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World Journal of Gastroenterology 2012年第24期18卷 3050-3057页

作者： Uday C Ghoshal Sunil B Daschakraborty Renu Singh Department of Gastroenterology Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknow 226104India

Achalasia cardia is one of the common causes of motor dysphagia.Though the disease was first described more than 300 years ago,exact pathogenesis of this condition still remains enigmatic.Pathophysiologically,achalasia cardia is caused by loss of inhibitory ganglion in the myenteric plexus of the esophagus.In the initial stage,degeneration of inhibitory nerves in the esophagus results in unopposed action of excitatory neurotransmitters such as acetylcholine,resulting in high amplitude non-peristaltic contractions(vigorous achalasia);progressive loss of cholinergic neurons over time results in dilation and low amplitude simultaneous contractions in the esophageal body(classic achalasia).Since the initial description,several studies have attempted to explore initiating agents that may cause the disease,such as viral infection,other environmental factors,autoimmunity,and genetic factors.Though Chagas disease,which mimics achalasia,is caused by an infective agent,available evidence suggests that infection may not be an independent cause of primary achalasia.A genetic basis for achalasia is supported by reports showing occurrence of disease in monozygotic twins,siblings and other first-degree relatives and occurrence in association with other genetic diseases such as Down's syndrome and Parkinson's disease.Polymorphisms in genes encoding for nitric oxide synthase,receptors for vasoactive intestinal peptide,interleukin 23 and the ALADIN gene have been reported.However,studies on larger numbers of patients and controls from different ethnic groups are needed before definite conclusions can be obtained.Currently,the disease is believed to be multi-factorial,with autoimmune mechanisms triggered by infection in a genetically predisposed individual leading to degeneration of inhibitory ganglia in the wall of the esophagus.

关键词：发病机制弛缓遗传性疾病兴奋性神经递质一氧化氮合成酶病毒感染胆碱能神经元血管活性肠肽

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Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

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World Journal of Gastroenterology 2011年第29期17卷 3431-3440页

作者： Natale Di Martino Antonio Brillantino Luigi Monaco Luigi Marano Michele Schettino Raffaele Porfidia Giuseppe Izzo Angelo Cosenza VIII Department of General and Gastrointestinal Surgery School of MedicineSecond University of NaplesPiazza Miraglia 280138 NaplesItaly

AIM:To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS:Fifty-six patients(26 men,30 women;mean age 42.8±14.7 years)presenting for minimally invasive surgery for oesophageal achalasia,were enrolled.All patients underwent laparoscopic Heller myotomy followed by a 180°anterior partial fundoplication in 30 cases(group 1)and calibrated NissenRossetti fundoplication in 26(group 2).Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication.A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken.One and two years after surgery,the patients underwent symptom questionnaires,endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS:At the 2-year follow-up,no significant difference in the median symptom score was observed between the 2 groups(P=0.66;Mann-WhitneyU-test).The median percentage time with oesophageal pH< 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group(2;range 0.8-10 vs 0.35;range 0-2)(P<0.0001;Mann-WhitneyU-test).CONCLUSION:Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia.Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.

关键词：胃镜检查腹腔镜食管校准弛缓 VS 微创手术平均年龄

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2011 update on esophageal achalasia

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World Journal of Gastroenterology 2012年第14期18卷 1573-1578页

作者： Seng-Kee Chuah Pin-I Hsu Keng-Liang Wu Deng-Chyang Wu Wei-Chen Tai Chi-Sin Changchien Division of Gastroenterology Kaohsiung ChangGung Memorial Hospital College of Medicine Chang GungUniversity Kaohsiung 833 Taiwan Division of Gastroenterology Department of Inter-nal Medicine Kaohsiung Veterans General Hospital NationalYang-Ming University Kaohsiung 813 Taiwan Cancer Center Division of Gastroenterol-ogy Department of Internal Medicine Kaohsiung MedicalUniversity Hospital Kaohsiung Medical University Kaohsiung807 Taiwan

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with typeⅠ(classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novelendoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real break-through from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

关键词：弛缓随机对照试验诊断工具 ic技术 Ⅱ型糖尿病高分辨率胃肠病学基础研究

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Achalasia: A review of Western and Iranian experiences

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World Journal of Gastroenterology 2009年第40期15卷 5000-5009页

作者： Javad Mikaeli Farhad Islami Reza Malekzadeh Digestive Disease Research Center Shariati HospitalTehran University of Medical Sciences International Agency for Research on Cancer King's College London Thames Cancer Registry

Achalasia is a primary motor disorder of the eso-phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical fi ndings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta-analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for medium-resource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, is the most effective treatment for achalasia. Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be conf irmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

