Papillary Fibroelastoma of the Papillary Muscle of the Tricuspid Valve: Reconstruction of the Papillary Muscle

Cardiac papillary fibroelastoma is the third most frequent primary cardiac tumor, after myxoma and fibroma. A papillary fibroelastoma that arises from the papillary muscle is rare. We removed a papillary fibroelastoma located at the anterior papillary muscle of the tricuspid valve. The papillary muscle needed reconstruction. We used the loop technique to adjust the length of the papillary muscle and performed annuloplasty by using an artificial ring.

Applied distally based peroneus brevis muscle flaps for coverage of the soft tissue defects over the lower one-third of the leg, ankle and foot

Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue

Synthesis and Structural Features of 3,5-Dihydroxy N′-(3-nitrobenzylidene) Benzohydrazide and Its Effect on the Intestinal Smooth Muscle

A new compound,3,5-dihydroxy-N-（3-nitrobenzylidene）benzohydrazide （DNBB） methanol solvate,was synthesized and characterized by single-crystal X-ray diffraction.DNBB crystallizes in a monoclinic system,space group P2 1/c with a=8.387（4）,b=23.237（10）,c=9.133（3）,β=122.10（3）o,Z=4,V=1507.8（12） 3,D c=1.464 g/cm 3,F（000）=696.0,μ=0.116 mm-1,the final R=0.0480 and wR=0.1294.DNBB exhibited low toxicity on Caco-2 cell culture and produced significant inhibitory effect on the contraction of rat jejunal longitudinal smooth muscle （JLSM）.The mechanism of DNBB on JLSM was correlated to the stimulation of α and β adrenergic receptors since α receptor antagonist phentolamine and β receptor antagonist propranolol abolished the inhibitory effects of DNBB on the contraction of JLSM,respectively.

Dilatation of the nasal valve by expansion of the vestibular oris (EVO)

Introduction: The main signs and symptoms of ankyloglossia with deviation of the epiglottis and larynx (ADEL) are sleep disorders caused by respiratory restraint. The author contrived the surgical procedure of correction of the glosso-larynx (CGL) and expansion of the vestibular oris (EVO) for the cure of ADEL. CGL increases vital capacity (VC) and forced expiratory volume in 1 second (1% FEV). EVO reduces nasal airflow resistance. The most important component of nasal airflow resistance is the nasal valve. Purpose: Our purpose was to measure how wide the nares were dilated after EVO. Method: The width of the nares, height of the nose, length of the philtrum and width of the lip were measured in patients who had signs and symptoms of ADEL, before and after EVO. Result: Significant increases were observed in the width of the nares, height of the nose and length of the lip after EVO. Conclusion: This study confirmed that the nares dilate after EVO. Not only the amelioration of nasal respiration by EVO increases immunity, but also aesthetic effects are obtained after EVO.

Delayed papillary muscle rupture after radiofrequency catheter ablation: A case report

BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation(RFCA)at papillary muscles in ventricular tachycardia(VT)patients with preoperative MVP.CASE SUMMARY We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before.The patient then underwent mitral valve replacement with no premature ventricular contraction or VT.During the surgery,a papillary muscle rupture was identified.Pathological examination showed necrosis of the papillary muscle.The patient recovered after mitral valve replacement.CONCLUSION Too many ablation procedures and energy should be avoided.

Left Ventricular Reconstruction and Mitral Valve Annuloplasty Combined with Papillary Muscle Relocation for Severe Ischemic Mitral Regurgitation

A 46-year-old man was referred to our hospital due to severe ischemic mitral regurgitation with severe bileaflet tethering and a dilated left ventricle. We performed left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation. Although left ventricular continued remodeling occurred during follow-up, left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation provided durable mitral repair, and his functional status was good. Thus, this combined surgical treatment may reduce mitral regurgitation recurrence after mitral valve annuloplasty.

Mitral Valve Repair for Mitral Valve Regurgitation with Papillary Muscle Displacement and Posterior Leaflet Prolapse

A case of abnormal chordae of the mitral valve (MV) associated with systolic anterior motion (SAM) is not commonly encountered in clinical practice. Here we report MV repair via the edge-to-edge technique in a 56-year-old male with MV regurgitation associated with papillary muscle displacement and posterior leaflet prolapse. Echocardiography revealed obstruction of the left ventricular outflow tract caused by SAM because of papillary muscle displacement and mitral regurgitation associated with posterior leaflet prolapse due to chordae rupture. MV repair was successfully performed by reconstruction with an Alfieri stitch. The outcome of this case demonstrated that this surgical technique is preferable for MV abnormalities with no complex malformations.

