BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and e...BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.展开更多
BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irrever...BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.展开更多
BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on th...BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.展开更多
BACKGROUND Skin cancer is a common malignant tumor in dermatology.A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer,and it is difficult to treat the wound.In the past,...BACKGROUND Skin cancer is a common malignant tumor in dermatology.A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer,and it is difficult to treat the wound.In the past,treatment with skin grafting and pressure dressing was easy to cause complications such as wound infections,subcutaneous effusion,skin necrosis,and contracture.Negative pressure wound therapy(NPWT)has been applied to treat huge frontotemporal skin cancer.CASE SUMMARY Herein,we report the case of a 92-year-old woman with huge frontotemporal skin cancer.The patient presented to the surgery department complaining of ruptured bleeding and pain in a right frontal mass.The tumor was pathologically diagnosed as highly differentiated squamous cell carcinoma.The patient underwent skin cancer surgery and skin grafting,after which NPWT was used.She did not experience a relapse during the three-year follow-up period.CONCLUSION NPWT is of great clinical value in the postoperative treatment of skin cancer.It is not only inexpensive but also can effectively reduce the risk of surgical effusion,infection,and flap necrosis.展开更多
Sustained casing pressure （SCP） in gas wells brings a serious threat to worker safety and environmental protection. According to geological conditions, wellbore structure and cement data of gas wells in the Sichuan-...Sustained casing pressure （SCP） in gas wells brings a serious threat to worker safety and environmental protection. According to geological conditions, wellbore structure and cement data of gas wells in the Sichuan-Chongqing region, China, the position, time, environmental condition and the value of SCP have been analyzed. On this basis, the shape of the pressure bleed-down plot and pressure buildup plot were diagnosed and the mechanism of SCP has been clarified. Based on generalized annular Darcy percolation theory and gas-liquid two-phase fluid dynamics theory, a coupled mathematical model of gas migration in a cemented annulus with a mud column above the cement has been developed. The volume of gas migrated in the annulus and the value of SCP changing with time in a gas well in Sichuan have been calculated by this model. Calculation results coincided well with the actual field data, which provide some reference for the following security evaluation and solution measures of SCP.展开更多
Although pressure cells have been produced and installed successfully for decades,the accuracy of measured pressure is often inadequate.Due to large differences between the stiffness of pressure cells and the surround...Although pressure cells have been produced and installed successfully for decades,the accuracy of measured pressure is often inadequate.Due to large differences between the stiffness of pressure cells and the surrounding media,there is a considerable difference between applied pressure and that measured from pressure cells.It is often difficult and expensive to make a pressure cell with stiffness（modulus of elasticity） similar to the surrounding material in which it will be embedded.In order to improve this situation,a casing material with proportional dimensions is recommended as a means to obtain reliable results.In our study,the effect of using casing in the installation of pressure cells is investigated,providing the characteristics of casing.Some practical recommendations are presented to improve the accuracy of the results using casing.展开更多
Based on statistical analysis on the situation of casing damage and water injection pressure in Pubei Oilfield, it shows that the main forms of casing damage in Pubei Oilfield are deformation and dislocation. Dip angl...Based on statistical analysis on the situation of casing damage and water injection pressure in Pubei Oilfield, it shows that the main forms of casing damage in Pubei Oilfield are deformation and dislocation. Dip angle and faults have a significant impact on casing damage and casing damage is closely related to water injection pressure. Through laboratory simulating experiment and theoretical calculation, the formula of critical injection pressure giving rise to casing damage is obtained and the preventive measures are drafted.展开更多
