Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemi...Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system(OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.展开更多
By investigating the ecotone between Mount Tai Scenic Area and downtown area of Tai'an City,the characteristics of such an ecotone are analyzed,serious problems brought by the over-urbanization to local natural en...By investigating the ecotone between Mount Tai Scenic Area and downtown area of Tai'an City,the characteristics of such an ecotone are analyzed,serious problems brought by the over-urbanization to local natural environment,such as destruction of eco-environment,aggravated pollution and degradation of mountainous landscape resources are studied.Then countermeasures for the harmonious development of the ecotone are proposed to better promote the coordinated development of cities and mountainous scenic areas.展开更多
安全DNS协议DNS-over-HTTPS(DoH)的标准化和部署应用,使DoH隧道成为一种新的隐蔽性网络威胁并受到广泛关注。在云网络环境中对大规模DoH业务流量中潜在的隧道流量进行甄别,需要同时兼顾计算效率和准确率。针对当前基于机器学习的DoH隧...安全DNS协议DNS-over-HTTPS(DoH)的标准化和部署应用,使DoH隧道成为一种新的隐蔽性网络威胁并受到广泛关注。在云网络环境中对大规模DoH业务流量中潜在的隧道流量进行甄别,需要同时兼顾计算效率和准确率。针对当前基于机器学习的DoH隧道检测算法特征效率低、计算复杂度高的问题,设计了一组数据包块长度特征并提出了一种基于最大相关最小冗余(max-Relevance and Min-Re-dundancy,mRMR)特征筛选算法和随机森林算法的低维快速DoH隧道检测方法,该方法通过特征筛选选取对DoH隧道检测任务贡献大的特征,并使用随机森林分类器进行DoH隧道检测任务。实验结果表明,该方法在仅使用10维特征的情况下,达到了与使用24~34维特征的其他算法相当的准确率,可有效降低部署应用的计算复杂度,更好地适应大规模DoH业务流量分析的应用场景。展开更多
AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84...AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.展开更多
A 2-yr field experiment was conducted on a calcareous alluvial soil with four summer maize intercropping systems at Shangzhuang Experiment Station （116.3°E, 39.9°N） in the North China Plain. The objective ...A 2-yr field experiment was conducted on a calcareous alluvial soil with four summer maize intercropping systems at Shangzhuang Experiment Station （116.3°E, 39.9°N） in the North China Plain. The objective was to determine nitrate leaching from intercropping systems involving maize （Zea mays L.）： sole maize （CK）, maize ＋ soybean （CST）, maize ＋ groundnut （CGT）, maize ＋ ryegrass （CHM）, and maize ＋ alfalfa （CMX）. Intercropping greatly reduced nitrate accumulation in the 100-200 cm soil layers compared with maize monoculture. Nitrate accumulation under intercropping systems decreased significantly at the 140-200 cm soil depth; the accumulation varied in the order CK〉CST〉CMX〉CHM〉CGT. However, compared to the CK treatment, nitrate leaching losses during the maize growing period were reduced by 20.9- 174.8 （CGT）, 35.2-130.8 （CHM）, 60.4-122.0 （CMX）, and 30.6-82.4 kg ha-1 （CST）. The results also suggested that intereropping is an effective way to reduce nitrogen leaching in fields with N fertilizer over-dose.展开更多
AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted a...AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014.Indications for OTSC application were fistulae,anastomotic leakage,perforation,unroofed submucosal lesion for biopsy,refractory bleeding,and stent fixation in the gastrointestinal(GI)tract.Primary technical success was defined as the adequate deployment of the OTSC on the target lesion.Clinical success was defined as resolution of the problem;for instance,no requirement for surgery or further endoscopic intervention.In cases of recurrence,retreatment of a lesion with a second intervention was possible.Complications were classified into those related to sedation,endoscopy,or deployment of the clip.RESULTS:A total of 28 OTSC system applications werecarried out in 21 patients[median age 64 years(range42-85),33%females].The main indications were fistulae(52%),mostly after percutaneous endoscopic gastrostomy tube removal,and anastomotic leakage after GI surgery(29%).Further indications were unroofed submucosal lesions after biopsy,upper gastrointestinal bleeding,or esophageal stent fixation.The OTSC treatments were applied either in the upper(48%)or lower(52%)GI tract.The mean lesion size was 8 mm(range:2-20 mm).Primary technical success and clinical success rates were 85%and 67%,respectively.In53%of cases,the suction method was used without accessories(e.g.,twin grasper or tissue anchor).No endoscopy-related or OTSC-related complications were observed.CONCLUSION:OTSC is a useful tool for endoscopic closure of various GI lesions,including fistulae and leakages.Future randomized prospective multicenter trials are warranted.展开更多
AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS:...AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.展开更多
Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough ...Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.展开更多
