BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the effic...BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.展开更多
Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various f...Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various factors affect roots reinforcement during seismic loading have rarely been studied.The objective is to conduct a series of cyclic direct simple shear tests and DEM numerical simulation to investigate the cyclic behaviour of rooted loess.The effects of initial static shear stress and loading frequency on the cyclic resistance of root-soil composites were first investigated.After that,cyclic direct simple shear simulations at constant volume were carried out based on the discrete element method(PFC^(3D))to investigate the effects of root geome-try,mechanical traits and root-soil bond strength on the cyclic strength of rooted loess.It was discovered that the roots could effectively improve the cyclic resistance of loess.The cyclic resistance of the root-soil composite decreases with the increase of the initial shear stress,then increases,and improves with the increase of the frequency.The simulation result show that increases in root elastic modulus and root-soil interfacial bond strength can all enhance the cyclic resistance of root-soil composites,and the maximum cyclic resistance of the root-soil composite was obtained when the initial inclination angle of the root system was 90°.展开更多
Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial con...Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.展开更多
Tissue clearing combined with high-resolution confocal imaging is a cutting-edge approach for dissecting the three-dimensional(3D)architecture of tissues and deciphering cellular spatial interactions under physiologic...Tissue clearing combined with high-resolution confocal imaging is a cutting-edge approach for dissecting the three-dimensional(3D)architecture of tissues and deciphering cellular spatial interactions under physiological and pathological conditions.Deciphering the spatial interaction of leptin receptor-expressing(LepR^(+))stromal cells with other compartments in the bone marrow is crucial for a deeper understanding of the stem cell niche and the skeletal tissue.In this study,we introduce an optimized protocol for the 3D analysis of skeletal tissues,enabling the visualization of hematopoietic and stromal cells,especially LepR+stromal cells,within optically cleared bone hemisections.Our method preserves the 3D tissue architecture and is extendable to other hematopoietic sites such as calvaria and vertebrae.The protocol entails tissue fixation,decalcification,and cryosectioning to reveal the marrow cavity.Completed within approximately 12 days,this process yields highly transparent tissues that maintain genetically encoded or antibody-stained fluorescent signals.The bone hemisections are compatible with diverse antibody labeling strategies.Confocal microscopy of these transparent samples allows for qualitative and quantitative image analysis using Aivia or Bitplane Imaris software,assessing a spectrum of parameters.With proper storage,the fluorescent signal in the stained and cleared bone hemisections remains intact for at least 2–3 months.This protocol is robust,straightforward to implement,and highly reproducible,offering a valuable tool for tissue architecture and cellular interaction studies.展开更多
The El Pintado 1 Silurian section in Seville Province,Spain,described by Loydell et al.(2015),has been ratified by the IUGS as the replacement GSSP for the base of the Telychian Stage,to replace the Cefn Cerig quarry ...The El Pintado 1 Silurian section in Seville Province,Spain,described by Loydell et al.(2015),has been ratified by the IUGS as the replacement GSSP for the base of the Telychian Stage,to replace the Cefn Cerig quarry section in the Llandovery area of Wales,which was found to be within a sedimentary mélange and therefore not a continuous section.No section other than El Pintado 1 has been found to be continuously fossiliferous across the Aeronian/Telychian boundary.展开更多
Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objec...Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objective:To understand the placebo response of acupuncture treatment in simple obesity,a systematic review and meta-analysis was designed based on the comparison between sham acupuncture before and after treatment.Search strategy:Eight databases(Pub Med,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine Database,and Chinese Scientific Journals Database)were searched from inception to August 1,2023.The Me SH search terms comprised obesity and acupuncture.Inclusion criteria:Randomized controlled trials(RCTs)using sham or placebo acupuncture as a control in treating obesity were enrolled.Data extraction and analysis:Two researchers independently extracted data,and the results were crosschecked after completion.Each RCT’s detailed sham/placebo acupuncture treatment protocol was assessed according to the SHam Acupuncture REporting guidelines.The revised Cochrane risk-of-bias tool for randomized trials and the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system were used to determine the risk of bias and quality of evidence,respectively.Body mass index(BMI)was defined as the primary outcome.Anthropometric parameters and laboratory test parameters related to obesity were defined as secondary outcomes.We used standardized mean difference(SMD)with 95%confidence interval(CI)to calculate treatment effects of outcomes.Results:Fifteen RCTs with a total of 1250 patients were included.The BMI significantly decreased after treatment in the sham acupuncture group compared to baseline(SMD 0.37,95%CI 0.09–0.66;I2=81%,random model;P<0.01).Treatment duration(P=0.02)and other interventions significantly impacted the placebo response rate(P=0.00).Conclusion:The placebo response of sham acupuncture was strong in the RCTs for simple obesity,and the effect sizes differed between various outcomes.The treatment duration and other interventions emerged as potential influencing factors for the placebo response of sham acupuncture.展开更多
Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who requ...Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.展开更多
Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is...Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is still lacking.This study employed a rolled AZ31B plate with typical basal texture to investigate the shear behaviors.Positive and negative simple shear experiments were performed at different angles in the transverse plane,whereby the visco-plastic self-consistent model was calibrated to reveal the deformation mechanisms and predict the mechanical responses at various orientations.Positive-negative shear asymmetry is present because extension twinning preferentially operates in one shear direction but is suppressed in the opposite direction.Simple shear induces multiple twin variants,thus impedes twin growth and slows the consumption of matrix,as compared to in-plane compression.For slip dominated simple shear,the interaction between loading-induced rigid body rotation and slip-induced crystal rotation produces distinct hardening behaviors,namely orthogonally asymmetric mechanical responses at complementary loading angles,which is largely absent in uniaxial loading.Finally,simulation results verify that positive-negative shear asymmetry appears only when the deviatoric normal stress on the sheet plane is non-zero.Positive-negative shear asymmetry persists except for the conditions of shear plane parallel to sheet plane,or shear direction parallel or perpendicular to rolling direction.展开更多
The identification and characterization of rock types is a core activity in geology and related fields,including mining,petroleum,environmental science,industry,and construction.Traditionally,this task is performed by...The identification and characterization of rock types is a core activity in geology and related fields,including mining,petroleum,environmental science,industry,and construction.Traditionally,this task is performed by human specialists who analyze and describe the type,composition,texture,shape,and other properties of rock samples,whether collected in-situ or prepared in a laboratory.However,the process is subjective,dependent on the specialist’s experience,and time-consuming.This study proposes an artificial intelligence-based approach that combines computer vision and natural language processing to generate both textual and verbal descriptions from images of rock thin sections.A dataset of images and corresponding textual descriptions is used to train a hybrid deep learning model.Features extracted from the images using EfficientNetB7 are processed by a Transformer network to generate textual descriptions,which are then converted into verbal responses using a speech synthesis service.The experimental results show an accuracy of 0.892 and a BLEU score of 0.71.This model offers potential utility for research,professional,and academic applications and has been deployed as a web application for public use.展开更多
Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi...Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi-experimental design was carried out on the mothers scheduled for CS.Eighty participants were selected by a purposive sampling technique,which were divided(40 participants in each group)into an experimental group and a control group.Nurse-led informational video(NLIV)was shown to the experimental group,and routine care was provided for the control group.Modified hospital anxiety scale(HADS),scale for measuring maternal satisfaction in cesarean birth,and obstetric quality of recovery following cesarean delivery were used to assess anxiety,satisfaction,and recovery.Results:Both the experimental and control groups showed significant reductions in anxiety by the first postintervention day(P<0.001),with the experimental group experiencing a greater mean reduction(mean difference[MD]=4.37)than the control group(MD=3.35)but the intergroup difference was not statistically significant(P>0.05).The experimental group reported significantly higher satisfaction scores(175.55±9.42)on the 3rd postoperative day compared to the control group(151.93±14.89;P<0.001).Similarly,the experimental group’s recovery scores(79.90±6.24)were considerably higher than those of the control group(62.45±15.18;P<0.001).On the 3rd postintervention day,satisfaction was significantly associated with age(P<0.001),and recovery with gravidity(P<0.05).Conclusions:NLIV can be used in the preoperative period to reduce anxiety related to CS and to improve satisfaction and recovery after the CS.展开更多
OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar d...OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar defect(PCSD)]after cesarean section.METHODS:This is a single-center retrospective study.A total of 120 PCSD patients were enrolled from February 2022 to February 2023 and divided into two groups according to different treatment methods,the TCM group(n=60)and the control group(n=60).The control group was treated with hysteroscopy,and the TCM group combined TCM syndrome differentiation with hysteroscopy.Clinical outcome included menstrual scores,menstrual days,TCM symptom scores and intrauterine pregnancy recurrence rate was analyzed in two groups.RESULTS:The total response rate of the TCM group was significantly higher than that of the control group(P<0.05);after treatment,the menstrual scores,menstrual days and TCM symptoms of the two groups were decreased,and the menstrual scores,menstrual days and TCM symptoms of the TCM group were all lower than that of the control group(P<0.05);the recurrence rate of the TCM group was significantly lower than that of the control group(P<0.05).Follow-up results showed higher healing of incisional scar diverticulum in the TCM group than in the control group(P<0.05).The duration of menstruation before and after treatment,and the TCM group was better than the control group(P<0.05).CONCLUSION:TCM syndrome differentiation combined with hysteroscopy presented favorable outcome on the prolonged menstrual period of PCSD,which could significantly improve the recovery of menstruation,relief the symptoms of TCM,reduce the recurrence rate and accelerate wound healing.展开更多
