"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.

Half-integer Shapiro steps in MgB_(2) focused He ion beam Josephson junctions

Half-integer microwave induced steps(Shapiro steps)have been observed in many different Josephson junction systems,which have attracted a lot of attention because they signify the deviation of current phase relation(CPR)and uncover many unconventional physical properties.In this article,we first report the discovery of half-integer Shapiro steps in MgB_(2)focused He ion beam(He-FIB)Josephson junctions.The half-integer steps'dependence on microwave frequency,temperature,microwave power,and magnetic field is also analyzed.We find that the existence of half-integer steps can be controlled by the magnetic field periodically,which is similar to that of high temperature superconductor(HTS)grain boundary junctions,and the similarity of the microstructures between gain boundary junctions and He-FIB junctions is discussed.As a consequence,we mainly attribute the physical origin of half-integer steps in MgB_(2)He-FIB junctions to the model that a He-FIB junction is analogous to a parallel junctions'array.Our results show that He-FIB technology is a promising platform for researching CPR in junctions made of different superconductors.

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。

A novel dynamic step size LMS optimization scheme for interference reducing in FBMC-QAM

Filter bank multicarrier quadrature amplitude modulation(FBMC-QAM)will encounter inter-ference and noise during the process of channel transmission.In order to suppress the interference in the communication system,channel equalization is carried out at the receiver.Given that the con-ventional least mean square(LMS)equilibrium algorithm usually suffer from drawbacks such as the inability to converge quickly in large step sizes and poor stability in small step sizes when searching for optimal weights,in this paper,a design scheme for adaptive equalization with dynamic step size LMS optimization is proposed,which can further improve the convergence and error stability of the algorithm by calling the Sigmoid function and introducing three new parameters to control the range of step size values,adjust the steepness of step size,and reduce steady-state errors in small step sta-ges.Theoretical analysis and simulation results demonstrate that compared with the conventional LMS algorithm and the neural network-based residual deep neural network(Res-DNN)algorithm,the adopted dynamic step size LMS optimization scheme can not only obtain faster convergence speed,but also get smaller error values in the signal recovery process,thereby achieving better bit error rate(BER)performance.

TWO-STEP TRICK TO HACK INTO CELLS

In the microscopic world of viruses and human cells,a high-stakes game of lock-picking is constantly unfolding.In a recent study published in Cell on July 3,researchers from Fudan University,ShanghaiTech University,and the Institute of Biophysics(IBP)under the Chinese Academy of Sciences cracked the code on how one particular coronavirus,HCoV-HKU1,manages to sneak its way into our cells using a cunning two-step approach(doi:10.1016/j.cell.2024.06.016).

基于STEP模式下的计算机专业课堂实践教学效果提升策略

本研究的目的在于探讨基于STEP模式的计算机专业课堂实践教学效果提升策略。本研究采用了文献研究和理论分析的方法,探讨了STEP模式在计算机专业课堂中的优势,并提出了提升教学效果的策略。研究结果表明,STEP模式在计算机专业课堂实践教学中有利于跨学科整合、解决实际问题、促进团队协作。为了提高教学效果,本研究提出了多元化教学手段、师资队伍培训、及时更新理论教材等策略。本研究的结论是,采用STEP模式并实施相应策略可以有效提升计算机专业课堂实践教学的效果,帮助学生更好地适应现实问题解决和职业需求。

STEP教育模式下的环境设计课程探讨——以荆楚文化主题商业空间设计课程为例

随着社会对创新型人才需求的增加,STEP(Software, Theory, Experiment, Project)教育模式凭借其融合软件技能、理论知识、实验操作与项目管理的教学理念,为环境设计专业提供了新的教学策略。以荆楚文化主题的商业空间设计课程为例,概述了STEP教育模式的内涵,分析了环境设计专业课程实行STEP教学模式的必要性,探讨了基于STEP教学模式的商业空间设计课程实施路径。旨在提升学生的设计实践能力、强化文化理解力,有力支持环境设计专业的人才培养,促进地方文化与设计教育的有机结合。

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。

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.

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。