Human umbilical cord mesenchymal stem cell-derived exosomes loaded into a composite conduit promote functional recovery after peripheral nerve injury in rats

Complete transverse injury of peripheral nerves is challenging to treat.Exosomes secreted by human umbilical cord mesenchymal stem cells are considered to play an important role in intercellular communication and regulate tissue regeneration.In previous studies,a collagen/hyaluronic acid sponge was shown to provide a suitable regeneration environment for Schwann cell proliferation and to promote axonal regeneration.This three-dimensional(3D)composite conduit contains a collagen/hyaluronic acid inner sponge enclosed in an electrospun hollow poly(lactic-co-glycolic acid)tube.However,whether there is a synergy between the 3D composite conduit and exosomes in the repair of peripheral nerve injury remains unknown.In this study,we tested a comprehensive strategy for repairing long-gap(10 mm)peripheral nerve injury that combined the 3D composite conduit with human umbilical cord mesenchymal stem cell-derived exosomes.Repair effectiveness was evaluated by sciatic functional index,sciatic nerve compound muscle action potential recording,recovery of muscle mass,measuring the cross-sectional area of the muscle fiber,Masson trichrome staining,and transmission electron microscopy of the regenerated nerve in rats.The results showed that transplantation of the 3D composite conduit loaded with human umbilical cord mesenchymal stem cell-derived exosomes promoted peripheral nerve regeneration and restoration of motor function,similar to autograft transplantation.More CD31-positive endothelial cells were observed in the regenerated nerve after transplantation of the loaded conduit than after transplantation of the conduit without exosomes,which may have contributed to the observed increase in axon regeneration and distal nerve reconnection.Therefore,the use of a 3D composite conduit loaded with human umbilical cord mesenchymal stem cell-derived exosomes represents a promising cell-free therapeutic option for the treatment of peripheral nerve injury.

A novel flexible nerve guidance conduit promotes nerve regeneration while providing excellent mechanical properties

Autografting is the gold standard for surgical repair of nerve defects>5 mm in length;however,autografting is associated with potential complications at the nerve donor site.As an alternative,nerve guidance conduits may be used.The ideal conduit should be flexible,resistant to kinks and lumen collapse,and provide physical cues to guide nerve regeneration.We designed a novel flexible conduit using electrospinning technology to create fibers on the innermost surface of the nerve guidance conduit and employed melt spinning to align them.Subsequently,we prepared disordered electrospun fibers outside the aligned fibers and helical melt-spun fibers on the outer wall of the electrospun fiber lumen.The presence of aligned fibers on the inner surface can promote the extension of nerve cells along the fibers.The helical melt-spun fibers on the outer surface can enhance resistance to kinking and compression and provide stability.Our novel conduit promoted nerve regeneration and functional recovery in a rat sciatic nerve defect model,suggesting that it has potential for clinical use in human nerve injuries.

Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimization of the macroscopic holes silk^(+) tNGC approach containing macroscopic holes might result in improved grafting technology suitable for future clinical use.

Electrodeposition of chitosan/graphene oxide conduit to enhance peripheral nerve regeneration

Currently available commercial nerve guidance conduits have been applied in the repair of peripheral nerve defects.However,a conduit exhibiting good biocompatibility remains to be developed.In this work,a series of chitosan/graphene oxide(GO)films with concentrations of GO varying from 0-1 wt%(collectively referred to as CHGF-n)were prepared by an electrodeposition technique.The effects of CHGF-n on proliferation and adhesion abilities of Schwann cells were evaluated.The results showed that Schwann cells exhibited elongated spindle shapes and upregulated expression of nerve regeneration-related factors such as Krox20(a key myelination factor),Zeb2(essential for Schwann cell differentiation,myelination,and nerve repair),and transforming growth factorβ(a cytokine with regenerative functions).In addition,a nerve guidance conduit with a GO content of 0.25%(CHGFC-0.25)was implanted to repair a 10-mm sciatic nerve defect in rats.The results indicated improvements in sciatic functional index,electrophysiology,and sciatic nerve and gastrocnemius muscle histology compared with the CHGFC-0 group,and similar outcomes to the autograft group.In conclusion,we provide a candidate method for the repair of peripheral nerve defects using free-standing chitosan/GO nerve conduits produced by electrodeposition.

