Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.

Efficacy of continuous arterial perfusion chemotherapy combined with transarterial chemoembolization regional arterial thermal perfusion in the treatment of pancreatic cancer with liver metastases

Background:The aim of the study was to investigate the efficacy of continuous transcatheter arterial infusion chemotherapy combined with transarterial chemoembolization(TACE)for the treatment of advanced pancreatic cancer with liver metastasis.Methods:Sixty patients with advanced pancreatic cancer and liver metastases were enrolled in this study.In the treatment group,31patients underwent continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial thermal perfusion,whereas 29 patients included in the control group received intravenous chemotherapy with gemcitabine and S-1.All patients received maintenance chemotherapy with S-1 after 4 cycles of the study regimen.Treatment efficacy,quality of life,survival,and toxicity were evaluated.Results:Efficacy was better in the treatment group than in the control group,as reflected by the objective remission,partial remission,and disease progression rates(all P<0.05).The Eastern Cooperative Oncology Group and Numerical Rating Scale pain scores were also higher in the treatment group(both P<0.05).In survival analysis,the 1-year overall survival rates in the treatment and control groups were64.516%and 10.345%,respectively,whereas the median overall survival times were 16 and 6 months,respectively(both P<0.05).The6-month progression-free survival rates in the treatment and control groups were 77.419%and 13.790%,respectively,and the median progression-free survival times were 12 and 3 months,respectively(both P<0.05).The rates of hematological and nonhematological toxicological adverse effects were also lower in the treatment group(both P<0.05).Although the rate of liver dysfunction was higher in the treatment group,this finding had no adverse effects on prognosis.Conclusions:Continuous transcatheter arterial infusion chemotherapy combined with TACE regional arterial perfusion chemotherapy resulted in better efficacy and safety outcomes in patients with pancreatic cancer and liver metastasis,suggesting its utility as a reference method for the clinical treatment of advanced pancreatic cancer.

Effects of kallikrein gene transfer on penumbral microvascular proliferation and on regional cerebral blood flow following cerebral ischemia/reperfusion injury

BACKGROUND： Recent findings have demonstrated that the kallikrein-kinin system （KKS） participates in the pathological process of cerebral ischemia/reperfusion injury. Kallikrein gene transfer exhibits neural protective effects following cerebral infarction. OBJECTIVE： To observe the effects of kallikrein gene transfer on vascular proliferation in the peripheral infarct focus and on regional cerebral blood flow （rCBF） following cerebral ischemia/reperfusion injury. DESIGN, TIME AND SETTING： The completely randomized, controlled experiment was performed at the Lin Baixin Laboratory Center, the Second Affiliated Hospital of Sun Yat-sun University between September 2007 and April 2008. MATERIALS： pUCI9-HTK plasmid was constructed and maintained in the Laboratory for Neurology, the Second Affiliated Hospital of Sun Yat-sen University, China. Mouse anti-human kallikrein 1 monoclonal antibody was purchased from R＆D Systems, USA. METHODS Ninety healthy, male, Sprague Dawley rats were used. Middle cerebral artery occlusion （MCAO） was established in all rats to induce cerebral ischemia/reperfusion injury. Following MCAO establishment, all rats were randomly divided into three groups （n = 30）： blank control, saline, and pAdCMV-HTK. The saline and pAdCMV-HTK groups were stereotactically micro-injected with 5μL of physiological saline or with pAdCMV-HTK [multiplicity of infection （MOI） = 20], respectively, into the ischemic penumbra. In the blank control group, only sham injection was performed. MAIN OUTCOME MEASURES： At 12, 24, and 72 hours after treatment, cerebral infarction volume was measured by 2, 3, 5-triphenyltetrazolium chloride （TTC） staining. Exogenous HTK expression, as well as regional vascular endothelial growth factor （VEGF） expression, was detected by immunohistochemistry. rCBF was examined by 14C-iodoantipyrine micro tracing. In addition, neurological severity score （NSS） was performed. Higher scores indicated more severe neurological deficits. RESULTS： NSS results demonstrated that compared with the saline and the blank control groups, the pAdCMV-HTK group exhibited lower NSSs 24 hours after pAdCMV-HTK injection （P 〈 0.05）. The NSSs were further decreased after 72 hours （P 〈 0.01）. Cerebral infarction volume at 24 hours, and in particular at 72 hours after treatment, was significantly reduced in the pAdCMV-HTK group compared with the blank control and saline groups （P 〈 0.05）. The rCBF in the area surrounding the infarction lesion was slightly decreased in all groups compared with the contralateral area. At 24 and 72 hours following treatment, the rCBF in the peripheral infarction lesion was significantly elevated in the pAdCMV-HTK group compared with the blank control and saline groups （P 〈 0.05）. Immunohistochemistry results revealed that VEGF-positive cells were primarily found in the cortex and in some white matter surrounding the cerebral infarction lesion. In addition, the expression of VEGF in the pAdCMV-HTK group was significantly higher compared with that in the blank control and saline groups at 12, 24, and 72 hours following treatment （P 〈 0.05）. CONCLUSION： Following cerebral ischemia/reperfusion, kallikrein gene transfer can promote vascular proliferation in the brain tissue surrounding the infarction lesion, improve rCBF, and reduce infarction volume, thereby exhibiting protective effects to attenuate neurological deficits.

Effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer

Objective:To study the effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer. Methods:A total of 90 patients with primary gastric cancer who received treatment in Tianyou Hospital Affiliated to Wuhan University of Science & Technology between January 2014 and May 2016 were collected and divided into control group and observation group according to the random number table method, 45 cases in each group. The control group of patients received routine systemic intravenous chemotherapy + surgical treatment, and the observation group of patients received systemic intravenous chemotherapy combined with local arterial perfusion chemoembolization + surgical treatment. Levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were compared between the two groups of patients before and after chemotherapy.Results:Before chemotherapy, the levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were not significantly different between the two groups of patients;after chemotherapy, serum CEA, CA724, CA242, AFP, VEGF, Ang-2, COX2 and PD-ECGF levels of observation group were lower than those of control group, andiASPP, p130Cas, ERBB2 and C-myc mRNA expression in gastric cancer tissue were lower than those of control group while GKN1, p16, PTEN, TSPYL5 and merlin mRNA expression in gastric cancer tissue were higher than those of control group.Conclusions: Preoperative systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization can effectively reduce the malignancy of locally advanced gastric cancer and provide favorable conditions for the operation.

Does digitalization mitigate regional inequalities?Evidence from China

Regional inequality significantly influences sustainable development and human well-being.In China,there exists pronounced regional disparities in economic and digital advancements;however,scant research delves into the interplay between them.By analyzing the economic development and digitalization gaps at regional and city levels in China,extending the original Cobb-Douglas production function,this study aims to evaluate the impact of digitalization on China's regional inequality using seemingly unrelated regression.The results indicate a greater emphasis on digital inequality compared to economic disparity,with variable coefficients of 0.59 for GDP per capita and 0.92 for the digitalization index over the past four years.However,GDP per capita demonstrates higher spatial concentration than digitalization.Notably,both disparities have shown a gradual reduction in recent years.The southeastern region of the Hu Huanyong Line exhibits superior levels and rates of economic and digital advancement in contrast to the northwestern region.While digitalization propels economic growth,it yields a nuanced impact on achieving balanced regional development,encompassing both positive and negative facets.Our study highlights that the marginal utility of advancing digitalization is more pronounced in less developed regions,but only if the government invests in the digital infrastructure and education in these areas.This study's methodology can be utilized for subsequent research,and our findings hold the potential to the government's regional investment and policy-making.

Enhancing Autonomy Capability in Regional Power Grids:A Strategic Planning Approach with Multiple Autonomous Evaluation Indexes

After the integration of large-scale DistributedGeneration(DG)into the distribution network,the randomness and volatility of its output result in a reduction of spatiotemporal alignment between power generation and demand in the distribution network,exacerbating the phenomenon of wind and solar power wastage.As a novel power system model,the fundamental concept of Regional Autonomous Power Grids(RAPGs)is to achieve localized management and energy autonomy,thereby facilitating the effective consumption of DGs.Therefore,this paper proposes a distributed resource planning strategy that enhances the autonomy capabilities of regional power grids by considering multiple evaluation indexes for autonomy.First,a regional Energy Storage(ES)configuration strategy is proposed.This strategy can select a suitable reference value for the upper limit of ES configuration based on the regional load andDGoutput to maximize the elimination of source load deviations in the region as the upper limit constraint of ES capacity.Then,a control strategy for regional ES is proposed,the charging and discharging reference line of ES is set,and multiple autonomy and economic indexes are used as objective functions to select different proportions of ES to control the distributed resources of the regional power grid and establish evaluation indexes of the internal regional generation and load power ratio,the proportion of power supply matching hours,new energy consumption rate and tie line power imbalance outside the region to evaluate changes in the regional autonomy capabilities.The final simulation results showthat in the real regional grid example,the planning method in the planning year in the region of the overall power supply matching hour ratio and new energy consumption rate increased by 3.9%and 4.8%on average,and the power imbalance of the tie line decreased by 7.8%on average.The proposed planning approach enables the maximization of regional autonomy while effectively smoothing the fluctuation of power exchange between the regional grid and the higher-level grid.This presents a rational and effective planning solution for the regional grid,facilitating the coordinated development between the region and the distribution network.

