AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment s...AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.展开更多
Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to ...Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.展开更多
AIM: To evaluate the efficacy of a recently developed device that applies kneading-like motion on the abdomen in improving constipation in elderly long-term care patients. METHODS: Thirty constipated elderly patients ...AIM: To evaluate the efficacy of a recently developed device that applies kneading-like motion on the abdomen in improving constipation in elderly long-term care patients. METHODS: Thirty constipated elderly patients were randomly selected from two nursing homes. They were instructed to use the device once daily for 20 min. Rate of bowel movements, volume and consistency of stool and the use of laxantia were all recorded during a 3-wk baseline period and for 12-wk treatment period. Colonic transit time (CTT) was measured in 13 patients by radiopaque markers during the baseline and at the end of treatment. RESULTS: Bowel movement rate (BM/week) increased from 1.4±0.4 BM/wk during baseline to 3.9±0.8 BM/wk during treatment (P<5.0×10-7). Stool amount that was 'low' in 30 patients during baseline increased in 21 patients at the end of the study period (x2 = 19.048-P= 1.3×10-5). Stool consistency,that was 'hard' in 25 patients and 'soft' in 5 patients during baseline, ameliorated in 23 patients at the end of the study (only 2 patients referred 'hard' stool) (x2 = 21.043-P= 4.0×10-6). The mean baseline CTT measured was 92.3±32.3 h at baseline and decreased to 49.4±31.3 h during the study period (P = 0.000208). No side effects were observed during the study period. CONCLUSION: External mechanical vibration of the abdomen reduced CTT and helped to relieve severe constipation in elderly constipated patients.展开更多
Celiac disease has been associated with some autoimmune disorders. A 40-year-old competitive strongman with celiac disease responded to a gluten-free diet, but developed profound and generalized motor weakness with ac...Celiac disease has been associated with some autoimmune disorders. A 40-year-old competitive strongman with celiac disease responded to a gluten-free diet, but developed profound and generalized motor weakness with acetylcholine receptor antibody positive myasthenia gravis, a disorder reported to occur in about 1 in 5000. This possible relationship between myasthenia gravis and celiac disease was further explored in serological studies. Frozen stored serum samples from 23 acetylcholine receptor antibody positive myasthenia gravis patients with no intestinal symptoms were used to screen for celiac disease. Both endomysial and tissue transglutaminase antibodies were examined. One of 23 (or, about 4.3%) was positive for both IgA-endomysial and IgA tissue transglutaminase antibodies. Endoscopic studies subsequently showed duodenal mucosal scalloping and biopsies confirmed the histopathological changes of celiac disease. Celiac disease and myasthenia gravis may occur together more often than is currently appreciated. The presence of motor weakness in celiac disease may be a clue to occult myasthenia gravis, even in the absence of intestinal symptoms.展开更多
To figure out the distribution of temperature gradient along the girder height of steel-concrete composite box girder, combined with the mechanical characteristics of prestressed concrete composed box girder with corr...To figure out the distribution of temperature gradient along the girder height of steel-concrete composite box girder, combined with the mechanical characteristics of prestressed concrete composed box girder with corrugated steel webs, the calculation formulas of cross-sectional temperature stress along the span in a simply-supported beam bridge with composite section were derived under the conditions of static equilibrium and deformation compatibility of the beam element. The methods of calculating the maximum temperature stress value were discussed when the connectors are assumed rigid or flexible. Theoretical and numerical results indicate that the method proposed shows better precision for the calculation of temperature self-stress in both the top and the bottom surfaces of the box girder. Moreover, the regularity of temperature stress distribution at different locations along the girder span is that the largest axial force of the top or the bottom plate of the box girder is located in the midspan and spreads decreasingly until zero at both supported ends, and that the greatest longitudinal shear density in steel-concrete interface appears at both supported ends and then reduces gradually to zero in the midspan.展开更多
The prosperous post buckling load capacity of web plates of box girders can be used.In this article,the post buckling behaviour of web plates of box girders under different loading conditions is theoretically analyz...The prosperous post buckling load capacity of web plates of box girders can be used.In this article,the post buckling behaviour of web plates of box girders under different loading conditions is theoretically analyzed and on the basis of domestic and overseas design codes of steel structures,the corresponding simplified analysis methods are put forward for the engineering design or code revision.It is proved that the simplified methods are safe,efficient and practicable through the comparison between several results.展开更多
Although commonly used, no design method is available for steel web tapered tee section cantilevers. This paper investigates the bending stresses of such beams. Relationships between the maximum compressive stress and...Although commonly used, no design method is available for steel web tapered tee section cantilevers. This paper investigates the bending stresses of such beams. Relationships between the maximum compressive stress and the degree of taper were investigated. An analytical model is presented to determine the location of the maximum stress when subjected to a uniformly distributed load or a point load at the free end and was validated using finite element analysis and physical tests. It was found that the maximum stress always occurs at the support when subjected to a uniformly distributed load. When subjected to a point load at the free end and the degree of taper is up to seven, it was found that Miller＇s equation could be used to determine the location of the maximum stress. However, it is shown that when the degree of taper is greater than seven, Miller＇s equation does not accurately predict the location and the analytical model should be used. It was also found that the location of the maximum stress was solely dependent on the degree of taper, while a geometric ratio, fl was required to determine the magnitude of the maximum stress. A simple method that predicts the magnitude of the maximum stress is proposed. The average error in the prediction of the magnitude of the maximum stress is found to be less than 1.0%.展开更多
Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the ...Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.展开更多
文摘AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.