An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system...An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system was originally developed to treat intestinal perforation or to close the tissue after natural orifice transluminal endoscopic surgery.Two cases of successful management of an anastomotic leak after colorectal surgery using the OTSC system are reported.One patient avoided a temporary ileostomy.In the other,hospitalization was shortened by the use of the OTSC system.The OTSC system can be a potential option in the management of anastomotic leaks after colorectal surgery.展开更多
This paper presents a redundantly actuated and over-constrained 2 RPU-2 SPR parallel manipulator with two rotational and one translational coupling degrees of freedom.The kinematics analysis is firstly carried out and...This paper presents a redundantly actuated and over-constrained 2 RPU-2 SPR parallel manipulator with two rotational and one translational coupling degrees of freedom.The kinematics analysis is firstly carried out and the mapping relationship of the velocity,acceleration and the independent parameters between the actuator joint and the moving platform are deduced by using the vector dot product and cross product operation.By employing d′Alembert′s principle and the principle of virtual work,the dynamics equilibrium equation is derived,and the simplified dynamics mathematical model of the parallel manipulator is further derived.Simultaneously,the generalized inertia matrix which can characterize the acceleration performance between joint space and operation space is further separated,and the performance indices including the dynamics dexterity,inertia coupling characteristics,energy transmission efficiency and driving force/torque balance are introduced.The analysis results show that the proposed redundantly actuated and over-constrained 2 RPU-2 SPR parallel manipulator in comparison with the existing non-redundant one has better dynamic comprehensive performance,which can be demonstrated practically by the successful application of the parallel kinematic machine head module of the hybrid machine tool.展开更多
Bleeding of peptic ulcer at the posterior duodenal bulb still is a particular endoscopic challenge with increased risk of treatment failure and worse outcome.In this article,we report successful treatment of an active...Bleeding of peptic ulcer at the posterior duodenal bulb still is a particular endoscopic challenge with increased risk of treatment failure and worse outcome.In this article,we report successful treatment of an actively bleeding peptic ulcer located at the posterior duodenal wall,using an over-the-scope-clip in the case of a 54-year-old male patient with hemorrhagic shock.Incident primary hemostasis was achieved and no adverse events occurred during a follow-up of 60 d.展开更多
The effect of melt over-heating on the morphology of Al_9FeNi phase in 2618aluminum alloy with high contents of Fe and Ni and 0.22 wt. percent zirconium has been investigatedby optical microscopy. SEM and TEM. The mec...The effect of melt over-heating on the morphology of Al_9FeNi phase in 2618aluminum alloy with high contents of Fe and Ni and 0.22 wt. percent zirconium has been investigatedby optical microscopy. SEM and TEM. The mechanical properties of 2618 aluminum alloy after hotextrusion and quenching/aging have been tested. The results show: melt over-heating treatment of2618 alloy with high contents of Fe and Ni at 960 deg C led to finer and better-distributedneedle-like Al_9FeNi phase in cast microstructure and fine Al_9FeNi particles after hot extrusion;the grain size of the alloy after hot extrusion could also be refined evidently by alloying ofzirconium; the ambient and high temperature tensile strength and elongation of 2618 alloy have beenapparently enhanced due to fine Al_9FeNi particles and dispersed Al_3Zr as well as fine grain size.展开更多
文摘Percutaneous endoscopic gastrostomy(PEG) is a common practice for long-term nutrition of patients who are unable to take oral food. We report of an 85-year old man with a history of recurrent larynx carcinoma and hemicolectomy many years ago due to unknown reason. Laryngectomy was indicated. Preoperatively a PEG was inserted endoscopically after an abdominal ultrasonography without abnormal findings. Few months after PEG insertion, the patient was evaluated for diarrhea and insufficient feeding without signs of infection or peritonism. An upper endoscopy and computed tomography scan confirmed a buried bumper syndrome with migration of the PEG tube into the colon as a rare complication. He underwent successful colonoscopic removal of the internal bumper and closure of the colonic orifice of the fistula with the over-the-scope-clip system(OTSC). OTSC is an endoscopic device for treatment of bleeding, perforation, leak and fistula in the gastrointestinal tract. To the best of our knowledge, this is the first report of the use of OTSC for colonoscopic closure of a gastrocolocutaneous fistula due to a buried bumper syndrome with transcolonic PEG tube migration.
