Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsul...Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.展开更多
The siphon drainage is an effective measure for the slope groundwater control. However,for the traditional siphon drainage, limitations such as siphon lift restriction and poor reliability in longterm service prevent ...The siphon drainage is an effective measure for the slope groundwater control. However,for the traditional siphon drainage, limitations such as siphon lift restriction and poor reliability in longterm service prevent it from being widely used. In this study, an improved siphon drainage method with inclined borehole penetrating the deep part of the slope is proposed to overcome the limitations suffered by the traditional method. Through experimental research, theoretical analysis and engineering practice,the reliability and capability of the proposed method are investigated. The results demonstrate that with the inclined pipe the height difference between the control point of the groundwater level and the orifice can be controlled to be less than the height of the water column corresponding to the local atmospheric pressure. As a result, deep drainage can be achieved.In addition, by controlling the diameter of siphon drainage pipe not larger than 4 mm, a plug flow can be formed in the siphon pipe, which can prevent air accumulation in the siphon process and a continuous and effective siphon drainage is achieved. Through a practical project running smoothly since September 2013, it is found that the proposed method can effectively drain the groundwater deep in the slope and the maximum drawdown of groundwater level in boreholes can reach 8.5 m with an average drainage flow of 5.5 m3/d. The practical results also illustrate that 4 mm siphon pipe can be used to realize deep slope drainage and restart siphon automatically.展开更多
BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinic...BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.展开更多
Tunnel seepage is an important factor affecting the progress and safety of tunnel construction. In this paper, the mining method tunnel construction in the water-rich weathered granite stratum is taken as the research...Tunnel seepage is an important factor affecting the progress and safety of tunnel construction. In this paper, the mining method tunnel construction in the water-rich weathered granite stratum is taken as the research object. Through the analytical calculation method, the distribution law of tunnel seepage field under different waterproof and drainage types is studied, and the comparative analysis is carried out. According to the analytical solution, the influencing factors of grouting parameters are proposed. The sensitivity of the tunnel seepage field to the variation of grouting parameters is analyzed. A novel waterproof and drainage system, and construction technology suitable for subway tunnels with large buried depth below groundwater level were proposed.展开更多
Although time-dependent deformation of geomaterials underpins slope-failure prediction models,the influence of strain rate on shearing strength and deformation behavior of loess remains unclear.The consolidated undrai...Although time-dependent deformation of geomaterials underpins slope-failure prediction models,the influence of strain rate on shearing strength and deformation behavior of loess remains unclear.The consolidated undrained(CU)and drained(CD)triaxial testing elucidated the impact of strain rate(0.005–0.3 mm/min)on strength envelopes,deformation moduli,pore pressures,and dilatancy characteristics of unsaturated and quasi-saturated loess.Under drained conditions with a controlled matric suction of 50 kPa,increasing strain rates from 0.005 mm/min to 0.011 mm/min induced decreases in failure deviatoric stress(qf),initial deformation modulus(Ei),and cohesion(c),while friction angles remained unaffected.Specimens displayed initial contractive volumetric strains transitioning to dilation across varying confining pressures.Higher rates diminished contractive volumetric strains and drainage volumes,indicating reduced densification and strength in the shear zone.Under undrained conditions,both unsaturated and quasi-saturated(pore pressure coefficient B=0.75)loess exhibited deteriorating mechanical properties with increasing rates from 0.03 mm/min to 0.3 mm/min.For unsaturated loess,reduced contractive volumetric strains at higher rates manifested relatively looser structures in the pre-peak stress phase.The strength decrement in quasi-saturated loess arose from elevated excess porewater pressures diminishing effective stresses.Negative porewater pressures emerged in quasi-saturated loess at lower confining pressures and strain rates.Compared to previous studies,the qf and Ei exhibited rate sensitivity below threshold values before attaining minima with marginal subsequent influence.The underlying mechanism mirrors the transition from creep to accelerated deformation phase of landslides.展开更多
