A well developed network of roads must exist as a necessary infrastructure system in modem forestry to facilitate forest op- erations. But forest roads have the potential to disrupt the drainage characteristics of wat...A well developed network of roads must exist as a necessary infrastructure system in modem forestry to facilitate forest op- erations. But forest roads have the potential to disrupt the drainage characteristics of watersheds and lead to negative impacts on the environment with increased erosion and sediment yields. Numerous factors affect surface erosion of roads and sediment production potential; determining and ranking them could be a guide for management decisions to erosion control. In this study, the CULSED model （as an extension of ArcGIS） was used to estimate sediment delivery and the distribution of a road network, given the exist- ing culverts. Using the model, some culverts were added to the road network around places with high sediment delivery in order to minimize it. After a correlation analysis and adjustment between sediment production and the factors, i.e., road width, road gradient, age of road and vegetation cover, the trend of changes in sediment delivery with model changes in the input was investigated with a sensitivity analysis of the model. The results show that adding new culverts to the road resulted in a significant reduction of sediment delivery. The most important factor affecting sediment delivery was road width, followed by road gradient, vegetation cover and age of road. Road width and gradient were positively correlated with sediment delivery, while vegetation cover and age of road were neg- atively correlated. The best model to show the relation between sediment delivery and road width as well as with road gradient was a linear model, for vegetation cover a cubic equation and for road age a power model. The results of sensitivity analysis showed that sediment delivery had the greatest sensitivity to changes of road width and was least sensitive to changes in the age of the road. This model can help to estimate sediment delivery with its spatial distribution, which can be used for optimization of cross drain systems and strategies of sediment control. Application of the model requires field trials to acquire the necessary input data. The reliability of our results is a function of the accuracy of inputs, especially digital elevation model.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
AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched bas...AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion criteria.Postoperative outcomes were compared between patients with and those without routine drainage.Pooled odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects models.RESULTS:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were analyzed.Patients without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two groups.CONCLUSION:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication rates.Future randomized trials should compare routine vs selective drainage.展开更多
Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studie...Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy.The causes of pancreatic fluid leakage are;the parenchymal and/or thermal injury to the pancreas,and blunt injury to the pancreas by compression and retraction.Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery.Several studies have reported associations between D-AMY and POPF after gastrectomy,and the high value of D-AMY on postoperative day(POD)1 was an independent risk factor.To improve both sensitivity and specificity,attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers.Although several studies have shown a high predictive ability of POPF,it has not necessarily been exploited in clinical practice.Many problems remain unresolved;ideal timing for measurement,optimal cut-off value,and means of intervention after prediction.Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.展开更多
BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical i...BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.展开更多