关键词：伊朗西方弛缓

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Current clinical approach to achalasia

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World Journal of Gastroenterology 2009年第32期15卷 3969-3975页

作者： Alexander J Eckardt Volker F Eckardt Central Interdisciplinary Endoscopy Unit Department of Gastroenterology and HepatologyCharité University Hospitals BerlinCampus VirchowD-13353 BerlinGermany Department of Gastroenterology Deutsche Klinik für DiagnostikD-65191 WiesbadenGermany

Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus. These motor abnormalities lead to dysphagia, stasis, regurgitation, weight loss, or secondary respiratory complications. Although major strides have been made in understanding the pathogenesis of this rare disorder, including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals, a definite trigger has not been identified. The diagnosis of achalasia is suggested by clinical features and conf irmed by further diagnostic tests, such as esophagogastroduodenoscopy (EGD), manometry or barium swallow. These studies are not only used to exclude pseudoachalasia, but also might help to categorize the disease by severity or clinical subtype. Recent advances in diagnostic methods, including high resolution manometry (HRM), might allow prediction of treatment responses. The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods. Although limited high-quality data exist, it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients. However, the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease, but also on local expertise and patient preferences.

关键词：弛缓临床医学诊断 LES

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一种地铁列车齿轮传动系统弛缓状态诊断方法

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机车电传动 2019年第6期 115-117,121页

作者：许南南许浩翔张章株洲中车时代电气股份有限公司技术中心湖南株洲412001 长沙市轨道交通集团有限公司湖南长沙410000

地铁列车齿轮传动系统将牵引电机转矩传递给车轴,在运行过程中可能会出现弛缓现象。通过对比牵引、电制动和气制动过程中的牵引电机转速和轮轴转速大小,可以对地铁列车传动系统弛缓状态进行诊断。该方法可以利用既有车辆系统的设备,不... 详细信息

地铁列车齿轮传动系统将牵引电机转矩传递给车轴,在运行过程中可能会出现弛缓现象。通过对比牵引、电制动和气制动过程中的牵引电机转速和轮轴转速大小,可以对地铁列车传动系统弛缓状态进行诊断。该方法可以利用既有车辆系统的设备,不需要额外增加其他设备,并已在国内地铁线路上得到应用。

关键词：地铁列车齿轮传动系统弛缓状态诊断牵引电制动空气制动故障诊断

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高速列车车轴-轴承温度特性及弛缓机理

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山东大学学报（工学版） 2016年第2期46卷 116-121 134页

作者：刘义辉李林刘凯孙杰山东大学机械工程学院山东济南250061 哈尔滨工业大学(威海)理学院山东威海264209

针对高速列车运行过程中的车轴-轴承普遍存在的弛缓现象,从温度角度揭示弛缓产生机理,并给出预防措施。采用ABAQUS软件对工作条件下轴-轴承温度特性有限元建模,并仿真分析轴承各部件在不同车速下不同的温升情况,结合材料膨胀系数测试试... 详细信息

针对高速列车运行过程中的车轴-轴承普遍存在的弛缓现象,从温度角度揭示弛缓产生机理,并给出预防措施。采用ABAQUS软件对工作条件下轴-轴承温度特性有限元建模,并仿真分析轴承各部件在不同车速下不同的温升情况,结合材料膨胀系数测试试验和温升与轴承内圈膨胀量关系试验的方法,得出车轴、轴承内圈的膨胀量与温度的匹配关系。仿真和试验结果表明:在温升的作用下,车轴-轴承内圈的过盈量会出现一定程度的减小。最终获得温升对车轴-轴承内圈过盈量的影响规律,揭示弛缓产生的机理并从过盈量和温度两个角度给出指导参数。

关键词：弛缓温升热胀变形膨胀量过盈量

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Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

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World Journal of Gastroenterology 2009年第35期15卷 4461-4463页

作者： Ming-Tzung Lin King-Wah Chiu Yeh-Pin Chou Ming-Chao Tsai Tsung-Hui Hu Chuan-Mo Lee Chi-Sin Changchien Seng-Kee Chuah Division of Hepatogastroenterology Chang Gang Memorial Hospital Kaohsiung 123Ta-Pei RoadNiaosung HsiangKaohsiung Country 833TaiwanChina Chang Gung University College of MedicineKaohsiung 833TaiwanChina

Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation.It has been reported that delayed management of perforation for more than 24 h is associated with high mortality.Surgery is the treatment of choice within 24 h,but the management of delayed perforation remains controversial.Hereby,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia.She completely recovered after intensive medical care.A review of the literature is also discussed.

