The natural property of rock material,whether impact occurs,is the key influencing factor of the occurrence of rock burst disaster.To accurately assess rock burst proneness,this study focuses on typical sandstone as t...The natural property of rock material,whether impact occurs,is the key influencing factor of the occurrence of rock burst disaster.To accurately assess rock burst proneness,this study focuses on typical sandstone as the research object.Uniaxial cyclic loading and unloading tests were conducted to measure the elastic strain energy accumulated in sandstone under different stress levels and a relationship between elastic strain energy and stress level was established.The results show that:(1)The peak stress under cyclic loading and unloading conditions is slightly lower than the uniaxial compressive strength.With an increase in the number of cycles,the internal damage of sandstone continues to accumulate,and the mechanical properties such as compressive strength continue to deteriorate;(2)With an increase in stress,the input strain energy,elastic strain energy,and dissipated strain energy also increase;(3)When the stress is low,the increase in elastic strain energy is large and shows a steady growth;with an increase in stress,the increase of elastic strain energy decreases;(4)The square of stress at any time has a good linear relationship with elastic strain energy.According to the relationship obtained from the test,the elastic strain energy at the peak stress time can be obtained;(5)A new criterion for assessing rock burst proneness is proposed:residual energy release rate index W_(T),which characterizes the energy release per unit time when the rock burst occurs.The intervals for evaluating the rock burst proneness of the residual energy release rate index W_(T) are as follows:W_(T)<0.025,indicating no rock burst proneness;0.025≤W_(T)<0.15,indicating weak rock burst proneness;0.15≤W_(T)<2,indicating medium rock burst proneness;W_(T)>2,indicating strong rock burst proneness;and(6)The rationality of the proposed residual energy release rate index W_(T) is verified by the multi-index method and the multi-sample method,and the proposed residual energy release rate index is used to determine the rock burst proneness of 10 kinds of rock samples.The evaluation accuracy is shown to be high,and it can reflect the actual rock burst proneness.展开更多
The residual elastic energy index is a scientific evaluation index for rockburst proneness.In laboratory test,it is sometimes difficult to obtain the post-peak curve or to test the rock sample several times,which make...The residual elastic energy index is a scientific evaluation index for rockburst proneness.In laboratory test,it is sometimes difficult to obtain the post-peak curve or to test the rock sample several times,which makes it impossible to calculate the residual elastic energy index accurately.Based on 241 sets of experimental data and four input indexes of density,elastic modulus,peak intensity and peak input strain energy,this study proposed a machine learning model combining k-means clustering algorithm and random forest regression model:cluster forest(CF)model.The research employed a stratified sampling method on the dataset to ensure the representativeness and balance of the samples.Subsequently,grid search and five-fold cross-validation were utilized to optimize the model’s hyperparameters,aiming to enhance its generalization capability and prediction accuracy.Finally,the performance of the optimal model was evaluated using a test set and compared with five other commonly used models.The results indicate that the CF model outperformed the other models on the testing set,with a mean absolute error of 6.6%,and an accuracy of 93.9%.The results of sensitivity analyses reveal the degree of influence of each variable on rockburst proneness and the applicability of the CF model when the input parameters are missing.The robustness and generalization ability of the model were verified by introducing experimental data from other studies,and the results confirmed the reliability and applicability of the model.Therefore,the model not only effectively simplifies the acquisition of the residual elastic energy index,but also shows excellent performance and wide applicability.展开更多
A mathematical model describing the risks of road accidents has been built on the basis of statistical data of drivers’ accident rate. It has been revealed that drivers can be divided by the degree of their accident ...A mathematical model describing the risks of road accidents has been built on the basis of statistical data of drivers’ accident rate. It has been revealed that drivers can be divided by the degree of their accident proneness into four categories with sharply differing probabilities of road accidents. It has been shown that there is a possibility of classification of drivers in accordance with specified categories.展开更多
To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the la...To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the laboratory tests on fourteen types of rocks.This study begins firstly by introducing the twenty rockburst proneness criteria,and their origins,definitions,calculation methods and grading standards were summarized in detail.Subsequently,to evaluate and compare the judgment accuracy of the twenty criteria,a series of laboratory tests were carried out on fourteen types of rocks,and the rockburst proneness judgment results of the twenty criteria for the fourteen types of rocks were obtained accordingly.Moreover,to provide a unified basis for the judgment accuracy evaluation of above criteria,a classification standard(obtained according to the actual failure results and phenomena of rock specimen)of rockburst proneness in laboratory tests was introduced.The judgment results of the twenty criteria were compared with the judgment results of this classification standard.The results show that the judgment results of the criterion based on residual elastic energy(REE)index are completely consistent with the actual rockburst proneness,and the other criteria have some inconsistent situations more or less.Moreover,the REE index is based on the linear energy storage law and defined in form of a difference value and considered the whole failure process,and these superior characteristics ensure its accuracy.It is believed that the criterion based on REE index is comparatively more accurate and scientific than other criteria,and it can be recommended to be applied to judge the rockburst proneness of rock materials.展开更多
Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected w...Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected with the acoustic emission(AE) parameter in this work,which contributes to predicting the rock burst risk using AE technique.Primarily,a rock burst proneness index is proposed,and it just depends on the heterogeneous degree of rock material.Then,the quantificational formula between the value of rock burst proneness index and the accumulative AE counts in rock sample under uniaxial compression with axial strain increases is developed.Finally,three kinds of rock samples,i.e.,granite,limestone and sandstone are tested about variation of the accumulative AE counts under uniaxial compression,and the test data are fitted well with the theoretic formula.展开更多
Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can ...Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can affect the energy storage, dissipation, and surplus in rock. To explore the influence of temperature on the energy storage and dissipation characteristics and rockburst proneness, the present study has carried out a range of the uniaxial compression(UC) and single-cyclic loading-unloading uniaxial compression(SCLUC) tests on pre-heated granite specimens at 20℃-700℃. The results demonstrate that the rockburst proneness of pre-heated granite initially increases and subsequently decreases with the increase of temperature. The temperature of 300℃ has been found to be the threshold for rockburst proneness. Meanwhile, it is found that the elastic strain energy density increases linearly with the total input strain energy density for the pre-heated granites, confirming that the linear energy property of granite has not been altered by temperature. According to this inherent property, the peak elastic strain energy of pre-heated granites can be calculated accurately. On this basis, utilising the residual elastic energy index, the rockburst proneness of pre-heated granite can be determined quantitatively. The obtained results from high to low are: 317.9 k J/m^(3)(300℃), 264.1 k J/m^(3)(100℃), 260.6 k J/m^(3)(20℃), 235.5 k J/m^(3)(500℃), 158.9 k J/m^(3)(700℃), which are consistent with the intensity of actual rockburst for specimens. In addition, the relationship between temperature and energy storage capacity(ESC) of granite was discussed, revealing that high temperature impairs ESC of rocks, which is essential for reducing the rockburst proneness. This study provides some new insights into the rockburst proneness evaluation in high-temperature rock engineering.展开更多
A new method based on rough set theory and genetic algorithm was proposedto predict the rock burst proneness. Nine influencing factors were first selected, and then,the decision table was set up. Attributes were reduc...A new method based on rough set theory and genetic algorithm was proposedto predict the rock burst proneness. Nine influencing factors were first selected, and then,the decision table was set up. Attributes were reduced by genetic algorithm. Rough setwas used to extract the simplified decision rules of rock burst proneness. Taking the practical engineering for example, the rock burst proneness was evaluated and predicted bydecision rules. Comparing the prediction results with the actual results, it shows that theproposed method is feasible and effective.展开更多
To systematically assess the rockburst proneness considering specimen shape,multiple groups of laboratory tests were performed on 5 rock materials in cylindrical and cuboid shapes.The linear energy storage(LES)law of ...To systematically assess the rockburst proneness considering specimen shape,multiple groups of laboratory tests were performed on 5 rock materials in cylindrical and cuboid shapes.The linear energy storage(LES)law of both cylindrical and cuboid rock specimens under uniaxial compressive load was confirmed,and the energy storage coefficient was found to be unrelated to specimen shape.On the basis of LES law,two rockburst proneness indexes,namely the strain energy storage index(W_(et))and the potential energy of elastic strain(PES),were modified.Subsequently,the W_(et),PES,peak-strength strain energy storage index(W_(et))p,and peak-strength potential energy of elastic strain(PESp)were used to assess the rockburst proneness of the cylindrical and cuboid specimens.In addition,the fragment ejection course of specimens under test was recorded by a high-speed camera.Then,the rockburst proneness judgments obtained from the 4 indexes were compared with the qualitative data during rock destruction.The results show that,under similar stress conditions,specimen shape has an ignorable effect on the rockburst proneness as a whole.The judgment accuracy of the two modified indexes,especially that of the PESp,is favorably improved to evaluate the rockburst proneness of both cylindrical and cuboid specimens.However,misjudgment ofW_(et)^(p)and PESp may still occur in the assessment of rockburst proneness as these two indexes only consider the energy state before rock peak strength and the W_(et)^(p)is formulated in a ratio form.展开更多
Accurate prediction of rockburst proneness is one of challenges for assessing the rockburst risk and selecting effective control measures.This study aims to assess rockburst proneness by considering the energy charact...Accurate prediction of rockburst proneness is one of challenges for assessing the rockburst risk and selecting effective control measures.This study aims to assess rockburst proneness by considering the energy characteristics and qualitative information during rock failure.Several representative rock types in cylindrical and cuboidal sample shapes were tested under uniaxial compression conditions and the failure progress was detected by a high-speed camera.The far-field ejection mass ratio(FEMR)was determined considering the qualitative failure information of the rock samples.The peak-strength energy impact index and the residual elastic energy index were used to quantitatively evaluate the rockburst proneness of both cylindrical and cuboidal samples.Further,the performance of these two indices was analyzed by comparing their estimates with the FEMR.The results show that the accuracy of the residual elastic energy index is significantly higher than that of the peak-strength energy impact index.The residual elastic energy index and the FEMR are in good agreement for both cylindrical and cuboidal rock materials.This is because these two indices can essentially reflect the common energy release mechanism characterized by the mass,ejection velocity,and ejection distance of rock fragments.It suggests that both the FEMR and the residual elastic energy index can be used to accurately measure the rockburst proneness of cylindrical and cuboidal samples based on uniaxial compression test.展开更多