BACKGROUND Lower body positive pressure(LBPP)treadmill has potential applications for improving the gait of patients after stroke,but the related mechanism remains unclear.CASE SUMMARY A 62-year-old male patient suffe...BACKGROUND Lower body positive pressure(LBPP)treadmill has potential applications for improving the gait of patients after stroke,but the related mechanism remains unclear.CASE SUMMARY A 62-year-old male patient suffered from ischemic stroke with hemiplegic gait.He was referred to our hospital because of a complaint of left limb weakness for 2 years.The LBPP training was performed one session per day and six times per week for 2 wk.The dynamic plantar pressure analysis was taken every 2 d.Meanwhile,three-digital gait analysis and synchronous electromyography as well as clinical assessments were taken before and after LBPP intervention and at the 4-wk follow-up.During LBPP training,our patient not only improved his lower limb muscle strength and walking speed,but more importantly,the symmetry index of various biomechanical indicators improved.Moreover,the patient’s planter pressure transferring from the heel area to toe area among the LBPP training process and the symmetry of lower body biomechanical parameters improved.CONCLUSION In this study,we documented a dynamic improvement of gait performance in a stroke patient under LBPP training,which included lower limb muscle strength,walking speed,and symmetry of lower limb biomechanics.Our study provides some crucial clues about the potential dynamic mechanism for LBPP training on gait and balance improvement,which is related to rebuilding foot pressure distribution and remodeling symmetry of biomechanics of the lower limb.展开更多
Since the production regime of shut-in after fracturing is generally adopted for wells in shale oil reservoir,a shut-in pressure drop model coupling wellbore-fracture network-reservoir oil-water two-phase flow has bee...Since the production regime of shut-in after fracturing is generally adopted for wells in shale oil reservoir,a shut-in pressure drop model coupling wellbore-fracture network-reservoir oil-water two-phase flow has been proposed.The model takes into account the effects of wellbore afterflow,fracture network channeling,and matrix imbibition and oil exchange after stop of pumping.The simulated log-log curve of pressure-drop derivative by the model presents W-shape,reflecting the oil-water displacement law between wellbore,fracture network and matrix,and is divided into eight main control flow stages according to the soaking time.In the initial stage of pressure drop,the afterflow dominates;in the early stage,the pressure drop is controlled by the cross-flow and leakoff of the fracture system,and the fractures close gradually;in the middle stage of pressure drop,matrix imbibition and oil exchange take dominance,and the fracturing fluid loss basically balances with oil replaced from matrix;the late stage of pressure drop is the reservoir boundary control stage,and the leakoff rate of fracturing-fluid and oil exchange rate decrease synchronously till zero.Finally,the fracture network parameters such as half-length of main fracture,main fracture conductivity and secondary fracture density were inversed by fitting the pressure drop data of five wells in Jimsar shale oil reservoir,and the water imbibition volume of matrix and the oil replacement volume in fracture were calculated by this model.The study results provide a theoretical basis for comprehensively evaluating the fracturing effect of shale oil hori-zontal wells and understanding the oil-water exchange law of shale reservoir after fracturing.展开更多
BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patien...BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patients with uncontrolled IOP.A possible complication after any ocular surgery however is hyphema,which can itself progress to uveitis glaucoma hyphema(UGH)syndrome on rare occasions.UGH syndrome has not yet been reported as a complication of AGV implantation.CASE SUMMARY Here,we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation.We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube.After the second surgery,the patient’s IOP was reduced,and she had a clear cornea and no signs of hyphema.CONCLUSION This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.展开更多
BACKGROUND Artificial urethral sphincter(AUS)implantation is currently the gold standard for treating moderate and severe urinary incontinence.Currently,cuffs are chosen based on the surgeon’s experience,and adjustin...BACKGROUND Artificial urethral sphincter(AUS)implantation is currently the gold standard for treating moderate and severe urinary incontinence.Currently,cuffs are chosen based on the surgeon’s experience,and adjusting cuff tightness is crucial.The TDOC air-charged catheter has not been proven to be inferior to traditional catheters.We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment,to guide cuff selection and adjustment.CASE SUMMARY A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy,using five pads/d to maintain local dryness.Preoperatively,the maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)were 52 cmH2O and 17 cmH2O,respectively.An AUS was implanted.Intraoperatively,in the inactivated state,the MUP and MUCP were 53 cmH2O and 50 cmH2O,respectively;in the activated state,they were 112 cmH2O and 109 cmH2O,respectively.The pump was activated 6 wk postoperatively.Re-measurement of the urethral pressure on the same day showed that in the inactivated state,MUP and MUCP were 89 cmH2O and 51 cmH2O,respectively,and in the activated state,120 cmH2O and 92 cmH2O,respectively.One month after device activation,telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d,which met the standard for social continence(0-1 pad per day).There were no complications.CONCLUSION The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.展开更多
