The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,an...The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.展开更多
To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the la...To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the laboratory tests on fourteen types of rocks.This study begins firstly by introducing the twenty rockburst proneness criteria,and their origins,definitions,calculation methods and grading standards were summarized in detail.Subsequently,to evaluate and compare the judgment accuracy of the twenty criteria,a series of laboratory tests were carried out on fourteen types of rocks,and the rockburst proneness judgment results of the twenty criteria for the fourteen types of rocks were obtained accordingly.Moreover,to provide a unified basis for the judgment accuracy evaluation of above criteria,a classification standard(obtained according to the actual failure results and phenomena of rock specimen)of rockburst proneness in laboratory tests was introduced.The judgment results of the twenty criteria were compared with the judgment results of this classification standard.The results show that the judgment results of the criterion based on residual elastic energy(REE)index are completely consistent with the actual rockburst proneness,and the other criteria have some inconsistent situations more or less.Moreover,the REE index is based on the linear energy storage law and defined in form of a difference value and considered the whole failure process,and these superior characteristics ensure its accuracy.It is believed that the criterion based on REE index is comparatively more accurate and scientific than other criteria,and it can be recommended to be applied to judge the rockburst proneness of rock materials.展开更多
Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mor...Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.展开更多
Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. T...Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on improving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai（CV6）, Zhongwan（CV12）, Danzhong（CV17）, bilateral Zusanli（ST36）, and bilateral Xuehai（SP10） acupoints was performed once a day（1-day rest after 6-day treatment） for 14 consecutive days. Senescence-accelerated mouse prone 8（SAMP8） mice without acupuncture and senescence-accelerated mouse resistant 1（SAMR1） mice were used as normal controls. After 14 days of treatment, spatial learning and memory ability of mice was assessed in each group using the Morris water maze. Dendritic changes of pyramidal cells in the hippocampal CA1 region were analyzed by quantitative Golgi staining. Our results showed that acupuncture shortened escape latency and lengthened retention time of the former platform quadrant in SAMP8 mice. Further, SAMP8 mice exhibited a significant increase in the number of apical and basal dendritic branches and total length of apical and basal dendrites after acupuncture. These results suggest that acupuncture improves spatial learning and memory ability of middle-aged SAMP8 mice by ameliorating dendritic structure.Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on im- proving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai （CV6）, Zhongwan （CV 12）, Danzhong （CV17）, bilateral Zusanli （ST36）, and bilateral Xuehai （SP10） acupoints was performed once a day （1-day rest after 6-day treat- ment） for 14 展开更多
Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), wit...Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.展开更多
Brittleness is an important parameter controlling the mechanical behavior and failure characteristics of rocks under loading and unloading conditions,such as fracability,cutability,drillability and rockburst proneness...Brittleness is an important parameter controlling the mechanical behavior and failure characteristics of rocks under loading and unloading conditions,such as fracability,cutability,drillability and rockburst proneness.As such,it is of high practical value to correctly evaluate rock brittleness.However,the definition and measurement method of rock brittleness have been very diverse and not yet been standardized.In this paper,the definitions of rock brittleness are firstly reviewed,and several representative definitions of rock brittleness are identified and briefly discussed.The development and role of rock brittleness in different fields of rock engineering are also studied.Eighty brittleness indices publicly available in rock mechanics literature are compiled,and the measurement method,applicability and limitations of some indices are discussed.The results show that(1)the large number of brittleness indices and brittleness definitions is attributed to the different foci on the rock behavior when it breaks;(2)indices developed in one field usually are not directly applicable to other fields;and(3)the term“brittleness”is sometimes misused,and many empirically-obtained brittleness indices,which lack theoretical basis,fail to truly reflect rock brittleness.On the basis of this review,three measurement methods are identified,i.e.(1)elastic deformation before fracture,(2)shape of post-peak stressestrain curves,and(3)methods based on fracture mechanics theory,which have the potential to be further refined and unified to become the standard measurement methods of rock brittleness.It is highly beneficial for the rock mechanics community to develop a robust definition of rock brittleness.This study will undoubtedly provide a comprehensive timely reference for selecting an appropriate brittleness index for their applications,and will also pave the way for the development of a standard definition and measurement method of rock brittleness in the long term.展开更多
Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected w...Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected with the acoustic emission(AE) parameter in this work,which contributes to predicting the rock burst risk using AE technique.Primarily,a rock burst proneness index is proposed,and it just depends on the heterogeneous degree of rock material.Then,the quantificational formula between the value of rock burst proneness index and the accumulative AE counts in rock sample under uniaxial compression with axial strain increases is developed.Finally,three kinds of rock samples,i.e.,granite,limestone and sandstone are tested about variation of the accumulative AE counts under uniaxial compression,and the test data are fitted well with the theoretic formula.展开更多
To investigate the influence of the bedding angle,β,on the mechanical properties and rockburst proneness,uniaxial compression tests were conducted using cylindrical phyllite specimens with different bedding angles.Ac...To investigate the influence of the bedding angle,β,on the mechanical properties and rockburst proneness,uniaxial compression tests were conducted using cylindrical phyllite specimens with different bedding angles.According to the results,the peak stress,peak strain,cumulative acoustic emission counts,and potential energy of the elastic strain exhibited a U-shaped change trend.With an increase in β from 0°to 90°,the failure mode transformed from tensile splitting failure along the bedding plane to shear slip failure along the weak bedding plane.Finally,the failure mode evolved into a tensile splitting failure across the bedding plane.When β=15°,30°,and 45°,the phyllite specimens exhibited strong,slight,and moderate rockburst proneness,with strong,slight,and moderate shear slip rockbursts,respectively.When β=0°,60°,75°,and 90°,the phyllite specimens had extremely strong rockburst proneness,and an extremely strong strain rockburst occurred.展开更多
Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health ...Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.展开更多
Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery...Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery;however, the compromised and comminuted bones in osteoporotic fracture sites are not conducive to optimum reduction and rigid fixation. In addition, these patients always exhibit accompanying aging-related disorders, including high inflammatory status, decreased mechanical loading and abnormal skeletal metabolism, which are disadvantages for fracture healing around sites that have undergone orthopedic procedures. Since the incidence of osteoporosis is expected to increase worldwide, orthopedic surgeons should pay more attention to comprehensive strategies for improving the poor prognosis of osteoporotic fractures. Herein, we highlight the molecular basis of osteoimmunology and bone mechanosensation in different healing phases of elderly osteoporotic fractures, guiding perioperative management to alleviate the unfavorable effects of insufficient mechanical loading, high inflammatory levels and pathogen infection. The well-informed pharmacologic and surgical intervention, including treatment with anti-inflammatory drugs and sufficient application of antibiotics, as well as bench-to-bedside strategies for bone augmentation and hardware selection, should be made according to a comprehensive understanding of bone biomechanical properties in addition to the remodeling status of osteoporotic bones, which is necessary for creating proper biological and mechanical environments for bone union and remodeling. Multidisciplinary collaboration will facilitate the improvement of overall osteoporotic care and reduction of secondary fracture incidence.展开更多
Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can ...Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can affect the energy storage, dissipation, and surplus in rock. To explore the influence of temperature on the energy storage and dissipation characteristics and rockburst proneness, the present study has carried out a range of the uniaxial compression(UC) and single-cyclic loading-unloading uniaxial compression(SCLUC) tests on pre-heated granite specimens at 20℃-700℃. The results demonstrate that the rockburst proneness of pre-heated granite initially increases and subsequently decreases with the increase of temperature. The temperature of 300℃ has been found to be the threshold for rockburst proneness. Meanwhile, it is found that the elastic strain energy density increases linearly with the total input strain energy density for the pre-heated granites, confirming that the linear energy property of granite has not been altered by temperature. According to this inherent property, the peak elastic strain energy of pre-heated granites can be calculated accurately. On this basis, utilising the residual elastic energy index, the rockburst proneness of pre-heated granite can be determined quantitatively. The obtained results from high to low are: 317.9 k J/m^(3)(300℃), 264.1 k J/m^(3)(100℃), 260.6 k J/m^(3)(20℃), 235.5 k J/m^(3)(500℃), 158.9 k J/m^(3)(700℃), which are consistent with the intensity of actual rockburst for specimens. In addition, the relationship between temperature and energy storage capacity(ESC) of granite was discussed, revealing that high temperature impairs ESC of rocks, which is essential for reducing the rockburst proneness. This study provides some new insights into the rockburst proneness evaluation in high-temperature rock engineering.展开更多
BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features o...BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.展开更多
Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult...Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effectivetreatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.展开更多
文摘The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.
