Successful removal of a penoscrotal constricting ring in a 49-year-old male

Placement of constricting devices around the penis and scrotum for autoerotic purposes or increasing sexual performance represents a well-known challenge for urologists and can result in serious complications.The removal of the constricting devices can be challenging and often requires resourcefulness and multidisciplinary approach.We report one case of successful removal of a penoscrotal constricting metal ring in a 49-year-old male using a handheld orthopaedic saw under ketamine and midazolam sedation in the emergency department.

How carnivorous fungi use three-celled constricting rings to trap nematodes

Predacious fungi form specialized hyphae structures to trap nematodes and other microscopic animals.Among the six kinds of trapping devices,the constricting ring is the only one that actively captures nematodes.When a nematode enters the aperture of the ring,which is formed by three cells,the cells rapidly triple their vol-ume,close the aperture and hold the nematode in place.Hyphae then penetrate and consume the nematode.This paper reviews the data and hypotheses on con-serving the evolution of constricting rings and their cytological and molecular mechanisms.

Neuralgic amyotrophy with hourglass-like constrictions:A case report

BACKGROUND Neuralgic amyotrophy(NA)is a rare disease with sudden upper limb pain followed by affected muscle weakness.The most commonly affected area in NA is the upper part of the brachial plexus,and the paraspinal muscles are rarely affected(1.5%),making these cases difficult to distinguish from cervical radiculopathy.CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall.After undergoing left femoral neck fracture surgery,he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness.Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space.Three weeks later,an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root.Magnetic resonance neurography was performed for a differential diagnosis.Contrast enhancement was identified at the upper trunk of the brachial plexus,including the C5 nerve root.A suprascapular nerve hourglass-like focal constriction(HLFC)was also identified,confirming NA.After being diagnosed with NA,the patient received 15 mg prednisolone,twice daily,for 3 weeks.Physical therapy was initiated,including left arm strengthening exercises and electrical stimulation therapy.Left shoulder muscle strength significantly improved one CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis,avoiding confusion with cervical radiculopathy.

Life-threatening constrictive pericarditis accompanied by synthetic cannabinoid use:A case report and literature review

Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.

Experiments and Analyses on Heat Transfer Characteristics from a Solid Wall to a Strip-ShapedWick Structure

Centered or striped wick structures have been used to develop ultrathin heat pipes.Differing from traditional heat pipes,the centered or striped wick structures leave noncontact container surfaces with the wick structure.In this study,experiments andnumerical analyseswere conductedtoinvestigate the influenceof thesenoncontact surfaces.In the experiments,a strip-shaped wick structure was placed vertically,the top was sandwiched between wider rods and the bottom was immersed in a working fluid.The rod width was greater than the wick width;thus,noncontact surfaces were left between the rod and the wick structure.The heat was applied from the rod to the wick structure,and the evaporation heat transfer characteristics of the working fluid from the wick structure were evaluated.Water was used as the working fluid.The experiments were conducted by varying the rod and wick widths.The experimental results were obtained when the wick structures were placed separately.In the numerical analyses,the temperature and heat flux distributions in the rod were obtained.From the experimental and numerical results,it was confirmed that the noncontact surfaces caused the heat flux in the rod near both surfaces of the wick structure to concentrate,which increased the evaporation thermal resistance of the wick structure.A reduction in the noncontact surface area by increasing the wick width was found to be effective in decreasing the evaporation thermal resistance and increasing themaximumheat transfer rate of the wick structure.The separation of the wick structure increased the evaporation surface area.However,its effectiveness was limited when the heat transfer rate was small.

Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic strictures.Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is scarce.Due to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy.This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.METHODS Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query.Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records.The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months.Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 d.RESULTS During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course.In 33 ERCPs,the stent was removed or exchanged on a 3-month interval.No pancreatitis,perfor-ations or deaths occurred.Minor post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=0.40.All strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 months.The recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a single ERCP with Kaffes,21 with removal after 120 d and 7 within 120 d.There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course(71.0%vs 10.0%,P=0.01).CONCLUSION Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.

