Change in cross‐sectional area of esophageal muscle does not correlate with the outcome of achalasia after pneumatic balloon dilatation

Background and Aim: Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross‐sectional area (CSA), as measured by high‐frequency intraluminal ultrasound (HFIUS). Methods: Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA. Results: A single PD resulted in a 2‐year remission rate of 66%. A significance variance in change (?65%–248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post‐dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence. Conclusion: Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.     

间歇性充气压力泵在预防老年肺癌术后深静脉血栓形成的效果观察

目的探讨间歇性充气压力泵在老年肺癌术后预防深静脉血栓（deepvenousthrombosis,DVT）的应用效果。方法将115例肺癌术后患者分为对照组59例和试验组56例,对照组采用常规护理预防DVT,试验组采用在常规护理的基础上加用间歇性充气压力泵预防DVT。观察术后两组患者下肢深静脉血栓和水肿情况。结果两组患者下肢肿胀、DVT发生情况比较,差异具有统计学意义（均P〈0．05）。结论应用间歇性充气压力泵能有效预防术后深静脉血栓的形成。     

Efficacy of botulinum toxin injection before pneumatic dilatation in patients with idiopathic achalasia

Graded pneumatic dilatation (PD) is an appropriate long-term therapy and botulinum toxin injection (BT) is a relatively short-term therapy in idiopathic achalasia. Their combination has not been previously scrutinized. This study aimed to evaluate the role of BT in enhancing the efficacy of PD with 30 mm balloons. Patients who underwent PD with 30 mm balloons after botulinum toxin injections and a group of age- and sex-matched controls who were treated only with PD were enrolled in the study. Symptom scores were taken before, 1 month after and then every 3 months after PD. There were no significant differences between the two groups in gender, duration or severity of symptoms. One of the 12 patients in the case group relapsed 30 months after PD but the others were in remission for an average of 25.6 months. In the control group, all the patients relapsed after a mean of 12.6 months and needed a 35-mm PD. The cumulative remission rate was significantly higher in the case group compared with the control group (P < 0.01). The mean symptom score decreased by 76% in the case group (P < 0.001) and 53% in the controls (P < 0.01) at the end of the first month. Neither age, sex, nor duration or severity of symptoms were predictive of patients' responses to treatment. It seems that BT may be a meaningful enhancing factor in long-term efficacy of PD. PD with a 30 mm balloon after a BT session may resolve the need for the future higher grade PD.     

间歇充气压缩泵预防下肢深静脉血栓形成的疗效观察

目的观察运用间歇充气压缩泵对预防和减少髋部骨折术后患者下肢深静脉血栓（deep vein thrombosis．DVT）形成的疗效。方法将120例患者随机分为实验组和对照组,每组各60例。对照组术后DVT预防方案为低分子肝素。实验组术后DvT预防方案为间歇充气压缩泵。结果术后第7d经彩色多普勒超声检查。实验组有3例发生DVT,发生率为5．0％,而对照组有5例发生DVT,发生率为8．3％,经x2检验,两组DVT发生率差异没有统计学意义（P〉0.05）。两组未发生DVT患者血流速度比较,差异具有统计学意义,其中实验组血流速度大于对照组（P〈0．05）。结论与常规应用肝素相比,髋部骨折患者术后运用间歇充气压缩泵同样可以有效预防和减少DVT,而且该方法使用简单,患者感觉较舒适,具有临床推广意义。     

Femoral Vein Stasis During Laparoscopic Cholecystectomy Effect of an Intermittent Sequential Pneumatic Compression Device

Background: During laparoscopic cholecystectomy (LC), venous stasis of the legs may occur which cannot be prevented by a graded compression bandage used for a standard laparotomy. In this study, we investigated whether femoral vein stasis during LC could be prevented using an intermittent sequential pneumatic compression device (IPC). Methods: The effects of an IPC on blood flow in the legs prior to pneumoperitoneum (baseline), at pneumoperitoneum, at postural change and at deflation were examined by color Doppler ultrasonography on each of two groups, namely the patients without an IPC on the lower extremities (group 1, n = 20) and the patients with an IPC (group 2, n = 20). Results: The peak femoral vein velocity in group 1 at a pneumoperitoneum pressure of 10 mmHg in the reverse Trendelenburg's position was significantly decreased to 29.3 ± 3.4% of the baseline value (P < 0.05). However, in group 2, the velocity was maintained and there was no significant decrease. The blood flow velocity when the IPC was used significantly differed from that when the IPC was not used (P < 0.01). The area of the femoral vein in group 1 at a pneumoperitoneum pressure of 10 mmHg in the reverse Trendelenburg's position significantly increased to 379.5 ± 16.3% of the baseline value (P < 0.05). In group 2, it significantly increased to 387.0 ± 19.1% (P < 0.05). However, the area of the femoral vein when the IPC was used did not significantly differ from that when the IPC was not used. Conclusion: The use of an IPC maintained the peak femoral vein velocity even under pneumoperitoneum and in the reverse Trendelenburg's position.     

