Lung cancer is the leading cause of cancer death worldwide.Majority of newly diagnosed lung cancers are non-small cell lung cancer(NSCLC), of which up to half are considered locally advanced at the time of diagnosis.P...Lung cancer is the leading cause of cancer death worldwide.Majority of newly diagnosed lung cancers are non-small cell lung cancer(NSCLC), of which up to half are considered locally advanced at the time of diagnosis.Patients with locally advanced stage Ⅲ NSCLC consists of a heterogeneous population, making management for these patients complex.Surgery has long been the preferred local treatment for patients with resectable disease.For select patients, multimodality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone.For patients with unresectable disease, concurrent chemoradiation is the preferred treatment.More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life.The array of treatment approaches for locally advanced NSCLC is large and constantly evolving.An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage Ⅲ NSCLC patients are presented.展开更多
This paper addresses the cooperative control problem of multiple unmanned aerial vehicles(multi-UAV)systems.First,a new distributed consensus algorithm for second-order nonlinear multi-agent systems(MAS)is formulated ...This paper addresses the cooperative control problem of multiple unmanned aerial vehicles(multi-UAV)systems.First,a new distributed consensus algorithm for second-order nonlinear multi-agent systems(MAS)is formulated under the leader-following approach.The algorithm provides smooth input signals to the agents’control channels,which avoids the chattering effect generated by the conventional sliding mode-based control protocols.Second,a new formation control scheme is developed by integrating smooth distributed consensus control protocols into the geometric pattern model to achieve three-dimensional formation tracking.The Lyapunov theory is used to prove the stability and convergence of both distributed consensus and formation controllers.The effectiveness of the proposed algorithms is demonstrated through simulation results.展开更多
The concept of community resilience in the contexts of climate change and disasters draws increasing attention and interest from practitioners and researchers in recent development discourse. This paper provides a cri...The concept of community resilience in the contexts of climate change and disasters draws increasing attention and interest from practitioners and researchers in recent development discourse. This paper provides a critical review of six selected frameworks of community resilience building operationalized in Bangladesh over the span of years. In other words, this study aims to contribute to the understanding of resilience through a systematic analysis of the dimensions and indicators of community resilience frameworks. The analysis shows that comprehensive and effective community resilience frameworks should incorporate the missing components linked to fundamental elements of good governance, economic growth, environmental sustainability, social transformation, and capacity development. The paper concludes by highlighting a few other areas of grave concern that need more appropriate attention, considering the severe threats posed by climate change and natural disasters in line with sustainable development goals. Finally, this study recommends further research regarding the effectiveness of these frameworks in different climatic and disaster contexts that can lead the concept into a new dimension of community resilience and sustainability.展开更多
The objective is to develop a model considering demand dependent on selling price and deterioration occurs after a certain period of time, which follows two-parameter Weibull distribution. Shortages are allowed and fu...The objective is to develop a model considering demand dependent on selling price and deterioration occurs after a certain period of time, which follows two-parameter Weibull distribution. Shortages are allowed and fully backlogged. Fuzzy optimal solution is obtained by considering hexagonal fuzzy numbers and for defuzzification Graded Mean Integration Representation Method. A numerical example is provided for the illustration of crisp and fuzzy, both models. To observe the effect of changes in parameters, sensitivity analysis is carried out.展开更多
BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use.It is primarily linked with metabolic issues like insulin resistance,o...BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use.It is primarily linked with metabolic issues like insulin resistance,obesity,and abnormal lipid levels,and is often observed with other conditions such as type 2 diabetes and cardiovascular disease.However,whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated,especially in the Asian population.AIM To compare the severity of liver fibrosis among different MAFLD subtypes.METHODS A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December 2021.MAFLD was defined as per the Asian Pacific Association for the Study of the Liver guidelines.Fibrosis-4 index(Fib-4)and nonalcoholic fatty liver disease fibrosis score(NFS)were employed to evaluate liver fibrosis.RESULTS The mean age was 44.84±11 years.Seventy-two percent of the patients were female.Two hundred and seventy-three patients