游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的应用

目的探讨游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的临床应用及疗效。方法2016年5月-2022年11月,应用股前外侧Flow-through皮瓣急诊修复15例手部复杂性断指再植创面。通过旋股外侧降支动脉主干或穿支串联断指,完成复杂性断指血运重建,其中皮肤软组织缺损面积:7.0 cm×8.0 cm~12.0 cm×23.0 cm,主干血管缺损长度3.5~10.0 cm,对于合并血管、神经或肌腱缺损者,行血管移植、神经移植或携带阔筋膜张肌重建,合并手部死腔嵌合穿支肌皮瓣移植修复,术后门诊或微信随访分析患指及皮瓣情况评估并指导锻炼。结果除1例断指再植坏死,其余皮瓣及断指再植全部成活。患者均获得随访,随访时间6~24个月,断指及皮瓣成活质量良好,皮瓣厚度与周围皮肤接近,质地柔软,无严重瘢痕,恢复部分保护性感觉;断指指体轻度萎缩,恢复指体外形,功能恢复满意,两点辨别觉达5~11 mm;末次随访时根据中华医学会手外科学会上肢部分功能评定试用标准评定再植指功能:优3例,良9例,可2例,差1例,优良率达80%。结论应用游离股前外侧Flow-through皮瓣急诊修复手部复杂性断指再植创面,利用旋股外侧动脉降支或分支与缺损的主干动脉桥接,实现了重建远端血液循环及覆盖创面的双重功能,明显缩短手术时间,提高皮瓣及指体血运重建率,效果良好,值得临床推广。

股前外侧Flow-through皮瓣修复下肢大面积缺损合并主干动脉缺损

目的探讨应用股前外侧Flow-through皮瓣修复下肢大面积缺损合并主干动脉缺损的临床疗效。方法2017年9月-2022年3月,应用股前外侧Flow-through皮瓣修复下肢大面积缺损并主干动脉缺损10例,其中合并胫后动脉缺损7例,胫前动脉缺损3例。一期行骨折外固定,VSD覆盖创面,二期行股前外侧Flow-through皮瓣修复术。结果10例皮瓣均成活,1例皮瓣远端少许坏死,经换药后伤口愈合,2例术后出现静脉危象,探查后皮瓣成活。随访8~24个月,平均15个月,皮瓣外观质地良好,5例因皮瓣臃肿行皮瓣修整。供区除伤口瘢痕及色素沉着外,未出现功能影响等并发症。结论股前外侧Flow-through皮瓣穿支可靠,血管蒂长,轴心血管管径粗,可重建主干血管,是修复下肢大面积缺损合并主干动脉缺损的较好选择。

急诊拇指撕脱离断伤再植及一期Flow-through前臂静脉皮瓣或掌骨头间静脉转位修复效果观察

目的:探讨急诊拇指撕脱离断伤再植及一期Flow-through前臂静脉皮瓣或掌骨头间静脉转位修复的效果。方法:选取2018年2月-2020年3月笔者医院收治的83例急诊拇指撕脱离断伤患者为研究对象。其中62例静脉缺损患者,采用再植联合掌骨头间静脉转位修复,21例皮肤缺损及背侧静脉缺损患者,采用再植联合一期Flow-through前臂静脉皮瓣修复。术后,记录患者住院时间、手术时间及术中出血量,并记录术后7?d内患者并发症;术后3个月及术后12个月,分别对患者拇指功能进行评估;术后12个月,统计患者的治疗满意度。结果:患者手术时间为(3.42±0.69)h;术中出血量为(10.37±2.15)ml;住院时间为(7.42±1.83)d。术后12个月患者拇指功能优良率(95.18%)高于术后3个月(85.54%)(P<0.05)。83例患者术后皮瓣全部存活,术后7?d内,2例动脉危象,2例静脉危象,5例一期Flow-through皮瓣术后出现早期张力性水疱、肿胀瘀血,脱痂换药后皮瓣全部存活。随访12个月,皮瓣与再植指血运良好,拇指外形饱满,感觉功能部分恢复,对掌对指功能明显恢复。术后12个月,患者的治疗满意度为(82.79±6.85)分。结论:急诊拇指撕脱离断伤给予再植及一期Flow-through前臂静脉皮瓣或掌骨头间静脉转位修复效果良好,且患者治疗满意度良好,可临床推广应用。