Many dangerous effects arise from seepage through earth dams based on pervious layer. Therefore, the dam embankment must be provided with seepage control measures to avoid such effects. In the present work, different ...Many dangerous effects arise from seepage through earth dams based on pervious layer. Therefore, the dam embankment must be provided with seepage control measures to avoid such effects. In the present work, different control methods were used such as flat slopes, toe drainage systems, and a catch drain in the tail water. The hydraulic performance of each control measure was evaluated using the analytical solutions, previously developed, to estimate the seepage quantity (q), the height of seepage surface (h<sub>3</sub>), and the coordinates of the free surface (h<sub>x</sub>). Study was conducted on a physical model for a dam embankment having a top width (b) = 10.0 meter, height (H<sub>d</sub>) = 30.0 meter, and slope factor (m) = 1.5. The obtained results were analyzed and presented in dimensionless charts. Results showed that, the used control measures possess a great effect on the characteristics of seepage through earth dams based on pervious foundations. A comparative study was conducted between the studied toe drainage systems to enable the designers the better choice for design purposes.展开更多
OBJECTIVE:To evaluate the 10-year therapeutic efficacy of Traditional Chinese Medicine(TCM)using the Strengthening Spleen and Draining Dampness therapy in the management of idiopathic membranous nephropathy(IMN).METHO...OBJECTIVE:To evaluate the 10-year therapeutic efficacy of Traditional Chinese Medicine(TCM)using the Strengthening Spleen and Draining Dampness therapy in the management of idiopathic membranous nephropathy(IMN).METHODS:A single-center,retrospective analysis was conducted on patients diagnosed with IMN who met predefined inclusion and exclusion criteria.Data were collected from the Department of Nephrology at Longhua Hospital,affiliated with Shanghai University of Traditional Chinese Medicine,between January 2007 and December 2011.Clinical parameters including 24-h urinary protein,serum albumin,serum creatinine,and estimated glomerular filtration rate(e GFR,EPI)were assessed at baseline and at 1,3,5,and 10 years of follow-up.The efficacy of the Strengthening Spleen and Draining Dampness therapy was analyzed using repeated measures analysis of variance(ANOVA).Kaplan-Meier survival curves and multivariate proportional hazards model(Cox regression models)were employed to identify factors associated with treatment outcomes.RESULTS:A total of 265 patients were included,with a median follow-up duration of 96 months(36,122).TCM treatment significantly reduced 24-h urinary protein levels(P<0.001),and increased serum albumin levels(P<0.001),while serum creatinine remained stable(P=0.187).Remission rates at 1,3,5,and 10 years were 52.81%,69.71%,68.39%,and 72.36%,respectively,and the rates of avoiding composite outcome events at the same intervals were 98.27%,94.29%,94.19%,and 93.50%.In the subgroup receiving TCM only,remission rates were 56.67%,84.44%,76.32%,and 82.86%.For patients treated initially with Western Medicine followed by TCM,the rates were 52.83%,65.85%,67.47%and 67.75%.In the cohort of patients who received TCM as their first-line therapy,remission rates were 49.23%,62.50%,61.76%,and 69.23%.Multivariate Cox regression analysis revealed that the duration of TCM treatment[hazard ratio(HR)=0.826,95%confidence interval(CI)(0.779,0.876),P<0.001],presence of hypertension[HR=1.912,95%CI(1.181,3.094),P=0.008],baseline serum albumin level[HR=0.930,95%CI(0.894,0.969),P<0.001],and the rate of serum albumin increase within the first year of treatment[HR=0.930,95%CI(0.909,0.957),P<0.001]were significantly associated with clinical outcomes.CONCLUSION:The Strengthening Spleen and Draining Dampness therapy demonstrated robust short-and longterm efficacy in treating IMN,with high rates of remission and renal survival over 10 years.Key factors influencing clinical remission included the duration of TCM treatment,baseline serum albumin levels,the presence of hypertension,and the rate of increase in serum albumin within the first year.These findings suggest that this TCM approach provides a viable long-term treatment option for IMN.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migr...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.展开更多
Dear Editor,We introduce a novel surgical instrument designed to overcome the challenges in draining fluid from the suprachoroidal space in patients with choroidal detachment.In the evolving landscape of ophthalmic su...Dear Editor,We introduce a novel surgical instrument designed to overcome the challenges in draining fluid from the suprachoroidal space in patients with choroidal detachment.In the evolving landscape of ophthalmic surgeries,procedures that were once considered complex,such as those for choroidal detachment,are becoming increasingly common.Drainage of subchoroidal fluid was derived from 1985[1]with indirect visualization during scleral buckle surgery[2-4].展开更多