were classified as having MAFLD,of which 110(40.3%)carried a single,129(47.3%)had two,and 34(12.5%)had all three metabolic conditions.The cumulative number of metabolic conditions was related to elevated body mass index,triglyceride(TG)levels,and glycated hemoglobin,lower high-density lipoprotein(HDL)levels,higher liver inflammation(by aspartate aminotransferase andγ-glutamyl transferase),and higher likelihood of fibrosis(by NFS and Fib-4 scores)(P<0.05 for all).The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions(4.1%,25.5%,35.6%,and 44.1%by NFS and 6.1%,10.9%,17%,and 26.5%by Fib-4 for no MAFLD and MAFLD with 1,2,and 3 conditions,respectively).Among MAFLD patients,those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score(P<0.05),while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and alanine aminotransferase but the lowest HDL lev展开更多
In this paper,new SVPWM switching sequences for six-phase asymmetrical induction motor drives are derived with the aim to reduce inverter’s switching losses.Total three switching sequences are introduced in this pape...In this paper,new SVPWM switching sequences for six-phase asymmetrical induction motor drives are derived with the aim to reduce inverter’s switching losses.Total three switching sequences are introduced in this paper.These sequences are derived such that the phases get continuously clamped when a current of the phases is around its peak magnitude and hence reduced switching losses are recorded.The comparative performances of these modulation techniques are studied with two existing switching sequences.Simulation,analytical and experimental results are presented.Based on these results,it is found that new switching sequences reduce switching losses effectively in dual three phase inverters.展开更多
Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP lev...Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.展开更多
BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus ...BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.展开更多
[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19...[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19例行LHBT切断术(切断组),两组均行肩袖修补.比较两组近期临床效果.[结果]两组患者均顺利完成手术,无严重并发症,两组手术时间、切口长度、失血量的差异均无统计学意义(P>0.05).与术前相比,末次随访时两组VAS评分均显著降低,而ASES评分显著增加(P<0.05);但是,相应时间点两组间VAS和ASES评分的差异均无统计学意义(P>0.05).单纯切断组出现1例Popeye畸形,术后两组患者屈伸肘部肌力无明显差异,肩关节主被动活动度无显著障碍.[结论]对合并肩袖损伤的LHBT病变治疗,LHBT固定术与LHBT切断术联合肩袖修补均有显著的近期临床疗效,但单纯腱切断术后有Popeye畸形发生可能.展开更多
The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV s...The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.展开更多
We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid tr...We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.展开更多
Active tectonics in an area includes ongoing or recent geologic events.This paper investigates the tectonic influence on the subsidence,uplift and tilt of western Saurashtra through morphotectonic analysis of ten wate...Active tectonics in an area includes ongoing or recent geologic events.This paper investigates the tectonic influence on the subsidence,uplift and tilt of western Saurashtra through morphotectonic analysis of ten watersheds along with characteristics of relief and drainage orientation.Watersheds 7-9 to the north(N)are tectonically active,which can be linked with the North Kathiawar Fault System(NKFS)and followed by watersheds 6,10,1,4 and 5.Stream-length gradient index and sinuosity index indicate the effect of tectonic events along the master streams in watersheds 6-9.Higher R^(2)values of the linear curve fit for watershed 7 indicate its master stream is much more tectonically active than the others.The R^(2)curve fitting model and earthquake magnitude/depth analysis confirm the region to be active.The reactivation of the NKFS most likely led to the vertical movement of western Saurashtra.展开更多
Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyz...Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.展开更多
The selective aqueous-phase glycerol hydrogenolysis is a promising reaction to produce commercially useful 1,3-propanediol(1,3-PDO).The Pt-WOx bifunctional catalyst can catalyse the glycerol hydrogenol-ysis but the ca...The selective aqueous-phase glycerol hydrogenolysis is a promising reaction to produce commercially useful 1,3-propanediol(1,3-PDO).The Pt-WOx bifunctional catalyst can catalyse the glycerol hydrogenol-ysis but the catalyst deactivation via sintering,metal leaching,and coking can predominantly occur in the aqueous phase reaction.In this work,the effect of reaction temperature,pressure and second promoter(Cu,Fe,Rh,Mn,Re,Ru,Ir,Sn,B,and P)on catalytic performance and deactivation behaviour of Pt/WOx/-Al2O3 was investigated.When doped with Rh,Mn,Re,Ru,Ir,B,and P,the second promoter boosts catalytic activity by promoting great dispersion of Pt on support and increasing Pt surface area.The increased Bronsted acid sites lead to selective synthesis of 1,3-PDO than 1,2-propanediol(1,2-PDO).The characterization studies of fresh and spent catalysts reveal that the main cause of catalyst deactivation is the Pt sintering,as interpreted based on XRD,CO chemisorption,and TEM analyses.The Pt sintering is affected depending on the second promoter that can either or reduce the interaction between Pt,WO_(χ)/γ and Al_(2)O_(3).As an electron acceptor of Pt in Pt/WO_(χ)/γ-Al_(2)O_(3),Re and Mn as second promoters resulted in increased Pt^(2+) on the catalytic surface,which strengthens the contact between Pt andγ-Al_(2)O_(3) and WO_(χ),resulting in a decrease in Pt sintering.The metal leaching and coking are not affected by the presence of second promoter.The catalyst modified with a second promoter possesses improved catalytic activity and 1,3-PDO production,however the stability continues to remain a challenge.The present work unrav-elled the determining parameters of catalytic activity and deactivation,thus providing a promising pro-tocol toward effective catalysts for glycerol hydrogenolysis.展开更多
