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Objectives: Radial incision and cutting (RIC) is being investigated as an alternative endoscopic dilation method for lower intestinal tract stenosis, providing a high technical success rate and improving subjective symptoms. However, several patients develop re-stenosis following RIC. In this pilot study, we aimed to evaluate the safety and efficacy of triamcinolone acetonide (TA) addition after RIC. Methods: RIC with TA was performed in 20 patients with lower gastrointestinal tract stenosis. We evaluated the rate of adverse events 2 months after RIC with TA. We investigated the short- and long-term prognoses, as well as the improvement in subjective symptoms, using a visual analog scale. Results: The delayed bleeding rate after RIC was 23.8%. Endoscopic hemostasis was achieved in all patients with delayed bleeding. No perforations were observed. The cumulative re-stenosis-free, re-intervention-free, and surgery-free rates 1 year after RIC were 52.9%, 63.7%, and 85.2%, respectively. Subjective symptoms, including abdominal pain, abdominal bloating, nausea, and dyschezia, significantly improved after RIC with TA. Conclusion: Although additional TA administration after RIC could be safe, additional TA may not be effective on luminal patency after dilation. Further investigation is warranted.
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"Planting conifer and reserving broadleaved tree" is an effective way to restore broad-leaved pine forest of temperate zone in Northeast China. Liberation cutting can promote the growth of Korean pine (Pinus koraiensis) under forest crown and accelerate the succession. However, how liberation cutting intensity affects the growth of Korean pine in secondary forest is still unclear. Taking the "Planting conifer and reserving broadleaved tree" Korean pine forest in Changbai Mountain as the object, we constructed a growth model of diameter at breast height (DBH) and tree height of Korean pine with double dummy variables (liberation cutting intensity and tree classification) to predict the growth of Korean pine plantation under different liberation cutting intensities, i.e. control (no liberation cutting), light-intensity liberation cutting (retaining upper canopy closure 0.6), medium-intensity liberation cutting (0.4), heavy-intensity liberation cutting (0.2) and clear cutting (cutting all upper broadleaf trees) stands. We analyzed the effects of liberation cutting intensities on DBH, tree height, and the ratio of tree height to DBH. The results showed that among six theoretical growth equations, the Gompertz model on the DBH (R2=0.46) and tree height (R2=0.81) was optimal basic model. The R2 of the DBH model was increased to 0.65 and 0.89, respectively, after the single dummy variable and the double dummy variable were introduced into the basic model, while the R2 of the tree height model was increased to 0.84 and 0.94. Therefore, the double dummy variable model was the most suitable for predicting the growth of Korean pine. The growth of DBH of pressed tree increased with the increases of liberation cutting intensity (increase by 145.8%-933.3%) during the whole simulation period (0-80 a). Average and dominant trees showed the same pattern at 42 and 60 a. In the early and middle stages of liberation cutting (20 and 42 a), clear cutting and heavy-intensity liberation cutting had similar effects on the height growth of dominant trees (64.8%-68.5%), average trees (100.0%-144.2%), and pressed trees (138.5%-183.9%). The effects of medium-intensity liberation cutting and light-intensity liberation cutting on the height growth were similar (24.3%-35.1%, 56.0%-92.3%, 84.6%-103.2%). While in the middle and late period (42 and 80 a), height growth of three grade trees increased with the increases of liberation cutting intensity. Under each liberation cutting intensity, the ratio of height to DBH of the dominant, average, and pressed trees increased successively, ranging from 0.50-0.95, 0.64-1.23, and 0.73-4.33, respectively. Only the pressed tree decreased with the increases of liberation cutting intensity at 0-80 a. Therefore, about 40 years after the implementation of liberation cutting, the promoting effect of different liberation cutting intensities on DBH growth was significantly weakened, the promoting effect on tree height growth was significantly enhanced, and the ratio of tree height to diameter began to increase. In order to alleviate forest competition, second liberation cutting should be carried out for light-intensity liberation cutting and medium-intensity liberation cutting stands to further release the growth potential of Korean pine, and thinning management should be carried out in clear cutting and heavy-intensity liberation cutting stands.