The complex relationships between indicators and water conditions cause fuzzy and gray uncertainties in evaluation of water quality. Compared to conventional single-factor evaluation methods, the combination evaluatio...The complex relationships between indicators and water conditions cause fuzzy and gray uncertainties in evaluation of water quality. Compared to conventional single-factor evaluation methods, the combination evaluation method can consider these two uncertainties to produce more objective and reasonable evaluation results. In this paper, we propose a combination evaluation method with two main parts:(1) the use of fuzzy comprehensive evaluation and gray correlation analysis as submodels with which to consider the fuzzy and gray uncertainties and(2) the establishment of a combination model based on minimum bias squares. In addition, using this method, we evaluate the water quality of a ditch in a typical rice–wheat system of Yixing city in the Taihu Lake Basin during three rainfall events. The results show that the ditch water quality is not good and we found the chemical oxygen demand to be the key indicator that affects water quality most significantly. The proposed combination evaluation method is more accurate and practical than single-factor evaluation methods in that it considers the uncertainties of fuzziness and grayness.展开更多
A new anchor-siphon drainage combined method used for slope stabilization is proposed in this paper.It includes an anchoring section and a siphon drainage section.The novelty of the anchor-siphon drainage combined met...A new anchor-siphon drainage combined method used for slope stabilization is proposed in this paper.It includes an anchoring section and a siphon drainage section.The novelty of the anchor-siphon drainage combined method is the realization of the drainage and anchoring in the one inclined borehole.The engineering cost of drilling and the resulting disturbance to the slope is reduced.To validate the feasibility of the proposed method,a numerical method that combines the pore water pressure distribution after siphon drainage and the anchoring force of the anchoring section is used to evaluate the safety of the slope with the anchor-siphon drainage method.The proposed method was illustrated and validated with the Hongpu Village landslide,in Tonglu County,Zhejiang Province,in China.Compared with the common anchor bar with the same length in the anchoring section,the factor of safety(FOS)for Hongpu Village slope with anchorsiphon drainage is increased by 0.085.The calculation method of the optimal length ratio between the drainage section and the anchoring section and its influencing factors were studied.For the different design parameters,there is always an optimal length ratio of the drainage section.Compared with the siphon drainage and full-length anchor bar with the same borehole length,the anchor-siphon drainage combined method shows better landslide prevention ability.Moreover,when the optimized parameters with a bond strength of 560kPa,a borehole inclination of 35°,and no reduction in length are used,the calculated safety factor is 1.316,which is significantly higher than the FOS of 1.131 for the slope with siphon drainage.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
The purpose of underground methane drainage technology is to prevent methane disasters and enable the efficient use of coal mine methane(CMM),and the sealing depth is a key factor that affects the performance of under...The purpose of underground methane drainage technology is to prevent methane disasters and enable the efficient use of coal mine methane(CMM),and the sealing depth is a key factor that affects the performance of underground methane drainage.In this work,the layouts of in-seam and crossing boreholes are considered to analyze the stress distribution and failure characteristics of roadway surrounding rock through a numerical simulation and field stress investigation to determine a reasonable sealing depth.The results show that the depths of the plastic and elastic zones in two experimental coal mines are 16 and 20 m respectively.Borehole sealing minimizes the air leakage through the fractures around the roadway when the sealing material covers the failure and plastic zones,and the field test results for CMM drainage at different sealing depths indicate that the CMM drainage efficiency increases with increasing sealing depth but does not change once the sealing depth exceeds the plastic zone.Moreover,sealing in the high-permeability roadway surrounding rock does not have a strong influence on the borehole sealing performance.Considering these findings,a new CMM drainage system for key sealing in the low-permeability zone was developed that is effective for improving the CMM drainage efficiency and prolonging the high-concentration CMM drainage period.The proposed approach offers a valuable quantitative analysis method for selecting the optimum sealing parameters for underground methane drainage,thereby improving considerably the drainage and utilization rates of CMM.展开更多
Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,th...Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical approaches.Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise.For malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different modalities.The treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic therapy.Due to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents.These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.展开更多
BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a ...BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a total of 13 procedures within our medical facility,including five performed under local anesthesia and eight performed under general anesthesia.The source of the ailment was ultimately identified as Enterobacter cloacae.After the last procedure,the patient's symptoms were alleviated,and the recovery process was satisfactory.Three months post-operation,the Japanese Orthopaedic Association scores had improved to 100%.Imageological examination revealed a satisfactory position of internal fixation,and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.CONCLUSION The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection,providing an alternative to traditional surgery.展开更多