BACKGROUND Solitary fibrous tumors(SFT)are rare spindle cell tumors that are usually benign.A total of 10 cases of SFTs in the upper esophagus have ever been reported.Here,we report the anesthetic management of a pati...BACKGROUND Solitary fibrous tumors(SFT)are rare spindle cell tumors that are usually benign.A total of 10 cases of SFTs in the upper esophagus have ever been reported.Here,we report the anesthetic management of a patient with a large isolated fibrous tumor of the upper esophagus compressing the tracheal membrane.We also provide a literature review of the current research.CASE SUMMARY We report the case of a 49 year old male with“cough aggravation and wheezing after exercise”,who underwent esophagectomy for a large isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.We advise the use of a single-lumen tube with a blocker in patients with difficult airways to reduce the incidence of airway injury and fibrinoscopy at all stages of the perioperative period to guide airway management.This case study is the first report of the anesthetic management of a large,isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.CONCLUSION This rare case emphasizes the importance of perioperative management of anesthesia in patients with large isolated fibrous tumors of the upper esophagus that compress the tracheal membrane.The use of blocker reduce the incidence of airway injury and fibrinoscopy at the perioperative period to guide airway mana-gement.展开更多
BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine out...BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.Howev...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.However,treatment remains challenging and controversial.We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography(CT)-guided negative pressure drainage treatment.CASE SUMMARY A 69-year-old male patient complained of difficulty swallowing within the last six months.He was diagnosed with esophagogastric junction carcinoma,Siewert II,cT3N0M0 stage II.Total gastrectomy and Roux-en-Y esophagojejunostomy were performed.High fever,left chest pain and dyspnea appeared on postoperative day 5,and EJAL was confirmed by CT,gastroscopy and oral blue-dimethylene tests.Conservative treatment measures were applied immediately,including antibiotics,nasojejunal tubes,and repeated thoracic puncture and drainage under ultrasound guidance.However,without sufficient and effective drainage,the thoracic infection and systemic condition continued to deteriorate.With the cooperation of multiple departments,percutaneous CT-guided drainage(24 Fr 7 mm)in the thoracic cavity was successfully placed near the anastomotic leakage.Because of continuous negative pressure suction,the infection symptoms were effectively controlled and the general situation gradually recovered.Subsequent follow-up examination showed that the patient was in good condition.CONCLUSION Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.展开更多
Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydr...Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydrochlorothiazide,exploring the drug’s association with hypokalemia and clinical treatment strategies.The patient experienced symptoms of muscle weakness and palpitations after taking irbesartan-hydrochlorothiazide and was diagnosed with hypokalemia through laboratory tests.Reviewing the patient’s medication history and disease progression,it was hypothesized that the drug’s potassium-wasting effect was the direct cause of the hypokalemia.After discontinuing the medication and initiating potassium supplementation,the patient’s potassium levels returned to normal,and symptoms significantly improved,further confirming the link between hypokalemia and the medication.This case suggests that clinicians should consider the risk of hypokalemia when treating hypertension,especially in patients with chronic kidney disease,the elderly,or those at risk for electrolyte disturbances.For patients who have already developed hypokalemia,potassium supplementation and adjustment of the treatment regimen are recommended to prevent further deterioration.Timely discontinuation of potential causative drugs is also advised.In summary,ensuring medication safety and preventing potential complications has significant clinical importance in recognizing and managing hypokalemia induced by irbesartan-hydrochlorothiazide.Future research should focus on optimizing treatment protocols and developing more effective strategies for preventing and managing related adverse reactions to improve patient quality of life.展开更多