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Florestas , Pinus , Pinus/crescimento & desenvolvimento , China , Modelos Teóricos , Ecossistema , Conservação dos Recursos Naturais , PrevisõesRESUMO
BACKGROUND: Modified balloon (MB) treatment in severely calcified coronary artery lesions is an established technique. However, some lesions require Rotablation (RA) as bailout strategy. AIMS: This study aimed to assess predictors of switch from MB to RA and its impact on procedural and midterm outcomes. METHODS: Four hundred and eighty-three consecutive patients were included undergoing MB treatment (n = 204) with a scoring or cutting balloon, or upfront RA treatment (n = 279) serving as control cohort. Strategy switch from MB to RA was performed in 19 of 204 patients. Procedural success was defined as successful stent implantation and TIMI III flow. RESULTS: In the MB cohort, median age was 72 [63-78] years, 75.5% were male and 42.1% had acute coronary syndrome. Procedure success was achieved in 89.4% of the switch group versus 98.4% of the MB only group (p < 0.001) and in 96.4% of the RA cohort. In the switch group, periprocedural complications (31.6% vs. 8.1% vs. 11.8%, p = 0.007), radiation dose (149 [126-252] vs. 59 [30-97] vs. 102 [59-156] Gcm2; p < 0.001) and contrast volume (250 [190-250] vs. 190 [150-250] vs. 195 [190--250] mL; p < 0.001) were significantly higher. Diabetes (OR 3.8, 95% CI 1.1-13.9, p = 0.042), chronic kidney disease stage 4 or 5 (OR 19.0, 95% CI 3.3-108.6, p < 0.001) and pronounced calcification resulting in higher angiographic diameter stenosis (OR 1.13, 95% CI 1.1-1.2, p = 0.001) independently predicted strategy switch. Midterm results were not affected by strategy switch regarding 1-year target lesion revascularization rates (86% vs. 89% vs. 89%; log-rank p = 0.95). CONCLUSION: Primary RA strategy might be considered in patients with severely calcified coronary artery lesions with high angiographic diameter stenosis, diabetes or impaired renal function due to increased periprocedural complication rates, radiation dose, and contrast volume following strategy switch.
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In connection with the need to obtain a properly made and cut material and the appearance of the surface layer, new manufacturing technologies were used for tests, namely the laser cutting technology. This article describes the laboratory stand built for the purpose of research, as well as the possibility of using laser cutting on several sample materials (polymer films), together with an indication of the results obtained. The idea was to elaborate on the cutting technology that will be proper for manufacturing the desired type of spacers for ion-exchange membranes separating while maintaining the required level of product quality and chemical purity. The latter criterion was the basic one, due to the scope of use of the manufactured elements. This article also describes the problem encountered during the construction of the stand or during the research. The last part of this article describes the further steps of the research that will be carried out in the future along with a discussion and summary of the research performed. It is important from the point of view of the development of production technology, but also because of the characteristics of materials for the production of surface layers and coatings resistant to mechanical or thermal wear used in industry. The introduction of innovative solutions is also aimed at studying the improvement of the economics of the production of materials that are significant, in particular, for small- and medium-sized enterprises.
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The Ti-5Al-5V-5Mo-3Cr (Ti-5553) alloy is a relatively novel difficult-to-cut material with limited machinability and tool life analysis available in the literature, and hence requires further investigation. This study focuses on the machining and tribological performance of Ti-5553 under high-speed finish turning (150 m/min, 175 m/min, and 200 m/min) via novel mono/bi-layered PVD-coated WC tools. A base AlTiN coating is used as the reference monolayer coating, with AlCrN, diamond-like ta-C, and TiAlSiN coatings each deposited on top of a base AlTiN coating, totaling four separate coated tools (one monolayer and three bi-layer). Tool life, cutting forces, workpiece surface quality, and tribological chip analysis are among the subjects of investigation in this study. Overall, the AlTiN/AlCrN coated tool outperformed all the other combinations: an improvement of ~19% in terms of tool life in reference to the base AlTiN coating when averaging across the three speeds; lowest surface roughness values: ~0.30, 0.33, and 0.64 µm; as well as the lowest chip back surface roughness values: ~0.80, 0.68, and 0.81 µm at 150, 175, and 200 m/min, respectively. These results indicate that the AlTiN/AlCrN coating is an excellent candidate for industrial applications involving high-speed machining of Ti-5553.
