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.

The Optimization Design of the Nozzle Section for theWater Jet Propulsion System Applied in Jet Skis

The performance of a water jet propulsion system is related to the inlet duct,rotor,stator,and nozzle.Generally,the flow inlet design must fit the bottom line of the hull,and the design of the inlet duct is often limited by stern space.The entire section,from the rotor to the nozzle through the stator,must be designed based on system integration in that the individual performance of these three components will influence each other.Particularly,the section from the rotor to the nozzle significantly impacts the performance of a water jet propulsion system.This study focused on nozzle design and established referable analysis results to facilitate subsequent integrated studies on the design parameters regarding nozzle contour.Most existing studies concentrate on discussions on rotor design and the tip leakage flow of rotors or have replaced the existing complex computational domain with a simple flow field.However,research has yet to implement an integrated,optimal design of the section from the rotor to the nozzle.Given the above,our program conducted preliminary research on this system integration design issue,discussed the optimal nozzle for this section in-depth,and proposed design suggestions based on the findings.This program used an existing model as the design case.This study referred to the actual trial data as the design conditions for the proposed model.Unlike prior references’simple flow field form,this study added a jet ski geometry and free surface to the computational domain.After the linear hull shape was considered,the inflow in the inlet duct would be closer to the actual condition.Based on the numerical calculation result,this study recommends that the optimal nozzle outlet area should be 37%of the inlet area and that the nozzle contour should be linear.Furthermore,for the pump head,static pressure had a more significant impact than dynamic pressure.

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.

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.

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.

Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico

BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.

Flow patterns and boundary conditions for inlet and outlet conduits of large pump system with low head

The flow patterns in the inlet and outlet conduits have a decisive effect on the safe, stable, and highly efficient operation of the pump in a large pumping station with low head. The numerical simulation of three-dimensional （3D） turbulence flow in conduits is an important method to study the hydraulic performance and conduct an optimum hydraulic design for the conduits. With the analyses of the flow patterns in the inlet and outlet conduits, the boundary conditions of the numerical simulation for them can be determined. The main obtained conclusions are as follows： （i） Under normal operation conditions, there is essentially no pre-swirl flow at the impeller chamber inlet of an axial-flow pump system, based on which the boundary condition at the inlet conduit may be defined. （ii） The circulation at the guide vane outlet of an axial-flow pump system has a great effect on the hydraulic performance of the outlet conduit, and there is optimum circulation for the performance. Therefore, it is strongly suggested to design the guide vane according to the optimum circulation. （iii） The residual circulation at the guide vane outlet needs to be considered for the inlet boundary condition of the outlet conduit, and the value of the circulation may be measured in a specially designed test model.

Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

One-Stage Correction with Intra- and Extraatrial Rerouting of Anomalous Systemic and Pulmonary Venous Return and Intraventricular Repair of Double Outlet Right Ventricle in a Patient with Heterotaxy Syndrome

We report a very rare case of successful intracardiac correction in a patient with heterotaxy syndrome.The cardiac malformations included dextrocardia,double outlet right ventricle,pulmonary stenosis,interrupted inferior vena cava,hemiazygos continuation and total anomalous pulmonary venous return.One-stage correction was performed.The atrial procedure consisted of intra-and extraatrial rerouting of the anomalous systemic and pulmonary venous return.The hepatic veins were detached and diverted to the left atrium via an extracardiac conduit.The correction of the double outlet right ventricle was accomplished by intraventricular redirection of the blood flow from the left ventricle to the aorta.The right ventricular outflow was ultimately remodeled using a valved conduit.For better perception of the complex morphology,a three-dimensional model was designed,using CT scan images.This proved to be very useful for surgical planning,especially with regard to the intraatrial reconstruction of the systemic and pulmonary venous rerouting.

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

Outcomes of Transcatheter Closure in Outlet-Type Ventricular Septal Defect after 1 Year

Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.

