Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report

Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolonapproach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26 th postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.

Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up:A case report

BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.

Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.

对Pull-up效应革的认识

笔者根据近几年外国化工公司来沪交流的情况,以及笔者从事新产品项目研究的实践经验,重点阐述Pull—up效应革的特征、特点、变色机理、Pull—up油的特性、坯革、涂层的剖析、产品企业标准的制定。

Partial gastric pull-up in the treatment of patients with long-gap esophageal atresia

Background:This study was to analyze outcomes of long-gap esophageal atresia(LGEA)treated with partial gastric pull-up(PGP)into the thorax.Methods:The medical records of all children who had undergone PGP for LGEA from 1999 to 2012 were reviewed.Preoperative data,initial postoperative course,complications,time to full oral nutrition,follow-up diagnostics and nutritional status were assessed.Results:Nine children who had undergone PGP were followed up for a mean period of 6.2±3.1 years.Their median gestational age was 37+2 weeks,and mean birth weight 2462±658 g.Eight children were primarily treated with a gastrostomy,their mean age at PGP was 11.4+10.9 weeks and mean weight was 4484+1966 g.Their mean operation time was 199+51 minutes.Leakage was an early postoperative complication in three children,one of whom had a consecutive stricture resection.Late complications were stenosis(n=7)and gastro-esophageal reflux(n=5).The general status of the children was judged as"good"or"very good"on the last presentation.The median percentile of the body-mass-index was 25.Gastroscopy at 3.7±3.2 years after the operation revealed a grade I esophagitis in two children.There was no death in this group of children.Conclusions:Because of its high complication rate,partial gastric pull-up cannot be recommended as an alternative for the treatment of LGEA at present.A final judgment could be made on the basis of a comparative study.

Improvement of Physical Fitness Test Assessment Criteria Based on fNIRS Technology:Taking Pull-Up as an Example

Pull-up,as an important physical fitness test event of the“National Student Physical Health Standard”,is known as a difficult physical fitness test event.To improve the assessment criteria of pull-ups,this paper uses the functional near-infrared spectroscopy(fNIRS)to monitor the changes and activation of oxyhemoglobin(HbO)signals in the brain motor cortex of people with different body mass indexes(BMIs)during the pullup assessment.Then the relationship between BMIs and evaluation criteria is discussed.After collecting and analyzing experimental data of 18 recruited college students,it is found that the number of pull-ups performed by people with different BMIs is different when they reach the peak state of brain activation.The results of the study indicate that different assessment criteria should be adopted for different BMI groups.It is suggested that the BMI should be introduced as one of the test indexes in the examination of pull-ups event in“National Student Physical Health Standard”.

Aerodynamic, Kinematic and Control Coupling Simulation of Aircraft Maneuvering Flight

Aiming at the high angle of attack pull-up and multi-channel roll pull-up coupling problems of high maneuvering aircraft, this paper establishes the flight attitude control rate by means of unsteady flow numerical solution, dynamic unstructured nested mesh assembly method and numerical solution method of flight mechanics equation. On this basis, a virtual flight simulation platform integrating pneumatics, motion and control is established. Based on this virtual flight simulation platform, F-16 aircraft is simulated by high angle of attack pull-up flight mode and multi-channel roll pull-up coupling flight mode. Finally, the influence of rudder on the yaw control channel is investigated. The results show that the numerical virtual flight simulation platform established in this paper has the ability to simulate maneuvering flight of aircraft.

一种高频单片GaN DC-DC降压转换器设计

基于全耗尽型(D-mode)0.25μm硅基氮化镓(GaN-on-Si)工艺,设计了一款高频单片GaN DC-DC降压转换器芯片。该芯片集成了驱动电路和半桥功率级电路,驱动电路中电平放大功能通过有源上拉结构实现,在100~200 MHz频率范围内,单片GaN DC-DC降压转换器可直接被0.7 V的高速脉冲信号控制,无需片外模块,其峰值功率级效率达到92.2%,峰值总效率达到84.24%,峰值功率为7.7 W。相较于前期工作,芯片工作范围从100 MHz提升至200 MHz,在保证芯片效率性能的情况下,实现了对工作频率的大幅提升。

临近空间球载飞行器投放控制关键技术综述

临近空间作为地球新的认知领域和重要的国家安全空间逐渐受到世界主要大国的重视.临近空间飞行器球载投放起飞方式能够使飞行器快速达到期望的飞行高度,同时减少因穿越对流层稠密大气所需的能源消耗,因而受到广泛关注并迅速发展成为临近空间飞行器起飞的一种重要方式.独特的球载投放起飞方式对高空气球及被投放飞行器的多项控制关键技术提出了较高的要求,高空低密度的飞行环境使得低速飞行具有明显的低雷诺数特性,随高度剧烈变化的风场增加了球载平台定点区域驻空的难度,载球系统上升过程的旋转运动给投放控制带来巨大的干扰,投放时刻的判断与拉起控制给大翼展柔性飞行器带来了新挑战.本文梳理了临近空间球载飞行器投放控制的关键技术及其研究现状,并对其未来的应用进行了展望.

