Initial suction drainage decreases severe postoperative complications after pancreatic trauma:A cohort study

BACKGROUND Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma(PT).AIM To investigate whether sustained low negative pressure irrigation(NPI)suction drainage is superior to closed passive gravity(PG)drainage in PT patients.METHODS PT patients who underwent pancreatic surgery were enrolled consecutively at a referral trauma center from January 2009 to October 2021.The primary outcome was defined as the occurrence of severe complications(Clavien-Dindo grade≥Ⅲb).Multivariable logistic regression was used to model the primary outcome,and propensity score matching(PSM)was included in the regression-based sensitivity analysis.RESULTS In this study,146 patients underwent initial PG drainage,and 50 underwent initial NPI suction drainage.In the entire cohort,a multivariable logistic regression model showed that the adjusted risk for severe complications was decreased with NPI suction drainage[14/50(28.0%)vs 66/146(45.2%);odds ratio(OR),0.437;95%confidence interval(CI):0.203-0.940].After 1:1 PSM,44 matched pairs were identified.The proportion of each operative procedure performed for pancreatic injury-related and other intra-abdominal organ injury-related cases was comparable in the matched cohort.NPI suction drainage still showed a lower risk for severe complications[11/44(25.0%)vs 21/44(47.7%);OR,0.365;95%CI:0.148-0.901].A forest plot revealed that NPI suction drainage was associated with a lower risk of Clavien-Dindo severity in most subgroups.CONCLUSION This study,based on one of the largest PT populations in a single high-volume center,revealed that initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.

Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy

Preoperative biliary drainage may increase the morbidity and mortality of pancreatico-duodenectomy.Studies on percutaneous transhepatic biliary drainage(PTBD)before laparoscopic pancreaticoduodenectomy(LPD),however,are scarce.The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD.Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed.Demographics,catheterrelated complications,postoperative complications,and oncological outcormes were collected and analyzed.Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD(PTBD group),and those given LPD alone(LPD group).The results showed that,in the PTBD group relative to the LPD group,the operating time was significantly shortened(250.28±69.95 vs.278.58±86.51 min,P=0.0196),the intraopcrative blood loss was markedly reduced(271.96±403.47 vs.429.72±482.47 mL,P=0.022),and overall rates of complications(16.33%vs.36.49%,P=0.0025)including postoperative haemorrhage(2.04%vs.12.16%,P=0.0072)and delayed gastric emptying(4.08% vs.13.51%,P=0.0251)were greatly decreased.The propensity score-matched analysis,with 48 patients enrolled in each group,revealed no statistically significant differences in operating duration(262.71±68.64 vs.280.25±83.52 min,P=0.264),intraoperative blood loss(290.21±407.71 vs.373.75±422.33 mL,P=0.327)and delayed gastric emptying(4.17% vs.12.50%,P=0.1396).PTBD group had lower incidences in overall complications(22.92% vs.39.58%,P=0.0481)and postoperative haemorrhage(2.08% vs.12.50%,P=0.0497)than LPD group.In conclusion,patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma:An observational study

BACKGROUND Chronic subdural hematoma(CSDH)is a common disease in neurosurgery.The traditional treatment methods include burr hole drainage,bone flap craniectomy and other surgical methods,and there are certain complications such as recurrence,pneumocephalus,infection and so on.With the promotion of neuroendoscopic technology,its treatment effect and advantages need to be further evaluated.AIM To study the clinical effect of endoscopic small-bone approach in CSDH.METHODS A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method:the neuroendoscopy group(n=61 cases)and the burr hole drainage group(n=61 cases).The clinical treatment effect of the two groups of patients with CSDH was compared.RESULTS At the early postoperative stage(1 d and 3 d),the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete reexpansion was higher in the neuroendoscopy group than in the burr hole drainage group,and the difference between the two groups was statistically significant(P<0.05).The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group,and the difference between the two groups was statistically significant(P<0.05).No intracranial hematoma,low cranial pressure,tension pneumocephalus or other complications occurred in the neuroendoscopy group.CONCLUSION The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up.The surgical effect is apparent with few complications and definite curative effect,which is worthy of clinical promotion and application.