The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. Th... The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.……展开更多
The accurate monitor and prediction of fracturing pressure for formation is very important to hydraulic fracturing treatment operation, but whether hydraulic fracturing is successful or not, the fracturing fluid plays...The accurate monitor and prediction of fracturing pressure for formation is very important to hydraulic fracturing treatment operation, but whether hydraulic fracturing is successful or not, the fracturing fluid plays a very important role, leak-off coefficient is the most leading parameters of fracturing fluids. Mini-frac test was the most commonly used tools for leak-off coefficient analysis, but it has the shortcoming of time-consuming and costly that can not meet the requirement of the production. The main purpose of this paper is to introduce a simple and convenient leak off coefficient analysis method with more inexpensive and time-saving than former methods. Based on ISIP （instantaneous shut-in pressure） method, a new field method of leak off coefficient field analysis model was presented. According to twice ISIP of the fracturing treatment in field operation, therefore, fluid leak off coefficient and formation characteristic can be studied quickly and reliably. More than 40 wells were fractured using this field method. The results show that average liquid rates of post-fracturing was 20 m3/d which double improvement compared with the past treatment wells. It had an important role for fracturing treatments in low permeability used in field application. reservoirs, the new model for real time analysis and adjust is successful展开更多
One of the major concepts of the geological disposal of high level radioactive waste is to enclose a metallic container with bentonite buffer which is considered to be impermeable and chemically stable. Since the aver...One of the major concepts of the geological disposal of high level radioactive waste is to enclose a metallic container with bentonite buffer which is considered to be impermeable and chemically stable. Since the average density of the container is around 6 to 7 and very heavy compared to bentonite, the scenario of container sinking has been evaluated because excess sinking makes short the pathway of nuclide migration in the bentonite and is detrimental to the safety of the disposal system. Previous considerations on container sinking have been made from the viewpoint of mechanical deformation of the bentonite. In this paper, a chemical deformation process is presented as another mechanism of container sinking, which has not been previously considered for the container sinking in the field of radioactive waste disposal. The chemical deformation mentioned in this paper is the deformation through the process of pressure solution of minerals constituting the buffer, transportation by diffusion and precipitation. That such chemical deformation is a ubiquitous phenomenon occurring in various scales in the crust of the earth will be shown through the review of previous works. Then, some future research topics will be suggested which would be required in order to evaluate the container sinking in the safety case for radioactive waste disposal.展开更多
文摘BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.
文摘BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
基金Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022RC158.
文摘BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.
文摘BACKGROUND Skin cancer is a common malignant tumor in dermatology.A large area must be excised to ensure a negative incisal margin on huge frontotemporal skin cancer,and it is difficult to treat the wound.In the past,treatment with skin grafting and pressure dressing was easy to cause complications such as wound infections,subcutaneous effusion,skin necrosis,and contracture.Negative pressure wound therapy(NPWT)has been applied to treat huge frontotemporal skin cancer.CASE SUMMARY Herein,we report the case of a 92-year-old woman with huge frontotemporal skin cancer.The patient presented to the surgery department complaining of ruptured bleeding and pain in a right frontal mass.The tumor was pathologically diagnosed as highly differentiated squamous cell carcinoma.The patient underwent skin cancer surgery and skin grafting,after which NPWT was used.She did not experience a relapse during the three-year follow-up period.CONCLUSION NPWT is of great clinical value in the postoperative treatment of skin cancer.It is not only inexpensive but also can effectively reduce the risk of surgical effusion,infection,and flap necrosis.