Modified stomach-partitioning gastrojejunostomy for initially unresectable advanced gastric cancer with outlet obstruction: A case report

BACKGROUND Chemotherapy followed by gastrojejunostomy remains the main treatment for unresectable gastric cancer(GC)in the middle-or lower-third regions with gastric outlet obstruction(GOO).Radical surgery is performed as part of a multimodal treatment strategy for selected patients who respond well to chemotherapy.This study describes a case of successful radical resection with completely laparoscopic subtotal gastrectomy after a modified stomach-partitioning gastrojejunostomy(SPGJ)for obstruction relief,in a patient with GOO.CASE SUMMARY During the initial esophagogastroduodenoscopy,an advanced growth was detected in the lower part of the stomach,which caused an obstruction in the pyloric ring.Following this,a computed tomography(CT)scan revealed the presence of lymph node metastases and tumor invasion in the duodenum,but no evidence of distant metastasis was found.Consequently,we performed a modified SPGJ,a complete laparoscopic SPGJ combined with No.4sb lymph node dissection,for obstruction relief.Seven courses of adjuvant capecitabine plus oxaliplatin combined with Toripalimab(programmed death ligand-1 inhibitor)were administered thereafter.A preoperative CT showed partial response;therefore,completely laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy was performed after conversion therapy,and pathological complete remission was achieved.CONCLUSION Laparoscopic SPGJ combined with No.4sb lymph node dissection was an effective surgical technique for initially unresectable GC with GOO.

巴基斯坦瓜达尔某电厂温排水数值模拟研究

文章首先分析了北印度洋阿拉伯海的水文气象特征,重点分析了该海域的季风洋流特征,在此基础上,建立平面二维潮流水动力及热扩散数学模型,经率定验证后对巴基斯坦瓜达尔某燃煤电站不同取排水平面布置方案下的温排水扩散进行了数值模拟。巴基斯坦瓜达尔海域海流流向呈季节性长时间的单向流形态,为风海流,与北印度洋海区的季风洋流特征一致。研究结果表明:为了满足排放口100 m处温升不得超过3℃,可采用以下措施:采用多点分散式排水;增加排水口处的水深,使温水能够进行充分的垂向掺混作用;调整排水口的排水流量,按照水深浅、流量小或水深大、流量大的原则,充分利用每个排水口处的温水容纳体积。最后,总结了取排水口的相对位置优化原则,为取排水工程的设计提供了科学依据。

Test Research on the Characteristics of Pollution Boundary Layer in the River Outlet Area of Grand Liao River

By using the meteorological data in the pollution boundary layer which was observed in two ground observation sites:coast and land in the river outlet area of Grand Liao River during January-February in 2007,the daily change characteristics of pollute boundary layer in winter in the area were discussed. The results showed that the pollute boundary layer in the river outlet area of Grand Liao River was affected by the sea and land. In the certain weather condition,maybe the sea-land breeze appeared in the low altitude which was below 200 m in the coastal zone. The stability change in the different height in the coastal zone was more stable than in the land zone,and the wind field change in the area was mainly in 300 m low altitude. At night,the temperature inversion often appears in the area,and the thickness of temperature inversion layer is stably during 200-300 m. The thermal internal boundary layer penetrated deeply into the land about 10 km,and the height could reach 800 m. The atmospheric diffusion ability in the coastal area was weaker and stronger in the land area.

Plights and Outlet:Environmental Problem Analysis of Agricultural Eco-tourism

As agricultural eco-tourism development played a vital role in promoting rural economic and social development and constructing new harmonious countryside,the paper had analyzed environmental problem produced during its development,pointed out that blind development of agricultural eco-tourism had seriously destroyed resources and ecological environment and that tourist infrastructure construction and urbanization had ruined rural unique natural landscape.In view of current situation of environment,it also studied reasons causing environmental disruption,which lied in insufficient guidance and support of government,deficient scientific development planning and management system,and poor environmental consciousness of tourist operators and tourists.On this basis,it summarized that agricultural eco-tourism development should follow principles of sustainable development,synchronization between development and protection,and coordination between tourism development and environmental protection.It concluded proper ways to develop agricultural eco-tourism,and emphasized that it should draw up scientific and reasonable development planning,enhance government's macro-administration,establish and perfect ecological compensation mechanism,and strive to cultivate people's environmental awareness.