Construction and Application of a Regional Kilometer-Scale Carbon Source and Sink Assimilation Inversion System(CCMVS-R)

CO_(2)is one of the most important greenhouse gases(GHGs)in the earth’s atmosphere.Since the industrial era,anthropogenic activities have emitted excessive quantities of GHGs into the atmosphere,resulting in climate warming since the 1950s and leading to an increased frequency of extreme weather and climate events.In 2020,China committed to striving for carbon neutrality by 2060.This commitment and China’s consequent actions will result in significant changes in global and regional anthropogenic carbon emissions and therefore require timely,comprehensive,and objective monitoring and verification support(MVS)systems.The MVS approach relies on the top-down assimilation and inversion of atmospheric CO_(2)concentrations,as recommended by the Intergovernmental Panel on Climate Change(IPCC)Inventory Guidelines in 2019.However,the regional high-resolution assimilation and inversion method is still in its initial stage of development.Here,we have constructed an inverse system for carbon sources and sinks at the kilometer level by coupling proper orthogonal decomposition(POD)with four-dimensional variational(4DVar)data assimilation based on the weather research and forecasting-greenhouse gas(WRF-GHG)model.Our China Carbon Monito ring and Verification Support at the Regional level(CCMVS-R)system can continuously assimilate information on atmospheric CO_(2)and other related information and realize the inversion of regional and local anthropogenic carbon emissions and natural terrestrial ecosystem carbon exchange.Atmospheric CO_(2)data were collected from six ground-based monito ring sites in Shanxi Province,China to verify the inversion effect of regio nal anthropogenic carbon emissions by setting ideal and real experiments using a two-layer nesting method(at 27 and 9 km).The uncertainty of the simulated atmospheric CO_(2)decreased significantly,with a root-mean-square error of CO_(2)concentration values between the ideal value and the simulated after assimilation was close to 0.The total anthropogenic carbon emissions in Shanxi Province in 2019 from the assimilated inversions were approximately 28.6%(17%-38%)higher than the mean of five emission inventories using the bottomup method,showing that the top-down CCMVS-R system can obtain more comprehensive information on anthropogenic carbon emissions.

Early peripheral perfusion index predicts 28-day outcome in patients with septic shock

BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.

Uncertainties of ENSO-related Regional Hadley Circulation Anomalies within Eight Reanalysis Datasets

El Nino-Southern Oscillation(ENSO),the leading mode of global interannual variability,usually intensifies the Hadley Circulation(HC),and meanwhile constrains its meridional extension,leading to an equatorward movement of the jet system.Previous studies have investigated the response of HC to ENSO events using different reanalysis datasets and evaluated their capability in capturing the main features of ENSO-associated HC anomalies.However,these studies mainly focused on the global HC,represented by a zonal-mean mass stream function(MSF).Comparatively fewer studies have evaluated HC responses from a regional perspective,partly due to the prerequisite of the Stokes MSF,which prevents us from integrating a regional HC.In this study,we adopt a recently developed technique to construct the three-dimensional structure of HC and evaluate the capability of eight state-of-the-art reanalyses in reproducing the regional HC response to ENSO events.Results show that all eight reanalyses reproduce the spatial structure of HC responses well,with an intensified HC around the central-eastern Pacific but weakened circulations around the Indo-Pacific warm pool and tropical Atlantic.The spatial correlation coefficient of the three-dimensional HC anomalies among the different datasets is always larger than 0.93.However,these datasets may not capture the amplitudes of the HC responses well.This uncertainty is especially large for ENSO-associated equatorially asymmetric HC anomalies,with the maximum amplitude in Climate Forecast System Reanalysis(CFSR)being about 2.7 times the minimum value in the Twentieth Century Reanalysis(20CR).One should be careful when using reanalysis data to evaluate the intensity of ENSO-associated HC anomalies.

