Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).W...Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).Written informed consents were obtained from the patients.Acupuncture is an integral part of traditional Chinese medicine,and is widely used for the treatment of systemic diseases and ophthalmologic diseases^([1-8]),such as paralysis caused by stroke^([4]),diabetes^([7]),dry eye disease^([8]),pigmentary degeneration of retina,macular degeneration,glaucoma,and optic atrophy^([6]).Improper acupuncture technique can lead to accidents.展开更多
The perforating phase leads to complex and diverse hydraulic fracture propagation behaviors in laminated shale formations. In this paper, a 2D high-speed imaging scheme which can capture the interaction between perfor...The perforating phase leads to complex and diverse hydraulic fracture propagation behaviors in laminated shale formations. In this paper, a 2D high-speed imaging scheme which can capture the interaction between perforating phase and natural shale bedding planes was proposed. The phase field method was used to simulate the same conditions as in the experiment for verification and hydraulic fracture propagation mechanism under the competition of perforating phase and bedding planes was discussed.The results indicate that the bedding planes appear to be no influence on fracture propagation while the perforating phase is perpendicular to the bedding planes, and the fracture propagates along the perforating phase without deflection. When the perforating phase algins with the bedding planes, the fracture initiation pressure reserves the lowest value, and no deflection occurs during fracture propagation. When the perforating phase is the angle 45°, 60°and 75°of bedding planes, the bedding planes begin to play a key role on the fracture deflection. The maximum deflection degree is reached at the perforating phase of75°. Numerical simulation provides evidence that the existence of shale bedding planes is not exactly equivalent to anisotropy for fracture propagation and the difference of mechanical properties between different shale layers is the fundamental reason for fracture deflection. The findings help to understand the intrinsic characteristics of shale and provide a theoretical basis for the optimization design of field perforation parameters.展开更多
An oriented cluster perforating technology,which integrates both advantages of cluster and oriented perforating,will help solve a series of technical complexities in horizontal well drilling.For realizing its better a...An oriented cluster perforating technology,which integrates both advantages of cluster and oriented perforating,will help solve a series of technical complexities in horizontal well drilling.For realizing its better application in oil and gas development,a series of technologies were developed including perforator self-weight eccentricity,matching of the electronic selective module codes with the surface program control,axial centralized contact signal transmission,and post-perforation intercluster sealing insulation.In this way,the following functions could be realized,such as cable-transmission horizontal well perforator self-weight orientation,dynamic signal transmission,reliable addressing&selective perforation and post-perforation intercluster sealing.The combined perforation and bridge plug or the multi-cluster perforation can be fulfilled in one trip of perforation string.As a result,the horizontal-well oriented cluster perforating technology based on cable conveying was developed.This technology was successfully applied in unconventional gas reservoir exploitation,such as shale gas and coalbed methane,with accurate orientation,reliable selective perforation and satisfactory inter-cluster sealing.The horizontal-well oriented cluster perforating technology benefits the orientation of horizontal well drilling with a definite target and direction,which provides a powerful support for the subsequent reservoir stimulation.It also promotes the fracturing fluid to sweep the principal pay zones to the maximum extent.Moreover,it is conductive to the formation of complex fracture networks in the reservoirs,making quality and efficient development of unconventional gas reservoirs possible.展开更多
Finite element method is used to study the formations of the penetration jet,the bulge,and the burr in the designed reusable perforating gun.The attached layer of the soft metal on the perforator is studied for the co...Finite element method is used to study the formations of the penetration jet,the bulge,and the burr in the designed reusable perforating gun.The attached layer of the soft metal on the perforator is studied for the controlling of the bulge height on the casing of the reusable perforating gun.Results indicate that the shaped charge jet is initially formed in the center of the shaped charge liner and then the material of the liner is driven to the centerline of the liner by the detonation wave.The attachment of the soft metal layer to the cartridge of the perforator can be beneficial to control the bulge height.The design on the blind holes on the casing can affect the burr height formed by the collision between the jet and the casing.With the increase in the liner angle,the penetration width on the cement wall of the wellbore is increased.展开更多