Tight glutenite reservoirs are known for strong heterogeneity,complex wettability,and challenging development.Gas-Assisted Gravity Drainage(GAGD)technology has the potential to significantly improve recovery efficienc...Tight glutenite reservoirs are known for strong heterogeneity,complex wettability,and challenging development.Gas-Assisted Gravity Drainage(GAGD)technology has the potential to significantly improve recovery efficiency in glutenite reservoir.However,there is currently limited research on GAGD processes specifically designed for glutenite reservoirs,and there is a lack of relevant dimensionless numbers for predicting recovery efficiency.In this study,we developed a theoretical model based on the characteristics of glutenite reservoirs and used phase-field method to track the oil-gas interface for numerical simulations of dynamic GAGD processes.To explore the factors influencing gas-driven recovery,we simulated the effects of strong heterogeneity and dynamic wettability on the construction process under gravity assistance.Additionally,we introduced multiple dimensionless numbers(including capillary number,viscosity ratio,and Bond number)and conducted a series of numerical simulations.The results demonstrate that gravity enhances the stability of the oil-gas interface but causes unstable pressure fluctuations when passing through different-sized throat regions,particularly leading to front advancement in smaller throats.Although strong heterogeneity has negative impacts on GAGD,they can be mitigated by reducing injection velocity.Increasing oil-wettability promotes oil displacement by overcoming capillary forces,particularly in narrower pores,allowing residual oils to be expelled.Among the dimensionless numbers,the recovery efficiency is directly proportional to the Bond number and inversely proportional to the capillary number and viscosity ratio.Through sensitivity analysis of the dimensionless numbers’impact on the recovery efficiency,a new dimensionless N_(Glu) considering heterogeneity is proposed to accurately predict GAGD recovery of tight glutenite reservoirs.展开更多
BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary dra...BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.展开更多
Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperativ...Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperative pain, hospital stay, and other factors between the negative pressure group and the control group. Methods: This study is a prospective controlled trial that selected patients undergoing two-port thoracoscopic valve surgery at a certain hospital from January 2019 to December 2024. Patients were randomly assigned to the control group and the negative pressure group using a random number table method. The control group consisted of 30 patients (20 males, 10 females, mean age 42.03 ± 12.89 years), and the negative pressure group consisted of 35 patients (26 males, 9 females, mean age 41.84 ± 11.83 years). The control group received traditional chest drainage, while the negative pressure group received negative pressure chest drainage. Postoperative pain scores, hospital stay, drainage time, number of tube blockages, and incidences of pneumothorax or subcutaneous emphysema were recorded and statistically analyzed. Results: The negative pressure group had a significantly shorter postoperative drainage time compared to the control group (49.09 ± 11.99 hours vs. 79.10 ± 7.32 hours, P < 0.001). The postoperative pain score was lower in the negative pressure group (4.49 ± 1.27 vs. 7.03 ± 0.85, P < 0.001), and the hospital stay was significantly shorter (9.83 ± 1.69 days vs. 14.73 ± 2.32 days, P < 0.001). The incidence of pneumothorax or subcutaneous emphysema was significantly lower in the negative pressure group than in the control group (14.29% vs. 56.67%, P = 0.0003). Conclusion: The application of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery can effectively reduce postoperative pain, shorten hospital stay, and lower the incidence of tube blockage and pneumothorax, demonstrating good clinical outcomes.展开更多
BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain...BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain placement,identify the most effective drain type,and determine the optimal timing for drain removal.METHODS A systematic review of electronic databases,including PubMed,MEDLINE,PubMed Central,and Google Scholar,was conducted using Medical Subject Headings and keywords until December 2023.From an initial pool of 1910 articles,48 were included after exclusion and screening.The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying(DGE),overall morbidity,and mortality.Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.RESULTS Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE.Conversely,patients who did not have drains placed experienced a significant reduction in morbidity,readmission rates,and reoperations.No significant differences were observed between active and passive drain types.Early drain removal(<3 days)yielded favorable outcomes compared to delayed removal.CONCLUSION Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection,potentially contributing to increased morbidity and mortality.The decision to use drains should be left to the discretion of the operating surgeon.However,early drain removal can substantially reduce morbidity.展开更多
BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improveme...BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.展开更多
Hydrogel has developed into a very important platform in solar interface evaporator.However,the current hydrogel evaporators are usually three-dimensional evaporators,which will consume a lot of raw materials.Thus,a n...Hydrogel has developed into a very important platform in solar interface evaporator.However,the current hydrogel evaporators are usually three-dimensional evaporators,which will consume a lot of raw materials.Thus,a new two-dimensional hydrogel evaporator is urgently needed to alleviate this problem.Here,a double layer hydrogel evaporator was designed by twice vacuum filtration.Furthermore,through the arched design and the introduction of concentrated brine drainage system,the hydrogel evaporator has enhanced water transportation and tailored water transportation path.Such a unique drainage evaporation system greatly improves the stability of the evaporator.Thereby,a good balance is established between photothermal conversion and water supply,and solar energy is utilized efficiently.It can remain stable in continuous evaporation for up to 12 h with an excellent evaporation rate of 2.70 kg m^(-2)h^(-1)under 1 sun irradiation.Meanwhile,the drainage system realized the 1.8×10^(-10)mol m^(-2)s^(-1)diffusion flux of concentrated brine.Through one-time freeze-drying preparation,an arch-shaped drainage evaporator was used to prepare an evaporation area of more than 20 cm^(2).With the self-made condensate collecting device in outdoor environment,the fresh water yield reaches 7.5 L m^(-2)d^(-1).This provides a new scheme for building a new hydrogel evaporator and solving the fresh water crisis.展开更多
This study evaluates the effectiveness of microwave technology in producing activated carbon from lemongrass waste,an underutilized agricultural byproduct.Microwave-assisted production offers faster heating,lower ener...This study evaluates the effectiveness of microwave technology in producing activated carbon from lemongrass waste,an underutilized agricultural byproduct.Microwave-assisted production offers faster heating,lower energy consumption,and better process control compared to conventionalmethods.It also enhances pore development,resulting in larger,cleaner,and more uniform pores,making the activated carbon more effective for adsorption.The microwave-assisted process significantly accelerates production,reducing the required time to just 10 min at a power of 400 W.Activated carbon derived from lemongrass waste at 400 W exhibits a water absorption capacity of 7.88%,ash content of 5.51%,volatile matter of 6.96%,fixed carbon of 75.79%,and an iodine number of 790.97 g iodine/100 g.Scanning Electron Microscopy(SEM)analysis confirms the formation of larger,cleaner,and smoother pores,contributing to increased porosity and pore size.Additionally,Energy Dispersive X-ray(EDX)analysis identifies key elements in the lemongrass waste,with carbon being the dominant component at 75.57%.The Brunauer-Emmett-Teller(BET)surface area is measured at 818 m^(2)/g,with an average pore diameter of 1.91 nm,classifying the material as microporous.The activated carbon,meeting quality standards,is applied as an adsorbent in acid mine drainage(AMD)treatment,with varying mass concentrations introduced intowastewater samples.Adsorption tests confirmthat the microparticle carbon adsorption profile follows the Langmuir model,indicating a monolayer adsorption process.Furthermore,adsorption kineticswere analyzed over different time intervals,revealing that the process alignswith both pseudo-first-order(PFO)and pseudo-second-order(PSO)models,with all cases predominantly following the PFO rate equation.展开更多
Coastal cities in Vietnam face increasing urban flooding vulnerability due to climate change-induced extreme pre-cipitation.This study evaluates the response capacity of urban drainage systems,using Vung Tau City as a...Coastal cities in Vietnam face increasing urban flooding vulnerability due to climate change-induced extreme pre-cipitation.This study evaluates the response capacity of urban drainage systems,using Vung Tau City as a case study.We employed a comprehensive approach,combining Intensity-Duration-Frequency(IDF)curve analysis with hydrodynamic modeling,to assess drainage performance under current and projected rainfall intensities.A significant rainfall event on June 19,2020(54.4 mm in 3 h,peaking at 42 mm/h),which exceeded the 5-year return period design(TCVN 7957:2008),caused widespread flooding(25-50 cm depths).Design rainfall hyetographs for 2,5,and 10-year return periods(TCVN 7957:2008)were developed.Results show that under more extreme scenarios,flooded areas increase significantly,with depths up to 1.05 m in the 10-year scenario and prolonged durations due to stormwater routing through regulatory lakes.The analysis reveals the current infrastructure meets only 64%of the 5-year return period demands and merely 41% for a 10-year period.This research highlights the urgent need for enhanced flood management in Vung Tau and similar coastal cities,suggesting upgrades to drainage capacity,implementation of sustainable urban drainage systems,and improved early warning.These insights are valuable for developing climate-resilient infrastructure.展开更多
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.
