Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction:A case report and review of literature

BACKGROUND Mycobacterium tuberculosis(TB)is the causative agent of TB,a chronic granulo-matous illness.This disease is prevalent in low-income countries,posing a significant global health challenge.Gastrointestinal TB is one of the three forms.The disease can mimic other intra-abdominal conditions,leading to delayed diagnosis owing to the absence of specific symptoms.While gastric outlet obs-truction(GOO)remains a frequent complication,its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy.Gastroduodenal TB can cause upper gastrointestinal hemorrhage,obstruction,and malignancy-like tumors.CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain,distension,nausea,vomiting,and weight loss,prompting a referral to a gastroenterologist clinic.Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation.However,treatment was interrupted,possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes.Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall.Resection revealed gastric wall effacement with TB.CONCLUSION Primary gastric TB is rare,frequently leading to GOO.Given its rarity,suspicions should be promptly raised when encountering relevant symptoms,often requiring surgical intervention for diagnosis and treatment.

Navigating Market Choices: Understanding Carrot Market Outlet Selection among Smallholder Farmers in Kenya

This research delves into the hurdles and strategies aimed at augmenting the market involvement of smallholder carrot farmers in Nakuru County, Kenya. Employing a Multinomial Logit (MNL) model, it scrutinizes the factors influencing the selection of marketing outlets among carrot farmers. The findings unveil that a significant majority (81%) of surveyed farmers actively participate in diverse market outlets, encompassing the farm gate, cleaning point, local market, external market, and export market. Notably, pivotal buyers include aggregators, brokers, wholesalers, retailers, and consumers, with transactions predominantly occurring at the farm level. Additionally, the analysis discerns substantial influences of socio-economic characteristics, experiential factors, and geographical proximity on farmers’ choices of market outlets. Specifically, gender, age, land size, farming experience, and distance to markets emerge as critical determinants. Moreover, the study delves into the examination of market margins along the carrot value chain, shedding light on the potential profitability of carrot farming in the region. Remarkably, higher average gross margins are identified in export and external markets, signaling lucrative prospects for farmers targeting these segments. However, disparities in profit distribution between farmers and traders underscore the necessity for interventions to ensure equitable value distribution throughout the value chain. These findings underscore the imperative for tailored interventions to tackle challenges and foster inclusive agricultural development. Strategies such as farmer organizations, contracting, and vertical integration are advocated to enhance market access and profitability for smallholder carrot farmers. Thus, this study enriches our comprehension of the dynamics within carrot value chains and provides valuable insights for policymakers and development practitioners aiming to uplift rural livelihoods and bolster food security.

Revisiting tuberculosis as a cause of gastric outlet obstruction:Insights from a case report

Gastroduodenal tuberculosis(GD-TB)is exceptionally rare.The clinical manifestations of gastrointestinal TB are diverse and non-specific,which makes diagnosis difficult,leading to delayed diagnosis and high mortality.As a peer-reviewer of World Journal of Clinical Cases,I would like to share my opinion on the article published by this journal.The patient had no family history of TB or contact with people with TB.Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient.The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Unveiling hidden outcomes in malignant gastric outlet obstruction research–insights from a"Pancreas 2000"review

Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.

Treatment of choice for malignant gastric outlet obstruction: More than clearing the road

In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.

Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico

BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has recently emerged as an alternative treatment for gastric outlet obstruction(GOO)in selected patients.AIM To report the initial experience of EUS-GE in patients with GOO.METHODS This study was a retrospective,observational,multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected.We analyzed technical success,clinical success,adverse events,and survival.Technical success was defined as adequate positioning and deployment of the stent.Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure.Postprocedural adverse events were recorded.RESULTS Eleven procedures in 10 patients with GOO were included.The mean age of the patients was 67.5 years(range:56-77 years).Malignant GOO was present in 9 patients.Technical success was achieved in 9/11 procedures(82%).Among them,clinical success was achieved in 9 patients(100%).Adverse events occurred in 1 patient(9%).The median survival was 3 months(n=7;range:1-8 months).CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.

Supersonic swirling characteristics of natural gas in convergent-divergent nozzles

The supersonic nozzle is a new apparatus which can be used to condense and separate water and heavy hydrocarbons from natural gas.The swirling separation of natural gas in the convergent-divergent nozzle was numerically simulated based on a new design which incorporates a central body. Axial distribution of the main parameters of gas flow was investigated,while the basic parameters of gas flow were obtained as functions of radius at the nozzle exit.The effect of the nozzle geometry on the swirling separation was analyzed.The numerical results show that water and heavy hydrocarbons can be condensed and separated from natural gas under the combined effect of the low temperature（-80℃） and the centrifugal field（482,400g,g is the acceleration of gravity）.The gas dynamic parameters are uniformly distributed correspondingly in the radial central region of the channel,for example the distribution range of the static temperature and the centrifugal acceleration are from -80 to -55℃and 220,000g to 500,000g,respectively,which would create good conditions for the cyclone separation of the liquids.However,high gradients of gas dynamic parameters near the channel walls may impair the process of separation.The geometry of the nozzle has a great influence on the separation performance. Increasing the nozzle convergent angle can improve the separation efficiency.The swirling natural gas can be well separated when the divergent angle takes values from 4°to 12°in the convergent-divergent nozzle.

