Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

A Study on the Effects of Different Interaction Combinations and Language Levels on Continuous Writing in Online Environments

This study was conducted with non-English sophomore students,aiming to explore the effects of different interaction combinations and language levels on continuous writing in an online environment,and compare the differences in lexical alignments and composition quality of learners with different interaction combinations and language levels in the same continuous writing task through experiments.The results show that the mean values of the word-phrase alignment of the paired group were higher than those of the individual group in different interaction combinations,and the two groups showed significant differences;in terms of composition quality,the individual group was better than the paired group,but there was no significant difference between the two groups in terms of task continuation.Secondly,the word-phrase alignment and composition scores of the different language-level groups were higher than those of the same language-level groups,and there was a significant difference between the two groups in terms of word-phrase alignments,but not in terms of composition scores.The results of this study can be useful and informative for second language teachers in future continuous teaching in online environments.

Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

Multi-mode Multi-frequency GNSS-IR Combination System for Sea Level Retrieval

With the development of Global Navigation Satellite Systems(GNSS),geodetic GNSS receivers have been utilized to monitor sea levels using GNSS-Interferometry Reflectometry(GNSS-IR)technology.The multi-mode,multi-frequency signals of GPS,GLONASS,Galileo,and Beidou can be used for GNSS-IR sea level retrieval,but combining these retrievals remains problematic.To address this issue,a GNSS-IR sea level retrieval combination system has been developed,which begins by analyzing error sources in GNSS-IR sea level retrieval and establishing and solving the GNSS-IR retrieval equation.This paper focuses on two key points:time window selection and equation stability.The stability of the retrieval combination equations is determined by the condition number of the coefficient matrix within the time window.The impact of ill-conditioned coefficient matrices on the retrieval results is demonstrated using an extreme case of SNR data with only ascending or descending trajectories.After determining the time window and removing ill-conditioned equations,the multi-mode,multi-frequency GNSS-IR retrieval is performed.Results from three International GNSS Service(IGS)stations show that the combination method produces high-precision,high-resolution,and high-reliability sea level retrieval combination sequences.

Comprehensive Risk Assessment of Sea Level Rise and Tropical Cyclones in Dongzhaigang Mangroves,China

Mangroves play a pivotal role in tropical and subtropical coastal ecosystem,yet they are highly vulnerable to the effects of climate change,particularly the accelerated global sea level rise(SLR)and stronger tropical cyclones(TCs).However,there is a lack of research addressing future simultaneous combined impacts of the slow-onset of SLR and rapid-onset of TCs on China's mangroves.In order to develop a comprehensive risk assessment method considering the superimposed effects of these two factors and analyze risk for mangroves in Dongzhaigang,Hainan Island,China,we used observational and climate model data to assess the risks to mangroves under low,intermediate,and very high greenhouse gas(GHG)emission scenarios(such as SSP1-2.6,SSP2-4.5,and SSP5-8.5)in 2030,2050,and 2100,and compiled a risk assessment scheme for mangroves in Dongzhaigang,China.The results showed that the combined risks from SLR and TCs will continue to rise;however,SLRs will increase in intensity,and TCs will decrease.The comprehensive risk of the Dongzhaigang mangroves posed by climate change will remain low under SSP1-2.6 and SSP2-4.5 scenarios by 2030,but it will increase substantially by 2100.While under SSP5-8.5 scenario,the risks to mangroves in Dongzhaigang are projected to increase considerably by 2050,and approximately 68.8%of mangroves will be at very high risk by 2100.The risk to the Dongzhaigang mangroves is not only influenced by the hazards but also closely linked to their exposure and vulnerability.We therefore propose climate resilience developmental responses for mangroves to address the effects of climate change.This study for the combined impact of TCs and SLR on mangroves in Dongzhaigang,China can enrich the method system of mangrove risk assessment and provide references for scientific management.

