Management of a Retained Epidural Catheter in a Pregnant Patient: A Case Report and Review of Literature

Background: Epidural anesthesia is an effective intervention to treat labor pain and provide analgesia for orthopedic procedures. A rare complication of this technique is epidural catheter retention. Case Presentation: In this case report, we present an otherwise healthy 21-year-old G2P0010 woman at 39 weeks and 3 days gestation whose anesthetic management was complicated by a symptomatic retained epidural catheter fragment. Computed tomography (CT) imaging of her spine showed the fractured catheter within her paraspinal muscles and neurosurgery recommended no surgical intervention at that time. The patient reported resolution of back pain while in the postpartum unit which she continues to endorse two weeks after discharge. Conclusion: Retained epidural catheter is a medical emergency that requires immediate imaging and neurological evaluation. While magnetic resonance imaging is typically regarded as the standard imaging modality for this complication, in epidural sets that contain metallic components, we suggest using CT to avoid the risk of thermal nerve damage. In cases where the patient does not report any acute complaints, nonsurgical management may be appropriate but close follow-up is required to monitor for catheter migration.

Lateral earth pressure of granular backfills on retaining walls with expanded polystyrene geofoam inclusions under limited surcharge loading

Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.

Limit state analysis of rigid retaining structures against seismically induced passive failure in heterogeneous soils

Soils are not necessarily uniform and may present linearly varied or layered characteristics,for example the backfilled soils behind rigid retaining walls.In the presence of large lateral thrust imposed by arch bridge,passive soil failure is possible.A reliable prediction of passive earth pressure for the design of such wall is challenging in complicated soil strata,when adopting the conventional limit analysis method.In order to overcome the challenge for generating a kinematically admissible velocity field and a statically allowable stress field,finite element method is incorporated into limit analysis,forming finiteelement upper-bound(FEUB)and finite-element lower-bound(FELB)methods.Pseudo-static,original and modified pseudo-dynamic approaches are adopted to represent seismic acceleration inputs.After generating feasible velocity and stress fields within discretized elements based on specific criteria,FEUB and FELB formulations of seismic passive earth pressure(coefficient K_(P))can be derived from work rate balance equation and stress equilibrium.Resorting to an interior point algorithm,optimal upper and lower bound solutions are obtained.The proposed FEUB and FELB procedures are well validated by limit equilibrium as well as lower-bound and kinematic analyses.Parametric studies are carried out to investigate the effects of influential factors on seismic K_(P).Notably,true solution of K_(P) is well estimated based on less than 5%difference between FEUB and FELB solutions under such complex scenarios.

Protective effect of retaining wall on rock avalanche:A case study of Nayong rock avalanche in China

Rock avalanches are generally difficult to prevent and control due to their high velocities and the extensive destruction they cause.However,barrier structures constructed along the path of a rock avalanche can partially mitigate the magnitudes and consequences of such catastrophic events.We selected a rock avalanche in Nayong County,Guizhou Province,China as a case to study the effect of the location and height of a retaining wall on the dynamic characteristics of rock avalanche by using both actual terrain-based laboratory-model tests and coupled PFC3D-FLAC3D numerical simulations.Our findings demonstrate that a retaining wall can largely block a rock avalanche and its protective efficacy is significantly influenced by the integrity of the retaining wall.Coupled numerical simulation can serve as a powerful tool for analyzing the interaction between a rock avalanche and a retaining wall,facilitating precise observations of its deformation and destruction.The impact-curve characteristics of the retaining wall depend upon whether or not the rock avalanche-induced destruction is taken into account.The location of the retaining wall exerts a greater influence on the outcome compared to the height and materials of the retaining wall,while implementing a stepped retaining-wall pattern in accordance with the terrain demonstrates optimal efficacy in controlling rock avalanche.

Time-History Dynamic Characteristics of Reinforced Soil-Retaining Walls

Given the complexities of reinforced soil materials’constitutive relationships,this paper compares reinforced soil composite materials to a sliding structure between steel bars and soil and proposes a reinforced soil constitutive model that takes this sliding into account.A finite element dynamic time history calculation software for composite response analysis was created using the Fortran programming language,and time history analysis was performed on reinforced soil retaining walls and gravity retaining walls.The vibration time histories of reinforced soil retaining walls and gravity retaining walls were computed,and the dynamic reactions of the two types of retaining walls to vibration were compared and studied.The dynamic performance of reinforced earth retaining walls was evaluated.

Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.

Effect of Yizhikang Powder on Hemorheological Indexes in Dairy Cattle with Retained Placenta

[ Objective ] The aim of the research was to reveal the mechanism of Yizhikang powder treatment on dairy cattle with retained placenta from the hemorheological perspective. [ Method] Dairy cattle with retained placenta were treated with oral administration of Yizhikang powder. And their hemorheological indexes were measured and compared with the corresponding indicators of pre-administration group, healthy group, and control group （sick but untreated）.[ Result] There was large decrease amplitude in the indexes （whole blood viscosity, plasma viscosity, whole blood viscosity reduction viscosity, ESR, ESR equation K value, fibrinogen content, platelet aggregation rate, RBC deformability IF value） of treated dairy cattle with retained placenta. By t test, the indexes, except hematocrit, decreased significantly after treatment （P〈0.05） and reached the status of post partum healthy cows. The hemorheological indexes didn＇t change significantly in the control group before and after treatment. [ Conclusion] Yizhikang powder could significantly improve blood flow state and reduced the occurrence of qi stagnation and blood stasis in perinatal period.

