Application Effect of External Diaphragm Pacemaker Combined with Active Respiratory Circulation Technology in Pulmonary Rehabilitation of Perioperative Lung Cancer Patients

Aim: To explore the application effect of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients. Methods: A total of 98 lung cancer patients admitted to our hospital from April 2020 to November 2021 were selected as the observation objects, and then divided into a control group and an observation group using the random number table method, with 49 cases in each group. The control group received routine admission guidance and active respiratory circulation training, while the observation group was supplemented with external diaphragm pacemaker on the basis of the control group. The intervention effect was evaluated by blood gas indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators before and after intervention. Results: Before intervention, there were no significant differences in blood gas analysis indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators between the two groups (P > 0.05). After intervention, the improvement degree of the above indicators in the observation group was higher than that in the control group (P < 0.05). Conclusions: The application of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients is significant, which can effectively improve the pulmonary function, blood gas function, and diaphragm function of lung cancer patients after surgery, and improve the activities of daily living and quality of life of patients.

Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.

Theoretical and Experimental Study on the Performance of Hermetic Diaphragm Squeeze Film Dampers for Gas-Lubricated Bearings

Low damping characteristics have always been a key sticking points in the development of gas bearings.The application of squeeze film dampers can significantly improve the damping performance of gas lubricated bearings.This paper proposed a novel hermetic diaphragm squeeze film damper(HDSFD)for oil-free turbomachinery supported by gas lubricated bearings.Several types of HDSFDs with symmetrical structure were proposed for good damping performance.By considering the compressibility of the damper fluid,based on hydraulic fluid mechanics theory,a dynamic model of HDSFDs under medium is proposed,which successfully reflects the frequency dependence of force coefficients.Based on the dynamic model,the effects of damper fluid viscosity,bulk modulus of damper fluid,thickness of damper fluid film and plunger thickness on the dynamic stiffness and damping of HDSFDs were analyzed.An experimental test rig was assembled and series of experimental studies on HDSFDs were conducted.The damper fluid transverse flow is added to the existing HDSFD concept,which aims to make the dynamic force coefficients independent of frequency.Although the force coefficient is still frequency dependent,the damping coefficient at high frequency excitation with damper fluid supply twice as that without damper fluid supply.The results serve as a benchmark for the calibration of analytical tools under development.

Traumatic Diaphragmatic Hernia in Children: A Case Report

Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.

Congenital Diaphragmatic Hernia with Delayed Diagnosis: Report of Two Cases

Introduction: Advances in prenatal imaging studies have allowed early diagnosis of Congenital Diaphragmatic Hernia (CDH), although neonatal mortality remains at high levels (60% survival). Despite advances, this study found delayed diagnosis, demonstrating subdiagnosis, possibly caused by lack of resources and/or prenatal diagnostic failure. Case Report 1: Infant, 4 months and 22 days old, dyspneic, cyanotic, with fever and vomiting for 3 days, treated as pneumonia. After the second chest radiography, a right CDH was revealed. Surgical correction was performed and removal of Meckel’s diverticulum was surgical findings. The patient was discharged on the 10th days after admission. Case Report 2: Infant, 11 months and 3 days old, distended abdomen, with fever and dyspnea for 2 days, treated as pneumonia. After the second chest radiography, a left CDH was revealed. The patient was submitted to surgery, intestinal loop incarceration without necrosis was observed, and the correction of CDH was performed. The patient was discharged on the 7th day after admission. Discussion: Three cases, between July 2012 and July 2013, were diagnosed at Dom Malam Hospital;2 Cases of CDH, with delayed diagnosis, showed incidence of 66.66%. Delayed diagnosis of these patients with initial hypotheses of pneumonia demonstrated high risk, emphasizing the importance of diagnosis research through observation of the clinical course, the correct imaging interpretation, in order to establish early diagnosis and treatment.

Laparoscopic reduction and repair of acute traumatic diaphragmatic hernia:A video review

Traumatic diaphragmatic hernia is one of the sequela of thoraco-abdominal injury,occurring in about 0.5%-5% of patients presenting post major trauma.Motor vehicle collision is the leading blunt trauma etiology.A high level of suspicion is essential to discover such injuries,as a majority of the patients can be asymptomatic.A case of a successful trans-abdominal laparoscopic reduction and repair of a large acute traumatic diaphragmatic hernia is presented as a video demonstration.We were able to evacuate all intrathoracic air,obliviating the need for a chest tube.Post operatively the patient did well with no complications.If expertise is available,laparoscopic intervention is a feasible option even for large traumatic diaphragmatic hernia preventing the need for a large midline laparotomy incision.

Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm

AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency(RF) ablation vs computed tomography(CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma.Altogether, 24 hemangiomas were ablated via a CTguided percutaneous approach(CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach(laparoscopic ablation group).RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm(range, 6.0-12.0 cm). There was nodifference in the diameter of hemangiomas between the two groups(P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups(P > 0.05). There were 23 thoracic complications in 17 patients: 15(62.5%, 15/24) in the CT-guided ablation group and2(7.4%, 2/27) in the laparoscopic ablation group(P< 0.05). According to the Dindo-Clavien classification,two complications(pleural effusion and diaphragmatic rupture grade Ⅲ) were major in two patients. All others were minor(grade Ⅰ). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7%(22/24) and 96.3%(26/27) in the CT-guided and the laparoscopic ablation groups,respectively(P > 0.05).CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm.It avoids thermal injury to the diaphragm and reduces thoracic complications.

Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm

BACKGROUND It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency(RF) ablation for hepatocellular carcinomas(HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation.AIM To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.METHODS A total of 143 Child-Pugh class A patients who had undergone hepatic resection(n = 80) or percutaneous ultrasound-guided RF ablation(n = 63) for an HCC(≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression(LTP), cumulative intrahepatic distant recurrence(IDR), disease-free survival(DFS), and overall survival(OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated.RESULTS The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were "35.9% vs 65.8%", "64.1% vs 18.3%", and"88.4% vs 68.7%", respectively. Hepatic resection was an independent prognostic factor for DFS(P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups(P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group(1.3% vs 9.5%, P = 0.044).CONCLUSION Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm,DFS was better in the hepatic resection group.

Mechanism study of electrochemical oxidation in the terylene diaphragm cell

By using a self-made carbon/polytetrafluoroethylene （C/PTFE） O2-fed as cathode and Ti/IrO2/RuO2 as anode, the effects of electrochemical oxidation of phenol and the coal-gas wastewater containing phenol were studied. The terylene diaphragm which kept pH〉12 in cathodic compartment and pH〈1 in the anodic compartment was selected in the experiment in comparison with the other types of diaphragm. Furthermore, hydroxyl radical （HO·） was determined in the cathodic compartment of the diaphragm cell by electron spin resonance spectrum（ESR） and the fluorescence spectra. Compared with pH, the accumulated HzO2 and the COD removal of the no-diaphragm cell, the mechanism of electrochemical oxidation in the terylene diaphragm cell was supposed. The degradation of phenol was supposed to be cooperative oxidation by direct or indirect electrochemical oxidation at the anode and H2O2, HO· produced by oxygen reduction at the cathode. The mineralization of phenol in the diaphragm cell was better than that in the no-diaphragm cell. When the coal-gas wastewater was treated by the electrolysis system with terylene diaphragm, the average removal efficiency of the volatile phenol and COD were 100% and 79.6%, respectively.

Optimized functional linked neural network for predicting diaphragm wall deflection induced by braced excavations in clays

Deep excavation during the construction of underground systems can cause movement on the ground,especially in soft clay layers.At high levels,excessive ground movements can lead to severe damage to adjacent structures.In this study,finite element analyses(FEM)and the hardening small strain(HSS)model were performed to investigate the deflection of the diaphragm wall in the soft clay layer induced by braced excavations.Different geometric and mechanical properties of the wall were investigated to study the deflection behavior of the wall in soft clays.Accordingly,1090 hypothetical cases were surveyed and simulated based on the HSS model and FEM to evaluate the wall deflection behavior.The results were then used to develop an intelligent model for predicting wall deflection using the functional linked neural network(FLNN)with different functional expansions and activation functions.Although the FLNN is a novel approach to predict wall deflection;however,in order to improve the accuracy of the FLNN model in predicting wall deflection,three swarm-based optimization algorithms,such as artificial bee colony(ABC),Harris’s hawk’s optimization(HHO),and hunger games search(HGS),were hybridized to the FLNN model to generate three novel intelligent models,namely ABC-FLNN,HHO-FLNN,HGS-FLNN.The results of the hybrid models were then compared with the basic FLNN and MLP models.They revealed that FLNN is a good solution for predicting wall deflection,and the application of different functional expansions and activation functions has a significant effect on the outcome predictions of the wall deflection.It is remarkably interesting that the performance of the FLNN model was better than the MLP model with a mean absolute error(MAE)of 19.971,root-mean-squared error(RMSE)of 24.574,and determination coefficient(R^(2))of 0.878.Meanwhile,the performance of the MLP model only obtained an MAE of 20.321,RMSE of 27.091,and R^(2)of 0.851.Furthermore,the results also indicated that the proposed hybrid models,i.e.,ABC-FLNN,HHO-FLNN,HGS-FLNN,yielded more superior performances than those of the FLNN and MLP models in terms of the prediction of deflection behavior of diaphragm walls with an MAE in the range of 11.877 to 12.239,RMSE in the range of 15.821 to 16.045,and R^(2)in the range of 0.949 to 0.951.They can be used as an alternative tool to simulate diaphragm wall deflections under different conditions with a high degree of accuracy.