基金Project(41877272)supported by the National Natural Science Foundation of ChinaProject(2020zzts715)supported by the Fundamental Research Funds for the Central Universities of Central South University,ChinaProject(2242020R10023)supported by the Fundamental Research Funds for the Central Universities of Southeast University,China。
文摘To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the laboratory tests on fourteen types of rocks.This study begins firstly by introducing the twenty rockburst proneness criteria,and their origins,definitions,calculation methods and grading standards were summarized in detail.Subsequently,to evaluate and compare the judgment accuracy of the twenty criteria,a series of laboratory tests were carried out on fourteen types of rocks,and the rockburst proneness judgment results of the twenty criteria for the fourteen types of rocks were obtained accordingly.Moreover,to provide a unified basis for the judgment accuracy evaluation of above criteria,a classification standard(obtained according to the actual failure results and phenomena of rock specimen)of rockburst proneness in laboratory tests was introduced.The judgment results of the twenty criteria were compared with the judgment results of this classification standard.The results show that the judgment results of the criterion based on residual elastic energy(REE)index are completely consistent with the actual rockburst proneness,and the other criteria have some inconsistent situations more or less.Moreover,the REE index is based on the linear energy storage law and defined in form of a difference value and considered the whole failure process,and these superior characteristics ensure its accuracy.It is believed that the criterion based on REE index is comparatively more accurate and scientific than other criteria,and it can be recommended to be applied to judge the rockburst proneness of rock materials.
文摘Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.
基金supported by the National Natural Science Foundation of China,No.81603686,81603684the High School Science and Technology Fund Planning Project of Tianjin of China,No.20120211+1 种基金the Natural Science Foundation of Tianjin of China(Key Program),No.15JCZDJC36700,16JCZDJC37500the Natural Science Foundation of Tianjin of China,No.17JCYBJC26200
文摘Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on improving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai（CV6）, Zhongwan（CV12）, Danzhong（CV17）, bilateral Zusanli（ST36）, and bilateral Xuehai（SP10） acupoints was performed once a day（1-day rest after 6-day treatment） for 14 consecutive days. Senescence-accelerated mouse prone 8（SAMP8） mice without acupuncture and senescence-accelerated mouse resistant 1（SAMR1） mice were used as normal controls. After 14 days of treatment, spatial learning and memory ability of mice was assessed in each group using the Morris water maze. Dendritic changes of pyramidal cells in the hippocampal CA1 region were analyzed by quantitative Golgi staining. Our results showed that acupuncture shortened escape latency and lengthened retention time of the former platform quadrant in SAMP8 mice. Further, SAMP8 mice exhibited a significant increase in the number of apical and basal dendritic branches and total length of apical and basal dendrites after acupuncture. These results suggest that acupuncture improves spatial learning and memory ability of middle-aged SAMP8 mice by ameliorating dendritic structure.Acupuncture can improve the cognitive state of Alzheimer＇s disease, but its mechanism is not clear. Dendritic atrophy and synaptic loss in Alzheimer＇s disease brain are positively correlated with cognitive damage. Therefore, we speculated that the effect of acupuncture on im- proving cognitive function may be associated with reduced dendritic damage in the brain. Acupuncture at Qihai （CV6）, Zhongwan （CV 12）, Danzhong （CV17）, bilateral Zusanli （ST36）, and bilateral Xuehai （SP10） acupoints was performed once a day （1-day rest after 6-day treat- ment） for 14
文摘Laparoscopic liver resection(LLR) for tumors in the posterosuperior liver [segment(S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space(rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.