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Pure titanium is a preferred material for medical applications due to its outstanding properties, and the fabrication of its surface microtexture proves to be an effective method for further improving its surface-related functional properties, albeit imposing high demands on the processing accuracy of surface microtexture. Currently, we investigate the fabrication of precise microtextures on pure titanium surfaces with different grid depths using precision-cutting methods, as well as assess its impact on surface wettability through a combination of experiments and finite element simulations. Specifically, a finite element model is established for pure titanium precision cutting, which can predict the surface formation behavior during the cutting process and further reveal its dependence on cutting parameters. Based on this, precision-cutting experiments were performed to explore the effect of cutting parameters on the morphology of microtextured pure titanium with which optimized cutting parameters for high-precision microtextures and uniform feature size were obtained. Subsequent surface wettability measurement experiments demonstrated from a macroscopic perspective that the increase in the grid depth of the microtexture increases the surface roughness, thereby enhancing the hydrophilicity. Corresponding fluid-solid coupling finite-element simulation is carried out to demonstrate from a microscopic perspective that the increase in the grid depth of the microtexture decreases the cohesive force inside the droplet, thereby enhancing the hydrophilicity.
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When the drilling core method is used to determine the coalbed gas content, the cutting heat generated by the core bit cutting coal will increase the core tube temperature, and the excessively high core tube temperature will have an heating effect on the coal core, which will accelerate the coal core gas desorption rate and increase the gas loss amount. The generation of cutting heat of core bit and the measurement of core tube temperature are the basis for grasping the gas desorption law of coal core and projecting the amount of gas loss. Firstly, the self-developed core tube temperature measurement device was used to conduct on-site core temperature measurement experiments at different cutting speeds. Then, the cutting temperature of core bit was solved by establishing thermodynamic model for cutting coal and heat transfer model of cutting edge. Finally, based on the thermal conductivity characteristics of the core tube, the core tube temperature at different cutting speeds was simulated, and the simulated temperature was compared with the on-site measured temperature to verify the reliability of the model. The results show that when coring in primary structural coal, the temperature change trend of core tube wall temperature measurement point at different cutting speeds is basically consistent, the temperature measurement point at the front end of the core tube mainly goes through a relatively stable period in the drilling process, a sharp rising period in the cutting process, a slow rise and cooling period in the withdrawal process. However, the temperature measurement point at the back end of the core tube wall mainly goes through a relatively stable phase and a slowly increasing phase. The temperature rise of the core bit and the core tube wall are significantly positively correlated with the cutting speed. When coring in hard coal seam and the core depth is not large, the cutting heat generated by the core bit and the coal body is the dominant factor for the temperature rise of the core tube. The core tube wall temperature calculated using the model matches well with the field measured temperature, and the error is small, which fully shows that the coring thermodynamic model is feasible. This study provides a basis for further research on the dynamic distribution characteristic of coal core temperature during coring, which is of profound significance to calculate the gas loss and coalbed gas content.
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Climate change, driven by the natural process of global warming, is a worldwide issue of significant concern because of its adverse effects on livestock output. The increasing trend of environmental temperature surging has drastically affected meat production and meat product quality, hence result in economic losses for the worldwide livestock business. Due to the increasing greenhouse gas emissions, the situation would get prolonged, and heat exposure-related stress is expected to worsen. Heat exposure causes metabolic and physiological disruptions in livestock. Ruminants and monogastric animals are very sensitive to heat stress due to their rate of metabolism, development, and higher production levels. Before slaughter, intense hot weather triggers muscle glycogen breakdown, producing pale, mushy, and exudative meat with less water-holding capacity. Animals exposed to prolonged high temperatures experience a decrease in their muscle glycogen reserves, producing dry, dark, and complex meat with elevated final pH and increased water-holding capacity. Furthermore, heat stress also causes oxidative stresses, especially secondary metabolites from lipid oxidation, severely affects the functionality of proteins, oxidation of proteins, decreasing shelf life, and food safety by promoting exfoliation and bacterial growth. Addressing the heat-related issues to retain the sustainability of the meat sector is an essential task that deserves an inclusive and comprehensive approach. Considering the intensity of the heat stress effects, this review has been designed primarily to examine the consequences of hot environment temperatures and related stresses on the quality and safety of meat and secondarily focus on cutting edge technology to reduce or alleviate the situational impact.