In vertical channel transistors(VCTs),source/drain ion implantation(I/I)represents a significant technical challenge due to inherent three-dimensional structural constraints,which induce complications such as difficul...In vertical channel transistors(VCTs),source/drain ion implantation(I/I)represents a significant technical challenge due to inherent three-dimensional structural constraints,which induce complications such as difficulties in dummy gate forma-tion and shadowing effects of I/I.This article systematically investigates the impact of different implantation conditions on the performance of VCTs with and without dummy gates through TCAD simulation.It reveals the significant role of the lightly doped regions(LDRs)naturally formed due to ion implantation in source/drain of VCTs.Furthermore,it was found that VCT with-out dummy gates can achieve an approximately 27%increase in on-state current(Ion)under the same implantation conditions,and can greatly simplify the process flow and reduce costs.Finally,N-type and P-type VCTs were successfully fabricated using this implantation method.展开更多
液体燃料熔盐堆是第四代先进核能系统的候选堆型之一,应急排盐冷却系统是其可设置的特殊安全设计。本文以熔盐实验堆(Molten Salt Reactor Experiment,MSRE)应急排盐冷却系统为研究对象,探究换热元件内层屏障破损对其正常余热导出功能...液体燃料熔盐堆是第四代先进核能系统的候选堆型之一,应急排盐冷却系统是其可设置的特殊安全设计。本文以熔盐实验堆(Molten Salt Reactor Experiment,MSRE)应急排盐冷却系统为研究对象,探究换热元件内层屏障破损对其正常余热导出功能的影响。该研究基于计算流体动力学(Computational Fluid Dynamics,CFD)模拟方法,通过构建传热和多相流动模型分析破损后的传热和流动现象,并对关键影响参数进行敏感性分析。结果表明,内层套管破损后,18.4%的冷却水从破损位置经气隙层流出,单根换热元件功率提升到29.434 kW,破损位置附近外层套管出现局部温度低点。敏感性分析结果表明,破损尺寸、破损位置和气隙层压力变化均会对换热元件传热产生明显影响,其中传热对破损尺寸的敏感性最强。该分析结果可以为熔盐堆应急排盐冷却系统工程设计提供研究数据。展开更多
Backflling represents an environmentally friendly mining waste disposal technique.It is increasingly used in underground mines all over the world.However,its primary purpose remains to improve ground stability and to ...Backflling represents an environmentally friendly mining waste disposal technique.It is increasingly used in underground mines all over the world.However,its primary purpose remains to improve ground stability and to reduce ore dilution.Previous investigations have shown that fll drainage plays a key role in backfll and barricade design.With a poor drainage system in the backflled stope,the required dimension of barricade,which is constructed at the base of the stope near the drift entrance,has to be increased.A poor backfll drainage system can also lead to a signifcant increase in drainage waiting time and further reduction in mining productivity.In this paper,the drainage of conventional backfll design in backflled stopes is briefly reviewed.For the frst time,the application of the wick drain is introduced in the backfll within mine stopes.The drainage improvement from the introduction of the wick drain is illustrated using numerical modeling.展开更多
AIM: To determine predictors of clinically relevant pancreatic fistulas (CRPF) by measuring drain fluid amylase (DFA) in the early postoperative period.
Three dimensional （3D） DEM （discrete element method） simulations of drained triaxial compression and plane strain tests are presented for both dense and loose assemblies of polydisperse spheres using a periodic ce...Three dimensional （3D） DEM （discrete element method） simulations of drained triaxial compression and plane strain tests are presented for both dense and loose assemblies of polydisperse spheres using a periodic cell. In the work reported, drained tests were modelled by deforming the samples under constant mean stress conditions. The drained behaviour is shown to be qualitatively similar to published physical experimental results. The Bishop＇s formula for the estimation of the intermediate principal stress is evaluated. The existence of critical density is shown to be independent of initial packing densities and strain conditions. Different failure criteria have been compared based on the DEM simulation results, and the Lade criterion is found to be the most appropriate one. A new microscopic fabric parameter is introduced to give insight to structural anisotropy under general 3D fabric conditions. It is found that two parameters characterize the evolution of the stress and fabric respectively independent of strain conditions.展开更多
A 2D full cell thermo-electric model of 160kA drained cell was set up using finiteelement code to calculate its freeze profile, then the drained cell model was modifiedaccording to the freeze profile computed and its ...A 2D full cell thermo-electric model of 160kA drained cell was set up using finiteelement code to calculate its freeze profile, then the drained cell model was modifiedaccording to the freeze profile computed and its heat balance was calculated. Comparedwith that of a 160kA conventional Hall-Heroult cell (H-H cell), though the melts vol-ume of the drained cell reduced greatly, the whole heat loss from it didn't drop downapparently, and an analysis was presented in the paper. On the other hand, the anode-cathode distance (ACD) of a drained cell was much less than that of a H-H cell, sothe voltage drop on it and heat produced decreased too, steps should be taken to keepa workable heat balance on a drained cell.展开更多