High levels of Zinc-α-2-Glycoprotein among Omani AIDS patients on combined antiretroviral therapy

Objective:To investigate the levels of zinc-α-2-glycoprotein(ZAG) among Omani AIDS patients receiving combined antiretroviral therapy(cART).Methods:A total of 80 Omani AIDS patients(45 males and 33 females),average age of 36 vears.who were receiving cART at the Saltan Qaboos University Hospital(SQUH).Muscat,Oman,were tested for the levels of ZAG.In addition,SO healthy blood donors(46 males and 34 females),average age of 26 years,attending the SOUH Blood Bank,were tested in parallel as a control group.Measurement of the ZAG levels was performed using a competitive enzyme—linked immunosorbent assay and in accordance with the manufacturer's instructions.Results:The ZAG levels were found to he significantly higher among AIDS patients compared to the healthy individuals(P=0.033).A total of 56(70%) of the AIDS patients were found to have higher levels of ZAG and 16(20%) AIDS patients were found to have high ZAG levels,which are significantly(P>0.031) associated with weight loss.Conclusions:ZAG levels are high among Omani AIDS patients on cART and this necessitales the measurement of ZAG on routine basis,as it is associated with weight loss.

Combined Bearing Capacity of Spudcans on a Double Layer Deposit of Strong-Over-Weak Clays

An extreme sea storm process can lead to a jack-up rig under the combined loading condition of vertical load(V), horizontal load(H), and moment(M) to have stability problems. This paper presents the analysis of combined bearing capacities of a circular spudcan on layered clays with a strong layer overlying a comparatively weaker layer. Numerical models combined with displacement-based load tests, swipe tests, and constant ratio displacement probe tests are adopted to calculate the uniaxial bearing capacities, failure envelopes in combined V-H, V-M planes, and failure envelopes in a combined V-H-M load space, respectively. A parametric study on the effects of vertical load level V, the layer strength ratio s_(u,t)/s_(u,b), and the hard layer thickness t_1 on the bearing capacities is then performed. Results show that the vertical load level is a key factor that influences the values of H and M and the size of the H-M failure envelope. The existence of the underlying weak clay decreases the bearing capacities in all directions, and the vertical capacity Vult is affected more than the horizontal(H_(ult)) and moment(M_(ult)) capacities based on a single uniform deposit. The influence of the underlying weak clay on H-M failure envelope is mainly shown where H and M are coupled in the same direction. In contrast, little difference is observed when H and M are coupled in opposite directions.

考虑保供电需求的光储微电网优化配置及电能质量评估

针对用户日益迫切的保供电需求以及光伏出力与负荷用电的随机性、波动性引发的电能质量的问题,建立了考虑保供电需求的光储微电网双层优化模型,并对规划配置的微电网电能质量进行评估。该模型以等效净负荷标准差和弃光率最小为上层优化目标,以微电网有功功率损耗最小为下层优化目标,以储能满足保供电负荷的保供电需求作为附加约束条件,采用遗传算法求解。然后设计源、网、荷三类指标,采用组合赋权法确定各指标权重,实现对微电网电能质量的综合评估。最后以改进的IEEE-33系统验证了所提模型的有效性。结果表明考虑保供电需求后能够提高微电网电能质量,并在一定范围内保供电负荷越大时越能提高微电网电能质量和用户满意度。

SARIMA-GRU组合模型的水位预测

相较于传统的单一模型,组合模型在一定条件下具有更优的预测精度。为验证组合模型是否有利于提高模型的预测精度,本文以长江中游支流澧水石龟山水电站的水位数据为基础,建立SARIMA模型和GRU神经网络模型,并将这两种模型基于方差倒数法和IOWA算子进行组合,最后比较单一模型和组合模型在该水位数据集上的预测精度差异。结果表明,适当的组合方式有利于提高模型预测精度,基于IOWA算子的组合模型具优良的预测性能。