基金financially supported by the National Key R&D Program of China (Grant No. 2018YFC1504704)the National Natural Science Foundation of China (Grant No. 41772276)Key R&D project of Zhejiang Province (Grant No. 2017C03006)
文摘The siphon drainage is an effective measure for the slope groundwater control. However,for the traditional siphon drainage, limitations such as siphon lift restriction and poor reliability in longterm service prevent it from being widely used. In this study, an improved siphon drainage method with inclined borehole penetrating the deep part of the slope is proposed to overcome the limitations suffered by the traditional method. Through experimental research, theoretical analysis and engineering practice,the reliability and capability of the proposed method are investigated. The results demonstrate that with the inclined pipe the height difference between the control point of the groundwater level and the orifice can be controlled to be less than the height of the water column corresponding to the local atmospheric pressure. As a result, deep drainage can be achieved.In addition, by controlling the diameter of siphon drainage pipe not larger than 4 mm, a plug flow can be formed in the siphon pipe, which can prevent air accumulation in the siphon process and a continuous and effective siphon drainage is achieved. Through a practical project running smoothly since September 2013, it is found that the proposed method can effectively drain the groundwater deep in the slope and the maximum drawdown of groundwater level in boreholes can reach 8.5 m with an average drainage flow of 5.5 m3/d. The practical results also illustrate that 4 mm siphon pipe can be used to realize deep slope drainage and restart siphon automatically.
文摘BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
文摘Tunnel seepage is an important factor affecting the progress and safety of tunnel construction. In this paper, the mining method tunnel construction in the water-rich weathered granite stratum is taken as the research object. Through the analytical calculation method, the distribution law of tunnel seepage field under different waterproof and drainage types is studied, and the comparative analysis is carried out. According to the analytical solution, the influencing factors of grouting parameters are proposed. The sensitivity of the tunnel seepage field to the variation of grouting parameters is analyzed. A novel waterproof and drainage system, and construction technology suitable for subway tunnels with large buried depth below groundwater level were proposed.
文摘Although time-dependent deformation of geomaterials underpins slope-failure prediction models,the influence of strain rate on shearing strength and deformation behavior of loess remains unclear.The consolidated undrained(CU)and drained(CD)triaxial testing elucidated the impact of strain rate(0.005–0.3 mm/min)on strength envelopes,deformation moduli,pore pressures,and dilatancy characteristics of unsaturated and quasi-saturated loess.Under drained conditions with a controlled matric suction of 50 kPa,increasing strain rates from 0.005 mm/min to 0.011 mm/min induced decreases in failure deviatoric stress(qf),initial deformation modulus(Ei),and cohesion(c),while friction angles remained unaffected.Specimens displayed initial contractive volumetric strains transitioning to dilation across varying confining pressures.Higher rates diminished contractive volumetric strains and drainage volumes,indicating reduced densification and strength in the shear zone.Under undrained conditions,both unsaturated and quasi-saturated(pore pressure coefficient B=0.75)loess exhibited deteriorating mechanical properties with increasing rates from 0.03 mm/min to 0.3 mm/min.For unsaturated loess,reduced contractive volumetric strains at higher rates manifested relatively looser structures in the pre-peak stress phase.The strength decrement in quasi-saturated loess arose from elevated excess porewater pressures diminishing effective stresses.Negative porewater pressures emerged in quasi-saturated loess at lower confining pressures and strain rates.Compared to previous studies,the qf and Ei exhibited rate sensitivity below threshold values before attaining minima with marginal subsequent influence.The underlying mechanism mirrors the transition from creep to accelerated deformation phase of landslides.
基金supported by the National Key Research and Development Program of China (No. 2017YFC0405006)the Innovative Research Groups of the National Natural Science Foundation of China (No. 51621092)the Natural Science Foundation of Tianjin (No. 16JCYBJC23100)
文摘The complex relationships between indicators and water conditions cause fuzzy and gray uncertainties in evaluation of water quality. Compared to conventional single-factor evaluation methods, the combination evaluation method can consider these two uncertainties to produce more objective and reasonable evaluation results. In this paper, we propose a combination evaluation method with two main parts:(1) the use of fuzzy comprehensive evaluation and gray correlation analysis as submodels with which to consider the fuzzy and gray uncertainties and(2) the establishment of a combination model based on minimum bias squares. In addition, using this method, we evaluate the water quality of a ditch in a typical rice–wheat system of Yixing city in the Taihu Lake Basin during three rainfall events. The results show that the ditch water quality is not good and we found the chemical oxygen demand to be the key indicator that affects water quality most significantly. The proposed combination evaluation method is more accurate and practical than single-factor evaluation methods in that it considers the uncertainties of fuzziness and grayness.