关键词：穿孔弛缓食管延迟气囊局部放电死亡率治疗

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基于温度特性高速列车车轴—轴承弛缓机理研究

基于温度特性高速列车车轴—轴承弛缓机理研究

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作者：刘义辉山东大学

学位级别：硕士

随着中国高速铁路的蓬勃发展,高速列车已成为公众出行的一种重要选择,列车的安全问题就成为关系到公共安全的重要问题,而机车车轴-轴承弛缓是影响列车安全的一个重要因素,虽然国内外众多学者已经意识到轴承弛缓所带来的危害,但对弛缓问... 详细信息

随着中国高速铁路的蓬勃发展,高速列车已成为公众出行的一种重要选择,列车的安全问题就成为关系到公共安全的重要问题,而机车车轴-轴承弛缓是影响列车安全的一个重要因素,虽然国内外众多学者已经意识到轴承弛缓所带来的危害,但对弛缓问题的研究仅停留在开发监测装置、避免人为失误层面,未从机理上对机车车轴-轴承弛缓现象进行揭示,难以获得从根本上抑制弛缓的措施,为此对高速列车车轴-轴承弛缓产生的机理进行研究具有很强的理论及实际意义。针对列车车轴-轴承弛缓问题,从温度角度来研究并揭示弛缓可能产生的机理,并提出预防措施。基于装配单元不同材料的热物理力学特性可能对弛缓产生的影响,使用Diamond TMA型热机械分析仪对车轴-轴承各关键零部件材料的线膨胀系数进行测定,拟合出车轴-轴承各关键零部件材料的线膨胀系数曲线,并获得线膨胀系数与温度的关系式,通过分析各种材料的线膨胀系数,从热物理力学特性角度分析了在温度升高的作用下存在弛缓的可能性;基于轴承温升的热源分析,根据列车车轴轴承的实际工况,确定了圆锥滚子轴承的载荷及边界条件,结合ABAQUS有限元分析软件对轴承进行建模,按照列车速度为380km/h、350km/h、300km/h、250km/h、200km/h以及120km/h五种工况进行分析计算,对比各工况下圆锥滚子轴承各零部件的温度场,总结出不同列车速度下不同轴承部件的温度场分布情况,得出装配单元组件各自温升差异：一定转速下滚动体的温升最高,轴承外圈次之,轴承内圈最低;随着列车速度的提高,轴承各部件的温度均逐渐升高,列车速度每提高100km1/h,对轴承内圈和外圈而言,温度升高大约5℃,对滚动体而言,温度升高大约28℃;根据有限元仿真得出的轴承温度分布情况,采用ABAQUS有限元分析对该温度范围内的车轴、轴承内圈进行温升与膨胀量匹配计算,得出不同温升情况下车轴和轴承内圈各自的膨胀量,进而采用试验方法,将车轴与轴承内圈实物进行温升试验,使用激光三角反射位移传感器实时采集位移数据,得出温升范围内的车轴和轴承内圈的膨胀量,结合有限元仿真和试验的结果,分析温升对车轴-轴承内圈过盈量的影响,总结出温度对车轴-轴承弛缓的影响,并给出预防弛缓的措施。

关键词：轴承弛缓温度仿真试验

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导尿管球囊扩张术对脑卒中后环咽肌失弛缓所致吞咽障碍患者的疗效分析

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中文科技期刊数据库（全文版）医药卫生 2021年第2期 0044-0045页

作者：马德平闵利陈先花宋建平重庆医科大学附属第一医院全科医学科重庆400016 重庆医药高等专科学校附属第一医院重症医学科重庆400060 重庆医药高等专科学校附属第一医院康复医学科重庆400060

研讨脑卒中后环咽肌失弛缓所致吞咽障碍患者临床治疗期间,导尿管球囊扩张术的应用效果。纳入88例病例,纳入时间近2年。根据数值表,对照组接受基础康复训练,观察组采用导管球囊扩张治疗。比较相关的索引值。结果观察组有效率(95.5%)高于... 详细信息

研讨脑卒中后环咽肌失弛缓所致吞咽障碍患者临床治疗期间,导尿管球囊扩张术的应用效果。纳入88例病例,纳入时间近2年。根据数值表,对照组接受基础康复训练,观察组采用导管球囊扩张治疗。比较相关的索引值。结果观察组有效率(95.5%)高于对照组(75.0%),P<0.05;观察组有效率(95.5%)。观察组的渗水,流质食物,黏性食物和固体食物的百分比均高于对照组,P<0.05。随后,根据时间和VFSS,观察组的吞咽分数高于对照组,P<0.05。结果对吞咽障碍的脑卒中患者进行了球囊导管插入术,效果显着。

关键词：导尿管球囊扩张术脑卒中吞咽障碍弛缓后环咽肌

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