by introducing terrain parameters,demonstrating the value of this study.

Warhead fragments motion trajectories tracking and spatio-temporal distribution reconstruction method based on high-speed stereo photography

High speed photography technique is potentially the most effective way to measure the motion parameter of warhead fragment benefiting from its advantages of high accuracy,high resolution and high efficiency.However,it faces challenge in dense objects tracking and 3D trajectories reconstruction due to the characteristics of small size and dense distribution of fragment swarm.To address these challenges,this work presents a warhead fragments motion trajectories tracking and spatio-temporal distribution reconstruction method based on high-speed stereo photography.Firstly,background difference algorithm is utilized to extract the center and area of each fragment in the image sequence.Subsequently,a multi-object tracking(MOT)algorithm using Kalman filtering and Hungarian optimal assignment is developed to realize real-time and robust trajectories tracking of fragment swarm.To reconstruct 3D motion trajectories,a global stereo trajectories matching strategy is presented,which takes advantages of epipolar constraint and continuity constraint to correctly retrieve stereo correspondence followed by 3D trajectories refinement using polynomial fitting.Finally,the simulation and experimental results demonstrate that the proposed method can accurately track the motion trajectories and reconstruct the spatio-temporal distribution of 1.0×10^(3)fragments in a field of view(FOV)of 3.2 m×2.5 m,and the accuracy of the velocity estimation can achieve 98.6%.

Characterization and Analysis of Inconel 718 Alloy Ground at Different Speeds

Inconel 718(IN718)alloy is widely applied to fabricate high temperature resistant or corrosion resistant parts due to its excellent mechanical performance.However,the machining of IN718 alloy is difficult as it may cause serious tool wear and poor surface quality(SQ)of the workpiece.In this work,grinding experiments on IN718 alloy at different speeds were conducted by using a CBN grinding wheel.The relationship between grinding speed,SQ and subsurface damage(SSD)was well studied.With increasing grinding speed,surface roughness decreased,and SQ was greatly improved.Meanwhile,the microhardness of the grinding surface declined as the grinding speed increased.The SSD depth was almost unchanged when the grinding speed was lower than 15 m/s,then it decreased with higher grinding speeds.It was attributed to the mechanical-thermal synergistic effect in the grinding process.The results indicated that increasing grinding speed can effectively improve the SQ and reduce the SSD of IN718 alloy.The conclusion in the work may also provide insight into processing other hard-to-machining materials.

Revisiting tuberculosis as a cause of gastric outlet obstruction:Insights from a case report

Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Preheating-assisted solid-state friction stir repair of Al-Mg-Si alloy plate at different rotational speeds

Additive friction stir deposition(AFSD)is a novel structural repair and manufacturing technology has become a research hotspot at home and abroad in the past five years.In this work,the microstructural evolution and mechanical performance of the Al-Mg-Si alloy plate repaired by the preheating-assisted AFSD process were investigated.To evaluate the tool rotation speed and substrate preheating for repair quality,the AFSD technique was used to additively repair 5 mm depth blind holes on 6061 aluminum alloy substrates.The results showed that preheat-assisted AFSD repair significantly improved joint bonding and joint strength compared to the control non-preheat substrate condition.Moreover,increasing rotation speed was also beneficial to improve the metallurgical bonding of the interface and avoid volume defects.Under preheating conditions,the UTS and elongation were positively correlated with rotation speed.Under the process parameters of preheated substrate and tool rotation speed of 1000 r/min,defect-free specimens could be obtained accompanied by tensile fracture occurring in the substrate rather than the repaired zone.The UTS and elongation reached the maximum values of 164.2MPa and 13.4%,which are equivalent to 99.4%and 140%of the heated substrate,respectively.

