This paper presents a theoretical method and a finite element method to describe wellhead movement and uncemented casing strength in offshore oil and gas wells.Parameters considered in the theoretical method include o...This paper presents a theoretical method and a finite element method to describe wellhead movement and uncemented casing strength in offshore oil and gas wells.Parameters considered in the theoretical method include operating load during drilling and completion and the temperature field,pressure field and the end effect of pressure during gas production.The finite element method for multistring analysis is developed to simulate random contact between casings.The relevant finite element analysis scheme is also presented according to the actual procedures of drilling,completion and gas production.Finally,field cases are presented and analyzed using the proposed methods.These are four offshore wells in the South China Sea.The calculated wellhead growths during gas production are compared with measured values.The results show that the wellhead subsides during drilling and completion and grows up during gas production.The theoretical and finite element solutions for wellhead growth are in good agreement with measured values and the deviations of calculation are within 10％.The maximum von Mises stress on the uncemented intermediate casing occurs during the running of the oil tube.The maximum von Mises stress on the uncemented production casing,calculated with the theoretical method occurs at removing the blow-out-preventer （BOP） while that calculated with the finite element method occurs at gas production.Finite element solutions for von Mises stress are recommended and the uncemented casings of four wells satisfy strength requirements.展开更多
The dynamic modal model analysis of the oil casing connection is done by finite element method (FEM), and the first nature frequency, the second nature frequency, the vibration mode shape and the time domain of the no...The dynamic modal model analysis of the oil casing connection is done by finite element method (FEM), and the first nature frequency, the second nature frequency, the vibration mode shape and the time domain of the node displacement and the element stress variation in the thread connection are gotten. The Von.Mises stresses of the connection in the static and dynamic state are also studied. The results of calculation and analysis show: (1) because the maximum of static stress is at the coupling thread end of connection, the connection begins to thread off at the coupling thread end, which is in accord with the results of the thread off experiment in laboratory; (2) because the first nature frequency is very high, the probability of casing connection to be damaged from vibration is little; (3) the shock dynamic load makes casing connection begin to thread off at the tube thread end.展开更多
In drilling ultra-deep wells,the drilling fluid circulation usually causes erosion damage to downhole casing and drilling tools.However,the extent and process of this damage to the downhole tools is intricate and less...In drilling ultra-deep wells,the drilling fluid circulation usually causes erosion damage to downhole casing and drilling tools.However,the extent and process of this damage to the downhole tools is intricate and less understood.In order to systematically evaluate and clarify this damage process for different types of drilling fluid contamination,this research uses a high-temperature drilling fluid damage device to simulate the damage caused to the casing/drilling tools by various drilling fluid under a field thermal gradient.The results show that the drilling fluid residues are mainly solid-phase particles and organic components.The degree of casing/tool damage decreases with an increase in bottom hole temperature,and the casing/tool is least damaged within a temperature range of 150–180°C.Moreover,the surface of the casing/tool damaged by different types of drilling fluid shows different roughness,and the wettability of drilling fluid on the casing/tool surface increases with an increase in the degree of roughness.Oil-based drilling fluid have the strongest adhesion contamination on casing/drilling tools.In contrast,polysulfonated potassium drilling fluid and super-micro drilling fluid have the most potent erosion damage on casing/drilling tools.By analyzing the damage mechanism,it was established that the damage was mainly dominated by the abrasive wearing from solid-phase particles in concert with corrosion ions in drilling fluid,with solids producing many abrasion marks and corrosive ions causing a large number of pits.Clarifying drilling fluid's contamination and damage mechanism is significant in guiding the wellbore cleaning process and cutting associated costs.展开更多
Hydraulic fracturing-induced casing deformation and fault activation have greatly hinde red the safe and efficient development of shale oil and gas resources.In this study,statistical analysis,physical tests,and numer...Hydraulic fracturing-induced casing deformation and fault activation have greatly hinde red the safe and efficient development of shale oil and gas resources.In this study,statistical analysis,physical tests,and numerical simulation methods are used to comprehensively analyze hydraulic fracturing-induced fault activation and casing deformation processes.This study is based on the Longmaxi Formation of LZ block,a deep shale gas reservoir in the southwest Sichuan Basin(China),as a geological background.A large amount of field data on fracturing from the LZ Block is counted,and the main influencing factors are analyzed.The main factors of hydraulic fracturing-induced fault slip are(from strong to weak)parameters related to fluid injection volume,parameters related to segments and clusters,and parameters related to injection rate.Combined with physical experiments and numerical simulations,the fault activation law during fracturing has been studied.The degree of casing deformation and fault slip are linearly correlated.For hydraulic fractures to cross faults is very difficult,fault activation and casing deformation can only be mitigated as much as possible.We find that the number of clusters per segment and the injection rate are negatively correlated with the fault slip distance.Reducing the fluid injection volume can mitigate the fault slip distance.Therefore,low injection rates,low fluid volumes,and more clusters per segment are recommended for fracturing in high-risk segments.It is important to note that the scale and risk of fault activation induced by well-factory fracturing is much higher compared to single-well fracturing.In situations with extremely high risk,the injection volume should preferably not exceed 800 m^(3) to minimize the risk of geological and casing deformation.展开更多
