Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature,absence of radiation exposure,widespread availability,prompt results,high accuracy,and repeatability at the bedside.The diaphragm is a crucial respiratory muscle.Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients.In this editorial,we comment on an article,retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023.The study found that the diaphragm thickening fraction,an index from diaphragm ultrasound,can better predict the outcome of non-invasive ventilation in patients with AECOPD.The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged.Diaphragmatic dysfunction diagnosed with ultrasound is asso-ciated with prolonged mechanical ventilation and weaning times and higher mortality.

Theoretical and Experimental Study on the Performance of Hermetic Diaphragm Squeeze Film Dampers for Gas-Lubricated Bearings

Low damping characteristics have always been a key sticking points in the development of gas bearings.The application of squeeze film dampers can significantly improve the damping performance of gas lubricated bearings.This paper proposed a novel hermetic diaphragm squeeze film damper(HDSFD)for oil-free turbomachinery supported by gas lubricated bearings.Several types of HDSFDs with symmetrical structure were proposed for good damping performance.By considering the compressibility of the damper fluid,based on hydraulic fluid mechanics theory,a dynamic model of HDSFDs under medium is proposed,which successfully reflects the frequency dependence of force coefficients.Based on the dynamic model,the effects of damper fluid viscosity,bulk modulus of damper fluid,thickness of damper fluid film and plunger thickness on the dynamic stiffness and damping of HDSFDs were analyzed.An experimental test rig was assembled and series of experimental studies on HDSFDs were conducted.The damper fluid transverse flow is added to the existing HDSFD concept,which aims to make the dynamic force coefficients independent of frequency.Although the force coefficient is still frequency dependent,the damping coefficient at high frequency excitation with damper fluid supply twice as that without damper fluid supply.The results serve as a benchmark for the calibration of analytical tools under development.

Traumatic Diaphragmatic Hernia in Children: A Case Report

Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.

Hepatic ectopic pregnancy with hemorrhage secondary diaphragmatic adhesion:A case report

BACKGROUND Primary abdominal pregnancy is an extremely rare form of ectopic pregnancy.Ectopic pregnancies that occur in the liver and diaphragm are even rarer,limited case reports are available in the literature.CASE SUMMARY A woman of childbearing age was transferred to the emergency department due to lumbar and abdominal pain radiating to the back toward the lower right.After a series of physical and auxiliary examinations,she was clinically diagnosed with hepatic ectopic pregnancy.Laparoscopic surgery was performed to remove the pregnancy tissue and achieve hemostasis.After a period of follow-up,the patient was successfully cured.CONCLUSION Paying attention to the patient's signs and utilizing imaging examination methods can help avoid missed diagnoses of liver pregnancy.

Transverse mode-coupling instability with longitudinal impedance

Transverse mode-coupling instability(TMCI)is a dangerous transverse single-bunch instability that can lead to severe par-ticle loss.The mechanism of TMCI can be explained by the coupling of transverse coherent oscillation modes owing to the transverse short-range wakefield(i.e.,the transverse broadband impedance).Recent studies on future circular colliders,e.g.,FCC-ee,showed that the threshold of TMCI decreased significantly when both longitudinal and transverse impedances were included.We performed computations for the circular electron-positron collider(CEPC)and observed a similar phenom-enon.Systematic studies on the influence of longitudinal impedance on the TMCI threshold were conducted.We concluded that the imaginary part of the longitudinal impedance,which caused a reduction in the incoherent synchrotron tune,was the primary reason for the reduction in the TMCI threshold.Additionally,the real part of the longitudinal impedance assists in increasing the TMCI threshold.

Transverse momentum balance of dijets in Xe+Xe collisions at the LHC

We present a theoretical study of the medium modifications of the p_(T)balance (x_(J)) of dijets in Xe+Xe collisions at■.The initial production of dijets was carried out using the POWHEG+PYTHIA8 prescription,which matches the next-toleading-order (NLO) QCD matrix elements with the parton shower (PS) effect.The SHELL model described the in-medium evolution of nucleus–nucleus collisions using a transport approach.The theoretical results of the dijet xJin the Xe+Xe collisions exhibit more imbalanced distributions than those in the p+p collisions,consistent with recently reported ATLAS data.By utilizing the Interleaved Flavor Neutralisation,an infrared-and-collinear-safe jet flavor algorithm,to identify the flavor of the reconstructed jets,we classify dijets processes into three categories:gluon–gluon (gg),quark–gluon (qg),and quark–quark (qq),and investigated the respective medium modification patterns and fraction changes of the gg,qg,and qq components of the dijet sample in Xe+Xe collisions.It is shown that the increased fraction of qg component at a small x_(J)contributes to the imbalance of the dijet;in particular,the q_(1)g_(2)(quark-jet-leading) dijets experience more significant asymmetric energy loss than the g_(1)q_(2)(gluon-jet-leading) dijets traversing the QGP.By comparing the■of inclusive,■ dijets in Xe+Xe collisions,we observe■.Moreover,ρ_(Xe),P_(b),the ratios of the nuclear modification factors of dijets in Xe+Xe to those in Pb+Pb,were calculated,which indicates that the yield suppression of dijets in Pb+Pb is more pronounced than that in Xe+Xe owing to the larger radius of the lead nucleus.