Design and Dynamic Model of a Frog-inspired Swimming Robot Powered by Pneumatic Muscles

Pneumatic muscles with similar characteristics to biological muscles have been widely used in robots, and thus are promising drivers for frog inspired robots. How- ever, the application and nonlinearity of the pneumatic system limit the advance. On the basis of the swimming mechanism of the frog, a frog-inspired robot based on pneumatic muscles is developed. To realize the indepen- dent tasks by the robot, a pneumatic system with internal chambers, micro air pump, and valves is implemented. The micro pump is used to maintain the pressure difference between the source and exhaust chambers. The pneumatic muscles are controlled by high-speed switch valves which can reduce the robot cost, volume, and mass. A dynamic model of the pneumatic system is established for the sim- ulation to estimate the system, including the chamber, muscle, and pneumatic circuit models. The robot design is verified by the robot swimming experiments and the dynamic model is verified through the experiments and simulations of the pneumatic system. The simulation results are compared to analyze the functions of the source pressure, internal volume of the muscle, and circuit flow rate which is proved the main factor that limits the response of muscle pressure. The proposed research provides the application of the pneumatic muscles in the frog inspired robot and the pneumatic model to study muscle controller.

Plasma cladding of Stellite 6 powder on Ni76Cr19AlTi exhausting valve

Heavy duty engine valve head was prepared by Ni76Cr19AlTi alloy.It was coated by cobalt-base alloy on the surface topromote its wear-resistance.Hardness tester,metallograph,scanning microscopy,energy spectrum and X-ray diffraction were used toanalyze the mechanical properties,the microstructure of the welds and the coated layer of cobalt-base alloy.The results show that thegrains are obviously coasened in the side of Ni76Cr19AlTi alloy in the welds and it contains a typical dentritic structure in the sidecobalt-base alloy.It is found that micro-strain in weld is stronger than that in heat-effected-zone.Micro-strain in nickel-base alloy isstronger than that cobalt-base alloy.There are not obvious imperfects in the weld.Hardness in cobalt-base alloy is more than 390HVand the major carbides in cobalt-base alloy are Cr7C3 and W2C.

A Surgical Perspective on Ischemic Mitral Regurgitation: Tethering or Prolapse? Going Back to Papillary Muscles Anatomy. What the Surgeons Really Need to Know

More than one third of patients with ischemic mitral regurgitation (IMR) present a valve prolapse whose mechanism is subtended by a papillary injury. The recent literature is pointing at a regional ventricular injury or wall motion abnormality rather than a global LV dysfunction as responsible for IMR and the presence of localized valve prolapse related to papillary dysfunction is additionally supporting this idea. Leaflet tethering or prolapse in these patients is subtended by lesion of the papillary muscle (PM) per se rather than its dysfunction secondary to regional and global ventricle enlargement. Identification of this type of lesion is difficult and can be overlooked. Morphological characteristics and anatomical variability of the papillary muscles determine their different susceptibility ischemic damage and dysfunction. Pioneering work in mitral anatomy shows a range of morphological diversity of PM anatomy and leads to an anatomical classification with important implications in IMR surgery. New methods of investigation, as multidetector computed tomography or magnetic resonance provide a very accurate and proper identification of the morphological pattern of the subvalvular apparatus, which is crucial for a long-lasting and successful surgical correction. The involvement of PM in the pathophysiology of IMR not only in terms of their functional anomaly, but also of their effective anatomical aspects and characteristics is increasingly emerging. The modern advancements of imaging techniques can guide the preoperative surgical planning and the surgeon needs to be aware of morphological features of the subvalvular apparatus and combine these findings with echographic functional parameters before embarking in complex mitral repairs.

Oxidization resistance of Ni76Cr19AlTi valve alloy at temperatures under operating mode of heavy-duty engines

The oxidization resistance of the Ni76Cr19A1Ti alloy was studied by a static oxidization experiment at 600-800℃. The results show that the oxidation behavior of the alloy can be explained by a kinetic equation： （△m/S）2 = Kpt ＋ C, where Kp is a kinetic constant of the nickel-base alloy. The higher the experimental temperature, the higher the value of Kp. It is discovered that the microstructure of the oxide scales is compact and the thickness of it is less than 10 μm The oxidization of the alloy is in the first grade. It is also found that the oxide scales are mainly composed of Cr2O3 and TiO2. Chrome and titanium react more easily with oxygen at temperatures under the operating mode.

