Novel subtype of obesity influencing the outcomes of sleeve gastrectomy:Familial aggregation of obesity

BACKGROUND Differences in the preoperative characteristics and weight loss outcomes after sleeve gastrectomy(SG)between patients with familial aggregation of obesity(FAO)and patients with sporadic obesity(SO)have not been elucidated.AIM To explore the impact of SG on weight loss and the alleviation of obesity-related comorbidities in individuals with FAO.METHODS A total of 193 patients with obesity who underwent SG were selected.Patients with FAO/SO were matched 1:1 by propensity score matching and were categorized into 4 groups based on the number of first-degree relatives with obesity(1 SO vs 1FAO,2SO vs 2FAO).The baseline characteristics,weight loss outcomes,prevalence of obesity-related comorbidities and incidence of major surgeryrelated complications were compared between groups.RESULTS We defined FAO as the presence of two or more first-degree relatives with obesity.Patients with FAO did not initially show significant differences in baseline data,short-term postoperative weight loss,or obesity-related comorbidities when compared to patients with SO preoperatively.However,distinctions between the two groups became evident at the two-year mark,with statistically significant differences in both percentage of total weight loss(P=0.006)and percentage of excess weight loss(P<0.001).The FAO group exhibited weaker remission of type 2 diabetes mellitus(T2DM)(P=0.031),hyperlipidemia(P=0.012),and non-alcoholic fatty liver disease(NAFLD)(P=0.003)as well as a lower incidence of acid reflux(P=0.038).CONCLUSION FAO patients is associated with decreased mid-to-long-term weight loss outcomes;the alleviation of T2DM,hyperlipidemia and NAFLD;and decreased incidence of acid reflux postoperatively.

Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

Research on Sleeve Grouting Density Detection Based on the Impact Echo Method

Grouting defects are an inherent challenge in construction practices,exerting a considerable impact on the operational structural integrity of connections.This investigation employed the impact-echo technique for the detection of grouting anomalies within connections,enhancing its precision through the integration of wavelet packet energy principles for damage identification purposes.A series of grouting completeness assessments were meticulously conducted,taking into account variables such as the divergent material properties of the sleeves and the configuration of adjacent reinforcement.The findings revealed that:(i)the energy distribution for the highstrength concrete cohort predominantly occupied the frequency bands 42,44,45,and 47,whereas for other groups,it was concentrated within the 37 to 40 frequency band;(ii)the delineation of empty sleeves was effectively discernible by examining the wavelet packet energy ratios across the spectrum of frequencies,albeit distinguishing between sleeves with 50%and full grouting density proved challenging;and(iii)the wavelet packet energy analysis yielded variable detection outcomes contingent on the material attributes of the sleeves,demonstrating heightened sensitivity when applied to ultrahigh-performance concrete matrices and GFRP-reinforced steel bars.

Left lower lobe sleeve resection for the clear cell variant of pulmonary mucoepidermoid carcinoma:A case report

BACKGROUND Pulmonary mucoepidermoid carcinoma(PMEC)is a rare malignancy that arises from minor salivary glands within the tracheobronchial tree.The clear cell variant of PMEC is exceptionally uncommon and presents notable diagnostic challenges,primarily attributable to its morphological similarity to other tumors containing clear cells.CASE SUMMARY A 22-year-old male,formerly in good health,came in with a two-month duration of persistent cough and production of sputum.Subsequent imaging and bronchoscopy examinations revealed a 2 cm tumor in the distal left main bronchus,which resulted in complete atelectasis of the left lung.Further assessment via positron emission tomography/computed tomography scans and endoscopic biopsy confirmed the primary malignant nature of the tumor,charac-terized by clear cell morphology in most of the tumor cells.The patient underwent a left lower lobe sleeve resection accompanied by systematic mediastinal lymph node dissection.Molecular pathology analysis subsequently revealed a CRTC3-MAML2 gene fusion,leading to a definitive pathological diagnosis of the clear cell variant of PMEC,staged as T2N0M0.After surgery,the patient experienced a smooth recovery and exhibited no signs of recurrence during the one-and-a-half-year follow-up period.CONCLUSION This article describes an unusual case of a clear cell variant of PMEC characterized by the presence of a CRTC3-MAML2 gene fusion in a 22-year-old male.The patient underwent successful left lower lobe sleeve resection.This case underscores the distinctive challenges associated with diagnosing and treating this uncommon malignancy,underscoring the importance of precise diagnosis and personalized treatment strategies.