瞬时脉冲足底静脉泵在髋膝关节置换术后预防深静脉血栓形成的应用研究

目的 探讨瞬时脉冲足底静脉泵预防全髋/膝关节置换术后深静脉血栓形成（DVT）的效果,为临床医护人员选择最优的机械预防方式提供参考依据。方法 选取2019年11月至2020年8月在我院关节外科拟行全髋/膝关节置换术的病人210例,随机分为观察组（105例）和对照组（105例）;术后,观察组和对照组分别使用瞬时脉冲足底静脉泵和间歇性充气加压装置预防DVT。观察比较两组病人术后DVT的发生率、术后D-二聚体、C-反应蛋白、白细胞介素-6和患肢肿胀情况,住院时间和使用机械设备预防DVT的舒适度。结果 术后2周,观察组DVT总发生率为6.67%,对照组为9.52%,两组比较,差异无统计学意义（P＞0.05）;观察组病人机械设备使用的舒适度高于对照组,差异有统计学意义（P＜0.05）。结论 瞬时脉冲足底静脉泵可有效预防全髋/膝关节置换术后DVT,且舒适度高于间歇充气加压装置,预防DVT的时间成本低,值得临床推广。     

Quantification of Resistance to Flow at the Esophagogastric Junction in Man

Changes in resistance to flow at the esophagogastric junction contribute to the regulation of esophageal emptying and gastroesophageal reflux. To quantify esophagogastric resistance in man we have adapted our pneumatic resistometer, previously validated in the dog. The system is based on the measurement of nitrogen flow through a 5-cm-long polyurethane cylinder placed within the gut lumen and maintained electronically at a constant pressure gradient. In vitro experiments showed that the amplitude, length, and diameter of the constricted segment each contribute to resistance as measured by our instrument. In vivo studies performed on eight healthy volunteers showed that the esophagogastric junction was the place of maximal resistance in the gastroesophageal region. Intragastric resistance was also comparatively high whereas esophageal body resistance was negligible. Esophagogastric junction resistance was similar for antegrade and retrograde flow. During swallowing, it decreased to 10% of resting values. In three patients with achalasia, it was markedly increased and did not vary significantly during swallowing. We conclude that pneumatic resistometry accurately quantitates segmental resistance to flow in the esophagogastric region. Under normal conditions esophagogastric junction resistance exceeds gastric resistance and, hence, provides a gradient against gastroesophageal reflux. However, this resistance gradient between the junction and the stomach is much narrower than previously thought on the basis of manometric measurements.     

间歇式冲气压力抗栓泵治疗深静脉血栓的临床护理观察

目的:探讨间歇式冲气压力抗栓泵治疗深静脉血栓的临床效果。方法:将60例深静脉血栓患者随机分为对照组18例和实验组42例。对照组行常规抗凝、康复治疗和护理,实验组在此基础上,进行间歇性四肢血液循环泵治疗。结果:我科自2007年6月以来共运用间歇式冲气压力抗栓泵治疗下肢深静脉血栓60例,在第7、10天实验组疗效明显优于对照组(P<0.05)。结论:间歇式冲气压力抗栓泵治疗深静脉血栓疗效明确,且副作用较小,临床应用值得推广。     

气动调节阀黏滞故障引起的回路振荡消除方法

气动调节阀的黏滞故障是控制回路中常见的故障,由黏滞引起的回路振荡将会破坏整个控制回路的性能。针对不具有定位器的阀门,提出了利用T-S型模糊控制器代替传统的PI控制器来消除此种振荡。该控制器利用阀门黏滞时被控对象的状态信息与控制器输出变化率之间的关系来构建模糊控制的规则。通过对传统PI控制器的积分系数进行修正使得阀门快速移出黏滞区,最终消除黏滞故障对回路的影响。将该算法应用于实际的液位控制回路中,实验结果表明该算法能够较好地消除回路的振荡,且能够适应不同的设定值,具有一定的鲁棒性。