The purpose of this article is to explore the design of compound interchange interweaving sections on expressways.During the research phase,based on the support of the literature research method,the classification and...The purpose of this article is to explore the design of compound interchange interweaving sections on expressways.During the research phase,based on the support of the literature research method,the classification and development of the interchange system,as well as the design forms of the compound interchange interweaving section,were analyzed.Subsequently,based on the case method,the design of the compound interchange interweaving section of the ShiWu and ShiBai expressways in Shiyan,Hubei Province,was discussed,and a design scheme and scheme comparison were proposed.It is hoped that this article can provide technical reference and ideas for China’s road and bridge engineering teams,ensuring that the design results can not only guarantee the normal passage of traffic on the North Intersection Expressway but also ensure the straight-line traffic capacity of the main highway under the background of dislocation intersection,achieving smooth and safe transitions between different expressways.展开更多
Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet t...Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.展开更多
The direct and dissociative ionizations of oxygen molecule are investigated experimen-tally by electron collision with energies from 350 eV to 8000 eV.The absolute ionization cross sections for the product ions(O_(2)^...The direct and dissociative ionizations of oxygen molecule are investigated experimen-tally by electron collision with energies from 350 eV to 8000 eV.The absolute ionization cross sections for the product ions(O_(2)^(2+),O_(2)^(2+)O^(+),O^(2+),and their total)and two Coulomb explosion channels(O^(+)+O^(+)and O^(2+)+O^(+))are obtained by putting the data of O^(2+)on the scale of Ar+from O_(2)and Ar gases mixed with a fixed relative flow ratio of 1:1.The experimental errors are assessed by taking uncertainties of various factors into account.The present absolute cross sections are well consistent with the previous data in the overlapped energy range below 1000 eV.展开更多
Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,bu...Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,but severe obesity combined with refractory hypertension is very rare in clinical practice.The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable.This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy.Owing to fetal heart rate abnormalities,she was scheduled for emergency cesarean section.Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture,the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia.Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure,and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs.The entire anesthesia and surgical procedure proceeded uneventfully,with no major adverse events observed.Both the patient and fetus achieved favorable outcomes.This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount,necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.展开更多
Convolutional neural networks have been widely used for analyzing image data in industry,especially in the oil and gas area.Brazil has an extensive hydrocarbon reserve on its coast and has also benefited from these ne...Convolutional neural networks have been widely used for analyzing image data in industry,especially in the oil and gas area.Brazil has an extensive hydrocarbon reserve on its coast and has also benefited from these neural network models.Image data from petrographic thin section can be essential to provide information about reservoir quality,highlighting important features such as carbonate lithology.However,the automatic identification of lithology in reservoir rocks is still a significant challenge,mainly due to the heterogeneity that is part of the lithologies of the Brazilian pre-salt.Within this context,this work presents an approach using one-class or specialist models to identify four classes of lithology present in reservoir rocks in the Brazilian pre-salt.The proposed methodology had the challenge of dealing with a small number of images for training the neural networks,in addition to the complexity involved in the analyzed data.An auto-machine learning tool called AutoKeras was used to define the hyperparameters of the implemented models.The results found were satisfactory and presented an accuracy greater than 70%for image samples belonging to other wells not seen during the model building,which increases the applicability of the implemented model.Finally,a comparison was made between the proposed methodology and multiple-class models,demonstrating the superiority of one-class models.展开更多
Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin r...Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin release and improve milk production.Objective:The objective of the study was to evaluate the effectiveness of almond oil massage on breast milk adequacy among primigravida lower segment cesarean section(LSCS)mothers.Materials and Methods:A randomized pretest-posttest control group design was conducted among 60 primigravida mothers post-LSCS,randomly assigned to experimental(n=30)and control(n=30)groups.The experimental group received three daily almond oil breast massages(5-10 mL;5 min/breast)for 3 days;controls received routine care.Breast milk adequacy was measured using a validated 16-item rating scale at baseline and day 4 post-intervention.Results:The mean breast milk adequacy scores increased from 29.30±1.915 to 39.80±1.690 in the experimental group(t=22.15,P<0.001).Control group change(29.93±2.132-30.27±2.116)was non-significant(t=0.776,P>0.05).Posttest scores between the two groups differed significantly between groups(t=19.282,P<0.001).Conclusion:Almond oil breast massage significantly enhances breast milk adequacy in post-LSCS mothers and can be integrated into routine postnatal nursing care.展开更多
文摘BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.
