"Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy

BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.

A Clean Switch Inner Mongolian town takes giant steps in transitioning to clean energy production

Staff at the Ruichen Wanniu Livestock Farm in Jungar Zhao Town,Jungar Banner,Inner Mongolia,are consistently busy,even during important festivals.

基于TeamSTEPPS理论的案例情景教学法在急诊护理团队培训中的应用

急诊科具有危重患者多,突发状况多,医疗风险高等特点,目前国内大多数医院急诊科护士以团队形式开展工作,但临床工作中易出现职责分工不明确、配合不协调、组织抢救混乱等问题^([1])。团队培训是增强团队优质高效协作的重要途径^([2]),为进一步提升急诊护理团队协作,保障患者安全,本次研究将前期基于提高医疗质量和患者安全的团队策略与工具(team strategies and tools to enhance performance and patient safety,TeamSTEPPS)理论构建的急诊护理团队培训方案^([3])进行临床应用,取得了较好的效果。现报道如下。

In Her Father's Footsteps

Chinese nurse chooses to join a medical mission to Mali, just like her father Hong Min will never forget 18 July 2017. It was the day when the nurse received the medal of the Order of Health Merit of Mali for her service in the country as part of the 24th Chinese medical team.The award, in the words of Samba Ousmane Sow, then minister of health and public hygiene.

Performance improvement in stepped solar still modified by sponge layer

In this paper,the experimental investigation on the performance improvement of conventional stepped solar still is conducted.The steps are covered by the porous material to improve the performance of the conventional device and increase the evaporation rate.All the parameters,including the temperature on the glass surface,the water temperature inside the evaporation zone,and the amount of water produced in both conventional and modified stepped solar stills are measured and compared.The efficiency of two devices and their exergy efficiency have been calculated.Finally,the economic analysis of both devices has been done to check the economic feasibility of the modified device.The amount of freshwater generated during one day was 2244.4 and 3076.2 mL/m^(2),respectively for the conventional and modified stepped solar stills.As a result,the amount of water produced in one day by modified stepped solar still is 35.5% more than the conventional one.Also,the costs for the conventional and modified stepped solar stills have been calculated as 0.0359 and 0.029$/(L·m^(-2)),respectively.

Controllable step-flow growth of GaN on patterned freestanding substrate

A new kind of step-flow growth mode is proposed,which adopts sidewall as step source on patterned GaN substrate.The terrace width of steps originated from the sidewall was found to change with the growth temperature and ammonia flux.The growth mechanism is explained and simulated based on step motion model.This work helps better understand the behaviors of step advancement and puts forward a method of precisely modulating atomic steps.

Stability analysis of intermittently jointed rock slopes based on the stepped failure mode

In practical engineering,due to the noncontinuity characteristics of joints in rock slopes,in addition to plane failure,stepped sliding failure may occur for intermittently jointed rock slopes.Especially for intermittently bedding jointed rock slopes,the correlation and difference in strength parameters between joints and rock bridges,along with the various failure modes and intermittency of rock bridges,contribute to the complexity of stepped failure modes and the unpredictability of failure regions.Based on the upper-bound limit analysis method and multi-sliders step-path failure mode,considering the shear and tensile failure of rock bridges and the weakened relationship between the strength parameters of rock bridges and jointed surfaces,by introducing the modified M-C failure criterion and the formula for calculating the energy consumption of tensile failure of rock bridges,two failure mechanisms are constructed to obtain the safety factor(F_(s))of intermittently jointed rock slopes.The sequential quadratic programming method is used to obtain the optimal upper-bound solution for F_(s).The influence of multiple key parameters(slope height H,horizontal distance L,Slope angleβ,shear strength parameters of the rock bridgeφr and cr,Dimensionless parameter u,weakening coefficients of the internal friction angle and cohesion between the rock bridges and joint surfaces Kφand Kc)on the stability analysis of intermittently jointed rock slopes under the shear failure mode of rock bridges as well as under the tensile failure mode is also explored.The reliability of the failure mechanisms is verified by comparative analysis with theoretical results,numerical results,and landslide cases,and the variation rules of F_(s)with each key parameter are obtained.The results show that F_(s) varies linearly withφr and cr of the rock bridge and with K_(φ)and K_(c),whereas F_(s)changes nonlinearly with H and L.In particular,with the increase in Kφand Kc,Fs increases by approximately 52.78%and 171.02%on average,respectively.For rock bridge tensile failure,F_(s) shows a nonlinearly positive correlation withφr,cr,Kφand Kc.In particular,with the increase in Kφand Kc,Fs increases by approximately 13%and 61.69%on average,respectively.Fs decreases rapidly with increasing slope gradientβand decreasing dimensionless parameterμ.When Kφand Kc are both less than 1.0,the stepped sliding surface occurs more easily than the plane failure surface,especially in the case of tensile failure of the rock bridge.In addition,rock slopes with higher strength parameters,taller heights,and greater weakening coefficients are prone to rock bridge tension failure with lower Fs,and more attention should be given to the occurrence of such accidents in actual engineering.