A hyaluronic acid granular hydrogel nerve guidance conduit promotes regeneration and functional recovery of injured sciatic nerves in rats

A hyaluronic acid granular hydrogel can promote neuronal and astrocyte colony formation and axonal extension in vitro,suggesting that the hydrogel can simulate an extracellular matrix structure to promote neural regeneration.However,in vivo experiments have not been conducted.In this study,we transplanted a hyaluronic acid granular hydrogel nerve guidance conduit to repair a 10-mm long sciatic nerve gap.The Basso,Beattie,and Bresnahan locomotor rating scale,sciatic nerve compound muscle action potential recording,Fluoro-Gold retrograde tracing,growth related protein 43/S100 immunofluorescence staining,transmission electron microscopy,gastrocnemius muscle dry/wet weight ratio,and Masson’s trichrome staining results showed that the nerve guidance conduit exhibited similar regeneration of sciatic nerve axons and myelin sheath,and recovery of the electrophysiological function and motor function as autologous nerve transplantation.The conduit results were superior to those of a bulk hydrogel or silicone tube transplant.These findings suggest that tissue-engineered nerve conduits containing hyaluronic acid granular hydrogels effectively promote the morphological and functional recovery of the injured sciatic nerve.The nerve conduits have the potential as a material for repairing peripheral nerve defects.

Reduced graphene oxide-embedded nerve conduits loaded with bone marrow mesenchymal stem cell-derived extracellular vesicles promote peripheral nerve regeneration

We previously combined reduced graphene oxide(rGO)with gelatin-methacryloyl(GelMA)and polycaprolactone(PCL)to create an rGO-GelMA-PCL nerve conduit and found that the conductivity and biocompatibility were improved.However,the rGO-GelMA-PCL nerve conduits differed greatly from autologous nerve transplants in their ability to promote the regeneration of injured peripheral nerves and axonal sprouting.Extracellular vesicles derived from bone marrow mesenchymal stem cells(BMSCs)can be loaded into rGO-GelMA-PCL nerve conduits for repair of rat sciatic nerve injury because they can promote angiogenesis at the injured site.In this study,12 weeks after surgery,sciatic nerve function was measured by electrophysiology and sciatic nerve function index,and myelin sheath and axon regeneration were observed by electron microscopy,immunohistochemistry,and immunofluorescence.The regeneration of microvessel was observed by immunofluorescence.Our results showed that rGO-GelMA-PCL nerve conduits loaded with BMSC-derived extracellular vesicles were superior to rGO-GelMA-PCL conduits alone in their ability to increase the number of newly formed vessels and axonal sprouts at the injury site as well as the recovery of neurological function.These findings indicate that rGO-GelMA-PCL nerve conduits loaded with BMSC-derived extracellular vesicles can promote peripheral nerve regeneration and neurological function recovery,and provide a new direction for the curation of peripheral nerve defect in the clinic.

Chitosan conduits enriched with fibrin-collagen hydrogel with or without adipose-derived mesenchymal stem cells for the repair of 15-mm-long sciatic nerve defect

Hollow conduits of natural or synthetic origins have shown acceptable regeneration results in short nerve gap repair;however,results are still not comparable with the current gold standard technique“autografts”.Hollow conduits do not provide a successful regeneration outcome when it comes to critical nerve gap repair.Enriching the lumen of conduits with different extracellular materials and cells could provide a better biomimicry of the natural nerve regenerating environment and is expected to ameliorate the conduit performance.In this study,we evaluated nerve regeneration in vivo using hollow chitosan conduits or conduits enriched with fibrin-collagen hydrogels alone or with the further addition of adipose-derived mesenchymal stem cells in a 15 mm rat sciatic nerve transection model.Unexpected changes in the hydrogel consistency and structural stability in vivo led to a failure of nerve regeneration after 15 weeks.Nevertheless,the molecular assessment in the early regeneration phase(7,14,and 28 days)has shown an upregulation of useful regenerative genes in hydrogel enriched conduits compared with the hollow ones.Hydrogels composed of fibrin-collagen were able to upregulate the expression of soluble NRG1,a growth factor that plays an important role in Schwann cell transdifferentiation.The further enrichment with adipose-derived mesenchymal stem cells has led to the upregulation of other important genes such as ErbB2,VEGF-A,BDNF,c-Jun,and ATF3.

Contemporary outcomes of patients undergoing robotic-assisted radical cystectomy:A comparative analysis between intracorporeal ileal conduit and neobladder urinary diversions

Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.