Flow-through静脉皮瓣修复断指再植伴环形缺损的临床效果

目的探讨Flow-through静脉皮瓣修复断指再植伴环形缺损的临床疗效。方法选取100例(共112指)断指再植患者为研究对象,按照随机数字表法分为治疗组50例(60指)和对照组50例(52指)。对照组行侧方皮瓣修复,治疗组行Flow-through静脉皮瓣修复。2组均随访6个月,观察并比较2组临床治疗效果以及预后情况。结果治疗后,治疗组优良率为84.00%,显著高于对照组的56.00%(P<0.05)。治疗组不良预后总发生率为12.00%,显著低于对照组的36.00%(P<0.05)。结论Flow-through静脉皮瓣修复断指再植伴环形缺损的效果显著,能够显著降低不良预后发生率。

Flow-through静脉皮瓣在伴环形缺损断指再植中的应用

目的评价Flow-through静脉皮瓣在伴环形缺损断指再植中的临床应用价值。方法采用前瞻性随机对照研究法,将榆林市第一医院手足显微外科自2015年6月至2016年10月收治的70例伴环形皮肤及血管缺损的断指再植患者随机分为两组,对照组(n=35)采用侧方皮瓣修复治疗,观察组(n=35)采用Flow-through静脉皮瓣修复治疗,两组患者均随访12个月,比较两组患者的治疗效果、两点辨别感觉以及不良预后发生情况。结果观察组的末次随访手指功能优良率高于对照组(P<0.05);观察组的末次随访时两点辨别感觉为6.5~12.5 mm,平均(8.5±1.3)mm,对照组的末次随访时两点辨别感觉为7.5~14.0 mm,平均(10.4±1.5)mm,组间比较差异有统计学意义(P<0.05);观察组的静脉危象、弹性变差、颜色加深等不良预后发生率均低于对照组(P<0.05)。结论与侧方皮瓣修复治疗相比,采用Flow-through静脉皮瓣修复治疗伴环形皮肤及血管缺损断指的临床效果更佳,不良预后发生率更低;若临床条件允许,对于伴环形皮肤及血管缺损的断指再植患者,建议优先采用Flow-through静脉皮瓣修复治疗。

STUDY ON THE THROUGH-SPACE AND THROUGH-BOND INTERACTIONS IN TRICYCLO 4,2,2,2 DODECADIENE-1.5

Through-space interactions of pi orbiatl and sigma orbital in molecule tricycle 4,2,2,2,dodecadiene -1.5 were studied by means of DV-X alpha SVF method using a model molecule that consists of two ethylenes with interdeck distance D. The results show the through-space interactions of the title molecule decrease with the increasing of D,the through-space interactions of pi orbital are larger than that of sigma orbital. Furthermore, through-bond interactions of the pi orbtial and sigma orbital were analyzed basing on the calculations of the electronic structure of the title molecule. Both through-space and through-bond interactions are Large and,the net interactions are small. The calculated ionization potential energies of the title molecule which were obtained by transition-state procedure are in good agreement with the PE spectroscopy.

Flow-through旋股外侧动脉降支穿支皮瓣在上肢高压电击伤保肢治疗中的应用

目的探讨Flow-through旋股外侧动脉降支穿支皮瓣对上肢高压电击伤的保肢效果。方法回顾性分析2017年7月至2019年2月笔者单位收治的5例上肢高压电击伤患者,患肢均存在广泛的软组织坏死伴血循环障碍,急诊予以患肢切开减张、坏死组织清除、血管探查及游离Flow-through旋股外侧动脉降支穿支皮瓣移植修复创面并重建肢体远端血运。彻底清创后创面面积6.0cm×4.0cm~17.1 cm×10.3cm,切取皮瓣面积为7.2cm×5.0cm~18.3cm×11.5cm。供区均Ⅰ期闭合。结果1例患者术后7d发生皮瓣下感染,经扩创缝合后顺利愈合;其余患者皮瓣存活良好,创面I期愈合。所有患者获随访6~18个月,平均12个月,保肢成功,皮瓣质地柔软、外形满意,患肢尺、桡动脉通畅,手、腕部血运良好,功能有一定恢复。供区残余片状瘢痕,小范围感觉麻木。结论Flow-through旋股外侧动脉降支穿支皮瓣可及时有效重建肢体血运的同时修复创面,是上肢高压电击伤保肢的理想方法之一,值得推广。