Nerve growth factor-basic fibroblast growth factor poly-lactide co-glycolid sustained-release microspheres and the small gap sleeve bridging technique to repair peripheral nerve injury

We previously prepared nerve growth factor poly-lactide co-glycolid sustained-release microspheres to treat rat sciatic nerve injury using the small gap sleeve technique.Multiple growth factors play a synergistic role in promoting the repair of peripheral nerve injury;as a result,in this study,we added basic fibroblast growth factors to the microspheres to further promote nerve regeneration.First,in an in vitro biomimetic microenvironment,we developed and used a drug screening biomimetic microfluidic chip to screen the optimal combination of nerve growth factor/basic fibroblast growth factor to promote the regeneration of Schwann cells.We found that 22.56 ng/mL nerve growth factor combined with 4.29 ng/mL basic fibroblast growth factor exhibited optimal effects on the proliferation of primary rat Schwann cells.The successfully prepared nerve growth factor-basic fibroblast growth factor-poly-lactide-co-glycolid sustained-release microspheres were used to treat rat sciatic nerve transection injury using the small gap sleeve bridge technique.Compared with epithelium sutures and small gap sleeve bridging alone,the small gap sleeve bridging technique combined with drug-free sustained-release microspheres has a stronger effect on rat sciatic nerve transfection injury repair at the structural and functional level.

Endoscopic sleeve gastroplasty in class Ⅲ obesity:Efficacy, safety, and durability outcomes in 404 consecutive patients

BACKGROUND Endoscopic sleeve gastroplasty(ESG) is an effective therapy for class Ⅰ-Ⅱ obesity, but there are knowledge gaps in the published literature about its implementation in patients with class Ⅲ obesity [body mass index(BMI) ≥ 40 kg/m2].AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class Ⅲ obesity.METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss(TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss(EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.RESULTS 404 consecutive patients(78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type Ⅱ diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization(0.2% serious adverse event rate).CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class Ⅲ obesity, with improvement in comorbidities and an acceptable safety profile.

Numerical study on erosion behavior of sliding sleeve ball seat for hydraulic fracturing based on experimental data

The sleeve sealing ball seat is one of the important components in the multistage fracturing process of horizontal wells.The erosion and wear of the surface will decrease the sealing performance of the fracturing ball and the ball seat.This leads to pressure leakage during the fracturing process and fracturing failure.In this paper,combined with the actual ball seat materials and working conditions during the fracturing process,the erosion tests of ductile iron and tungsten carbide materials under different erosion speeds,angles,and mortar concentrations are carried out.Then the erosion test results were analyzed by mathematical fitting,and a set of erosion models suitable for sliding sleeve setting ball seat materials were innovatively established.For the first time,this paper combines the erosion model obtained from the experiment and the computational fluid dynamics(CFD)with Fluent software to simulate the erosion of the ball seat.Based on the simulation results,the morphology of the sliding sleeve seat ball after erosion is predicted.Through analysis of the test and simulation results,it is showed that the erosion rate of tungsten carbide material is lower and the wear resistance is better under the condition of small angle erosion.This research can offer a strong basis for fracturing site selection,surface treatment methods,and prediction of failure time of ball seats.

Laparoscopic Sleeve Gastrectomy following Pylorus-Preserving Pancreaticoduodenectomy

Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.

Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome

BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020.The changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically analyzed.RESULTS At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the operation.The percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before surgery.During the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after surgery.CONCLUSION The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.

Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big gastric hole, being afraid of causing some anatomic or functional disturbance in gastric emptying. Instead, we decided to use the gastric opening to construct a Roux-en-Y antrotrojejunal anastomosis, with a 50 cm alimentary limb and a 200 cm biliopancreatic limb. Accordingly, it was performed a sleeve gastrectomy, associated with an antrojejunostomy in a Roux-en-Y fashion. The patient had an uneventful postoperative course. In the second year, she achieved normal weight and good nutritional status, without gastroesophageal reflux symptoms complaints. Seriography study shows that most of the contrast material passes through the antrojejunal anastomosis, instead of the pylorus, while the duodenum is endoscopically patent. This case report shows an unexpected surgical finding that led to a tactic of adding a Roux-en-Y gastric bypass in the antrum, associated with a sleeve gastrectomy, a strategy that may be adopted in cases of morbidly obese patients with important GERD, for whom gastrointestinal exclusions are contraindicated. To confirm this hypothesis, controlled studies are needed.

Fibroblast growth factor 15,induced by elevated bile acids,mediates the improvement of hepatic glucose metabolism after sleeve gastrectomy

BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine manner.The levels of both bile acids(BAs)and FGF15/19 are elevated after bariatric surgery.However,it is unclear whether the increase in FGF15/19 is induced by BAs.Moreover,it remains to be understood whether FGF15/19 elevations contribute to improvements in hepatic glucose metabolism after bariatric surgery.AIM To investigate the mechanism of improvement of hepatic glucose metabolism by elevated BAs after sleeve gastrectomy(SG).METHODS By calculating and comparing the changes of body weight after SG with SHAM group,we examined the weight-loss effect of SG.The oral glucose tolerance test(OGTT)test and area under the curve of OGTT curves were used to assess the anti-diabetic effects of SG.By detecting the glycogen content,expression and activity of glycogen synthase as well as the glucose-6-phosphatase(G6Pase)and phosphoenolpyruvate carboxykinase(Pepck),we evaluated the hepatic glycogen content and gluconeogenesis activity.We examined the levels of total BA(TBA)together with the farnesoid X receptor(FXR)-agonistic BA subspecies in systemic serum and portal vein at week 12 post-surgery.Then the histological expression of ileal FXR and FGF15 and hepatic FGF receptor 4(FGFR4)with its corresponding signal pathways involved in glucose metabolism were detected.RESULTS After surgery,food intake and body weight gain of SG group was decreased compare with the SHAM group.The hepatic glycogen content and glycogen synthase activity was significantly stimulated after SG,while the expression of the key enzyme for hepatic gluconeogenesis:G6Pase and Pepck,were depressed.TBA levels in serum and portal vein were both elevated after SG,the FXR-agonistic BA subspecies:Chenodeoxycholic acid(CDCA),lithocholic acid(LCA)in serum and CDCA,DCA,LCA in portal vein were all higher in SG group than that in SHAM group.Consequently,the ileal expression of FXR and FGF15 were also advanced in SG group.Moreover,the hepatic expression of FGFR4 was stimulated in SG-operated rats.As a result,the activity of its corresponding pathway for glycogen synthesis:FGFR4-Ras-extracellular signal regulated kinase pathway was stimulated,while the corresponding pathway for hepatic gluconeogenesis:FGFR4-cAMP regulatory element-binding protein-peroxisome proliferator-activated receptorγcoactivator-1αpathway was suppressed.CONCLUSION Elevated BAs after SG induced FGF15 expression in distal ileum by activating their receptor FXR.Furthermore,the promoted FGF15 partly mediated the improving effects on hepatic glucose metabolism of SG.

