Costal Margin Research Articles

Research on Mechanical Characteristics and Load-bearing Behavior of Nodes of Steel Fiber Concrete Arch Bridges

Steel fiber reinforced concrete (SFRC) is a new type of composite material formed by dispersing discontinuous short steel fibers in a uniform and random direction throughout the concrete, which has excellent properties of tensile, shear and high toughness, can effectively improve the load-bearing capacity of arch bridges. In this paper, the mechanics of SFRP in the nodal structure of an arch bridge is initially explored by means of indoor model tests and numerical simulation studies. The results show that the maximum principal tensile stress occurs at the intersection of arch rib, arch foot and tie beam, and the maximum principal compressive stress occurs at the connection between arch rib and arch seat, which should be considered in the design. In this paper, we hope to understand the characteristics of the force and bearing capacity of this type of structure to provide a reference for similar projects.

Cable Force Calculation of Cable Hoisting of CFST Arch Bridge Research

To effectively control the stress state and spatial alignment of arch ribs in the cable hoisting construction of a long-span, concrete-filled, steel tube arch bridge and ensure the safety of the structure, it is necessary to calculate and determine the appropriate cable force. Based on the actual project of a double-span, concrete-filled, steel tubular arch bridge, the construction stage of the left span of the bridge from the beginning of construction to the closure is taken as an example. The linear control method of “quiet do not move” is adopted. Based on the principle that the vertical displacement of the front end of the installed segment caused by the self-weight of the new hoisting segment is equal to the vertical displacement of the front end of the previous segment caused by the tension of the new hoisting segment, the tension cable force is calculated by forward iteration. Finally, based on the theory of the stress-free state method, the ideal linear design of the structure was achieved. The results show that after the closure of the bridge, the error range of the cable tension force is −13.33–15.40% on the left bank and −8.37–11.00% on the right bank. The elevation error of the arch rib is −0.003–0.043 m on the left bank and −0.007–0.032 m on the right bank. The overall stress error of the bridge arch is ±7.0 MPa. The error between the theoretical value and the actual value is within the scope of the specification requirements, which meets the specification requirements. After the closure, the arch shape of the bridge meets the smooth requirements.

Open Gastrostomy by Mini-Laparotomy: Our Method.

When percutaneous endoscopic gastrostomy (PEG) is not feasible owing to anatomical obstacles, laparotomic or laparoscopic gastrostomy (LAG) is an alternative. At our institution, LAG has been the first choice for patients who are unable to undergo PEG; however, we have introduced a small open gastrostomy through a 2-cm-long transverse incision since 2020. By December 2022, 12 patients had undergone this procedure without complications. In one case where the stomach was located cephalad to the rib arch and the patient had a round dorsum, the incision wound was extended, and a lengthy operation was required. We believe that our small-incision gastrostomy is a useful option in addition to LAG for cases in which PEG is difficult to perform. Further studies are required to determine the indications for this procedure.

Characteristics of Low Back Pain (LBP) in The Lumbosacral Examination in Radiological Installations: A Case of Tidore Island Hospital and Jailolo Hospital, Indonesia

The International Classification of Disease (ICD) shows that Low Back Pain (LBP) is a condition of pain and discomfort in a person below the corner of the last rib (costal margin) and above the lower gluteal fold, accompanied by pain in the legs. Low Back Pain (LBP) is not a disease or a diagnosis but instead triggers the term used for pain syndromes in which anatomical structures are affected in various ways by the duration of pain. Low Back Pain cases worldwide vary annually, reaching 15 to 45%. WHO shows that 33% of the population in developing countries experience persistent back pain. The prevalence of musculoskeletal disorders in Indonesia is 11.9% based on diagnosis by health workers, 24.7% based on diagnosis or incidence, and about 4.73% in North Maluku. Prevalence has increased significantly at the age of 35 to 55 years. The Lumbosacral Vertebrae examination technique is an initial examination to determine the presence of LBP abnormalities in the lumbosacral. The most frequently used radiological procedure in cases of LBP is a lumbosacral examination using anteroposterior (AP) and lateral projections. This research used a descriptive and retrospective approach. This research was conducted at the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital for one year, January-December 2021. The results showed that the lumbosacral check in patients with clinical Low Back Pain (LBP) in the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital was 64 at the Tidore Islands Hospital and 72 at the Jailolo Hospital. The people with the highest age in the two hospitals is the age range of 46-55 years, dominated by women (57.8%) at the Tidore Islands City Hospital and men (59.7%) at Jailolo Hospital. Also, the characteristics of Low Back Pain (LBP) based on the lumbosacral examination were lumbar spondylosis (43.8%) at the Tidore Islands Hospital and (41.7%) at the Jailolo Hospital.