基于改进YOLOv7-Pose网络综合体测计数算法

针对体测项目中引体向上和仰卧起坐计数效率及准确率低问题,设计基于改进YOLOv7-Pose网络综合体测计数算法。该算法通过检测人体关键点数据来计算肢体关节角度,设定阈值判断动作是否达标并实现计数。针对应用场景,将网络检测重点放在人体姿态中大目标上,删除小目标感受野模块和面部关键点,减小模型规模,提高实时性,以便移植到便携设备中;在原始YOLO7-Pose网络中引入SE注意力机制模块,提高模型特征提取能力;为最小化预测边界框和真实边界框的高度和宽度差异,使网络有更快收敛速度和更好定位结果,用EIoU替换原网络中的CIoU损失函数。在COCO数据集上实验结果表明,改进后的算法模型mAP@0.5提高了0.9个百分点,FPS显著提升,计数准确率均达到98%以上,满足体测场景对计数准确率的要求。

基于语义分割和人体姿态估计的引体向上测试平台设计

为了促进体测的智能化发展,设计了一种结合语义分割与人体姿态估计的引体向上测试系统。在充分考虑到引体向上计数规则和硬件部署的基础上,针对语义分割模型DeepLabV3+的特征提取部分Xception用ShuffleNetV2进行轻量化改进,并在解码模块中引入高效通道注意力(ECA)机制,整体应用到引体向上的单杠的分割任务中;运用姿态估计模型BlazePose检测人体关键点信息,通过其位置坐标之间的变换特征编写判别算法,完成引体向上测试功能。最后,将单杠目标分割任务与人体关键点检测任务成功部署在边缘计算平台Jetson nano上,并使用TensorRT加速推理,实现了18 fps的流畅运行。

表面肌电监测在引体向上教学训练中的应用研究

目的针对军队男性文职人员体能考核引体向上科目及格率较低、训练效果不理想的问题,基于人因工程学表面肌电监测方法对受试者引体向上运动进行分析,探究表面肌电信号辅助引体向上教学训练是否可行。方法随机选取5名男性社会招聘文职人员,通过监测其引体向上运动过程中肱桡肌、肱二头肌、三角肌后束、斜方肌和背阔肌电信号,选用肌肉激活强度、贡献率和激活时序3个参数分析受试者技术动作特性。结果肌电监测数据显示,受试者肌肉激活强度、贡献率和肌肉激活时序等与标准引体向上存在差异。受试者主发力肌群为肱桡肌和肱二头肌,斜方肌与背阔肌激活不足,导致三角肌后束与肱二头肌代偿发力,作为辅助肌群的三角肌后束贡献率高于背阔肌。结论表面肌电监测可将视觉无法观察到的内在肌肉动作以肌电信号形式呈现,辅助教员及时分析受试者的技术动作特性,为后续进行针对性训练指导提供参考。

卡前列素氨丁三醇联合宫颈提拉式缝合术在前置胎盘出血中的效果

目的探讨针对前置胎盘剖宫产过程中发生难治性产后出血的产妇应用卡前列素氨丁三醇联合宫颈提拉式缝合术的作用。方法选取2022年1月—2023年12月东莞市大朗医院收治的60例确诊为前置胎盘且行剖宫产术分娩中难治性产后出血的产妇为研究对象。依据随机数字表法分为观察组与对照组,各30例。观察组实施缩宫素、卡前列素氨丁三醇联合宫颈提拉式缝合术,对照组实施缩宫素联合子宫动脉下行支结扎治疗。对比2组术中、术后不同时间点出血量,临床治疗效果及纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer,D-D)等凝血功能指标变化和并发症发生情况。结果观察组术后2、12、24 h出血量分别为(674.33±35.37)mL、(908.22±42.24)mL、(1003.24±43.47)mL,均低于对照组的(753.63±40.62)mL、(1110.87±51.15)mL、(1124.54±60.28)mL,差异有统计学意义(P<0.05)。术后24 h,观察组D-D与FIB指标低于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率为93.33%,高于对照组的73.33%,差异有统计学意义(P<0.05)。2组均未有子宫切除病例。观察组并发症总发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论为前置胎盘剖宫产术中难治性产后出血产妇提供卡前列素氨丁三醇联合宫颈提拉式缝合术进行治疗可减少产妇产后出血量,提高止血疗效,降低并发症发生率,改善凝血功能指标,促进产妇产后更快恢复。