The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the seco...The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.展开更多
BACKGROUND Despite advances in medical therapy for Crohn’s disease(CD),most patients with CD require repeated resection surgeries.AIM To analyze the perforating and nonperforating indications of repeated CD operation...BACKGROUND Despite advances in medical therapy for Crohn’s disease(CD),most patients with CD require repeated resection surgeries.AIM To analyze the perforating and nonperforating indications of repeated CD operations and identify the anastomosis characteristics for postoperative CD.METHODS We retrospectively reviewed 386 patients who underwent at least one resection for CD between 2003 and 2013.Clinical characteristics of each surgery were collected.Univariate and multivariate analyses were performed to determine risk factors for recurrence.RESULTS The indication for reoperation in CD tends to be the same as that for primary operation,i.e.,perforating disease tends to represent as perforating disease and nonperforating as nonperforating.Concordance was found between the first surgery and second surgery in terms of the indication for the operation(P=0.006),and the indication for the third surgery was also correlated with that for the second surgery(P=0.033).Even if the correlation of surgical indications between repeated operations,the rate of perforating indication for the second and third surgeries was significantly higher than that of the first surgery.In addition,the presence of perforating CD was a predictor of recurrence for both the first and second surgeries.Moreover,anastomotic lesions were the most common sites of recurrence after the operation.Based on the importance of anastomosis,anastomosis might be a new type of disease location for the classification of postoperative CD.CONCLUSION CD not only has stable characteristics but also progresses chronically.Perforation is a progressive surgical indication for Crohn’s disease.For CD after surgery,anastomosis may be a new classification of disease location.展开更多
BACKGROUND The diagnosis and therapy during surgery depend largely on a full account of anatomic characteristics.Apart from regular structures,the common,less common or even uncommon anatomic variations are critical f...BACKGROUND The diagnosis and therapy during surgery depend largely on a full account of anatomic characteristics.Apart from regular structures,the common,less common or even uncommon anatomic variations are critical for procedural planning.This is especially true during craniocerebral microsurgery,where small vascular variations can affect the final surgical results and patient prognosis.CASE SUMMARY Herein,two rare variations concerning the A1(horizontal)segment of anterior cerebral artery(ACA1)were introduced.One enabled the communication between perforating branch of ACA1 and dural artery of anterior skull base,which was discovered during autopsy.The other was ophthalmic artery(OA)originating from ACA1,shown on digital angiography.CONCLUSION In this study,we found two rare anatomical variations.One was an abnormal OA originated from the anterior communicating artery.The other was a perforating branch of the A1 segment of the anterior cerebral artery,which communicated with meningeal vessels in the anterior skull base.This finding is of great significance for the treatment of anterior communicating artery aneurysm or in other anterior skull base surgery.展开更多
We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforat...We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.展开更多
Compound technique of perforating and fracturing can effectively control the perforating direction and the fracturing expansion. The feasibility of this technique used in fracturing coal seams is analyzed. In this pap...Compound technique of perforating and fracturing can effectively control the perforating direction and the fracturing expansion. The feasibility of this technique used in fracturing coal seams is analyzed. In this paper, the experiments of perforating and fracturing are carried out on samples of coal and the experimental effects are satisfactory. Compound technique of perforating and fracturing is promising in coal seams.展开更多
Objective To investigate anterior tragal perforating aftery( ATPA) and provide anatomic basis for flap derived from preauricular area. Methods Twenty ( 40 sides) cadaver heads fixed in 10% formalin solution and perfus...Objective To investigate anterior tragal perforating aftery( ATPA) and provide anatomic basis for flap derived from preauricular area. Methods Twenty ( 40 sides) cadaver heads fixed in 10% formalin solution and perfused with red - colored latex were used to perform gross anatomy study. Two heads of fresh cadaver展开更多
BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of th...BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.展开更多
Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal o...Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.展开更多