文摘Plant roots are widely known to provide mechanical reinforcement to soils against shearing and further increase slope stability.However,whether roots provide reinforcement to loess cyclic re-sistance and how various factors affect roots reinforcement during seismic loading have rarely been studied.The objective is to conduct a series of cyclic direct simple shear tests and DEM numerical simulation to investigate the cyclic behaviour of rooted loess.The effects of initial static shear stress and loading frequency on the cyclic resistance of root-soil composites were first investigated.After that,cyclic direct simple shear simulations at constant volume were carried out based on the discrete element method(PFC^(3D))to investigate the effects of root geome-try,mechanical traits and root-soil bond strength on the cyclic strength of rooted loess.It was discovered that the roots could effectively improve the cyclic resistance of loess.The cyclic resistance of the root-soil composite decreases with the increase of the initial shear stress,then increases,and improves with the increase of the frequency.The simulation result show that increases in root elastic modulus and root-soil interfacial bond strength can all enhance the cyclic resistance of root-soil composites,and the maximum cyclic resistance of the root-soil composite was obtained when the initial inclination angle of the root system was 90°.
文摘Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.
基金National Natural Science Foundation of China(grant number 82272563 to B.S.)National Science and Technology Major Project of the Ministry of Science and Technology of China(grant number 2023ZD0501202 to B.S.)+4 种基金institutional grants allocated to the National Institute of Biological Sciences,Beijing(NIBS)from the Chinese Ministry of Science and Technology,Beijing Municipal Commission of Science and Technology,and Tsinghua Universitythe support from China Pharmaceutical University(grant number 3150140001 to S.F.)National Natural Science Foundation of China(grant numbers 82203653 to S.F.,82371957 to L.W.,and 82371956 to X.C.)Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes(grant number JYY2023-8 to X.C.)Research Grants Council of University Grants Committee Hong Kong(grant numbers 14113723,14108720,14121721,14202920,N_CUHK472/22,C7030-18G,T13-402/17-N,and AoE/M-402/20)。
文摘Tissue clearing combined with high-resolution confocal imaging is a cutting-edge approach for dissecting the three-dimensional(3D)architecture of tissues and deciphering cellular spatial interactions under physiological and pathological conditions.Deciphering the spatial interaction of leptin receptor-expressing(LepR^(+))stromal cells with other compartments in the bone marrow is crucial for a deeper understanding of the stem cell niche and the skeletal tissue.In this study,we introduce an optimized protocol for the 3D analysis of skeletal tissues,enabling the visualization of hematopoietic and stromal cells,especially LepR+stromal cells,within optically cleared bone hemisections.Our method preserves the 3D tissue architecture and is extendable to other hematopoietic sites such as calvaria and vertebrae.The protocol entails tissue fixation,decalcification,and cryosectioning to reveal the marrow cavity.Completed within approximately 12 days,this process yields highly transparent tissues that maintain genetically encoded or antibody-stained fluorescent signals.The bone hemisections are compatible with diverse antibody labeling strategies.Confocal microscopy of these transparent samples allows for qualitative and quantitative image analysis using Aivia or Bitplane Imaris software,assessing a spectrum of parameters.With proper storage,the fluorescent signal in the stained and cleared bone hemisections remains intact for at least 2–3 months.This protocol is robust,straightforward to implement,and highly reproducible,offering a valuable tool for tissue architecture and cellular interaction studies.
