Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity scorematched analysis

BACKGROUND During emergency endoscopic retrograde cholangiopancreatography(ERCP),the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis(AC)due to choledocholithiasis are unclear.AIM To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.METHODS We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023.The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later,employing a propensity score(PS)frame-work.Our primary outcomes were intensive care unit(ICU)admission rates,ICU length of stay,and duration of antibiotic use.RESULTS In total,we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention:The urgent group(≤24 h,n=102)and the elective group(>24 h,n=152).Ninety-three pairs of patients with similar characteristics were selected by PS matching.The urgent ERCP group had more ICU admissions(34.4%vs 21.5%,P=0.05),shorter ICU stays(3 d vs 9 d,P<0.001),fewer antibiotic use(6 d vs 9 d,P<0.001),and shorter hospital stays(9 d vs 18.5 d,P<0.001).There were no significant differences observed in adverse events,in-hospital mortality,recurrent cholangitis occurrence,30-d readmission rate or 30-d mortality.CONCLUSION Urgent one-stage ERCP provides the advantages of a shorter ICU stay,a shorter duration of antibiotic use,and a shorter hospital stay.

Efficient Cloud Resource Scheduling with an Optimized Throttled Load Balancing Approach

Cloud Technology is a new platform that offers on-demand computing Peripheral such as storage,processing power,and other computer system resources.It is also referred to as a system that will let the consumers utilize computational resources like databases,servers,storage,and intelligence over the Internet.In a cloud network,load balancing is the process of dividing network traffic among a cluster of available servers to increase efficiency.It is also known as a server pool or server farm.When a single node is overwhelmed,balancing the workload is needed to manage unpredictable workflows.The load balancer sends the load to another free node in this case.We focus on the Balancing of workflows with the proposed approach,and we present a novel method to balance the load that manages the dynamic scheduling process.One of the preexisting load balancing techniques is considered,however it is somewhat modified to fit the scenario at hand.Depending on the experimentation’s findings,it is concluded that this suggested approach improves load balancing consistency,response time,and throughput by 6%.

Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

Analytical study on water hammer pressure in pressurized conduits with a throttled surge chamber for slow closure

This paper presents an analytical investigation of water hammer in a hydraulic pressurized pipe system with a throttled surge chamber located at the junction between a tunnel and a penstock, and a valve positioned at the downstream end of the penstock. Analytical formulas of maximum water hammer pressures at the downstream end of the tunnel and the valve were derived for a system subjected to linear and slow valve closure. The analytical results were then compared with numerical ones obtained using the method of characteristics. There is agreement between them. The formulas can be applied to estimating water hammer pressure at the valve and transmission of water hammer pressure through the surge chamber at the junction for a hydraulic pipe system with a surge chamber.

Study on the Availability Opening Size of Throttle and Affection to the Velocity Characteristic of Shock Absorber

Based on the solution of the governing differential equation for deformation of throttle slice while satisfying required boundary conditions, the coefficient （Gr） and an analytical formula for computing the deformation of throttle slice is presented through equivalency transformation, which is a concise, accurate and practical method for throttle slice design and characteristic analysis. Researched the deformation at any radius, compared with ANSYS FEA software by the simulation analysis, the availability opening size of throttle that was defined by the deformation at the valve mouth radius is studied. The affection of valve mouth radius to the damper characteristic is analyzed. Tests are made for the damper characteristic, compared with simulation results, it is shown that Gr method is an accurate computation method for computing the deformation of throttle slice at valve mouth radius, suitihle to use in the damper design, analysis, and verification. The deformation at mouth radius could not be replaced with the outside radius.

Adaptive Sliding-Mode Control of an Automotive Electronic Throttle in the Presence of Input Saturation Constraint

In modern vehicles, electronic throttle(ET) has been widely utilized to control the airflow into gasoline engine. To solve the control difficulties with an ET, such as strong nonlinearity,unknown model parameters and input saturation constraints,an adaptive sliding-mode tracking control strategy for an ET is presented. Compared with the existing control strategies for an ET, input saturation constraints and parameter uncertainties are adequately considered in the proposed control strategy. At first, the nonlinear dynamic model for control of an ET is described. According to the dynamical model, the nonlinear adaptive sliding-mode tracking control method is presented,where parameter adaptive laws and auxiliary design system are employed. Parameter adaptive law is given to estimate the unknown parameter with an ET. An auxiliary system is designed,and its state is utilized in the tracking control method to handle the input saturation. Stability proof and analysis of the adaptive sliding-mode control method is performed by using Lyapunov stability theory. Finally, the reliability and feasibility of the proposed control strategy are evaluated by computer simulation.Simulation research shows that the proposed sliding-mode control strategy can provide good control performance for an ET.