RELATIONSHIP BETWEEN RETAINED AUSTENITE AND STRAIN FOR Si-Mn TRIP STEEL

The equation which reflects the relationship between the retained austenite and strain has been proposed and clear TRIP can be obtained while the S value (An index of retained austenite stability) is less than 6.5 for Silicon-Manganese TRIP steel

基于RETAIN模型的对外汉字教育游戏的设计与开发

基于系统化的教学设计原则,Gunter等提出了RETAIN教育游戏设计模型,该模型能够很好地兼顾教育性与游戏性,受到广泛关注。以RETAIN模型为基础,结合对外汉字教学的相关研究成果,重点针对字形研发汉字教育游戏。首次构建出对外汉语汉字教育游戏的设计框架,并使用Unity3D进行PENZZLE的设计与开发,探讨教育性与游戏性的有机融合途径。调查结果显示,在学习兴趣提升、知识目标达成度、学习效果提升度三个方面,该游戏的开发都取得良好效果。

EFFECT OF CHEMICAL COMPOSITION ON RETAINED AUSTENITE IN TRIP STEEL

The systematic chemical compositions including common C, Si, Mn, Al, and micro-alloying elements of Ti and Nb were designed for high volume fraction of retained austenite as much as possible. The thermo-cycle experiments were conducted by using Gleeble 2000 thermo-dynamic test machine for finding the appropriate composition. The experimental results showed that chemical composition had a significant effect on retained austenite, and the appropriate compositions were determined for commercial production of TRIP steels.

Effects of Si on the stability of retained austenite and temper embrittlement of ultrahigh strength steels

Effects of silicon （Si） content on the stability of retained austenite and temper embrittlement of ultrahigh strength steels were investigated using X-ray diffraction （XRD）,transmission electron microscopy （TEM）,and other experimental methods.The results show that Si can suppress temper embrittlement,improve temper resistance,and hinder the decomposition of retained austenite.Reversed austenite appears gradually with the increase of Si content during tempering.Si has a significant effect on enhancing carbon （C） partitioning and improving the stability of retained austenite.Si and C atoms are mutually exclusive in lath bainite,while they attract each other in austenite.ε-carbides are found in 1.8wt% Si steel tempered at 250℃,and they get coarsened obviously when tempered at 400℃,leading to temper embrittlement.Not ε-carbides but acicular or lath carbides lead to temper embrittlement in 0.4wt% Si steel,which can be inferred as cementites and composite compounds.Temper embrittlement is closely related to the decomposition of retained austenite and the formation of reversed austenite.

EFFECTS OF CARBON CONTENT AND ROLLING PROCESSING ON RETAINED AUSTENITE FOR HOT-ROLLED TRIP STEELS

The effects of finishing rolling temperature and coiling temperature on retained austen-ite were studied for hot-rolled transformation induced plasticity (TRIP) steels with different carbon content. The experimental results showed that an appropriate volume fraction of retained austenite from 6% to 11% could be obtained according to the different carbon content less than 0.20% by controlled finishing rolling and coiling for the hot-rolled TRIP steels. It can be concluded that carbon content has a significant effect on the fraction of retained austenite and coiling processing plays stronger role on retaining austenite than fishing rolling processing.

Effect of lower bainite/martensite/retained austenite triplex microstructure on the mechanical properties of a low-carbon steel with quenching and partitioning process

We present a study concerning Fe-0. 176C-1.31Si-1.58Mn-0.26Al-0.3Cr （wt%） steel subjected to a quenching and partitioning （Q＆P） process. The results of scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and tensile tests demon- strate that the microstructures primarily consist of lath martensite, retained austenite, lower bainite （LB）, and a small amount of tempered martensite; moreover, few twin austenite grains were observed. In the microstrucmre, three types of retained austenite with different sizes and morphologies were observed： blocky retained austenite （-300 nm in width）, film-like retained austenite （80-120 nm in width）, and ul- tra-fine film-like retained austenite （30-40 nm in width）. Because of the effect of the retained austenite/martensite/LB triplex microstructure, the specimens prepared using different quenching temperatures exhibit high ultimate tensile strength and yield strength. Furthermore, the strength effect of LB can partially counteract the decreasing strength effect of martensite. The formation of LB substantially reduces the amount of retained austenite. Analyses of the retained austenite and the amount of blocky retained austenite indicated that the carbon content is critical to the total elongation of Q＆P steel.

Topical nitrate drip infusion using cystic duct tube for retained bile duct stone:A six patients case series

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.