State of art on the mechanisms of laparoscopic sleeve gastrectomy in treating type 2 diabetes mellitus

Obesity and type-2 diabetes mellitus(T2DM)are metabolic disorders.Obesity increases the risk of T2DM,and as obesity is becoming increasingly common,more individuals suffer from T2DM,which poses a considerable burden on health systems.Traditionally,pharmaceutical therapy together with lifestyle changes is used to treat obesity and T2DM to decrease the incidence of comorbidities and allcause mortality and to increase life expectancy.Bariatric surgery is increasingly replacing other forms of treatment of morbid obesity,especially in patients with refractory obesity,owing to its many benefits including good long-term outcomes and almost no weight regain.The bariatric surgery options have markedly changed recently,and laparoscopic sleeve gastrectomy(LSG)is gradually gaining popularity.LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity,with a high cost-benefit ratio.Here,we review the mechanism associated with LSG treatment of T2DM,and we discuss clinical studies and animal experiments with regard to gastrointestinal hormones,gut microbiota,bile acids,and adipokines to clarify current treatment modalities for patients with obesity and T2DM.

Methodology for Obtaining Optimal Sleeve Friction and Friction Ratio Estimates from CPT Data

Cone penetration testing (CPT) is a cost effective and popular tool for geotechnical site characterization. CPT consists of pushing at a constant rate an electronic penetrometer into penetrable soils and recording cone bearing (qc), sleeve friction (fc) and dynamic pore pressure (u) with depth. The measured qc, fs and u values are utilized to estimate soil type and associated soil properties. A popular method to estimate soil type from CPT measurements is the Soil Behavior Type (SBT) chart. The SBT plots cone resistance vs friction ratio, Rf [where: Rf = (fs/qc)100%]. There are distortions in the CPT measurements which can result in erroneous SBT plots. Cone bearing measurements at a specific depth are blurred or averaged due to qc values being strongly influenced by soils within 10 to 30 cone diameters from the cone tip. The qcHMM algorithm was developed to address the qc blurring/averaging limitation. This paper describes the distortions which occur when obtaining sleeve friction measurements which can in association with qc blurring result in significant errors in the calculated Rf values. This paper outlines a novel and highly effective algorithm for obtaining accurate sleeve friction and friction ratio estimates. The fc optimal filter estimation technique is referred to as the OSFE-IFM algorithm. The mathematical details of the OSFE-IFM algorithm are outlined in this paper along with the results from a challenging test bed simulation. The test bed simulation demonstrates that the OSFE-IFM algorithm derives accurate estimates of sleeve friction from measured values. Optimal estimates of cone bearing and sleeve friction result in accurate Rf values and subsequent accurate estimates of soil behavior type.

套筒灌浆搭接及对接接头高应力反复拉压试验

为比较套筒灌浆搭接及对接接头间力学性能差异,进行了41个搭接接头和20个对接接头的单拉及高应力反复拉压试验。结果表明:单拉及高应力反复拉压时,两种接头均能实现最大力下总伸长率大于6%、延性系数大于4,强度基本满足规范要求;高应力反复拉压后单拉时,两种接头承载力均有所提高,但接头初始刚度和延性下降;防偏转措施可减少搭接接头残余变形,但其约束刚度有限,搭接接头残余变形略大于对接接头,防偏转搭接接头及对接接头残余变形基本满足规范要求;高应力反复拉压后单拉时,搭接接头套筒中部截面在加载前期纵向受拉、环向受压,加载后期纵向受压、环向受拉,对接接头套筒加载过程中均为纵向受拉、环向受压;高应力反复拉压结束后单拉时,防偏转、不防偏转搭接接头套筒中部截面近钢筋侧最大纵向拉应变分别为对接接头的0.10~0.39倍、0.13~0.18倍,最大环向压应变分别为对接接头的0.09~0.49倍、0.02~0.32倍,搭接接头对套筒材性要求较低;钢筋直径相同时搭接接头材料成本较对接接头降低约35%。