基金Sponsored by Tai'an Municipal Scientific and Technological Development Project (20085002)~~
文摘By investigating the ecotone between Mount Tai Scenic Area and downtown area of Tai'an City,the characteristics of such an ecotone are analyzed,serious problems brought by the over-urbanization to local natural environment,such as destruction of eco-environment,aggravated pollution and degradation of mountainous landscape resources are studied.Then countermeasures for the harmonious development of the ecotone are proposed to better promote the coordinated development of cities and mountainous scenic areas.
文摘安全DNS协议DNS-over-HTTPS(DoH)的标准化和部署应用,使DoH隧道成为一种新的隐蔽性网络威胁并受到广泛关注。在云网络环境中对大规模DoH业务流量中潜在的隧道流量进行甄别,需要同时兼顾计算效率和准确率。针对当前基于机器学习的DoH隧道检测算法特征效率低、计算复杂度高的问题,设计了一组数据包块长度特征并提出了一种基于最大相关最小冗余(max-Relevance and Min-Re-dundancy,mRMR)特征筛选算法和随机森林算法的低维快速DoH隧道检测方法,该方法通过特征筛选选取对DoH隧道检测任务贡献大的特征,并使用随机森林分类器进行DoH隧道检测任务。实验结果表明,该方法在仅使用10维特征的情况下,达到了与使用24~34维特征的其他算法相当的准确率,可有效降低部署应用的计算复杂度,更好地适应大规模DoH业务流量分析的应用场景。
基金Supported by The“Endo-Verein Erlangen”a registered non-profit training organization+1 种基金BaiersdorfGermany
文摘AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.
基金the Key Technologies R&D Program of China during the 11th Five-Year Plan period (2007BAD89B01)the Key Technologies R&D Program of China during the 12th Five-Year Plan period(2011BAD16B15)the Project of Collaboration between Henan Province and Chinese Academy of Agricultural Sciences Program (102106000034)
文摘A 2-yr field experiment was conducted on a calcareous alluvial soil with four summer maize intercropping systems at Shangzhuang Experiment Station （116.3°E, 39.9°N） in the North China Plain. The objective was to determine nitrate leaching from intercropping systems involving maize （Zea mays L.）： sole maize （CK）, maize ＋ soybean （CST）, maize ＋ groundnut （CGT）, maize ＋ ryegrass （CHM）, and maize ＋ alfalfa （CMX）. Intercropping greatly reduced nitrate accumulation in the 100-200 cm soil layers compared with maize monoculture. Nitrate accumulation under intercropping systems decreased significantly at the 140-200 cm soil depth; the accumulation varied in the order CK〉CST〉CMX〉CHM〉CGT. However, compared to the CK treatment, nitrate leaching losses during the maize growing period were reduced by 20.9- 174.8 （CGT）, 35.2-130.8 （CHM）, 60.4-122.0 （CMX）, and 30.6-82.4 kg ha-1 （CST）. The results also suggested that intereropping is an effective way to reduce nitrogen leaching in fields with N fertilizer over-dose.
文摘AIM:To evaluate the outcome of over-the-scope-clip system(OTSC)for endoscopic treatment of various indications in daily clinical practice in Switzerland.METHODS:This prospective,consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014.Indications for OTSC application were fistulae,anastomotic leakage,perforation,unroofed submucosal lesion for biopsy,refractory bleeding,and stent fixation in the gastrointestinal(GI)tract.Primary technical success was defined as the adequate deployment of the OTSC on the target lesion.Clinical success was defined as resolution of the problem;for instance,no requirement for surgery or further endoscopic intervention.In cases of recurrence,retreatment of a lesion with a second intervention was possible.Complications were classified into those related to sedation,endoscopy,or deployment of the clip.RESULTS:A total of 28 OTSC system applications werecarried out in 21 patients[median age 64 years(range42-85),33%females].The main indications were fistulae(52%),mostly after percutaneous endoscopic gastrostomy tube removal,and anastomotic leakage after GI surgery(29%).Further indications were unroofed submucosal lesions after biopsy,upper gastrointestinal bleeding,or esophageal stent fixation.The OTSC treatments were applied either in the upper(48%)or lower(52%)GI tract.The mean lesion size was 8 mm(range:2-20 mm).Primary technical success and clinical success rates were 85%and 67%,respectively.In53%of cases,the suction method was used without accessories(e.g.,twin grasper or tissue anchor).No endoscopy-related or OTSC-related complications were observed.CONCLUSION:OTSC is a useful tool for endoscopic closure of various GI lesions,including fistulae and leakages.Future randomized prospective multicenter trials are warranted.