In order to obtain the perforation depth, the three zones with different permeability because of plastic deformation and fluid invasion were studied based on related theories. The study shows that the calculation of p...In order to obtain the perforation depth, the three zones with different permeability because of plastic deformation and fluid invasion were studied based on related theories. The study shows that the calculation of perforation depth should take account of not only damaged zone, but also plastic zone, because the plastic zone has much lower permeability. The required minimum perforation depth was obtained by making the solution of elastic/plastic equations, and the factors affecting perforation depth were analyzed accordingly.展开更多
Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopi...Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.展开更多
Perforating ocular trauma with retained intraorbital foreign body （IOrFB） is a severe injury with a poor prognosis. The injury involves the posterior segment of the eye, and foreign bodies are mostly lodged posterio...Perforating ocular trauma with retained intraorbital foreign body （IOrFB） is a severe injury with a poor prognosis. The injury involves the posterior segment of the eye, and foreign bodies are mostly lodged posterior to the globe. Vitreoretinal surgery and IOrFB removal are always performed separately in patients with ocular perforating injury and IOrFBs. Obviously, separate procedures increase the cost and patient discomfort, lntraoperative fluoroscopy,展开更多
We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault.The bullet entered above the right zygomatic arch,travelling through the coronal pl...We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault.The bullet entered above the right zygomatic arch,travelling through the coronal plane,and exited from the left zygomatic arch.The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay.Non-contrast CT scan of the head revealed fractures of the right orbit,bilateral maxilla,bilateral pterygoid plates,ethmoid air cells,vomer and left zygoma,and without any cerebral damage.He was treated conservatively and the facial palsy was resolved.The patient survived without any complications.Such case has not been described in the available literature till date.展开更多
An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on t...An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on the formation of perforation by AWJ is unclear yet.In this study,we investigate AWJ impacts on three types of granite samples with different mineral fractions using a polarizing microscope and scanning electron microscope(SEM).The results show that when the grain size is doubled,the perforation depth increases by 16.22%under the same type of structure and properties.In general,fractures are more likely to be created at the position of rough surfaces caused by abrasive impact,and the form of fractures is determined by the mineral type.In addition,microstructure analysis shows that transgranular fractures typically pass through large feldspar particles and quartz removal occurs along mineral boundaries.The longitudinal extension of perforation depends mainly on the strong kinetic energy of the jet,while the lateral extension is controlled by the backflow.The results contribute to a better understanding of the process involved in the breaking of hard rock by abrasive jets during deep geothermal drilling.展开更多
A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless emp...A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless empirical equation to describe the variation of energy absorbed through global deformation as a function of impact velocity.The study further investigates the energy absorption mechanisms of Weldox 460E steel plates,with particular focus on the“plateau”phenomenon,i.e.,limited increase in ballistic limit with increasing plate thickness.This phenomenon is explained and compared with results from previously studied 2024-T351 aluminium plates.The model predictions agree well with experimental data for Weldox 460E steel plates impacted by flat-nosed projectiles,including:relationship between global deformation and impact velocity,ballistic limit,residual velocity,and critical conditions for the transition of failure modes.Moreover,the model effectively predicts the“plateau”phenomenon observed in intermediate plate thickness range.It is also found that the indentation absorption energy contributes a significantly larger fraction of the total absorption energy in Weldox 460E steel plates perforated by flat-nosed projectiles than in 2024-T351 aluminium plates,due to the differences in material properties.展开更多
BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In...BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.展开更多
基金Supported by Shaanxi Provincial Science and Technology Development Plan Project(No.2024SFYBXM-327).
文摘Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).Written informed consents were obtained from the patients.Acupuncture is an integral part of traditional Chinese medicine,and is widely used for the treatment of systemic diseases and ophthalmologic diseases^([1-8]),such as paralysis caused by stroke^([4]),diabetes^([7]),dry eye disease^([8]),pigmentary degeneration of retina,macular degeneration,glaucoma,and optic atrophy^([6]).Improper acupuncture technique can lead to accidents.