Effectiveness analysis of methane-drainage by deep-hole controlled pre-splitting blasting for preventing coal and gas outburst

In the study of the application effectiveness of deep-hole controlled pre-splittingblasting technology,it was found through laboratory micro test and field study on a mine insouth China that under the technology,coal masses produce many irreversible cracks.Afterblasting,the nearer the distance from blasting hole,the larger the BET surface areaand volume ratio of the infiltration pore are;they increased by 11.47%and 5.73%,respectively.The coefficient of air permeability is increased 4 times.After 3 months,the gasdrainage rate was increased by 66%.In the first 15 days,the cumulative pumped gas was1.93 times of blasting before.The average absolute gas emission decreased by 63.46%.Experimental results show that deep-hole controlled pre-splitting blasting not only preventscoal and gas outburst,but also gives good economic results.

Application of Newtonian approximate model to LIGO gravitational wave data processing

With the observation of a series of ground-based laser interferometer gravitational wave(GW)detectors such as LIGO and Virgo,nearly 100 GW events have been detected successively.At present,all detected GW events are generated by the mergers of compact binary systems and are identified through the data processing of matched filtering.Based on matched filtering,we use the GW waveform of the Newtonian approximate(NA)model constructed by linearized theory to match the events detected by LIGO and injections to determine the coalescence time and utilize the frequency curve for data fitting to estimate the parameters of the chirp masses of binary black holes(BBHs).The average chirp mass of our results is 22.05_(-6.31)^(+6.31)M_(⊙),which is very close to 23.80_(-3.52)^(+4.83)M_(⊙)provided by GWOSC.In the process,we can analyze LIGO GW events and estimate the chirp masses of the BBHs.This work presents the feasibility and accuracy of the low-order approximate model and data fitting in the application of GW data processing.It is beneficial for further data processing and has certain research value for the preliminary application of GW data.

数据引流下异构传感器网络能量空洞防护算法

异构传感器网络在工作时,靠近传感器基站位置的节点会由于接收转发次数较多而出现能量空洞现象。为有效对此现象实施防护,保障网络安全运行,提出数据引流下异构传感器网络能量空洞防护算法。构建网络节点部署模型,对传感器网络节点实施节点优化部署;计算网络节点能耗对网络实施能量均衡控制,获取异构传感器网络节点的簇内传输跳数;结合获取的节点簇内跳数以及能量均衡结果开展节点接收数据的的引流分配,平衡传感器网络层内节点能量消耗,实现传感器网络的能量空洞防护。实验结果表明,使用上述方法开展传感器网络能量空洞防护时,数据转发接收能耗较低,防护方法性能高,防护效果好。

LCBDE术中一期缝合与T管引流的术后胆漏发生率比较

目的比较腹腔镜胆总管探查术中(LCBDE)行一期缝合和T管引流的术后胆漏发生率,并分析术后胆漏的危险因素。方法回顾性分析2015年1月至2022年11月于温州医科大学附属第一医院行LCBDE的患者资料,分为一期缝合组和T管引流组,采用Logistic多因素回归分别分析两组发生胆漏的危险因素。对两组中有肝内结石、上段胆总管结石、最大结石直径、体温最高值和中性粒细胞百分比5项指标进行倾向性评分匹配(PSM)后,比较两组胆漏发生率。结果共纳入患者1052例,其中143例患者发生术后胆漏,发生率为13.5%。Logistic多因素回归分析显示年龄>60岁为一期缝合组(n=506)胆漏的危险因素(OR=2.242,95%CI 1.300-4.038,P=0.005),主刀医师实施LCBDE少于10例为T管引流组(n=546)胆漏的危险因素(OR=3.525,95%CI 1.469-7.996,P=0.003)。经PSM成功匹配383对患者,一期缝合组胆漏发生率较T管引流组高[15.1%(58/383)vs 9.9%(38/383),P=0.029]。结论患者年龄>60岁是行LCBDE术中一期缝合后发生胆漏的独立危险因素,医师经验不足(主刀医师实施LCBDE少于10例)是行留置T管后发生胆漏的独立危险因素。相较于一期缝合,留置T管引流可以降低LCBDE术后胆漏的发生率。