Explosion Event of Cavitation in Intact Xylem Conduit

Cavitation in plant conduits only involves two processes of air bubbles: the gradual expansion and elongation, and the explosion event. An explosion event of cavitation, which can only occur in intact conduit at water tension, trigs acoustic (or ultrasound) emission and induces air to diffuse with high speed, simultaneously. Synchrotron X-ray phase contrast microscopy (XPCM) was used to capture cavitation event in intact conduits of leaves of corn and rice. Cavitation events occur in certain areas of leaves and have a certain time frame. Before XPCM experiment, several preliminary experiments were done as follows: 1) Paraffin sections of leaves of different species were observed to select samples and to determine the occurrence area of cavitation event of leaves. 2) The time frame of cavitation occurrence was determined by ultrasonic emission. 3) The water potentials of leaves were determined, to know the water state of the leaves during cavitation. Locked the area and time frame of cavitation event in the leaves, consecutive XPCM images of cavitation process were more easily acquired. The images show that the phenomenon of gas bubble fully filling conduits for an instant took place in intact conduits of detached leaves of corn and rice more easily. It is that the gas diffusing in a moment was caused by the explosion of the air seeds which had entered in the intact conduits of the leaves. For living plants, it is suggested that the explosion event of cavitation is the most important for embolism formation.

Hypoxic pre-conditioned adipose-derived stem/progenitor cells embedded in fibrin conduits promote peripheral nerve regeneration in a sciatic nerve graft model

Recent results emphasize the supportive effects of adipose-derived multipotent stem/progenitor cells(ADSPCs)in peripheral nerve recovery.Cultivation under hypoxia is considered to enhance the release of the regenerative potential of ADSPCs.This study aimed to examine whether peripheral nerve regeneration in a rat model of autologous sciatic nerve graft benefits from an additional custom-made fibrin conduit seeded with hypoxic pre-conditioned(2%oxygen for 72 hours)autologous ADSPCs(n=9).This treatment mode was compared with three others:fibrin conduit seeded with ADSPCs cultivated under normoxic conditions(n=9);non-cell-carrying conduit(n=9);and nerve autograft only(n=9).A 16-week follow-up included functional testing(sciatic functional index and static sciatic index)as well as postmortem muscle mass analyses and morphometric nerve evaluations(histology,g-ratio,axon density,and diameter).At 8 weeks,the hypoxic pre-conditioned group achieved significantly higher sciatic functional index/static sciatic index scores than the other three groups,indicating faster functional regeneration.Furthermore,histologic evaluation showed significantly increased axon outgrowth/branching,axon density,remyelination,and a reduced relative connective tissue area.Hypoxic pre-conditioned ADSPCs seeded in fibrin conduits are a promising adjunct to current nerve autografts.Further studies are needed to understand the underlying cellular mechanism and to investigate a potential application in clinical practice.

费曼式学习法在低年资护士儿童PICC维护培训中的应用

目的:探讨费曼式学习法在低年资护士儿童经外周静脉置入中心静脉导管(PICC)维护培训中的应用。方法:2022年3月—12月选取无锡市儿童医院80名低年资护士参与儿童PICC导管维护培训,采用随机数字表法将其分为观察组及对照组,每组40人。对照组行规范性培训,观察组应用费曼式学习法,比较两组护士规范化培训参与率、PICC置管知识及技能考核评分、护士自主学习能力及PICC知信行评分。结果:观察组护士第4次~第6次培训参与率明显高于对照组(P<0.05);观察组培训结束时PICC置管知识评分、技能考核评分、护士自主学习能力评分及PICC知信行评分高于对照组(P<0.05)。结论:费曼式学习法可提升低年资护士参与儿童PICC维护培训参与率,改善低年资护士自主学习能力及PICC维护知信行水平,有助于护士PICC维护知识及维护技能的提升。

岩浆通道成矿核心内涵“两深一浅一通道”及其找矿意义

岩浆通道成矿模型的建立深刻改变了岩浆铜镍硫化物矿床成因研究的范式,成为该领域的研究前沿,而且已经成功地应用于找矿勘查中。该模型揭示了硫化物熔离与聚集成矿在空间上的不一致性以及成矿与相关玄武岩铂族元素强烈亏损的成因联系,很好地解释了为什么很多含矿岩体围岩贫硫化物的现象。笔者将该模型的核心内涵概括为“两深一浅一通道”,“两深”指成矿物质来源于地幔、硫化物熔离发生在深部,“一浅”指硫化物的聚集成矿主要发生在较浅的岩浆房,“一通道”指较稳定的岩浆通道更有利于成大矿。结合对典型矿床和成矿带的分析,笔者提出侵位较浅的、规模相对较大的岩体,其成矿潜力好于深部的岩浆通道相。因此,认为地表矿化并不是唯一可靠的、甚至不能作为最重要的找矿标志,要提高找矿效率(特别是隐伏矿床),首先要全面分析成矿带岩浆通道系统在不同区域的埋藏、剥蚀和暴露状况,目标岩体地质产状及其与围岩时代差异等宏观地质要素,查明深部通道相与浅部岩体空间分布和形成深度的差异,在此基础上,判断浅部岩体的位置、合理部署重点勘查区域、选择有效的勘查技术、定位目标岩体,进行钻探验证。