Casing damage resulting from sand production in unconsolidated sandstone reservoirs can significantly impact the average production of oil wells.However,the prediction task remains challenging due to the complex damag...Casing damage resulting from sand production in unconsolidated sandstone reservoirs can significantly impact the average production of oil wells.However,the prediction task remains challenging due to the complex damage mechanism caused by sand production.This paper presents an innovative approach that combines feature selection(FS)with boosting algorithms to accurately predict casing damage in unconsolidated sandstone reservoirs.A novel TriScore FS technique is developed,combining mRMR,Random Forest,and F-test.The approach integrates three distinct feature selection approaches—TriScore,wrapper,and hybrid TriScore-wrapper and four interpretable Boosting models(AdaBoost,XGBoost,LightGBM,CatBoost).Moreover,shapley additive explanations(SHAP)was used to identify the most significant features across engineering,geological,and production features.The CatBoost model,using the Hybrid TriScore-rapper G_(1)G_(2)FS method,showed exceptional performance in analyzing data from the Gangxi Oilfield.It achieved the highestaccuracy(95.5%)and recall rate(89.7%)compared to other tested models.Casing service time,casing wall thickness,and perforation density were selected as the top three most important features.This framework enhances predictive robustness and is an effective tool for policymakers and energy analysts,confirming its capability to deliver reliable casing damage forecasts.展开更多
As a common fault of the aero-engine,the blade-casing rubbing(BCR)has the potential to cause catastrophic accidents.In this paper,to investigate the dynamic responses and wear characteristics of the system,the laminat...As a common fault of the aero-engine,the blade-casing rubbing(BCR)has the potential to cause catastrophic accidents.In this paper,to investigate the dynamic responses and wear characteristics of the system,the laminated shell element is used to establish the finite element model(FEM)of a flexibly coated casing system.Using the shell element,the blade is modeled,and the surface stress of the blade is calculated.The stress-solving method of the blade is validated through comparisons with the measured time-domain waveform of the stress.Then,a dynamic model of a blade-flexibly coated casing system with rubbing is proposed,accounting for the time-varying mass and stiffness of the casing caused by coating wear.The effects of the proposed flexible casing model are compared with those of a rigid casing model,and the stress changes induced by rubbing are investigated.The results show that the natural characteristics of the coated casing decrease due to the coating wear.The flexibly coated casing model is found to be more suitable for studying casing vibration.Additionally,the stress changes caused by rubbing are slight,and the change in the stress maximum is approximately 5%under the influence of the abrasive coating.展开更多
Milling bridge plugs in shale gas wells with severe casing deformation often leads to the accumulation of cuttings,increasing the risk of stuck drill bits.Friction in the wellbore further complicates tool deployment i...Milling bridge plugs in shale gas wells with severe casing deformation often leads to the accumulation of cuttings,increasing the risk of stuck drill bits.Friction in the wellbore further complicates tool deployment into the horizontal section,posing challenges to efficient plug drilling and achieving wellbore access to the target layer.This paper integrates the theory of positive displacement motors and models their actual working characteristics to study the milling of bridge plugs in severely deformed horizontal wells.It examines the effects of coiled tubing diameter and wall thickness on the bending load of horizontal sections and discusses key technical requirements,including the timing of plug drilling,extending the run in the horizontal section,parameter control,and real-time field analysis.Field practices have shown that after casing deformation occurs,priority should be given to drilling out the bridge plugs below the point of deformation.The primary factors contributing to stuck drills in deformed wells include smaller mill shoe sizes and larger cuttings sizes.Short well-washing cycles and targeted cuttings removal can effectively reduce sticking risks.If sticking occurs,high-tonnage pulling should be avoided.Instead,releasing the stick through up-anddown string motion,combined with high-volume nozzle spraying and annulus pumping,is recommended.The selection of coiled tubing should consider diameter,wall thickness,and steel grade to handle complex situations.Larger diameters,thicker walls,and low-frequency,multi-head hydraulic oscillators are more effective for unlocking horizontal sections.This approach can reduce the risk of drill sticking and solve the problem of horizontal section lock-ups,offering a reliable solution for smooth drilling and efficient production in wells with severe casing deformation.展开更多
An experimental investigation is conducted to evaluate the performance and the stalling process of a fan subjected to inlet swirls,as well as the effectiveness of an Impedance Boundary-Controlled(IBC)Casing Treatment(...An experimental investigation is conducted to evaluate the performance and the stalling process of a fan subjected to inlet swirls,as well as the effectiveness of an Impedance Boundary-Controlled(IBC)Casing Treatment(CT)on the stall margin recovery.An operating cycle is proposed based on the hysteresis effect of harmonic flap oscillation of airfoils and parallel compressor theory to explain the pressure characteristic of the fan under twin swirl inlets.Twin swirls are observed to reduce the stall margin of the fan,and the circumferential location where the spike is detected turns to the intersection area of the twin swirl.The IBC CT is proven to extend the stall margin of the fan for 12.7%–22.3%when subjected to inlet swirls with an efficiency loss of around 1%.The IBC CT helps to reduce the size of the operating cycle of the fan by redistributing the blade loading and adding the system damping to dissipate the perturbation energy.展开更多