免缝拉合技术在山区门诊术后延迟愈合伤口护理中的应用价值

目的探究免缝拉合技术在山区门诊术后延迟愈合伤口护理中的应用价值。方法选取2018年8月至2020年8月在本院门诊就诊、接受过外科手术治疗的80例伤口延迟愈合患者为研究对象,根据就诊时间将其分为对照组(39例)和研究组(41例)。对照组采用常规护理,研究组采用免缝拉合技术。比较两组的干预效果。结果研究组的治疗总有效率高于对照组(P<0.05)。干预2、4周后,两组的创面面积均小于干预前,且研究组小于对照组(P<0.05);研究组的温哥华瘢痕量表(VSS)评分、换药费用低于对照组(P<0.05)。干预4周后,两组的伤口面积、渗液量及创面组织类型评分均低于干预前,且研究组低于对照组(P<0.05)。结论免缝拉合技术应用于山区门诊术后延迟愈合伤口患者中,具有简单、方便等优势,可以减少瘢痕,缩短伤口愈合时间,降低医疗费用。

新能源汽车进气风箱面盖注塑模具的创新设计

根据某款新能源汽车进气风箱面盖的结构特点和技术要求,设计了一副复杂侧向抽芯机构注塑模具。通过采用1个斜向滑块成型和2个不同方向侧向倒扣的复合侧向抽芯机构,有效地解决了模具在生产过程中侧向抽芯容易发生卡滞故障的问题。通过采用11组“直通式冷却水管+隔片式冷却水井”组合式随形水路的冷却系统,有效地解决了成型塑件变形及尺寸精度较差的问题。模具结构先进合理,投产后运行平稳顺利,成型周期降低了约12%,成型塑件尺寸精度提高了一级,达到了MT3(GB/T 14486—2008)。

自升式钻井平台插拔桩技术发展现状及趋势

针对自升式钻井平台在插桩和拔桩过程中面临的土工问题,系统地梳理插桩和拔桩涉及的关键技术。分析插桩过程中的土工试验技术、土体破坏机理、上硬下软地层承载力和桩脚滑移问题;阐述拔桩过程中的拔桩阻力计算方法和减小拔桩阻力方法的研究进展情况。在此基础上,根据目前面临的新挑战,提出今后自升式钻井平台插拔桩技术研究的重点,并预测其发展趋势。

AFA3G燃料组件拉棒机爪头收爪工艺分析与改进

分析AFA3G燃料组件拉棒机拉杆爪头收爪工艺的原理及存在的问题,提出有针对性的改进措施,包括爪头和卡管的材质、尺寸、表面处理等方面的优化。通过定性和定量对比分析,改进后的收爪工艺的可靠性明显提升,有效避免了燃料组件产品的质量隐患。

坐位颈部拔伸手法在治疗颈椎间盘突出症中的应用

目的:对于行颈椎牵引有不良反应的颈椎间盘突出症患者,尝试使用坐位颈部拔伸手法进行治疗,以提高该类疾病的治疗效果。方法:随机将62例颈椎牵引有不良反应的颈椎间盘突出症患者分为实验组(31例)和对照组(31例)。对照组采用药物、超声波、颈部围领和推拿的方法进行治疗,实验组则在上述方法的基础上增加坐位颈部拔伸手法。由专人对每位患者的疗效进行评定和记录,并在治疗前和治疗30次后分别对每位患者尿中-SH含量进行检测。结果:治疗30次后尿中-SH含量与治疗前相比两组均有明显的下降,实验组和对照组分别为71.3%和57.3%,t检验结果P﹤0.001,其差异具有非常显著性意义。对实验组和对照组的每位患者进行疗效评定,优良率分别为77.5%和51.6%,无效率分别为3.2%和29.1%,用Ridit检验和秩和检验分别进行统计学处理,P﹤0.01,差异具有非常显著性意义。结论:颈椎间盘突出症在传统的治疗方法中增加坐位颈部拔伸手法可以明显地提高行颈椎牵引有不良反应的患者的临床治疗效果。

Tm^(3+)离子在钨酸锌单晶中的光谱特征

采用丘克拉斯基法生长出一系列ZnWO4:Tm3 + 单晶 ,Tm3 + 浓度x =0 1 ,0 3,0 5 ,0 7和 1 0mol%。用 80 7nmLD激发 ,观察到 4 86和 6 95nm的上转换发光 ,分别相应于 1 G4→ 3 H6和3 F3 → 3 H6的跃迁 ,发光强度与泵浦光功率成双对数关系 ,其指数分别为 0 8和 1 1次方关系。