Vascularized lymph node transfer using axilla as recipient site restores lymphatic flow in upper limb lymphedema:Evidence from magnetic resonance lymphangiography

Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.

Donor defects after lymph vessel transplantation and free vascularized lymph node transfer:A comparison and evaluation of complications

BACKGROUND Secondary lymphedema after surgical interventions is a progressive,chronic disease that is still not completely curable.Over the past years,a multitude of surgical therapy options have been described.AIM To summarize the single-center complications in lymph vessel(LVTx)and free vascularized lymph node transfer(VLNT).METHODS In total,the patient collective consisted of 87 patients who were undergoing treatment for secondary leg lymphedema during the study period from March 2010 to April 2020.The data collection was performed preoperatively during consultations,as well as three weeks,six months and twelve months after surgical treatment.In the event of complications,more detailed follow-up checks were carried out.In total n=18 robot-assisted omental lymph node transplantations,n=33 supraclavicular lymph node transplantations and n=36 Lymph vessel transplantations were analyzed.An exemplary drawing is shown in Figure 1.A graphical representation of patient selection is shown in Figure 2.Robotic harvest was performed with the Da Vinci Xi Robot Systems(Intuitive Surgical,CA,United States).RESULTS In total,11 male and 76 female patients were operated on.The mean age of the patients at study entry was:omental VLNT:57.45±8.02 years;supraclavicular VLNT:49.76±4.16 years and LVTx:49.75±4.95 years.The average observation time postoperative was:omental VLNT:18±3.48 mo;supraclavicular VLNT:14.15±4.9 and LVTx:14.84±4.46 mo.In our omental VLNT,three patients showed a slight abdominal sensation of tension within the first 12 postoperative days.No other donor side morbidities occurred.No intraoperative conversion to open technique was needed.Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention.In our LVTx collective,12 cases of donor side morbidity were registered.In one case,surgical intervention was necessary.CONCLUSION Concerning donor side morbidity,robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.

Combination of lymphovenous anastomosis and lymph node transfer for breast cancer-related lymphedema

With the remarkable advancement of microsurgery,surgical treatment for lymphedema has been increasing,and its good results are well established.However,surgical treatment for advanced-stage lymphedema is still a challenging task.We reviewed several methods of combining lymphovenous anastomosis(LVA)and vascularized lymph node transfer(VLNT)in breast cancer-related lymphedema(BCRL)patients.Representative VLNT flap options for BCRL patients include the omental flap,superficial circumflex iliac perforator(SCIP)flap,and deep inferior epigastric artery(DIEA)flap combined with inguinal lymph nodes performed simultaneously with breast reconstruction.The surgical outcome,technical details,and donor site morbidities of each surgical option were reviewed.While all three options show significant surgical benefits,each has its clear advantages and disadvantages.The decision on the surgical method may vary according to the needs of each patient and the clinical situation.

Lower extremity lymphedema and vascularized lymph node transfer recipient sites:a review of the current literature

Vascularized lymph node transfer is a surgical treatment for lower extremity lymphedema aimed at restoring physiological lymphatic flow.Much variation exists in determining the appropriate donor site from which to harvest lymph nodes as well as the optimal recipient site to anastomose the new lymph nodes.This article reviews the underlying principles of free vascularized lymph node transfer and discusses patient-specific,disease-specific and surgery-specific factors in considering recipient sites from the proximal,middle,and distal lower extremity.The clinical outcomes of published studies in lymphatic surgery for lower extremity lymphedema are presented.An omental flap to the middle lower extremity(mid-thigh,popliteal fossa,or medial calf)is then recommended due to the abundance of lymphatic tissue,proximity to pooled lymph fluid,and avoidance of added bulk or poor cosmesis of the distal lower extremity.However,additional clinical outcomes studies are needed and represent an area of further investigation.