Abdominal drainage was previously recommended as a post-hepatectomy procedure for patients with cirrhosis.This report introduces a simple technique that prevents leakage of ascitic fluid after cirrhotic hepatectomy co...Abdominal drainage was previously recommended as a post-hepatectomy procedure for patients with cirrhosis.This report introduces a simple technique that prevents leakage of ascitic fluid after cirrhotic hepatectomy complicated by blockage of the abdominal drain.In 59 patients who had had cirrhotic hepatectomy complicated by leakage of ascites in the drain site after drainage removal between January 2001 and April 2011,31 underwent suture ligation(sutured group) and 28 were given urostomy bag at the abdominal drainage site(drainage group).The mean length of postoperative hospital stay in the drainage group was shorter than in the sutured group(16.11±2.61 vs 34.23±4.86 days,P=0.000).Meanwhile,the drainage group showed decreased postoperative complications,including leakage of ascites,wound infection,and collection of ascites.Drainage by urostomy bag can prevent prolonged leakage of ascitic fluid after the blockage of abdominal drains in patients undergoing cirrhotic hepatectomy.展开更多
Based on the commercial CFD software CFX-4.3, two-phase flow of electrolyte in 156 kA drained aluminum reduction cells with a new structure was numerically simulated by multi-fluid model and k-ε turbulence model. The...Based on the commercial CFD software CFX-4.3, two-phase flow of electrolyte in 156 kA drained aluminum reduction cells with a new structure was numerically simulated by multi-fluid model and k-ε turbulence model. The results show that the electrolyte flow in the drained cells is more even than in the conventional cells. Corresponding to center point feeding, the electrolyte flow in the drained cells is more advantageous to the release of anode gas, the dissolution and diffusion of alumina, and the gradient reduction of the electrolyte density and temperature. The average velocity of the electrolyte is 8.3 cm/s, and the maximum velocity is 59.5 cm/s. The average and maximum velocities of the gas are 23.2 cm/s and 61.1 cm/s, respectively. The cathode drained slope and anode cathode distance have certain effects on the electrolyte flow.展开更多
文摘A well developed network of roads must exist as a necessary infrastructure system in modem forestry to facilitate forest op- erations. But forest roads have the potential to disrupt the drainage characteristics of watersheds and lead to negative impacts on the environment with increased erosion and sediment yields. Numerous factors affect surface erosion of roads and sediment production potential; determining and ranking them could be a guide for management decisions to erosion control. In this study, the CULSED model （as an extension of ArcGIS） was used to estimate sediment delivery and the distribution of a road network, given the exist- ing culverts. Using the model, some culverts were added to the road network around places with high sediment delivery in order to minimize it. After a correlation analysis and adjustment between sediment production and the factors, i.e., road width, road gradient, age of road and vegetation cover, the trend of changes in sediment delivery with model changes in the input was investigated with a sensitivity analysis of the model. The results show that adding new culverts to the road resulted in a significant reduction of sediment delivery. The most important factor affecting sediment delivery was road width, followed by road gradient, vegetation cover and age of road. Road width and gradient were positively correlated with sediment delivery, while vegetation cover and age of road were neg- atively correlated. The best model to show the relation between sediment delivery and road width as well as with road gradient was a linear model, for vegetation cover a cubic equation and for road age a power model. The results of sensitivity analysis showed that sediment delivery had the greatest sensitivity to changes of road width and was least sensitive to changes in the age of the road. This model can help to estimate sediment delivery with its spatial distribution, which can be used for optimization of cross drain systems and strategies of sediment control. Application of the model requires field trials to acquire the necessary input data. The reliability of our results is a function of the accuracy of inputs, especially digital elevation model.