Transfer matrix method for free and forced vibrations of multi-level functionally graded material stepped beams with different boundary conditions

Functionally graded materials(FGMs)are a novel class of composite materials that have attracted significant attention in the field of engineering due to their unique mechanical properties.This study aims to explore the dynamic behaviors of an FGM stepped beam with different boundary conditions based on an efficient solving method.Under the assumptions of the Euler-Bernoulli beam theory,the governing differential equations of an individual FGM beam are derived with Hamilton’s principle and decoupled via the separation-of-variable approach.Then,the free and forced vibrations of the FGM stepped beam are solved with the transfer matrix method(TMM).Two models,i.e.,a three-level FGM stepped beam and a five-level FGM stepped beam,are considered,and their natural frequencies and mode shapes are presented.To demonstrate the validity of the method in this paper,the simulation results by ABAQUS are also given.On this basis,the detailed parametric analyses on the frequencies and dynamic responses of the three-level FGM stepped beam are carried out.The results show the accuracy and efficiency of the TMM.

Contribution to the Full 3D Finite Element Modelling of a Hybrid Stepping Motor with and without Current in the Coils

The paper presents our contribution to the full 3D finite element modelling of a hybrid stepping motor using COMSOL Multiphysics software. This type of four-phase motor has a permanent magnet interposed between the two identical and coaxial half stators. The calculation of the field with or without current in the windings (respectively with or without permanent magnet) is done using a mixed formulation with strong coupling. In addition, the local high saturation of the ferromagnetic material and the radial and axial components of the magnetic flux are taken into account. The results obtained make it possible to clearly observe, as a function of the intensity of the bus current or the remanent induction, the saturation zones, the lines, the orientations and the magnetic flux densities. 3D finite element modelling provide more accurate numerical data on the magnetic field through multiphysics analysis. This analysis considers the actual operating conditions and leads to the design of an optimized machine structure, with or without current in the windings and/or permanent magnet.

谐波驱动系统Back-stepping滑模控制研究

针对谐波传动系统动力学模型中存在的柔性变形、摩擦和运动误差等非线性因素。为了提高系统的传动精度,针对系统非线性刚度和静态误差因素进行了建模,并提出了一种Back-stepping滑模控制方法。利用Lyapunov稳定性理论,证明了闭环系统的误差是一致有界的。仿真结果表明,与PID控制相比,采用Back-stepping滑模控制,系统传动误差曲线峰峰值减小66.63%;负载端角速率误差曲线峰峰值减小77.35%。Back-stepping滑模控制能有效地补偿系统传动误差,抑制其负载端的速度波动,提高了系统的传动精度。

疏散模拟软件STEPS与Pathfinder对比研究

为了了解两款疏散模拟软件STEPS与Pathfinder的功能差异及适用范围,采用理论研究与实际模拟相结合的方法进行对比分析。研究发现:STEPS软件采用元胞自动机(CA)模型,疏散规则简单,人员智能化程度低,疏散时人员行为特征与现实情况不完全相符,但路径决策系统很好地解决了上述问题,可以真实地模拟常态下人员疏散;Pathfinder软件采用Agent-based模型,人员智能化程度高,个体可以回应环境刺激,人员可以轻松规避障碍物,人群中的个体行为特征丰富且与现实情况十分相符,但在出口选择上存在缺陷,人员只能选择前方的出口而忽略后方的出口,不能模拟常态下的人员疏散。分析得出,Pathfinder模拟结果与真实情况相符程度更高,STEPS更适合模拟常态下人员疏散。

基于STEPS的某高校学生宿舍楼人群疏散

建立实际的宿舍楼模型,通过STEPS进行模拟,研究宿舍楼出口数量、宽度、位置等因素对人员疏散时间的影响。根据不同疏散出口的开启情况设置7个场景,分析不同时刻的人员分布、不同场景下的疏散时间以及不同场景下各出口的利用率等。建议此宿舍楼在突发状况下至少开启2个疏散出口,并对人员疏散加以引导。

基于STEPS的山区高含硫气井周边居民疏散模拟研究

我国高含硫气井都位于一些远郊区或偏远山区,在生产运行中已多次因出现井喷、井口溢气等险情而疏散周边居民.以山区某高含硫气井周围1 km内的居民疏散为研究对象,针对当地山峦起伏、山路坡陡等复杂地形的特点,使用STEPS软件进行模拟.根据NASA 2009年的全球DEM数据、航拍图和实地调研结果,提供了在软件中直接绘制山区三维地形和道路网络模型的方法.在人员属性的设置中,考虑了地形坡度对不同性别和年龄的人员移动速度的影响.最后通过STEPS模拟,研究了气井周围三条主要道路上的疏散时间、疏散效率以及不同类型人员的疏散.

