Two big orifices in the second duodenal portion:A case of an atypical double papilla

With the advent of endoscopic retrograde cholangiopancreatography(ERCP)in the early 1970s,anatomic anomalies of the Vaterian system were described endoscopically[1].Although the occurrence is rare,the common bile duct(CBD)and the pancreatic duct may fail to coalesce during embryologic development.This leads to double major papilla because both ducts open into the duodenum separately[1].In this way the cranial duct communicates with the CBD,while the caudal orifice communicates with the pancreatic duct[2].

Removal of a guide-wire sliding into abdominal cavity via transgastric natural orifice transluminal endoscopic surgery: A case report

BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery(NOTES).The goal is to enhance physicians'understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.CASE SUMMARY A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites.To proceed with treatment,the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage.Unfortunately,a 0.035-inch guidewire slipped into the abdominal cavity during the procedure.Following a comprehensive evaluation and consultation by a multidisciplinary team,the guidewire was successfully removed using NOTES.CONCLUSION This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body,such as a guidewire,within the abdominal cavity.

Analysis of quality of life in patients after transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery

BACKGROUND At present,laparoscopic cholecystectomy(LC)is the main surgical treatment for gallstones.But,after gallbladder removal,there are many complications.Therefore,it is hoped to remove stones while preserving the function of the gallbladder,and with the development of endoscopic technology,natural orifice transluminal endoscopic surgery came into being.AIM To compare the quality of life,perioperative indicators,adverse events after LC and transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery(EGPS)in patients with gallstones.METHODS Patients who were admitted to The First Affiliated Hospital of Xinjiang Medical University from 2020 to 2022 were retrospectively collected.We adopted propen-sity score matching(1:1)to compare EGPS and LC patients.RESULTS A total of 662 cases were collected,of which 589 cases underwent LC,and 73 cases underwent EGPS.Propensity score matching was performed,and 40 patients were included in each of the groups.In the EGPS group,except the gastr-ointestinal defecation(P=0.603),the total score,physical well-being,mental well-being,and gastrointestinal digestion were statistically significant compared with the preoperative score after surgery(P<0.05).In the LC group,except the mental well-being,the total score,physical well-being,gastrointestinal digestion,the gastrointestinal defecation was statistically significant compared with the preoperative score after surgery(P<0.05).When comparing between groups,gastrointestinal defecation had significantly difference(P=0.002)between the two groups,there was no statistically significant difference in the total postoperative score and the other three subscales.In the surgery duration,hospital stay and cost,LC group were lower than EGPS group.The recurrence factors of gallstones after EGPS were analyzed:and recurrence was not correlated with gender,age,body mass index,number of stones,and preoperative score.CONCLUSION Whether EGPS or LC,it can improve the patient’s symptoms,and the EGPS has less impact on the patient’s defecation.It needed to,prospective,multicenter,long-term follow-up,large-sample related studies to prove.

EXPERIMENTAL INVESTIGATIONS OF CAVITATION EFFECTS ON FLOW CHARACTERISTICS OF SMALL ORIFICES AND VALVES IN WATER HYDRAULICS

The flow characteristics and cavitation effects of water passing throughsmall sharp-edged cylindrical orifices and valves of different shapes in water hydraulics areinvestigated. The test results using orifices with different aspect ratios and different diametersshow that the flow coefficients in the case of non-cavitating flow are larger than that of flow inthe case of cavitation occurrence. The flow coefficients of flow with cavitation initially decreaseas Reynolds number increases and ultimately tend to be of constant values close to contractioncoefficient. Large aspect ratio has an effect of suppressing cavitation. The experimental resultsabout disc valves illustrate that the valves with sharp edge at large opening are less affected bycavitation than that at small opening. Throttle with triangle notch has better anti-cavitationability than that with square notch. The flowrate of the throttle with square notch is significantlyaffected by the flow direction or the flow passage shape.

