In this paper, a surface potential based threshold voltage model of fully-depleted（FD） recessed-source/drain（Re-S/D）silicon-on-insulator（SOI） metal-oxide semiconductor field-effect transistor（MOSFET） is presen...In this paper, a surface potential based threshold voltage model of fully-depleted（FD） recessed-source/drain（Re-S/D）silicon-on-insulator（SOI） metal-oxide semiconductor field-effect transistor（MOSFET） is presented while considering the effects of high-k gate-dielectric material induced fringing-field. The two-dimensional（2D） Poisson＇s equation is solved in a channel region in order to obtain the surface potential under the assumption of the parabolic potential profile in the transverse direction of the channel with appropriate boundary conditions. The accuracy of the model is verified by comparing the model＇s results with the 2D simulation results from ATLAS over a wide range of channel lengths and other parameters,including the dielectric constant of gate-dielectric material.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 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
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
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
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
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 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
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
A pancreatic paraganglioma is a rare neoplasm that is difficult to distinguish from a pancreatic neuroendocrine tumour. Here we present a case of pancreatic paraganglioma that was surgically resected following preoper...A pancreatic paraganglioma is a rare neoplasm that is difficult to distinguish from a pancreatic neuroendocrine tumour. Here we present a case of pancreatic paraganglioma that was surgically resected following preoperative diagnosis of a pancreatic neuroendocrine tumour. Careful evaluation of the endoscopic ultrasonography findings revealed abundant draining ves-sels,which could have led to a correct preoperative diagnosis of pancreatic paraganglioma.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
AIM:To investigate the value of elevated drain amylase concentrations for detecting anastomotic leakage(AL) after minimally invasive Ivor-Lewis esophagectomy(MIILE).METHODS:This was a retrospective analysis of prospec...AIM:To investigate the value of elevated drain amylase concentrations for detecting anastomotic leakage(AL) after minimally invasive Ivor-Lewis esophagectomy(MIILE).METHODS:This was a retrospective analysis of prospectively collected data in two hospitals in the Netherlands. Consecutive patients undergoing MI-ILE were included. A Jackson-Pratt drain next to the dorsal side of the anastomosis and bilateral chest drains were placed at the end of the thoracoscopic procedure. Amylase levels in drain fluid were determined in all patients during at least the first four postoperative days. Contrast computed tomography scans and/or endoscopic imaging were performed in cases of a clinically suspected AL. Anastomotic leakage was defined as any sign of leakage of the esophago-gastric anastomosis on endoscopy,re-operation,radiographic investigations,post mortal examination or when gastro-intestinal contents were found in drain fluid. Receiver operator characteristic curves were used to determine the cut-off values. Sensitivity,specificity,positive predictive value,negative predictive value,risk ratio and overall test accuracy were calculated for elevated drain amylase concentrations.RESULTS:A t o t a l o f 8 9 p a t ie n t s w e re in c lu d e d between March 2013 and August 2014. No differences in group characteristics were observed between patients with and without AL,except for age. Patients with AL were older than were patients without AL(P = 0.01). One patient(1.1%) without AL died within 30 d after surgery due to pneumonia and acute respiratory distress syndrome. Anastomotic leakage that required any intervention occurred in 15 patients(16.9%). Patients with proven anastomotic leakage had higher drain amylase levels than patients without anastomotic leakage [median 384 IU/L(IQR 34-6263) vs median 37 IU/L(IQR 26-66),P = 0.003]. Optimal cut-off values on postoperative days 1,2,and 3 were 350 IU/L,200 IU/L and 160 IU/L,respectively. An elevated amylase level was found in 9 of the 15 patients with AL. Five of these 9 patients had early elevations of their amylase levels,with a median of 2 d(IQR 2-5) before signs and symptoms occurred.CONCLUSION:Measurement of drain amylase levels is an inexpensive and easy tool that may be used to screen for anastomotic leakage soon after MI-ILE. However,clinical validation of this marker is necessary.展开更多
基金supported by the Science and Engineering Research Board(SERB),Department of Science and Technology,Ministry of Human Resource and Development,Government of India under Young Scientist Research(Grant No.SB/FTP/ETA-415/2012)
文摘In this paper, a surface potential based threshold voltage model of fully-depleted（FD） recessed-source/drain（Re-S/D）silicon-on-insulator（SOI） metal-oxide semiconductor field-effect transistor（MOSFET） is presented while considering the effects of high-k gate-dielectric material induced fringing-field. The two-dimensional（2D） Poisson＇s equation is solved in a channel region in order to obtain the surface potential under the assumption of the parabolic potential profile in the transverse direction of the channel with appropriate boundary conditions. The accuracy of the model is verified by comparing the model＇s results with the 2D simulation results from ATLAS over a wide range of channel lengths and other parameters,including the dielectric constant of gate-dielectric material.
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 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.
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].
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 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.
文摘A pancreatic paraganglioma is a rare neoplasm that is difficult to distinguish from a pancreatic neuroendocrine tumour. Here we present a case of pancreatic paraganglioma that was surgically resected following preoperative diagnosis of a pancreatic neuroendocrine tumour. Careful evaluation of the endoscopic ultrasonography findings revealed abundant draining ves-sels,which could have led to a correct preoperative diagnosis of pancreatic paraganglioma.
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.
文摘AIM:To investigate the value of elevated drain amylase concentrations for detecting anastomotic leakage(AL) after minimally invasive Ivor-Lewis esophagectomy(MIILE).METHODS:This was a retrospective analysis of prospectively collected data in two hospitals in the Netherlands. Consecutive patients undergoing MI-ILE were included. A Jackson-Pratt drain next to the dorsal side of the anastomosis and bilateral chest drains were placed at the end of the thoracoscopic procedure. Amylase levels in drain fluid were determined in all patients during at least the first four postoperative days. Contrast computed tomography scans and/or endoscopic imaging were performed in cases of a clinically suspected AL. Anastomotic leakage was defined as any sign of leakage of the esophago-gastric anastomosis on endoscopy,re-operation,radiographic investigations,post mortal examination or when gastro-intestinal contents were found in drain fluid. Receiver operator characteristic curves were used to determine the cut-off values. Sensitivity,specificity,positive predictive value,negative predictive value,risk ratio and overall test accuracy were calculated for elevated drain amylase concentrations.RESULTS:A t o t a l o f 8 9 p a t ie n t s w e re in c lu d e d between March 2013 and August 2014. No differences in group characteristics were observed between patients with and without AL,except for age. Patients with AL were older than were patients without AL(P = 0.01). One patient(1.1%) without AL died within 30 d after surgery due to pneumonia and acute respiratory distress syndrome. Anastomotic leakage that required any intervention occurred in 15 patients(16.9%). Patients with proven anastomotic leakage had higher drain amylase levels than patients without anastomotic leakage [median 384 IU/L(IQR 34-6263) vs median 37 IU/L(IQR 26-66),P = 0.003]. Optimal cut-off values on postoperative days 1,2,and 3 were 350 IU/L,200 IU/L and 160 IU/L,respectively. An elevated amylase level was found in 9 of the 15 patients with AL. Five of these 9 patients had early elevations of their amylase levels,with a median of 2 d(IQR 2-5) before signs and symptoms occurred.CONCLUSION:Measurement of drain amylase levels is an inexpensive and easy tool that may be used to screen for anastomotic leakage soon after MI-ILE. However,clinical validation of this marker is necessary.