Vascularized lymph node transfer for the treatment of lymphedema:a systematic review and metaanalysis of clinical and patient-reported outcomes

Aim:The aim of this systematic review was to summarize clinical and patient-reported outcomes(PROs)for various vascularized lymph node transfer(VLNT)donor sites and identify gaps in the literature to guide future research.Methods:A literature search of five databases was performed for articles related to VLNT that were published prior to November 2021.Studies that included clinical outcomes or PROs from at least five adult patients who received VLNTs to treat lymphedema were included.Results:Sixty-six studies met the study criteria.Most studies reported improved limb circumference/volume,reduction or discontinuation of conservative therapy,infection rate reduction,improved PROs,or postoperative imaging findings reflecting functional lymph nodes.There were significantly lower infection rates(P<0.05)and a trend towards improved PROs in patients who received intra-abdominal flaps,but overall few studies reported these outcomes.There were no significant differences in complication rates at the donor or recipient site based on VLNT donor sites,or between intra-abdominal vs.extra-abdominal VLNT donor sites,although these outcomes are not uniformly reported.Conclusion:This meta-analysis identified that intra-abdominal donor sites have the potential to reduce postoperative infectious episodes more than extra-abdominal donor sites.Though recent investigations address many understudied VLNT donor sites,larger comparative studies and a standardized methodology are needed to better characterize postoperative outcomes,which can offer more concrete evidence to guide surgical practice.

Surgical debulking, lymphatico venous anastomosis, vascularised lymph node transfer in lower limb lymphoedema

Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.

基于核密度估计模型优化手术调度的设计与应用

目的针对现有手术患者转运平台转运流程中,手术状态节点变动存在人工操作依赖性和滞后性、手术衔接不高效的问题,改进手术患者转运平台的手术流转流程。方法结合集成蓝牙低能耗技术的智能手环、人员定位系统,运用核密度估计模型估算手术平均时长,从而改进手术患者转运平台的手术流转流程,并对模型的有效性进行验证。结果应用改进的手术转运平台后,首台延迟率、手术衔接时间较改进前下降6.2%、8.0 min,日均麻醉利用率和日间手术利用率较应用前提高了6.9%、6.4%,且差异均有统计学意义(P<0.01)。结论通过应用改进后的手术患者转运平台,手术室手术衔接效率更高,手术调度更加智能化,可有效提高手术室效率。

地铁既有站换乘改造通信系统升级方案研究

地铁已形成网络化运营模式,换乘节点越来越多。因为规划等原因,建设较早的地铁线路没有预留后期换乘接入条件。因此,在新线建设过程中,往往伴随着新建站带来的既有车站换乘改造和升级。其中,通信传输系统的改移和升级建设是重点工作之一。通信系统是城市轨道的交通神经,包括公安通信系统,民用通信系统和专用通信系统等,支持控制中心与车站、车辆的信息往来,并为乘客提供稳定的通信服务。针对在既有线运行条件下,换乘站改造带来的通信设备改移以及通信扩容需求等问题进行方案探讨,提出公安传输系统增强型MSTP建设方案和骨干传输系统OTN建设方案。以北京地铁10号线西土城站为例进行方案设计,10号线西土城站与新建地铁昌平线南延(简称昌南线)相交,换乘站建筑结构及功能的改变,对通信系统的设备升级、机房部署等都提出了新的要求,本文将设计方案应用于该换乘项目,验证了所提方案的合理性,研究成果以期为其他既有站换乘改造的通信系统升级提供参考。