基金financially supported by the National Natural Science Foundation of China(Grant Nos.52074315&U19B6003)。
文摘The perforating phase leads to complex and diverse hydraulic fracture propagation behaviors in laminated shale formations. In this paper, a 2D high-speed imaging scheme which can capture the interaction between perforating phase and natural shale bedding planes was proposed. The phase field method was used to simulate the same conditions as in the experiment for verification and hydraulic fracture propagation mechanism under the competition of perforating phase and bedding planes was discussed.The results indicate that the bedding planes appear to be no influence on fracture propagation while the perforating phase is perpendicular to the bedding planes, and the fracture propagates along the perforating phase without deflection. When the perforating phase algins with the bedding planes, the fracture initiation pressure reserves the lowest value, and no deflection occurs during fracture propagation. When the perforating phase is the angle 45°, 60°and 75°of bedding planes, the bedding planes begin to play a key role on the fracture deflection. The maximum deflection degree is reached at the perforating phase of75°. Numerical simulation provides evidence that the existence of shale bedding planes is not exactly equivalent to anisotropy for fracture propagation and the difference of mechanical properties between different shale layers is the fundamental reason for fracture deflection. The findings help to understand the intrinsic characteristics of shale and provide a theoretical basis for the optimization design of field perforation parameters.
基金Project supported by the National Major S&T Project“Shale gas reservoir stimulation technology”(No.:2012ZX05018-004).
文摘An oriented cluster perforating technology,which integrates both advantages of cluster and oriented perforating,will help solve a series of technical complexities in horizontal well drilling.For realizing its better application in oil and gas development,a series of technologies were developed including perforator self-weight eccentricity,matching of the electronic selective module codes with the surface program control,axial centralized contact signal transmission,and post-perforation intercluster sealing insulation.In this way,the following functions could be realized,such as cable-transmission horizontal well perforator self-weight orientation,dynamic signal transmission,reliable addressing&selective perforation and post-perforation intercluster sealing.The combined perforation and bridge plug or the multi-cluster perforation can be fulfilled in one trip of perforation string.As a result,the horizontal-well oriented cluster perforating technology based on cable conveying was developed.This technology was successfully applied in unconventional gas reservoir exploitation,such as shale gas and coalbed methane,with accurate orientation,reliable selective perforation and satisfactory inter-cluster sealing.The horizontal-well oriented cluster perforating technology benefits the orientation of horizontal well drilling with a definite target and direction,which provides a powerful support for the subsequent reservoir stimulation.It also promotes the fracturing fluid to sweep the principal pay zones to the maximum extent.Moreover,it is conductive to the formation of complex fracture networks in the reservoirs,making quality and efficient development of unconventional gas reservoirs possible.
基金financially supported by the National Natural Science Foundation of China(11572074)Liaoning Provincial Natural Science Foundation(2019-KF-05-07)。
文摘Finite element method is used to study the formations of the penetration jet,the bulge,and the burr in the designed reusable perforating gun.The attached layer of the soft metal on the perforator is studied for the controlling of the bulge height on the casing of the reusable perforating gun.Results indicate that the shaped charge jet is initially formed in the center of the shaped charge liner and then the material of the liner is driven to the centerline of the liner by the detonation wave.The attachment of the soft metal layer to the cartridge of the perforator can be beneficial to control the bulge height.The design on the blind holes on the casing can affect the burr height formed by the collision between the jet and the casing.With the increase in the liner angle,the penetration width on the cement wall of the wellbore is increased.
文摘The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.