基金co-financed by the China National Natural Science Foundation and Shanghai Baosteel Group Corporation (No. 51074135)Program for New Century Excellent Talents in University (No. NCET-08-0907)Jilin Oilfield Company Project (No. JS10-W-14-JZ-32-51)
文摘Sustained casing pressure （SCP） in gas wells brings a serious threat to worker safety and environmental protection. According to geological conditions, wellbore structure and cement data of gas wells in the Sichuan-Chongqing region, China, the position, time, environmental condition and the value of SCP have been analyzed. On this basis, the shape of the pressure bleed-down plot and pressure buildup plot were diagnosed and the mechanism of SCP has been clarified. Based on generalized annular Darcy percolation theory and gas-liquid two-phase fluid dynamics theory, a coupled mathematical model of gas migration in a cemented annulus with a mud column above the cement has been developed. The volume of gas migrated in the annulus and the value of SCP changing with time in a gas well in Sichuan have been calculated by this model. Calculation results coincided well with the actual field data, which provide some reference for the following security evaluation and solution measures of SCP.
文摘Although pressure cells have been produced and installed successfully for decades,the accuracy of measured pressure is often inadequate.Due to large differences between the stiffness of pressure cells and the surrounding media,there is a considerable difference between applied pressure and that measured from pressure cells.It is often difficult and expensive to make a pressure cell with stiffness（modulus of elasticity） similar to the surrounding material in which it will be embedded.In order to improve this situation,a casing material with proportional dimensions is recommended as a means to obtain reliable results.In our study,the effect of using casing in the installation of pressure cells is investigated,providing the characteristics of casing.Some practical recommendations are presented to improve the accuracy of the results using casing.
文摘Based on statistical analysis on the situation of casing damage and water injection pressure in Pubei Oilfield, it shows that the main forms of casing damage in Pubei Oilfield are deformation and dislocation. Dip angle and faults have a significant impact on casing damage and casing damage is closely related to water injection pressure. Through laboratory simulating experiment and theoretical calculation, the formula of critical injection pressure giving rise to casing damage is obtained and the preventive measures are drafted.
基金National Natural Science Foundation for Young Scientists of China,No.81902281Guangdong Medical Science and Technology Research Foundation of China,No.A2019120 and No.A2020362and Special Project of Chinese Government for Science and Technology of Guangdong Province,No.2019SKJ003.
文摘BACKGROUND Lower body positive pressure(LBPP)treadmill has potential applications for improving the gait of patients after stroke,but the related mechanism remains unclear.CASE SUMMARY A 62-year-old male patient suffered from ischemic stroke with hemiplegic gait.He was referred to our hospital because of a complaint of left limb weakness for 2 years.The LBPP training was performed one session per day and six times per week for 2 wk.The dynamic plantar pressure analysis was taken every 2 d.Meanwhile,three-digital gait analysis and synchronous electromyography as well as clinical assessments were taken before and after LBPP intervention and at the 4-wk follow-up.During LBPP training,our patient not only improved his lower limb muscle strength and walking speed,but more importantly,the symmetry index of various biomechanical indicators improved.Moreover,the patient’s planter pressure transferring from the heel area to toe area among the LBPP training process and the symmetry of lower body biomechanical parameters improved.CONCLUSION In this study,we documented a dynamic improvement of gait performance in a stroke patient under LBPP training,which included lower limb muscle strength,walking speed,and symmetry of lower limb biomechanics.Our study provides some crucial clues about the potential dynamic mechanism for LBPP training on gait and balance improvement,which is related to rebuilding foot pressure distribution and remodeling symmetry of biomechanics of the lower limb.