To examine the effect of bedding angle upon burst proneness in terms of energy,phyllites with seven various bedding angles are selected for conventional uniaxial compression and single-cyclic loading eunloading uniaxi...To examine the effect of bedding angle upon burst proneness in terms of energy,phyllites with seven various bedding angles are selected for conventional uniaxial compression and single-cyclic loading eunloading uniaxial compression tests.The ejection and failure during compression process of phyllites are monitored in real-time by high-speed camera system.The results demonstrate that the phyllites with different bedding angles all consistently follow the linear energy storage and dissipation(LESD)law during compression.The ultimate energy storage of phyllites with varying bedding angles can be calculated precisely via using the LESD law.Based on this,four kinds of energy-based rockburst indices are applied to quantitatively assess the burst proneness for phyllites.Combined with the recorded images of high-speed camera system,ejection distance,and mass of rock fragments and powder,the burst proneness for phyllites with various bedding angles is qualitatively evaluated adopting the far-field ejection mass ratio.Next,burst proneness of anisotropic phyllites is assessed quantitatively and qualitatively.It is found that phyllites with bedding angles of 0°,15°,and 90°have a high burst proneness,and that with bedding angle of 30°has a medium burst proneness,whereas the ones with bedding angles of 45°,60°,and 75°have a low burst proneness.Finally,the published experimental data of shale and sandstone specimens with different bedding angles are extracted,and it is preliminarily verified that the bedding angle does not change the LESD law of rocks.展开更多
Frequent traffic accidents constitute a major danger to human beings.The accident-prone driver who has the stable physiological,psychological,and behavioral characteristics is one of the most prominent causes of traff...Frequent traffic accidents constitute a major danger to human beings.The accident-prone driver who has the stable physiological,psychological,and behavioral characteristics is one of the most prominent causes of traffic accidents.The internal link between the individual characteristics and the accident proneness has been a difficult point in the accident prevention research.The authors selected accident-prone drivers as cases and safe drivers as controls(case-control group) from 18,360 drivers who were enrolled from three public transportation incorporations of China using area stratified sampling method.The case-control groups were 1:1 matched.The authors performed genome-wide association study(GWAS) by 179 cases and 179 controls using the U.S.Affymetrix Genome-Wide Human Mapping SNP 6.0Array.The authors observed that the gene frequencies of34 single-nucleotide polymorphisms(SNPs) in three regions of cases were higher than those in the control(P < 10^(–4)).The authors then tested two independent replication sets for strong association 6 SNPs in 349 pairs of case-control drivers using the U.S.ABI 3730 sequencing method.The results indicated that SNP rs6069499 within linked CBLN4 gene are strongly associated with accident proneness(Pcombined= 6.37×10^(-10)).According to CBLN4 gene mainly involved in adrenal development and the regulation of secretion,the authors performed 12 biochemical parameters of the blood using radioimmunoassay.The levels of dopamine(DA) and adrenocorticotropic(ACTH)hormone showed significant differences between accidentprone drivers and safe drivers(P_(DA)= 0.03,P_(ACTH)= 0.01).It is suggested that the accident-prone drivers may have the idiosyncrasy of susceptibility.展开更多
To explore the effectiveness of accident proneness test in drivers. Methods: Accident proneness test results in 100*!000 drivers were simulated by function of RANNOR using SAS statistical software, their accident reco...To explore the effectiveness of accident proneness test in drivers. Methods: Accident proneness test results in 100*!000 drivers were simulated by function of RANNOR using SAS statistical software, their accident records were simulated by function of UNIFORM according to 3 alternatives, the accident rate of qualified drivers was 0.01 , and the accident rate of unqualified drivers was 0.01 , 0.05 and 0.10 , respectively. Results: It was found that there was no effectiveness of accident proneness test if the accident rate of unqualified drivers was equal to that of the qualified ones, if the accident rate of the unqualified drivers was really higher than that of the qualified ones, the test could identify a certain proportion of high risk drivers. Conclusions: Accident proneness test may be effective to some extent, it is advisable to carry out further prospective study or pilot work so as to practically prove the effectiveness of the test.展开更多
BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral an...BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.展开更多
Rockburst has perennially posed a formidable challenge to the stability of underground engineering works,particularly under conditions of deep-seated high stress.This paper provides a comprehensive review of recent ad...Rockburst has perennially posed a formidable challenge to the stability of underground engineering works,particularly under conditions of deep-seated high stress.This paper provides a comprehensive review of recent advancements in on-site research related to rockburst occurrences,covering on-site case analyses,monitoring methodologies,early warning systems,and risk(proneness)evaluation.Initially,the concepts and classifications of rockburst based on on-site understanding were summarized.The influences of structural planes(in various spatial distribution combinations),in-situ stress(particularly magnitude and direction of the principal stress),dynamic disturbances,and excavation profiles on rockburst were thoroughly assessed and discussed through the analysis of published rockburst cases and on-site survey results.Subsequently,a compendium of commonly employed on-site monitoring techniques was outlined,delineating their respective technical attributes.Particular emphasis is accorded to the efficacy of microseismic monitoring technology and its prospective utility in facilitating dynamic rockburst early warning mechanisms.Building upon this foundation,the feasibility of assessing rockburst propensity while considering on-site variables is verified,encompassing the selection and quantitative evaluation of pertinent indicators.Ultimately,a comprehensive synthesis of the paper is presented,alongside the articulation of prospective research goals for the future.展开更多