基金the financial support of the National Natural Science Foundation of China(Key Project)(No.42230702)National Natural Science Foundation of China(No.42277129)Natural Science Foundation of Zhejiang Province(No.LY21D020001)。
文摘A new anchor-siphon drainage combined method used for slope stabilization is proposed in this paper.It includes an anchoring section and a siphon drainage section.The novelty of the anchor-siphon drainage combined method is the realization of the drainage and anchoring in the one inclined borehole.The engineering cost of drilling and the resulting disturbance to the slope is reduced.To validate the feasibility of the proposed method,a numerical method that combines the pore water pressure distribution after siphon drainage and the anchoring force of the anchoring section is used to evaluate the safety of the slope with the anchor-siphon drainage method.The proposed method was illustrated and validated with the Hongpu Village landslide,in Tonglu County,Zhejiang Province,in China.Compared with the common anchor bar with the same length in the anchoring section,the factor of safety(FOS)for Hongpu Village slope with anchorsiphon drainage is increased by 0.085.The calculation method of the optimal length ratio between the drainage section and the anchoring section and its influencing factors were studied.For the different design parameters,there is always an optimal length ratio of the drainage section.Compared with the siphon drainage and full-length anchor bar with the same borehole length,the anchor-siphon drainage combined method shows better landslide prevention ability.Moreover,when the optimized parameters with a bond strength of 560kPa,a borehole inclination of 35°,and no reduction in length are used,the calculated safety factor is 1.316,which is significantly higher than the FOS of 1.131 for the slope with siphon drainage.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
基金This research was supported by the National Natural Science Foundation of China(51974300)the Fundamental Research Funds for the Central Universities(2021YCPY0206 and 2020ZDPY0224)the Postgraduate Research&Practice Innovation Program of Jiangsu Province(KYCX21_2467),and as a project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘The purpose of underground methane drainage technology is to prevent methane disasters and enable the efficient use of coal mine methane(CMM),and the sealing depth is a key factor that affects the performance of underground methane drainage.In this work,the layouts of in-seam and crossing boreholes are considered to analyze the stress distribution and failure characteristics of roadway surrounding rock through a numerical simulation and field stress investigation to determine a reasonable sealing depth.The results show that the depths of the plastic and elastic zones in two experimental coal mines are 16 and 20 m respectively.Borehole sealing minimizes the air leakage through the fractures around the roadway when the sealing material covers the failure and plastic zones,and the field test results for CMM drainage at different sealing depths indicate that the CMM drainage efficiency increases with increasing sealing depth but does not change once the sealing depth exceeds the plastic zone.Moreover,sealing in the high-permeability roadway surrounding rock does not have a strong influence on the borehole sealing performance.Considering these findings,a new CMM drainage system for key sealing in the low-permeability zone was developed that is effective for improving the CMM drainage efficiency and prolonging the high-concentration CMM drainage period.The proposed approach offers a valuable quantitative analysis method for selecting the optimum sealing parameters for underground methane drainage,thereby improving considerably the drainage and utilization rates of CMM.
文摘Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical approaches.Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise.For malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different modalities.The treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic therapy.Due to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents.These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.
基金Supported by Natural Science Foundation of Shandong Province,No.ZR2023MH331.
文摘BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a total of 13 procedures within our medical facility,including five performed under local anesthesia and eight performed under general anesthesia.The source of the ailment was ultimately identified as Enterobacter cloacae.After the last procedure,the patient's symptoms were alleviated,and the recovery process was satisfactory.Three months post-operation,the Japanese Orthopaedic Association scores had improved to 100%.Imageological examination revealed a satisfactory position of internal fixation,and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.CONCLUSION The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection,providing an alternative to traditional surgery.
基金supported by the National Natural Science Foundation of China(U22B2075)the Fundamental Research Funds for the Central Universities(2024ZKPYSB03)support from Beijing University of Science and Technology.