文摘Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.
文摘AIM: To evaluate the efficacy of a recently developed device that applies kneading-like motion on the abdomen in improving constipation in elderly long-term care patients. METHODS: Thirty constipated elderly patients were randomly selected from two nursing homes. They were instructed to use the device once daily for 20 min. Rate of bowel movements, volume and consistency of stool and the use of laxantia were all recorded during a 3-wk baseline period and for 12-wk treatment period. Colonic transit time (CTT) was measured in 13 patients by radiopaque markers during the baseline and at the end of treatment. RESULTS: Bowel movement rate (BM/week) increased from 1.4±0.4 BM/wk during baseline to 3.9±0.8 BM/wk during treatment (P<5.0×10-7). Stool amount that was 'low' in 30 patients during baseline increased in 21 patients at the end of the study period (x2 = 19.048-P= 1.3×10-5). Stool consistency,that was 'hard' in 25 patients and 'soft' in 5 patients during baseline, ameliorated in 23 patients at the end of the study (only 2 patients referred 'hard' stool) (x2 = 21.043-P= 4.0×10-6). The mean baseline CTT measured was 92.3±32.3 h at baseline and decreased to 49.4±31.3 h during the study period (P = 0.000208). No side effects were observed during the study period. CONCLUSION: External mechanical vibration of the abdomen reduced CTT and helped to relieve severe constipation in elderly constipated patients.
文摘Celiac disease has been associated with some autoimmune disorders. A 40-year-old competitive strongman with celiac disease responded to a gluten-free diet, but developed profound and generalized motor weakness with acetylcholine receptor antibody positive myasthenia gravis, a disorder reported to occur in about 1 in 5000. This possible relationship between myasthenia gravis and celiac disease was further explored in serological studies. Frozen stored serum samples from 23 acetylcholine receptor antibody positive myasthenia gravis patients with no intestinal symptoms were used to screen for celiac disease. Both endomysial and tissue transglutaminase antibodies were examined. One of 23 (or, about 4.3%) was positive for both IgA-endomysial and IgA tissue transglutaminase antibodies. Endoscopic studies subsequently showed duodenal mucosal scalloping and biopsies confirmed the histopathological changes of celiac disease. Celiac disease and myasthenia gravis may occur together more often than is currently appreciated. The presence of motor weakness in celiac disease may be a clue to occult myasthenia gravis, even in the absence of intestinal symptoms.
基金Supported by National Natural Science Foundation of China (No. 50978105)
文摘To figure out the distribution of temperature gradient along the girder height of steel-concrete composite box girder, combined with the mechanical characteristics of prestressed concrete composed box girder with corrugated steel webs, the calculation formulas of cross-sectional temperature stress along the span in a simply-supported beam bridge with composite section were derived under the conditions of static equilibrium and deformation compatibility of the beam element. The methods of calculating the maximum temperature stress value were discussed when the connectors are assumed rigid or flexible. Theoretical and numerical results indicate that the method proposed shows better precision for the calculation of temperature self-stress in both the top and the bottom surfaces of the box girder. Moreover, the regularity of temperature stress distribution at different locations along the girder span is that the largest axial force of the top or the bottom plate of the box girder is located in the midspan and spreads decreasingly until zero at both supported ends, and that the greatest longitudinal shear density in steel-concrete interface appears at both supported ends and then reduces gradually to zero in the midspan.
基金Supported by Ministry of Metallurgical Industry of China
文摘The prosperous post buckling load capacity of web plates of box girders can be used.In this article,the post buckling behaviour of web plates of box girders under different loading conditions is theoretically analyzed and on the basis of domestic and overseas design codes of steel structures,the corresponding simplified analysis methods are put forward for the engineering design or code revision.It is proved that the simplified methods are safe,efficient and practicable through the comparison between several results.
文摘Although commonly used, no design method is available for steel web tapered tee section cantilevers. This paper investigates the bending stresses of such beams. Relationships between the maximum compressive stress and the degree of taper were investigated. An analytical model is presented to determine the location of the maximum stress when subjected to a uniformly distributed load or a point load at the free end and was validated using finite element analysis and physical tests. It was found that the maximum stress always occurs at the support when subjected to a uniformly distributed load. When subjected to a point load at the free end and the degree of taper is up to seven, it was found that Miller＇s equation could be used to determine the location of the maximum stress. However, it is shown that when the degree of taper is greater than seven, Miller＇s equation does not accurately predict the location and the analytical model should be used. It was also found that the location of the maximum stress was solely dependent on the degree of taper, while a geometric ratio, fl was required to determine the magnitude of the maximum stress. A simple method that predicts the magnitude of the maximum stress is proposed. The average error in the prediction of the magnitude of the maximum stress is found to be less than 1.0%.
文摘Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.