双阀芯增量式高水基数字阀的设计及实验研究

刮板输送机的直线度控制,是实现煤矿智能化的关键技术,但由于井下工作面通断式支架电液阀的不连续性,难以满足综采工作面直线度的自适应控制需求。此外,由于支架液压系统采用乳化液作为介质,用于油介质的比例阀难以直接用于支架液压系统。针对上述问题,提出了一种新型双阀芯增量式高水基数字阀结构,其主要由电机丝杠驱动部、双阀芯组件和阀块组成。首先,对双阀芯增量式数字阀的结构和工作原理进行了分析,其新型的双阀芯结构形式,可实现负载口独立控制,兼具开环与闭环两种工作方式。其次,对阀芯阀座处的关键密封副进行数学建模,综合考虑密封比压与密封接触宽度,发现采用“硬对软”材料配对时,可兼顾密封副的密封性与使用寿命,且在阀座半锥角为0.61 rad时达到最佳效果。再次,对电–机械转换器进行建模并采用滑模控制算法进行仿真分析,正弦响应时,滑模控制算法经过0.08 s能稳定跟踪参考信号,响应性能明显优于PID。最后,搭建xPC Target实时控制平台进行样机实验,测试了密封副的密封性,以及不同电机细分控制下和不同阶跃幅值下的性能。结果表明:在21 MPa压力下密封副能可靠密封;采用1600脉冲/转的细分控制性能最佳;0.2 mm阶跃响应时,其响应时间为0.25 s,稳态误差为3μm,流量为13 L/min,具有较优的控制性能。

心脏瓣膜术后发生急性肾损伤危险因素的Meta分析

目的:通过Meta分析探讨心脏瓣膜术后发生急性肾损伤(AKI)的危险因素。方法:计算机检索中国知网(CNKI)、万方数据库(WanFang Database)、维普数据库(VIP)、中华医学期刊全文数据库、the Cochrane Library、PubMed等中关于心脏瓣膜术后发生AKI危险因素的研究,检索时限为建库至2024年2月20日。由2名研究员按照标准独立筛选文献、提取相关数据并采用纽卡斯尔⁃渥太华量表(NOS)对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果:最终纳入28篇文献,涉及样本量14855例,其中病例组3255例,对照组11600例。Meta分析结果显示,年龄[MD=5.25,95%CI(1.30,9.20),P=0.009]、男性[OR=1.69,95%CI(1.06,2.69),P=0.03]、体质指数(BMI)[MD=0.95,95%CI(0.20,1.71),P=0.01]、左心室射血分数(LVEF)[MD=-3.58,95%CI(-5.54,-1.63),P<0.001]、基础血肌酐(Scr)升高[OR=2.72,95%CI(1.75,4.21),P<0.001]、肾小球滤过率(eGFR)<60 mL/(min·1.73 m^(2))[OR=2.73,95%CI(2.17,3.47),P<0.001]、血红蛋白[MD=-1.19,95%CI(-2.03,-0.36),P=0.005]、高血压[OR=2.31,95%CI(1.84,2.90),P<0.001]、糖尿病[OR=3.62,95%CI(2.69,4.87),P<0.001]、肾功能不全[OR=8.34,95%CI(5.03,13.82),P<0.001]、脑血管疾病[OR=2.89,95%CI(1.81,4.61),P<0.001]、贫血[OR=1.94,95%CI(1.49,2.54),P<0.001]、手术时长[MD=75.03,95%CI(6.44,143.61),P=0.03]、体外循环时长[MD=22.40,95%CI(10.88,33.92),P<0.001]、围术期输血[OR=2.69,95%CI(1.85,3.91),P<0.001]、呼吸机应用时间>24 h[OR=6.64,95%CI(1.10,40.00),P=0.04]、术后并发低心排血量综合征[OR=2.92,95%CI(1.35,6.29),P=0.006]均为心脏瓣膜术后发生AKI的危险因素,且使用主动脉内球囊反搏(IABP)[OR=4.33,95%CI(1.12,16.74),P=0.03]是心脏瓣膜术后发生AKI及随访死亡的独立危险因素。而血清清蛋白是心脏瓣膜术后发生AKI的危险因素证据不充分[OR=-0.43,95%CI(-1.08,0.21),P=0.19]。结论:现有证据表明,年龄、男性、BMI、LVEF、基础Scr升高、eGFR<60 mL(min·1.73 m^(2))、贫血、高血压、糖尿病、脑血管疾病、肾功能不全、手术时长、体外循环时长、围术期输血、呼吸机应用时间>24 h、术后并发低心排血在量综合征是心脏瓣膜术后发生AKI的危险因素,且使用IABP可能是心脏瓣膜术后发生AKI及随访死亡的独立危险因素。临床医护人员根据以上危险因素早期识别心脏瓣膜术后发生AKI的高危人群,并采取措施进行预防和治疗,降低术后AKI发生率,改善其预后。