The “well factory” mode's high-density well placement and multi-stage hydraulic fracturing technology enable efficient development of unconventional oil and gas resources.However,the deployment of platform wells...The “well factory” mode's high-density well placement and multi-stage hydraulic fracturing technology enable efficient development of unconventional oil and gas resources.However,the deployment of platform wells in the “well factory” model results in small wellbore spacing,and the stress disturbances caused by fracturing operations may affect neighboring wells,leading to inter-well interference phenomena that cause casing deformation.This study investigates the issue of inter-well interference causing casing deformation or even failure during multi-stage hydraulic fracturing in the “well factory”model,and predicts high-risk locations for casing failure.A flow-mechanics coupled geomechanical finite element model with retaining geological stratification characteristics was established.Based on the theory of hydraulic fracturing-induced rock fragmentation and fluid action leading to the degradation of rock mechanical properties,the model simulated the four-dimensional evolution of multi-well fracturing areas over time and space,calculating the disturbance in the regional stress field caused by fracturing operations.Subsequently,the stress distribution of multiple well casings at different time points was calculated to predict high-risk locations for casing failure.The research results show that the redistribution of the stress field in the fracturing area increases the stress on the casing.The overlapping fracturing zones between wells cause significant stress interference,greatly increasing the risk of deformation and failure.By analyzing the Mises stress distribution of multi-well casings,high-risk locations for casing failure can be identified.The conclusion is that the key to preventing casing failure in platform wells in the “well factory” model is to optimize the spatial distribution of fracturing zones between wells and reasonably arrange well spacing.The study provides new insights and methods for predicting casing failure in unconventional oil and gas reservoirs and offers references for optimizing drilling and fracturing designs.展开更多
The manufacturing processes of casing rings are prone to multi-type defects such as holes,cracks,and porosity,so ultrasonic testing is vital for the quality of aeroengine.Conventional ultrasonic testing requires manua...The manufacturing processes of casing rings are prone to multi-type defects such as holes,cracks,and porosity,so ultrasonic testing is vital for the quality of aeroengine.Conventional ultrasonic testing requires manual analysis,which is susceptible to human omission,inconsistent results,and time-consumption.In this paper,a method for automated detection of defects is proposed for the ultrasonic Total Focusing Method(TFM)inspection of casing rings based on deep learning.First,the original datasets of defect images are established,and the Mask R-CNN is used to increase the number of defects in a single image.Then,the YOLOX-S-improved lightweight model is proposed,and the feature extraction network is replaced by Faster Net to reduce redundant computations.The Super-Resolution Generative Adversarial Network(SRGAN)and Convolutional Block Attention Module(CBAM)are integrated to improve the identification precision.Finally,a new test dataset is created by ultrasonic TFM inspection of an aeroengine casing ring.The results show that the mean of Average Precision(m AP)of the YOLOX-S-improved model reaches 99.17%,and the corresponding speed reaches 77.6 FPS.This study indicates that the YOLOX-S-improved model performs better than conventional object detection models.And the generalization ability of the proposed model is verified by ultrasonic B-scan images.展开更多
Casing deformation is a widespread problem in a certain block of Jiaoshiba Shale Gas Field in Sichuan Basin,China,and it severely limits the development benefits of shale gas in that block.Based on the spatiotemporal ...Casing deformation is a widespread problem in a certain block of Jiaoshiba Shale Gas Field in Sichuan Basin,China,and it severely limits the development benefits of shale gas in that block.Based on the spatiotemporal characteristics of block formation,fracture development,and casing deformation occurrence,this paper employs an integrated geological—engineering research approach to identify the primary mechanisms governing casing deformation within the block and proposes countermeasures to prevent such deformation.The present research indicates the following findings:(1)The block has undergone multiple phases of tectonic superposition,with fracture development serving as the geological factor causing casing deformation.(2)Fracturing activation constitutes the engineering factor causing casing deformation,with 4 mm of formation slip inducing deformation.(3)The fracture activation risk map shows that Class Ⅰ and Class Ⅱ fractures account for 73.36%of the total recorded in the block.Within the most susceptible Class I risk zone,the critical activation pressure increment for fracturing operations ranges from 13.43 MPa to 13.99 MPa.Based on the distribution of casing failure risk zones identified in the fracture activation risk map,this paper proposes relevant technical countermeasures for preventing casing failure from three perspectives:shale gas well location deployment,drilling techniques,and fracturing techniques.These measures provide robust support for safeguarding the integrity of casing systems within the studied block.展开更多
BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major...BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.展开更多