基金Supported by Peking University Medicine Fund of Fostering Young Scholars’ Scientific&Technological Innovation Supported by the Fundamental Research Funds for the Central Universities,No. BMU2021PYB009Peking University People’s Hospital Research and Development Funds,No. RDY2020-14National Natural Science Foundation of China,No. 82100546
文摘BACKGROUND Despite advances in medical therapy for Crohn’s disease(CD),most patients with CD require repeated resection surgeries.AIM To analyze the perforating and nonperforating indications of repeated CD operations and identify the anastomosis characteristics for postoperative CD.METHODS We retrospectively reviewed 386 patients who underwent at least one resection for CD between 2003 and 2013.Clinical characteristics of each surgery were collected.Univariate and multivariate analyses were performed to determine risk factors for recurrence.RESULTS The indication for reoperation in CD tends to be the same as that for primary operation,i.e.,perforating disease tends to represent as perforating disease and nonperforating as nonperforating.Concordance was found between the first surgery and second surgery in terms of the indication for the operation(P=0.006),and the indication for the third surgery was also correlated with that for the second surgery(P=0.033).Even if the correlation of surgical indications between repeated operations,the rate of perforating indication for the second and third surgeries was significantly higher than that of the first surgery.In addition,the presence of perforating CD was a predictor of recurrence for both the first and second surgeries.Moreover,anastomotic lesions were the most common sites of recurrence after the operation.Based on the importance of anastomosis,anastomosis might be a new type of disease location for the classification of postoperative CD.CONCLUSION CD not only has stable characteristics but also progresses chronically.Perforation is a progressive surgical indication for Crohn’s disease.For CD after surgery,anastomosis may be a new classification of disease location.
文摘BACKGROUND The diagnosis and therapy during surgery depend largely on a full account of anatomic characteristics.Apart from regular structures,the common,less common or even uncommon anatomic variations are critical for procedural planning.This is especially true during craniocerebral microsurgery,where small vascular variations can affect the final surgical results and patient prognosis.CASE SUMMARY Herein,two rare variations concerning the A1(horizontal)segment of anterior cerebral artery(ACA1)were introduced.One enabled the communication between perforating branch of ACA1 and dural artery of anterior skull base,which was discovered during autopsy.The other was ophthalmic artery(OA)originating from ACA1,shown on digital angiography.CONCLUSION In this study,we found two rare anatomical variations.One was an abnormal OA originated from the anterior communicating artery.The other was a perforating branch of the A1 segment of the anterior cerebral artery,which communicated with meningeal vessels in the anterior skull base.This finding is of great significance for the treatment of anterior communicating artery aneurysm or in other anterior skull base surgery.
文摘We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations.
文摘Compound technique of perforating and fracturing can effectively control the perforating direction and the fracturing expansion. The feasibility of this technique used in fracturing coal seams is analyzed. In this paper, the experiments of perforating and fracturing are carried out on samples of coal and the experimental effects are satisfactory. Compound technique of perforating and fracturing is promising in coal seams.
文摘Objective To investigate anterior tragal perforating aftery( ATPA) and provide anatomic basis for flap derived from preauricular area. Methods Twenty ( 40 sides) cadaver heads fixed in 10% formalin solution and perfused with red - colored latex were used to perform gross anatomy study. Two heads of fresh cadaver
文摘BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades,but the incidence of reported peptic ulcer complications has not decreased.Perforating peptic ulcer(PPU)is a severe form of the disease.AIM To assess trends in the incidence,presentation,and outcome of PPU over a period of 40 years.METHODS This was a single-centre,retrospective,cohort study of all patients admitted to Levanger Hospital,Norway,with PPU from 1978 to 2017.The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases(ICD),revision 8,ICD-9,and ICD-10 codes for perforated gastric and duodenal ulcers.We reviewed the medical records of the patients to retrieve data.Vital statistics were available for all patients.The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable,and sex,age,and calendar year from 1978 to 2017 as covariates.Relative survival analysis was performed to compare long-term survival over the four decades.RESULTS Two hundred and nine patients were evaluated,including 113(54%)men.Fortysix(22%)patients were older than 80 years.Median age increased from the first to the last decade(from 63 to 72 years).The incidence rate increased with increasing age,but we measured a decline in recent decades for both sexes.A significant increase in the use of acetylsalicylic acid,from 5%(2/38)to 18%(8/45),was observed during the study period.Comorbidity increased significantly over the 40 years of the study,with 22%(10/45)of the patients having an American Society of Anaesthesiologists(ASA)score 4-5 in the last decade,compared to 5%(2/38)in the first decade.Thirty-nine percent(81/209)of the patients had one or more postoperative complications.Both 100-day mortality and long-term survival were associated with ASA score,without significant variations between the decades.CONCLUSION Declining incidence rates occurred in recent years,but the patients were older and had more comorbidity.The ASA score was associated with both short-term mortality and long-term survival.
