[目的]研究地铁隧道近距离下穿施工对既有地铁车站及高架桩基的影响。[方法]以合肥S1线五里墩站安全线隧道施工近距离下穿既有地铁2号线五里墩站为背景,利用有限元软件ABAQUS对项目施工全过程进行三维建模,对比分析了逐线开挖和两线同...[目的]研究地铁隧道近距离下穿施工对既有地铁车站及高架桩基的影响。[方法]以合肥S1线五里墩站安全线隧道施工近距离下穿既有地铁2号线五里墩站为背景,利用有限元软件ABAQUS对项目施工全过程进行三维建模,对比分析了逐线开挖和两线同时开挖两种方案下车站结构和高架桩基的变形。为考察类似工程在不同土体条件下的适用性,通过改变隧道处土体黏聚力和弹性模量两参数,分析了两参数在隧道开挖过程中对土体以及车站底板沉降的影响。[结果及结论]隧道开挖完成后,2号线五里墩站底板在两种方案下的最大沉降相近,分别为0.73 mm和0.77mm,均满足控制标准要求;当土体的黏聚力和弹性模量分别小于70 k Pa和100 MPa时,隧道开挖过程中车站结构的沉降和桩基的水平位移开始显著增大,应对此引起重视。展开更多
Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal an...Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD.Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD,respectively.We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon;i.e.,antecolic route or retrocolic route,is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy(PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy.We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct.Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route".展开更多
AIM:To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer.METHODS:The new stent is composed of a proximal big cu...AIM:To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer.METHODS:The new stent is composed of a proximal big cup segment(20 mm in length and 48-55 mm in diameter),a middle part(60 mm in length and 20 mm in diameter)covered by a polyethylene membrane and a distal sphericity(20 mm in length and 28 mm in diameter).Half of the proximal big cup segment is also covered by a polyethlene membrane,which is adjacent to the middle part of the stent.The stent is preloaded in a 6.0-mm-diameter introducer system.Thirteen patients with gastric outlet obstruction resulting from gastric cancer received the new stents under endoscopic and fluoroscopic guidance.RESULTS:Technical success was achieved in 12 of 13(92.3%)patients.Among the 12 patients in whom endoscopic stent was placed successfully,the clinical success rate was 91.7%during a follow-up of average 6.5 mo.During the first month follow-up,the migration rate was 0%,recurrent obstruction 0%and gastric bleeding 8.3%.During the follow-up between 2-12 mo,no migration,recurrent obstruction and gastric bleeding occurred.CONCLUSION:The proximal big cup segment seems to be effective and promising for technical efficacy,clinical outcome,and preventing migration and tumor ingrowth and increasing the emptying rate of sinus ventriculi.展开更多
Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not...Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles(i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.展开更多
文摘[目的]研究地铁隧道近距离下穿施工对既有地铁车站及高架桩基的影响。[方法]以合肥S1线五里墩站安全线隧道施工近距离下穿既有地铁2号线五里墩站为背景,利用有限元软件ABAQUS对项目施工全过程进行三维建模,对比分析了逐线开挖和两线同时开挖两种方案下车站结构和高架桩基的变形。为考察类似工程在不同土体条件下的适用性,通过改变隧道处土体黏聚力和弹性模量两参数,分析了两参数在隧道开挖过程中对土体以及车站底板沉降的影响。[结果及结论]隧道开挖完成后,2号线五里墩站底板在两种方案下的最大沉降相近,分别为0.73 mm和0.77mm,均满足控制标准要求;当土体的黏聚力和弹性模量分别小于70 k Pa和100 MPa时,隧道开挖过程中车站结构的沉降和桩基的水平位移开始显著增大,应对此引起重视。
文摘Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD.Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD,respectively.We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon;i.e.,antecolic route or retrocolic route,is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy(PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy.We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct.Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route".
文摘AIM:To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer.METHODS:The new stent is composed of a proximal big cup segment(20 mm in length and 48-55 mm in diameter),a middle part(60 mm in length and 20 mm in diameter)covered by a polyethylene membrane and a distal sphericity(20 mm in length and 28 mm in diameter).Half of the proximal big cup segment is also covered by a polyethlene membrane,which is adjacent to the middle part of the stent.The stent is preloaded in a 6.0-mm-diameter introducer system.Thirteen patients with gastric outlet obstruction resulting from gastric cancer received the new stents under endoscopic and fluoroscopic guidance.RESULTS:Technical success was achieved in 12 of 13(92.3%)patients.Among the 12 patients in whom endoscopic stent was placed successfully,the clinical success rate was 91.7%during a follow-up of average 6.5 mo.During the first month follow-up,the migration rate was 0%,recurrent obstruction 0%and gastric bleeding 8.3%.During the follow-up between 2-12 mo,no migration,recurrent obstruction and gastric bleeding occurred.CONCLUSION:The proximal big cup segment seems to be effective and promising for technical efficacy,clinical outcome,and preventing migration and tumor ingrowth and increasing the emptying rate of sinus ventriculi.
文摘Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles(i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration.