Optimal Place for Precordial Stethoscope Attachment in Nonintubated Children under Two Years of Age: An Observational Trial

Background: The precordial stethoscope is a non-invasive monitoring method in pediatric anesthesia. We previously investigated optimal place for its attachment among intubated children under two years old. Now we also did in nonintubated children under two years old.
 Methods: Twenty-five patients who underwent general anesthesia in our institution were involved in this study. Lung and heart sounds via precordial stethoscope were recorded (MP3 format) at the six places: Site A (paratracheal region), B (suprasternal notch), C (between place of the nipple and clavicle on the left midclavicular line), D (between place of the costal arch and nipple on the left midclavicular line), E (horizontal level of Site D on the left midaxillary line), and F (epigastric fossa). Two blinded evaluators scored random sorted lung and heart sounds on a 10-point scale (0: cannot hear at all and 10: can hear clearly) individually.
 Results: Statistically significant differences were observed between Sites A: 10.0 (8.5–10.0), B: 9.0 (2.5–9.5), C: 8.0 (6.5-9.0) and D: 1.5 (1.0–6.5), E: 4.5 (1.5–7.0), F: 1.0 (0.0–4.5) for lung sounds and between Sites B: 9.0 (5.0–10.0), C: 9.5 (8.0–10.0), D: 9.0 (4.5–9.5) and A: 0.0 (0.0–0.0), E: 0.5 (0.0–2.5), F: 0.5 (0.0–0.5) for heart sounds.
 Conclusion: Site C is the optimal place for precordial stethoscope attachment for children under two years of age during general anesthesia

An underrecognized cause of hepatomegaly in uncontrolled type I diabetes.

A 29-year-old woman with a past medical history of poorly controlled type 1 diabetes and autoimmune hypothyroidism presented to the emergency department for evaluation of abdominal pain, nausea and vomiting. The patient was a cocaine user, but she did not use alcohol and did not smoke. Her current medications included Insulin aspart, Insulin degludec, L-thyroxine and Pantoprazole. She reported no use of over-thecounter medication or herbal and dietary supplements. acute distress. The abdomen was nondistended and soft with diffusely tenderness and a smooth palpable liver 3 to 4 cm below the costal margin. Laboratory studies was significant for glucose 539 mg/dL (normal 65-110), alkaline phosphatase 153 U/L (normal 35-105), gamma-GT 44 U/L (normal <36), lactate 42,1 mg/dL (normal 4,5-19,8), arterial pH 7,32 (normal 7,35-7,45) and HbA1c 11% (4,5-6). A computed tomography (figure 1; panel A and B) and liver biopsy (figure 1; panel C and D) were performed.

A Propensity Score-Matching Analysis: Robotic Thymectomy Through the Subxiphoid Has Advantages Over Video-Assisted Thymectomy Surgery.

Objective: The purpose of this article is to evaluate the security and effectiveness of subxiphoid and subcostal robot-assisted thoracoscopic thymectomy (S-RATT) and compare it with subxiphoid and subcostal video-assisted thoracoscopic thymectomy (S-VATT) in terms of short-term perioperative results and costs. Methods: A retrospective study was carried out on 62 individuals who had undergone successful complete thymectomy for anterior mediastinal disease using subxiphoid and subcostal arch approaches. Propensity score-matching analysis was utilized between the two groups, and the perioperative outcomes were compared. Results: The S-RATT group exhibited less intraoperative blood loss (20 ± 15.35 versus 69.55 ± 69.54, P < .001), lower levels of C-reactive protein (112.38 ± 68.08 versus 72.58 ± 42.62, P = .027), and lower postoperative pain scores (2.09 ± 1.54 versus 4.27 ± 1.28, P < .001). However, the hospitalization costs of patients in the S-VATT group were found to be lower than those in the S-RATT group (33,802.41 ± 8785.05 versus 49,977.53 ± 20,221.79, P < .001). Conclusions: S-RATT appears to be a viable and secure method for managing anterior mediastinal tumors.