基金funded by project PDI2021-125585NB-I00 of the Spanish Ministry of Science,Innovation and Universities‒Agencia Estatal de Investigacion.JF thanks the Grant Agency of the Czech Republic for support of his study(GA23-06198S).
文摘The El Pintado 1 Silurian section in Seville Province,Spain,described by Loydell et al.(2015),has been ratified by the IUGS as the replacement GSSP for the base of the Telychian Stage,to replace the Cefn Cerig quarry section in the Llandovery area of Wales,which was found to be within a sedimentary mélange and therefore not a continuous section.No section other than El Pintado 1 has been found to be continuously fossiliferous across the Aeronian/Telychian boundary.
基金supported by grants from the National Natural Science Foundation of China(82405192)the Capital’s Funds for Health Improvement and Research(CFH 2022-2-20213,CFH 2022-1-2021)+1 种基金the project of"Friendship Seed Plan"Talent Project of Beijing Friendship Hospital,Capital Medical University(YYZZ202333)Beijing key project of major disease by Chinese medicine and Western medicine(Fatty liver,No.2023BJSZDYNJBXTGG-017)。
文摘Background:Acupuncture has shown potential therapeutic benefits for individuals with simple obesity.However,some researchers argue that some of the effectiveness of acupuncture may be due to the placebo response.Objective:To understand the placebo response of acupuncture treatment in simple obesity,a systematic review and meta-analysis was designed based on the comparison between sham acupuncture before and after treatment.Search strategy:Eight databases(Pub Med,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine Database,and Chinese Scientific Journals Database)were searched from inception to August 1,2023.The Me SH search terms comprised obesity and acupuncture.Inclusion criteria:Randomized controlled trials(RCTs)using sham or placebo acupuncture as a control in treating obesity were enrolled.Data extraction and analysis:Two researchers independently extracted data,and the results were crosschecked after completion.Each RCT’s detailed sham/placebo acupuncture treatment protocol was assessed according to the SHam Acupuncture REporting guidelines.The revised Cochrane risk-of-bias tool for randomized trials and the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system were used to determine the risk of bias and quality of evidence,respectively.Body mass index(BMI)was defined as the primary outcome.Anthropometric parameters and laboratory test parameters related to obesity were defined as secondary outcomes.We used standardized mean difference(SMD)with 95%confidence interval(CI)to calculate treatment effects of outcomes.Results:Fifteen RCTs with a total of 1250 patients were included.The BMI significantly decreased after treatment in the sham acupuncture group compared to baseline(SMD 0.37,95%CI 0.09–0.66;I2=81%,random model;P<0.01).Treatment duration(P=0.02)and other interventions significantly impacted the placebo response rate(P=0.00).Conclusion:The placebo response of sham acupuncture was strong in the RCTs for simple obesity,and the effect sizes differed between various outcomes.The treatment duration and other interventions emerged as potential influencing factors for the placebo response of sham acupuncture.
文摘Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.
基金supports of the National Key Research and Development Program of China(Grant No.2023YFB3710900)the National Natural Science Foundation of China(Grant Nos.52071211 and 52071208)。
文摘Mg alloy often undergoes shear deformation during industrial processing.While its anisotropy and tension-compression asymmetry have been thoroughly studied under uniaxial loading,the understanding for shear loading is still lacking.This study employed a rolled AZ31B plate with typical basal texture to investigate the shear behaviors.Positive and negative simple shear experiments were performed at different angles in the transverse plane,whereby the visco-plastic self-consistent model was calibrated to reveal the deformation mechanisms and predict the mechanical responses at various orientations.Positive-negative shear asymmetry is present because extension twinning preferentially operates in one shear direction but is suppressed in the opposite direction.Simple shear induces multiple twin variants,thus impedes twin growth and slows the consumption of matrix,as compared to in-plane compression.For slip dominated simple shear,the interaction between loading-induced rigid body rotation and slip-induced crystal rotation produces distinct hardening behaviors,namely orthogonally asymmetric mechanical responses at complementary loading angles,which is largely absent in uniaxial loading.Finally,simulation results verify that positive-negative shear asymmetry appears only when the deviatoric normal stress on the sheet plane is non-zero.Positive-negative shear asymmetry persists except for the conditions of shear plane parallel to sheet plane,or shear direction parallel or perpendicular to rolling direction.