Mixed refrigerant composition shift due to throttle valves opening in auto cascade refrigeration system

Auto cascade refrigeration(ACR) cycle with phase separators is widely used in the cryogenic system. The composition of mixed refrigerant has a great effect on the performance of the system. Based on the assumption of infinite volume of phase separator, ACR system with one phase separator is simulated in this paper. The variation of refrigerant composition under different valves opening is obtained. A related experimental system is set up to verify the variation. The result shows that when the valve opening connected to the evaporator increases or the valve opening under the phase separator decreases, the low-boiling component concentration of the working mixture passing through the compressor and condenser increases, while the high-boiling component concentration decreases. Furthermore, the variations of condensation pressure and evaporation pressure under different valves opening are also observed. This paper is helpful to deepen the understanding of ACR system.

EXPERIMENTAL STUDY OF EFFECTS OF OPERATING CONDITIONS ON THE FLOW CHARACTERISTICS OF WATER HYDRAULIC THROTTLE

Experimental investigations are made on the effects of operating conditionson the flow characteristics of throttle when tap water is used as the working media. The researchedthrottles include cone poppet valve, ball valve, disc valve and dumping orifice. Operating conditionincludes poppet lift, working media, back pressure, medium temperature, etc. Because the vapourouspressure of water is much higher than that of oil, cavitation is easier to occur in water hydraulicelements and systems, so the effects of operating conditions on the cavitation characteristics ofthrottle are also researched.

THROTTLE CONTROL STRATEGIES IN THE PROCESS OF INTEGRATED POWERTRAIN CONTROL

Combining with the development of automated manual transmission （AMT）, the various throttle control demands are analyzed under different working conditions of AMT such as tracking acceleration pedal, start, shift and so on. Based on simulation, the responding throttle control strategies are proposed, and a simple but effective throttle control method is presented. The testing results have proved that the strategies are effective for improving the pedal tracking precision and the qualities of start and shift.

Influence of Diesel Engine Intake Throttle and Late Post Injection Process on the Rise of Temperature in the Diesel Oxidation Catalyst

In order to effectively implement DPF(Diesel Particulate Filters)regeneration control,thermal management of exhaust products before and inside Diesel Oxidation Catalyst(DOC)is necessary.In the present study,the Influence of the intake throttle valve and late post injection process on temperature rise inside DOC is analyzed through engine bench tests.The steady experiment results show that adjustment of the intake throttle valve can effectively increase exhaust temperature before DOC;in particular,with intake throttle valve opening at 20%,temperature before DOC can be increased by about 170℃ with respect to the full opening.An increase in the late post injection quantity can produce a significant rise of the temperature inside DOC,however its impact on the exhaust temperature before DOC is relatively limited.As the late post injection quantity increases,Hydrocarbon(HC)emissions also grow;in the present work it is shown that with a proper injection quantity,a considerable temperature increase inside the DOC can be obtained with relatively low HC emission.More specifically,with the intake throttle valve at 30%and DOC reaching ignition temperature as the late post injection quantity is increased,the exhaust temperature after DOC can be made larger than 550℃,adequate for DPF active regeneration.

Numerical Simulation on a Throttle Governing System with Hydraulic Butterfly Valves in a Marine Environment