Background:The outbreak of coronavirus disease 2019(COVID-19)infection posed a huge threat and burden to public healthcare in late 2022.Non-drug measures of traditional Chinese medicine(TCM),such as acupuncture,cuppin...Background:The outbreak of coronavirus disease 2019(COVID-19)infection posed a huge threat and burden to public healthcare in late 2022.Non-drug measures of traditional Chinese medicine(TCM),such as acupuncture,cupping and moxibustion,are commonly used as adjuncts in China to help in severe cases,but their effects remain unclear.Objectives:To observe the clinical effect of TCM non-drug measures in improving respiratory function and symptoms among patients with severe COVID-19.Design,setting,participants and interventions:This study was designed as a multicenter,assessor-blind,randomized controlled trial.Hospitalized patients with COVID-19 were randomly assigned to the treatment or control group.The treatment group received individualized TCM non-drug measures in combination with prone position ventilation,while the control group received prone position ventilation only for 5 consecutive days.Main outcome measures:The primary outcome measures were the percentage of patients with improved oxygen saturation(SpO_(2))at the end of the 5-day intervention,as well as changes of patients'respiratory rates.The secondary outcome measures included changes in SpO_(2)and total score on the self-made respiratory symptom scale.The improvement rate,defined as a 3-day consecutive increase in SpO_(2),the duration of prone positioning,and adverse events were recorded as well.Results:Among the 198 patients included in the intention-to-treat analysis,159(80.3%)completed all assessments on day 5,and 39(19.7%)patients withdrew from the study.At the end of the intervention,71(91%)patients in the treatment group had SpO_(2)above 93%,while 61(75.3%)in the control group reached this level.The proportion of participant with improved SpO_(2)was significantly greater in the intervention group(mean difference[MD]=15.7;95%confidence interval[CI]:4.4,27.1;P=0.008).Compared to the baseline,with daily treatment there were significant daily decreases in respiratory rates in both groups,but no statistical differences between groups were found(all P≥0.05).Compared to the control group,the respiratory-related symptoms score was lower among patients in the treatment group(MD=-1.7;95%CI:-2.8,-0.5;P=0.008)after day 3 of treatment.A gradual decrease in the total scores of both groups was also observed.Thirty-one adverse events occurred during the intervention,and 2patients were transferred to the intensive care unit due to deterioration of their illness.Conclusion:TCM non-drug measures combined with prone positioning can effectively treat patients with severe COVID-19.The combined therapy significantly increased SpO_(2)and improved symptom scores compared to prone positioning alone,thus improving the patients'respiratory function to help them recover.However,the improvement rate did not differ between the two groups.展开更多
Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significan...Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significance of this knowledge, a comprehensive quantification of the influence of regional topographical and geological factors on the spatial heterogeneity of debris-flow-prone areas has been lacking. This study selected the Hengduan Mountains, an earthquake-prone region characterized by diverse surface conditions and complex landforms, as a representative study area. An improved units zoning and objective factors identification methodology was employed in earthquake and fault analysis to assess the impact of seismic activity and geological factors on spatial heterogeneity of debrisflow prone areas. Results showed that the application of GIS technology with hydrodynamic intensity and geographical units analysis can effectively analyze debris-flow prone areas. Meanwhile, earthquake and fault zones obviously increase the density of debrisflow prone catchments and make them unevenly distributed. The number of debris-flow prone areas shows a nonlinear variation with the gradual increase of geomorphic factor value. Specifically, the area with 1000 m-2500 m elevation difference, 25°-30° average slope, and 0.13-0.15 land use index is the most favorable conditions for debris-flow occurrence;The average annual rainfall from 600 to 1150 mm and landslides gradient from 16° to 35° are the main causal factors to trigger debris flow. Our study sheds light on the quantification of spatial heterogeneity in debris flow-prone areas in earthquake-prone regions, which can offer crucial support for post-debris flow risk management strategies.展开更多
Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data o...Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.展开更多
Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The ...Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2<sup>nd</sup> and 3<sup>rd</sup> waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO<sub>2</sub> showed improvement with significant associations with SpO<sub>2</sub> at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extremes of 1 and 67 days. Univariate analysis of the effect of the prone position showed a reduction in length of hospital stay with a strong association (p = 0.001) and a mean difference of 14 days. The prone position reduced mortality with a significant association (OR = 0.44;95% CI = 0.20 - 0.98). Conclusion: Awake prone position prevents complications of COVID, improves SPO<sub>2</sub> even up to hospital discharge and reduces hospital stay. This practice is simple, less costly and suitable in low income countries.展开更多
Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is...Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.展开更多
Objective:To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection.Methods:A total of 100 patients with severe traumatic brain injury combined wi...Objective:To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection.Methods:A total of 100 patients with severe traumatic brain injury combined with pulmonary infection in the hospital were randomly divided into a prone ventilation group and a conventional ventilation group,with 50 patients in each group.The Glasgow Coma Scale(GCS)score,APACHE II score,sputum culture results,oxygenation indicators,and prognosis were compared between the two groups.Data were processed using SPSS 25.0 statistical software,and t-tests and chi-square tests were used to compare continuous and categorical variables,respectively.Results:The experimental group showed better oxygenation indicators,a lower positive rate of sputum cultures,and reduced intracranial pressure compared to the control group(all P<0.05).Multivariate Cox regression analysis indicated that GCS score,APACHE II score,and prone ventilation were independent risk factors affecting patient prognosis(all P<0.05).Conclusion:Prone ventilation can improve oxygenation,reduce the risk of pulmonary infection,and decrease intracranial pressure in patients with severe traumatic brain injury combined with pulmonary infection,thereby improving patient prognosis.GCS score and APACHE II score can serve as important indicators for prognostic evaluation.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.52304142)basic scientific research fees of colleges and universities directly under Inner Mongolia Autonomous Region(Grant No.2023QNJS108).