For the automatic tracking of unknown moving targets on the ground,most of the commonly used methods involve circling above the target.With such a tracking mode,there is a moving laser spot on the target,which will br...For the automatic tracking of unknown moving targets on the ground,most of the commonly used methods involve circling above the target.With such a tracking mode,there is a moving laser spot on the target,which will bring trouble for cooperative manned helicopters.In this paper,we propose a new way of tracking,where an unmanned aerial vehicle(UAV) circles on one side of the tracked target.A circular path algorithm is developed for monitoring the relative position between the UAV and the target considering the real-time range and the bearing angle.This can determine the center of the new circular path if the predicted range between the UAV and the target does not meet the monitoring requirements.A transition path algorithm is presented for planning the transition path between circular paths that constrain the turning radius of the UAV.The transition path algorithm can generate waypoints that meet the flight ability.In this paper,we analyze the entire method and detail the scope of applications.We formulate an observation angle as an evaluation index.A series of simulations and evaluation index comparisons verify the effectiveness of the proposed algorithms.展开更多
The robotic airship can provide a promising aerostatic platform for many potential applications.These applications require a precise autonomous trajectory tracking control for airship.Airship has a nonlinear and uncer...The robotic airship can provide a promising aerostatic platform for many potential applications.These applications require a precise autonomous trajectory tracking control for airship.Airship has a nonlinear and uncertain dynamics.It is prone to wind disturbances that offer a challenge for a trajectory tracking control design.This paper addresses the airship trajectory tracking problem having time varying reference path.A lumped parameter estimation approach under model uncertainties and wind disturbances is opted against distributed parameters.It uses extended Kalman filter(EKF)for uncertainty and disturbance estimation.The estimated parameters are used by sliding mode controller(SMC)for ultimate control of airship trajectory tracking.This comprehensive algorithm,EKF based SMC(ESMC),is used as a robust solution to track airship trajectory.The proposed estimator provides the estimates of wind disturbances as well as model uncertainty due to the mass matrix variations and aerodynamic model inaccuracies.The stability and convergence of the proposed method are investigated using the Lyapunov stability analysis.The simulation results show that the proposed method efficiently tracks the desired trajectory.The method solves the stability,convergence,and chattering problem of SMC under model uncertainties and wind disturbances.展开更多
文摘Lung cancer is the leading cause of cancer death worldwide.Majority of newly diagnosed lung cancers are non-small cell lung cancer(NSCLC), of which up to half are considered locally advanced at the time of diagnosis.Patients with locally advanced stage Ⅲ NSCLC consists of a heterogeneous population, making management for these patients complex.Surgery has long been the preferred local treatment for patients with resectable disease.For select patients, multimodality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone.For patients with unresectable disease, concurrent chemoradiation is the preferred treatment.More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life.The array of treatment approaches for locally advanced NSCLC is large and constantly evolving.An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage Ⅲ NSCLC patients are presented.
基金This work was supported by the Deanship of Scientific Research(DSR)at King Abdulaziz University,Jeddah(G-363-135-1438).
文摘This paper addresses the cooperative control problem of multiple unmanned aerial vehicles(multi-UAV)systems.First,a new distributed consensus algorithm for second-order nonlinear multi-agent systems(MAS)is formulated under the leader-following approach.The algorithm provides smooth input signals to the agents’control channels,which avoids the chattering effect generated by the conventional sliding mode-based control protocols.Second,a new formation control scheme is developed by integrating smooth distributed consensus control protocols into the geometric pattern model to achieve three-dimensional formation tracking.The Lyapunov theory is used to prove the stability and convergence of both distributed consensus and formation controllers.The effectiveness of the proposed algorithms is demonstrated through simulation results.