Regional economic assessment of a novel place-based model for sustainable food systems

Several actions from both the environmental and human viewpoints have already been made to meet the sustainability goals targeted at food systems.Still,new place-based ideas to improve sustainability are needed.Agroecological symbiosis(AES),a novel food system model,is an example of a suggested system-level change to attain sustainability targets;it is a symbiosis of food production and processing using renewable energy that uses its own feedstock.AES has already been found advantageous from the ecological and biophysical viewpoints,but a regional economic evaluation of the model is still lacking.Thus,the aim of our paper is to assess the regional economic impact of a possible systemic change in the food system using the network of agroecological symbiosis(NAES)as an example.We applied scenarios representing different ways of moving towards envisioned NAES models in Mäntsälä,Finland,and a computable general equilibrium model to evaluate the regional economic impact.According to our results,both regional economy and employment would increase,and the regional production base would diversify with NAES implementation applied to the region,but the extent of the benefits varies between scenarios.The scenario that includes change in both public and private food demand,production of bioenergy and utilization of by-products would cause the largest impacts.However,realizing NAES requires investments that may influence the actual implementation of such models.Nonetheless,a change towards NAES can promote an economically and spatially just transition to sustainability,as NAES seems to be economically most beneficial for rural areas.

Individual alcohol consumption by the population of Russia versus regional living conditions

Background:There are substantial regional differences in drinking alcohol in Russia,both at the population and individual levels.However,the causes of these differences have not been studied yet.Objective:The goal of our study was to examine the effect of regional living conditions on individual alcohol consumption by the population of Russia.Methods:For the analysis,we used data from a cross-sectional epidemiological study conducted in 2013-2014.The final analytical sample included 18,130 people aged 25-64 years.We conducted the interviews face to face,based on which any drinking in the last year,as well as alcohol abuse,were considered as a response.Alcohol abuse was recorded when the respondent consumed 5.75 or more grams of pure ethanol per day(75th percentile of average daily alcohol consumption among alcohol drinkers).The assessment of the regional living conditions was accomplished via integral indexing,which was previously performed based on publicly available data for 2010-2014.Associations were assessed using generalized scoring equations with unchanging standard errors.The associations were expressed by odds ratios(OR)and 95%confidence intervals(C).Results:Deterioration of social conditions and increase in demographic depression in the region of residence increased the odds of any drinking(OR 1.51,95%CI:1.33 to 1.72,P<0.001 and OR 1.22,95%CI:1.05 to 1.41,P=0.oo9,respectively).The odds of alcohol abuse increased with the deterioration of social living conditions and the growth of the industrial development in the region:OR 1.35,95%CI:1.14 to 1.59,P<0.001 and OR 1.16,95%CI:1.05 to 1.28,P=0.002,respectively.Conclusion:Our analysis allowed assessing the impact of the regional living conditions on individual drinking alcohol in the population of Russia.

Online identification and extraction method of regional large-scale adjustable load-aggregation characteristics

This article introduces the concept of load aggregation,which involves a comprehensive analysis of loads to acquire their external characteristics for the purpose of modeling and analyzing power systems.The online identification method is a computer-involved approach for data collection,processing,and system identification,commonly used for adaptive control and prediction.This paper proposes a method for dynamically aggregating large-scale adjustable loads to support high proportions of new energy integration,aiming to study the aggregation characteristics of regional large-scale adjustable loads using online identification techniques and feature extraction methods.The experiment selected 300 central air conditioners as the research subject and analyzed their regulation characteristics,economic efficiency,and comfort.The experimental results show that as the adjustment time of the air conditioner increases from 5 minutes to 35 minutes,the stable adjustment quantity during the adjustment period decreases from 28.46 to 3.57,indicating that air conditioning loads can be controlled over a long period and have better adjustment effects in the short term.Overall,the experimental results of this paper demonstrate that analyzing the aggregation characteristics of regional large-scale adjustable loads using online identification techniques and feature extraction algorithms is effective.

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.

Current evidence on artificial intelligence in regional anesthesia

The recent advancement in regional anesthesia(RA)has been largely attributed to ultrasound technology.However,the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer.Even with adequate training,experience,and knowledge,human-related limitations such as fatigue,failure to recognize the correct anatomical structure,and unintentional needle or probe movement can hinder the overall effectiveness of RA.The amalgamation of artificial intelligence(AI)to RA practice has promised to override these human limitations.Machine learning,an integral part of AI can improve its performance through continuous learning and experience,like the human brain.It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA.AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images,and it can also assist in needle tracking and accurate deposition of local anesthetics.The future of RA with AI integration appears promising,yet obstacles such as device malfunction,data privacy,regulatory barriers,and cost concerns can deter its clinical implementation.The current mini review deliberates the current application,future direction,and barrier to the application of AI in RA practice.