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.
文摘AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic drainage.METHODS:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion criteria.Postoperative outcomes were compared between patients with and those without routine drainage.Pooled odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects models.RESULTS:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were analyzed.Patients without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two groups.CONCLUSION:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication rates.Future randomized trials should compare routine vs selective drainage.
基金We are grateful to the nonprofit organization Epidemiological and Clinical Research Information Network(ECRIN)for providing their valuable support with this work.
文摘Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy.The causes of pancreatic fluid leakage are;the parenchymal and/or thermal injury to the pancreas,and blunt injury to the pancreas by compression and retraction.Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery.Several studies have reported associations between D-AMY and POPF after gastrectomy,and the high value of D-AMY on postoperative day(POD)1 was an independent risk factor.To improve both sensitivity and specificity,attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers.Although several studies have shown a high predictive ability of POPF,it has not necessarily been exploited in clinical practice.Many problems remain unresolved;ideal timing for measurement,optimal cut-off value,and means of intervention after prediction.Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 21K10715 and No.JP 20K10404Northern Advancement Center for Science&Technology,No.T-2-2+9 种基金the Yasuda Medical Foundation,No.31010316the Okawa Foundation for Information and Telecommunications,No.41111042Taiju Life Social Welfare Foundation,No.50811490Japan Keirin Autorace Foundation,No.2023M-378Project Mirai Cancer Research Grants,No.31010269Takahashi Industrial and Economic Research Foundation,No.50411278Sapporo Doto Hospital,No.50311211Noguchi Hospital,No.40310551Doki-kai Tomakomai Hospital,No.40710739Tsuchida Hospital,No.50811478.
文摘BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.
文摘Many dangerous effects arise from seepage through earth dams based on pervious layer. Therefore, the dam embankment must be provided with seepage control measures to avoid such effects. In the present work, different control methods were used such as flat slopes, toe drainage systems, and a catch drain in the tail water. The hydraulic performance of each control measure was evaluated using the analytical solutions, previously developed, to estimate the seepage quantity (q), the height of seepage surface (h<sub>3</sub>), and the coordinates of the free surface (h<sub>x</sub>). Study was conducted on a physical model for a dam embankment having a top width (b) = 10.0 meter, height (H<sub>d</sub>) = 30.0 meter, and slope factor (m) = 1.5. The obtained results were analyzed and presented in dimensionless charts. Results showed that, the used control measures possess a great effect on the characteristics of seepage through earth dams based on pervious foundations. A comparative study was conducted between the studied toe drainage systems to enable the designers the better choice for design purposes.
基金Supported by the National Key Research and Development Project,Clinical Study on the Treatment of Refractory Membranous Nephropathy with the Treatment of Strengthening Spleen and Draining Dampness in Method using Single Group Target Value Method(No.2019YFC1709403)Systematic Study on the Diagnosis and Treatment Rules of Membranous Nephropathy in Traditional Chinese Medicine(No.2023YFC35033501,No.2023YFC35033503)。
文摘OBJECTIVE:To evaluate the 10-year therapeutic efficacy of Traditional Chinese Medicine(TCM)using the Strengthening Spleen and Draining Dampness therapy in the management of idiopathic membranous nephropathy(IMN).METHODS:A single-center,retrospective analysis was conducted on patients diagnosed with IMN who met predefined inclusion and exclusion criteria.Data were collected from the Department of Nephrology at Longhua Hospital,affiliated with Shanghai University of Traditional Chinese Medicine,between January 2007 and December 2011.Clinical parameters including 24-h urinary protein,serum albumin,serum creatinine,and estimated glomerular filtration rate(e GFR,EPI)were assessed at baseline and at 1,3,5,and 10 years of follow-up.The efficacy of the Strengthening Spleen and Draining Dampness therapy was analyzed