文摘The identification and characterization of rock types is a core activity in geology and related fields,including mining,petroleum,environmental science,industry,and construction.Traditionally,this task is performed by human specialists who analyze and describe the type,composition,texture,shape,and other properties of rock samples,whether collected in-situ or prepared in a laboratory.However,the process is subjective,dependent on the specialist’s experience,and time-consuming.This study proposes an artificial intelligence-based approach that combines computer vision and natural language processing to generate both textual and verbal descriptions from images of rock thin sections.A dataset of images and corresponding textual descriptions is used to train a hybrid deep learning model.Features extracted from the images using EfficientNetB7 are processed by a Transformer network to generate textual descriptions,which are then converted into verbal responses using a speech synthesis service.The experimental results show an accuracy of 0.892 and a BLEU score of 0.71.This model offers potential utility for research,professional,and academic applications and has been deployed as a web application for public use.
文摘Objective:The objective of this study is to determine the effect of nurse-led instructional video(NLIV)on anxiety,satisfaction,and recovery among mothers admitted for cesarean section(CS).Materials and Methods:A quasi-experimental design was carried out on the mothers scheduled for CS.Eighty participants were selected by a purposive sampling technique,which were divided(40 participants in each group)into an experimental group and a control group.Nurse-led informational video(NLIV)was shown to the experimental group,and routine care was provided for the control group.Modified hospital anxiety scale(HADS),scale for measuring maternal satisfaction in cesarean birth,and obstetric quality of recovery following cesarean delivery were used to assess anxiety,satisfaction,and recovery.Results:Both the experimental and control groups showed significant reductions in anxiety by the first postintervention day(P<0.001),with the experimental group experiencing a greater mean reduction(mean difference[MD]=4.37)than the control group(MD=3.35)but the intergroup difference was not statistically significant(P>0.05).The experimental group reported significantly higher satisfaction scores(175.55±9.42)on the 3rd postoperative day compared to the control group(151.93±14.89;P<0.001).Similarly,the experimental group’s recovery scores(79.90±6.24)were considerably higher than those of the control group(62.45±15.18;P<0.001).On the 3rd postintervention day,satisfaction was significantly associated with age(P<0.001),and recovery with gravidity(P<0.05).Conclusions:NLIV can be used in the preoperative period to reduce anxiety related to CS and to improve satisfaction and recovery after the CS.
文摘OBJECTIVE:To evaluate the clinical outcome of Traditional Chinese Medicine(TCM)syndrome differentiation combined with hysteroscopic treatment for uterine incision defect after cesarean section[previous cesarean scar defect(PCSD)]after cesarean section.METHODS:This is a single-center retrospective study.A total of 120 PCSD patients were enrolled from February 2022 to February 2023 and divided into two groups according to different treatment methods,the TCM group(n=60)and the control group(n=60).The control group was treated with hysteroscopy,and the TCM group combined TCM syndrome differentiation with hysteroscopy.Clinical outcome included menstrual scores,menstrual days,TCM symptom scores and intrauterine pregnancy recurrence rate was analyzed in two groups.RESULTS:The total response rate of the TCM group was significantly higher than that of the control group(P<0.05);after treatment,the menstrual scores,menstrual days and TCM symptoms of the two groups were decreased,and the menstrual scores,menstrual days and TCM symptoms of the TCM group were all lower than that of the control group(P<0.05);the recurrence rate of the TCM group was significantly lower than that of the control group(P<0.05).Follow-up results showed higher healing of incisional scar diverticulum in the TCM group than in the control group(P<0.05).The duration of menstruation before and after treatment,and the TCM group was better than the control group(P<0.05).CONCLUSION:TCM syndrome differentiation combined with hysteroscopy presented favorable outcome on the prolonged menstrual period of PCSD,which could significantly improve the recovery of menstruation,relief the symptoms of TCM,reduce the recurrence rate and accelerate wound healing.