Studies on Melt Spinning of Sheath-Core Bicomponent Fibers: Fundamental Equations on the Dynamics of Melt Spinning

An attempt was made to numerically compute the temperature profile within the melt spinning of sheath core bicomponent fibers by deriving a set of simultaneous partial differential equations. The effects of acceleration, gravity, and air friction on the kinetics of the polymer were included and the upper-convected Maxwell model as the constitutive equation was adopted in this model.The sheath- core bicomponent fibers were partitioned intb a serial of circular cross section and it is assumed that each circular cross section has a temperature gradient while conducting the equation of energy balance. A mathematical model was developed to describe the melt spinning of sheath-core bicomponent fibers.

Novel deformable self-assembled magnetic anastomosis ring for endoscopic treatment of colonic stenosis via natural orifice

BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.

Effect of Dynamic Pressure Feedback Orifice on Stability of Cartridge-Type Hydraulic Pilot-Operated Relief Valve

Current research on pilot-operated relief valve stability is primarily conducted from the perspective of system dynamics or stability criteria,and most of the existing conclusions focus on the spool shape,damping hole size,and pulsation frequency of the pump.However,the essential factors pertaining to the unstable vibration of relief valves remain ambiguous.In this study,the dynamic behavior of a pilot-operated relief valve is investigated using the frequency-domain method.The result suggests that the dynamic pressure feedback orifice is vital to the dynamic characteristics of the valve.A large orifice has a low flow resistance.In this case,the fluid in the main spring chamber flows freely,which is not conducive to the stability of the relief valve.However,a small orifice may create significant flow resistance,thus restricting fluid flow.In this case,the oil inside the main valve spring chamber is equivalent to a high-stiffness liquid spring.The main mass-spring vibration system has a natural frequency that differs significantly from the operating frequency of the relief valve,which is conducive to the stability of the relief valve.Good agreement is obtained between the theoretical analysis and experiments.The results indicate that designing a dynamic pressure feedback orifice of an appropriate size is beneficial to improving the stability of hydraulic pilot-operated relief valves.In addition,the dynamic pressure feedback orifice reduces the response speed of the relief valve.This study comprehensively considers the stability,rapidity,and immunity of relief valves and expands current investigations into the dynamic characteristics of relief valves from the perspective of classical control theory,thus revealing the importance of different parameters.

Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.

Expanding endoscopic boundaries:Endoscopic resection of large appendiceal orifice polyps with endoscopic mucosal resection and endoscopic submucosal dissection

BACKGROUND Large appendiceal orifice polyps are traditionally treated surgically.Recently,endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been utilized as alternative resection techniques.AIM To evaluate the efficacy and safety of endoscopic resection techniques for the management of large appendiceal orifice polyps.METHODS This was a retrospective observational study conducted to assess the feasibility and safety of EMR and ESD for large appendiceal orifice polyps.This project was approved by the Baylor College of Medicine Institutional Review Board.Patients who underwent endoscopic resection of appendiceal orifice polyps≥1 cm from 2015 to 2022 at a tertiary referral endoscopy center in the United States were enrolled.The main outcomes of this study included en bloc resection,R0 resection,post resection adverse events,and polyp recurrence.RESULTS A total of 19 patients were identified.Most patients were female(53%)and Caucasian(95%).The mean age was 63.3±10.8 years,and the average body mass index was 28.8±6.4.The mean polyp size was 25.5±14.2 mm.74%of polyps were localized to the appendix(at or inside the appendiceal orifice)and the remaining extended into the cecum.68%of polyps occupied≥50%of the appendiceal orifice circumference.The mean procedure duration was 61.6±37.9 minutes.Polyps were resected via endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures in 5,6,and 8 patients,respectively.Final pathology was remarkable for tubular adenoma(n=10)[one with high grade dysplasia],sessile serrated adenoma(n=7),and tubulovillous adenoma(n=2)[two with high grade dysplasia].En bloc resection was achieved in 84%with an 88%R0 resection rate.Despite the large polyp sizes and challenging procedures,89%(n=17)of patients were discharged on the same day as their procedure.Two patients were admitted for post-procedure observation for conservative pain management.Eight patients underwent repeat colonoscopy without evidence of residual or recurrent adenomatous polyps.CONCLUSION Our study highlights how endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid procedures are all appropriate techniques with minimal adverse effects,further validating the utility of endoscopic procedures in the management of large appendiceal polyps.