松辽盆地深层中-基性火山岩有利相带及储层“甜点”逐级识别

松辽盆地深层下白垩统火石岭组中-基性火山岩广泛发育,岩性-岩相复杂,储层横向非均质性强,储层“甜点”识别难,制约了油气勘探和开发。以查干花地区为例,研究了松辽盆地深层中-基性火山岩岩相及储层特征,提出了火山通道、有利岩相、有利岩性及储层甜点识别方法。研究表明:①火山岩岩相主要为3相6亚相,优质储层岩性主要为粗粒、细粒凝灰岩和凝灰质砂岩,在近-中源相带中火山爆发相储层最为发育,相带控制了有利岩性凝灰岩的分布区域,物性和含气性是火山岩“甜点”的主要控制因素。②通过分析每个喷发期次的裂缝密度,结合蚂蚁体与地震数据的叠合剖面,识别出了不同喷发期次的火山通道,以判断火山近源相带,再结合火山机构厚度和能量半衰时属性划分中源与远源相带的边界,实现储层“甜点”发育区的定性刻画。③为降低地震反演定量预测中-基性火山岩储层的多解性,优选出低波阻抗表征沉凝灰岩,低密度表征高核磁孔隙度储层,低拉梅常数表征气层,基于此,在叠前反演密度预测孔隙度数据体的基础上,逐级剔除干扰沉凝灰岩、低孔隙度层及非气层,得到较为可靠的火山岩储层“甜点”空间分布预测结果。经验证,预测结果符合有利相带分布规律,且与已钻井气层解释结论吻合。应用有利相带定性认识及逐级定量刻画“甜点”空间分布,部署井取得较好效果,该方法可在深层火山岩“甜点”分布地震预测中广泛推广。

基于冲刷指数的雨水管渠冲刷淤积分析

流速、雷诺数、充满度等单因素指标虽然与雨水管渠的冲刷和淤积量有一定的关联,但是通过单因素指标不足以全面地判断雨水管道的冲刷和淤积。在起动流速和止动流速的基础上,提出了冲刷指数的概念。结合连续非恒定流不同工况下冲刷和淤积量模拟,计算了流速、雷诺数、充满度、冲刷指数4个因素与冲刷量的灰色关联度,其关联度大小依次为:冲刷指数>雷诺数>充满度>流速。根据不同工况的恒定流模型实验的结果,其关联度大小依次为:冲刷指数>>流速>雷诺数>充满度。可以认为,在恒定流与非恒定流工况下,冲刷量和冲刷指数有显著的强相关性,冲刷指数能代替具体的冲刷量计算实现对冲刷程度和趋势的合理判断。

小型泵站进水池改造为肘形进水流道水力性能研究

为了解决淮安市徐溜电灌站水泵进水流态差导致机组振动和水泵装置运行效率低下等问题,基于该电灌站的设计参数,采用三维湍流流动数值模拟方法对进水池及其改造为肘形进水流道的水力性能进行了研究,对两种进水型式时的泵装置能量性能进行预测计算,并对改造前后的流道及泵装置的流态和性能进行比较分析。研究结果表明:该站进水池具备改造为肘形进水流道的条件;原进水池方案的流道水头损失大、池内流态紊乱,改造后的肘形进水流道水头损失显著减小、流场平顺无旋涡,水力性能大幅度提升;改造后的泵装置水力性能较改造前明显提升,设计流量下泵装置效率提升5%以上。改造后现场水泵机组整体运行稳定,表明将开敞式进水池改造为肘形进水流道是成功的,可为同类型的小型泵站的建设和改造提供参考。

完全腹腔镜膀胱根治性切除回肠膀胱术治疗膀胱癌25例疗效观察

目的探讨完全腹腔镜膀胱根治性切除回肠膀胱术的临床效果和手术技巧,以期为膀胱癌患者手术方式的选择提供参考。方法回顾性分析首都医科大学附属北京朝阳医院泌尿外科2017年3月—2022年8月收治的48例行腹腔镜膀胱根治性切除回肠膀胱术治疗膀胱癌患者的临床资料。按照手术方式分为传统腹腔镜组(腹腔镜膀胱根治性切除+脐下正中切口回肠膀胱术)患者23例,完全腹腔镜组25例。比较两组患者的手术时间、估计出血量、术后肠道功能恢复时间、引流管拔除时间及住院时间。结果48例患者手术均顺利完成,所有患者均未发生Clavien-Dindo>3级并发症。传统腹腔镜组与完全腹腔镜组的手术时间分别为(227.0±46.4)min与(253.6±58.9)min,出血量分别为(131.7±79.8)mL与(154.0±93.0)mL,两组术后肠道功能恢复时间、引流管拔除时间比较差异无统计学意义(P>0.05),而完全腹腔镜组的术后住院时间较传统腹腔镜组更短,差异有统计学意义(P=0.035)。结论完全腹腔镜膀胱根治性切除回肠膀胱术安全可行,与传统腹腔镜手术方式效果相当,而完全腹腔镜组术后住院时间更短,有利于术后快速康复。