using repeated measures analysis of variance(ANOVA).Kaplan-Meier survival curves and multivariate proportional hazards model(Cox regression models)were employed to identify factors associated with treatment outcomes.RESULTS:A total of 265 patients were included,with a median follow-up duration of 96 months(36,122).TCM treatment significantly reduced 24-h urinary protein levels(P<0.001),and increased serum albumin levels(P<0.001),while serum creatinine remained stable(P=0.187).Remission rates at 1,3,5,and 10 years were 52.81%,69.71%,68.39%,and 72.36%,respectively,and the rates of avoiding composite outcome events at the same intervals were 98.27%,94.29%,94.19%,and 93.50%.In the subgroup receiving TCM only,remission rates were 56.67%,84.44%,76.32%,and 82.86%.For patients treated initially with Western Medicine followed by TCM,the rates were 52.83%,65.85%,67.47%and 67.75%.In the cohort of patients who received TCM as their first-line therapy,remission rates were 49.23%,62.50%,61.76%,and 69.23%.Multivariate Cox regression analysis revealed that the duration of TCM treatment[hazard ratio(HR)=0.826,95%confidence interval(CI)(0.779,0.876),P<0.001],presence of hypertension[HR=1.912,95%CI(1.181,3.094),P=0.008],baseline serum albumin level[HR=0.930,95%CI(0.894,0.969),P<0.001],and the rate of serum albumin increase within the first year of treatment[HR=0.930,95%CI(0.909,0.957),P<0.001]were significantly associated with clinical outcomes.CONCLUSION:The Strengthening Spleen and Draining Dampness therapy demonstrated robust short-and longterm efficacy in treating IMN,with high rates of remission and renal survival over 10 years.Key factors influencing clinical remission included the duration of TCM treatment,baseline serum albumin levels,the presence of hypertension,and the rate of increase in serum albumin within the first year.These findings suggest that this TCM approach provides a viable long-term treatment option for IMN.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.
基金Supported by Science and Technology Foundation of Tianjin Eye Hospital(No.YKPY2207)Tianjin Key Medical Discipline(Specialty)Construction Project(No.TJYXZDXK-016A).
文摘Dear Editor,We introduce a novel surgical instrument designed to overcome the challenges in draining fluid from the suprachoroidal space in patients with choroidal detachment.In the evolving landscape of ophthalmic surgeries,procedures that were once considered complex,such as those for choroidal detachment,are becoming increasingly common.Drainage of subchoroidal fluid was derived from 1985[1]with indirect visualization during scleral buckle surgery[2-4].
文摘In vertical channel transistors(VCTs),source/drain ion implantation(I/I)represents a significant technical challenge due to inherent three-dimensional structural constraints,which induce complications such as difficulties in dummy gate forma-tion and shadowing effects of I/I.This article systematically investigates the impact of different implantation conditions on the performance of VCTs with and without dummy gates through TCAD simulation.It reveals the significant role of the lightly doped regions(LDRs)naturally formed due to ion implantation in source/drain of VCTs.Furthermore,it was found that VCT with-out dummy gates can achieve an approximately 27%increase in on-state current(Ion)under the same implantation conditions,and can greatly simplify the process flow and reduce costs.Finally,N-type and P-type VCTs were successfully fabricated using this implantation method.
基金the financial support of School of Advanced Technology(FIRPSIRE-research+1 种基金FDETS)the Natural Sciences and Engineering Research Council of Canada(RGPIN)
文摘Backflling represents an environmentally friendly mining waste disposal technique.It is increasingly used in underground mines all over the world.However,its primary purpose remains to improve ground stability and to reduce ore dilution.Previous investigations have shown that fll drainage plays a key role in backfll and barricade design.With a poor drainage system in the backflled stope,the required dimension of barricade,which is constructed at the base of the stope near the drift entrance,has to be increased.A poor backfll drainage system can also lead to a signifcant increase in drainage waiting time and further reduction in mining productivity.In this paper,the drainage of conventional backfll design in backflled stopes is briefly reviewed.For the frst time,the application of the wick drain is introduced in the backfll within mine stopes.The drainage improvement from the introduction of the wick drain is illustrated using numerical modeling.