Effects of wind speed,underlying surface,and seed morphological traits on the secondary seed dispersal in the Tengger Desert,China

The maintenance of sand-fixing vegetation is important for the stability of artificial sand-fixing systems in which seed dispersal plays a key role.Based on field wind tunnel experiments using 11 common plant species on the southeastern edge of the Tengger Desert,China,we studied the secondary seed dispersal in the fixed and semi-fixed sand dunes as well as in the mobile dunes in order to understand the limitations of vegetation regeneration and the maintenance of its stability.Our results indicated that there were significant variations among the selected 11 plant species in the threshold of wind speed(TWS).The TWS of Caragana korshinskii was the highest among the 11 plant species,whereas that of Echinops gmelinii was the lowest.Seed morphological traits and underlying surface could generally explain the TWS.During the secondary seed dispersal processes,the proportions of seeds that did not disperse(no dispersal)and only dispersed over short distance(short-distance dispersal within the wind tunnel test section)were significantly higher than those of seeds that were buried(including lost seeds)and dispersed over long distance(long-distance dispersal beyond the wind tunnel test section).Compared with other habitats,the mobile dunes were the most difficult places for secondary seed dispersal.Buried seeds were the easiest to be found in the semi-fixed sand dunes,whereas fixed sand dunes were the best sites for seeds that dispersed over long distance.The results of linear mixed models showed that after controlling the dispersal distance,smaller and rounder seeds dispersed farther.Shape index and wind speed were the two significant influencing factors on the burial of seeds.The explanatory power of wind speed,underlying surface,and seed morphological traits on the seeds that did not disperse and dispersed over short distance was far greater than that on the seeds that were buried and dispersed over long distance,implying that the processes and mechanisms of burial and long-distance dispersal are more complex.In summary,most seeds in the study area either did not move,were buried,or dispersed over short distance,promoting local vegetation regeneration.

Switching Frequency Improvement of a High Speed on/off Valve Based on Pre-excitation Control Algorithm

The high-speed on/off valve(HSV)serves as the fundamental component responsible for generating discrete fluids within digital hydraulic systems.As the switching frequency of the HSV increases,the properties of the generated discrete fluid approach those of continuous fluids.Therefore,a higher frequency response characteristic of HSV is the key to ensure the control accuracy of digital hydraulic systems.However,the current research mainly focuses on its dynamic performance,but neglect its FRC.This paper presents a theoretical analysis demonstrating that the FRC of the HSV can be enhanced by minimizing its switching time.The maximum switching frequency(MSF)is mainly determined by opening dynamic performance when HSV operates with low switching duty ratio(SDR),whereas the closing dynamic performance limits the MSF when HSV operates with high SDR.Building upon these findings,the pre-excitation control algorithm(PECA)is proposed to reduce the switching time of the HSV,and consequently enhance its FRC.Experimental results demonstrate that PECA shortens the opening delay time of HSV by 1.12 ms,the closing delay time by 2.54 ms,and the closing moving time by 0.47 ms in comparison to the existing advanced control algorithms.As a result,a larger MSF of 417 Hz and a wider controllable SDR range from 20%to 70%were achieved at a switching frequency of 250 Hz.Thus,the proposed PFCA in this paper has been verified as an effective and promising approach for enhancing the control performance of digital hydraulic systems.

Piecewise Acoustic Source Imaging with Unknown Speed of Sound Using a Level-Set Method

We investigate the following inverse problem:starting from the acoustic wave equation,reconstruct a piecewise constant passive acoustic source from a single boundary temporal measurement without knowing the speed of sound.When the amplitudes of the source are known a priori,we prove a unique determination result of the shape and propose a level set algorithm to reconstruct the singularities.When the singularities of the source are known a priori,we show unique determination of the source amplitudes and propose a least-squares fitting algorithm to recover the source amplitudes.The analysis bridges the low-frequency source inversion problem and the inverse problem of gravimetry.The proposed algorithms are validated and quantitatively evaluated with numerical experiments in 2D and 3D.

Time-Domain Higher-Order Boundary Element Method for Simulating High Forward-Speed Ship Motions in Waves

The hydrodynamic performance of a high forward-speed ship in obliquely propagating waves is numerically examined to assess both free motions and wave field in comparison with a low forward-speed ship.This numerical model is based on the time-domain potential flow theory and higher-order boundary element method,where an analytical expression is completely expanded to determine the base-unsteady coupling flow imposed on the moving condition of the ship.The ship in the numerical model may possess different advancing speeds,i.e.stationary,low speed,and high speed.The role of the water depth,wave height,wave period,and incident wave angle is analyzed by means of the accurate numerical model.It is found that the resonant motions of the high forward-speed ship are triggered by comparison with the stationary one.More specifically,a higher forward speed generates a V-shaped wave region with a larger elevation,which induces stronger resonant motions corresponding to larger wave periods.The shoaling effect is adverse to the motion of the low-speed ship,but is beneficial to the resonant motion of the high-speed ship.When waves obliquely propagate toward the ship,the V-shaped wave region would be broken due to the coupling effect between roll and pitch motions.It is also demonstrated that the maximum heave motion occurs in beam seas for stationary cases but occurs in head waves for high speeds.However,the variation of the pitch motion with period is hardly affected by wave incident angles.