腹腔镜胃袖状切除术治疗肥胖症的效果及对血清瘦素、脂联素水平的影响

目的分析腹腔镜胃袖状切除术(LSG)治疗肥胖症的效果及对血清瘦素、脂联素水平的影响。方法纳入50例行LSG治疗的肥胖症患者,统计患者的手术情况(手术时间、术中出血量、术后肛门排气时间、术后住院时间)。术后随访6个月,比较患者术前和术后1个月、3个月、6个月的血清瘦素、脂联素水平及减重指标[体重、体质指数、多余体重减少百分比(EWL%)、腰围]。统计患者术后6个月内不良反应的发生情况及合并症的改善情况。结果50例患者均顺利完成手术,手术时间为70~160(118.6±20.4)min,术中出血量为24~75(48.3±18.7)mL,术后肛门排气时间为2~4(2.3±0.5)d,术后住院天数为4~10(8.2±2.4)d。患者的血清瘦素、脂联素水平及体重、体质指数、EWL%、腰围均有随时间变化的趋势(P<0.05),其中,术后1个月、3个月、6个月,患者血清瘦素水平、体重、体质指数、腰围低于术前,血清脂联素水平高于术前,术后EWL%呈逐渐升高的趋势(P<0.05)。术后6个月,仅有1例患者出现肺部感染,患者的合并疾病均得到明显改善。结论LSG治疗肥胖症的效果显著,可明显改善患者的血清瘦素和脂联素水平,还可以改善肥胖症的合并疾病,临床效果较好。

钢筋连接套筒智能检测生产线控制系统设计

针对当前工业生产中钢筋连接套筒检测效率和精度低下等问题,设计一种基于PLC的钢筋连接套筒智能检测生产线,有效提高钢筋连接套筒的检测效率。介绍该生产线的主体结构、工作原理,重点阐述该设备中智能检测和自动旋转定位系统的硬件组成和控制方法。设计以PLC为核心,以触摸屏为人机界面的控制系统,得到硬件结构图和主要控制元件型号,并详细介绍PLC的连接和编程问题。对于气动系统,得到了气动系统原理图和主要气动元件型号。在触摸屏中设计了手自动控制画面,实现了数据记录和报警记录功能模块的开发。生产样机的测试结果表明:系统运行稳定可靠,进一步优化改进后,可大量替代人工检测。

带锚板预应力螺纹钢筋抗拔性能试验研究

目的为了探讨直径25 mm、强度等级PSB1080的带锚板预应力螺纹钢筋在有效锚固长150,200,250 mm的钢筋混凝土厚板或基础中拔出时的锚固性能,方法以有效锚固长度、套管有无、锚板宽度和构造钢筋数量为试验参数,对7个试件进行抗拔性能试验研究。研究试件的破坏特征,分析荷载-位移曲线、极限抗拔承载力、试件开裂荷载和荷载-应变曲线。结果结果表明:试件抗拔承载力随着锚固长度的增加而增加,当有效锚固长度为250 mm时,预应力螺纹钢筋均能达到屈服;混凝土开裂荷载随着有效锚固长度、锚板宽度和套管的增设而增加,构造钢筋数量对面层混凝土开裂荷载的影响并不明显;采用套管试件的面层混凝土开裂荷载比未采用套管试件提高了2.66倍;根据荷载-位移曲线可知,在锚板上增设构造钢筋可以防止带锚板预应力螺纹钢筋拔出时承载力急剧下降;基于试验结果和相关文献结果,对比锚固区混凝土锥体破坏试件的试验值与计算值可知,Nilforoush建议式和日本JSCE规范式9.2.11分别比试验值低19%和10%。结论增设套管可以有效提高开裂荷载;使用日本JSCE规范式9.2.11计算抗拔承载力更接近试验值。