膨胀海绵地塞米松填塞治疗外耳道狭窄

目前外耳道狭窄以手术治疗为主。对于外耳道成形术后及慢性中耳炎术后瘢痕形成初期（术后2～4周）和继发于外耳道炎症、肉芽组织增生所致的狭窄，我们用膨胀海绵配合地塞米松治疗，取得满意疗效，现报道如下。

Optimal choice of parameters for particle swarm optimization

The constriction factor method (CFM) is a new variation of the basic particle swarm optimization (PSO), which has relatively better convergent nature. The effects of the major parameters on CFM were systematically investigated based on some benchmark functions. The constriction factor, velocity constraint, and population size all have significant impact on the per- formance of CFM for PSO. The constriction factor and velocity constraint have optimal values in practical application, and im- proper choice of these factors will lead to bad results. Increasing population size can improve the solution quality, although the computing time will be longer. The characteristics of CFM parameters are described and guidelines for determining parameter values are given in this paper.

Molecular mechanisms underlying the effects of acupuncture on neuropathic pain

Acupuncture has been used to treat neuropathic pain for a long time, but its mechanisms of action remain unknown. In this study, we observed the effects of electroacupuncture and manual acu- puncture on neuropathic pain and on ephrin-B/EphB signaling in rats models of chronic constriction injury-induced neuropathic pain. The results showed that manual acupuncture and electroacu- puncture significantly reduced mechanical hypersensitivity following chronic constriction injury, es- pecially electroacupuncture treatment. Real-time PCR results revealed that ephrin-B1/B3 and EphB1/B2 mRNA expression levels were significantly increased in the spinal dorsal horns of chronic constriction injury rats. Electroacupuncture and manual acupuncture suppressed the high expres- sion of ephrin-B1 mRNA, and elevated EphB3/B4 mRNA expression. Electroacupuncture signifi- cantly enhanced the mRNA expression of ephrin-B3 and EphB3/B6 in the dorsal horns of neuro- pathic pain rats. Western blot results revealed that electroacupuncture in particular, and manual acupuncture, significantly up-regulated ephrin-B3 protein levels in rat spinal dorsal horns. The re- sults of this study suggest that acupuncture could activate ephrin-B/EphB signaling in neuropathic pain rats and improve neurological function.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry,by implementing surgical planning with SimPlant OMS.Using this method,we conducted LF1 osteotomy,intraoral vertical ramus osteotomy（IVRO）,sagittal split ramus osteotomy（SSRO）,mandibular constriction and mandibular border genioplasty.Not only did we obtain a class I occlusal relationship,but the complicated surgery also improved the asymmetry of the frontal view,as well as of the profile view,of the patient.The virtual operation using three-dimensional computed tomography（3D-CT）could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

Experimental study on sliding shaft lining mechanical mechanisms under ground subsidence conditions

Aimed at more than 60 shaft linings damaged in Huaibei, Datun, Xuzhou and Yanzhou mine areas, this paper presents a new type of sliding shaft lining with asphalt blocks sliding layer. By model test, it is obtained that the deformation characteristics and the mechanical mechanisms of the sliding shaft lining under the condition of ground subsidence. The research results provide a testing basis for the sliding shaft lining design. By now, this kind of sliding shaft lining had been applied in 9 shafts in China and Bangladesh.

Effect of Zhenwu Tang Granule on pressure-overloaded left ventricular myocardial hypertrophy in rats