股前外侧Flow-through皮瓣的临床应用

目的探讨应用股前外侧Flow-through皮瓣修复四肢软组织损伤的临床效果。方法对2013年10月-2020年10月收治的12例四肢软组织缺损患者应用股前外侧Flow-through皮瓣进行修复,并分析该皮瓣的临床应用及特点。结果术后皮瓣一期愈合,患者均获得随访,随访时间为4~16个月,皮瓣成活质量良好。结论股前外侧Flow-through皮瓣具有供区损伤小、可直接缝合、皮瓣面积大、重建受区远端血供等优点,在四肢大面积软组织缺损的修复中效果良好,值得推广。

介词的语义扩展——through的个案研究

从认知语言学的角度分析介词的语义扩展。通过对介词through的分析,探讨认知机制在介词语义扩展中的作用,及其在介词语义系统结构中的中心地位和在新语义产生时所扮演的角色。挖掘介词through在隐喻及换喻的认知功能作用下从空间意义逐步映射到隐喻意义的认知过程。

Nonlinear energy harvesting based on a modified snap-through mechanism

A modified snap-through mechanism is used in an electromagnetic energy harvester to improve its effectiveness. It mainly comprises three springs that are configured so that the potential energy of the system has two stable equilibrium points. In particular, the small vibration behavior of the harvester around one of the equilibriums is of interest. A multi-scale method(MSM) is used to analyze the frequency response curve. Two snap-through mechanisms are considered. One has both horizontal and vertical springs. The other has only horizontal springs. The frequency response curves of these two classes are compared under the same excitation and electric loading conditions. The latter exhibits more bending of the frequency response curve than the former one. The results are also validated by some numerical work. The averaged power subject to the Gaussian white noise is calculated numerically, and the results demonstrate that bi-stable energy harvesting with only horizontal springs can outperform the mechanism with both horizontal and vertical springs for the same distance between two equilibriums.

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.

Adaptive prediction system of sintering through point based on self-organize artificial neural network

A soft sensing method of burning through point (BTP) was described and a new predictive parameter—the mathematics inflexion point of waste gas temperature curve in the middle of the strand was proposed. The artificial neural network was used in predicting BTP, modification on backpropagation algorithm was made in order to improve the convergence and self organize the hidden layer neurons. The adaptive prediction system developed on these techniques shows its characters such as fast, accuracy, less dependence on production data. The prediction of BTP can be used as operation guidance or control parameter.[

An Oscillating Wave Energy Converter with Nonlinear Snap-Through Power-Take-Off Systems in Regular Waves

Floating oscillating bodies constitute a large class of wave energy converters, especially for offshore deployment. Usually the Power-Take-Off（PTO） system is a directly linear electric generator or a hydraulic motor that drives an electric generator. The PTO system is simplified as a linear spring and a linear damper. However the conversion is less powerful with wave periods off resonance. Thus, a nonlinear snap-through mechanism with two symmetrically oblique springs and a linear damper is applied in the PTO system. The nonlinear snap-through mechanism is characteristics of negative stiffness and double-well potential. An important nonlinear parameter γ is defined as the ratio of half of the horizontal distance between the two springs to the original length of both springs. Time domain method is applied to the dynamics of wave energy converter in regular waves. And the state space model is used to replace the convolution terms in the time domain equation. The results show that the energy harvested by the nonlinear PTO system is larger than that by linear system for low frequency input. While the power captured by nonlinear converters is slightly smaller than that by linear converters for high frequency input. The wave amplitude, damping coefficient of PTO systems and the nonlinear parameter γ affect power capture performance of nonlinear converters. The oscillation of nonlinear wave energy converters may be local or periodically inter well for certain values of the incident wave frequency and the nonlinear parameter γ, which is different from linear converters characteristics of sinusoidal response in regular waves.

Automatic User Goals Identification Based on Anchor Text and Click-Through Data

Understanding the underlying goal behind a user＇s Web query has been proved to be helpful to improve the quality of search. This paper focuses on the problem of automatic identification of query types according to the goals. Four novel entropy-based features extracted from anchor data and click-through data are proposed, and a support vector machines （SVM） classifier is used to identify the user＇s goal based on these features. Experi- mental results show that the proposed entropy-based features are more effective than those reported in previous work. By combin- ing multiple features the goals for more than 97% of the queries studied can be correctly identified. Besides these, this paper reaches the following important conclusions： First, anchor-based features are more effective than click-through-based features; Second, the number of sites is more reliable than the number of links; Third, click-distribution- based features are more effective than session-based ones.