文摘The natural property of rock material,whether impact occurs,is the key influencing factor of the occurrence of rock burst disaster.To accurately assess rock burst proneness,this study focuses on typical sandstone as the research object.Uniaxial cyclic loading and unloading tests were conducted to measure the elastic strain energy accumulated in sandstone under different stress levels and a relationship between elastic strain energy and stress level was established.The results show that:(1)The peak stress under cyclic loading and unloading conditions is slightly lower than the uniaxial compressive strength.With an increase in the number of cycles,the internal damage of sandstone continues to accumulate,and the mechanical properties such as compressive strength continue to deteriorate;(2)With an increase in stress,the input strain energy,elastic strain energy,and dissipated strain energy also increase;(3)When the stress is low,the increase in elastic strain energy is large and shows a steady growth;with an increase in stress,the increase of elastic strain energy decreases;(4)The square of stress at any time has a good linear relationship with elastic strain energy.According to the relationship obtained from the test,the elastic strain energy at the peak stress time can be obtained;(5)A new criterion for assessing rock burst proneness is proposed:residual energy release rate index W_(T),which characterizes the energy release per unit time when the rock burst occurs.The intervals for evaluating the rock burst proneness of the residual energy release rate index W_(T) are as follows:W_(T)<0.025,indicating no rock burst proneness;0.025≤W_(T)<0.15,indicating weak rock burst proneness;0.15≤W_(T)<2,indicating medium rock burst proneness;W_(T)>2,indicating strong rock burst proneness;and(6)The rationality of the proposed residual energy release rate index W_(T) is verified by the multi-index method and the multi-sample method,and the proposed residual energy release rate index is used to determine the rock burst proneness of 10 kinds of rock samples.The evaluation accuracy is shown to be high,and it can reflect the actual rock burst proneness.
基金Project(42077244)supported by the National Natural Science Foundation of ChinaProject(SDGZK2431)supported by the State Key Laboratory of Intelligent Construction and Healthy Operation and Maintenance of Deep Underground Engineering,Sichuan University,China。
文摘The residual elastic energy index is a scientific evaluation index for rockburst proneness.In laboratory test,it is sometimes difficult to obtain the post-peak curve or to test the rock sample several times,which makes it impossible to calculate the residual elastic energy index accurately.Based on 241 sets of experimental data and four input indexes of density,elastic modulus,peak intensity and peak input strain energy,this study proposed a machine learning model combining k-means clustering algorithm and random forest regression model:cluster forest(CF)model.The research employed a stratified sampling method on the dataset to ensure the representativeness and balance of the samples.Subsequently,grid search and five-fold cross-validation were utilized to optimize the model’s hyperparameters,aiming to enhance its generalization capability and prediction accuracy.Finally,the performance of the optimal model was evaluated using a test set and compared with five other commonly used models.The results indicate that the CF model outperformed the other models on the testing set,with a mean absolute error of 6.6%,and an accuracy of 93.9%.The results of sensitivity analyses reveal the degree of influence of each variable on rockburst proneness and the applicability of the CF model when the input parameters are missing.The robustness and generalization ability of the model were verified by introducing experimental data from other studies,and the results confirmed the reliability and applicability of the model.Therefore,the model not only effectively simplifies the acquisition of the residual elastic energy index,but also shows excellent performance and wide applicability.
文摘A mathematical model describing the risks of road accidents has been built on the basis of statistical data of drivers’ accident rate. It has been revealed that drivers can be divided by the degree of their accident proneness into four categories with sharply differing probabilities of road accidents. It has been shown that there is a possibility of classification of drivers in accordance with specified categories.
基金Project(41877272)supported by the National Natural Science Foundation of ChinaProject(2020zzts715)supported by the Fundamental Research Funds for the Central Universities of Central South University,ChinaProject(2242020R10023)supported by the Fundamental Research Funds for the Central Universities of Southeast University,China。
文摘To review the rockburst proneness(or tendency)criteria of rock materials and compare the judgment accuracy of them,twenty criteria were summarized,and their judgment accuracy was evaluated and compared based on the laboratory tests on fourteen types of rocks.This study begins firstly by introducing the twenty rockburst proneness criteria,and their origins,definitions,calculation methods and grading standards were summarized in detail.Subsequently,to evaluate and compare the judgment accuracy of the twenty criteria,a series of laboratory tests were carried out on fourteen types of rocks,and the rockburst proneness judgment results of the twenty criteria for the fourteen types of rocks were obtained accordingly.Moreover,to provide a unified basis for the judgment accuracy evaluation of above criteria,a classification standard(obtained according to the actual failure results and phenomena of rock specimen)of rockburst proneness in laboratory tests was introduced.The judgment results of the twenty criteria were compared with the judgment results of this classification standard.The results show that the judgment results of the criterion based on residual elastic energy(REE)index are completely consistent with the actual rockburst proneness,and the other criteria have some inconsistent situations more or less.Moreover,the REE index is based on the linear energy storage law and defined in form of a difference value and considered the whole failure process,and these superior characteristics ensure its accuracy.It is believed that the criterion based on REE index is comparatively more accurate and scientific than other criteria,and it can be recommended to be applied to judge the rockburst proneness of rock materials.
基金Project(2010CB226804)supported by the National Basic Research Program(973 Program)of ChinaProject(11202108)supported by the National Natural Science Foundation of ChinaProject(BK20130189)supported by the Natural Science Foundation of Jiangsu Province,China
文摘Rock burst is a severe disaster in mining and underground engineering,and it is important to predict the rock burst risk for minimizing the loss during the constructing process.The rock burst proneness was connected with the acoustic emission(AE) parameter in this work,which contributes to predicting the rock burst risk using AE technique.Primarily,a rock burst proneness index is proposed,and it just depends on the heterogeneous degree of rock material.Then,the quantificational formula between the value of rock burst proneness index and the accumulative AE counts in rock sample under uniaxial compression with axial strain increases is developed.Finally,three kinds of rock samples,i.e.,granite,limestone and sandstone are tested about variation of the accumulative AE counts under uniaxial compression,and the test data are fitted well with the theoretic formula.