DCE-MRI、CT、乳腺钼靶对乳腺癌患者腋窝淋巴结转移的诊断价值

目的探讨动态增强磁共振成像(DCE-MRI)、CT、乳腺钼靶(MG)对乳腺癌患者腋窝淋巴结转移的诊断价值。方法选取2021年1月至2022年12月在河南省肿瘤医院和平顶山市妇幼保健院诊治的148例乳腺癌患者,均接受DCE-MRI、CT、MG检查,比较3种检查方法及其联合对乳腺癌患者腋窝淋巴结转移的诊断价值。结果经病理诊断,148例乳腺癌患者腋窝淋巴结转移71例。在DCE-MRI检查中,真阳性、假阳性、假阴性和真阴性分别为70、17、1、60例,CT检查中为62、19、9、58例,MG检查中为41、8、30、69例,联合检查中为70、3、1、74例。受试者工作特征(ROC)曲线显示,DCE-MRI、CT、MG、联合诊断乳腺癌患者腋窝淋巴结转移的曲线下面积(AUC)分别为0.883、0.56、0.737、0.973。联合诊断的敏感度高于CT、MG(P<0.05),特异度高于DCE-MRI、CT(P<0.05),准确性高于DCE-MRI、CT、MG(P<0.05);DCE-MRI的敏感度高于CT、MG,特异度低于MG,准确性高于MG(P<0.05);CT的敏感度高于MG,特异度低于MG(P<0.05)。结论DCE-MRI、CT诊断乳腺癌患者腋窝淋巴结转移具有较高的敏感度,MG具有较高的特异度,DCE-MRI、CT、MG三者联合可提高对乳腺癌患者腋窝淋巴结的诊断价值。

物联网内节点信任传递能耗智能感知仿真

物联网由大量分布在不同位置的节点组成,通过能耗感知,可以优化信任传递路径的选择和节点之间的通信方式,从而提高整个物联网网络的性能和效率。因此,提出一种物联网节点信任传递能耗智能感知方法。通过对物联网体系架构展开分析,提取物联网节点信任传递能耗评估指标,建立对应的指标体系。利用T-S模糊神经网络获取各个指标对应的节点信任传递能耗智能感知结果,通过层次分析法将全部感知结果展开融合处理,最终实现物联网节点信任传递能耗智能感知。通过实验分析表明,所提方法可以精准感知物联网节点信任传递能耗变化情况且感知效率高,耗时短,可以为物联网节点信任传递能耗智能感知的进一步研究和应用提供重要的参考依据。

术前趋化因子水平与宫颈癌患者术后复发转移的关系

目的 探究术前趋化因子水平与宫颈癌患者术后复发转移的关系。方法 选择行根治性子宫切除术+盆腔淋巴结清扫术的宫颈癌患者作为研究对象。术前、术后检测患者趋化因子[趋化因子受体4(CXCR4)、趋化因子受体7(CCR7)、CXC亚家族趋化因子13(CXCL13)、CXC亚家族趋化因子16(CXCL16)],随访1年,将发生复发转移的患者纳入发生组,将未发生复发转移的患者纳入未发生组。结果 共纳入102例宫颈癌患者,随访1年发现,术后出现复发转移有25例,占24.51%。术前及术后,发生组CXCR4与CCR7高表达占比高于未发生组,CXCL13与CXCL16水平高于未发生组,差异有统计学意义(P<0.05)。经卡方检验Phi系数分析,CXCR4和CCR7与宫颈癌患者术后复发转移呈正相关关系(P均<0.05);经点二列相关性分析,CXCL13和CXCL16与宫颈癌患者术后复发转移呈正相关关系(P均<0.05)。绘制ROC曲线显示,术前CXCR4、CCR7、CXCL13、CXCL16预测宫颈癌患者术后复发转移的AUC为0.712、0.711、0.797、0.764,联合预测的AUC为0.873,联合预测价值更高。结论 宫颈癌患者术前CXCR4与CCR7呈高表达、CXCL13与CXCL16水平高,术后复发转移的风险越大,术前检测患者趋化因子表达可作为预测宫颈癌患者术后复发转移的参考指标。

破除车站换乘节点预留墙体结构的变形及内力分析

随着轨道交通的发展,线网密度将会越来越大,导致换乘车站越来越多。新建换乘车站与既有车站衔接成为一个重要的设计内容,施工破除既有运营车站墙体成为一个重要关键的技术,一方面要保证既有线路运营安全,另一方面要保证既有地铁结构的受力在正常范围之内。以新建某地换乘车站为例,运用ANSYS有限元分析软件模拟凿除换乘节点侧墙的施工,求得既有结构的变形和内力变化,从设计和施工方面提出相应的技术措施。