Unsteady Behavior of Cavitating Waterjet in an Axisymmetric Convergent-Divergent Nozzle: High Speed Observation and Image Analysis Based on Frame Difference Method

Although it is well known that cloud cavitation shows unsteady behavior with the growing motion of an attached cavity, the shedding motion of a cloud, the collapsing motion of the cloud shed downstream and a reentrant motion in flow fields such as on a 2-D hydrofoil and in a convergent- divergent channel with a rectangular cross-section, observations for the periodic behavior of cloud cavitation in a cylindrical nozzle with a convergent-divergent part, which is mainly used in an industrial field, have hardly been conducted. From engineering viewpoints, it is important to elucidate the mechanism of periodic cavitation behavior in a cylindrical nozzle. In this study, a high-speed observation technique with an image analysis technique was applied to the cloud cavitation behavior in the nozzle to make clear the mechanism of unsteady behavior. As a result, it was observed in the nozzle that the periodic behavior occurs in the cloud cavitation and pressure waves form at the collapse of clouds shed downstream. Also, it was found through the image analysis based on the present technique that the pressure wave plays a role as a trigger mechanism to cause a reentrant motion at the downstream end of an attached cavity.

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

Modified stomach-partitioning gastrojejunostomy for initially unresectable advanced gastric cancer with outlet obstruction: A case report

BACKGROUND Chemotherapy followed by gastrojejunostomy remains the main treatment for unresectable gastric cancer(GC)in the middle-or lower-third regions with gastric outlet obstruction(GOO).Radical surgery is performed as part of a multimodal treatment strategy for selected patients who respond well to chemotherapy.This study describes a case of successful radical resection with completely laparoscopic subtotal gastrectomy after a modified stomach-partitioning gastrojejunostomy(SPGJ)for obstruction relief,in a patient with GOO.CASE SUMMARY During the initial esophagogastroduodenoscopy,an advanced growth was detected in the lower part of the stomach,which caused an obstruction in the pyloric ring.Following this,a computed tomography(CT)scan revealed the presence of lymph node metastases and tumor invasion in the duodenum,but no evidence of distant metastasis was found.Consequently,we performed a modified SPGJ,a complete laparoscopic SPGJ combined with No.4sb lymph node dissection,for obstruction relief.Seven courses of adjuvant capecitabine plus oxaliplatin combined with Toripalimab(programmed death ligand-1 inhibitor)were administered thereafter.A preoperative CT showed partial response;therefore,completely laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy was performed after conversion therapy,and pathological complete remission was achieved.CONCLUSION Laparoscopic SPGJ combined with No.4sb lymph node dissection was an effective surgical technique for initially unresectable GC with GOO.

Outcomes of Transcatheter Closure in Outlet-Type Ventricular Septal Defect after 1 Year

Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.

泄水建筑物抗冲磨混凝土降粘抗裂性能研究

为改善抗冲磨混凝土的施工性和抗裂性、延长泄水建筑物衬砌混凝土的使用寿命,选用了一种新型的抗裂降粘剂,并以掺硅灰、纤维、HF剂的混凝土为比较对象,对四种混凝土的工作性能、力学性能、抗冲磨性能及抗裂性进行对比试验。结果表明,掺加抗裂降粘剂可大幅降低抗冲磨混凝土的塑性粘度,改善混凝土施工性能;掺硅灰+抗裂降粘剂的混凝土抗压强度和抗拉强度整体上优于其余混凝土,且抗冲磨强度比HF混凝土提高40%;就抗开裂能力而言,硅灰+纤维混凝土>硅灰+抗裂降粘剂混凝土>HF混凝土。因此,抗裂降粘剂能有效降低抗冲磨混凝土的粘度、提升力学性能和抗冲磨强度,降低早期开裂风险。