The jacket structure and transition piece comprise the supporting structure of a bottom-fixed offshore wind turbine(OWT)connected to the steel tower,which determines the overall structural dynamic performance of the e...The jacket structure and transition piece comprise the supporting structure of a bottom-fixed offshore wind turbine(OWT)connected to the steel tower,which determines the overall structural dynamic performance of the entire OWT.Ideally,optimal performance can be realized by effectively coordinating two components,notwithstanding their separate design processes.In pursuit of this objective,this paper proposes a concurrent design methodology for the jacket structure and transition piece by exploiting topology optimization(TO).The TO for a three-legged jacket foundation is formulated by minimizing static compliance.In contrast to conventional TO,two separated volume fractions are imposed upon the structural design domain of the jacket structure and transition piece to ensure continuity.A 5 MW(megawatt)OWT supported by a four-legged or three-legged jacket substructure is under investigation.The external loads are derived from various design load cases that are acquired using the commercial software platform DNV Bladed(Det Norske Veritas).Through a comparative analysis of the fundamental frequency and maximum nodal deformation,it was found that the optimized solution demonstrates a reduced weight and superior stiffness.The findings demonstrate the present concurrent design approach using TO can yield significant benefits by reducing the overall design cycle and enhancing the feasibility of the final design.展开更多
BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of th...BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of the postoperative patient,more effective and less invasive treatments are favorable.CASE SUMMARY A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis.He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital.On the second postoperative day,laboratory data and computed tomography showed that the patient had developed acute pancreatitis.Although conservative management(antibiotics,hydration,etc.)had helped in relieving the symptoms of acute pancreatitis,peripancreatic fluid collection(PFC)persisted,accompanied by duodenal obstruction and vomiting.Contrastenhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased,consistent with walled-off WON.We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC.As a result,the WON resolved gradually,resulting in improved oral intake.CONCLUSION Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery.To the best of our knowledge,this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.展开更多
An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained ...An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained in Jan. 2003 in the same area. And then, the chlorophyll, suspended sediments and gelbstoff of the SeaWiFS pixels on Jan. 29, 2003 corresponding to the in-situ sites of Jan. 25 and 26, 2003 were synchronously retrieved, with average relative errors of 14.9%, 12.1% and 13.6% for chlorophyll, suspended sediments and gelbstoff, respectively. The research results indicated that the optimal retrieval algorithm established here was relatively fit for the retrieval of the chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary, and had quite good retrieval accuracy.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patie...BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.展开更多
BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sar...BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver;it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components.CASE SUMMARY This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS.After chemotherapy with the vincristine+doxorubicin+cyclophosphamide regimen,the alpha-fetoprotein level increased significantly.Therefore,a second liver puncture was performed,the pathological result of which was hepatic sarcomatoid carcinoma.Next-generation sequencing revealed MET gene amplification with an average copy number of 9 in the tumor tissue;however,both fluorescence in situ hybridization and immunohistochemical tests were negative for MET amplification.The treatment regimen was adjusted to chemotherapy combined with immunotherapy;however,the disease progressed rapidly,and the overall survival was only 6 months.CONCLUSION By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature,we aim to help clinicians enhance their understanding of two rare diseases,namely pleomorphic RMS and sarcomatoid carcinoma of the liver.展开更多
BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary app...BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.展开更多
BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupt...BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.展开更多
基金financial support from the National Key Sci-Tech Major Special Item(No.2011ZX05026-001)Program for Changjiang Scholars and Innovative Research Team in University(IRT1086)
文摘This paper presents a theoretical method and a finite element method to describe wellhead movement and uncemented casing strength in offshore oil and gas wells.Parameters considered in the theoretical method include operating load during drilling and completion and the temperature field,pressure field and the end effect of pressure during gas production.The finite element method for multistring analysis is developed to simulate random contact between casings.The relevant finite element analysis scheme is also presented according to the actual procedures of drilling,completion and gas production.Finally,field cases are presented and analyzed using the proposed methods.These are four offshore wells in the South China Sea.The calculated wellhead growths during gas production are compared with measured values.The results show that the wellhead subsides during drilling and completion and grows up during gas production.The theoretical and finite element solutions for wellhead growth are in good agreement with measured values and the deviations of calculation are within 10％.The maximum von Mises stress on the uncemented intermediate casing occurs during the running of the oil tube.The maximum von Mises stress on the uncemented production casing,calculated with the theoretical method occurs at removing the blow-out-preventer （BOP） while that calculated with the finite element method occurs at gas production.Finite element solutions for von Mises stress are recommended and the uncemented casings of four wells satisfy strength requirements.