文摘Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.
文摘In order to obtain the perforation depth, the three zones with different permeability because of plastic deformation and fluid invasion were studied based on related theories. The study shows that the calculation of perforation depth should take account of not only damaged zone, but also plastic zone, because the plastic zone has much lower permeability. The required minimum perforation depth was obtained by making the solution of elastic/plastic equations, and the factors affecting perforation depth were analyzed accordingly.
文摘Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.
文摘Perforating ocular trauma with retained intraorbital foreign body （IOrFB） is a severe injury with a poor prognosis. The injury involves the posterior segment of the eye, and foreign bodies are mostly lodged posterior to the globe. Vitreoretinal surgery and IOrFB removal are always performed separately in patients with ocular perforating injury and IOrFBs. Obviously, separate procedures increase the cost and patient discomfort, lntraoperative fluoroscopy,
文摘We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault.The bullet entered above the right zygomatic arch,travelling through the coronal plane,and exited from the left zygomatic arch.The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay.Non-contrast CT scan of the head revealed fractures of the right orbit,bilateral maxilla,bilateral pterygoid plates,ethmoid air cells,vomer and left zygoma,and without any cerebral damage.He was treated conservatively and the facial palsy was resolved.The patient survived without any complications.Such case has not been described in the available literature till date.
基金supported by the Postdoctoral Fellowship Program of CPSF(Grant No.GZC20233326)the Chongqing Science Fund for Distinguished Young Scholars(Grant No.CSTB2022NSCQJQX0028)the National Natural Science Foundation of China(Grant Nos.U23A20597,52274112).
文摘An abrasive water jet(AWJ)is commonly used to develop deep geothermal resources,such as drilling in hot dry rock(HDR).The influence of rock mineral properties,such as mineral types,mineral contents,and grain size,on the formation of perforation by AWJ is unclear yet.In this study,we investigate AWJ impacts on three types of granite samples with different mineral fractions using a polarizing microscope and scanning electron microscope(SEM).The results show that when the grain size is doubled,the perforation depth increases by 16.22%under the same type of structure and properties.In general,fractures are more likely to be created at the position of rough surfaces caused by abrasive impact,and the form of fractures is determined by the mineral type.In addition,microstructure analysis shows that transgranular fractures typically pass through large feldspar particles and quartz removal occurs along mineral boundaries.The longitudinal extension of perforation depends mainly on the strong kinetic energy of the jet,while the lateral extension is controlled by the backflow.The results contribute to a better understanding of the process involved in the breaking of hard rock by abrasive jets during deep geothermal drilling.
文摘A theoretical analysis on the perforation of Weldox 460E steel plates struck by flat-nosed projectiles is presented using a previously developed model within a unified framework.This model contains a dimensionless empirical equation to describe the variation of energy absorbed through global deformation as a function of impact velocity.The study further investigates the energy absorption mechanisms of Weldox 460E steel plates,with particular focus on the“plateau”phenomenon,i.e.,limited increase in ballistic limit with increasing plate thickness.This phenomenon is explained and compared with results from previously studied 2024-T351 aluminium plates.The model predictions agree well with experimental data for Weldox 460E steel plates impacted by flat-nosed projectiles,including:relationship between global deformation and impact velocity,ballistic limit,residual velocity,and critical conditions for the transition of failure modes.Moreover,the model effectively predicts the“plateau”phenomenon observed in intermediate plate thickness range.It is also found that the indentation absorption energy contributes a significantly larger fraction of the total absorption energy in Weldox 460E steel plates perforated by flat-nosed projectiles than in 2024-T351 aluminium plates,due to the differences in material properties.
文摘BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.