高水基数字比例阀控电液位置伺服系统建模与控制

针对我国煤矿液压装备底层执行机构存在控制精度差与数字化程度低的问题,提出了基于高水基数字比例阀和换向阀组合控制液压缸的方案。首先,对高水基数字比例阀控电液位置伺服系统的结构与工作原理进行深入分析,在此基础上构建了伺服系统AMESim仿真模型,并对步进电机子模型、高水基数字比例阀子模型进行验证。其次,提出了液压缸位移/速度双闭环、液压缸位移/主阀位移双闭环两种控制方法,并基于Simulink和AMESim搭建了系统机电液联合仿真模型,仿真结果验证了所提方法的有效性。进一步,搭建了高水基数字比例阀控电液位置伺服系统试验平台,试验表明,液压缸位移/速度双闭环控制方法存在抖动现象,且液压缸位置的最大误差达到了1.5 mm,液压缸位移/主阀位移双闭环控制下的液压缸跟踪误差在0.4 mm内,超调量为0,满足控制精度需求。研究结果对提升我国煤矿液压装备的控制精度和数字化水平具有实际意义。

正念认知疗法结合渐进式肌肉放松训练对酒精所致精神障碍患者精神心理状态、自我效能及应对方式的影响

目的:探讨正念认知疗法(MBCT)结合渐进式肌肉放松训练(PMRT)对酒精所致精神障碍(AIPD)患者精神心理状态、自我效能及应对方式的影响。方法:选取某院2022年9月至2024年1月收治的82例AIPD患者为研究对象,采用随机数字表法将患者对照组、观察组,各41例。两组均接受常规药物治疗,对照组给予常规护理,观察组在对照组的基础上联合MBCT、PMRT。比较两组患者干预前、干预后(出院前)精神心理状态、自我效能、应对方式及生活质量,调查患者出院后6个月的复饮情况。结果:出院后6个月,观察组患者复饮率低于对照组(34.15%vs.56.10%),差异具有统计学意义(χ^(2)=3.989,P<0.05)。干预后,观察组患者焦虑忧郁、敌对猜疑、缺乏活力、思维障碍、激活性评分及简明精神病评定量表(BPRS)总分均低于干预前,差异具有统计学意义(t=3.237,2.793,2.549,2.871,2.981,6.071;P<0.05);观察组患者一般自我效能感量表(GSES)评分高于对照组,差异具有统计学意义(t=3.649,P<0.05);观察组患者简易应对方式问卷(SCSQ)评分中积极应对维度评分高于对照组,消极应对评分低于对照组,差异具有统计学意义(t=3.418,2.205;P<0.05)。结论:MBCT结合PMRT有利于改善AIPD患者精神心理状态及应对方式,提升自我效能,降低复饮率。

基于点模式匹配的直流输电VBE设备电路板缺陷检测方法

随着特高压直流输电技术飞速发展,换流阀阀基电子VBE(valve base electronics)设备的稳定性对于保障直流输电的可靠性和效率至关重要。VBE设备电路板缺陷,如短路和失效元件,直接影响直流系统稳定性,而现有的检测方法,包括人工显微镜检查和自动检测算法,常受限于效率低和准确性不足。针对该问题,提出一种基于点模式匹配的自动视觉检测方法,通过生成代表关键区域的点模式并进行匹配来提高检测的效率和准确率。通过实验验证,所提方法在检测速度和准确性方面相较于传统方法有显著提升,适合于生产线上的快速质量控制,为提高直流输电设备的质量提供了有效的技术方案。