粤港澳大湾区防风暴潮生态海堤核心技术研究及应用

在大湾区灵山岛北岸防风暴潮生态海堤工程的设计中,为解决城市防洪潮和滨海景观生态海堤亲水性的矛盾,在技术理念上由传统单一的防潮海堤向多元化滨海景观生态海堤转变,创新提出了多级消浪平台技术和滨海景观带迎水面系统排水技术来解决消浪与排水的问题,在实践中提出“横向换纵向”“外水外排,内水内排”的理念,打破传统海堤对海浪的“挡”和“抗”硬对硬模式,采用横向多级消浪平台技术消减越浪,并设置多级排水系统实现越浪自排,对迎水面海浪采用“通”和“排”的柔性衔接,可有效降低纵向堤顶高程以破解“堤防围城”的难题,实现海堤成为滨海生态景观的目的。研究成果已应用在该项目中,经过数次风暴潮检验证明达到了预期效果,灵山岛在韧性城市方面尤其是生态堤设计上,以宽度换高度,既能防洪同时又满足亲水、休闲、景观要求,为岭南地区的生态建设乃至中国滨海河口地区同类型建设提供了经验和参考。

黔北煤田矿井顶板水害特征及防治措施研究

黔北煤田近年来发生了22起工作面顶板涌水事故,对该地区矿井安全生产造成了很大威胁。为了研究黔北煤田矿井顶板水害特征及防治措施,以黔北煤田某片区为研究对象,分析了研究区域顶板水害的充水水源、水化学特征、突水通道、水害特征,并提出了相应的顶板水害防治措施。研究发现:长兴组含水层的水质类型为SO_(4)^(2−)、HCO_(3)^(−)-Na^(+),玉龙山段含水层的水质类型为HCO_(3)^(−)、SO_(4)^(2−)-Ca^(2+)和HCO_(3)^(−)、SO_(4)^(2−)-Na^(+)、Ca^(2+);区内各含水层的pH值以弱碱性为主,范围为7.63~8.18。开采9号煤层时,顶板水害的充水水源主要为长兴组灰岩含水层;顶板涌水特征主要表现为:涌水突发性强、水头值大、衰减速度快、涌水持续时间较短,涌水出现的位置绝大部分处于工作面下三分之一位置。针对黔北煤田顶板水害问题,提出了控制工作面开采速度,避免工作面长时间停采;加强顶板初次来压和周期来压期间水害防治,以及提前施工顶板水疏放孔等防治水措施。研究结果为黔北煤田顶板水害防治工作提供借鉴。

钢拱架铰接孔视觉定位方法研究

针对钢拱架自动化拼接过程中需要对钢拱架铰接孔进行定位的实际问题,设计了一种基于双目视觉的钢拱架铰接孔定位方法。首先通过模板匹配对钢拱架铰接孔进行初定位,找到感兴趣区域;采用一种新的自适应阈值算法计算阈值,对感兴趣区域进行二值化处理;利用边缘检测和最小二乘法提取得到铰接孔椭圆轮廓特征;然后找到椭圆轮廓上特殊的两条弦,根据空间几何关系,计算空间圆平面的法向量;利用消影线和椭圆参数矩阵,计算铰接孔圆心在图像上的实际投影点;最后基于双目视觉成像模型计算铰接孔圆心的精确空间坐标。实验证明,本方法可实现钢拱架铰接孔高精度定位,满足实际工业需求,为钢拱架自动化拼接提供技术支撑。

下向低浓钻孔“抽-注”排水排渣抽采一体化技术研究

为了防止永夏矿区陈四楼煤矿煤与瓦斯突出事故的发生,在采用水力排渣钻孔进行抽采瓦斯时,发现在钻孔内存在着大量的水和煤渣,堵塞了煤体内部的孔隙通道,对煤层瓦斯运移和钻孔孔壁的稳定性产生不利影响,从而严重影响了瓦斯抽采的效果。针对煤矿急需解决的俯孔排水排渣问题,提出采用压风吹孔技术,将孔内水和煤渣带出孔外,疏通钻孔堵塞通道。该技术在陈四楼煤矿井下现场应用效果良好,吹孔后钻孔平均在抽浓度由11.86%提升到了18.73%~56.38%,低浓钻孔提升效果明显;代替了以往水力排渣钻进技术,达到高效抽采瓦斯、保证煤矿安全生产的目的,对钻孔抽采瓦斯过程中能够及时排出水和煤渣有一定指导意义。在此基础上,形成的一套下向低浓钻孔“抽—注”排水排渣一体化技术及工艺,为下向低浓钻孔排水排渣工作提供参考借鉴。