文摘The dynamic modal model analysis of the oil casing connection is done by finite element method (FEM), and the first nature frequency, the second nature frequency, the vibration mode shape and the time domain of the node displacement and the element stress variation in the thread connection are gotten. The Von.Mises stresses of the connection in the static and dynamic state are also studied. The results of calculation and analysis show: (1) because the maximum of static stress is at the coupling thread end of connection, the connection begins to thread off at the coupling thread end, which is in accord with the results of the thread off experiment in laboratory; (2) because the first nature frequency is very high, the probability of casing connection to be damaged from vibration is little; (3) the shock dynamic load makes casing connection begin to thread off at the tube thread end.
基金support and funding from the CNPC Project(2021ZG10)National Natural Science Foundation of China(No.52174047)Sinopec Project(No.P23138).
文摘In drilling ultra-deep wells,the drilling fluid circulation usually causes erosion damage to downhole casing and drilling tools.However,the extent and process of this damage to the downhole tools is intricate and less understood.In order to systematically evaluate and clarify this damage process for different types of drilling fluid contamination,this research uses a high-temperature drilling fluid damage device to simulate the damage caused to the casing/drilling tools by various drilling fluid under a field thermal gradient.The results show that the drilling fluid residues are mainly solid-phase particles and organic components.The degree of casing/tool damage decreases with an increase in bottom hole temperature,and the casing/tool is least damaged within a temperature range of 150–180°C.Moreover,the surface of the casing/tool damaged by different types of drilling fluid shows different roughness,and the wettability of drilling fluid on the casing/tool surface increases with an increase in the degree of roughness.Oil-based drilling fluid have the strongest adhesion contamination on casing/drilling tools.In contrast,polysulfonated potassium drilling fluid and super-micro drilling fluid have the most potent erosion damage on casing/drilling tools.By analyzing the damage mechanism,it was established that the damage was mainly dominated by the abrasive wearing from solid-phase particles in concert with corrosion ions in drilling fluid,with solids producing many abrasion marks and corrosive ions causing a large number of pits.Clarifying drilling fluid's contamination and damage mechanism is significant in guiding the wellbore cleaning process and cutting associated costs.
基金financially supported by the National Natural Science Foundation of China(U24B2035 and 52304070)Postdoctoral Fellowship Program of CPSF(GZC20241889 and 2024M753456)Natural Science Foundation of Hubei Province of China(2024AFD374)。
文摘Hydraulic fracturing-induced casing deformation and fault activation have greatly hinde red the safe and efficient development of shale oil and gas resources.In this study,statistical analysis,physical tests,and numerical simulation methods are used to comprehensively analyze hydraulic fracturing-induced fault activation and casing deformation processes.This study is based on the Longmaxi Formation of LZ block,a deep shale gas reservoir in the southwest Sichuan Basin(China),as a geological background.A large amount of field data on fracturing from the LZ Block is counted,and the main influencing factors are analyzed.The main factors of hydraulic fracturing-induced fault slip are(from strong to weak)parameters related to fluid injection volume,parameters related to segments and clusters,and parameters related to injection rate.Combined with physical experiments and numerical simulations,the fault activation law during fracturing has been studied.The degree of casing deformation and fault slip are linearly correlated.For hydraulic fractures to cross faults is very difficult,fault activation and casing deformation can only be mitigated as much as possible.We find that the number of clusters per segment and the injection rate are negatively correlated with the fault slip distance.Reducing the fluid injection volume can mitigate the fault slip distance.Therefore,low injection rates,low fluid volumes,and more clusters per segment are recommended for fracturing in high-risk segments.It is important to note that the scale and risk of fault activation induced by well-factory fracturing is much higher compared to single-well fracturing.In situations with extremely high risk,the injection volume should preferably not exceed 800 m^(3) to minimize the risk of geological and casing deformation.