基金We gratefully acknowledge financial support from the National Natural Science Foundation of China(Grant Nos.51879135 and 41877217)The work in this paper was also supported by the Hong Kong Scholars Program(Grant No.XJ2017043).
文摘Brittleness is an important parameter controlling the mechanical behavior and failure characteristics of rocks under loading and unloading conditions,such as fracability,cutability,drillability and rockburst proneness.As such,it is of high practical value to correctly evaluate rock brittleness.However,the definition and measurement method of rock brittleness have been very diverse and not yet been standardized.In this paper,the definitions of rock brittleness are firstly reviewed,and several representative definitions of rock brittleness are identified and briefly discussed.The development and role of rock brittleness in different fields of rock engineering are also studied.Eighty brittleness indices publicly available in rock mechanics literature are compiled,and the measurement method,applicability and limitations of some indices are discussed.The results show that(1)the large number of brittleness indices and brittleness definitions is attributed to the different foci on the rock behavior when it breaks;(2)indices developed in one field usually are not directly applicable to other fields;and(3)the term“brittleness”is sometimes misused,and many empirically-obtained brittleness indices,which lack theoretical basis,fail to truly reflect rock brittleness.On the basis of this review,three measurement methods are identified,i.e.(1)elastic deformation before fracture,(2)shape of post-peak stressestrain curves,and(3)methods based on fracture mechanics theory,which have the potential to be further refined and unified to become the standard measurement methods of rock brittleness.It is highly beneficial for the rock mechanics community to develop a robust definition of rock brittleness.This study will undoubtedly provide a comprehensive timely reference for selecting an appropriate brittleness index for their applications,and will also pave the way for the development of a standard definition and measurement method of rock brittleness in the long term.
基金Project(2010CB226804)supported by the National Basic Research Program(973 Program)of ChinaProject(11202108)supported by the National Natural Science Foundation of ChinaProject(BK20130189)supported by the Natural Science Foundation of Jiangsu Province,China
文摘Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected with the acoustic emission(AE) parameter in this work,which contributes to predicting the rock burst risk using AE technique.Primarily,a rock burst proneness index is proposed,and it just depends on the heterogeneous degree of rock material.Then,the quantificational formula between the value of rock burst proneness index and the accumulative AE counts in rock sample under uniaxial compression with axial strain increases is developed.Finally,three kinds of rock samples,i.e.,granite,limestone and sandstone are tested about variation of the accumulative AE counts under uniaxial compression,and the test data are fitted well with the theoretic formula.
基金The authors are grateful for the financial supports from the National Natural Science Foundation of China(Nos.51904335,11972378,41630642)the Fundamental Research Funds for the Central Universities of Central South University,China(No.2019zzts310).
文摘To investigate the influence of the bedding angle,β,on the mechanical properties and rockburst proneness,uniaxial compression tests were conducted using cylindrical phyllite specimens with different bedding angles.According to the results,the peak stress,peak strain,cumulative acoustic emission counts,and potential energy of the elastic strain exhibited a U-shaped change trend.With an increase in β from 0°to 90°,the failure mode transformed from tensile splitting failure along the bedding plane to shear slip failure along the weak bedding plane.Finally,the failure mode evolved into a tensile splitting failure across the bedding plane.When β=15°,30°,and 45°,the phyllite specimens exhibited strong,slight,and moderate rockburst proneness,with strong,slight,and moderate shear slip rockbursts,respectively.When β=0°,60°,75°,and 90°,the phyllite specimens had extremely strong rockburst proneness,and an extremely strong strain rockburst occurred.