套筒压裂作用下岩石细观裂隙与能量演化规律探究

为从细观层面揭示不同围压作用下套筒压裂岩石破坏机理及能量运移规律,基于套筒压裂试验以及膨胀力测定试验构建了PFC^(3D)数值模型,采用离散元法对套筒压裂过程开展数值模拟,结合声发射信息探究了套筒压裂过程中不同围压对岩石细观裂隙及能量变化的影响规律,并依据弹性力学揭示了套筒压裂力学机制,研究结果表明:①套筒注液过程存在压力损失,依据注液压力损失率可将注液过程大致划分为充填阶段、增压阶段、快速增压阶段。注液压力与套筒膨胀力呈线性关系,其修正系数为0.678。②基于PFC^(3D)所构建的数值模型能够较好的反映套筒压裂过程中岩石力学性质与变形破坏特征,岩石压裂过程以张拉破坏为主。围压决定着裂缝的扩展路径,并对岩石内部微裂纹的生成起抑制作用。随着应力差的逐渐增大,岩石内部剪切裂纹数量及占比均逐渐增大。③声发射信号可分为平静期与活跃期,累计裂缝数目曲线呈现阶梯状上升。无围压条件下,声发射特征呈现单峰值分布;有围压条件下,声发射特征呈现多峰值分布,压裂过程存在多个破坏阶段。④套筒膨胀力作用范围有限,环向拉应力作用范围与套筒膨胀力呈现对数关系。切向应力随应力差的增大而增大,当夹角φ取值为45°或135°时,岩石内部剪切破坏最明显。⑤同一膨胀力作用下,围压越大岩石内部输入能越小。不同围压条件下岩石的输入能、弹性能、耗散能均出现不同程度的激增,这主要是由于宏观裂缝的形成引发了钻孔扩容;耗散能平均增长速率更快,为弹性能的1.27~1.55倍。

耳穴压豆联合艾灸在减重术后患者中的应用效果

目的探究耳穴压豆联合艾灸在腹腔镜袖状胃切除术(LSG)后患者中的应用效果。方法选取2018年3月至2022年11月期间在普外一科接受LSG的105例患者作为研究对象,采用随机抽签法将其分为对照组(n=53)与试验组(n=52)。对照组术后采用常规护理加认知行为模式进行干预,试验组在对照组护理的基础上,于术后6个月时增加使用艾灸联合耳穴压豆方法干预。比较2组患者手术后6、8、10、12个月所测体重、体重指数(BMI)、腰臀比(WHR)、体脂率(BF)、内脏脂肪面积(VFA)、多余体重减少百分比(EWL)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平。结果术后6个月,2组体重、BMI、WHR、BF、VFA、EWL、TC、TG、LDL-C、HDL-C比较差异无统计学意义(P>0.05)。术后8、10和12个月时,试验组体重、BMI、WHR、BF、VFA、TC、TG、LDL-C、HDL-C明显低于对照组(P<0.05或P<0.001),且EWL明显高于对照组(P<0.05)。结论耳穴压豆联合艾灸应用于LSG术后的患者可以有效提高其代谢水平,调节其内分泌功能,有助于巩固减重手术的中长期效果,预防术后复胖的发生。

无线射频压裂滑套系统模拟试验研究

将无线射频识别(RFID)技术应用到油水井压裂中,能够很好地解决现有压裂滑套存在的压裂级数受限、操作非智能等诸多问题。因井下工况复杂,理论分析与实际应用差别较大,为进一步系统地探究井下无线射频系统的开发应用,使用三维软件设计无线射频滑套模拟试验台,对标签的运动状态进行理论分析,并建立室内模拟试验平台,系统地进行井下相关试验。试验结果表明:标签选择有铁氧体磁芯,且天线绕制形式选用单层螺线管线圈,可以提高整个系统的性能;在系统电感值相同的情况下,单层螺线管天线轴向长度对阅读器模块能识别的标签最大通过速度有积极的影响;标签天线线圈与阅读器天线线圈平面之间的角度也会影响标签的识别率。研究结果对井下无线射频系统的开发应用具有一定的指导作用。