基金funded by the National Natural Science Foundation Project(Grant No.52274015)the National Science and Technology Major Project(Grant No.2025ZD1402205)。
文摘Casing damage resulting from sand production in unconsolidated sandstone reservoirs can significantly impact the average production of oil wells.However,the prediction task remains challenging due to the complex damage mechanism caused by sand production.This paper presents an innovative approach that combines feature selection(FS)with boosting algorithms to accurately predict casing damage in unconsolidated sandstone reservoirs.A novel TriScore FS technique is developed,combining mRMR,Random Forest,and F-test.The approach integrates three distinct feature selection approaches—TriScore,wrapper,and hybrid TriScore-wrapper and four interpretable Boosting models(AdaBoost,XGBoost,LightGBM,CatBoost).Moreover,shapley additive explanations(SHAP)was used to identify the most significant features across engineering,geological,and production features.The CatBoost model,using the Hybrid TriScore-rapper G_(1)G_(2)FS method,showed exceptional performance in analyzing data from the Gangxi Oilfield.It achieved the highestaccuracy(95.5%)and recall rate(89.7%)compared to other tested models.Casing service time,casing wall thickness,and perforation density were selected as the top three most important features.This framework enhances predictive robustness and is an effective tool for policymakers and energy analysts,confirming its capability to deliver reliable casing damage forecasts.
基金Project supported by the National Science and Technology Major Project(No.J2022-IV-0005-0022)the Aero Science Foundation of China(No.20230015050001)the Shenyang Science and Technology Plan Project of China(No.24-202-6-01)。
文摘As a common fault of the aero-engine,the blade-casing rubbing(BCR)has the potential to cause catastrophic accidents.In this paper,to investigate the dynamic responses and wear characteristics of the system,the laminated shell element is used to establish the finite element model(FEM)of a flexibly coated casing system.Using the shell element,the blade is modeled,and the surface stress of the blade is calculated.The stress-solving method of the blade is validated through comparisons with the measured time-domain waveform of the stress.Then,a dynamic model of a blade-flexibly coated casing system with rubbing is proposed,accounting for the time-varying mass and stiffness of the casing caused by coating wear.The effects of the proposed flexible casing model are compared with those of a rigid casing model,and the stress changes induced by rubbing are investigated.The results show that the natural characteristics of the coated casing decrease due to the coating wear.The flexibly coated casing model is found to be more suitable for studying casing vibration.Additionally,the stress changes caused by rubbing are slight,and the change in the stress maximum is approximately 5%under the influence of the abrasive coating.
基金supported by Major Technology Promotion Project of CNPC,China(No.2022ZT01)Major Field Test Project of CNPC,China(No.2019F-31-04)CNPC Chuanqing Drilling Engineering Company Science and Technology Special Project,China(No.CQ2024B-11-Z2-4).
文摘Milling bridge plugs in shale gas wells with severe casing deformation often leads to the accumulation of cuttings,increasing the risk of stuck drill bits.Friction in the wellbore further complicates tool deployment into the horizontal section,posing challenges to efficient plug drilling and achieving wellbore access to the target layer.This paper integrates the theory of positive displacement motors and models their actual working characteristics to study the milling of bridge plugs in severely deformed horizontal wells.It examines the effects of coiled tubing diameter and wall thickness on the bending load of horizontal sections and discusses key technical requirements,including the timing of plug drilling,extending the run in the horizontal section,parameter control,and real-time field analysis.Field practices have shown that after casing deformation occurs,priority should be given to drilling out the bridge plugs below the point of deformation.The primary factors contributing to stuck drills in deformed wells include smaller mill shoe sizes and larger cuttings sizes.Short well-washing cycles and targeted cuttings removal can effectively reduce sticking risks.If sticking occurs,high-tonnage pulling should be avoided.Instead,releasing the stick through up-anddown string motion,combined with high-volume nozzle spraying and annulus pumping,is recommended.The selection of coiled tubing should consider diameter,wall thickness,and steel grade to handle complex situations.Larger diameters,thicker walls,and low-frequency,multi-head hydraulic oscillators are more effective for unlocking horizontal sections.This approach can reduce the risk of drill sticking and solve the problem of horizontal section lock-ups,offering a reliable solution for smooth drilling and efficient production in wells with severe casing deformation.