基金supported by the National Natural Science Foundation of China (Grant No. 41877272)the Fundamental Research Funds for the Central Universities (Grant No.2242022k30054)the Fundamental Research Funds for the Central Universities of Central South University (Grant No.2021zzts0861)。
文摘Many underground engineering projects show that rockburst can occur in rocks at great depth and high temperature, and temperature is a critical factor affecting the intensity of rockburst. In general, temperature can affect the energy storage, dissipation, and surplus in rock. To explore the influence of temperature on the energy storage and dissipation characteristics and rockburst proneness, the present study has carried out a range of the uniaxial compression(UC) and single-cyclic loading-unloading uniaxial compression(SCLUC) tests on pre-heated granite specimens at 20℃-700℃. The results demonstrate that the rockburst proneness of pre-heated granite initially increases and subsequently decreases with the increase of temperature. The temperature of 300℃ has been found to be the threshold for rockburst proneness. Meanwhile, it is found that the elastic strain energy density increases linearly with the total input strain energy density for the pre-heated granites, confirming that the linear energy property of granite has not been altered by temperature. According to this inherent property, the peak elastic strain energy of pre-heated granites can be calculated accurately. On this basis, utilising the residual elastic energy index, the rockburst proneness of pre-heated granite can be determined quantitatively. The obtained results from high to low are: 317.9 k J/m^(3)(300℃), 264.1 k J/m^(3)(100℃), 260.6 k J/m^(3)(20℃), 235.5 k J/m^(3)(500℃), 158.9 k J/m^(3)(700℃), which are consistent with the intensity of actual rockburst for specimens. In addition, the relationship between temperature and energy storage capacity(ESC) of granite was discussed, revealing that high temperature impairs ESC of rocks, which is essential for reducing the rockburst proneness. This study provides some new insights into the rockburst proneness evaluation in high-temperature rock engineering.
基金Supported by the Youth Science Foundation of North China University of Water Conservancy and Electric Power(HSQJ2009016)
文摘A new method based on rough set theory and genetic algorithm was proposedto predict the rock burst proneness. Nine influencing factors were first selected, and then,the decision table was set up. Attributes were reduced by genetic algorithm. Rough setwas used to extract the simplified decision rules of rock burst proneness. Taking the practical engineering for example, the rock burst proneness was evaluated and predicted bydecision rules. Comparing the prediction results with the actual results, it shows that theproposed method is feasible and effective.
基金National Natural Science Foundation of China,Grant/Award Number:41877272Fundamental Research Funds for the Central Universities,Grant/Award Number:2242022k30054。
文摘To systematically assess the rockburst proneness considering specimen shape,multiple groups of laboratory tests were performed on 5 rock materials in cylindrical and cuboid shapes.The linear energy storage(LES)law of both cylindrical and cuboid rock specimens under uniaxial compressive load was confirmed,and the energy storage coefficient was found to be unrelated to specimen shape.On the basis of LES law,two rockburst proneness indexes,namely the strain energy storage index(W_(et))and the potential energy of elastic strain(PES),were modified.Subsequently,the W_(et),PES,peak-strength strain energy storage index(W_(et))p,and peak-strength potential energy of elastic strain(PESp)were used to assess the rockburst proneness of the cylindrical and cuboid specimens.In addition,the fragment ejection course of specimens under test was recorded by a high-speed camera.Then,the rockburst proneness judgments obtained from the 4 indexes were compared with the qualitative data during rock destruction.The results show that,under similar stress conditions,specimen shape has an ignorable effect on the rockburst proneness as a whole.The judgment accuracy of the two modified indexes,especially that of the PESp,is favorably improved to evaluate the rockburst proneness of both cylindrical and cuboid specimens.However,misjudgment ofW_(et)^(p)and PESp may still occur in the assessment of rockburst proneness as these two indexes only consider the energy state before rock peak strength and the W_(et)^(p)is formulated in a ratio form.
基金supported by the National Natural Science Foundation of China(Grant Nos.41877272 and 42077244)the National Key Research and Development Program of China e 2023 Key Special Project(Grant No.2023YFC2907400).
文摘Accurate prediction of rockburst proneness is one of challenges for assessing the rockburst risk and selecting effective control measures.This study aims to assess rockburst proneness by considering the energy characteristics and qualitative information during rock failure.Several representative rock types in cylindrical and cuboidal sample shapes were tested under uniaxial compression conditions and the failure progress was detected by a high-speed camera.The far-field ejection mass ratio(FEMR)was determined considering the qualitative failure information of the rock samples.The peak-strength energy impact index and the residual elastic energy index were used to quantitatively evaluate the rockburst proneness of both cylindrical and cuboidal samples.Further,the performance of these two indices was analyzed by comparing their estimates with the FEMR.The results show that the accuracy of the residual elastic energy index is significantly higher than that of the peak-strength energy impact index.The residual elastic energy index and the FEMR are in good agreement for both cylindrical and cuboidal rock materials.This is because these two indices can essentially reflect the common energy release mechanism characterized by the mass,ejection velocity,and ejection distance of rock fragments.It suggests that both the FEMR and the residual elastic energy index can be used to accurately measure the rockburst proneness of cylindrical and cuboidal samples based on uniaxial compression test.
基金supported by the National Natural Science Foundation of China(Grant No.42077244).
