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1.
BACKGROUND: Recently, investigators have reported the use of endoscopic myotomy in the treatment of esophageal achalasia. As with the open operation, considerable disagreement exists regarding the appropriate length of the myotomy and the need for a concomitant antireflux procedure. METHODS: Patients presenting with symptomatic achalasia between 1993 and 1997 were included in this prospective study. Preoperative studies included barium upper gastrointestinal study, endoscopy, and esophageal manometry. Laparoscopic myotomy was completed in all 20 patients; 18 had concomitant Toupet fundoplication. RESULTS: Operative times ranged from 95 to 345 minutes (mean 216). Blood loss ranged from 50 to 300 cc (mean 100 cc). There were 7 minor complications (5 mucosal injuries repaired laparoscopically, 1 bile leak and 1 splenic capsular tear). Nine patients began a liquid diet on the first day postoperatively; 19 were tolerating liquids by postoperative day 3. Hospital stay ranged from 2 to 20 days (mean 5). Eighteen patients had complete relief of dysphagia, with less than one reflux episode per month. One individual continues to have mild persistent solid food dysphagia. Another patient initially did well but subsequently developed mild recurrent dysphagia and reflux. One patient required laparoscopic take-down of the wrap because of recurrent dysphagia and now has no problems swallowing, but does complain of mild reflux. Two other patients also have mild reflux, 1 of whom did not undergo fundoplication. CONCLUSIONS: Laparoscopic Heller myotomy can be performed safely with excellent results in patients with achalasia. Adding a partial fundoplication appears to help control postoperative symptoms of reflux. This procedure should be considered the procedure of choice in patients with symptomatic esophageal achalasia.  相似文献   
2.
In training the weights of a feedforward neural network, it is well known that the global extended Kalman filter (GEKF) algorithm has much better performance than the popular gradient descent with error backpropagation in terms of convergence and quality of solution. However, the GEKF is very computationally intensive, which has led to the development of efficient algorithms such as the multiple extended Kalman algorithm (MEKA) and the decoupled extended Kalman filter algorithm (DEKF), that are based on dimensional reduction and/or partitioning of the global problem. In this paper we present a new training algorithm, called local linearized least squares (LLLS), that is based on viewing the local system identification subproblems at the neuron level as recursive linearized least squares problems. The objective function of the least squares problems for each neuron is the sum of the squares of the linearized backpropagated error signals. The new algorithm is shown to give better convergence results for three benchmark problems in comparison to MEKA, and in comparison to DEKF for highly coupled applications. The performance of the LLLS algorithm approaches that of the GEKF algorithm in the experiments.  相似文献   
3.
The fatty acid composition of the tunicateBotryllus schlosseri and of two bacterial strains found within the tunicate, namelyVibrio parahaemolyticus and of an associated but previously unreported gram positive cocci were studied. The polyunsaturated fatty acids 6,9,12-octadecatrienoic acid, 5,8,11,14,17-eicosapentaenoic acid, and 4,7,10,13,16,19-docosahexaenoic acid were particularly abundant inB. schlosseri and were not detected in the two bacterial strains found in the tunicate. Theiso/anteiso pair, 13-methyltetradecanoic acid and 12-methyltetradecanoic acid, were the principal fatty acids in the gram positive cocci, and the 9- and 11-hexadecenoic acids were particulary abundant inV. parahaemolyticus. The diunsaturated fatty acid 9,12-octadecadienoic acid was also shown to be present inV. parahaemolyticus. The fatty acid composition of a third bacterial strain, characterized as either aPseudomonas or anAlteromonas species, and shown to be present only in the sea water from the Black Sea and not inB. schlosseri, is also reported. This is the first investigation on fatty acids from Black Sea bacteria.  相似文献   
4.
An emerging sensor technology referred to as electric cell-substrate impedance sensing (ECIS) has been extended for monitoring the behavior of insect cells including attachment, motility, and mortality. In ECIS, adherent cells were cultured on an array of eight small gold electrodes deposited on the bottom of tissue culture wells and immersed in a culture medium. Upon the attachment and spreading of cells on the gold electrode, the impedance increased because the cells acted as insulating particles to restrict the current flow. Experimental data revealed that insect cells interacted differently with various proteins used to precoat the gold electrode with concanavalin A as the best promoter to accelerate the rate of cell attachment. After the cells were fully spread, the measured impedance continued to fluctuate to reflect the constant motion and metabolic activity of the cells. As the cell behavior was sensitive to external chemicals, the applicability of ECIS for inhibition assays was demonstrated with HgCl2, trinitrotoluene, trinitrobenzene (TNB), and 2-amino-4,6-dinitrotoluene as model systems. Unlike conventional assays, the quantitative data obtained in this study are taken in real time and in a continuous fashion to depict cell motility and mortality.  相似文献   
5.
The asymptotic behavior of block floating-point and floating-point digital filters is analyzed. As a result, mantissa wordlength conditions are derived guaranteeing the absence of limit cycles in the regular dynamic range. Explicitly, the requirements are given for block floating-point state space filters with different quantization formats. Although these conditions are only sufficient, examples are given in which they are also necessary. In most cases the conditions are easily satisfied.  相似文献   
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Multiple target tracking based on symmetric measurement equations   总被引:1,自引:0,他引:1  
An approach to track maintenance in multiple target tracking is presented in terms of measurements which are symmetric functions of target positions. In this approach, the data association problem is embedded in the process of target state estimation so that there is no need to consider possible target/measurement associations. For N targets moving in three-dimensional space, the first-order version of the target state estimator is an extended Kalman filter of dimension 6N. Attention is focused on the case of constant-velocity targets with the number of measurements (of a given coordinate) assumed to be equal to the number of targets  相似文献   
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OBJECTIVE: To explore possible effects of aging on the excitability of spinal reflexes. DESIGN: Using a cross-sectional design, the influences of muscle vibration and the Jendrassik maneuver on patellar tendon reflex function were compared between 30 young adults and 15 older adults. SETTING: Motor control research laboratory. SUBJECTS: The young adults were volunteers of college age. The older adults (74.5 +/- 4.14 yr) were volunteers from the local community. All subjects were free of medications and neurological conditions that would affect normal neuromuscular responses. MAIN OUTCOME MEASURES: A force-time curve analysis of the patellar tendon reflex response was used to assess the inhibition and facilitation of spinal reflexes. In the experimental protocol to assess spinal reflex inhibition, 100 Hz vibration was applied to the right quadriceps muscle. In another experimental protocol, spinal reflex facilitation was assessed using the Jendrassik maneuver. To perform the Jendrassik maneuver, subjects were instructed to grasp their hands together and to pull as hard as possible while breathing normally. After a 2-second count, the tendon tap was delivered to the right leg and the subject was instructed to relax. In both experimental protocols, control patellar tendon reflexes were collected. RESULTS: Analysis of variance for reflex peak force revealed a significant 30% reduction in the amount of vibration-induced reflex inhibition with increasing age, and a similar 33% reduction in the amount of Jendrassik maneuver facilitation observed for the older adults as compared with the younger adults. CONCLUSION: These results support the hypothesis that inhibitory and excitatory influences acting on the alpha motoneuron pool are different in young and older adults.  相似文献   
10.
A single carrier system capable of transmitting simultaneously the combined information content of 12 to 20 channels of television, complete with the TV carrier and the color and sound subcarriers, is presented. The system uses an original modulation system which carries the information in the width and spacing of a continuous train of pulses. The amplitude insensitivity permits extremely broad-band transmissions on an "all-weather" basis in the band from 10 to 10 000 GHz, millimeter to long wave infrared wave-lengths.  相似文献   
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