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study.

Traditional rib anatomy and costal margin teaching contends that the costal margin consists of a combined costal cartilage made up of ribs 7 to 10. Variations in 9th and 10th rib anatomy have been observed. We sought to evaluate the variability of interchondral joints and the make-up of the costal margin. Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin. Experienced chest wall surgeons evaluated this anatomy through a standardized dissection and assessment. Dissection videos were performed to allow for further review/assessment. Bilateral chest wall anatomy of 30 cadavers was evaluated (15 male, 15 female). The average age was 78 ± 12 years, and all patients were Caucasian. In all patients, the first rib attached to the manubrium, the second rib attached to the manubriosternal junction, and ribs 3 to 6 attached directly to the sternum. Interchondral joints were present between ribs 4/5-3%, 5/6-68%, 6/7-83%, 7/8-72%. Ribs combining to form a common costal cartilage via cartilaginous unions were observed between 6/7-3%, 7/8-45%, 8/9-30%, and 9/10-20%.The 8th rib attached directly to the sternum without joining the 7th rib in 10% of cadavers. The 8th and 9th ribs had free tips in 45% and 60% of evaluations, respectively. The 10th rib was found to have a hooked tip in 25% of cases and was a floating rib without attachment to the 9th rib 52% of the time. Rib tip mobility was noted in ribs 8, 9, and 10 in 52%, 70%, and 90%, respectively. Interchondral joints are common between ribs 5 and 8. Significant variability exists in the chest wall and costal margin compared with traditional teaching. It is important for chest wall surgeons treating diseases of the costal margin to appreciate this anatomic variability.

325 Modified Abdominal Assess for Laparoscopic Cholecystectomy in Obese Population: Our Recommendation

Abstract Background and Aim Conventional Umbilical access can be time consuming, surgically challenging due to inadequate ‘Critical View of Safety’ and pneumoperitoneum maintenance for high BMI patients undergoing laparoscopic cholecystectomy (LC). Assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30. Method and Technique Prospective study of consecutive patients undergoing LC in a large DGH (2007-2022) that included age, sex, BMI, ASA, grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer’s point. After 2 litre (minimum) insufflations, optical port introduced at intersection of two imaginary lines: a 15cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3cm to the right of midline. Remaining ports standard. Group B (BMI &amp;lt;30): Conventional umbilicus entry. Results Group A: 543 with Female: Male 4:1 (436:107), Age 49* (16-82) years, BMI 36*(30-65), ASA 2 * (1-3), Grade 1 * (1-4), Operating time 50* (15-200) mins, PO stay 0* (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections. Group B: 1168 with Female: Male 3:1 (861:307), Age 53* (16-89) years, BMI 26 * (17-29), ASA 2* (1-3), Grade 1* (1-4), Operating time 45 *(15-240) mins, PO stay 0* (0-12) day. Ten conversions, 3 bile leaks, 5 collections, 8 wound infections, and 6 wash outs. Conclusion Modified LC abdominal access for obese patients allows safe quick entry with excellent ‘Critical view of Safety’ for a good outcome. * Median

Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification.

Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options. Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom. Computed tomography scans were interrogated and injuries were categorized according to the Sheffield Classification. Clinical, radiologic, management and outcome variables were assessed. Fifty-four patients were included in the study. Intercostal hernia (IH) was present in 30 patients and associated with delayed presentation ( p = 0.004), expulsive mechanism of injury (i.e. such as occurs with coughing, sneezing, or retching), higher body mass index ( p < 0.001), and surgical management ( p = 0.02). There was a bimodal distribution of the level of the costal margin rupture, with IH Present and expulsive mechanism injuries occurring predominantly at the ninth costal cartilage, and IH Absent cases and other mechanisms at the seventh costal cartilage ( p < 0.001). There were correlations between the costal cartilage being thin at the site of the CMR and the presence of IH and expulsive etiology ( p < 0.001). Management was conservative in 23 and surgical in 31 cases. Extrathoracic mesh IH repairs were performed in 3, Double Layer Mesh Repairs in 8, Suture IH repairs in 5, CMR plating in 8, CMR sutures in 2, and associated Surgical Stabilization of Rib Fractures in 11 patients. There was one postoperative death. There were seven repeat surgical procedures in five patients. The Sheffield Classification is associated statistically with presentation, related chest wall injury patterns, and type of definitive management. Further collaborative data collection is required to determine the optimal management strategies. Therapeutic/Care Management; Level III.

