Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

A holistic approach to improving safety for battery energy storage systems

The integration of battery energy storage systems(BESS)throughout our energy chain poses concerns regarding safety,especially since batteries have high energy density and numerous BESS failure events have occurred.Wider spread adoption will only increase the prevalence of these failure events unless there is a step change in the management and design of BESS.To understand the causes of failure,the main challenges of BESS safety are summarised.BESS consequences and failure events are discussed,including specific focus on the chain of events causing thermal runaway,and a case study of a BESS explosion in Surprise Arizona is analysed.Based on the technology and past events,a paradigm shift is required to improve BESS safety.In this review,a holistic approach is proposed.This combines currently adopted approaches including battery cell testing,lumped cell mathematical modelling,and calorimetry,alongside additional measures taken to ensure BESS safety including the requirement for computational fluid dynamics and kinetic modelling,assessment of installation level testing of the full BESS system and not simply a single cell battery test,hazard and layers of protection analysis,gas chromatography,and composition testing.The holistic approach proposed in this study aims to address challenges of BESS safety and form the basis of a paradigm shift in the safety management and design of these systems.

A novel refined dynamic model of high-speed maglev train-bridge coupled system for random vibration and running safety assessment

Running safety assessment and tracking irregularity parametric sensitivity analysis of high-speed maglev train-bridge system are of great concern,especially need perfect refinement models in which all properties can be well characterized based on various stochastic excitations.A three-dimensional refined spatial random vibration analysis model of high-speed maglev train-bridge coupled system is established in this paper,in which multi-source uncertainty excitation can be considered simultaneously,and the probability density evolution method(PDEM)is adopted to reveal the system-specific uncertainty dynamic characteristic.The motion equation of the maglev vehicle model is composed of multi-rigid bodies with a total 210-degrees of freedom for each vehicle,and a refined electromagnetic force-air gap model is used to account for the interaction and coupling effect between the moving train and track beam bridges,which are directly established by using finite element method.The model is proven to be applicable by comparing with Monte Carlo simulation.By applying the proposed stochastic framework to the high maglev line,the random dynamic responses of maglev vehicles running on the bridges are studied for running safety and stability assessment.Moreover,the effects of track irregularity wavelength range under different amplitude and running speeds on the coupled system are investigated.The results show that the augmentation of train speed will move backward the sensitive wavelength interval,and track irregularity amplitude influences the response remarkably in the sensitive interval.

Seismic safety assessment with non-Gaussian random processes for train-bridge coupled systems

Extensive high-speed railway(HSR)network resembled the intricate vascular system of the human body,crisscrossing mainlands.Seismic events,known for their unpredictability,pose a significant threat to both trains and bridges,given the HSR’s extended operational duration.Therefore,ensuring the running safety of train-bridge coupled(TBC)system,primarily composed of simply supported beam bridges,is paramount.Traditional methods like the Monte Carlo method fall short in analyzing this intricate system efficiently.Instead,efficient algorithm like the new point estimate method combined with moment expansion approximation(NPEM-MEA)is applied to study random responses of numerical simulation TBC systems.Validation of the NPEM-MEA’s feasibility is conducted using the Monte Carlo method.Comparative analysis confirms the accuracy and efficiency of the method,with a recommended truncation order of four to six for the NPEM-MEA.Additionally,the influences of seismic magnitude and epicentral distance are discussed based on the random dynamic responses in the TBC system.This methodology not only facilitates seismic safety assessments for TBC systems but also contributes to standard-setting for these systems under earthquake conditions.