基金supported by the National Natural Science Foundation of China(Nos.52306035 and 52325602)the Science Center for Gas Turbine Project,China(Nos.P2022-A-II-002-001 and P2022-C-II-003-001)+1 种基金the National Science and Technology Major Project,China(Nos.Y2022-II-0002-0005 and Y2022-II-0003-0006)the Key Laboratory of Pre-Research Management Centre,China(No.6142702200101)。
文摘An experimental investigation is conducted to evaluate the performance and the stalling process of a fan subjected to inlet swirls,as well as the effectiveness of an Impedance Boundary-Controlled(IBC)Casing Treatment(CT)on the stall margin recovery.An operating cycle is proposed based on the hysteresis effect of harmonic flap oscillation of airfoils and parallel compressor theory to explain the pressure characteristic of the fan under twin swirl inlets.Twin swirls are observed to reduce the stall margin of the fan,and the circumferential location where the spike is detected turns to the intersection area of the twin swirl.The IBC CT is proven to extend the stall margin of the fan for 12.7%–22.3%when subjected to inlet swirls with an efficiency loss of around 1%.The IBC CT helps to reduce the size of the operating cycle of the fan by redistributing the blade loading and adding the system damping to dissipate the perturbation energy.
基金supported by the National Natural Science Foundation of China (No.52104008&No.52274042)the Natural Science Foundation of Sichuan,China (No.2024NSFSC0963)。
文摘The “well factory” mode's high-density well placement and multi-stage hydraulic fracturing technology enable efficient development of unconventional oil and gas resources.However,the deployment of platform wells in the “well factory” model results in small wellbore spacing,and the stress disturbances caused by fracturing operations may affect neighboring wells,leading to inter-well interference phenomena that cause casing deformation.This study investigates the issue of inter-well interference causing casing deformation or even failure during multi-stage hydraulic fracturing in the “well factory”model,and predicts high-risk locations for casing failure.A flow-mechanics coupled geomechanical finite element model with retaining geological stratification characteristics was established.Based on the theory of hydraulic fracturing-induced rock fragmentation and fluid action leading to the degradation of rock mechanical properties,the model simulated the four-dimensional evolution of multi-well fracturing areas over time and space,calculating the disturbance in the regional stress field caused by fracturing operations.Subsequently,the stress distribution of multiple well casings at different time points was calculated to predict high-risk locations for casing failure.The research results show that the redistribution of the stress field in the fracturing area increases the stress on the casing.The overlapping fracturing zones between wells cause significant stress interference,greatly increasing the risk of deformation and failure.By analyzing the Mises stress distribution of multi-well casings,high-risk locations for casing failure can be identified.The conclusion is that the key to preventing casing failure in platform wells in the “well factory” model is to optimize the spatial distribution of fracturing zones between wells and reasonably arrange well spacing.The study provides new insights and methods for predicting casing failure in unconventional oil and gas reservoirs and offers references for optimizing drilling and fracturing designs.
基金supported by the Postdoctoral Fellowship Program of CPSF,China(No.GZC20232015)the China Postdoctoral Science Foundation(No.2024M752499)+3 种基金the Postdoctoral Project of Hubei Province,China(No.2024HBBHCXA076)the Wuhan East Lake New Technology Development Zone Open List Project,China(No.2022KJB128)the National Natural Science Foundation of China(No.51875428)the Fundamental Research Funds for the Central Universities,China(No.104972024RSCbs0013)。
文摘The manufacturing processes of casing rings are prone to multi-type defects such as holes,cracks,and porosity,so ultrasonic testing is vital for the quality of aeroengine.Conventional ultrasonic testing requires manual analysis,which is susceptible to human omission,inconsistent results,and time-consumption.In this paper,a method for automated detection of defects is proposed for the ultrasonic Total Focusing Method(TFM)inspection of casing rings based on deep learning.First,the original datasets of defect images are established,and the Mask R-CNN is used to increase the number of defects in a single image.Then,the YOLOX-S-improved lightweight model is proposed,and the feature extraction network is replaced by Faster Net to reduce redundant computations.The Super-Resolution Generative Adversarial Network(SRGAN)and Convolutional Block Attention Module(CBAM)are integrated to improve the identification precision.Finally,a new test dataset is created by ultrasonic TFM inspection of an aeroengine casing ring.The results show that the mean of Average Precision(m AP)of the YOLOX-S-improved model reaches 99.17%,and the corresponding speed reaches 77.6 FPS.This study indicates that the YOLOX-S-improved model performs better than conventional object detection models.And the generalization ability of the proposed model is verified by ultrasonic B-scan images.
文摘Casing deformation is a widespread problem in a certain block of Jiaoshiba Shale Gas Field in Sichuan Basin,China,and it severely limits the development benefits of shale gas in that block.Based on the spatiotemporal characteristics of block formation,fracture development,and casing deformation occurrence,this paper employs an integrated geological—engineering research approach to identify the primary mechanisms governing casing deformation within the block and proposes countermeasures to prevent such deformation.The present research indicates the following findings:(1)The block has undergone multiple phases of tectonic superposition,with fracture development serving as the geological factor causing casing deformation.(2)Fracturing activation constitutes the engineering factor causing casing deformation,with 4 mm of formation slip inducing deformation.(3)The fracture activation risk map shows that Class Ⅰ and Class Ⅱ fractures account for 73.36%of the total recorded in the block.Within the most susceptible Class I risk zone,the critical activation pressure increment for fracturing operations ranges from 13.43 MPa to 13.99 MPa.Based on the distribution of casing failure risk zones identified in the fracture activation risk map,this paper proposes relevant technical countermeasures for preventing casing failure from three perspectives:shale gas well location deployment,drilling techniques,and fracturing techniques.These measures provide robust support for safeguarding the integrity of casing systems within the studied block.