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Ultrasonic scalpels (USs), as the preferred energy instruments, are facing a growing need to exhibit enhanced performance with the diversification of modern surgical challenges. Hence, we proposed an acoustic black hole ultrasonic scalpel (ABHUS) in longitudinal-bending coupled vibration for efficient surgical cutting. By incorporating an acoustic black hole profile, the local bending wave velocity is reduced and the amplitude is amplified cumulatively, thus creating a high-energy region near the blade tip to enhance the cutting performance of the ABHUS. The precise physical analysis model is established for systematic design of the ABHUS and quick estimation of its frequency characteristics. The vibration simulation and experiments demonstrate that compared with the conventional ultrasonic scalpel (CUS), the output amplitude of the ABHUS significantly increases, particularly a 425% increase in bending vibration displacement. The in-vitro cutting experiment confirms that ABHUS exhibits superior cutting performance. Our design presents vast possibilities and potential for the development of high-performance ultrasonic surgical instruments, serving as an innovative supplement with extraordinary significance for application of acoustic black holes.
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Recent advances in "omics" technologies have enabled the identification of new beef quality biomarkers and have also allowed for the early detection of quality defects such as dark-cutting beef, also known as DFD (dark, firm, and dry) beef. However, most of the studies conducted were carried out on a small number of animals and mostly applied gel-based proteomics. The present study proposes for the first time a Sequential Window Acquisition of All Theoretical Mass Spectra (SWATH-MS) proteomics approach to characterize and comprehensively quantify the post-mortem muscle proteome of DFD (pH24 ≥ 6.2) and CONTROL (5.4 ≤ pH24 ≤ 5.6) beef samples within the largest database of DFD/CONTROL beef samples to date (26 pairs of the Longissimus thoracis muscle samples of young bulls from Asturiana de los Valles breed, n = 52). The pairwise comparison yielded 35 proteins that significantly differed in their abundances between the DFD and CONTROL samples. Chemometrics methods using both PLS-DA and OPLS-DA revealed 31 and 36 proteins with VIP > 2.0, respectively. The combination of different statistical methods these being Volcano plot, PLS-DA and OPLS-DA allowed us to propose 16 proteins as good candidate biomarkers of DFD beef. These proteins are associated with interconnected biochemical pathways related to energy metabolism (DHRS7B and CYB5R3), binding and signaling (RABGGTA, MIA3, BPIFA2B, CAP2, APOBEC2, UBE2V1, KIR2DL1), muscle contraction, structure and associated proteins (DMD, PFN2), proteolysis, hydrolases, and activity regulation (AGT, C4A, GLB1, CAND2), and calcium homeostasis (ANXA6). These results evidenced the potential of SWATH-MS and chemometrics to accurately identify novel biomarkers for meat quality defects, providing a deeper understanding of the molecular mechanisms underlying dark-cutting beef condition.
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Biomarcadores , Músculo Esquelético , Proteômica , Carne Vermelha , Animais , Bovinos , Carne Vermelha/análise , Biomarcadores/análise , Proteômica/métodos , Masculino , Músculo Esquelético/química , Espectrometria de Massas/métodos , Proteoma/análise , Proteínas Musculares/análiseRESUMO
Loading both lateral and medial compartments is crucial to understanding the effect of muscle fatigue during sidestep cutting. The present study investigated the changes in tibiofemoral contact forces in the medial and lateral compartments and the muscle force contributions during the sidestep-cutting manoeuvre after a handball-specific fatigue protocol. Twenty female handball athletes performed three trials of the sidestep-cutting manoeuvre before (baseline) and after the fatigue protocol. Motion capture and ground reaction forces were measured, and the data were processed in OpenSim. The variables were compared using statistical parametric mapping (SPM), with a significance level of p < 0.05. The results showed a decreased knee flexion angle during fatigue in the early stance phase. In addition, the post-fatigue analysis demonstrated significantly reduced forces in vasti muscles. Similarly, during fatigue, the SPM analysis showed decreased tibiofemoral contact forces in the vertical and anterior directions. Vertical force applied to both medial and lateral condyles demonstrated a significant reduction after the fatigue protocol. These results indicated that forces applied to the tibiofemoral joint were reduced following the fatigue protocol compared to the baseline values. However, no consistent evidence exists that fatigue increases the risk of knee injuries.