聚结构件形式对管式油水分离器油出口含油率的影响

为了对比不同结构形式聚结构件对管式油水分离器油出口含油率的影响规律,为工程设计选型提供技术支持,通过CFD方法分析了正V形斜板、倒V形斜板、传统斜板和蛇形背向折板4种不同聚结构件作用下的浓度场和油出口含油率,并探究了正V形聚结构件在单一条件下的最适宜结构参数。结果表明,在所研究的流速(0.05~0.35 m·s^(-1))内,4种聚结构件中正V形构件具有最好的油出口含油率,蛇形背向折板与倒V形斜板位列第2、3位,传统斜板最低;随着进口流速的增大,4种聚结构件油出口含油率均相应降低,其中传统斜板下降速度最快,正V形斜板与蛇形背向折板下降最慢,相差不大,而倒V形斜板下降速度居中;利用控制变量法确定了正V形构件与壁面间距C=10 mm、水平夹角θ=60°时油出口含油率最高。

多分水口长距离输水工程停泵水锤防护措施

为了能够有效避免多泵且多分水口输水系统在无防护抽水断电时可能出现较为严重的负水锤带来的危害,建立了全长106.46 km的大型供水工程的数学模型进行系统过渡过程计算,选择空气阀与两阶段液控蝶阀联合防护与单向塔防护2种方案消除其负水锤,在前者远不达理想防护效果后针对后者进行优化.结合工程实际在确定了单向塔的数量、位置以及塔高后,对不同位置单向塔的底面积进行多种方案的对比选取,最终选用塔1#的底面积为28.26 m^(2),塔2#的底面积为176.63 m^(2);为了防止单向塔漏空需要分水口以及供水终端调流阀配合关闭,在确保管道最大压力不超出其承压能力的前提下,创新性地对各分水口调流阀与供水终端调流阀的关闭时间规律进行了效果比较,使输水系统能够更加经济安全地稳定运行,为此类长距离多分水口多泵供水工程的水锤防护提供了优化方向.

热风加热沥青路面冲击射流共轭传热特性

为提高热风加热沥青路面的就地再生加热效果,基于热风冲击射流对流换热和沥青路面内部导热的共轭传热过程,建立了热风加热沥青路面的冲击射流共轭传热理论模型,选取有限容积法得到了共轭传热模型的通用离散方程,采用压力-速度耦合半隐式算法(semi-implicit method for pressure linked equations,SIMPLE)获得了整个求解域内温度场分布,选取平均热流密度和平均换热系数反映沥青路面加热效果,通过正交试验研究了热风出口速度和热风出口温度对路面加热效果的影响程度。仿真和试验结果表明:理论计算与实验温度场分布趋势吻合度高,两者平均误差为8.4%;平均热流密度和平均换热系数在加热初期均从最大值急剧下降,而后下降幅度逐渐减小趋于平衡,两者的仿真计算与实验结果趋势相同,平均误差分别为6.4%和7.8%;热风出口速度和热风出口温度对平均热流密度均有显著影响,热风出口速度对平均换热系数有显著影响,热风出口温度对平均换热系数的影响相较于平均热流密度指标表现为不显著。研究结果为后续沥青路面就地热再生热风加热温度控制和加热器设计提供了理论依据。

基于LSTM神经网络的烟丝水分恒定控制系统设计

在烟丝加工过程中,水分分布受到温度、湿度多个因素的影响,控制系统无法准确反映整体水分情况;为全面提高加工型香烟的质量水平,设计基于LSTM神经网络的烟丝水分恒定控制系统;部署Profibus控制总线,并在线路体系中连接水分检测仪与水分恒定器,完成烟丝水分恒定控制系统的硬件设计;在系统软件设计方面,构建LSTM神经网络单元,根据烟叶吸湿能力分析条件,求解具体的水分分布模型,实现基于LSTM神经网络的烟丝水分模型建模;分别计算烟叶出口湿度与出口温度,并联合传递函数逼近参量与恒定时滞参数,完成对控制参数的整定处理,再联合相关应用部件,实现基于LSTM神经网络的烟丝水分恒定控制系统设计;实验结果表明,LSTM神经网络模型作用下,生丝含水量被稳定控制在13%~18%数值之间,不会因水分过量问题而导致香烟质量水平无法达到实际加工标准。

县域商业网点与路网形态耦合度分析——以江苏省太仓市为例

路网形态影响到居民出行并塑造着城市的商业形态。为了识别县域商业网点与路网形态的协同发展及空间差异性,以太仓商业网点和路网形态为研究对象,选取路网的几何指标和拓扑指标,运用核密度分析法、平均最近邻指数、标准差椭圆、扩展空间句法模型(s DNA)等,研究城市道路形态与商业网点的对应关系,并对太仓各行政区的商业布局交通耦合性进行评价。结果表明:第一,太仓商业网点的集聚核心与路网综合指数核心基本一致,太仓主城区大集聚,各乡镇多核小集聚分布。不同类型商业网点的集聚程度具有差异性。第二,太仓商业分布方向为“东北—西南”走向,而路网分布更偏南北向,休闲娱乐类网点和餐饮类更偏东西向分布。第三,太仓商业的分布和街道路网形态显著相关,与商业布局关联最强的是道路接近度,相关性最弱是路网的穿行度,与道路形态各参数相关程度最大的商业业态是餐饮业。第四,太仓大部分区域商业网点分布与交通综合指数总体基本匹配,但城区部分区域的商业发展滞后于道路综合指数,乡镇则呈现相反的态势。

