AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was develope...AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraductal ultrasonography could be performed in 8 sessions.As for complications,hyperamylasemia(defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient(7 sessions) with a B-Ⅱ gastrectomy and 4 patients(19 sessions) with an R-Y gastrectomy.After ERCP in patients with an R-Y gastrectomy,2 patients(19 sessions) had pancreatitis,1 patient(21 sessions) had gastrointestinal perforation,and 1 patient(19 sessions) had papillary bleeding.Pancreatitis and bleeding were both mild.Gastrointestinal perforation improved after conservative treatment.CONCLUSION:Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.展开更多
AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus wer...AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively collected.All patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after surgery.RESULTS:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo postoperatively.Approximately 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or HbA1c.In multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes duration.CONCLUSION:Diabetes improved in more than 50%of patients during the first year after gastric cancer surgery.The degree of diabetes control was related to diabetes duration.展开更多
梯级水电短期调度时需保障各电站下游河段的生态要求,而生态调度的深入研究要求生态约束越来越多样化,使得流域梯级短期优化调度问题愈加复杂。该文首先将生态约束按流量约束和控制方式分为Ⅰ类、Ⅱ类和Ⅲ类,满足梯级库群复杂的生态调...梯级水电短期调度时需保障各电站下游河段的生态要求,而生态调度的深入研究要求生态约束越来越多样化,使得流域梯级短期优化调度问题愈加复杂。该文首先将生态约束按流量约束和控制方式分为Ⅰ类、Ⅱ类和Ⅲ类,满足梯级库群复杂的生态调度要求;接着以剩余负荷峰谷差最小为目标,构建了耦合复杂生态约束的梯级水电短期日前调峰模型;最后利用分段线性化技术处理一元水力非线性约束,将四边形网格栅格化技术与第二类特殊顺序集(special ordered sets of type 2,SOS2)约束建模方法结合处理二元电力非线性约束,采用大M法对较为复杂的Ⅲ类生态约束进行线性化,将原模型转化为标准混合整数线性规划(mixed-integer linear programming,MILP)模型后进行求解。以乌江干流(贵州段)6座梯级水库为工程背景,在汛枯期不同来水场景下验证了模型的有效性且计算结果较逐次逼近动态规划(dynamic programming successive approximation,DPSA)算法优越性显著,通过与3个参照模型的结果对比分析得出生态约束的设置与类型会明显影响调峰效果,强调水利工程生态流量合理设计的必要性。展开更多
为了减小旋流器的短路流流量,提高旋流分离性能,研究提出了一种“喇叭型”溢流管旋流器,并通过数值模拟的方法,对不同尺寸“喇叭型”溢流管旋流器的压力场、速度场、湍流强度和分离效率进行了探讨。结果表明:随着“喇叭”长度的增加,静...为了减小旋流器的短路流流量,提高旋流分离性能,研究提出了一种“喇叭型”溢流管旋流器,并通过数值模拟的方法,对不同尺寸“喇叭型”溢流管旋流器的压力场、速度场、湍流强度和分离效率进行了探讨。结果表明:随着“喇叭”长度的增加,静压最大值从150.5 k Pa降低到139.7 k Pa,较低的静压可以减少能量消耗;“喇叭型”溢流管旋流器的轴向速度低于常规旋流器,颗粒在“喇叭型”溢流管旋流器内停留时间更长,分离更彻底;随着“喇叭”长度的增加,分流比和短路流流量都减小,降低了颗粒“错配”的数量;湍流强度随“喇叭”长度的增加而趋于平稳,使流场更加稳定;随着“喇叭”长度的增加,陡度指数先增大后减小,“喇叭”长度为20 mm时陡度指数最大,分离精度最高。展开更多
基金Supported by A Prototype Single Balloon Enteroscope from Olympus Medical Systems,Tokyo,Japan
文摘AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraductal ultrasonography could be performed in 8 sessions.As for complications,hyperamylasemia(defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient(7 sessions) with a B-Ⅱ gastrectomy and 4 patients(19 sessions) with an R-Y gastrectomy.After ERCP in patients with an R-Y gastrectomy,2 patients(19 sessions) had pancreatitis,1 patient(21 sessions) had gastrointestinal perforation,and 1 patient(19 sessions) had papillary bleeding.Pancreatitis and bleeding were both mild.Gastrointestinal perforation improved after conservative treatment.CONCLUSION:Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology,2011-0011301a faculty research grant of Yonsei University College of Medicine for 2011,6-2011-0084
文摘AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively collected.All patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after surgery.RESULTS:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo postoperatively.Approximately 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or HbA1c.In multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes duration.CONCLUSION:Diabetes improved in more than 50%of patients during the first year after gastric cancer surgery.The degree of diabetes control was related to diabetes duration.
文摘梯级水电短期调度时需保障各电站下游河段的生态要求,而生态调度的深入研究要求生态约束越来越多样化,使得流域梯级短期优化调度问题愈加复杂。该文首先将生态约束按流量约束和控制方式分为Ⅰ类、Ⅱ类和Ⅲ类,满足梯级库群复杂的生态调度要求;接着以剩余负荷峰谷差最小为目标,构建了耦合复杂生态约束的梯级水电短期日前调峰模型;最后利用分段线性化技术处理一元水力非线性约束,将四边形网格栅格化技术与第二类特殊顺序集(special ordered sets of type 2,SOS2)约束建模方法结合处理二元电力非线性约束,采用大M法对较为复杂的Ⅲ类生态约束进行线性化,将原模型转化为标准混合整数线性规划(mixed-integer linear programming,MILP)模型后进行求解。以乌江干流(贵州段)6座梯级水库为工程背景,在汛枯期不同来水场景下验证了模型的有效性且计算结果较逐次逼近动态规划(dynamic programming successive approximation,DPSA)算法优越性显著,通过与3个参照模型的结果对比分析得出生态约束的设置与类型会明显影响调峰效果,强调水利工程生态流量合理设计的必要性。
文摘为了减小旋流器的短路流流量,提高旋流分离性能,研究提出了一种“喇叭型”溢流管旋流器,并通过数值模拟的方法,对不同尺寸“喇叭型”溢流管旋流器的压力场、速度场、湍流强度和分离效率进行了探讨。结果表明:随着“喇叭”长度的增加,静压最大值从150.5 k Pa降低到139.7 k Pa,较低的静压可以减少能量消耗;“喇叭型”溢流管旋流器的轴向速度低于常规旋流器,颗粒在“喇叭型”溢流管旋流器内停留时间更长,分离更彻底;随着“喇叭”长度的增加,分流比和短路流流量都减小,降低了颗粒“错配”的数量;湍流强度随“喇叭”长度的增加而趋于平稳,使流场更加稳定;随着“喇叭”长度的增加,陡度指数先增大后减小,“喇叭”长度为20 mm时陡度指数最大,分离精度最高。
