Design Method and Performance for Large Stone Porous Asphalt Mixtures

Design method for large stone porous asphalt mixtures （LSPM） was analyzed to avoid the early distresses of semi-rigid asphalt pavements. Based on stone-to-stone skeleton structure concept, processes of LSPM gradation design was given. The gradation composite design for LSPM shows that the LSPM nominal maximum size （ N MS） should be larger than 26.5 mm, and the NMS sieve passing percentage should be greater than 50%. Through experiments and calculations on the volume properties of the aggregate, the range of aggregate gradation curve of LSPM was given. In terms of asphalt binder＇s normalized test results, MAC-70 and SBS modified asphalt were selected as the asphalt binders. The applicability of large scale Marshall Method and gyratory compaction method to shape specimens was investigated. Based on the asphalt mixture performance evaluation, the optimum asphalt content range （3.1%-3.6%）, the bitumen film＇s thickness range （13-16 μm） and the air void range （13%-18 %） were recommended. Finally, LSPM was tested by the laboratory performance tests including rutting resistance test, fatigue test and water stability test. The theoretic and practical analysis shows that LSPM has a good performance on water permeability, rutting resistance and reflection crack resistance.

Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

Use of a modified ureteral access sheath in semi-rigid ureteroscopy to treat large upper ureteral stones is associated with high stone free rates

Objective:To examine differences in outcomes of semi-rigid ureteroscopy(URS)with or without a modified-ureteral-access-sheath(mUAS)to treat large upper ureteral stones.Methods:Patients with single,radio-opaque large upper ureteral stone(≥10 mm)treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated.The stone-free status was determined from Kidney-ureter-bladder(KUB)X-ray films taken on postoperative Day 1 and after 1 month.Results:Of 103 patients meeting inclusion criteria,43(41.75%)and 60(58.25%)were treated with semi-rigid URS with and without mUAS,respectively.The immediate stone-free rate(SFR)for the mUAS group was significantly higher than the non-mUAS group(40[93.0%]vs.46[76.7%];p=0.033).The SFR at 1 month was also high for patients treated using mUAS,but not statistically different from patients not treated with mUAS(41[95.3%]mUAS vs.51[85.0%]non-mUAS;p=0.115).Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients(2[4.7%]vs.14[23.3%];p=0.01).There were no significant differences in surgical duration and hospital stays,and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients(1[2.3%]vs.3[5.0%];p=0.638).

Endoscopic papillary large balloon dilation for removal of bile duct stones

AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study.

Should we redefi ne large common bile duct stone?

The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.

Numerical analysis of reflective cracking and fatigue lives of semi-rigid pavement structures using ABAQUS and FE-SAFE

In order to compare the impact of thickness of different layers on fatigue lives of different semi-rigid asphalt pavement structures, the mechanical results from finite element models in ABAQUS are incorporated with the fatigue results from fatigue models in FE-SAFE to calculate the mechanical response and fatigue lives of semi-rigid pavement structures under heavy traffic loads. Then the influences on fatigue lives caused by the changes in the thickness of layers in pavement structures are also evaluated. The numerical simulation results show that the aggregated base and the large stone porous mixture （LSPM） base have better anti-cracking performance than the conventional semi-rigid base. The appropriate thickness range for the aggregated layer in the aggregated base is 15 to 18 cm. The thickness of the LSPM layer in the LSPM base is recommended to be less than 15 cm.