E56 A 16-year diagnosis delay of a patient with Pigmented Villonodular Synovitis

Abstract Introduction Pigmented villonodular synovitis (PVNS), a subtype of tenosynovial giant cell tumours, is a rare non-cancerous proliferative synovial disorder usually affecting the knee in adults(1). The incidence rate is 1.8 patients per million people of the general population, with few reports amongst the paediatric population, hence it is frequently misdiagnosed(2). It has a slow onset of symptoms and has been noted to take ∼18 months to make a definitive diagnosis(3). Objective To describe a case of pigmented villonodular synovitis in a seventeen-year-old African female. Methods A retrospective chart review was done to ascertain the clinical presentation and management of the patient. Case description We present a case of a 17-year-old African female who presented with bilateral knee pain and swelling from 10 months of age. She had been on follow-up at a peripheral facility for 14 years, where she was being managed with methotrexate 12.5 mg weekly and folic acid 5 mg OD for Juvenile Idiopathic Arthritis with no marked improvement in her symptoms. In view of her poor response to therapy, the mother stopped her treatment 3 months prior to presentation in our facility. She initially had intermittent bilateral swelling of the small joints of the hand that were tender which eventually evolved to involve both knee joints. The pain was worse in the morning and was associated with the inability to ambulate and occasional night awakening. The systemic inquiry was otherwise unremarkable. She had an unremarkable birth history, and normal developmental milestones. She was however shorter than her peers and had not attained menarche. The patient had been admitted 8–10 times per year during the span of her illness for similar complaints and had undergone multiple knee joint fluid aspirations to relieve the swelling and several laboratory tests and radiological studies were done. On assessment, she was noted to be of fair general condition with gross asymmetric swelling of both knees and a surgical scar over the right knee with no limitation in the range of movement. There was minimal effusion of bilateral elbows and ankles, and the MCP, ICP and wrist joints weren’t affected. The patient had thoracic scoliosis, a grade 3/6 systolic murmur on the left lower sternal border, no radiation, and hepatomegaly 4 cm below the costal margin. She was prepubertal on sexual maturation rating. There was no central nervous system, abdominal, or respiratory abnormalities. A series of lab investigations to exclude the possibility of juvenile idiopathic arthritis were conducted. This panel included a complete blood count, which showed hypochromic, microcytic anaemia, c-reactive protein was raised at 61 mg/l but normal biochemistry and unremarkable autoantibody profile. Imaging done included a bilateral knee X-Ray followed by a bilateral knee MRI which showed large volume bilateral knee joint effusions associated with synovial-based masses causing extrinsic periarticular bony erosions and intra-articular synovial proliferation forming a villonodular appearance. The patient was referred to orthopaedic surgery and bilateral arthrotomy, drainage and synovectomy of both knees were done. She continues to be followed up in our paediatric rheumatology and orthopaedic clinic with good mobility and no other co-morbidities. She is currently undergoing work up for a delayed puberty. Conclusion Pigmented villonodular synovitis is a rare disease in the paediatric population. In the absence of awareness of its existence and expertise on how to diagnose it, patients may be misdiagnosed and mismanaged over a long duration of time as seen in the presented case.