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Articulação do Joelho , Fadiga Muscular , Humanos , Feminino , Fenômenos Biomecânicos , Fadiga Muscular/fisiologia , Adulto Jovem , Articulação do Joelho/fisiologia , Esportes/fisiologia , Músculo Esquelético/fisiologia , Estudos de Tempo e Movimento , Joelho/fisiologia , Movimento/fisiologiaRESUMO
During the preslaughter phase, cattle are transported from their place of origin to a slaughter facility, experiencing transportation, lairage, environmental factors, and novel environments. Although research exists that has focused how the preslaughter phase impacts cattle welfare and meat quality, some significant preslaughter management factors and subsequent welfare and meat quality outcomes have not been thoroughly explored. The objective of this study was to assess the effects of preslaughter management factors on welfare and meat quality outcomes in fed beef cattle in the United States. Transportation factors, environmental characteristics, lairage factors, cattle characteristics, and several meat quality variables were collected from 5 federally inspected commercial processing facilities in the United States. After excluding slaughter lots that included <75% complete datasets, a total of 619 slaughter lots representing 84,508 head of cattle were used for further analysis. Predictor variables of interest included processing plant, cattle breed, sex class, operation shift at the plant, distance traveled to the plant, truck waiting time to unload at the plant, lairage duration and space allowance, temperature humidity index, and windspeed. Outcome variables of interest included cattle mobility, carcass bruising, dark cutting (DC), quality grades, and hot carcass weights. Logistic and linear regressions were used to analyze the associations between the predictor and outcome variables of interest. Increased distance traveled and truck waiting time were associated with higher odds of mobility impairment (Pâ =â 0.0009 and Pâ =â 0.007, respectively), with each 10 km increase in distance traveled having an odds ratio (OR) of 1.001 (95% confidence interval [CI]: 1.000 to 1.001) and each 1-min increase in waiting time having an OR of 1.003 (CI: 1.001 to 1.004). Conversely, a 10-km increase in distance traveled decreased the odds of carcass bruising (OR: 0.997, CI: 0.996 to 0.998; Pâ <â 0.0001). Longer lairage was associated with increased odds of DC (Pâ =â 0.0415), with each 60-min increase in duration having an OR of 1.034 (CI: 1.001 to 1.068). The results demonstrate the importance of truck arrival management (i.e., scheduling, prioritizing unloading) on mobility. Focusing on lairage management (i.e., density and time) may provide some opportunities to improve meat quality.
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The existence of striations, and scratches in Abrasive waterjet (AWJ) cutting surface necessitates an exploration of these features for enhancing the cutting accuracy of AWJ machining. This article investigates surface roughness and micro-scratch morphology characteristics on brass cutting surfaces. According to the variation law of surface roughness values, the cutting section can be divided into three regions: the initial region, smooth region, and rough region. Numerous micron-scale scratches were observed in the cutting section. The scratch length, width, and depth values all show an increasing trend as the cutting depth increases, with the scratch length experiencing the greatest growth and variability. The influence of position and traverse speed on scratch size was studied using variance analysis. Furthermore, the length and width of the scratches on the cutting surface are significantly influenced by their position, accounting for 89.19% and 81.13%, respectively. Traverse speed had a minor effect on scratch length and width, accounting for 0.01% and 2.64% respectively. The depth of the scratches is influenced by their position on the cutting surface at a rate of 41.12%, while traverse speed had an impact of 38.10%. Finally, a mathematical method based on standard scores was proposed to assess the quality of the cutting section based on micro-scratch dimension.
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OBJECTIVE: International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes. METHODS: This was an observational study using data from a cross-sectional population-based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928). We estimated the FGM/C prevalence using (i) the diagnosed cases and (ii) the indirect prevalence estimated by UNICEF in each source country. We compared population characteristics and perinatal outcomes between women diagnosed with FGM/C and two groups: (i) women originating in source countries and diagnosed as without FGM/C and (ii) all women without diagnosis of FGM/C whatever the country of birth. RESULTS: Diagnosed prevalence of FGM/C was 95% (95% CI: 0.78-1.14] and the indirect computed estimation prevalence was estimated at 1.53% (95% CI: 1.31-1.77) in 113 and 183 women, respectively. Labor and delivery outcomes were globally similar in women with FGM/C and the other two groups. Only episiotomy was more frequently performed in women with FGM/C than in the other two groups. CONCLUSION: In receiving countries, obstetric outcomes of women with FGM/C can be similar to those of other women, which does not preclude need of further research and training to provide the most appropriate care, including enhanced attention to diagnosis.