文摘Tight glutenite reservoirs are known for strong heterogeneity,complex wettability,and challenging development.Gas-Assisted Gravity Drainage(GAGD)technology has the potential to significantly improve recovery efficiency in glutenite reservoir.However,there is currently limited research on GAGD processes specifically designed for glutenite reservoirs,and there is a lack of relevant dimensionless numbers for predicting recovery efficiency.In this study,we developed a theoretical model based on the characteristics of glutenite reservoirs and used phase-field method to track the oil-gas interface for numerical simulations of dynamic GAGD processes.To explore the factors influencing gas-driven recovery,we simulated the effects of strong heterogeneity and dynamic wettability on the construction process under gravity assistance.Additionally,we introduced multiple dimensionless numbers(including capillary number,viscosity ratio,and Bond number)and conducted a series of numerical simulations.The results demonstrate that gravity enhances the stability of the oil-gas interface but causes unstable pressure fluctuations when passing through different-sized throat regions,particularly leading to front advancement in smaller throats.Although strong heterogeneity has negative impacts on GAGD,they can be mitigated by reducing injection velocity.Increasing oil-wettability promotes oil displacement by overcoming capillary forces,particularly in narrower pores,allowing residual oils to be expelled.Among the dimensionless numbers,the recovery efficiency is directly proportional to the Bond number and inversely proportional to the capillary number and viscosity ratio.Through sensitivity analysis of the dimensionless numbers’impact on the recovery efficiency,a new dimensionless N_(Glu) considering heterogeneity is proposed to accurately predict GAGD recovery of tight glutenite reservoirs.
文摘BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.
文摘Objective: This study aims to investigate the drainage effect and clinical outcomes of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery, comparing the differences in postoperative pain, hospital stay, and other factors between the negative pressure group and the control group. Methods: This study is a prospective controlled trial that selected patients undergoing two-port thoracoscopic valve surgery at a certain hospital from January 2019 to December 2024. Patients were randomly assigned to the control group and the negative pressure group using a random number table method. The control group consisted of 30 patients (20 males, 10 females, mean age 42.03 ± 12.89 years), and the negative pressure group consisted of 35 patients (26 males, 9 females, mean age 41.84 ± 11.83 years). The control group received traditional chest drainage, while the negative pressure group received negative pressure chest drainage. Postoperative pain scores, hospital stay, drainage time, number of tube blockages, and incidences of pneumothorax or subcutaneous emphysema were recorded and statistically analyzed. Results: The negative pressure group had a significantly shorter postoperative drainage time compared to the control group (49.09 ± 11.99 hours vs. 79.10 ± 7.32 hours, P < 0.001). The postoperative pain score was lower in the negative pressure group (4.49 ± 1.27 vs. 7.03 ± 0.85, P < 0.001), and the hospital stay was significantly shorter (9.83 ± 1.69 days vs. 14.73 ± 2.32 days, P < 0.001). The incidence of pneumothorax or subcutaneous emphysema was significantly lower in the negative pressure group than in the control group (14.29% vs. 56.67%, P = 0.0003). Conclusion: The application of negative pressure chest drainage in patients after two-port thoracoscopic valve surgery can effectively reduce postoperative pain, shorten hospital stay, and lower the incidence of tube blockage and pneumothorax, demonstrating good clinical outcomes.
文摘BACKGROUND Historically intraoperative drains were employed after pancreatic surgery but over the last decade,there has been debate over the routine usage of drains.AIM To assess the necessity of intra-abdominal drain placement,identify the most effective drain type,and determine the optimal timing for drain removal.METHODS A systematic review of electronic databases,including PubMed,MEDLINE,PubMed Central,and Google Scholar,was conducted using Medical Subject Headings and keywords until December 2023.From an initial pool of 1910 articles,48 were included after exclusion and screening.The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying(DGE),overall morbidity,and mortality.Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.RESULTS Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE.Conversely,patients who did not have drains placed experienced a significant reduction in morbidity,readmission rates,and reoperations.No significant differences were observed between active and passive drain types.Early drain removal(<3 days)yielded favorable outcomes compared to delayed removal.CONCLUSION Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection,potentially contributing to increased morbidity and mortality.The decision to use drains should be left to the discretion of the operating surgeon.However,early drain removal can substantially reduce morbidity.
基金Supported by the National Key Research and Development Program,China,No.2022YFC2503603.
文摘BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.