Numerical analysis of effect of friction between diaphragm wall and soil on braced excavation

A plane strain finite element model was established to investigate the effect of friction between diaphragm wall and soil on braced excavation. The behavior of interface between diaphragm wall and soil was simulated with the interface model of ABAQUS. Parametric studies were conducted with different diaphragm wall external friction angles δ. The results show that deflection of diaphragm wall and ground surface settlement decrease with the decrease of δ. However, the reduction effect on diaphragm wall deflection is the most significant at the depth where the maximum wall deflection occurs and can be neglected at the wall base. The ratio between wall deep inward component and wall cantilever component reaches its peak value 2.7 when δ=5°. The ratio of the maximum ground surface settlement to the maximum wall lateral deflection decreases at a reduced rate with the increase of δ. For excavation with braced diaphragm wall, the effect of friction between diaphragm and soil on the deflection of diaphragm wall and ground settlement, especially the distribution of ground surface settlement behind diaphragm, should be taken into account.

NONLINEAR BENDING OF CORRUGATED DIAPHRAGM WITH LARGE BOUNDARY CORRUGATION UNDER COMPOUND LOAD

By using the simplified Reissner's equation of axisymmetric shells of revolution, the nonlinear bending of a corrugated annular plate with a large boundary corrugation and a nondeformable rigid body at the center under compound load are investigated. The nonlinear boundary value problem of the corrugated diaphragm reduces to the nonlinear integral equations by applying the method of Green's function. To solve the integral equations, a so_called interpolated parameter important to prevent divergence is introduced into the iterative format. Computation shows that when loads are small, any value of interpolated parameter can assure the convergence of iteration. Interpolated parameter equal or almost equal to 1 yields a faster convergence rate; when loads are large, interpolated parameter cannot be taken too large in order to assure convergence. The characteristic curves of the corrugated diaphragm for different load combinations are given. The obtained characteristic curves are available for reference to design. It can be concluded that the deflection is larger when the diaphragm is acted by both uniform load and concentrated load than when it is acted only by uniform load. The solution method can be applied to corrugated shells of arbitrary diametral sections.

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.

Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma against the Diaphragm: Is Artificial Ascites Necessary?

Purpose: To evaluate the utility of artificial ascites induction for radiofrequency ablation (RFA) of peridiaphragmatic hepatocellular carcinoma (HCC) through retrospective cohort analysis comparing characteristics and complications of peridiaphragmatic HCC without the use of artificial ascites to non-peridiaphragmatic HCC. Materials and Methods: IRB approval was obtained. From September 2003 to December 2008, 150 consecutive patients with hepatic tumors received percutaneous RFA. 110 patients had presumed HCC, and of those 21 had lesions abutting the diaphragm. Of the remaining 89 patients with non-peridiaphragmatic HCC lesions, 21 were randomly selected for the comparison group. RFA volume, major and minor complication rates, pain, technical success, and recurrence rates were compared between the two groups. Results: There was no statistical difference in RFA volume (P = 0.962), overall major complication rate (P = 0.343) and minor complication rate (P = 0.118) between the two groups. However, the peridiaphragmatic group that underwent RFA with a clustered-needle demonstrated a statistically significant higher proportion of major complications compared to the non-peridiaphragmatic clustered-needle group (P = 0.033). There was no statistical difference in pain severity (P = 0.8802) or pain location (P = 0.15). There was no statistical difference in technical success rates (P = 1), local tumor progression rates (P = 1), or time to local tumor recurrence (P = 0.67). Conclusion: Artificial ascites induction for RFA of HCC lesions adjacent to the diaphragm may not be necessary, although clustered electrode technique should be avoided in this location as they present with a higher complication rate.

Modelling and Optimisation of a Spring-Supported Diaphragm Capacitive MEMS Microphone

Audio applications such as mobile communication and hearing aid devices demand a small size but high performance, stable and low cost microphone to reproduce a high quality sound. Capacitive microphone can be designed to fulfill such requirements with some trade-offs between sensitivity, operating frequency range, and noise level mainly due to the effect of device structure dimensions and viscous damping. Smaller microphone size and air gap will gradually decrease its sensitivity and increase the viscous damping. The aim of this research was to develop a mathematical model of a spring-supported diaphragm capacitive MEMS microphone as well as an approach to optimize a microphone’s performance. Because of the complex shapes in this latest type of diaphragm design trend, analytical modelling has not been previously attempted. A novel diaphragm design is proposed that offers increased mechanical sensitivity of a capacitive microphone by reducing its diaphragm stiffness. A lumped element model of the spring-supported diaphragm microphone is developed to analyze the complex relations between the microphone performance factors and to find the optimum dimensions based on the design requirements. It is shown analytically that the spring dimensions of the spring-supported diaphragm do not have large effects on the microphone performance com pared to the diaphragm and backplate size, diaphragm thickness, and air-gap distance. A 1 mm2 spring-supported diaphragm microphone is designed using several optimized performance parameters to give a –3 dB operating bandwidth of 10.2 kHz, a sensitivity of 4.67 mV/Pa (–46.5 dB ref. 1 V/Pa at 1 kHz using a bias voltage of 3 V), a pull-in voltage of 13 V, and a thermal noise of –22 dBA SPL.