基于STEPS的音乐厅人员疏散模拟研究

介绍元胞自动机理论和STEPS软件。研究音乐厅人员疏散的设计,运用STEPS软件,分析火灾导致某安全出口失效的情况下音乐厅人员疏散过程,分析其他安全出口的利用率。模拟结果显示,安全出口利用不均衡,人员在疏散楼梯口以及个别直通室外的安全出口发生拥堵。建议增大安全出口宽度,合理分流,统筹疏散;制定完善的管理制度和维护措施。将STEPS模拟结果与Pathfinder模拟结果进行对比,模拟结果基本一致。

基于STEPS的超高层建筑人员疏散模拟研究

选取某超高层写字楼,使用STEPS软件进行人员疏散模拟。按照建筑设计容量和人员密度计算各楼层的人员荷载。将楼梯、不同分布高度的电梯、避难层三种疏散设施相组合,设置5种疏散方案进行模拟研究,得出不同方案下建筑内部剩余人数随时间变化的曲线以及不同方案中由电梯疏散的人数占总人数的百分比,分析各疏散方案的疏散效率。研究结果表明,"楼梯+电梯+避难层"的组合为最优疏散方案,疏散效率和安全性最高。

基于STEPS的历史地段火灾疏散模拟研究

作为具有生命力的遗产,历史地段不断受到来自火灾的严重威胁。在保护历史地段自身安全的同时,地段内公众的疏散避难安全应得到保证。为了在保护历史地段的基础上保障公众的火灾疏散避难安全性,应用基于细胞自动机的理论的STEPS软件,以宁波走马塘古村落为例,以疏散时间、出口距离、通道使用强度3个指标为依据,对历史地段进行火灾疏散避难模拟分析,对历史地区空间规划提出相应的改造策略,并进行进一步的模拟验证。

英格兰青少年足球训练理论与实践分析——基于四角模型和STEPS原则

文章运用实地访谈法、文献资料法等方法对英格兰青少年足球运动员训练培养的内容与方法进行了研究.通过分析训练实例得出,四角模型能从技术、体能、心理和社交四个方面综合培养青少年足球运动员的比赛能力;STEPS原则广泛应用于英格兰青少年各个年龄阶段的足球训练,且不同年龄阶段培养、发展技能的侧重点十分明确;在训练内容的安排上,注重进阶,接近实战,训练内容和方法具有科学性、针对性和全面性.文章旨在为我国青少年足球运动员的训练培养提供参考.

在STEPS中的三维宿舍火灾的人群疏散研究

在STEPS里建立了一个三维火灾逃生模型,在这个模型当中,首先找到最近的安全出口模拟人群疏散,同时记录每个时段的疏散人数及总的疏散时间;然后以此来研究起火楼层、备用出口的位置和个数、人的反应时间一致性等因素对总的疏散时间的影响。

远程抄表STEPS系统在校园中的应用

本文阐述了远程集中抄表系统与传统抄表模式的比较,结合我国校园自身的特点,建立和推出适合学校用电管理状况的新型的三层用电管理系统(STEPS)。为学校的用电管理系统在现行的用电管理系统的基础上探索出一条行之有效的新路和解决方案。

Recovery of waste rare earth fluorescent powders by two steps acid leaching

The effects of the acid leaching and alkali fusion on the leaching efficiency of Y,Eu,Ce,and Tb from the waste rare earth fluorescent powders were investigated in this paper.The results show that hydrochloric acid is better than sulfuric acid in the first acid leaching,and NaOH is better than Na2CO3in the alkali fusion.In the first acid leaching,the Wloss is 20.94%when the waste rare earth fluorescent powders are acid leached in H?concentration 3 mol L-1and S/L ratio 1:3 for 4 h due to red powders dissolved.The better results of the alkali fusion can be got at 800℃ for 2 h when the NaOH is used.The blue powders and the green powders can be dissolved into NaAlO2and oxides such as rare earth oxide(REO).The REO can be dissolved in H?concentration 5 mol L-1,S/L1:10 for 3 h in the second acid leaching.The leaching rates of the Y,Eu,Ce,and Tb are 99.06%,97.38%,98.22%,and 98.15%,respectively.The leaching rate of the total rare earth is 98.60%.