文摘The concept of community resilience in the contexts of climate change and disasters draws increasing attention and interest from practitioners and researchers in recent development discourse. This paper provides a critical review of six selected frameworks of community resilience building operationalized in Bangladesh over the span of years. In other words, this study aims to contribute to the understanding of resilience through a systematic analysis of the dimensions and indicators of community resilience frameworks. The analysis shows that comprehensive and effective community resilience frameworks should incorporate the missing components linked to fundamental elements of good governance, economic growth, environmental sustainability, social transformation, and capacity development. The paper concludes by highlighting a few other areas of grave concern that need more appropriate attention, considering the severe threats posed by climate change and natural disasters in line with sustainable development goals. Finally, this study recommends further research regarding the effectiveness of these frameworks in different climatic and disaster contexts that can lead the concept into a new dimension of community resilience and sustainability.
文摘The objective is to develop a model considering demand dependent on selling price and deterioration occurs after a certain period of time, which follows two-parameter Weibull distribution. Shortages are allowed and fully backlogged. Fuzzy optimal solution is obtained by considering hexagonal fuzzy numbers and for defuzzification Graded Mean Integration Representation Method. A numerical example is provided for the illustration of crisp and fuzzy, both models. To observe the effect of changes in parameters, sensitivity analysis is carried out.
文摘BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use.It is primarily linked with metabolic issues like insulin resistance,obesity,and abnormal lipid levels,and is often observed with other conditions such as type 2 diabetes and cardiovascular disease.However,whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated,especially in the Asian population.AIM To compare the severity of liver fibrosis among different MAFLD subtypes.METHODS A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December 2021.MAFLD was defined as per the Asian Pacific Association for the Study of the Liver guidelines.Fibrosis-4 index(Fib-4)and nonalcoholic fatty liver disease fibrosis score(NFS)were employed to evaluate liver fibrosis.RESULTS The mean age was 44.84±11 years.Seventy-two percent of the patients were female.Two hundred and seventy-three patients were classified as having MAFLD,of which 110(40.3%)carried a single,129(47.3%)had two,and 34(12.5%)had all three metabolic conditions.The cumulative number of metabolic conditions was related to elevated body mass index,triglyceride(TG)levels,and glycated hemoglobin,lower high-density lipoprotein(HDL)levels,higher liver inflammation(by aspartate aminotransferase andγ-glutamyl transferase),and higher likelihood of fibrosis(by NFS and Fib-4 scores)(P<0.05 for all).The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions(4.1%,25.5%,35.6%,and 44.1%by NFS and 6.1%,10.9%,17%,and 26.5%by Fib-4 for no MAFLD and MAFLD with 1,2,and 3 conditions,respectively).Among MAFLD patients,those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score(P<0.05),while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and alanine aminotransferase but the lowest HDL lev
文摘In this paper,new SVPWM switching sequences for six-phase asymmetrical induction motor drives are derived with the aim to reduce inverter’s switching losses.Total three switching sequences are introduced in this paper.These sequences are derived such that the phases get continuously clamped when a current of the phases is around its peak magnitude and hence reduced switching losses are recorded.The comparative performances of these modulation techniques are studied with two existing switching sequences.Simulation,analytical and experimental results are presented.Based on these results,it is found that new switching sequences reduce switching losses effectively in dual three phase inverters.
文摘Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.
文摘BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.
文摘[目的]对比分析合并肩袖损伤的肱二头肌长头腱(long head of biceps tendon,LHBT)病变固定与切断术的疗效.[方法]回顾性分析2018年1月-2020年6月关节镜治疗合并肩袖损伤的LHBT病变30例患者的临床资料.其中,11例行LHBT固定术(固定组),19例行LHBT切断术(切断组),两组均行肩袖修补.比较两组近期临床效果.[结果]两组患者均顺利完成手术,无严重并发症,两组手术时间、切口长度、失血量的差异均无统计学意义(P>0.05).与术前相比,末次随访时两组VAS评分均显著降低,而ASES评分显著增加(P<0.05);但是,相应时间点两组间VAS和ASES评分的差异均无统计学意义(P>0.05).单纯切断组出现1例Popeye畸形,术后两组患者屈伸肘部肌力无明显差异,肩关节主被动活动度无显著障碍.[结论]对合并肩袖损伤的LHBT病变治疗,LHBT固定术与LHBT切断术联合肩袖修补均有显著的近期临床疗效,但单纯腱切断术后有Popeye畸形发生可能.
文摘The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.
文摘We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.