基金Supported by the National Natural Science Foundation of China(No.51974332)。
文摘Since the production regime of shut-in after fracturing is generally adopted for wells in shale oil reservoir,a shut-in pressure drop model coupling wellbore-fracture network-reservoir oil-water two-phase flow has been proposed.The model takes into account the effects of wellbore afterflow,fracture network channeling,and matrix imbibition and oil exchange after stop of pumping.The simulated log-log curve of pressure-drop derivative by the model presents W-shape,reflecting the oil-water displacement law between wellbore,fracture network and matrix,and is divided into eight main control flow stages according to the soaking time.In the initial stage of pressure drop,the afterflow dominates;in the early stage,the pressure drop is controlled by the cross-flow and leakoff of the fracture system,and the fractures close gradually;in the middle stage of pressure drop,matrix imbibition and oil exchange take dominance,and the fracturing fluid loss basically balances with oil replaced from matrix;the late stage of pressure drop is the reservoir boundary control stage,and the leakoff rate of fracturing-fluid and oil exchange rate decrease synchronously till zero.Finally,the fracture network parameters such as half-length of main fracture,main fracture conductivity and secondary fracture density were inversed by fitting the pressure drop data of five wells in Jimsar shale oil reservoir,and the water imbibition volume of matrix and the oil replacement volume in fracture were calculated by this model.The study results provide a theoretical basis for comprehensively evaluating the fracturing effect of shale oil hori-zontal wells and understanding the oil-water exchange law of shale reservoir after fracturing.
文摘BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patients with uncontrolled IOP.A possible complication after any ocular surgery however is hyphema,which can itself progress to uveitis glaucoma hyphema(UGH)syndrome on rare occasions.UGH syndrome has not yet been reported as a complication of AGV implantation.CASE SUMMARY Here,we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation.We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube.After the second surgery,the patient’s IOP was reduced,and she had a clear cornea and no signs of hyphema.CONCLUSION This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.
基金National Key R and D Program of China,No.2018YFC2002202
文摘BACKGROUND Artificial urethral sphincter(AUS)implantation is currently the gold standard for treating moderate and severe urinary incontinence.Currently,cuffs are chosen based on the surgeon’s experience,and adjusting cuff tightness is crucial.The TDOC air-charged catheter has not been proven to be inferior to traditional catheters.We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment,to guide cuff selection and adjustment.CASE SUMMARY A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy,using five pads/d to maintain local dryness.Preoperatively,the maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)were 52 cmH2O and 17 cmH2O,respectively.An AUS was implanted.Intraoperatively,in the inactivated state,the MUP and MUCP were 53 cmH2O and 50 cmH2O,respectively;in the activated state,they were 112 cmH2O and 109 cmH2O,respectively.The pump was activated 6 wk postoperatively.Re-measurement of the urethral pressure on the same day showed that in the inactivated state,MUP and MUCP were 89 cmH2O and 51 cmH2O,respectively,and in the activated state,120 cmH2O and 92 cmH2O,respectively.One month after device activation,telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d,which met the standard for social continence(0-1 pad per day).There were no complications.CONCLUSION The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.
文摘BACKGROUND Solitary fibrous tumors(SFT)are rare spindle cell tumors that are usually benign.A total of 10 cases of SFTs in the upper esophagus have ever been reported.Here,we report the anesthetic management of a patient with a large isolated fibrous tumor of the upper esophagus compressing the tracheal membrane.We also provide a literature review of the current research.CASE SUMMARY We report the case of a 49 year old male with“cough aggravation and wheezing after exercise”,who underwent esophagectomy for a large isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.We advise the use of a single-lumen tube with a blocker in patients with difficult airways to reduce the incidence of airway injury and fibrinoscopy at all stages of the perioperative period to guide airway management.This case study is the first report of the anesthetic management of a large,isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.CONCLUSION This rare case emphasizes the importance of perioperative management of anesthesia in patients with large isolated fibrous tumors of the upper esophagus that compress the tracheal membrane.The use of blocker reduce the incidence of airway injury and fibrinoscopy at the perioperative period to guide airway mana-gement.
文摘BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.