单分散Al-4.5wt%Cu合金粒子的制备与凝固过程模拟

使用脉冲微孔喷射法制备了粒径可控的单分散Al-4.5wt%Cu液滴,对液滴凝固成的粒子进行分析表征。结果表明:该粒子具有粒径均一、高球形度、热履历一致的优点。随着粒径的增长,粒子的内部微观结构由胞状晶变为树枝晶。建立了粒子凝固过程的传热数值计算模型,分析了粒子下落中温度、温度梯度变化及冷却速率与粒子微观组织形貌的关系。在本实验条件下,310.0μm粒子内部凝固组织为胞状晶,冷却速率为771.71 K/s;485.1μm粒子内部凝固组织为树枝晶,冷却速率为382.40 K/s。

真空环境下小孔节流径向气浮轴承特性研究

单轴气浮台中的涡流力矩主要是由径向气浮轴承的制造误差引起的。采用CFD软件首先研究了真空环境对小孔节流径向气浮轴承的承载力、耗气量的影响规律,其次对比研究了真空环境下简化和实测常见制造误差对涡流力矩的影响规律。在常压和真空环境下,进、出口压力差相同时,常压环境下静态承载能力优于真空环境;当出口压力逐渐越接近真空时,承载力下降趋势更加突出;在真空环境下的平均耗气量要比常压下小。对简化的制造误差进行分析时,涡流力矩出现正弦周期性变化,其峰值出现规律与制造误差的相对位置有关。依据实际误差测量数据进行建模分析,发现涡流力矩在一定范围内波动,这是轴颈制造误差与节流孔直径制造误差共同作用的结果,峰值数量和位置与节流孔的数量和相对位置一致,且节流孔直径制造误差也会对峰值时的涡流力矩结果产生影响。

某660 MW超临界锅炉深度调峰过程中分隔屏超温计算分析及改造方案研究

针对660 MW超临界褐煤锅炉分隔屏实炉数据分析发现,在175 MW负荷下,分隔屏的超温报警主要发生在屏3、屏4靠近炉内的管子。为解决分隔屏超温报警问题,采用流动网络系统法,结合质量、能量和动量守恒方程建立了分隔屏水动力计算数学模型,提出添加节流圈以及升级管子材料两种改造方案。对分隔屏进行回路及管段划分,采用175 MW负荷实炉测量数据反推计算得到炉内实际热偏差,对低、中、高负荷下添加节流圈与升级材料为Super304H的分隔屏出口汽温进行计算。计算结果表明:添加节流圈后分隔屏出口汽温偏差变小,且屏3、屏4出口汽温降低至材料TP347H报警温度以下;升级材料为Super304H后分隔屏出口汽温均小于材料的报警温度,分隔屏可安全运行。对添加节流圈以及将材料升级为Super304H两种方案进行壁温计算及强度校核,结果显示两种改造方案在各个负荷下,壁温以及强度均是安全的。为给锅炉运行留出更大的安全裕度,建议在分隔屏最后一片屏上添加节流圈的同时将材料由TP347H升级为Super304H。