基金Supported by the Zhejiang Medical Science and Technology Project,No.2022KY1325 and No.2023KY381Public Welfare Project of Jinhua Science and Technology Plan,No.2023-4-084Major Project of Jinhua Science and Technology Plan,No.2023-3-066.
文摘BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.
基金supports were received from the National Key Research and Development Program of China(2024YFE0208600)New Energy Joint Laboratory of China Southern Power Grid Corporation(GDXNY2024KF03)+2 种基金the National Natural Science Foundation of China(Grant No.U24B2090)National Key R&D Program(No.2022YFB4201300)Science and Technology Project of Huaneng Group(HNKJ24-H78).
文摘The jacket structure and transition piece comprise the supporting structure of a bottom-fixed offshore wind turbine(OWT)connected to the steel tower,which determines the overall structural dynamic performance of the entire OWT.Ideally,optimal performance can be realized by effectively coordinating two components,notwithstanding their separate design processes.In pursuit of this objective,this paper proposes a concurrent design methodology for the jacket structure and transition piece by exploiting topology optimization(TO).The TO for a three-legged jacket foundation is formulated by minimizing static compliance.In contrast to conventional TO,two separated volume fractions are imposed upon the structural design domain of the jacket structure and transition piece to ensure continuity.A 5 MW(megawatt)OWT supported by a four-legged or three-legged jacket substructure is under investigation.The external loads are derived from various design load cases that are acquired using the commercial software platform DNV Bladed(Det Norske Veritas).Through a comparative analysis of the fundamental frequency and maximum nodal deformation,it was found that the optimized solution demonstrates a reduced weight and superior stiffness.The findings demonstrate the present concurrent design approach using TO can yield significant benefits by reducing the overall design cycle and enhancing the feasibility of the final design.
文摘BACKGROUND Although acute pancreatitis and walled-off necrosis(WON)are rare complications following aortic surgery,they are serious risk factors for postoperative mortality.Considering the poor general condition of the postoperative patient,more effective and less invasive treatments are favorable.CASE SUMMARY A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis.He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital.On the second postoperative day,laboratory data and computed tomography showed that the patient had developed acute pancreatitis.Although conservative management(antibiotics,hydration,etc.)had helped in relieving the symptoms of acute pancreatitis,peripancreatic fluid collection(PFC)persisted,accompanied by duodenal obstruction and vomiting.Contrastenhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased,consistent with walled-off WON.We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC.As a result,the WON resolved gradually,resulting in improved oral intake.CONCLUSION Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery.To the best of our knowledge,this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.
文摘An optimal algorithm for the retrieval of chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary was established with the optical parameters derived from the in-situ data obtained in Jan. 2003 in the same area. And then, the chlorophyll, suspended sediments and gelbstoff of the SeaWiFS pixels on Jan. 29, 2003 corresponding to the in-situ sites of Jan. 25 and 26, 2003 were synchronously retrieved, with average relative errors of 14.9%, 12.1% and 13.6% for chlorophyll, suspended sediments and gelbstoff, respectively. The research results indicated that the optimal retrieval algorithm established here was relatively fit for the retrieval of the chlorophyll, suspended sediments and gelbstoff of case Ⅱ waters in the Pearl River estuary, and had quite good retrieval accuracy.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
文摘BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.
基金Supported by Shaanxi Provincial Natural Science Basic Research Program,No.2020JQ-951.
文摘BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver;it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components.CASE SUMMARY This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS.After chemotherapy with the vincristine+doxorubicin+cyclophosphamide regimen,the alpha-fetoprotein level increased significantly.Therefore,a second liver puncture was performed,the pathological result of which was hepatic sarcomatoid carcinoma.Next-generation sequencing revealed MET gene amplification with an average copy number of 9 in the tumor tissue;however,both fluorescence in situ hybridization and immunohistochemical tests were negative for MET amplification.The treatment regimen was adjusted to chemotherapy combined with immunotherapy;however,the disease progressed rapidly,and the overall survival was only 6 months.CONCLUSION By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature,we aim to help clinicians enhance their understanding of two rare diseases,namely pleomorphic RMS and sarcomatoid carcinoma of the liver.
文摘BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.
文摘BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.
