Influence of Wellbore Trajectory on Pressure Drop and Fluid Discharge

An experimental analysis has been conducted to study the process of fluid accumulation for different borehole trajectories.More specifically,five heel angles have been experimentally realized to simulate the borehole trajectory of the sloping section of the formation.The fluid-carrying capacity,pressure drop and fluid discharge volatility have been investigated for these conditions and,accordingly,the relationship between heel angle and wellbore pressure drop fluid-carrying capacity has been determined.The results show that while the reasonable roll angle can increase the pressure loss in the wellbore,it is beneficial to drainage.In terms of pressure loss and liquid-carrying capacity,when the heeling angle is 50°,the latter is increased while the former becomes very high,which indicates that when drilling and completing wells on site,a 50°roll angle should be avoided.It is found that the main reason for the increase of the total pressure drop in the wellbore is the increase of the local pressure loss in the inclined section.From the perspective of drainage stability,when there is heeling in the inclined section of the horizontal well,the fluctuation of the wellbore drainage tends to be enhanced.Through the comparison of the Beggs-Brill(B-B)and Mukherjee-Brill liquid holdup methods,it is found that B-B method better predicts liquid holdup.A new method for calculating the pressure drop in the inclined section in the presence of lateral inclination is obtained by taking into account the pressure drop in the curved section.Through comparison with experimental data,it is found that the error is within 20%,and the prediction accuracy is high.

Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

LNG船舶HEEL的应用和管理

HEEL(底脚货)的应用和管理是LNG船舶运输的一个极为重要的方面。HEEL担负着多项使命,它既是货舱冷却的冷剂,又是船舶燃料,又是货物。正确地认识、应用和管理HEEL,有助于LNG船舶安全、稳定和可靠的运输。

Biomechanical evaluation of heel elevation on load transfer——experimental measurement and finite element analysis

In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.

Three-dimensional impact kinetics with foot-strike manipulations during running

Background: Lack of an observable vertical impact peak in fore/mid-foot running has been suggested as a means of reducing lower extremity impact forces, although it is unclear if impact characteristics exist in other axes. The purpose of the investigation was to compare three-dimensional(3 D) impact kinetics among foot-strike conditions in over-ground running using instantaneous loading rate–time profiles.Methods: Impact characteristics were assessed by identifying peak loading rates in each direction(medial–lateral(ML), anterior–posterior(AP),vertical, and 3 D resultant) following foot-strike instructions(fore-foot, mid-foot, subtle heel, and obvious heel strike). Kinematic and kinetic data were analyzed among 9 male participants in each foot-strike condition.Results: Loading rate peaks were observed in each direction and foot-strike condition, differing in magnitude by direction(3 D resultant and vertical > AP > ML, p ≤ 0.031) and foot-strike: ML(fore-foot and mid-foot strike > obvious heel strike, p ≤ 0.032), AP(fore-foot and mid-foot strikes > subtle-heel and obvious heel strikes, p ≤ 0.023). In each direction, the first loading rate peak occurred later during heel strike running relative to fore-foot(p ≤ 0.019), with vertical and 3 D resultant impact durations exceeding shear(ML and AP, p ≤ 0.007) in each condition.Conclusion: Loading rate–time assessment identified contrasting impact characteristics in each direction and the 3 D resultant following foot-strike manipulations, with potential implications for lower extremity structures in running.

Clinical Application of Fengchi Point

For Painful Heels - an Example for Treating Diseases of the Lower Body by Needling Points at the Upper Part of the BodyMrs. Mai, 40 years old, paid her first visit on the 4th August 1991, with the chief complaint of pain in the heels after getting up in the morning for 5 years. The pain was gradually aggravated and so severe that she could only walk on the tiptoes. On examination, her tongue proper was reddened with whitish fur, the pulse was thready, and with no abnormal findings of the sole and calcaneus revealed on X-ray films. The condition was due to deficiency of yin,and obstruction of blood stasis in the channels and collaterals. Prescription of acupoints: bilateral Fengchi (GB 20) and Taixi (KI 3).

Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain-A case report and literature review

BACKGROUND Heel pain is a common orthopaedic complaint,and if left untreated can be a source of chronic morbidity.Accurate diagnosis can be challenging,owing to the complex anatomy and multiple pain generators present in the foot.We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain.He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverski?ld test.He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention.Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus.The decision was made for excision of the osteochondroma,and the patient has been pain-free since.CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients.While most are benign with a very low risk of malignant transformation,surgical excision can yield excellent results and significant pain relief in symptomatic patients.