点阵式二氧化碳激光治疗外阴阴道口萎缩的外阴色素减退性疾病的疗效分析

目的研究点阵式二氧化碳激光治疗外阴阴道口萎缩的外阴色素减退性疾病患者的疗效及可行性。方法回顾性选取2021年2月至2022年4月期间郑州大学第三附属医院妇科门诊就诊的具有外阴阴道口萎缩症状的患者43例,观察组23例患者采用点阵式二氧化碳激光治疗仪进行外阴及阴道口治疗3次,对照组20例患者采用外阴和阴道内使用普罗雌烯胶囊。于治疗前、治疗后3个月及6个月采用皮肤病生活质量指数(Dermatology Life Quality Index,DLQI)评分、女性性苦恼量表(female sexual distress scale-revised,FSDS-R)及女性性功能指数(Female Sexual Function Index,FSFI)量表评估患者的症状和性生活状况,并进行满意度调查。结果治疗后3个月,观察组DLQI、FSDS-R和FSFI评分均较治疗前有改善(P<0.05),对照组FSDS-R和FSFI评分均有改善(P<0.05),观察组患者改善效果优于对照组(P<0.05)。治疗后6个月,观察组DLQI、FSDS-R和FSFI评分均较治疗前有改善(P<0.05),对照组评分无明显改善(P>0.05)。结论点阵式二氧化碳激光治疗能够改善外阴阴道口萎缩的外阴色素减退性疾病患者症状,疗效确切。

腹腔镜下应用硬膜外针带双色线法经皮单通道穿刺腹膜外内环结扎术治疗小儿腹股沟疝的临床效果

目的探讨腹腔镜下应用硬膜外针带双色线法经皮单通道穿刺腹膜外内环结扎术治疗小儿腹股沟疝的临床价值。方法选取2019年7月至2022年7月在萍乡市人民医院小儿外科行腹腔镜下经皮穿刺腹膜外内环口结扎术的514例资料完整的腹股沟疝患儿作为研究对象,按照单双通道穿刺的不同分为双通道穿刺组(273例)和单通道穿刺组(241例),其中2019年7月至2021年5月患儿采用硬膜外针带线经皮双通道穿刺完成腹膜外结扎术,2021年6月至2022年7月患儿采用硬膜外针带双色线法单通道经皮穿刺完成腹膜外结扎术。比较两组患儿的单/双侧、手术时间、穿刺点硬结、线结反应、腹股沟区疼痛及复发率等指标。结果两组患儿术后腹股沟区疼痛及疝复发率的比较,差异无统计学意义(P>0.05),单通道穿刺组手术时间短于双通道穿刺组,穿刺点硬结及线结反应发生率低于双通道穿刺组,差异有统计学意义(P<0.05)。结论腹腔镜下应用硬膜外针带双色线法经皮单通道穿刺腹膜外内环结扎术治疗小儿腹股沟疝,是一种安全有效的手术方法,可简化操作、缩短手术操作时间,降低穿刺点硬结及线结反应发生率,有利于在基层地区医院推广。

非均布压力作用下纯弯曲孔道预应力摩阻损失

为获得更准确的孔道预应力摩阻损失计算方法,保证桥梁结构设计的有效预应力和桥梁结构的安全运行。根据赫兹接触理论,综合考虑摩擦力、接触压力与张拉力间的相互作用,导出了纯弯曲孔道在非均匀压力作用下摩阻损失公式。通过有限元软件分析不同参数对摩阻损失计算值的影响。通过实际工程的摩阻试验探究纯弯曲孔道在非均匀压力下预应力摩阻损失的具体分布规律,并通过规范公式、推导公式的理论计算值与现场实测数据的偏差,验证公式的合理性。结果表明:弯曲角度小于120°、摩擦系数为0.2~0.4范围内,推导公式计算值更接近实际情况;随着张拉应力和弯曲角度的增加,利用推导公式计算得到的摩阻损失值更接近实测结果。

改进7N喷头阻隔CO扩散有效性的模拟研究

为弥补常规组合式喷头存在的挡烟空隙不足,在普通7N喷头的基础上改进,设计出一种侧喷式7N喷头,并开展了数值模拟研究。通过对比下游截面处CO总质量通量、流场分布以及温度的变化情况,验证了改进喷头挡烟的有效性。在此基础上,分析了改进喷头在不同火源功率、流量、粒径下的作用效果。结果表明,普通喷头形成的雾幕能够有效降低通道温度,但并不能阻隔CO的扩散。在同样条件下,改进后的雾幕能够有效抑制CO蔓延,降温能力也有所提高,且其作用效果随喷头流量的增大更加显著。在流量为11.42 L/min时,下游CO质量通量及最高温度较改进前分别降低了71.64%、30.05%;即使火源功率增大至5 MW,改进后的雾幕仍能有效限制CO扩散;总体来看,粒径对CO的阻挡影响并不明显,对2 MW火灾的降温效果也在粒径200 m时达到最佳。