基于改进SqueezeNet算法的VBE设备电路板元件失效识别研究

在直流输电系统中,换流阀阀基电子VBE(valve base electronics)设备的稳定运作对维护直流系统安全至关重要。传统的阀基电子设备电路板(VBE板)元件失效检测方法依赖于耗时的人工检查或基于规则的自动化系统,这些方法通常检测效率低下且准确性有限。针对该问题,提出一种基于改进的SqueezeNet深度学习模型的VBE板元件失效区域识别方法。通过引入深度可分离卷积和残差连接,所提改进SqueezeNet模型旨在提高元件失效检测的准确性,同时降低计算资源的需求。在VBE板元件失效数据集上的实验结果表明,所提方法在元件失效检测准确率和运算效率方面均优于传统方法和标准SqueezeNet模型,准确率达到了95.27%,比原模型高出4.45%。不仅提升了VBE板元件失效检测的效率和准确性,而且为电力系统中类似设备的元件失效诊断提供了新的技术参考。

经导管心脏瓣膜手术患者出院准备服务的最佳证据总结

目的 检索、筛选、评价并整合国内外经导管心脏瓣膜手术患者出院准备服务的相关证据,为规范经导管心脏瓣膜手术患者的出院准备服务临床护理实践提供循证依据。方法系统检索国内外数据库中有关经导管心脏瓣膜手术患者出院准备服务的临床决策、推荐实践、证据总结、临床实践指南、系统评价、专家共识和随机对照研究等。检索时限为建库至2023年4月,由2名研究者对文献进行方法学质量评价,并根据主题对证据进行提取和汇总。结果 共纳入14篇文献,其中临床决策1篇、指南1篇、最佳实践3篇、系统评价3篇、专家共识3篇、证据总结2篇和随机对照研究1篇。从入院时、住院期间、出院前、出院后和出院后效果评价5个方面汇总31条最佳证据。结论 该研究总结了经导管心脏瓣膜手术患者出院准备服务的最佳证据,在后续证据转化过程中应结合国内临床具体情境,有针对性地选择证据,以提升患者的出院准备度,提高患者满意度。

基于5G互联网的延续性护理联合盆底肌康复训练在妇科肿瘤术后盆底肌功能障碍预防中的价值

目的分析基于5G互联网的延续性护理联合盆底肌康复训练在妇科肿瘤术后盆底肌功能障碍(PFD)预防中的价值。方法该研究总共纳入86例实验对象,均是2021年9月至2023年9月到本院诊治的妇科肿瘤术后患者,利用随机数字表法进行分组,分为对照组(常规护理,n=43)与试验组(基于5G互联网的延续性护理联合盆底肌康复训练,n=43)。对比两组的盆底肌肉锻炼自我效能、心理痛苦程度、盆底肌功能、盆底肌纤维疲劳度及术后PFD发生率。结果干预后,试验组相较于对照组,盆底肌肉锻炼自我效能量表(BPM-SES)评分、手测肌力以及电测肌力均更高,心理痛苦管理筛查量表(DMSM)评分、Ⅰ类肌纤维疲劳度、Ⅱ类肌纤维疲劳度以及术后PFD发生率均更低(均P<0.05)。结论基于5G互联网的延续性护理联合盆底肌康复训练干预用于妇科肿瘤术患者,有利于增强盆底肌肉锻炼自我效能,减轻心理痛苦程度,预防术后PFD的发生,改善盆底肌功能。

ICU机械通气患者撤机后呼吸肌训练的循证实践

目的将重症监护病房(intensive care unit,ICU)机械通气患者撤机后呼吸肌训练的最佳证据应用于临床实践并评价其效果。方法运用循证护理的方法,将获取的最佳证据应用于临床,比较循证实践前后上海市某三级甲等医院ICU机械通气患者撤机后肺功能、再插管率以及ICU住院时间,以及护士对ICU机械通气患者撤机后呼吸肌训练知识问卷得分和各个审查指标的执行情况。结果证据应用后,ICU机械通气撤机患者呼气峰流速及第1 s用力呼吸容积均有所改善,撤机后ICU住院时间缩短,护士的知识问卷得分以及对审查指标的执行率有所提高(均P<0.05)。结论开展基于最佳证据的循证实践,能够有效改善ICU机械通气撤机患者的肺功能,提高ICU护士对相关知识的掌握程度,缩短证据与临床实践的差距,从而提高护理质量。