Investigating the effect of Banxia Houpu decoction for the treatment of gastrointestinal dysfunction after multiple fractures: involvement of interstitial cells of Cajal

Background:Fracture is a common large-organ traumatic injury and usually leads to complications in other systems.Multiple fractures are often associated with gastrointestinal(GI)dysfunction.However,no study has evaluated the treatment of GI dysfunction.The purpose of the study is to explore the efficacy and mechanism based on ICC pathway of Banxia-Houpu decoction on GI.Methods:Male Sprague-Dawley mice were randomly divided according to the fracture modeling method and intervention.We detected the“GI residual rate”and motility.Gastric antrum and jejunum tissues were dissected for hematoxylin and eosin staining to observe the structural integrity of the GI tract,and immunohistochemistry was used to detect the expression of c-kit protein.Results:Compared with the fracture group the GI residual rates in the Banxia Houpu decoction and mosapride groups were significantly low,while GI motility was significantly high.HE staining revealed significant GI tissue necrosis and inflammatory cell infiltrations in the fracture groups.The Banxia Houpu decoction and mosapride groups,exhibited less pathology.Immunohistochemical staining showed upregulated c-kit protein expression in the fracture groups.The c-kit protein level was decreased in the mosapride group.Additionally,c-kit protein expression in the Banxia Houpu decoction groups was significantly decreased in a concentration-dependent manner.Conclusion:Banxia Houpu decoction improves GI dysfunction after multiple fractures,reduces inflammation and necrosis of gastric epithelial cells,and inhibits c-kit protein expression in GI tissues of mice.Results showed revealed one of the mechanisms underlying the effects of this decoction on the GI dysfunction in mice after multiple fractures.

Memory alloy embracing fixator in treatment of multiple fractured ribs and flail chest

BACKGROUND： With the development of internal fixation materials, simple operation with internal fixation has become a tendency. Ni-Ti shape memory alloy embracing fixator has such advantages as slight injury, easy operation, security, reliable fixation, and better histocompatibility. The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest.METHODS： The curative effect and long-term follow-up results were observed after internal ？ xation with a shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest from January 2006 to December 2009.RESULTS： All patients were cured with an average hospital stay of 10.31±3.14 days. Post-operative pain was less severe than preoperative pain （P=0.02）.The rate of postoperative complications such as atelectasis, pulmonary infection, etc was 17.65%. There were fewer long-term complications and less in？ uence on daily work and life.CONCLUSIONS： It is practical to perform an operation for fracture of multiple ribs using a Ti-Ni shape memory alloy embracing ？ xator. The ？ xator, which is less traumatic, simple, safe, and reliable, has a good-histocompatibility and fewer postoperative complications.

Pressure transient analysis of a finite-conductivity multiple fractured horizontal well in linear composite gas reservoirs

Faulted gas reservoirs are very common in reality,where some linear leaky faults divide the gas reservoir into several reservoir regions with distinct physical properties.This kind of gas reservoirs is also known as linear composite(LC)gas reservoirs.Although some analytical/semi-analytical models have been proposed to investigate pressure behaviors of producing wells in LC reservoirs based on the linear composite ideas,almost all of them focus on vertical wells and studies on multiple fractured horizontal wells are rare.After the pressure wave arrives at the leaky fault,pressure behaviors of multiple fractured horizontal wells will be affected by the leaky faults.Understanding the effect of leaky faults on pressure behaviors of multiple fractured horizontal wells is critical to the development design.Therefore,a semi-analytical model of finite-conductivity multiple fractured horizontal(FCMFH)wells in LC gas reservoirs is established based on Laplace-space superposition principle and fracture discrete method.The proposed model is validated against commercial numerical simulator.Type curves are obtained to study pressure characteristics and identify flow regimes.The effects of some parameters on type curves are discussed.The proposed model will have a profound effect on developing analytical/semi-analytical models for other complex well types in LC gas reservoirs.

Rate decline analysis of multiple fractured horizontal well in shale reservoir with triple continuum

Multiple fractured horizontal well(MFHW) is widely applied in the development of shale gas. To investigate the gas flow characteristics in shale, based on a new dual mechanism triple continuum model, an analytical solution for MFHW surrounded by stimulated reservoir volume(SRV) was presented. Pressure and pressure derivative curves were used to identify the characteristics of flow regimes in shale. Blasingame type curves were established to evaluate the effects of sensitive parameters on rate decline curves, which indicates that the whole flow regimes could be divided into transient flow, feeding flow, and pseudo steady state flow. In feeding flow regime, the production of gas well is gradually fed by adsorbed gases in sub matrix, and free gases in matrix. The proportion of different gas sources to well production is determined by such parameters as storability ratios of triple continuum, transmissibility coefficients controlled by dual flow mechanism and fracture conductivity.

A multi-mechanism numerical simulation model for CO_(2)-EOR and storage in fractured shale oil reservoirs

Under the policy background and advocacy of carbon capture,utilization,and storage(CCUS),CO_(2)-EOR has become a promising direction in the shale oil reservoir industry.The multi-scale pore structure distribution and fracture structure lead to complex multiphase flow,comprehensively considering multiple mechanisms is crucial for development and CO_(2) storage in fractured shale reservoirs.In this paper,a multi-mechanism coupled model is developed by MATLAB.Compared to the traditional Eclipse300 and MATLAB Reservoir Simulation Toolbox(MRST),this model considers the impact of pore structure on fluid phase behavior by the modified Peng—Robinson equation of state(PR-EOS),and the effect simultaneously radiate to Maxwell—Stefan(M—S)diffusion,stress sensitivity,the nano-confinement(NC)effect.Moreover,a modified embedded discrete fracture model(EDFM)is used to model the complex fractures,which optimizes connection types and half-transmissibility calculation approaches between non-neighboring connections(NNCs).The full implicit equation adopts the finite volume method(FVM)and Newton—Raphson iteration for discretization and solution.The model verification with the Eclipse300 and MRST is satisfactory.The results show that the interaction between the mechanisms significantly affects the production performance and storage characteristics.The effect of molecular diffusion may be overestimated in oil-dominated(liquid-dominated)shale reservoirs.The well spacing and injection gas rate are the most crucial factors affecting the production by sensitivity analysis.Moreover,the potential gas invasion risk is mentioned.This model provides a reliable theoretical basis for CO_(2)-EOR and sequestration in shale oil reservoirs.

Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report

BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury,although elbow dislocation or fracture of the ulna and radius may occur separately.CASE SUMMARY We report the case of a 37-year-old woman with open(IIIA)fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony.After providing advanced trauma life support,damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room.Subsequently,one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling.The patient achieved good outcome at the 7 mo follow-up.CONCLUSION One-or two-stage treatment must be performed according to the type of injury;we efficiently used the“damage control principle.”

Pressure transient analysis of multiple fractured horizontal wells in naturally fractured unconventional reservoirs based on fractal theory and fractional calculus

Currently,most models for multiple fractured horizontal wells(MFHWs)in naturally fractured unconventional reservoirs(NFURs)are based on classical Euclidean models which implicitly assume a uniform distribution of natural fractures and that all fractures are homogeneous.While fractal theory provides a powerful method to describe the disorder,heterogeneity,uncertainty and complexity of the NFURs.In this paper,a fractally fractional diffusion model(FFDM)for MFHWs in NFURs is established based on fractal theory and fractional calculus.Particularly,fractal theory is used to describe the heterogeneous,complex fracture network,with consideration of anomalous behavior of diffusion process in NFURs by employing fractional calculus.The Laplace transformation,line source function,dispersion method,and superposition principle are used to solve this new model.The pressure responses in the real time domain are obtained with Stehfest numerical inversion algorithms.The type curves of MFHW with three different outer boundaries are plotted.Sensitivity analysis of some related parameters are discussed as well.This new model provides the relatively more accurate and appropriate evaluation results for pressure transient analysis for MFHWs in NFURs,which could be applied to accurately interpret the real pressure data of an MFHW in field.

Chronic Lymphoedema and Bone Infarction: Rare Complications of Multiple Segmental Fractures of the Lower Limb in a Young Adult

Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.

Quantitative investigation of multi-fracture morphology during TPDF through true tri-axial fracturing experiments and CT scanning

Due to the reservoir heterogeneity and the stress shadow effect, multiple hydraulic fractures within one fracturing segment cannot be initiated simultaneously and propagate evenly, which will cause a low effectiveness of reservoir stimulation. Temporary plugging and diverting fracturing(TPDF) is considered to be a potential uniform-stimulation method for creating multiple fractures simultaneously in the oilfield. However, the multi-fracture propagation morphology during TPDF is not clear now. The purpose of this study is to quantitatively investigate the multi-fracture propagation morphology during TPDF through true tri-axial fracturing experiments and CT scanning. Critical parameters such as fracture spacing, number of perforation clusters, the viscosity of fracturing fluid, and the in-situ stress have been investigated. The fracture geometry before and after diversion have been quantitively analyzed based on the two-dimensional CT slices and three-dimensional reconstruction method. The main conclusions are as follows:(1) When injecting the high viscosity fluid or perforating at the location with low in-situ stress, multiple hydraulic fractures would simultaneously propagate. Otherwise, only one hydraulic fracture was created during the initial fracturing stage(IFS) for most tests.(2) The perforation cluster effectiveness(PCE) has increased from 26.62% during the IFS to 88.86% after using diverters.(3) The diverted fracture volume has no apparent correlation with the pressure peak and peak frequency during the diversion fracturing stage(DFS) but is positively correlated with water-work.(4) Four types of plugging behavior in shale could be controlled by adjusting the diverter recipe and diverter injection time, and the plugging behavior includes plugging the natural fracture in the wellbore, plugging the previous hydraulic fractures, plugging the fracture tip and plugging the bedding.

Fracture development during disposal of hazardous drilling cuttings by deep underground injection: A review

Drilling fluids with complicated compositions are becoming more common as the oil and gas industry develops. The production of hazardous cuttings is increasing, which not only stifles the oil and gas industry’s development but also poses a severe environmental threat. Deep underground re-injection is a cost-effective and efficient method for dealing with hazardous cuttings. Numerous experiments and numerical studies on cuttings re-injection have been conducted in the past thirty years. However, there is still a divergence of views on the fracture development in the process of cuttings re-injection. A comprehensive review of existing studies is necessary to help researchers advance this technology. This paper provides a review of the fundamental studies on fracture behaviors during the deep underground re-injection of drilling cuttings. The limitations of the existing studies are also discussed to inspire new research endeavors.

Short-term outcome of total knee replacement in a patient with hemophilia:A case report and review of literature

BACKGROUND Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor Ⅷ gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat.CASE SUMMARY We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis(cemented) equipped with extended distal and proximal stems. At 3 years’ follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement.CONCLUSION This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.

Multiple bilateral lower limb fractures in a 2-year-old child： previously unreported injury with a unique mechanism

Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a balcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2), right distal metaphysis of the tibia and fibula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open reduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily activities comfortably. We also proposed the unique mechanism of injury in this report.

Undetected traumatic cardiac herniation like playing hide-and-seek-delayed incidental findings during surgical stabilization of flail chest:A case report

BACKGROUND Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission.However,pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram(ECG)changes or be asymptomatic.CASE SUMMARY In this case,we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography.We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment.The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.CONCLUSION Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.