文摘To examine the effect of bedding angle upon burst proneness in terms of energy,phyllites with seven various bedding angles are selected for conventional uniaxial compression and single-cyclic loading eunloading uniaxial compression tests.The ejection and failure during compression process of phyllites are monitored in real-time by high-speed camera system.The results demonstrate that the phyllites with different bedding angles all consistently follow the linear energy storage and dissipation(LESD)law during compression.The ultimate energy storage of phyllites with varying bedding angles can be calculated precisely via using the LESD law.Based on this,four kinds of energy-based rockburst indices are applied to quantitatively assess the burst proneness for phyllites.Combined with the recorded images of high-speed camera system,ejection distance,and mass of rock fragments and powder,the burst proneness for phyllites with various bedding angles is qualitatively evaluated adopting the far-field ejection mass ratio.Next,burst proneness of anisotropic phyllites is assessed quantitatively and qualitatively.It is found that phyllites with bedding angles of 0°,15°,and 90°have a high burst proneness,and that with bedding angle of 30°has a medium burst proneness,whereas the ones with bedding angles of 45°,60°,and 75°have a low burst proneness.Finally,the published experimental data of shale and sandstone specimens with different bedding angles are extracted,and it is preliminarily verified that the bedding angle does not change the LESD law of rocks.
基金supported by grants from the Research Foundation of Anhui Sanlian University
文摘Frequent traffic accidents constitute a major danger to human beings.The accident-prone driver who has the stable physiological,psychological,and behavioral characteristics is one of the most prominent causes of traffic accidents.The internal link between the individual characteristics and the accident proneness has been a difficult point in the accident prevention research.The authors selected accident-prone drivers as cases and safe drivers as controls(case-control group) from 18,360 drivers who were enrolled from three public transportation incorporations of China using area stratified sampling method.The case-control groups were 1:1 matched.The authors performed genome-wide association study(GWAS) by 179 cases and 179 controls using the U.S.Affymetrix Genome-Wide Human Mapping SNP 6.0Array.The authors observed that the gene frequencies of34 single-nucleotide polymorphisms(SNPs) in three regions of cases were higher than those in the control(P < 10^(–4)).The authors then tested two independent replication sets for strong association 6 SNPs in 349 pairs of case-control drivers using the U.S.ABI 3730 sequencing method.The results indicated that SNP rs6069499 within linked CBLN4 gene are strongly associated with accident proneness(Pcombined= 6.37×10^(-10)).According to CBLN4 gene mainly involved in adrenal development and the regulation of secretion,the authors performed 12 biochemical parameters of the blood using radioimmunoassay.The levels of dopamine(DA) and adrenocorticotropic(ACTH)hormone showed significant differences between accidentprone drivers and safe drivers(P_(DA)= 0.03,P_(ACTH)= 0.01).It is suggested that the accident-prone drivers may have the idiosyncrasy of susceptibility.
文摘To explore the effectiveness of accident proneness test in drivers. Methods: Accident proneness test results in 100*!000 drivers were simulated by function of RANNOR using SAS statistical software, their accident records were simulated by function of UNIFORM according to 3 alternatives, the accident rate of qualified drivers was 0.01 , and the accident rate of unqualified drivers was 0.01 , 0.05 and 0.10 , respectively. Results: It was found that there was no effectiveness of accident proneness test if the accident rate of unqualified drivers was equal to that of the qualified ones, if the accident rate of the unqualified drivers was really higher than that of the qualified ones, the test could identify a certain proportion of high risk drivers. Conclusions: Accident proneness test may be effective to some extent, it is advisable to carry out further prospective study or pilot work so as to practically prove the effectiveness of the test.
文摘BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.
基金Project(2023YFB2603602)supported by the National Key Research and Development Program of ChinaProjects(52222810,52178383)supported by the National Natural Science Foundation of China。
文摘Rockburst has perennially posed a formidable challenge to the stability of underground engineering works,particularly under conditions of deep-seated high stress.This paper provides a comprehensive review of recent advancements in on-site research related to rockburst occurrences,covering on-site case analyses,monitoring methodologies,early warning systems,and risk(proneness)evaluation.Initially,the concepts and classifications of rockburst based on on-site understanding were summarized.The influences of structural planes(in various spatial distribution combinations),in-situ stress(particularly magnitude and direction of the principal stress),dynamic disturbances,and excavation profiles on rockburst were thoroughly assessed and discussed through the analysis of published rockburst cases and on-site survey results.Subsequently,a compendium of commonly employed on-site monitoring techniques was outlined,delineating their respective technical attributes.Particular emphasis is accorded to the efficacy of microseismic monitoring technology and its prospective utility in facilitating dynamic rockburst early warning mechanisms.Building upon this foundation,the feasibility of assessing rockburst propensity while considering on-site variables is verified,encompassing the selection and quantitative evaluation of pertinent indicators.Ultimately,a comprehensive synthesis of the paper is presented,alongside the articulation of prospective research goals for the future.