A novel method for the recovery of continuous missing data using multivariate variational mode decomposition and fully convolutional networks

The sensor failure is the frequently-occurring event in engineering activities related to the measurement, which could yield a serious problem of continuous data loss. This special issue will affect the accuracy of structural damage identification and condition assessment. However, traditional methods (e.g., deep learning methods) are hard to settle the recovery of the data with complex characteristics. To this end, this study develops an innovative framework based on the combination of multivariate variational mode decomposition (MVMD), fully convolutional networks (FCN), and a systematic evaluation pattern. In this framework, MVMD is first used to simultaneously decompose the multichannel data into a set of intrinsic mode functions (IMFs) with a modal alignment attribute. Then, FCN is designed to construct a mapping relationship among different IMFs having the same level number in an end-to-end manner, by which the continuous data recovery at the location of interest can be realized. Obviously, this method can not only make the utmost of the spatial information, but also involve an excellent data mining ability of FCN. Further, a systematic pattern from the perspective of time and frequency domains is defined to evaluate the recovery ability of the concerned models. Finally, case study based on the measured data of a steel-frame reinforced arch rib is used to exhibit the performance of the proposed method. Additionally, the parameter analysis and practical application are respectively performed to examine its robustness and practicality. All these results demonstrate the superiority of this method, and its performance is closely related to the location of interest, the number of training data channels and their corresponding location.

Construction-Monitoring Analysis of a Symmetrical Rigid Frame Tied Steel Box Arch Bridge in Southwest China Based on Segmental Assembly Technique

Tied steel box arch bridges are increasingly being used due to their attractive appearance, high load-bearing capacity, and good stress performance. Their construction involves multiple processes and factors. Construction monitoring can ensure that such a bridge remains in its intended stress and linear states during and after construction. This helps to minimize deviations from the design state at every stage of construction. Using the segmental assembly construction technique, this study conducted construction monitoring of the alignment and force at each stage of the reconstruction of bridges using MIDAS Civil software. The construction monitoring analysis indicated that the arch rib and lattice beam were correctly placed, thereby meeting the specified requirements for arch rib closure. Displacement errors between the measured and theoretical values at each stage of construction fell within an allowable range, resulting in overall smooth bridge alignment. The measured stress in the main arch and the lattice beam generally corresponded to the theoretical stress derived from the control section stress of the entire bridge. The deviation between the cable force of the suspender and the tie rod and theoretical value fell within 10%, indicating good stress reserve. The symmetrical monitoring points in the analyzed rigid-frame tied steel box arch bridges exhibited symmetrical displacement, stress, and cable force results under various working conditions. This observation further confirms the effectiveness of construction monitoring using the segmental assembly technique.

Human-Induced Vibration Analysis and Reduction Design for Super Long Span Pedestrian Arch Bridges with Tuned Mass Dampers

With the increasing demands on span length, aesthetics, and urban landscapes of pedestrian bridges, the fundamental frequency of pedestrian bridges is continuing to decrease, and their vibration and walking comfort issues are becoming increasingly prominent. The pedestrian load model of the pedestrian bridge was introduced here referencing current design specifications, and a spatial finite element model was established to study the dynamic characteristics of the case of a long-span pedestrian arch bridge. The comfort of the bridge under human-induced vibration was analyzed using the time history analysis method. According to the optimal damper parameter expression, the design parameters of the damper were obtained. In addition, the vibration reduction effects of different generalized mass ratios were analyzed, and the damping effects of setting the tuned mass damper (TMD) at different positions were compared. The results indicated that setting the TMD on the bridge can enhance the damping effect, and the transverse vibration can be suppressed by setting TMDs on both the arch ribs and the bridge deck. The research content could provide recommended parameters for the vibration reduction design of long-span pedestrian arch bridges.

Autologous Lipo-Dermal Advancement Flap for Inframammary Fold Reconstruction: A Technical Note for Prevention and Management of Caudal Breast Implant Migration

Inferior breast implant displacement, also known as caudal migration, or bottoming-out, is a known complication of breast augmentation. This leads to a loss of upper pole fullness, a more superiorly located nipple-areolar complex, and an unnatural appearance. Avoiding these complaints has been a longstanding challenge in the field of aesthetics and this technical note suggests a novel solution. This technical note describes the process of preoperative assessment, careful markings, and the use of an autologous lipo-dermal advancement flap that has been designed, mobilized, and rotated to be internally fixated to costal margins and the relevant deep fascial structures at the proposed inframammary fold level. This technique creates a robust partitioning hammock-like structure that stabilizes the breast implant and prevents future caudal displacement. The described technique may be implemented as an independent solution, or as an adjunct to other modalities like biological meshes in revision breast surgery.