文摘AIM: To determine predictors of clinically relevant pancreatic fistulas (CRPF) by measuring drain fluid amylase (DFA) in the early postoperative period.
基金funded by the Engineering and Physical Sciences Research Council, UK (Grant No.GR/R91588)
文摘Three dimensional （3D） DEM （discrete element method） simulations of drained triaxial compression and plane strain tests are presented for both dense and loose assemblies of polydisperse spheres using a periodic cell. In the work reported, drained tests were modelled by deforming the samples under constant mean stress conditions. The drained behaviour is shown to be qualitatively similar to published physical experimental results. The Bishop＇s formula for the estimation of the intermediate principal stress is evaluated. The existence of critical density is shown to be independent of initial packing densities and strain conditions. Different failure criteria have been compared based on the DEM simulation results, and the Lade criterion is found to be the most appropriate one. A new microscopic fabric parameter is introduced to give insight to structural anisotropy under general 3D fabric conditions. It is found that two parameters characterize the evolution of the stress and fabric respectively independent of strain conditions.
基金supported by the National Key Fundamental Research&Development Project of China(No.G1999064903).
文摘A 2D full cell thermo-electric model of 160kA drained cell was set up using finiteelement code to calculate its freeze profile, then the drained cell model was modifiedaccording to the freeze profile computed and its heat balance was calculated. Comparedwith that of a 160kA conventional Hall-Heroult cell (H-H cell), though the melts vol-ume of the drained cell reduced greatly, the whole heat loss from it didn't drop downapparently, and an analysis was presented in the paper. On the other hand, the anode-cathode distance (ACD) of a drained cell was much less than that of a H-H cell, sothe voltage drop on it and heat produced decreased too, steps should be taken to keepa workable heat balance on a drained cell.
基金supported by grants from the International Collaborational Foundation of Jiangsu Province (BZ2011041,ZX05200904 and WS2011106)the National Nature Science Foundation of China (81100270 and 81070380)
文摘Abdominal drainage was previously recommended as a post-hepatectomy procedure for patients with cirrhosis.This report introduces a simple technique that prevents leakage of ascitic fluid after cirrhotic hepatectomy complicated by blockage of the abdominal drain.In 59 patients who had had cirrhotic hepatectomy complicated by leakage of ascites in the drain site after drainage removal between January 2001 and April 2011,31 underwent suture ligation(sutured group) and 28 were given urostomy bag at the abdominal drainage site(drainage group).The mean length of postoperative hospital stay in the drainage group was shorter than in the sutured group(16.11±2.61 vs 34.23±4.86 days,P=0.000).Meanwhile,the drainage group showed decreased postoperative complications,including leakage of ascites,wound infection,and collection of ascites.Drainage by urostomy bag can prevent prolonged leakage of ascitic fluid after the blockage of abdominal drains in patients undergoing cirrhotic hepatectomy.
基金Project(G1999064903) supported by the National Key Fundamental Research and Development Program of China
文摘Based on the commercial CFD software CFX-4.3, two-phase flow of electrolyte in 156 kA drained aluminum reduction cells with a new structure was numerically simulated by multi-fluid model and k-ε turbulence model. The results show that the electrolyte flow in the drained cells is more even than in the conventional cells. Corresponding to center point feeding, the electrolyte flow in the drained cells is more advantageous to the release of anode gas, the dissolution and diffusion of alumina, and the gradient reduction of the electrolyte density and temperature. The average velocity of the electrolyte is 8.3 cm/s, and the maximum velocity is 59.5 cm/s. The average and maximum velocities of the gas are 23.2 cm/s and 61.1 cm/s, respectively. The cathode drained slope and anode cathode distance have certain effects on the electrolyte flow.