岩溶管道构造影响下浅部地层温度数值模拟研究

当含水岩溶构造体存在时,浅部地层温度场会产生变化。浅层测温法可以简单快速地获得浅层地温数据,通过温度差异反演出岩溶构造的分布。为了研究以贵州省盘州市某场地及其周围场地为对象时,浅层测温技术探测岩溶管道构造体的可行性,笔者采用数值模拟方法。结果表明:构造体不同的埋深会显著改变浅部地层的温度,对于单个岩溶构造体(等效直径为0.5 m,水温12℃),可探测深度极限约为66 m;在管道内流体的温度为12℃时,岩溶管道构造体有效流动截面积的增大会降低浅部地层温度,等效直径在0.1~1.0 m区间内改变时,2.0 m处地层温度的变化在0.02℃以内,这使得利用浅层测温法识别岩溶构造体的有效流动截面积变得困难;流体温度在一定范围内(12~18℃)的变化会改变浅部地层温度,尤其是低温流体的影响更为明显。

耐高压PICC在肿瘤患者腹部CT增强中的应用研究

目的分析耐高压经外周静脉置入中心静脉导管(PICC)在肿瘤患者腹部CT增强中的应用情况。方法随机选取我院2021年1月至2023年6月期间实施腹部CT增强扫描的肿瘤患者300例,按随机数字表法分为例数相同的3组,其中对照组100例实施常规静脉留置针予以对比剂团注;观察1组(n=100)、观察2组(n=100)均用耐高压PICC导管予以对比剂团注,根据对比剂说明书参照剂量以及患者实际特点、医院常规使用情况,将对比剂用量分别设置为1.3、1.1 mL/kg;对比三组CT增强扫描并发症、图像质量等。结果总的增强扫描不良事件发生率方面,观察1组、2组明显低于对照组(P<0.05),而1、2组相比差异无统计学意义(P>0.05)。观察1组、2组从进入检查室至CT扫描的时间、CT扫描结束至按压无出血的时间、整体耗时均短于对照组,图像质量、噪声及锐利度评分均高于对照组(P<0.05),而观察1、2组相比差异无统计学意义(P>0.05)。三组患者CT增强扫描结束后未出现导管高压注射损坏及导管堵塞的情况。观察2组的对比剂用量低于观察1组、对照组(P<0.05)。结论肿瘤患者应用耐高压PICC导管并联合低对比剂注射用量行腹部CT增强,优化了CT增强的检查流程,提高了患者的检查舒适度,减少不良事件的发生,值得临床推广。

同种异体带瓣管道的研究进展

根治复杂性心瓣膜病需采用心外管道,目前心外管道有人工材料、同种异体带瓣管道(VHC)及异种带瓣管道。VHC具有符合人体的抗钙化、抗感染和无需终生抗凝等生理特点,然而VHC仍存在供体短缺和无法长期保存等问题,导致其无法被大力推广,但深低温保存技术有望解决长期保存这一问题。笔者综述了VHC供体的筛选、保存方法及其临床应用的研究进展,为VHC在临床上对左、右心室流出道的重建提供参考。

隧道洞口浅埋偏压段超前支护方案数值模拟

由于山岭隧道洞口段多处于浅埋偏压地形,为保证施工进洞安全,常常需要采取超前支护以控制洞口段围岩变形,保证围岩稳定。以彝良隧道洞口段为工程背景,采用FLAC 3D有限差分软件,分别建立无超前支护、管棚超前支护、超前小导管超前支护和管棚+超前小导管联合超前支护方案进行比选分析。计算结果表明:超前支护可大幅度降低围岩竖向位移、水平位移、竖向应力以及抑制拱顶塑性区发育;从支护效果上看,管棚支护效果最佳,管棚+超前小导管联合支护次之,超前小导管最差;从管棚长度自身以及施工经济合理性考虑,在控制围岩变形效果相当的条件下,采用管棚+超前小导管联合支护较佳。研究可为类似浅埋偏压隧道洞口段超前支护方式的选择提供借鉴。