BACKGROUND： In the perspective of traditional Chinese medicine, few studies have focused on the compound preparations though there are many investigations. The present study was undertaken to investigate the effect of Zhenwu Tang Granule on chronic pressure-overloaded left ventricular hypertrophy in rats.METHODS： The study was performed at the laboratory of Guangzhou Institute of Respiratory Disease. Male SD rats were divided randomly into 3 groups： sham operation group （n=8）, operation group （n=15） and traditional Chinese medicine （TCM） group （n=15）.The model of myocardial hypertrophy was made by gradually constricting the abdominal aorta. Sixteen weeks later, cardiac ultrasonography was performed in all groups in order to ascertain post-operational left ventricular （LV） hypertrophy. And Zhenwu Tang Granule was added at a dose of 12 g/kg in the mixed feedstuff for 8 weeks in the TCM group. In the 24th week, weight, structure as well as function of the heart in each group were measured by high-frequency ultrasonography, and Masson＇s staining was performed on the cardiac muscles. Meanwhile, total collagen volume fraction （CVF-T） and non-coronary vessel collagen volume fraction （CVF-NV） were analyzed.RESULTS： There was an increase in the weight of the heart in the operation group, with the left ventricule dominated （P〈0.05）. The heart was enlarged, with diastolic interventricular septal distance （IVSd） and left ventricular posterior wall distance （LVPWd） dominated （P〈0.01）.There was a significant decrease in the cardiac function （P〈0.05）. The weight （P〈0.01） and volume of the heart decreased in the TCM group compared with the operation group, with IVSd and systolic left ventricular posterior wall dominated （P〈0.01）. And the cardiac function was improved （P〈0.05）. Significant interstitial and collagen hyperplasia was shown in the operation group based on pathological analysis, and various improvements were proved in the TCM group, i.e. there was a significant decrease in CVF-T and CVF-NV （P〈0.01） compared with the operation group; but no difference （P〉0.05） was found when compared with the pseudo-operation group.CONCLUSION： Zhenwu Tang Granule could reduce the weight and volume of the heart, improve the cardiac function, inhibit hyperplasia of collagen, and reverse myocardial hypertrophy in rats with pressure-overloaded left ventricular hypertrophy.

Weld formation and heating mechanism in ultra-narrow gap withconstricted arc by ultra-fine granular flux

Ultra-narrow gap welding （UNGW） process with high stabilization, reliability and without spatter can be achieved with constricted arc by molten slag wall, which is made from melted flux. The experiments are carried out by changing voltage under different currents. The results indicate voltage range being fit for UNGW is about 22 -31 V under the current range of 200 -320 A. With the increasing of voltage, weld formation of UNGW has the law of lack of fusion on sidewall, good weld and undercut in turn under a certain current. In addition, the action relationships among arc, molten slag wall and sidewalls can be improved by properly adjusting voltage and current of arc, which makes cathode spot properly distribute in ultra-narrow gap. Therefore, the effective control of weld formation of UNGW has been achieved.

Mechanism of persistent hyperalgesia in neuropathic pain caused by chronic constriction injury

Transmembrane member 16 A(TMEM16 A) is involved in many physiological functions, such as epithelial secretion, sensory conduction, nociception, control of neuronal excitability, and regulation of smooth muscle contraction, and may be important in peripheral pain transmission. To explore the role of TMEM16 A in the persistent hyperalgesia that results from chronic constriction injury-induced neuropathic pain, a rat model of the condition was established by ligating the left sciatic nerve. A TMEM16 A selective antagonist(10 μg T16 Ainh-A01) was intrathecally injected at L5–6. For measurement of thermal hyperalgesia, the drug was administered once at 14 days and thermal withdrawal latency was recorded with an analgesia meter. For measurement of other indexes, the drug was administered at 12 days,once every 6 hours, totally five times. The measurements were performed at 14 days. Western blot assay was conducted to analyze TMEM16 A expression in the L4–6 dorsal root ganglion. Immunofluorescence staining was used to detect the immunoreactivity of TMEM16 A in the L4–6 dorsal root ganglion on the injured side. Patch clamp was used to detect electrophysiological changes in the neurons in the L4–6 dorsal root ganglion. Our results demonstrated that thermal withdrawal latency was shortened in the model rats compared with control rats.Additionally, TMEM16 A expression and the number of TMEM16 A positive cells in the L4–6 dorsal root ganglion were higher in the model rats, which induced excitation of the neurons in the L4–6 dorsal root ganglion. These findings were inhibited by T16 Ainh-A01 and confirm that TMEM16 A plays a key role in persistent chronic constriction injury-induced hyperalgesia. Thus, inhibiting TMEM16 A might be a novel pharmacological intervention for neuropathic pain. All experimental protocols were approved by the Animal Ethics Committee at the First Affiliated Hospital of Shihezi University School of Medicine, China(approval No. A2017-170-01) on February 27, 2017.