Study on non-linear analysis of arch bridges subjected to ground motion

Thanks to the cantilever launching technique, arch bridge building has once again become popular throughout the world. Today, these structures are one of the three main types of long-span bridges, along with suspension and cable-stayed bridges. Arch bridge structures have a complex behavior during powerful earthquakes because the arch rib is an element that is primarily susceptible to a large axial compression force brought on by dead loads. The nonlinear dynamic analysis of an arch bridge using STAAD Pro V8i software with earthquake loading is the subject of this research. Due to their easy load bearing qualities, arch bridges with short and medium spans are currently being constructed frequently for traffic bypass. Therefore, it is necessary to assess its stability in the event of a powerful earthquake. The STAAD-modeled arch bridge's nonlinear, time history analysis. The research in this study uses pro. For Time History analysis, data from the Bhuj Earthquake of 2001 is used, and the Rudramata Bridge, which collapsed during the Bhuj Earthquake, is researched. The primary focus of this study is on the analysis of the displacement, time-velocity, and time- acceleration responses of an arch bridge to lateral loads. And the results demonstrate that the displacement for the arch bridge is less than that for the Rudramata Bridge in all three directions.

The Hyper-Reactive Malarial Splenomegaly- A Rare and Severe Form of Chronic Plasmodial Infection: About A Case

Introduction: Hyper-reactive malarial splenomegaly is a leading cause of large tropical splenomegaly in endemic zones. Here, we report a case diagnosed in a young woman living in Guinea, a malaria-endemic area. Clinical observation: A 32-year-old Guinean woman with a history of repetitive malaria infection episodes presented to the internal medicine outpatient clinic with 5-months history of voluminous mass of the left flank extending to the umbilical region, with no pain and progressive onset, and a sensation of early satiety accompanied by eructation and epigastralgia worsened with eating. Digestive examination revealed a large, firm, smooth-surfaced, painless splenomegaly with a splenic size 20 centimeters below the left costal margin on the mid-clavicular line and measuring 28 centimeters in its long axis. The initial complete blood count showed a normocytic normochromic anemia with lymphocytosis, neutropenia and thrombocytopenia. The erythrocyte sedimentation rate (ESR) was 65 mm at the first hour. Malaria rapid diagnostic test (RDT) was positive for Plasmodium. The thick blood smear had come back negative. Serum protein electrophoresis demonstrated a decrease in albumin to 36.5 g/l and an increase in gamma globulins to 19.1 g/l. Immunoelectrophoresis of serum proteins showed a polyclonal increase in IgG. Abdominal ultrasound revealed enormous homogeneous splenomegaly (180 millimeters). The diagnosis of Hyper-reactive malarial splenomegaly was made on the basis of diagnostic criteria established by Fakunle et al in 1981. Our patient presented with enlarged splenomegaly, negative thick smear, positive RDT for plasmodium, elevated erythrocyte sedimentation rate, lymphocytosis, pancytopenia, and a good therapeutic response. Atovaquone-proguanil 250mg/100 mg at a dose of 1000mg/400 mg, i.e. 4 tablets taken as a single dose over three days, was initiated, then relayed by alternance of doxycycline 100 mg (100 mg once daily) for 1 month and nivaquine 100 mg ..........

A phase I study of ruxolitinib in combination with abemaciclib for patients with primary or post-polycythemia vera/essential thrombocythemia myelofibrosis.