Risk identification and safety assessment of human-computer interaction in integrated avionics based on STAMP

To solve the problem of risk identification and quantitative assessment for human-computer interaction(HCI)in complex avionics systems,an HCI safety analysis framework based on system-theoretical process analysis(STPA)and cognitive reliability and error analysis method(CREAM)is proposed.STPACREAM can identify unsafe control actions and find the causal path during the interaction of avionics systems and pilot with the help of formal verification tools automatically.The common performance conditions(CPC)of avionics systems in the aviation environment is established and a quantitative analysis of human failure is carried out.Taking the head-up display(HUD)system interaction process as an example,a case analysis is carried out,the layered safety control structure and formal model of the HUD interaction process are established.For the interactive behavior“Pilots approaching with HUD”,four unsafe control actions and35 causal scenarios are identified and the impact of common performance conditions at different levels on the pilot decision model are analyzed.The results show that HUD's HCI level gradually improves as the scores of CPC increase,and the quality of crew member cooperation and time sufficiency of the task is the key to its HCI.Through case analysis,it is shown that STPACREAM can quantitatively assess the hazards in HCI and identify the key factors that impact safety.

Field Load Test Based SHM System Safety Standard Determination for Rigid Frame Bridge

The deteriorated continuous rigid frame bridge is strengthened by external prestressing. Static loading tests wereconducted before and after the bridge rehabilitation to verify the effectiveness of the rehabilitation process. Thestiffness of the repaired bridge is improved, and the maximum deflection of the load test is reduced from 37.9 to27.6 mm. A bridge health monitoring system is installed after the bridge is reinforced. To achieve an easy assessmentof the bridge’s safety status by directly using transferred data, a real-time safety warning system is createdbased on a five-level safety standard. The threshold for each safety level will be determined by theoretical calculationsand the outcomes of static loading tests. The highest risk threshold will be set at the ultimate limit statevalue. The remaining levels, namely middle risk, low risk, and very low risk, will be determined usingreduction coefficients of 0.95, 0.9, and 0.8, respectively.

Artificial-intelligent-powered safety and efficiency improvement for controlling and scheduling in integrated railway systems

The multi-mode integrated railway system,anchored by the high-speed railway,caters to the diverse travel requirements both within and between cities,offering safe,comfortable,punctual,and eco-friendly transportation services.With the expansion of the railway networks,enhancing the efficiency and safety of the comprehensive system has become a crucial issue in the advanced development of railway transportation.In light of the prevailing application of artificial intelligence technologies within railway systems,this study leverages large model technology characterized by robust learning capabilities,efficient associative abilities,and linkage analysis to propose an Artificial-intelligent(AI)-powered railway control and dispatching system.This system is elaborately designed with four core functions,including global optimum unattended dispatching,synergetic transportation in multiple modes,high-speed automatic control,and precise maintenance decision and execution.The deployment pathway and essential tasks of the system are further delineated,alongside the challenges and obstacles encountered.The AI-powered system promises a significant enhancement in the operational efficiency and safety of the composite railway system,ensuring a more effective alignment between transportation services and passenger demands.

Laws of strata energy release and corresponding safety warning system in metal mine

The strata deformation in mining area was monitored in Dabaoshan copper-iron mine,and an analytical method of strata energy release was put forward.On the basis of chaotic theory,by reconstructing the phase space for time series data of strata energy release,the saturated embedding dimension and the correlation dimension of the dynamic system were obtained to be 4 and 1.212 8,respectively,and the evolution laws of distances between phase points of strata energy release in the phase space were revealed.With grey theory,a prediction model of strata energy release was set up,the maximum error of which was less than 6.7%.The results show that there are chaotic characters in strata energy release during mining;after reconstructing phase space,the subtle changing characteristics of energy release can be magnified,and the internal rules can be fully demonstrated.According to the laws,a warning system for strata stability in mining area was established to provide a technical safeguard for safe mining.

Design and Implementation of Traceability Management System of Agricultural Products Quality and Safety Based on Domestic Basic Software of China

[Objective] To establish the traceability mechanism of agricultural products safety, and the application of promote domestic based software in the supervision area of agricultural products quality and safety. [Method] Through the analysis on the circulation characteristics of agricultural products, like fruits, vegetables, livestock and poultry, the agricultural products quality safety management and traceability query business component libraries were designed. Based on the run-time-supporting environment provided by domestic based software, traceability management system of agricultural products quality and safety was constructed. [Result] The traceability management system provided the information interaction and comprehensive management platform of agricultural product quality and safety based on domestic based software for the government, enterprises and consumers. [Conclusion] Through the application demonstration, the quality control and information traceability of full circulation of agricultural products was achieved effective and reliably, and the management level of agricultural products quality and safety was improved.