基金the financial support of the National Natural Science Foundation of China(No.52075309)the Youth Innovation Team of Shaanxi Universities(21JP021)。
文摘Hydrogel has developed into a very important platform in solar interface evaporator.However,the current hydrogel evaporators are usually three-dimensional evaporators,which will consume a lot of raw materials.Thus,a new two-dimensional hydrogel evaporator is urgently needed to alleviate this problem.Here,a double layer hydrogel evaporator was designed by twice vacuum filtration.Furthermore,through the arched design and the introduction of concentrated brine drainage system,the hydrogel evaporator has enhanced water transportation and tailored water transportation path.Such a unique drainage evaporation system greatly improves the stability of the evaporator.Thereby,a good balance is established between photothermal conversion and water supply,and solar energy is utilized efficiently.It can remain stable in continuous evaporation for up to 12 h with an excellent evaporation rate of 2.70 kg m^(-2)h^(-1)under 1 sun irradiation.Meanwhile,the drainage system realized the 1.8×10^(-10)mol m^(-2)s^(-1)diffusion flux of concentrated brine.Through one-time freeze-drying preparation,an arch-shaped drainage evaporator was used to prepare an evaporation area of more than 20 cm^(2).With the self-made condensate collecting device in outdoor environment,the fresh water yield reaches 7.5 L m^(-2)d^(-1).This provides a new scheme for building a new hydrogel evaporator and solving the fresh water crisis.
基金funded by the Ministry of Research,Technology,and Higher Education under Grant Number B/67/D.D3/KD.02.00/2019as part of the BPPDN(Beasiswa Pendidikan Pascasarjana Dalam Negeri—Domestic Postgraduate Education Scholarship)program.
文摘This study evaluates the effectiveness of microwave technology in producing activated carbon from lemongrass waste,an underutilized agricultural byproduct.Microwave-assisted production offers faster heating,lower energy consumption,and better process control compared to conventionalmethods.It also enhances pore development,resulting in larger,cleaner,and more uniform pores,making the activated carbon more effective for adsorption.The microwave-assisted process significantly accelerates production,reducing the required time to just 10 min at a power of 400 W.Activated carbon derived from lemongrass waste at 400 W exhibits a water absorption capacity of 7.88%,ash content of 5.51%,volatile matter of 6.96%,fixed carbon of 75.79%,and an iodine number of 790.97 g iodine/100 g.Scanning Electron Microscopy(SEM)analysis confirms the formation of larger,cleaner,and smoother pores,contributing to increased porosity and pore size.Additionally,Energy Dispersive X-ray(EDX)analysis identifies key elements in the lemongrass waste,with carbon being the dominant component at 75.57%.The Brunauer-Emmett-Teller(BET)surface area is measured at 818 m^(2)/g,with an average pore diameter of 1.91 nm,classifying the material as microporous.The activated carbon,meeting quality standards,is applied as an adsorbent in acid mine drainage(AMD)treatment,with varying mass concentrations introduced intowastewater samples.Adsorption tests confirmthat the microparticle carbon adsorption profile follows the Langmuir model,indicating a monolayer adsorption process.Furthermore,adsorption kineticswere analyzed over different time intervals,revealing that the process alignswith both pseudo-first-order(PFO)and pseudo-second-order(PSO)models,with all cases predominantly following the PFO rate equation.
基金supported by the Ministry of Natural Resources and Environment project 2024.06.04,“Research on the application of artificial intelligence combined with remote sensing in warning of flood risks due to heavy rain and high tides for coastal cities”,grant number 2024.06.04.
文摘Coastal cities in Vietnam face increasing urban flooding vulnerability due to climate change-induced extreme pre-cipitation.This study evaluates the response capacity of urban drainage systems,using Vung Tau City as a case study.We employed a comprehensive approach,combining Intensity-Duration-Frequency(IDF)curve analysis with hydrodynamic modeling,to assess drainage performance under current and projected rainfall intensities.A significant rainfall event on June 19,2020(54.4 mm in 3 h,peaking at 42 mm/h),which exceeded the 5-year return period design(TCVN 7957:2008),caused widespread flooding(25-50 cm depths).Design rainfall hyetographs for 2,5,and 10-year return periods(TCVN 7957:2008)were developed.Results show that under more extreme scenarios,flooded areas increase significantly,with depths up to 1.05 m in the 10-year scenario and prolonged durations due to stormwater routing through regulatory lakes.The analysis reveals the current infrastructure meets only 64%of the 5-year return period demands and merely 41% for a 10-year period.This research highlights the urgent need for enhanced flood management in Vung Tau and similar coastal cities,suggesting upgrades to drainage capacity,implementation of sustainable urban drainage systems,and improved early warning.These insights are valuable for developing climate-resilient infrastructure.