Hydraulic butterfly valves have been widely applied in marine engineering because of their large switching torque, low pressure loss and suitability for large and medium diameter pipelines. Due to control problems resulting from switching angular speeds of the hydraulic butterfly valve, a throttle-governing control mode has been widely adopted, and detailed analysis has been carried out worldwide on the structural principle concerning speed-regulation and the load torque on the shaft while opening or closing a hydraulic butterfly valve. However relevant reports have yet been published on the change law, the error and the influencing factors of the rotational angular velocity of the hydraulic butterfly valve while opening and closing. In this article, research was based on some common specifications of a hydraulic butterfly valve with a symmetrical valve flap existing in a marine environment. The throttle governing system supplied by the accumulator to achieve the switching of the hydraulic control valve was adopted, and the mathematical models of the system were established in the actual conditions while the numerical simulations took place. The simulation results and analysis show that the rotational angular velocity and the error of the hydraulic butterfly valve while switching is influenced greatly by the drainage amount of the accumulator, resulting in pressure loss in the pipeline, the temperature of hydraulic medium and the load of the hydraulic butterfly valve. The simulation results and analysis provide a theoretical basis for the choice of the total capacity of the accumulator and pipeline diameters in a throttle governing system with a hydraulic butterfly valve.It also determines the type and specification of the hydraulic butterfly valve and the design of motion parameters of the transported fluid.

Water Hammer Model of Shock Absorber Throttle Slice

In allusion to easy invalidation of damping valve in vehicle shock absorber caused by the impact from the road surface, the importance of the study of damping valve water hammer pressure is presented. The physical model of damping valve with the circle throttle slice is established. The time for the throttle slice deformation is studied by using the finite software, and the laws that how the structure parameters affect the deformation time are obtained. Combining the theory of water hammer, the water hammer initial and boundary condition of the damping valve is deduced, and the water hammer model of throttle slice is established. The analysis of simulation results indicates that the water hammer pressure amplitude and the amount of water hammer oscillation period can be reduced and the dependability of the valve can be enhanced by modifying the structure parameters and aperture width between slice and valve body.

Cavitation Bubble Luminescence in Cone-Type Throttle Valve

In light of the light emission from cavitation bubbles under certain conditions, the phenomena of the cavitation bubble luminescence in the hydraulic cone-type throttle valve is focused in this paper. Firstly,the software of automatic dynamic incremental nonlinear analysis( ADINA) is applied to studying the flow field of the flow channel of the cone-type throttle valve. And the pressure distribution of the valve flow channel is obtained. The easyhappening area of cavitation in the cone-type throttle valve is also found out by ADINA. Then,the experimental research on the conetype throttle valve is carried out in this paper. The changing law of the hydraulic oil temperature in the corresponding region under different system pressure and the backpressure condition are experimentally researched. The relationship between the luminescence intensity and the cavitation intensity,the pressure,and the temperature are also studied. Finally,a summary of the causal relationship between the luminescence and cavitation in the cone-type throttle valve,the cavitation effect on the hydraulic oil temperature,and the method for the inhibition of cavitation bubble luminescence are presented. The results show that the light intensity increases with the increase of the cavitation intensity,and the luminescence can be inhibited by the increase of backpressure.

A Rare Long Term Survival Case of Complete Pentalogy of Cantrell in Adult after One-Staged Surgery

Pentalogy of Cantrell is a rare congenital abnormality.Even with high-quality medical care and staged corrective surgeries in professional hospitals,the mortality rate is still very high and long-term prognosis is poor.Survival is largely determined by the complexity and severity of cardiac abnormalities,the efficiency of abdominal wall closure and postoperative complications.A 24-year-old male patient with complete pentalogy of Cantrell was diagnosed.One-stage surgical repair of all abnormalities were completed.The patient recovered well and had been follow-up for 7 years.He has a good cosmetic outcome,with no signs of cardiac dysfunction.No complications were noted.

One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection:A case report

BACKGROUND Ochronotic arthropathy(OcA)is a rare disease,which is caused by the accumulation of homogentisic acid in the joint.Patients with OcA have obvious joint pain and the disease progresses rapidly,eventually resulting in disability.Arthroplasty is an efficacious treatment in patients with OcA.However,when OcA patients have joint infection,is joint replacement an option?In the present report,we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.CASE SUMMARY A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years.On physical examination,the patient was found to have dark brown pigmentation of the sclera and auricle.Laboratory test results showed elevations in C-reactive protein level(65.79 mg/L)and erythrocyte sedimentation rate(90.00 mm/h).The patient underwent debridement of the left knee joint,during which the cartilage surface of the knee joint was found to be black-brown in color.Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans.We then carried out arthroplasty under the guidance of the theory of one-stage revision.After surgery,the patient’s left knee joint pain disappeared and function recovered without joint infection.CONCLUSION OcA accompanied by joint infection is rare.One-stage revision arthroplasty may be a treatment option for this disease.