基金Research Development Fund(IIT Bombay)supported SM。
文摘Active tectonics in an area includes ongoing or recent geologic events.This paper investigates the tectonic influence on the subsidence,uplift and tilt of western Saurashtra through morphotectonic analysis of ten watersheds along with characteristics of relief and drainage orientation.Watersheds 7-9 to the north(N)are tectonically active,which can be linked with the North Kathiawar Fault System(NKFS)and followed by watersheds 6,10,1,4 and 5.Stream-length gradient index and sinuosity index indicate the effect of tectonic events along the master streams in watersheds 6-9.Higher R^(2)values of the linear curve fit for watershed 7 indicate its master stream is much more tectonically active than the others.The R^(2)curve fitting model and earthquake magnitude/depth analysis confirm the region to be active.The reactivation of the NKFS most likely led to the vertical movement of western Saurashtra.
文摘Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.
基金funded by the National Research Council of Thailand (NRCT)the Second Century Foundation (C2F),Chulalongkorn University,ThailandResearcher Supporting Project RSP2024RR400,King Saud University,Saudi Arabia
文摘The selective aqueous-phase glycerol hydrogenolysis is a promising reaction to produce commercially useful 1,3-propanediol(1,3-PDO).The Pt-WOx bifunctional catalyst can catalyse the glycerol hydrogenol-ysis but the catalyst deactivation via sintering,metal leaching,and coking can predominantly occur in the aqueous phase reaction.In this work,the effect of reaction temperature,pressure and second promoter(Cu,Fe,Rh,Mn,Re,Ru,Ir,Sn,B,and P)on catalytic performance and deactivation behaviour of Pt/WOx/-Al2O3 was investigated.When doped with Rh,Mn,Re,Ru,Ir,B,and P,the second promoter boosts catalytic activity by promoting great dispersion of Pt on support and increasing Pt surface area.The increased Bronsted acid sites lead to selective synthesis of 1,3-PDO than 1,2-propanediol(1,2-PDO).The characterization studies of fresh and spent catalysts reveal that the main cause of catalyst deactivation is the Pt sintering,as interpreted based on XRD,CO chemisorption,and TEM analyses.The Pt sintering is affected depending on the second promoter that can either or reduce the interaction between Pt,WO_(χ)/γ and Al_(2)O_(3).As an electron acceptor of Pt in Pt/WO_(χ)/γ-Al_(2)O_(3),Re and Mn as second promoters resulted in increased Pt^(2+) on the catalytic surface,which strengthens the contact between Pt andγ-Al_(2)O_(3) and WO_(χ),resulting in a decrease in Pt sintering.The metal leaching and coking are not affected by the presence of second promoter.The catalyst modified with a second promoter possesses improved catalytic activity and 1,3-PDO production,however the stability continues to remain a challenge.The present work unrav-elled the determining parameters of catalytic activity and deactivation,thus providing a promising pro-tocol toward effective catalysts for glycerol hydrogenolysis.
基金the Deanship of Scientific Research at King Saud University through research group number(RG-1440-048)。
文摘For the automatic tracking of unknown moving targets on the ground,most of the commonly used methods involve circling above the target.With such a tracking mode,there is a moving laser spot on the target,which will bring trouble for cooperative manned helicopters.In this paper,we propose a new way of tracking,where an unmanned aerial vehicle(UAV) circles on one side of the tracked target.A circular path algorithm is developed for monitoring the relative position between the UAV and the target considering the real-time range and the bearing angle.This can determine the center of the new circular path if the predicted range between the UAV and the target does not meet the monitoring requirements.A transition path algorithm is presented for planning the transition path between circular paths that constrain the turning radius of the UAV.The transition path algorithm can generate waypoints that meet the flight ability.In this paper,we analyze the entire method and detail the scope of applications.We formulate an observation angle as an evaluation index.A series of simulations and evaluation index comparisons verify the effectiveness of the proposed algorithms.
文摘The robotic airship can provide a promising aerostatic platform for many potential applications.These applications require a precise autonomous trajectory tracking control for airship.Airship has a nonlinear and uncertain dynamics.It is prone to wind disturbances that offer a challenge for a trajectory tracking control design.This paper addresses the airship trajectory tracking problem having time varying reference path.A lumped parameter estimation approach under model uncertainties and wind disturbances is opted against distributed parameters.It uses extended Kalman filter(EKF)for uncertainty and disturbance estimation.The estimated parameters are used by sliding mode controller(SMC)for ultimate control of airship trajectory tracking.This comprehensive algorithm,EKF based SMC(ESMC),is used as a robust solution to track airship trajectory.The proposed estimator provides the estimates of wind disturbances as well as model uncertainty due to the mass matrix variations and aerodynamic model inaccuracies.The stability and convergence of the proposed method are investigated using the Lyapunov stability analysis.The simulation results show that the proposed method efficiently tracks the desired trajectory.The method solves the stability,convergence,and chattering problem of SMC under model uncertainties and wind disturbances.