基金funded by the Construction Program of Demonstration Centers for TCM Non-Drug Therapyfrom Shanghai Municipal Health Commission(No.ZY[2021-2023]-0204)。
文摘Background:The outbreak of coronavirus disease 2019(COVID-19)infection posed a huge threat and burden to public healthcare in late 2022.Non-drug measures of traditional Chinese medicine(TCM),such as acupuncture,cupping and moxibustion,are commonly used as adjuncts in China to help in severe cases,but their effects remain unclear.Objectives:To observe the clinical effect of TCM non-drug measures in improving respiratory function and symptoms among patients with severe COVID-19.Design,setting,participants and interventions:This study was designed as a multicenter,assessor-blind,randomized controlled trial.Hospitalized patients with COVID-19 were randomly assigned to the treatment or control group.The treatment group received individualized TCM non-drug measures in combination with prone position ventilation,while the control group received prone position ventilation only for 5 consecutive days.Main outcome measures:The primary outcome measures were the percentage of patients with improved oxygen saturation(SpO_(2))at the end of the 5-day intervention,as well as changes of patients'respiratory rates.The secondary outcome measures included changes in SpO_(2)and total score on the self-made respiratory symptom scale.The improvement rate,defined as a 3-day consecutive increase in SpO_(2),the duration of prone positioning,and adverse events were recorded as well.Results:Among the 198 patients included in the intention-to-treat analysis,159(80.3%)completed all assessments on day 5,and 39(19.7%)patients withdrew from the study.At the end of the intervention,71(91%)patients in the treatment group had SpO_(2)above 93%,while 61(75.3%)in the control group reached this level.The proportion of participant with improved SpO_(2)was significantly greater in the intervention group(mean difference[MD]=15.7;95%confidence interval[CI]:4.4,27.1;P=0.008).Compared to the baseline,with daily treatment there were significant daily decreases in respiratory rates in both groups,but no statistical differences between groups were found(all P≥0.05).Compared to the control group,the respiratory-related symptoms score was lower among patients in the treatment group(MD=-1.7;95%CI:-2.8,-0.5;P=0.008)after day 3 of treatment.A gradual decrease in the total scores of both groups was also observed.Thirty-one adverse events occurred during the intervention,and 2patients were transferred to the intensive care unit due to deterioration of their illness.Conclusion:TCM non-drug measures combined with prone positioning can effectively treat patients with severe COVID-19.The combined therapy significantly increased SpO_(2)and improved symptom scores compared to prone positioning alone,thus improving the patients'respiratory function to help them recover.However,the improvement rate did not differ between the two groups.
基金supported by the Hubei Provincial Engineering Research Center of Slope Habitat Construction Technique Using Cement-based Materials Open Research Program (Grant No. 2022SNJ112022SNJ12)+4 种基金National Natural Science Foundation of China (Grant No. 42371014)Hubei Key Laboratory of Disaster Prevention and Mitigation (China Three Gorges University) Open Research Program (Grant No. 2022KJZ122023KJZ19)CRSRI Open Research Program (Grant No. CKWV2021888/KY)the Key Laboratory of Mountain Hazards and Earth Surface Processes, Chinese Academy of Sciences (Grant No. KLMHESP20-0)。
文摘Understanding the spatial heterogeneity of debris-flow-prone areas holds significant implications for regional risk management, particularly in seismically active regions with geological faults. Despite the significance of this knowledge, a comprehensive quantification of the influence of regional topographical and geological factors on the spatial heterogeneity of debris-flow-prone areas has been lacking. This study selected the Hengduan Mountains, an earthquake-prone region characterized by diverse surface conditions and complex landforms, as a representative study area. An improved units zoning and objective factors identification methodology was employed in earthquake and fault analysis to assess the impact of seismic activity and geological factors on spatial heterogeneity of debrisflow prone areas. Results showed that the application of GIS technology with hydrodynamic intensity and geographical units analysis can effectively analyze debris-flow prone areas. Meanwhile, earthquake and fault zones obviously increase the density of debrisflow prone catchments and make them unevenly distributed. The number of debris-flow prone areas shows a nonlinear variation with the gradual increase of geomorphic factor value. Specifically, the area with 1000 m-2500 m elevation difference, 25°-30° average slope, and 0.13-0.15 land use index is the most favorable conditions for debris-flow occurrence;The average annual rainfall from 600 to 1150 mm and landslides gradient from 16° to 35° are the main causal factors to trigger debris flow. Our study sheds light on the quantification of spatial heterogeneity in debris flow-prone areas in earthquake-prone regions, which can offer crucial support for post-debris flow risk management strategies.
文摘Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.
文摘Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2<sup>nd</sup> and 3<sup>rd</sup> waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO<sub>2</sub> showed improvement with significant associations with SpO<sub>2</sub> at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extremes of 1 and 67 days. Univariate analysis of the effect of the prone position showed a reduction in length of hospital stay with a strong association (p = 0.001) and a mean difference of 14 days. The prone position reduced mortality with a significant association (OR = 0.44;95% CI = 0.20 - 0.98). Conclusion: Awake prone position prevents complications of COVID, improves SPO<sub>2</sub> even up to hospital discharge and reduces hospital stay. This practice is simple, less costly and suitable in low income countries.
文摘Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.
基金Research Project of the 900th Hospital of Joint Logistics Support Force(Project No.2020L30)。
文摘Objective:To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection.Methods:A total of 100 patients with severe traumatic brain injury combined with pulmonary infection in the hospital were randomly divided into a prone ventilation group and a conventional ventilation group,with 50 patients in each group.The Glasgow Coma Scale(GCS)score,APACHE II score,sputum culture results,oxygenation indicators,and prognosis were compared between the two groups.Data were processed using SPSS 25.0 statistical software,and t-tests and chi-square tests were used to compare continuous and categorical variables,respectively.Results:The experimental group showed better oxygenation indicators,a lower positive rate of sputum cultures,and reduced intracranial pressure compared to the control group(all P<0.05).Multivariate Cox regression analysis indicated that GCS score,APACHE II score,and prone ventilation were independent risk factors affecting patient prognosis(all P<0.05).Conclusion:Prone ventilation can improve oxygenation,reduce the risk of pulmonary infection,and decrease intracranial pressure in patients with severe traumatic brain injury combined with pulmonary infection,thereby improving patient prognosis.GCS score and APACHE II score can serve as important indicators for prognostic evaluation.