Adaptive Back-Stepping Control of Automotive Electronic Control Throttle

Back-stepping control (BSC), which is deemed effective for a non-holonomic system, is applied to improving both responsiveness and resolution performance of an electronic control throttle (ECT) used in automotive engines. This paper is characterized by the use of a two-step type BSC in a manner that achieves an improvement in responsiveness with the ETC operated in a fully opened state by adding a derivative term in Step 1 and the improvement in resolution performance with the ETC operated in a minutely opened state by adding an adaptive feature in the form of an integral term using the control deviation in Step 2. This paper presents an ECT control expressed as a second-order system including nonlinearities such as backlash of gear train and static friction in sliding area, a BSC system designed based on Lyapunov stability, and a determination method for control parameters. Also, a two-step type BSC system is formulated using Matlab/Simulink with a physics model as a control object. As a result of simulation analyses, it becomes clear that the BSC system can achieve quicker response because the derivative term works effectively and finer resolution because the adaptive control absorbs the error margin of the nonlinear compensation than conventional PID control.

Experimental Study and 3D CFD Analysis on the Optimization of Throttle Angle for a Convergent Vortex Tube

Seven adjustments of convergent-type Vortex Tube （VT） with different throttle angles were applied. The adjustments were made to analyze the influences of such angles on cold and hot temperature drops as well as flow structures inside the VTs. An experimental setup was designed, and tests were performed on different convergent VT configurations at injection pressures ranging from 0.45 to 0.65 MPa. The angles of the throttle valve were arranged between 30° to 90°, and the numbers of injection nozzles ranged between 2 and 6. Laboratory results indicated that the maximum hot and cold temperature drops ranged from 23.24 to 35 K and from 22.87 to 32.88 K, respectively, at four injection nozzles. Results also showed that temperature drop is a function of hot throttle valve angle with the maximum hot and cold temperature drops depending on the angle applied. We used graphs to demonstrate the changes in the cold and hot temperature drops with respect to hot throttle angle values. These values were interpreted and evaluated to determine the optimum angle, which was 60°. The CFD outputs agreed very well with the laboratory results. The proposed CFD results can help future researchers gain good insights into the complicated separation process taking place inside the VTs.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.

An extended smart driver model considering electronic throttle angle changes with memory

Based on the fact that the electronic throttle angle effect performs well in the traditional car following model,this paper attempts to introduce the electronic throttle angle into the smart driver model(SDM)as an acceleration feedback control term,and establish an extended smart driver model considering electronic throttle angle changes with memory(ETSDM).In order to show the practicability of the extended model,the next generation simulation(NGSIM)data was used to calibrate and evaluate the extended model and the smart driver model.The calibration results show that,compared with SDM,the simulation value based on the ETSDM is better fitted with the measured data,that is,the extended model can describe the actual traffic situation more accurately.Then,the linear stability analysis of ETSDM was carried out theoretically,and the stability condition was derived.In addition,numerical simulations were explored to show the influence of the electronic throttle angle changes with memory and the driver sensitivity on the stability of traffic flow.The numerical results show that the feedback control term of electronic throttle angle changes with memory can enhance the stability of traffic flow,which shows the feasibility and superiority of the proposed model to a certain extent.

Research on two-step throttle characteristics of double-rotation valve port for hydraulic servo joint

The hydraulic robot with large output torque is widely used in industry,however,its precision is not high.In order to solve this problem,this paper presents a new structure of rotary valve with double-rotation valve port,which can improve the two-step throttle characteristics of the valve port,reduce the cavitation phenomenon of the valve port,and increase the output accuracy of the hydraulic servo joint.Firstly,the internal flow field of the rotary valve is simulated by using the sliding grid technology of FLUENT software,and the changing rule of the throttle position in the working process of the structure is analyzed.Secondly,compared with the simulation results of rotary valve with single-rotation valve port,it is shown that the two-step throttle characteristics of the structure are less affected by the change of the opening of the rotary valve,and the cavitation index of the joint valve port is reduced.Finally,the influence of the rotation speed of the valve core,oil supply pressure and key dimension of valve core on throttle characteristics of rotary valve have been analyzed.