TPS7086 Background: Patients (pts) with myelofibrosis (MF) have a reduced life-expectancy compared to age-matched controls. Several oral Janus Kinase (JAK) inhibitors such as ruxolitinib (RUX) have been approved by the US FDA based on improvements in symptom burden and spleen volume reduction compared to physician’s choice of best available therapy. However, duration of response to these agents is generally time-limited and treatment with JAK inhibitors is not considered to have disease-modifying potential. Additionally, median overall survival after RUX discontinuation is only 11-14 months. Thus, novel mechanism-based therapies for pts with disease progression on RUX are needed. JAK2 V617F mutations promote transition from G1 to S-phase of the cell cycle via increased expression of CDC25A, which is also upregulated in primary MPN patient samples. Additional cell cycle regulators such as CDK6 and Cyclin D have also been implicated in MF pathogenesis. Finally, we and others have shown that combination of the CDK4/6 inhibitors and RUX had synergistic effects in murine models of MF (Rampal et al., CCR 2021) providing the preclinical rationale for this trial. Methods: This multicenter, phase I dose-escalation trial (NCT05714072) evaluates the safety of RUX + the CDK4/6 inhibitor abemaciclib in pts with primary or secondary MF with intermediate-1/2 or high-risk disease by DIPSS who require treatment and had an inadequate response to RUX. Among the currently FDA-approved CDK4/6 inhibitors, abemaciclib was chosen for combination therapy due to less myelosuppressive effects compared with other CDK4/6 inhibitors. Inadequate response to RUX is defined by (I) palpable splenomegaly ≥5 cm below the left costal margin at study entry AND/OR (II) active MPN symptoms, as defined by the presence of one symptom score ≥5 or two symptom scores ≥3 using the screening MPN-SAF TSS. Following a conventional “3+3” dose-escalation design, pts will be treated with increasing doses of abemaciclib and stable doses of RUX (10mg or 15mg BID). The primary endpoint is to determine the maximum tolerated dose of RUX + abemaciclib. Secondary endpoints include measures of efficacy. Exploratory endpoints include changes in allele fraction of driver mutations, gene expression profiling, and clonal architecture to identify biomarkers of response, mechanisms of resistance, and to assess for any disease-modifying effects of the combination therapy. This trial is open to enrollment at Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center. Clinical trial information: NCT05714072 .

Research on Optimal Arch Rib Inclination of Large Span Highway CFST through Arch Bridge

To investigate the reasonable range of the inclination angle of arch ribs, a spatial finite element method was employed based on a concrete-filled steel tube (CFST) basket-handle through an arch bridge with a span of 360 m. A spatial finite element model was established using Midas/Civil software, which was verified with actual bridge data. The effects of different arch rib inclination angles were investigated under static loads. The structural natural frequencies, linear elastic stability coefficients, internal forces, and displacements were comprehensively considered to determine the reasonable range of the inclination angle. The results show that when the inclination angle ranges between 8° and 10°, the first, third, and sixth natural frequencies of the structure are increased. It effectively improves the lateral and torsional stiffness of the arch ribs while ensuring optimal out-of-plane stability of the arch ribs. Compared with the parallel arch, the stability is improved by 20.2%. The effects of angle variation on displacement and internal force of the arch ribs were not significant. Considering all indicators, the optimal range of the inclination angle for the arch ribs of 300-m-level highway CFST arch bridges is suggested to be 8~10°.

Development of a Modified Duodenum Traction Technique in Laparoscopic Duodenal Web Excision.

Introduction: Laparoscopic duodenal web resection surgery remains safe in neonates. The pearls in laparoscopic duodenal web excision are a proper and stable duodenal exposure. Herein, we present a modified duodenal traction technique, which can improve operative field exposure in laparoscopic surgery. Material and Methods: This modified technique was performed in 54 patients during laparoscopic duodenal web resection surgery at our center. It was performed using a 5-0 PDS-II suture, which was introduced percutaneously at 1-2 cm under either side of the costal margin at the anterior axillary line, respectively, to retract the duodenum. Results: Perioperative data of these patients and short-term follow-up data of duodenal web patients were retrospectively reviewed. All 54 procedures were completed without conversion to open surgery or requiring additional ports. Patients' mean age at surgery was 5 days (range 2-30 days), and the median weight at the time of surgery was 3.25 kg (range 2.52-3.88 kg). Eight patients (14.8%) had complete membranes, whereas 46 (85.2%) had a membrane with a hole. The mean time required for this technique was 336 (range 216-416) seconds and the mean duration of the entire surgery was 77 (range 65-89) minutes. The mean postoperative hospital stay was 16 (range 9-90) days and no postoperative complication related to the suspension procedure occurred. Conclusion: Our outcomes demonstrated the modified duodenal traction technique is a feasible and ideal method during laparoscopic duodenal web resection surgery.