高能液动锤超硬岩快速钻进成套装备与技术

当煤矿井下瓦斯抽放孔钻孔施工中遇到f≥12的岩层时,采用PDC钻头的回转切削效率极低。为解决煤矿井下硬岩钻进的技术难题,提出了煤矿井下高能液动锤的成套配置方案。采用该技术方案开展了井下钻孔试验。试验结果表明,在石英砂岩(10≤f≤12)中,机械钻速18.63~32.84 m/h;在硅质泥岩(12≤f≤17)中,平均机械钻速21.91 m/h。为煤矿井下硬岩钻进提供了一种新技术,可提高煤矿硬岩钻进效率。

中浅层煤层气井定量化排采制度

针对中浅层煤层气井排采制度与低渗透煤储层解吸-扩散-渗流特征不匹配的问题,以大宁-吉县区块为例,从煤层气低产井及低产原因入手,将煤层气井低产原因归纳为地质因素、工程因素及排采因素,排采因素又可进一步细化为初期排液速度慢、压降传播规律复杂和煤粉伤害3个方面。结合原因分析和工程实践,优化煤层气井排采制度,提出中浅层煤层气井“4321”排采管控方案:划分4大排采阶段、抓好3个关键控制点、实现2项参数平衡、形成1个排采标准模版。实践表明,采用“4321”排采管控方案,利用关键点、重要参数等定量化排采制度,缩小排采参数取值范围,可以有效提高煤层气井稳产能力,使气井稳产期产气量大于900 m^(3)/d。研究成果可为中浅层煤层气井排采制度的制定提供有效借鉴。

高位定向长钻孔水力输送对接筛管护孔技术研究

保障高位定向长钻孔在工作面回采过程中的稳定抽采是实现“以孔代巷”的前提,而采用筛管完孔是维持钻孔稳定的有效护孔措施。为了实现高位定向长钻孔全孔段筛管护孔的工程应用,开发了钻孔内水力输送分组筛管自主对接完孔工艺技术,配套研制了ø95 mm筛管悬挂装置、ø95 mm玻璃钢筛管、ø100 mm封堵短节、ø140 mm钻头通水堵头以及ø95 mm分组筛管对接装置,并在皖北矿区两个煤矿的不同工作面顶板高位钻孔进行了水力输送分组筛管完孔现场试验。试验结果表明:玻璃钢筛管质量轻推送阻力小,可在倾角17°~26°的钻孔内人工连接长100 mø95 mm玻璃钢分组筛管,分组筛管输送过程中水压为1.0~1.5 MPa,输送到位时水压降为0.5 MPa以下,在泵量200~390 L/min下,分组筛管水力平均输送速度可达150~260 m/min,试验期间分组筛管输送到位时泵压变化明显,前后两组筛管对接可靠,可有效实现到位报信,成功实现ø153 mm高位定向钻孔内ø95 mm筛管的全孔段护孔,2个钻孔的筛管水力输送试验深度分别达到501、522 m,工作面回采120 d累计抽采瓦斯纯量分别为139945、176139 m^(3)。钻孔内水力输送对接筛管护孔技术为高位定向长钻孔全孔段大直径筛管护孔提供了可实现的技术解决方案,有助于保障高位定向长钻孔的瓦斯抽采效果,为煤矿井下“以孔代巷”的瓦斯治理模式革新提供技术支撑。

钻孔冲洗引流术治疗老年慢性硬脑膜下血肿的效果分析

目的:探讨钻孔冲洗引流术治疗老年慢性硬脑膜下血肿患者的效果。方法:选择龙南市第一人民医院神经外科2019年4月—2022年4月收治的80例老年慢性硬脑膜下血肿患者,按照不同手术方式分组:采取锥孔引流术治疗为A组、钻孔冲洗引流术治疗为B组,各40例。对比疗效,包括临床总有效率、手术相关指标、炎症因子、复发率,同时采用美国国立卫生研究院卒中量表(NIHSS)评价患者神经功能缺损程度。结果:B组临床总有效率为95.00%较A组的75.00%高,差异有统计学意义(P<0.05)。B组手术时间较A组短,术中出血量少于A组,NIHSS评分、血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平均低于A组,差异均有统计学意义(P<0.05)。B组术后并发症发生率5.00%低于A组的20.00%,复发率2.50%低于A组的20.00%,差异有统计学意义(P<0.05)。结论:钻孔冲洗引流术近远期效果显著,且安全性高,利于减轻患者炎症反应、神经功能受损程度,降低复发率。