上海地铁某车站空调系统高效制冷机房改造实测分析

地铁车站空调系统高效技术是当前轨道交通节能降碳的主要手段,针对上海某地铁车站制冷机房高效化改造的具体情况、改造效果、能效提升进行了详细的分析和研究。改造选择了磁悬浮冷水机组,应用了变频技术来优化水泵的运行,改造后空调季制冷机房平均能效比达到5.16,年节电量约为30万kWh,节能效果显著。通过对制冷机房运行数据进行对比分析得知,负载率的优化对冷水机组能效具有直接而显著的影响,通过调整冷机出水温度和优化水泵变频策略,能进一步提高制冷机房的能效,为地铁车站制冷机房高效化改造和能效提升提供参考和帮助。

电针通过调节膀胱及尿道平滑肌中的血清素受体表达改善骶上脊髓损伤大鼠的排尿功能

目的观察电针治疗后骶上脊髓损伤(suprasacral cord injury,SSCI)大鼠的膀胱最大容量(maximum cystometric capacity,MCC)、漏尿点压力(leakage point pressure,LPP),结合分析逼尿肌、内尿道括约肌(internal urethral sphincter,IUS)中血清素(5-hydroxytryptamine,5-HT)不同亚型受体的表达,探讨电针治疗通过突触后5-HT受体调节逼尿肌-尿道括约肌协同失调(detrusor sphincter dyssynergia,DSD)大鼠排尿功能的效应机制。方法36只SD雌性大鼠,随机抽取12只作为空白组,剩余24只采用改良Hassan Shaker脊髓横断法在T10脊髓节段全横断制作SSCI大鼠模型,成模后随机分为模型组和电针组,每组12只。电针组取次髎、中极、三阴交穴予持续电针刺激40 min,1次/d,连续治疗7 d;空白组与模型组只捆绑不治疗。采用膀胱造瘘法进行尿流动力学检测;处死大鼠后取逼尿肌和近端尿道组织,采用Western blot法检测5-HT受体含量。结果模型组大鼠MCC、LPP显著高于空白组(P<0.01);电针组MCC显著低于模型组且高于空白组(P<0.01),LPP显著低于模型组(P<0.01)。与空白组比较,5-HT1A受体在模型组大鼠逼尿肌中表达显著降低(P<0.01),IUS中显著增高(P<0.01);电针组大鼠逼尿肌中5-HT1A受体显著高于模型组(P<0.01),IUS中5-HT1A受体低于模型组(P<0.05),但仍显著高于空白组(P<0.01)。模型组大鼠逼尿肌中5-HT2B受体表达高于空白组(P<0.05);电针组大鼠逼尿肌中5-HT2B受体表达低于模型组和空白组(P<0.05)。与空白组比较,5-HT7受体在模型组大鼠逼尿肌中表达显著降低(P<0.01),IUS中表达显著增高(P<0.01);电针组大鼠逼尿肌和IUS中5-HT7受体的表达均低于模型组(P<0.05)。结论电针刺激SSCI后DSD大鼠次髎、三阴交、中极穴引起膀胱及尿道平滑肌中5-HT受体表达变化,5-HT1A和5-HT2B受体可能通过Ca^(2+)流入使平滑肌产生相性和/或强直性收缩,5-HT7受体可能通过环磷酸腺苷(cyclic adenosine monophosphate,cAMP)途径影响大电导Ca^(2+)激活K^(+)(big-conductance Ca^(2+)-activated K^(+),BK)通道活性介导平滑肌松弛,电针治疗由此抑制逼尿肌过度活动、增加其收缩能力并协调尿道阻力以改善SSCI后DSD大鼠下尿路功能。

竖井式进出水口水力特性研究进展

竖井式进出水口是抽水蓄能电站水道系统两端控制水流的常用进出水口型式之一。竖井式进出水口双向过流,水流在短距离内经历两次90°流向转变(水平-竖直-水平),流向变化剧烈,水力条件复杂,深入研究竖井式进出水口水力特性,进而优化其体型结构,对抽水蓄能电站设计及施工具有重要意义。首先,介绍竖井式进出水口应用背景及体型特点,分析竖井式进出水口水力特性存在的问题;其次,对竖井式进出水口孔口流量分配、拦污栅断面流速分布、漩涡和水头损失等方面研究进展进行总结;最后,归纳了竖井式进出水口水力特性研究方法,探讨了今后研究应聚焦的主要方向。