Mathematical Description of the Arming Process of a Fuze Safety System

By determining the state variables of a fuze safety system,some mathematical models——the system of ordinary differential and functional differential equations about the system's arming process are founded in a state space.Also,the arming states and restricted relations of the safety factors are described and some demonstrations are presented.

Bayes Estimation of Parameter for the Safety Component Failure Model of the Safe Arming System of Missile

A Bayesian method is used to evaluate the component safety failure model parameter of the safe arming system of an air faced missile in flight. It was proved that Bayes estimation of the model parameter is coincident with the physical explanation of the prior probability density distribution of the random parameter.

Establishment of the Basic Theory of Fuze Safety Systems

Presents a series of new concepts and design ideas about the fuze safety system, establishing thereby a proposed theory and relevant mathematical descriptions. The basic the- ory indicates that any fuze safety system is a physical system comprising finite safety ele- ments each of which can independently affect the system's states, and the arming process is a dynamic one in which the extent of safety of the system changes only gradually. The theory and method can be used to analyse the arming process and to guide the development of fuze safety systems.

Study on Pork Quality and Safety Traceability System and Relevant Management Systems

It is the key to construct the traceability mechanism of quality responsibility for ensuring the quality and safety of animal products. In this study, after defining the concept of traceability system and analyzing its function mechanism, the design ideas of pork quality and safety traceability system based on bar code and Internet were put forward, including network structure, system process, business process and information identifica- tion. Then the relevant management systems were proposed.

Research on Technological Support System of Control and Management of Rural Tourism Safety

As the sources of overt and covert potential safety hazards were widespread, the safety control and management of rural tourism became more complicated and difficult, which required more for technological support of rural tourism safety management. Based on the latitude of technological support, from the perspective of management practice of rural tourism safety, through analysis on inner symbiosis of management and technological support of rural tourism safety, the paper had studied three parts of control and management system of rural tourism safety, which were rural tourism safety identification, rural tourism safety isolation and control, and rural tourism safety treatment and solution; and the connotation of technological support during safety management had been discussed from the three aspects. It hoped to serve as reference for tourism safety management and control, so as to promote healthy, stable and sustainable development of tourism.

Food safety regulatory systems in Europe and China:A study of how co-regulation can improve regulatory effectiveness

Food safety has received a great deal of attention in both developed and developing countries in recent years. In China, the numerous food scandals and scares that have struck over the past decade have spurred significant food safety regulatory reform, which has been increasingly oriented towards the public-private partnership model adopted by the Europe Union＇s （EU） food safety regulatory system. This paper analyzes the development of both the EU＇s and China＇s food safety regu- latory systems, identifies the current challenges for China and additionally considers the role of public-private partnership. The success of co-regulation in the food regulatory system would bring significant benefits and opportunities for China. Finally, this paper recommends additional measures like training and grants to improve the private＇s sector effectiveness in co-regulating China＇s food safety issues.

A holistic strategy for quality and safety control of traditional Chinese medicines by the “iVarious” standard system

An effective quality control system is the key to ensuring the quality, safety and efficacy of traditional Chinese medicines(TCMs). However, the current quality standard research lacks top-level design and systematic design,mostly based on specific technologies or evaluation methods. To resolve the challenges and questions of quality control of TCMs, a brand-new quality standard system, named "iVarious", was proposed. The system comprises eight elements in a modular format. Meaning of every element was specifically illustrated via corresponding research instances. Furthermore, frankincense study was taken as an example for demonstrating standards and research process, based on the "i Various" system. This system highlighted a holistic strategy for effectiveness,security, integrity and systematization of quality and safety control standards of TCMs. The establishment of"i Various" integrates multi-disciplinary technologies and progressive methods, basis elements and key points of standard construction. The system provides a novel idea and technological demonstration for regulation establishment of TCMs quality standards.