Experimental study on the variation of optical remote sensing imaging characteristics of internal solitary waves with wind speed

Optical remote sensing has been widely used to study internal solitary waves(ISWs).Wind speed has an important effect on ISW imaging of optical remote sensing.The light and dark bands of ISWs cannot be observed by optical remote sensing when the wind is too strong.The relationship between the characteristics of ISWs bands in optical remote sensing images and the wind speed is still unclear.The influence of wind speeds on the characteristics of the ISWs bands is investigated based on the physical simulation experiments with the wind speeds of 1.6,3.1,3.5,3.8,and 3.9 m/s.The experimental results show that when the wind speed is 3.9 m/s,the ISWs bands cannot be observed in optical remote sensing images with the stratification of h_(1)∶h_(2)=7∶58,ρ_(1)∶ρ_(2)=1∶1.04.When the wind speeds are 3.1,3.5,and 3.8 m/s,which is lower than 3.9 m/s,the ISWs bands can be obtained in the simulated optical remote sensing image.The location of the band’s dark and light extremum and the band’s peak-to-peak spacing are almost not affected by wind speed.More-significant wind speeds can cause a greater gray difference of the light-dark bands.This provided a scientific basis for further understanding of ISW optical remote sensing imaging.

Corrosion Test of the Steel Plate in a WJ-8 Fastener for High Speed Rail

It was found that the steel plate in the composite plate in the WJ-8 fastener used in high speed rail is rusty. The objective of this study is to test the zinc coating of the steel plate. A literature review was conducted to identify the zinc coating techniques, and the companies that can provide different coating service was identified. A salt fog chamber was built that was in compliance with the ANSI B117 code, and the steel plates that were coated by the identified companies were tested using the salt fog chamber. The results indicated that the coating technique that had the best performance in preventing corrosion was the Greenkote plates with passivation. The galvanized option had the roughest coating layer, and it was the most reactive in the salt water solution. This makes it non-ideal for the dynamic rail environment because the increased friction of the plate could damage the supports, especially during extreme temperatures that would cause the rail to expand or contract. Greenkote with Phosphate and ArmorGalv also provided increased corrosion prevention with a smooth, strong finish, but it had more rust on the surface area than the Greenkote with ELU passivation. The ArmorGalv sample had more rust on the surface area than the Greenkote samples. This may not be a weakness in the ArmorGalv process;rather, it likely was the result of this particular sample not having the added protection of a colored coating.

Improving the ductility and toughness of nano-TiC/AZ61 composite by optimizing bimodal grain microstructure via extrusion speed

In this study,the nano-TiC/AZ61 composites with different heterogeneous bimodal grain(HBG)structures and uniform structure are obtained by regulating the extrusion speed.The effect of HBG structure on the mechanical properties of the composites is investigated.The increasing ductility and toughening mechanism of HBG magnesium matrix composites are carefully discussed.When the extrusion speed increases from 0.75 mm/s to 2.5 mm/s or 3.5 mm/s,the microstructure transforms from uniform to HBG structure.Compared with Uniform-0.75 mm/s composite,Heterogeneous-3.5 mm/s composite achieves a 116.7%increase in ductility in the plastic deformation stage and almost no reduction in ultimate tensile strength.This is mainly because the lower plastic deformation inhomogeneity and higher strain hardening due to hetero-deformation induced(HDI)hardening.Moreover,Heterogeneous-3.5 mm/s composite achieves a 108.3%increase in toughness compared with the Uniform-0.75 mm/s composite.It is mainly because coarse grain(CG)bands can capture and blunt cracks,thereby increasing the energy dissipation for crack propagation and improving toughness.In addition,the CG band of the Heterogeneous-3.5 mm/s composite with larger grain size and lower dislocation density is more conducive to obtaining higher strain hardening and superior blunting crack capability.Thus,the increased ductility and toughness of the Heterogeneous-3.5 mm/s composite is more significant than that Heterogeneous-2.5 mm/s composite.