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.

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.

A Review of Throttling Technology Development for Large-Thrust Liquid Rocket Engines

Throttling of large-thrust liquid rocket engines,which can improve mission adaptability of a carrier rocket,reduce risk and facilitate rocket recovery,is a key technology for current and future space development.This paper summarizes the state of the art and trends of throttling technology for large-thrust liquid rocket engines at home and abroad.According to the working principles of propulsion for rocket engines,throttling the propellant flow rate is a major way of adjusting thrust,and regulation devices along with adjustable injectors are primary measures of throttling propellant flow rates.This paper clarifies the working principles of typical regulation devices and adjustable injectors,introduces the regulation schemes of typical large-thrust engines such as YF-100,RD-170,and SSME,and summarizes the main characteristics of current throttleable large-thrust engines.Finally,critical technologies and development trends of throttling are discussed,including combustion stability and reliable cooling of thrust chambers at low thrust levels,turbopump stability,and stable regulation and precise control in a wide range of operating conditions.

Multi-stage and multi-orifice throttling analysis for thermal power generating sets

Multi stage and multi orifice throttling analysis for bypass valves in thermal power generating sets is important for normal operation of power generating equipment. It is improper to exclude the factor of flow resistance from the expansion coefficient for the flow formula used for analysing the multi stage and multi orifice flow of compressible fluid, which means expansion of gas has nothing to do with resistance. The authors put forward an expanded energy equation and related formula to overcome the drawback, and use them for multi stage and multi orifice throttling analysis of compressible fluid for thermal power generating sets.

Application of Dual Throttling Air-Conditioning System to Explosion-Proof Frequency Converter

An explosion-proof dual throttling air-conditioning system was put forward to solve the heat dissipation and internal dewing problems of explosion-proof frequency converter in the underground coal mine. This study investigated the feasibility and benefits of explosion-proof dual throttling cooling and dehumidification air-conditioning system applied to the explosion-proof frequency converter. The physical model of dual throttling air-conditioning system was established and its performance parameter was described by mathematical method. The design calculation of the system has also been done. The experimental result showed that the system reached the steady state at the refrigeration mode after running 45 min, and the maximum internal temperature of the flame-proof cavity was 31.0 ℃. The system reached the steady state at the dehumidification mode after running 37 min. The maximum internal relative humidity and temperature of the flame-proof cavity were 33.4% and 36.3 ℃, respectively. Therefore, the proposed system had excellent ability of heat dissipation and avoided internal dewing. Compared with water cooling system, it was more energy-saving and economical. The airflow field of dual throttling air-conditioning system was also studied by CFD simulation. It was found that the result of CFD numerical simulation was highly consistent with the experimental data.

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.

Hydraulic Domestic Heating by Throttling

In this work an experimental investigation was carried out in order to explore the possibility of realizing a domestic heating system by throttling hydraulic oil. Considering the continuous increasing price of diesel oil, this work gains unique importance. Generating heat directly by throttling is realized using a simple environment friendly system which does not require oil transportation and storage, and eliminates the need for chimneys and annual preventive maintenance, as it is the case with heating by utilizing oil burners, which is prevailing in Jordan. Experimental results show that it is possible to raise the room temperature up to 70?C during 15 minutes which is not a limit value. Experimental results show that temperature rate could be increased by selecting the appropriate pump power and by connecting a number of throttles in parallel.

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.

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.

One-Stage Bilateral Total Hip Arthroplasty for Hemophilic Spontaneous Ankylotic Hip: A Case Report

Total hip arthroplastys (THAs) for hemophilic spontaneous ankylotic hips are rare. We performed one-stage bilateral THA for hemophilic patient and I would like to report the results of the case. A 61-year-old male had been diagnosed with mild hemophilia A as a neonate. He had severe pain in both hips and moderate pain in both knees. His hips were ankylotic and had no mobility. Uncemented simultaneous bilateral THAs were performed under general anesthesia. This case suggests that one-stage THA can be a good option for hemophilic hips, provided that sufficient substitution therapy is used.

One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

Objective To report the treatment of perineal hypospadias with one - stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the cprona and the urethral plate to correct chordee. A U - shaped skin incision was then made surrounding the meatus。

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.