Footwear modification following hallux valgus surgery: The all-or-none phenomenon

AIM:To define footwear outcomes following hallux valgus surgery,focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection.METHODS:Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods,with favourable reported outcomes.The return to various types of footwear postoperatively is reflective of the degree of correction achieved,and corresponds to patient satisfaction.Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms.Many female patients will additionally attempt to return to high-heeled,narrow toe box shoes.However,minimal evidence exists to guide their expectations.Sixtyfive female hallux valgus patients that had undergone primary surgery bet ween 2011 and 2013 were retrospectively identified using our hospital surgical database.Patients were reviewed using a footwearspecific outcome questionnaire at a mean 18.5 mo follow-up.RESULTS:Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort.Of those intending to resume wearing heeled footwear,62%were able to do so,with 77%of these patients wearing these as or more frequently than pre-operatively.No significant difference was observed between pre-and post-operative heel size.Mean time to return to heeled footwear was 21.4wk post-operation.Cosmetic outcomes were very high and did not adversely impact footwear selection.CONCLUSION:We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery.We observed an"all-ornone phenomenon"where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively.A minority of patients were unable to return to comfortable footwear post-operatively,which had adverse ramifications on their quality-of-life.We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.

Heel pain caused by os subcalcis:A case report

BACKGROUND The accessory bones are common bone variations around the feet and ankles,which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass,and most of them remain asymptomatic.Os subcalcis is an accessory bone at the plantar aspect of the calcaneus,which is located just posterior to the insertion of the plantar fascia.Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years.X-ray,computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus,located at the insertion of the plantar fascia.He underwent surgical excision of the lesion.Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain.It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.

Calcified plaque: the Achilles' Heel of present computed tomography coronary angiography for the elderly?

Nine percent to 27% of cardiac catheterizations today showed either angiographic normal coronary arteries or minimal atherosclerosis. 1,2 Given the expense of cardiac catheterization and the desire to use this valuable resource for therapeutic rather than diagnostic purpose, there is a strong impetus to develop non-invasive means of accurately detecting significant coronary artery stenosis.……

Where Do We Stand on High Heels in 2018? An Audit

We present an audit of public awareness, freedom of choice and health behavior change relating to high heel wear subsequent to a major public awareness campaign in the summer of 2017. Substantial reductions in workplace high heel wear were found, whereby increasingly those who wear high heels regularly at work have freely chosen to do so, although certain issues of social expectations remain in certain sectors. Largely, freedom of choice has greatly increased in workplaces in line with increased public and employer awareness.? However, high heel wear has not substantially reduced in social settings, and progress has not been made with social expectation and explicit requirement to wear high heels at social events.

Pressure Ulcer Prevention: Effectiveness of Heel Off-Loading Methodologies

Skin integrity breakdown and pressure ulcer formation on the heel are predictable and preventable healthcare occurrences. By minimizing surface contact pressures that can cause heel capillary occlusion, heel off-loading devices help mitigate the risk of decubitus ulceration. The purpose of this study is to investigate the efficacy of six off-loading methods commonly used in clinical settings to decrease heel contact pressure. Pressure mapping is used to evaluate contact pressure at the heel for underweight, normal weight, and overweight simulations. Based upon averages across four trials, it is shown that all devices reduce heel contact pressure when compared to no off-load- ing. The PRUventor&#8482 boot exhibits significantly lower average pressure values than other off-load- ing strategies tested, suggesting that the PRUventor&#8482 is the most effective off-loading device. From the analysis of the experimental data and comparison to similar data for respective off-loading alternatives, it is concluded that the PRUventor&#8482 boot is an effective heel off-loading device for use in clinical settings.

Sever’s Disease: An Underdiagnosed Foot Injury in the Pediatric Emergency Department

Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.

Study on the Effect of the Intervention on Traditional Chinese Medicine Negative Heel Shoes in Geriatric Orthopedics Patients

In the clinical practice of orthopedics,geriatric patients are prone to form and exhibit complex and diverse clinical complications during long-term bedridden treatment.This can result in poor survival rate and adverse final clinical outcomes.Hence,it is essential to select appropriate methods for nursing intervention and health-care support for long-term bedridden geriatric orthopedic patients.It is of great significance to support and guarantee patients to obtain the best clinical results.This article focuses on the topic of interventional health effects of traditional Chinese medicine negative-heeled shoes in orthopedic bedridden patients,and two specific aspects were selected for a brief explanation.