复杂条件下矿石破碎厂房结构设计

三山岛矿石破碎厂房因建筑生产工艺的要求,在厂房主楼层下布置了近800t的混凝土矿石仓。由于矿仓壁无落地条件,采用了部分框支剪力墙结构体系。该建筑地处临海地区,风荷载大;且工程地质条件差,地处中、强腐蚀环境,抗震不利地段。对厂房结构采用SAP2000进行有限元分析,发现厂房框支转换构件(剪力墙与转换梁)近似表现为“压杆-拉杆”桁架的受力机制,比国内常用的转换梁受拉剪作用效应更突出;通过对框支柱、转换梁、钢筋混凝土楼板内力计算分析后,采取了柱承式矿仓构造措施,将框支柱兼作扶壁柱,并竖向加腋延伸至矿仓顶,加强转换梁,增加矿仓壁和楼盖的厚度,以满足结构的承载力和延性要求,确保整体结构达到4级抗震性能要求。为提高该厂房混凝土结构的耐腐蚀性能,采用了混凝土添加抗硫酸盐外加剂和外涂环氧沥青等措施。

郑州地铁3号线二期建筑方案研究与设计实践

从郑州地铁3号线二期四座车站建筑设计方案展开论述,对方案变化过程、设计重难点等进行了分析,并就建设过程中发生的主要问题及解决方案进行了归纳总结,提出可供后续其他地铁线路建设推广的主要经验与建议。

仿真系统中阻塞状态的电价预测

仿真系统是中电联组织技能竞赛中使用的实操系统,描述了在仿真系统中,现货电价的形成方式、无阻塞和发生阻塞时不同情形下预测电价的方法。在实际电力市场中,由于输电容量的限制,很容易发生输电阻塞的情况。做好阻塞管理,提前预判和锁定阻塞费用,既能缓解阻塞提升电力系统的稳定性,又能预先决策减少经济损失,必将在将来的输电权市场中占得先机。

基于广义节点及熵理论的电网脆弱节点电压辨识方法

在电力系统中为了避免发生一系列的连锁故障,需要给出评估电网中最具关键性的脆弱节点的相应指标和模型,考虑到传统直流输电系统对交流电网换相电压敏感性,提出一种基于广义节点及熵理论的电网脆弱节点电压辨识方法,该方法结合熵的一般性原则,将电网受到冲击时广义节点的奇异值熵、潮流分布和转移熵三者统一起来共同作为电网脆弱节点的辨识依据,并采用熵权值法修正AHP方法的手段获得综合权重系数,充分考虑了各指标的主客观影响因子,采用层次分析法和熵权值法获得脆弱节点综合评估模型的权重系数。最后通过IEEE 39节点系统仿真结果验证了该方法对于电网整体性脆弱节点辨识的有效性和实际运用价值,证实了该方法可以有效衡量交流电网电压突变量对直流输电系统影响。

无线传感器网络中无线充电关键技术研究

无线传感器网络具有低功耗、低成本、高可靠性等特性,近年来被广泛应用于智慧交通、绿色节能以及环境监测等领域。传感器节点通常采用电池供电,其充电技术逐渐成为无线传感器网络领域的一个重要研究问题。为提高无线传感器网络中的节点充电效率,引入无线能量传输技术,开展传感器节点无线充电方法的设计研究。首先,根据节点的能量消耗来源,建立各节点能量消耗模型;其次,基于传感器节点的电量消耗模型,设计移动充电车的充电方案;最后,针对复杂网络环境,设计多台充电车分工合作充电机制。实验结果表明,文章所提出的充电技术有效提高了无线传感器网络的充电效率和网络监控质量,为延长传感器节点生命周期提供了新的思路和方法,具有较好的理论和应用价值。