文摘The purpose of this article is to explore the design of compound interchange interweaving sections on expressways.During the research phase,based on the support of the literature research method,the classification and development of the interchange system,as well as the design forms of the compound interchange interweaving section,were analyzed.Subsequently,based on the case method,the design of the compound interchange interweaving section of the ShiWu and ShiBai expressways in Shiyan,Hubei Province,was discussed,and a design scheme and scheme comparison were proposed.It is hoped that this article can provide technical reference and ideas for China’s road and bridge engineering teams,ensuring that the design results can not only guarantee the normal passage of traffic on the North Intersection Expressway but also ensure the straight-line traffic capacity of the main highway under the background of dislocation intersection,achieving smooth and safe transitions between different expressways.
文摘Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.
基金supported by the National Key Research and Development Program of China(No.2022YFA1602502)the National Natural Science Foundation of China(No.12127804).
文摘The direct and dissociative ionizations of oxygen molecule are investigated experimen-tally by electron collision with energies from 350 eV to 8000 eV.The absolute ionization cross sections for the product ions(O_(2)^(2+),O_(2)^(2+)O^(+),O^(2+),and their total)and two Coulomb explosion channels(O^(+)+O^(+)and O^(2+)+O^(+))are obtained by putting the data of O^(2+)on the scale of Ar+from O_(2)and Ar gases mixed with a fixed relative flow ratio of 1:1.The experimental errors are assessed by taking uncertainties of various factors into account.The present absolute cross sections are well consistent with the previous data in the overlapped energy range below 1000 eV.
文摘Emergency cesarean section has always been a challenge for patients,surgeons,and anesthesiologists,as it endangers the safety of both parturients and fetuses.Obesity and hypertension are common among pregnant women,but severe obesity combined with refractory hypertension is very rare in clinical practice.The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable.This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy.Owing to fetal heart rate abnormalities,she was scheduled for emergency cesarean section.Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture,the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia.Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure,and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs.The entire anesthesia and surgical procedure proceeded uneventfully,with no major adverse events observed.Both the patient and fetus achieved favorable outcomes.This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount,necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.
基金supported by the R&D cooperation agreement be-tween Petrobras and CBPF(Contract No.0050.0121790.22.9)Brazilian Research Council(CNPq)for the scholarships for students.
文摘Convolutional neural networks have been widely used for analyzing image data in industry,especially in the oil and gas area.Brazil has an extensive hydrocarbon reserve on its coast and has also benefited from these neural network models.Image data from petrographic thin section can be essential to provide information about reservoir quality,highlighting important features such as carbonate lithology.However,the automatic identification of lithology in reservoir rocks is still a significant challenge,mainly due to the heterogeneity that is part of the lithologies of the Brazilian pre-salt.Within this context,this work presents an approach using one-class or specialist models to identify four classes of lithology present in reservoir rocks in the Brazilian pre-salt.The proposed methodology had the challenge of dealing with a small number of images for training the neural networks,in addition to the complexity involved in the analyzed data.An auto-machine learning tool called AutoKeras was used to define the hyperparameters of the implemented models.The results found were satisfactory and presented an accuracy greater than 70%for image samples belonging to other wells not seen during the model building,which increases the applicability of the implemented model.Finally,a comparison was made between the proposed methodology and multiple-class models,demonstrating the superiority of one-class models.
基金funded by the Sum Nursing College,SOA University,Bhubaneswar,Odisha.
文摘Background:Postcesarean mothers often experience delayed lactogenesis II due to surgical stress and reduced oxytocin levels.Almond oil breast massage is a nonpharmacological intervention thought to enhance prolactin release and improve milk production.Objective:The objective of the study was to evaluate the effectiveness of almond oil massage on breast milk adequacy among primigravida lower segment cesarean section(LSCS)mothers.Materials and Methods:A randomized pretest-posttest control group design was conducted among 60 primigravida mothers post-LSCS,randomly assigned to experimental(n=30)and control(n=30)groups.The experimental group received three daily almond oil breast massages(5-10 mL;5 min/breast)for 3 days;controls received routine care.Breast milk adequacy was measured using a validated 16-item rating scale at baseline and day 4 post-intervention.Results:The mean breast milk adequacy scores increased from 29.30±1.915 to 39.80±1.690 in the experimental group(t=22.15,P<0.001).Control group change(29.93±2.132-30.27±2.116)was non-significant(t=0.776,P>0.05).Posttest scores between the two groups differed significantly between groups(t=19.282,P<0.001).Conclusion:Almond oil breast massage significantly enhances breast milk adequacy in post-LSCS mothers and can be integrated into routine postnatal nursing care.