Flow-through静脉皮瓣在伴环形缺损断指再植中的应用

目的观察Flow-through静脉皮瓣在伴环形缺损断指再植中的应用效果。方法选取2010年1月至2013年1月我院收治的断指再植患者56例62指,采用随机数字法将其分为观察组与对照组。观察组30例35指,行Flow-through静脉皮瓣修复;对照组26例27指,行侧方皮瓣修复。术后随访12~18个月,比较两组患者的手功能恢复情况。结果随访期间,观察组患者的手功能恢复优良率为97.1%,明显高于对照组的88.9%,差异具有统计学意义（P〈0.05）;观察组静脉危象及皮瓣坏死发生率分别为8.6%、5.7%,与对照组的11.1%、7.4%相当,差异均无统计学意义（P〉0.05）;观察组颜色加深及弹性变差率分别为5.7%、5.7%,明显低于对照组的18.5%、14.8%,差异均具有统计学意义（P〈0.05）。结论 Flow-through静脉皮瓣用于伴环形缺损断指再植中,能够有效改善患者临床疗效,降低不良预后的发生。

Antenna planes based wall-clutter mitigation in through-wall-imaging applications

In ultra-wideband through-wall-imaging applications, wall clutters are always much stronger than the target reflections, and they tend to persist over a long period of time. As a result, targets are obscured and not visible in the image. In this work, an antenna planes-based wall clutter mitigation method was proposed. By using two imaging procedures in different scanning planes, this method can mitigate the wall clutter in both SAR and MIMO modes. The proposed method was tested using EM numerical data via the FDTD method. The processing results show that the imaging quality is improved significantly.

Seismic Behavior of Diaphragm-Through Connections of Concrete-Filled Square Steel Tubular Columns and H-Shaped Steel Beams

Based on the introductions of a type of diaphragm-through connection between concrete-filled square steel tubular columns (CFSSTCs) and H-shaped steel beams,a finite element model of the connection is developed and used to investigate the seismic behavior of the connection.The results of the finite element model are validated by a set of cyclic loading tests.The cyclic loading tests and the finite element analyses indicate that the failure mode of the suggested connections is plastic hinge at the beam with inelastic rotation angle exceeding 0.04 rad.The suggested connections have sufficient strength,plastic deformation and energy dissipation capacity to be used in composite moment frames as beam-to-column rigid connections.

Bearing Capacity and Critical Punch-Through Depth of Spudcan on Sand Overlying Clay

Spudcan may experience punch-through failure on strong over weak layered soils, such as sand overlying clay. A large deformation finite element method （LDFE） is used to simulate the penetration process of spudcan into sand overlying clay. The sand is simulated by smoothed hyperbolic Mohr-Coulomb model, and the clay is simulated by a simple elasto-plastic model which obeys Tresca yield criterion. According to the LDFE results of a large amount of cases, the effects of the strength, unit weight and thickness of the top sand layer, as well as the effect of the strength of the underlying clay on the spudcan punch-through behavior, are investigated. The critical depth occurring punch-through and the critical bearing capacity are presented in charts. Fitting equations to calculate the critical punch-through depth and the critical bearing capacity are proposed for the convenience of engineering practice.

Transumbilical enterostomy for Hirschsprung’s disease with a two-stage laparoscopy-assisted pull-through procedure

BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.

Through-silicon-via crosstalk model and optimization design for three-dimensional integrated circuits

Through-silicon-via （TSV） to TSV crosstalk noise is one of the key factors affecting the signal integrity of three- dimensional integrated circuits （3D ICs）. Based on the frequency dependent equivalent electrical parameters for the TSV channel, an analytical crosstalk noise model is established to capture the TSV induced crosstalk noise. The impact of various design parameters including insulation dielectric, via pitch, via height, silicon conductivity, and terminal impedance on the crosstalk noise is analyzed with the proposed model. Two approaches are proposed to alleviate the TSV noise, namely, driver sizing and via shielding, and the SPICE results show 241 rnV and 379 mV reductions in the peak noise voltage, respectively.