Eighty Cases of Heel Bone Spikes Treated With Little Needle-Knife

ＥｉｇｈｔｙＣａｓｅｓｏｆＨｅｅｌＢｏｎｅＳｐｉｋｅｓＴｒｅａｔｅｄＷｉｔｈＬｉｔｔｌｅＮｅｅｄｌｅ－Ｋｎｉｆｅ￥ＸｕａｎＪｏｎｇｈｕａ（ＯｕｔｐａｔｉｅｎｔＤｅｐａｒｔｍｅｎｔｏｆＰＬＡＮｏ．１８１Ｈｏｓｐｉｔａｌ，Ｇｕｉｌｉｎ５４１００２）Ｈｅｅ...

A Prospective Single-Arm Investigation Assessing Performance of a Multifunctional Foot Cream in Subjects with Tinea Pedis Interdigitalis and Heel Cracks, Calluses and/or Dry Feet

This prospective, open-label, single-arm investigation evaluated the performance of a multifunctional foot cream used twice daily for 8 weeks in the combined treatment of mild/moderate tinea pedis interdigitalis (TPI) and heel cracks, calluses and/or dry feet in 46 adult subjects. All subjects showed reductions in the severity of symptoms of both TPI (53.7% reduction) and heel cracks, calluses and/or dry feet (51.6% reduction), beginning already after 2 weeks of treatment, with reduction continuation and improvement after 4 and 8 weeks of treatment. Negative mycological cultures were obtained post-treatment in 85.7% of subjects, while 35.7% of subjects also obtained mycological cure (negative mycological culture + negative KOH test). Post-treatment questionnaires showed improved quality of life, good treatment tolerability, easy use, and that 69% of subjects would recommend the product. The results reveal that the foot cream is safe and effective in the combined treatment of TPI and heel cracks, calluses and/or dry feet.

Design of axial flaps with color Doppler flow imaging technique for repairing deep wounds of heels

To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap.Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds.There were 25 flaps including 10 cases of the distal-based sural neurovascular flap,nine medial sole flap and six medial leg flap.All the axial pattern flaps were designed on the basis of traditional design ways before operation;then,CDFI appliance with high resolution was used to examine the starting spot,exterior diameter,trail and length of the flap’s major artery.The flaps were redesigned according to the results of CDFI and transferred to cover the wounds.In the meantime,both the results of operation and examination were compared.Results The major artery’s starting spot,exterior diameter,trail and anatomic layers were displayed clearly,in consistency with the results of operation.The flaps survived completely and recovered well,with perfect appearance,color and arthral function.Conclusion CDFI is a simple,macroscopic and atraumatic method for designing the axial pattern flap on lower limb,can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.10 refs,4 figs,2 tabs.

“the Heel of Achilles”中的heel是脚后跟吗?

英语中的“heel”,就是汉语里的“脚后跟”,无可争议。但成语“the heel of Achilles”(或“Achilles’s heel”),在《新英汉词典》里的释义是“唯一致命的弱点”,一般也可译成“致命弱点'、“要害”、“可乘之隙”,都与“脚后跟”不相干。有例句为证:

Clinical application of acupuncture at distal single point to treatment of painful heels

Clinical application of acupuncture at a single point to treatment of painful heels was introduced by 5 proved cases of acupuncture at distal single point for treatment of painful heels. Acupuncture at distal single point, such as Fēngchí （风池 GB 20）, Xiàguān （下关 ST 7）, Jiānqí （肩奇）, Hòuxī （后溪 SI 3）, Zúgēn （足跟）, etc., in combination with movement of heels can rapidly and effectively alleviate pain and restore the function. Results indicated that single needling a distal point is beneficial to the freely flow of qi and blood in meridians and the manipulation promotes conduction of the needling sensation, and local movement was combined, bringing the point into the best function. This method is not only convenient, easy to manipulate, but also safe and practical, and has obvious effects, so it is worthy to be popularized.

Minimally invasive treatment of the KobyGard system for plantar fasciitis： a retrospective study

Background Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis. Methods From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People＇s Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale （VAS）, American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated. Results The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 （P 〈0.001）, respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 （P 〈0.001）, respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome. Conclusion Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.