Analysis of Regional Difference of Agricultural Land Productivity in Heilongjiang Province

The sustenance of humanity is contingent upon the production of food.The foundation of this production is agriculture,which in turn is dependent upon the cultivation of the land.As a fundamental element of agricultural advancement,the rational development and utilization of land play a pivotal role in the process of rural revitalization.Agricultural land productivity serves as a principal indicator of the efficacy of land utilization and the extent of agricultural advancement.Nevertheless,there is a paucity of research examining the productivity of agricultural land,particularly a lack of specialized research on large agricultural provinces.In light of the aforementioned considerations,this paper presents a comprehensive examination of agricultural land productivity and its regional variations in Heilongjiang Province in 2022,with the aid of pertinent statistical data.The findings of the analysis indicate that among the prefecture-level cities,Daqing and Suihua exhibit the highest levels of agricultural land productivity.Additionally,Zhaodong City,Zhaozhou,Qinggang,Wangkui,and Lanxi counties exhibit high levels of agricultural land productivity within their respective prefecture-level cities.There are notable disparities in agricultural land productivity across various regions,including Yichun,Heihe,Harbin,Daqing,Hegang,and Suihua.In contrast,other regions demonstrate a more balanced spatial distribution.In order to facilitate the prosperous development of the agricultural industry in Heilongjiang Province,it is essential to optimize the spatial planning of the land,to investigate the potential for agricultural development in each region,to establish effective collaboration between resources and industries,and to create a development synergy that will collectively advance rural revitalization.

Effectiveness and safety of rocuronium or nitroglycerin plus ropivacaine on pain during intravenous regional anesthesia:A double-blind randomized controlled trial

Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.

Complex Regional Pain Syndrome: Outpatient Pain Management in the Chronic Setting: A Case Report

Background: Complex Regional Pain Syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a neuropathic pain condition that usually develops after an injury to an extremity. CRPS can be a debilitating condition with high levels of pain and reduced function. Aim: This case report aims to discuss the multimodal approach in the management of a patient who presented with ongoing poorly controlled pain secondary to CRPS from an injury that happened years prior. Case Presentation: A 45-year-old female was involved in a motor vehicle accident where her right leg was injured. She underwent several surgeries and developed CRPS that significantly reduced her mobility and quality of life. She presented to the pain clinic years after her initial injury and a multimodal regimen was started for her resulting in significantly improved function. Conclusion: CRPS can be a severely debilitating condition. While early diagnosis and management are important, ongoing management in the outpatient chronic pain setting is important in maintaining a good level of function.

Resilience-Oriented Load Restoration Method and Repair Strategies for Regional Integrated Electricity-Natural Gas System

The rising frequency of extreme disaster events seriously threatens the safe and secure operation of the regional integrated electricity-natural gas system(RIENGS).With the growing level of coupling between electric and natural gas systems,it is critical to enhance the load restoration capability of both systems.This paper proposes a coordinated optimization strategy for resilience-enhanced RIENGS load restoration and repair scheduling and transforms it into a mixed integer second-order cone programming(MISOCP)model.The proposed model considers the distribution network reconfiguration and the coordinated repair strategy between the two systems,minimizing the total system load loss cost and repair time.In addition,a bi-directional gas flow model is used to describe the natural gas system,which can provide the RIENGS with more flexibility for load restoration during natural gas system failure.Finally,the effectiveness of the proposed approach is verified by conducting case studies on the test systems RIENGS E13-G7 and RIENGS E123-G20.

Specialization and Coordination: New Paradigm, Theory, and Path for Regional Development

In its new development stage,China seeks to derive new dynamism from reform and opening up at a higher level to boost consumption and services.This process coincides with a further differentiation of comparative advantages across regions.Economic activity and population will continue to concentrate in clusters in coastal and central cities amid a continuous outflow of population from remote areas.Development expansion from coastal to interior regions and from central cities to the periphery will promote a new regional development paradigm of“dual centers and periphery”.Therefore,China’s regional development strategy should follow the new theory of seeking relative equilibrium amid development,identify regions of population inflow and outflow,and explore a new development path of regional specialization and coordination.By deepening market reforms and increasing central government coordination,the country is poised to improve the spatial allocation of resources and unleash institutional dividends in the process of developing a unified national market.

Asia Pacific Regional Young Professional Campaign held in Shenzhen

Jointly supported by the Secretariat of IEC and SAC,the 2024 Asia Pacific Regional Young Professional(APRE YP)Campaign was successfully held in Shenzhen from June 25 to 30.The event was hosted by the Quality and Standards Academy,Shenzhen Technology University(SZTU),guided by the IEC Asia-Pacific Regional Center and the IEC Academy&Capacity Building.The 6-day event included roundtable discussion,theme discussion,expert lectures,business practice,and other activities,which were participated by 27 young experts from Singapore,Malaysia,Thailand,Vietnam,Laos,Myanmar,Cambodia,Russia,and China.