文摘AIM: To retrospectively review the results of over-thescope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD). METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size. CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.
基金Supported by the National Hi-Tech Research and Development Program of China(863 Program)(Grant No .2006 AA04Z311)K.C.Wong Education Foundation,Hong Kong
文摘Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemo-clips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we present a case of successful endoscopic closure of a gastrocolic fistula in a severely malnourished patient with complex post-surgical upper GI anatomy. We strongly believe that this device is a major breakthrough for the management of various types of discontinuity defects or fistulas. In addition, we show the usefulness of placing a direct jejunostomy using the double balloon enteroscopy (DBE) technique during the same procedure. The concept of providing direct jejunal feedings while allowing for upper gas-trointestinal bowel rest to promote the healing of the minimally invasive endoscopic operation is novel. Thus, our case is unique and exemplifies the utility of mini-mally invasive endoscopic endoluminal surgery.
文摘An anastomotic leak is one of the major complications following colorectal surgery.Standard treatments for anastomotic leak are total parenteral nutrition or temporary ileostomy.The over-the-scope-clipping(OTSC)system was originally developed to treat intestinal perforation or to close the tissue after natural orifice transluminal endoscopic surgery.Two cases of successful management of an anastomotic leak after colorectal surgery using the OTSC system are reported.One patient avoided a temporary ileostomy.In the other,hospitalization was shortened by the use of the OTSC system.The OTSC system can be a potential option in the management of anastomotic leaks after colorectal surgery.
基金supported by the Fundamental Research Funds for the Central Universities (Nos. 2018JBZ007, 2018YJS136 and 2017YJS158)China Scholarship Council (CSC) (No. 201807090079)National Natural Science Foundation of China (No. 51675037)
文摘This paper presents a redundantly actuated and over-constrained 2 RPU-2 SPR parallel manipulator with two rotational and one translational coupling degrees of freedom.The kinematics analysis is firstly carried out and the mapping relationship of the velocity,acceleration and the independent parameters between the actuator joint and the moving platform are deduced by using the vector dot product and cross product operation.By employing d′Alembert′s principle and the principle of virtual work,the dynamics equilibrium equation is derived,and the simplified dynamics mathematical model of the parallel manipulator is further derived.Simultaneously,the generalized inertia matrix which can characterize the acceleration performance between joint space and operation space is further separated,and the performance indices including the dynamics dexterity,inertia coupling characteristics,energy transmission efficiency and driving force/torque balance are introduced.The analysis results show that the proposed redundantly actuated and over-constrained 2 RPU-2 SPR parallel manipulator in comparison with the existing non-redundant one has better dynamic comprehensive performance,which can be demonstrated practically by the successful application of the parallel kinematic machine head module of the hybrid machine tool.
文摘Bleeding of peptic ulcer at the posterior duodenal bulb still is a particular endoscopic challenge with increased risk of treatment failure and worse outcome.In this article,we report successful treatment of an actively bleeding peptic ulcer located at the posterior duodenal wall,using an over-the-scope-clip in the case of a 54-year-old male patient with hemorrhagic shock.Incident primary hemostasis was achieved and no adverse events occurred during a follow-up of 60 d.
基金The present study was supported by the National Key Basic Research and Development Programme of China (Project No. G1999064909).
文摘The effect of melt over-heating on the morphology of Al_9FeNi phase in 2618aluminum alloy with high contents of Fe and Ni and 0.22 wt. percent zirconium has been investigatedby optical microscopy. SEM and TEM. The mechanical properties of 2618 aluminum alloy after hotextrusion and quenching/aging have been tested. The results show: melt over-heating treatment of2618 alloy with high contents of Fe and Ni at 960 deg C led to finer and better-distributedneedle-like Al_9FeNi phase in cast microstructure and fine Al_9FeNi particles after hot extrusion;the grain size of the alloy after hot extrusion could also be refined evidently by alloying ofzirconium; the ambient and high temperature tensile strength and elongation of 2618 alloy have beenapparently enhanced due to fine Al_9FeNi particles and dispersed Al_3Zr as well as fine grain size.