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Aluminum honeycomb sandwich structure has been widely used in the aeronautic and astronautic fields. As the core part, aluminum honeycomb needs to be machined but defects are easily generated. Ultrasonic cutting is an advanced machining technology for honeycomb materials due to improved machining quality. However, ultrasonic cutting aluminum honeycomb by straight-blade knife is usually accompanied by cell wall deformation, which results in poor machining quality. To facilitate the industrial use of ultrasonic cutting aluminum honeycomb with a straight-blade knife, a finite element (FE) model was developed, and experimental studies had been performed. The effects of the blade-inclined angle and lead angle of the straight-blade knife were studied by analyzing the cutting force, the stress and deformation in the cutting zone. Results showed that the cell wall deformation was significantly suppressed when cutting with a corresponding blade-inclined angle and a lead angle. Meanwhile, effects of ultrasonic cutting parameters on the cell wall deformation were also studied, indicating that a well-machined cell wall could be obtained when cutting with large ultrasonic amplitude.
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Frontal sinus surgery and particularly frontal sinus osteotomy represent historically a procedure demanding precision and careful planning. Achieving optimal results while minimizing complications requires meticulous preoperative planning and execution. Cutting guides are crucial tools in surgical procedures, particularly in complex osteotomies like could be those involving the frontal sinus. The aim of the study is to show the worflow for the in-house custom made cutting guide for secure and accurated frontal sinus approach. Given the simplicity, efficacy, rapidity, and safety of the procedure, the workflow for programming the cutting guide can be considered valid for all surgical procedures that contemplate performing an osteotomy on the anterior wall of the frontal sinus, such as trauma pathology, inflammatory naso-sinus pathology, benign or malignant neoplastic pathology, and craniofacial malformation pathology.
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This study assessed the effect of boning processing method (hot vs. cold) on pork belly morphological and mechanical traits and the evolution of these traits during refrigerated storage postmortem (PM). A total of 14 crossbred pigs were slaughtered and their carcasses and bellies processed under two conditions: hot boning (n = 14, right sides of carcasses cut immediately after slaughter) and cold boning (n = 14, left sides of carcasses cut 24 h PM). Morphological and mechanical evaluations were made at 1-, 5-, 24- and 48-h PM on the hot-boned bellies, and at 24 and 48 h on the cold-boned ones. Compared to the cold-boned bellies, the hot-boned ones were shorter, wider and thicker (P < 0.01), with greater firmness (flop distance and angle) (P < 0.001) and cohesiveness (skin-fat separation) (P < 0.05 in the dorsal and central sections). At 48 h PM, hot-boned bellies had a thicker skin (P < 0.001) and softer subcutaneous fat in the dorsal-cranial and central sections (finger scores and compression textural test) (P < 0.05). Morphological and mechanical traits for hot-boned bellies confirmed an intense shortening and hardening (increased firmness and cohesiveness), and a slight yield loss from 1 to 24 h PM. From 24 to 48 h PM, there was a certain flattening in hot-boned bellies that was associated with a slight softening (reduced firmness). Although a larger sample may be needed to corroborate these findings, they demonstrate the impact of carcass processing method and refrigerated storage time on belly quality. This may be useful for the pork industry for obtaining the desired type of belly.
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BACKGROUND: Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea, vomiting, and postprandial fullness. The treatment for this disease is mostly surgical. Endoscopic treatment techniques have been developed and attempted for this disease. Endoscopic radial incision and cutting (RIC) techniques are reportedly very effective in benign anastomotic stricture. This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs. CASE SUMMARY: A 23-year-old female patient with indigestion was referred to a tertiary hospital. The patient complained of postprandial fullness in the epigastric region. Previous physical examinations or blood tests indicated no abnormalities. Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum. Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb; a very small hole was observed in the distal part of the second portion, and scope passage was not possible. Gastrografin upper gastrointestinal series was performed, revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim, a typical "windsock" sign. Endoscopic RIC was performed on the duodenal web. The patient recovered uneventfully. Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis. The patient reported complete resolution of symptoms at the 18-month follow-up. CONCLUSION: Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.
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BACKGROUND: This study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load. METHODS: Twenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 [Formula: see text]) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling. RESULTS: After the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64â87% of the hip frontal moment (p < 0.001) and 32â100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32â100% of the knee frontal moment and 21â100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44â95% in the medial-lateral direction and at 17â43% and 73â100% in the vertical direction (p < 0.001). CONCLUSIONS: Injury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.