自研单向阀在大口径矿山排水钻孔工程中的应用

鉴于目前大口径钻井固管工艺容易造成固管不密实,管道壁后空洞等问题,在某矿山排水钻孔的施工过程中,通过研制的单向阀完成了排水管的安装和固管,解决固管不密实及固管后残留物较多的问题。本文主要介绍了单向阀的结构及作用,总结了一项利用单向阀完成大口径排水管的安装和固管工艺,可为今后类似工程施工提供经验和参考。

掘进工作面顶板富水区超前疏放治理技术

为解决吕梁山煤电有限公司3-3032综掘巷道顶板富水区对掘进安全及巷道支护的影响,保证安全掘进,采取物探手段明确低阻异常区域划分范围,利用定向钻机向异常区施工顶板疏放水钻孔,待孔口放水量稳定在5 m^(3)/h及以下时,对钻孔实施全段注浆封孔,充填导水裂隙,掘进期间通过注浆锚杆与螺纹钢锚杆对顶帮围岩补强加固,加固后的巷道顶板最大移近量为164 mm,未出现明显离层空顶现象。

颅骨锥孔穿刺引流术与钻孔穿刺引流术治疗中等量高血压脑出血患者的效果比较

目的:比较颅骨锥孔穿刺引流术与钻孔穿刺引流术治疗中等量高血压脑出血(HICH)患者的效果。方法:选取2020年1月至2023年1月该院收治的82例中等量HICH患者进行前瞻性研究,以随机数字表法将其分为研究组(n=41)和对照组(n=41)。研究组采用颅骨锥孔穿刺引流术,对照组采用颅骨钻孔穿刺引流术,比较两组血肿清除率、围术期指标水平,手术前后血清炎性因子[C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)]水平、神经功能缺损程度[美国国立卫生研究院卒中量表(NIHSS)]评分、日常生活能力(Barthel指数),以及术后1个月并发症发生率。结果:两组血肿清除率比较,差异无统计学意义(P>0.05);研究组手术时间、皮肤切口长度和住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后7、14 d,研究组血清CRP、PCT、TNF-α水平均低于对照组,差异有统计学意义(P<0.05);术后3个月,两组NIHSS评分均低于术前,Barthel指数均高于术前,差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:颅骨锥孔穿刺引流术治疗中等量HICH患者可降低围术期指标水平和血清炎性因子水平,效果优于钻孔穿刺引流术治疗。

瓦斯抽放孔“一孔两用”注水降尘技术研究

为了解决潞安集团郭庄煤业3308工作面粉尘浓度高的问题,基于煤层注水降尘技术,开展工作面瓦斯抽采孔进行动静压联合注水降尘实验研究。实验结果表明,煤层注水过程中,距离钻孔越近增水量越大,平均增水率为55.6%,煤层注水前后粉尘质量浓度最大降幅可达78%,“一孔两用”钻孔布置以及注水方式能够减少煤层注水二次打孔周期及投资,取得一定的经济效益。

煤层瓦斯抽采钻孔智能调控技术研究与应用

为了解决刘庄煤矿瓦斯抽采钻孔负压分配不合理、煤层瓦斯抽采浓度衰减速度快等问题,进一步提高煤层瓦斯抽采效果,以支持向量机回归机技术为基础,构建了煤层瓦斯抽采钻孔调控模型,提出了煤层瓦斯抽采钻孔调控判识及策略,研发了煤层瓦斯抽采钻孔智能调控系统,在刘庄煤矿151108工作面进行了现场工程应用。结果表明:煤层瓦斯抽采钻孔调控模型可以有效确定瓦斯钻孔最佳抽采负压;采用煤层瓦斯抽采钻孔智能调控技术的组孔调控时,煤层瓦斯抽采浓度提升15%以上,而采用单孔调控时,抽采浓度可提升30%以上,可以有效延长钻孔瓦斯有效抽采期,提升煤层瓦斯抽采能力。