Esophagogastric anastomosis with invagination into stomach:New technique to reduce fistula formation

AIM: To present a new technique of cervical esophagogastric anastomosis to reduce the frequency of fistula formation. METHODS: A group of 31 patients with thoracic and abdominal esophageal cancer underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube. In the region elected for anastomosis, a transverse myotomy of the esophagus was carried out around the entire circumference of the esophagus. Afterwards, a 4-cm long segment of esophagus was invaginated into the stomach and anastomosed to the anterior and the posterior walls. RESULTS: Postoperative minor complications occurred in 22 (70.9%) patients. Four (12.9%) patients had serious complications that led to death. The discharge of saliva was at a lower region, while attempting to leave the anastomosis site out of the alimentary transit. Three (9.7%) patients had fistula at the esophagogastric anastomosis, with minimal leakage of air or saliva and with mild clinical repercussions. No patients had esophago- gastric fistula with intense saliva leakage from either the cervical incision or the thoracic drain. Fibrotic stenosis of anastomoses occurred in seven (22.6%) patients. All these patients obtained relief from their dysphagia with endoscopic dilatation of the anastomosis.CONCLUSION: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula with mild clinical repercussions.

Three-dimensional analysis of the physiological foramen geometry of maxillary and mandibular molars by means of micro-CT

The aim of this study was to investigate the physiological foramen diameter, shape and distance between physiological and anatomical apex of maxillary and mandibular first and second molars. Accurate knowledge of the physiological foramina morphology; thus, inherent mechanical shaping technical hindrances, is decisive when taking the corresponding root canal final preparation decision. The morphological dimensions of a total of 1 727 physiological foramina were investigated by means of micro-computed tomography. Mean narrow and wide （to a high number, oval） diameters of the physiological foramen were 0.24, 0.22 and 0.33 mm and 0.33, 0.31 and 0.42 mm in mesiobuccal （MB）, distobuccal （DB） and palatal （P） roots in maxillary first molars; 0.24, 0.22 and 0.33 mm and 0.41, 0.33 and 0.44 in MB, DB, and P roots in maxillary second molars. Mandibular first molars showed mean narrow and wide diameters of 0.24 and 0.30 mm and of 0.39 and 0.46 mm in mesial （M） and distal （D） roots; second mandibular molars showed 0.25 and 0.31 mm and 0.47 mm in M and D roots. The mean distance between the physiological foramina and anatomical apex was 0.82, 0.81 and 1.02 mm and 0.54, 0.43 and 0.63 mm in MB, DB and P roots of the maxillary first and second molars, respectively. A mean distance of 0.95 mm （M） and 1.05 mm （D） in the first and 0.78 mm （M） and 0.81 mm （D） in the second mandibular molars was observed. Based on the results obtained, assumable recommendations for final preparation size of the physiological foramen were calculated. However, when taking into consideration, the resulting standard deviations of marginal errors must be cautiously considered when taking a final decision in clinical endodontic treatment.

Nuclear mechanics during constricted migration

Cell migration through narrow interstitial space in tissues is commonly seen in both physiological and pathological conditions. For example, immune cells have to squeeze through vasculature and extracellular matrix to reach the wound or diseased sites, and similarly cancer cells need to crawl through porous space in tissues to invade surrounding tumor-free regions. Therefore, the bulky stiff nucleus in the cell becomes a barrier during constricted migration making such process pore-size dependent with smaller pores exponentially alleviate the passage capability. However, in some cases, cells can actively deform their nuclei to squeeze through constrictions although some price needs to be paid. In this review, we focus on:(1) nuclear structures and morphological regulations,(2) proposed mechanisms that drive constricted migration,(3) short-term consequences such as nuclear envelope (NE) rupture and DNA damage during such process,(4) biophysical factors that facilitate NE rupture, and (5) long term consequences such as genomic variation caused by repetitive NE rupture. Both experimental results and modeling are provided with the intention to better understand the constricted migration.