Position-optimization on retained entry and backfilling wall in gob-side entry retaining techniques

This study investigates the stability problem of gob-side entry retaining （GER） and backfilling wall which located under the key block B. Based on the combined research of elastic-plastic mechanics, structure mechanics and modern theory of mining-induced pressure, the caving characteristic and roof structure over the GER were analyzed, and the vertical force and the torque on retained entry roof were also derived as the position for the retained entry varies. On the basis of the specific geology in Huainan mining area, the results indicate that a relatively more stable position for retained entry neighbors the hinge point of block A and B, and it also located at a scope ranging from this point to the one-third length of block B in horizontal direction. As to appropriate position for backfilling wall, this study recommends partial- road-in backfilling method for GER. Field trial conducted at panel face 12418 of Xieqiao Mine demonstrates that the recommended width for original entry is 3.6 m and the preferred width proportion between original retained entry and original entry is 75 % or so whereas the avoidable one is 88 % or so. These findings provide qualitative references to the mines which share similar geology as what Huainan mining area characterized.

Research on Retained Austenite for Advanced Aluminum-containing Hot-rolled TRIP Steel

A new type of hot-rolled transformation induced plasticity （TRIP） steel with 2.3%AI was developed to replace conventional Si-bearing TRIP steel to improve surface quality of the steel sheet. The relationship between retained austenite volume fraction and hot-rolling processing was researched by Gleeble-2000 thermo-dynamic test for the Al-bearing steel. The experimental result showed that aluminum played an important role on retaining austenite and the volume fraction increased from 4.4% to 7.5% as coiling temperature increased from 350℃ to 450℃, while coiling temperature had a stronger effect on retaining austenite than finishing rolling temoerature.

Stability control of gob-side entry retained under the gob with close distance coal seams

In multi-seam mining,the interlayer rock strata between the upper coal seam(UCS)and the lower coal seam(LCS)appear damage and strength weakening after mining the UCS.Ground stability control of the gob-side entry retaining(GER)under the gob with close distance coal seams(CDCS)is faced with difficulties due to little attention to GER under this condition.This paper focuses on surrounding rock stability control and technical parameters design for GER under the gob with CDCS.The floor rock strata damage characteristics after mining the UCS is first evaluated and the damage factor of the interlayer rock strata below the UCS is also determined.Then,a structural mechanics model of GER surrounding rock is set up to obtain the main design parameters of the side-roadway backfill body(SBB)including the maximum and minimum SBB width calculation formula.The optimal SBB width and the water-to-cement ratio of high water quick-setting material(HWQM)to construct the SBB are determined as 1.2 m and 1.5:1.0,respectively.Finally,engineering trial tests of GER are successfully carried out at#5210 track transportation roadway of Xingwu Colliery.Research results can guide GER design under similar mining and geological conditions.

Characteristics of Retained Austenite in TRIP Steels with Bainitic Ferrite Matrix

Heat treatment process for producing cold rolled transformation induced plasticity-aided （TRIP-aided） steels with bainitic ferrite matrix was adopted. Characteristics of retained austenite （RA） in such TRIP steels were investigated. SEM and OM determination results showed that the stable austenite retained at room temperature were mainly located between laths and some of them inside the coarse ferrite. The grains were uniformly distributed in heat treated steel matrix and the regularly dispersed RA represented to be triangular morphology. XRD analysis indicated that RA content in matrix was not less than 10%, and TEM testified that RA inside the matrix were formed at the prior austenite boundaries and represented to be single or twin crystals. The ductile fracture originated from the boundaries of martensite islands from RA and ferrite. The cracks propagated along grain boundaries and some passed through the large ferrite grains and induced transgranular fracture.

Deformation failure mechanism and application of the backfill along the goaf-side retained roadway

In order to determine the rational width of backfill in the goaf-side retained roadway, the deformation failure mechanism of surrounding rock in retained roadway is studied in the use of theoretical analysis, numerical simulation, etc., when the width of backfill is different. The results show that: with the increase of backfill width, the roof deformation above the backfill decreases; the outside of backfill obviously suffers from greater stress compared to the inner side of backfill; the damage firstly appears in the intersection of top backfill and roof; the plastic failure area is mainly distributed in the roof and floor of inside the roadway; 2 m wide backfill in the goaf-side retained roadway can meet the requirements of roadway deformation. Based on the original combination support of "anchor-mesh-belt-lock" in the haulage-track roadway, the study also considers the reinforced support of "anchor-mesh-belt" above the backfill, and 50 m ahead of working face, and 200 m behind the working face. This kind of support achieves a good result. The roadway deformation of field measurement shows that it can satisfy the need of the next working face.

Wide pillar roadway retained in the deep high gas coal seam

According to the geological and mining conditions of deep high gas coal seam,this paper established the mechanical model of stope surrounding rock,and analyzed the stress distribution and deformation failure mechanism of working face and coal pillar.The research determined the arrangement mode that adjacent working faces retain wide pillar,and the reasonable support method of roadway that the combined support of roof and grouting combined together.The reasonable time of reinforced roadway was determined.Through analyzing the mechanical model of the ways of roadway supporting,this research drew the conclusions as follows:the combined support of roof and working slope improved the support strength and range of surrounding rock,optimized the support by adjusting the angle of anchor,and reached the support requirements by using cement grouting in working slope and chemical grout in roof.The technology was applied in 15104 working face of Baoan Mine,and obtained good results.