医联体县级医院静脉输液治疗专科护理帮扶体系的构建

目的:构建医联体县级医院静脉输液治疗专科护理帮扶体系,为医联体县级医院静脉输液治疗专科护理帮扶提供依据。方法:以“结构-过程-结果”三维质量结构理论为理论基础,运用文献回顾、问卷调查、半结构式访谈初步拟定县级医院静脉输液治疗专科护理帮扶体系初稿,采用德尔菲专家咨询法构建医联体县级医院静脉输液治疗专科护理帮扶体系终稿。结果:3轮专家咨询问卷有效回收率分别为91.3%、100.0%、100.0%,专家权威系数均为0.931,肯德尔协调系数分别为0.239、0.244、0.312,经χ2检验,差异均有统计学意义(P<0.001)。最终形成的医联体县级医院静脉输液治疗专科护理帮扶体系包括结构、过程、结果3项一级指标、11项二级指标和54项三级指标。结论:医联体县级医院静脉输液治疗专科护理帮扶体系具有科学性、可靠性和临床适用性,符合静脉输液治疗专科护理临床实践与护理管理特点,能促进静脉输液治疗专科护理优质资源有效、有序地下沉到县级医院。

基于育训结合理念的中国特色高层次学徒制人才培养模式探索

经过十年的试点工作,现代学徒制人才培养模式已经取得了明显效果,也形成了一定的中国特色,但仍然存在培养层次不高、人才发展后劲不足、中国特色不够鲜明等问题。在加快构建新发展格局、着力推动高质量发展的新时代,中国特色高层次学徒制作为高技能人才培养的重要模式登上时代舞台。文章以中国特色高层次学徒制的内涵与特征为切入点,深入分析实施中国特色高层次学徒制人才培养模式的动力、条件和亟待突破的重点、难点,进而探索基于育训结合理念推进中国特色高层次学徒制人才培养模式的实施路径。

试析医养结合规范性文件的法理依据、效力及合法性要求

2013年国家提出医养结合新型养老模式,是应对人口老龄化的创新举措。中央和省级政府及其部门陆续出台一系列规范性文件,促进各地探索医养结合体制机制试点工作,并取得一定成效。然而,由于这些规范性文件效力位阶低,其创设的相关义务超越所涉上位法规定,致使医养结合面临制度性障碍。对此,应加大力度推进医养结合法治建设,为医养结合发展提供法治保障。这也是我国全面依法治国战略对医养结合依法推进的必然要求。

基于Copula函数的宿迁市区域暴雨和外河水位遭遇组合分析

在系统化全域推进海绵城市建设背景下,为充分发挥河湖水系等海绵体的作用,江苏宿迁市开展了防洪、排涝不同系统间的衔接研究,对区域暴雨和外河水位进行遭遇组合分析。选取宿迁市老城区为研究区域,通过对比不同Copula函数对区域暴雨和外河水位遭遇组合分析情况,选择拟合精度最高的GH Copula函数进行计算分析,计算不同设计暴雨条件下遭遇概率最大的外河水位。结果表明:2年一遇设计暴雨遭遇18.6~18.7 m外河水位概率最大,3年一遇设计暴雨遭遇18.9~19.0 m外河水位概率最大,5年一遇设计暴雨遭遇19.0~19.1 m外河水位概率最大。研究成果可帮助实现城市排涝—防洪的有效衔接,对提升城市水系统的整体优化和协同发展具有重要意义,以期为宿迁市系统化海绵城市建设提供科学参考。

基于耦合协调模型的地面集输系统能效对标研究

为提高地面集输系统的综合用能水平,充分挖掘内部节能潜力,在构建集输系统能效对标评价体系的前提下,通过改进层次分析法和熵权法对各级指标权重进行了计算,采用博弈论组合赋权方式对指标权重进行赋值,并利用耦合协调模型表示不同子系统间用能水平的协同发展趋势,最后基于现场实例验证了模型的准确性。结果表明:加热炉用能水平的权重为0.5084,对综合用能水平的影响最大,其次为泵机组用能水平和管道用能水平;耦合协调度越高,集输系统的综合用能水平越高。通过多种措施实现了对标和追标工作,优化调整后,预计节约燃油、电和各类维修费用共计1.39亿元以上,节能效果显著。

求解不可压缩两相流的复合Level Set-VOF方法

目前,不可压缩两相流问题的数值求解方法主要有VOF方法和Level Set方法等.根据CLSVOF方法基本思想,通过将VOF和Level Set两种方法结合,实现了复合Level Set-VOF方法追踪不可压缩两相流相界面的模拟计算;对比分析了VOF、Level Set和复合Level Set-VOF方法计算经典两相流问题的结果.研究结果表明,复合Level Set-VOF方法继承了VOF方法精确构造相界面和Level Set方法精确计算表面张力的优点,能够有效削弱两相流求解过程中出现的虚假流动问题,因此可以更加精确地求解不可压缩两相流问题.