文摘Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and exprimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goat is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heat. Based on current data, a trial of prone positioning ventilation should be offeted to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of pronmg ventilation strategy is warranted to enable definitive conclusions to be drawn.
基金supported by the National Natural Science Foundation of China (81772369, 81401809, 81373150)CAMS Innovation Fund for Medical Sciences (CIFMS, 2017-I2M-3-001)+1 种基金supported by the Beijing Nova program (Z171100001117110)supported by the Beijing Natural Science Foundation (7192127)
文摘Osteoporosis is characterized by a decrease in bone mass and strength, rendering people prone to osteoporotic fractures caused by low-energy forces. The primary treatment strategy for osteoporotic fractures is surgery;however, the compromised and comminuted bones in osteoporotic fracture sites are not conducive to optimum reduction and rigid fixation. In addition, these patients always exhibit accompanying aging-related disorders, including high inflammatory status, decreased mechanical loading and abnormal skeletal metabolism, which are disadvantages for fracture healing around sites that have undergone orthopedic procedures. Since the incidence of osteoporosis is expected to increase worldwide, orthopedic surgeons should pay more attention to comprehensive strategies for improving the poor prognosis of osteoporotic fractures. Herein, we highlight the molecular basis of osteoimmunology and bone mechanosensation in different healing phases of elderly osteoporotic fractures, guiding perioperative management to alleviate the unfavorable effects of insufficient mechanical loading, high inflammatory levels and pathogen infection. The well-informed pharmacologic and surgical intervention, including treatment with anti-inflammatory drugs and sufficient application of antibiotics, as well as bench-to-bedside strategies for bone augmentation and hardware selection, should be made according to a comprehensive understanding of bone biomechanical properties in addition to the remodeling status of osteoporotic bones, which is necessary for creating proper biological and mechanical environments for bone union and remodeling. Multidisciplinary collaboration will facilitate the improvement of overall osteoporotic care and reduction of secondary fracture incidence.
基金supported by the National Natural Science Foundation of China (Grant No. 41877272)the Fundamental Research Funds for the Central Universities (Grant No.2242022k30054)the Fundamental Research Funds for the Central Universities of Central South University (Grant No.2021zzts0861)。
文摘Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can affect the energy storage, dissipation, and surplus in rock. To explore the influence of temperature on the energy storage and dissipation characteristics and rockburst proneness, the present study has carried out a range of the uniaxial compression(UC) and single-cyclic loading-unloading uniaxial compression(SCLUC) tests on pre-heated granite specimens at 20℃-700℃. The results demonstrate that the rockburst proneness of pre-heated granite initially increases and subsequently decreases with the increase of temperature. The temperature of 300℃ has been found to be the threshold for rockburst proneness. Meanwhile, it is found that the elastic strain energy density increases linearly with the total input strain energy density for the pre-heated granites, confirming that the linear energy property of granite has not been altered by temperature. According to this inherent property, the peak elastic strain energy of pre-heated granites can be calculated accurately. On this basis, utilising the residual elastic energy index, the rockburst proneness of pre-heated granite can be determined quantitatively. The obtained results from high to low are: 317.9 k J/m^(3)(300℃), 264.1 k J/m^(3)(100℃), 260.6 k J/m^(3)(20℃), 235.5 k J/m^(3)(500℃), 158.9 k J/m^(3)(700℃), which are consistent with the intensity of actual rockburst for specimens. In addition, the relationship between temperature and energy storage capacity(ESC) of granite was discussed, revealing that high temperature impairs ESC of rocks, which is essential for reducing the rockburst proneness. This study provides some new insights into the rockburst proneness evaluation in high-temperature rock engineering.
基金supported by the National Natural Science Foundation of China(grant number 81501654)Natural Science Foundation of Shanghai(grant number 14ZR1433700)
文摘BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.
文摘Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effectivetreatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.