预制装配墩柱-桩基础承插节点冲切性能研究

承插连接由于具有整体性能好、施工工序简单和拼装容许误差大等优点,成为预制装配桥墩节点的有效连接方式之一。为探明桩基础承插节点的冲切失效模式及承载力计算方法,采用ABAQUS有限元软件建立预制装配墩柱-桩基础承插节点数值计算模型,通过UHPC-NC直剪试验和墩柱-桩基础轴压试验进行了数值模型校验,研究了底板、接缝和承插连接参数对预制装配墩柱-桩基础承插节点的冲切传力机制、承载能力和失效模式的影响规律,提出了预制装配墩柱-桩基础承插节点冲切承载力计算公式。数值模拟结果表明,预制装配墩柱-桩基础承插节点的传力路径沿墩柱底部到桩的顶部;峰值荷载过后,承台底部混凝土开裂失效;接缝承载力和UHPC与混凝土之间的接触面积呈正相关,承台的冲切承载力与底板高度呈正相关。此外,当承插深度与底板高度之比由0.60增大到2.08时,接缝承载力提升了80.2%,而承插连接以及底板承载力分别降低了27.7%、52.9%,承插连接参数与底板参数具有相同的变化趋势,且底板承载力对承插连接承载力的占比较大,说明底板对承插节点承载力的贡献起主导作用。通过对已有试验和数值模拟分析,将底板和接缝的贡献系数分别取为1.00和0.92,为类似预制装配墩柱-桩基础承插节点冲切承载力的计算提供了依据。

基于信息节点的智能配电网中压电力线载波通信信道建模方法

电力线载波(power-line carrier,PLC)技术是智能配电网重要的通信手段。为适应智能配电网可能出现的新的网络拓扑结构,提出一种基于信息节点的中压电力线信道建模方法。首先在网络关键位置设置信息节点,然后根据电路基本理论和均匀传输线理论推导出各信息节点间的电流电压关系式,最后利用传输矩阵方法得到信息接收点与发射点之间的电压传输特性。通过实验验证了该方法的正确性和普遍适用性。该方法可适用于树形、环网以及网格化等各种网络拓扑结构,为在智能配电网中压电力线采用载波通信技术提供了较好的分析方法。

宫颈癌根治术中加行腹主动脉旁淋巴结切除在ⅠB2及ⅡA2期宫颈癌治疗中的临床价值

目的:探讨宫颈癌根治术中加行腹主动脉旁淋巴结切除在ⅠB2及ⅡA2期宫颈癌治疗中的临床应用价值。方法:选择2006年5月至2011年7月在我院诊治的ⅠB2及ⅡA2期宫颈癌患者86例,分成两组。对照组45例,行宫颈癌根治术;观察组41例,宫颈癌根治术中加行腹主动脉旁淋巴结切除术;两组术后辅以放疗或放化疗。对两组术中、术后情况及复发率、生存率进行比较分析,并分析盆腔淋巴结转移、腹主动脉旁淋巴结转移与临床病理因素的关系。结果:观察组复发6例,复发率为15.0%;48个月总生存率和无瘤生存率均为70.0%。对照组复发17例,复发率为38.6%;48个月总生存率和无瘤生存率分别为68.0%和66.0%。两组比较,差异均有统计学意义(P<0.05)。两组并发症发生率(29.3vs40.0%)、术中出血量(325.0±58.0mlvs315.0±50.1ml)及盆腔淋巴结阳性率(56.1%vs57.8%)比较,差异均无统计学意义(P>0.05)。观察组中腹主动脉旁淋巴结阳性率为17.1%,盆腔淋巴结转移个数与腹主动脉旁淋巴结转移呈正相关(P<0.01)。单因素分析表明腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P<0.05);多因素分析则表明盆腔淋巴结转移个数及腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P<0.05)。结论:宫颈癌盆腔淋巴结转移个数与腹主动脉旁淋巴结转移有关。在宫颈癌根治性手术中加腹主动脉旁淋巴结切除并辅以术后治疗,可以降低复发率,提高生存率,且安全可行。