基于云模型的电压暂降严重度评估

针对电压暂降严重程度判断的模糊性,评估结果必须与其他暂降事件对比才能得到自身相对严重度。而一般等级评估方法无法考虑到评价中存在的指标量化模糊和等级边界的不确定性问题。基于组合赋权云模型理论,提出了兼顾系统侧和负荷侧多指标的电压暂降严重程度评估方法。通过分析典型敏感设备耐受曲线构建指标集合,得到不同指标的等级划分,运用云模型对指标严重等级进行定性和定量描述。然后通过TOPSIS理想点法对指标进行主客观组合赋权。最后利用云模型隶属度和云相似度的算法分别对节点和整个系统电压暂降严重等级进行判断。通过IEEE 30节点系统进行仿真验证,云模型能反映指标数据的定性和定量、模糊和随机性以及不确定性等特征,使电压暂降评估更加合理。

基于周期组合序列调制的三电平双有源桥均压策略

应用在双极性直流微电网(BDC-MGs)的三电平双有源桥(TL-DAB)变换器,在匹配多类型不平衡负载运行时,输出侧正负母线电压的不平衡将影响系统稳定运行。该文首先分析不平衡负载工况时TL-DAB变换器输出侧上、下端口分电容电压的不均衡原因,并提出一种基于功率传输与电压均衡的周期组合序列调制策略。该均压策略无需附加额外电路和储能器件,仅通过改变功率传输的周期数及单周期内端口电平脉宽占比,便可实现输出侧上下端口传输功率的差额分配以达到分电容电压的均衡。仿真和实验结果表明,在上下分电容负载极不平衡工况下,相对于传统对称调制策略,该文所提均压策略可以将电压不均衡度从12%降低至1%以下。

长江流域平原河网地区合流制排水系统溢流污染特征研究

在平原河网地区丹金溧漕河金坛段选取3个典型合流制溢流排口及管道检查井进行溢流污染监测,分析溢流水质水量变化。以合流制管道沉积物为试验材料进行冲刷模拟试验,探究沉积物冲刷规律。结果表明,累积降雨量≥2 mm就会产生溢流现象;溢流水量变化主要受降雨等级、降雨强度及居民用水量影响,且溢流量峰值较降雨强度峰值滞后;溢流污染物浓度与前期干旱天数、排口性质、降雨等级和降雨强度有直接联系,其变化基本均呈先上升后下降趋势,且无论哪种降雨等级溢流口在产生径流后约20~30 min后污染物浓度会较高。沉积物对溢流污染贡献占比较大,管道冲刷过程中沉积颗粒物呈阶段交替式运动,各污染指标在降雨形成径流一段时间后出现峰值。

计及改进阶梯型碳交易和热电联产机组灵活输出的园区综合能源系统低碳调度

为了进一步降低园区综合能源系统(park-level integrated energy system,PIES)碳排放量,优化热电联产(combined heat and power,CHP)机组出力的灵活性,提出一种考虑改进阶梯型碳交易和CHP热电灵活输出的PIES低碳经济调度策略。首先,将遗传算法与模糊控制相结合,设计一种遗传模糊碳交易参数优化器,从而对现有阶梯型碳交易机制进行改进,实现该机制参数的自适应变化;其次,在传统CHP中加入卡琳娜(Kalina)循环与电锅炉(electricboiler,EB),构造CHP热电灵活输出模型,以同时满足电、热负荷的不同需求;然后,提出一种柔性指标——电、热输出占比率,进而计算出电、热输出占比率区间,以衡量CHP运行灵活性;最后,将改进阶梯型碳交易机制和CHP热电灵活输出模型协同优化,以系统运行成本和碳交易成本之和最小为目标,构建PIES低碳经济优化模型。算例分析表明,所提策略可有效降低经济成本和碳排放量,同时还可扩展CHP灵活输出调节范围,能够为PIES低碳经济调度提供参考。