平头孔板的初生空化特性定量分析

随着现代水利水电工程的日益优化创新,高坝设计中需要解决的重大技术瓶颈是消杀高坝泄放洪流所携带的超大能量。利用水流的突扩、突缩消能的孔板制造简便,并且消能效率高。孔板的抗空化特性跟它的最小壁面压强系数大小紧密相关,其作为孔板设计制造的一个关键性指标。通过数值模拟和物理模型试验的方法,研究了平头孔板初生空化数与相关体型要素和水力要素之间的关系,并得到了经验表达式。研究结果表明,平头孔板初生空化数的经验表达式与实际吻合较好,为孔板的工程应用提供了参考。

象性合参论远志效用特色与优势

采用药性与法象理论合参方法,融合现代药理与临床认识,阐释远志双调心神的作用机制,为远志治疗难治性病证提供药学与临床依据。研究发现,远志的特殊药象是其宁心安神功效的药材学基础,结合其“辛烈开窍”的性能特点,采用象性合参的方法,不仅有助于理解远志双调心神的特殊功效及其“安神不闭窍,开窍不动神”的药效特点,而且对认识用其治心神疾患、睡眠紊乱以及惊风、中风、癫痫等病证的作用优势,也提供了“象思维”的路径。象性合参还可揭示远志交通心肾的作用机制,并与其双调心神作用结合,拓展治疗心神失常之应用范围。因此,运用象性合参阐释远志的多重药理效用,是探析其治疗疑难杂病机制的重要方法。

基于“线粒体-氧化应激”损伤机制从“痰”论治血管性痴呆

血管性痴呆(vascular dementia,VaD)多继发于脑血管病,其患病率高,发病机制不明。脑血管病使神经元缺血、缺氧,进而诱发线粒体形态和功能异常,大量强氧化物质释放,最终造成神经元氧化损伤,因此“线粒体-氧化应激”损伤机制是VaD认知障碍的关键机制。本文通过梳理和总结国内外“线粒体-氧化应激”损伤机制的研究和报道,将氧化应激损伤和中医学呆病关键病理因素“痰浊”结合,从而建立VaD“痰浊-氧化应激-神经炎症”的中西医结合病理理论,在此基础上深入探讨VaD认知障碍修复机制和潜在治疗靶点,论述“治痰法”的有效性和科学性,为中医药防治VaD提供新的思路。

腹腔镜经自然腔道取标本手术在老年高位直肠癌患者中的疗效分析

目的:探讨经自然腔道取标本手术治疗老年高位直肠癌的临床疗效。方法:回顾性选取2017年9月至2022年9月手术治疗的64例老年高位直肠癌患者,分为对照组与观察组,每组32例,两组均行腹腔镜直肠癌根治术,对照组经腹部辅助切口取标本,观察组经肛门取标本。比较两组术中出血量、手术时间、清扫淋巴结数量、术后首次排气时间、疼痛评分、首次下床活动时间及术后并发症发生率等。结果:两组患者临床资料差异无统计学意义(P>0.05);术中出血量、病理分级、淋巴结清扫数量、术后并发症差异亦无统计学意义(P>0.05)。两组术后病理切缘均为阴性;观察组手术时间长于对照组,疼痛评分低于对照组,术后首次排气时间、术后首次下床活动时间及术后住院时间短于对照组,差异有统计学意义(P<0.05)。结论:对于老年高位直肠癌的手术治疗,经自然腔道取标本手术是安全、有效、可行的,与经辅助切口取标本手术相比,在减少术后疼痛、胃肠功能恢复等方面具有一定优势。