Influence of Axial Load Ratio on Shear Behavior of Through-Diaphragm Connections of Concrete-Filled Square Steel Tubular Columns

Nonlinear finite element analysis and parametric studies were carried out to study the influence of axial load ratio on the shear behavior of the through-diaphragm connections of concrete-filled square steel tubular columns. The analysis reveals that smaller axial load ratio can improve the shear bearing capacity and ductility while larger axial load ratio will decrease the shear behavior of the through-diaphragm connections. The parametric studies indicate that the axial load ratio should be limited to less than 0.4 and its influence should be considered in the analysis and design of such connections.

Flexural Capacity Formula of Diaphragm-Through Joints of Concrete-Filled Square Steel Tubular Columns

Finite element analysis and parametric studies were performed to investigate the flexural capacity of the panel zone of diaphragm-through joints between concretefilled square steel tubular columns and H-shaped steel beams.Through the comparisons of failure modes,load–displacement curves,and bearing capacity,it was found that the flexural capacity of the panel zone of diaphragmthrough joints was determined by the tensile action and influence of the web of H-shaped steel beams,and the axial load should be taken into account.The steel tube and the diaphragm were the major parts of the joint that resisted the bending moment.The contribution of in-filled concrete had little influence on the flexural capacity of the panel zone of the joint and could be neglected.According to the results of these numerical studies,a formula that considered the influence of the web of H-shaped steel beams and the axial load was developed based on the yield lines in the diaphragm and the steel tube.The results of the proposed formula were in good agreement with the numerical data of this investigation.

Clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome

Objective:To study the clinical effect of under the diaphragm by stasis soup combinated with point thread-embedding on infertility patients with obesity-type polycystic ovary syndrome (PCOS) and evaluate the the rate of ovulation and pregnancy.Method:Selecting 100 infertility patients with obesity-type PCOS, then they were randomly divided into control group (n=80) and observation group (n=80). The control group patients were given metformin+ under the diaphragm by stasis soup, the observation group were given metformin + exenatide + point thread-embedding, they were treated 3 months. Before and after treatment, we observed the changes of body mass index (BMI), waist-to-hipratio (WHR), fasting plasma glucose (FBG), 2-hour postprandial blood glucose (2hPBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma insulin (FINS), follicule-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estrogen (E2), and testosterone (T). At last, we assessed the rate of ovulation and pregnancy.Results: After the treatment, the FBG, 2hPBG, TC, LDL-C, TG, BMI, WHR, HOMA-IR, FINS, LH, LH/FSH, E2, and T were lower than before treatment in both groups, and the difference had statistical significance, and the observation group were lower than control group, and the difference had statistical significance;the HDL-C and FSH were higher than before treatment in both groups, and the difference had statistical significance, and the observation group were higher than control group, and the difference had statistical significance. The rate of ovulation and pregnancy in the observation group were higher than control group, and the difference had statistical significance.Conclusions:Under the diaphragm by stasis soup combinated with point thread-embedding can improve the metabolize of carbohydrate and lipid, and the abnormity of sex hormones, through this process, the rate of ovulation and pregnancy can be raised.

Finite Element Analysis of Steam Turbine Diaphragm

Thediaphragmofsteam turbine isoneofthemainpartsofthepassageunitfor air flowing.For studying its working conditionand performance, the three-dimensionalfinite element model（FEM）with thesoftware ANSYS10.0 isestablished according to theactualworking parameters. With the model, the deformation resultsand stress field resultsare analyzed andthe maximum displacement and stress value are calculated, meanwhile,theircorrespondingpositions are found. It provides a good foundationfor solving the problem inproduction.

Gastric body diaphragm-like stricture as a rare complication of nonsteroidal anti-inflammatory drugs

Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely reported, gastric body diaphragm-like stricture has not been reported. We describe the first case of gastric body diaphragm-like stricture due to NSAIDs in a 44-year-old male patient who was successfully treated by an endoscopic approach to avoid complicated surgery. This case highlights new insight into the disadvantages of NSAIDs and provides new data for future clinical studies.