基金Supported by National Natural Science Foundation of China,No.H0306/81100254.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.However,treatment remains challenging and controversial.We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography(CT)-guided negative pressure drainage treatment.CASE SUMMARY A 69-year-old male patient complained of difficulty swallowing within the last six months.He was diagnosed with esophagogastric junction carcinoma,Siewert II,cT3N0M0 stage II.Total gastrectomy and Roux-en-Y esophagojejunostomy were performed.High fever,left chest pain and dyspnea appeared on postoperative day 5,and EJAL was confirmed by CT,gastroscopy and oral blue-dimethylene tests.Conservative treatment measures were applied immediately,including antibiotics,nasojejunal tubes,and repeated thoracic puncture and drainage under ultrasound guidance.However,without sufficient and effective drainage,the thoracic infection and systemic condition continued to deteriorate.With the cooperation of multiple departments,percutaneous CT-guided drainage(24 Fr 7 mm)in the thoracic cavity was successfully placed near the anastomotic leakage.Because of continuous negative pressure suction,the infection symptoms were effectively controlled and the general situation gradually recovered.Subsequent follow-up examination showed that the patient was in good condition.CONCLUSION Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.
文摘Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydrochlorothiazide,exploring the drug’s association with hypokalemia and clinical treatment strategies.The patient experienced symptoms of muscle weakness and palpitations after taking irbesartan-hydrochlorothiazide and was diagnosed with hypokalemia through laboratory tests.Reviewing the patient’s medication history and disease progression,it was hypothesized that the drug’s potassium-wasting effect was the direct cause of the hypokalemia.After discontinuing the medication and initiating potassium supplementation,the patient’s potassium levels returned to normal,and symptoms significantly improved,further confirming the link between hypokalemia and the medication.This case suggests that clinicians should consider the risk of hypokalemia when treating hypertension,especially in patients with chronic kidney disease,the elderly,or those at risk for electrolyte disturbances.For patients who have already developed hypokalemia,potassium supplementation and adjustment of the treatment regimen are recommended to prevent further deterioration.Timely discontinuation of potential causative drugs is also advised.In summary,ensuring medication safety and preventing potential complications has significant clinical importance in recognizing and managing hypokalemia induced by irbesartan-hydrochlorothiazide.Future research should focus on optimizing treatment protocols and developing more effective strategies for preventing and managing related adverse reactions to improve patient quality of life.
文摘 The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.……
文摘The accurate monitor and prediction of fracturing pressure for formation is very important to hydraulic fracturing treatment operation, but whether hydraulic fracturing is successful or not, the fracturing fluid plays a very important role, leak-off coefficient is the most leading parameters of fracturing fluids. Mini-frac test was the most commonly used tools for leak-off coefficient analysis, but it has the shortcoming of time-consuming and costly that can not meet the requirement of the production. The main purpose of this paper is to introduce a simple and convenient leak off coefficient analysis method with more inexpensive and time-saving than former methods. Based on ISIP （instantaneous shut-in pressure） method, a new field method of leak off coefficient field analysis model was presented. According to twice ISIP of the fracturing treatment in field operation, therefore, fluid leak off coefficient and formation characteristic can be studied quickly and reliably. More than 40 wells were fractured using this field method. The results show that average liquid rates of post-fracturing was 20 m3/d which double improvement compared with the past treatment wells. It had an important role for fracturing treatments in low permeability used in field application. reservoirs, the new model for real time analysis and adjust is successful
文摘One of the major concepts of the geological disposal of high level radioactive waste is to enclose a metallic container with bentonite buffer which is considered to be impermeable and chemically stable. Since the average density of the container is around 6 to 7 and very heavy compared to bentonite, the scenario of container sinking has been evaluated because excess sinking makes short the pathway of nuclide migration in the bentonite and is detrimental to the safety of the disposal system. Previous considerations on container sinking have been made from the viewpoint of mechanical deformation of the bentonite. In this paper, a chemical deformation process is presented as another mechanism of container sinking, which has not been previously considered for the container sinking in the field of radioactive waste disposal. The chemical deformation mentioned in this paper is the deformation through the process of pressure solution of minerals constituting the buffer, transportation by diffusion and precipitation. That such chemical deformation is a ubiquitous phenomenon occurring in various scales in the crust of the earth will be shown through the review of previous works. Then, some future research topics will be suggested which would be required in order to evaluate the container sinking in the safety case for radioactive waste disposal.