公共建筑单出口虹吸排水系统运行特性试验与数值研究

虹吸排水系统有利于大型公共建筑的安全运行。然而,传统的虹吸排水系统基于全管流量设计,仅适用于特定标准,无法评估从启动到整个虹吸形成过程的详细流量特性。因此,提出全尺寸的单出口虹吸排水系统实验平台,以研究虹吸排水的流动特性。并建立虹吸排水系统的全尺寸数值模型,进一步研究管道直径、排水量和管道坡度对水力性能4个要素的影响。实验结果表明:当悬浮管内的空气耗尽,立管内的空气较小时,可以确定虹吸满管流完全形成。此时,如果取水量大于排量,则系统继续以全流量状态运行。在相同水量下,减小管道直径可以有效降低水位高度,但同时也会增加满水程度。在直径较大的管道中,坡度越小,水力跃迁的能量耗散越弱,水力跃迁的持续时间越长。

High Hydrostatic Pressure Exacerbates Bladder Fibrosis through Activating Piezo1

Objective Bladder outlet obstruction(BOO)results in significant fibrosis in the chronic stage and elevated bladder pressure.Piezo1 is a type of mechanosensitive(MS)channel that directly responds to mechanical stimuli.To identify new targets for intervention in the treatment of BOO-induced fibrosis,this study investigated the impact of high hydrostatic pressure(HHP)on Piezo1 activity and the progression of bladder fibrosis.Methods Immunofluorescence staining was conducted to assess the protein abundance of Piezo1 in fibroblasts from obstructed rat bladders.Bladder fibroblasts were cultured under normal atmospheric conditions(0 cmH_(2)O)or exposed to HHP(50 cmH_(2)O or 100 cmH_(2)O).Agonists or inhibitors of Piezo1,YAP1,and ROCK1 were used to determine the underlying mechanism.Results The Piezo1 protein levels in fibroblasts from the obstructed bladder exhibited an elevation compared to the control group.HHP significantly promoted the expression of various pro-fibrotic factors and induced proliferation of fibroblasts.Additionally,the protein expression levels of Piezo1,YAP1,ROCK1 were elevated,and calcium influx was increased as the pressure increased.These effects were attenuated by the Piezo1 inhibitor Dooku1.The Piezo1 activator Yoda1 induced the expression of pro-fibrotic factors and the proliferation of fibroblasts,and elevated the protein levels of YAP1 and ROCK1 under normal atmospheric conditions in vitro.However,these effects could be partially inhibited by YAP1 or ROCK inhibitors.

柔直换流站柔性直流换流阀控制保护屏出口回路异常情况分析

通过对柔直换流站极2低端阀组站系统调试期间,极2低端A套阀控制保护带电跳闸试验时断路器操作箱三相出口不一致情况进行分析,对极2低端阀控跳闸出口逻辑、组控跳闸出口逻辑及断路器操作箱回路进行梳理,总结出阀控系统跳闸出口时,组控系统手跳与远跳命令同时下发,STJ继电器与TJR继电器由于动作时序不一致,导致断路器操作箱出口跳闸信号灯三相不一致。通过对该回路进行改进,取消了阀控系统跳闸启动组控系统手跳回路的逻辑,通过逻辑优化确保现场调试及后期运维工作安全有序开展。该策略可在柔直换流站阀控、组控逻辑配置中推广使用。

Interferon-gamma release assays as a tool for differential diagnosis of gastrointestinal tuberculosis

In this editorial,we comment on an article published in a recent issue of the World Journal of Clinical Cases.There is a pressing need for reliable tools for diagnosing tuberculosis(TB)of the gastrointestinal tract.Despite advancements in the diagnosis and treatment,TB remains a global health challenge.Ali et al demon-strated that TB may mimic gastrointestinal conditions,such as gastric outlet obstruction,causing a delay in the diagnosis.Furthermore,the latter complication is frequently observed during infections,including Helicobacter pylori,and rarely is related to TB,as in the presented case.In line with this,we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract.Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.

基于压力载荷谱的挖掘机行走液压系统液压泵异常检测方法

针对矿用挖掘机液压泵运行环境复杂、振动信号难以识别的问题,提出一种基于压力载荷谱的挖掘机行走液压系统液压泵的异常检测方法。根据挖掘机行走工作特点划分行走液压系统典型工况;筛选行走液压系统液压泵出口压力、先导阀压力、发动机转速及扭矩百分比作为压力载荷谱,并进行数据清洗、插值对齐以及平滑滤波;最后,基于压力载荷谱和LSTM网络建立液压泵异常检测模型,利用模型分别对泵1、2的出口压力进行预测,采用滑动余弦相似性度量技术对预测结果进行差异性评估,结合评估结果与1δ准则以实现矿用挖掘机行走液压泵异常检测。实验结果表明:所提方法能够实现对液压泵的异常检测,可以对矿用挖掘机行走液压泵故障进行提前预警。