Estrogen affects neuropathic pain through upregulating N-methyl-D-aspartate acid receptor 1 expression in the dorsal root ganglion of rats

Estrogen affects the generation and transmission of neuropathic pain,but the specific regulatory mechanism is still unclear.Activation of the N-methyl-D-aspartate acid receptor 1（NMDAR1） plays an important role in the production and maintenance of hyperalgesia and allodynia.The present study was conducted to determine whether a relationship exists between estrogen and NMDAR1 in peripheral nerve pain.A chronic sciatic nerve constriction injury model of chronic neuropathic pain was established in rats.These rats were then subcutaneously injected with 17β-estradiol,the NMDAR1 antagonist D（-）-2-amino-5-phosphonopentanoic acid（AP-5）,or both once daily for 15 days.Compared with injured drug na？ve rats,rats with chronic sciatic nerve injury that were administered estradiol showed a lower paw withdrawal mechanical threshold and a shorter paw withdrawal thermal latency,indicating increased sensitivity to mechanical and thermal pain.Estrogen administration was also associated with increased expression of NMDAR1 immunoreactivity（as assessed by immunohistochemistry） and protein（as determined by western blot assay） in spinal dorsal root ganglia.This 17β-estradiol-induced increase in NMDAR1 expression was blocked by co-administration with AP-5,whereas AP-5 alone did not affect NMDAR1 expression.These results suggest that 17β-estradiol administration significantly reduced mechanical and thermal pain thresholds in rats with chronic constriction of the sciatic nerve,and that the mechanism for this increased sensitivity may be related to the upregulation of NMDAR1 expression in dorsal root ganglia.

Comparative Characterization of Maxillary Expansion and Alternate Maxillary Expansions and Constrictions in Rats

The purpose of this study was to evaluate whether the cranial and circumaxillary sutures react differently to maxillary expansion （ME） and alternate maxillary expansions and constrictions （Alt-MEC） in a rat model. Twenty-two male Sprague-Dawley rats （6 weeks old） were used and divided into three groups. In ME group （n=9）, an expander was activated for 5 days. In Alt-MEC group （9 animals）, an al- ternate expansion and constriction protocol （5-day expansion and 5-day constriction for one cycle） was conducted for 2.5 cycles （25 days total）. The control group comprised 4 animals with no appliances used, each of two sacrificed on day 5 and day 25 respectively. Midpalatal suture expansion or constriction levels were assessed qualitatively and quantitatively by bite-wing X-rays and cast models. Distances between two central incisors and two maxillary first molars were measured on cast models after each activation. Circumaxillary sutures （midpalatal, maxillopalatine, premaxillary, zygomaticotemporal and frontonasal suture） in each group were characterized histologically. Results showed that midpalatal suture was wid- ened and restored after each expansion and constriction. At the end of activation, the widths between both central incisors and first molars in Alt-MEC group were significantly larger than those in ME group （P〈0.05）. Histologically, all five circumaxillary sutures studied were widened in multiple zones in Alt- MEC group. However, only midpalatal suture was expanded with cellular fibrous tissue filling in ME group. Significant osteoclast hyperplasia was observed in all circumaxillary sutures after alternate expan- sions and constrictions, but osteoclast count increase was only observed in midpalatal suture in ME group. These results suggested that cranial and circumaxillary sutures were actively reconstructed after Alt-MEC, while only midpalatal suture had active reaction after ME.

Simulation Research of Magnetic Constriction Effect and Controlling by Axial Magnetic Field of Vacuum Arc

Based on magnetohydrodynamic (MHD) model of vacuum arc, the computer simulation of vacuum arc was carried out in this paper. In the MHD model, mass conservation equation, momentum conservation equations, energy conservation equations, generalized ohm's law and Maxwell equation were considered. MHD equations were calculated by numerical method, and the distribution of vacuum arc plasma parameters and current density were obtained. Simulation results showed that the magnetic constriction effect of vacuum arc is primarily caused by the Hall effect. In addition, the inhibition of axial magnetic field (AMF) on constriction of vacuum arc was calculated and analyzed.