Comparison of renal safety of tenofovir and entecavir in patients with chronic hepatitis B: Systematic review with meta-analysis

BACKGROUND Recently, the American Association for the Study of Liver Disease suggested no preference between tenofovir(TDF) and entecavir(ETV) regarding potential long-term risks of renal complications. Over the years, renal safety has become a critical concern in nucleos(t)ide analog-treated patients due to the long-term use of these drugs. However, existing studies do not show significant differences in renal dysfunction between these two drugs. Further, there is a paucity of studies comparing the long-term renal effects of TDF and ETV.AIM To investigate the effects of TDF and ETV on renal function, we performed systematic review and meta-analysis.METHODS Two investigators independently searched the Cochrane Library, MEDLINE, and Embase databases for randomized controlled trials and nonrandomized studies(NRSs) using the keywords 'CHB', 'Tenofovir', and 'Entecavir', and additional references were obtained from the bibliographies of relevant articles published through December 2017. The quality of each study was assessed using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment,Development and Evaluation criteria. The primary outcome was the change in serum creatinine level in the TDF and ETV groups at baseline, 6 mo, 12 mo and24 mo.RESULTSNine NRSs comprising 2263 participants met the inclusion criteria. Changes in creatinine levels were higher in the TDF group than in the ETV group at 6 mo[mean difference(MD) = 0.03 mg/dL;95%CI: 0.02-0.04;I2 = 0%], 12 mo(MD =0.05 mg/dL;95%CI: 0.02-0.08;I2 = 78%), and 24 mo(MD = 0.07 mg/dL;95%CI:0.01-0.13;I2 = 93%). The change in estimated glomerular filtration rate(eGFR) was significantly higher in the TDF group than in the ETV group at 6 mo[standardized mean difference(SMD),-0.22;95%Cl:-0.36--0.08;I2 = 0%], 12 mo(SMD =-0.24;95%Cl:-0.43--0.05;I2 = 50%), and 24 mo(-0.35;95%Cl:-0.61--0.09;I2= 67%).CONCLUSION TDF statistically significantly increased serum creatinine levels and decreased the eGFR in 6-24 mo compared to ETV, with moderate to low quality of evidence.However, the differences are negligible.

Fabrication of Fuze Micro-electro-mechanical System Safety Device

Fuze micro-electro-mechanical system（MEMS） has become a popular subject in recent years.Studies have been done for the application of MEMS-based fuze safety and arm devices.The existing researches mainly focused on reducing the cost and volume of the fuze safety device.The reduction in volume allows more payload and,thus,makes small-caliber rounds more effective and the weapon system more affordable.At present,MEMS-based fuze safety devices are fabricated mainly by using deep reactive ion ething or LIGA technology,and the fabrication process research on the fuze MEMS safety device is in the exploring stage.In this paper,a new micro fabrication method of metal-based fuze MEMS safety device is presented based on ultra violet（UV）-LIGA technology.The method consists of SU-8 thick photoresist lithography process,micro electroforming process,no back plate growing process,and SU-8 photoresist sacrificial layer process.Three kinds of double-layer moveable metal devices have been fabricated on metal substrates directly with the method.Because UV-LIGA technology and no back plate growing technology are introduced,the production cycle is shortened and the cost is reduced.The smallest dimension of the devices is 40 μm,which meets the requirement of size.To evaluate the adhesion property between electroforming deposit layer and substrate qualitatively,the impact experiments have been done on the device samples.The experimental result shows that the samples are still in good condition and workable after undergoing impact pulses with 20 kg peak and 150 μs duration and completely met the requirement of strength.The presented fabrication method provides a new option for the development of MEMS fuze and is helpful for the fabrication of similar kinds of micro devices.