Analytical solution for the effective elastic properties of rocks with the tilted penny-shaped cracks in the transversely isotropic background

Seismic prediction of cracks is of great significance in many disciplines,for which the rock physics model is indispensable.However,up to now,multitudinous analytical models focus primarily on the cracked rock with the isotropic background,while the explicit model for the cracked rock with the anisotropic background is rarely investigated in spite of such case being often encountered in the earth.Hence,we first studied dependences of the crack opening displacement tensors on the crack dip angle in the coordinate systems formed by symmetry planes of the crack and the background anisotropy,respectively,by forty groups of numerical experiments.Based on the conclusion from the experiments,the analytical solution was derived for the effective elastic properties of the rock with the inclined penny-shaped cracks in the transversely isotropic background.Further,we comprehensively analyzed,according to the developed model,effects of the crack dip angle,background anisotropy,filling fluid and crack density on the effective elastic properties of the cracked rock.The analysis results indicate that the dip angle and background anisotropy can significantly either enhance or weaken the anisotropy degrees of the P-and SH-wave velocities,whereas they have relatively small effects on the SV-wave velocity anisotropy.Moreover,the filling fluid can increase the stiffness coefficients related to the compressional modulus by reducing crack compliance parameters,while its effects on shear coefficients depend on the crack dip angle.The increasing crack density reduces velocities of the dry rock,and decreasing rates of the velocities are affected by the crack dip angle.By comparing with exact numerical results and experimental data,it was demonstrated that the proposed model can achieve high-precision estimations of stiffness coefficients.Moreover,the assumption of the weakly anisotropic background results in the consistency between the proposed model and Hudson's published theory for the orthorhombic rock.

Suppression of stimulated Brillouin and Raman scatterings using an alternating frequency laser and transverse magnetic fields

A novel scheme to suppress both stimulated Brillouin scattering(SBS) and stimulated Raman scattering(SRS) by combining an alternating frequency(AF) laser and a transverse magnetic field is proposed. The AF laser allows the laser frequency to change discretely and alternately over time. The suppression of SBS is significant as long as the AF difference is greater than the linear growth rate of SBS or the alternating time of the laser frequency is shorter than the linear growth time of SBS. However, the AF laser proves ineffective in suppressing SRS, which usually has a much higher linear growth rate than SBS. To remedy that, a transverse magnetic field is included to suppress the SRS instability. The electrons trapped in the electron plasma waves(EPWs) of SRS can be accelerated by the surfatron mechanism in a transverse magnetic field and eventually detrapped. While continuously extracting energy from EPWs, the EPWs are dissipated and the kinetic inflation of SRS is suppressed. The one-dimensional particle-in-cell simulation results show that both SBS and SRS can be effectively suppressed by combining the AF laser with a transverse magnetic field with tens of Tesla. The total reflectivity can be dramatically reduced by more than one order of magnitude. These results provide a potential reference for controlling SBS and SRS under the related parameters of inertial confinement fusion.

Longitudinally extensive transverse myelitis associated with scrub typhus:A case report

Rationale:Longitudinally extensive transverse myelitis(LETM)is a rare inflammatory demyelinating disease predominantly associated with autoimmune and inflammatory disorders.Scrub typhus can cause a variety of neurological complications,which may result in poor recovery and long-term disability.This report reveals a rare linkage between LETM and scrub typhus.Patient concerns:A 24-year-old female presented with a history of fever for 10 days associated with progressive quadriparesis.Physical examination revealed bilateral lower limb weakness(grade 0/5)and bilateral upper limb weakness(grade 2/5)with reduced sensation below the T3 dermatome.Diagnosis:Scrub typhus presenting with longitudinally extensive transverse myelitis.Interventions:Steroid pulse therapy with antibiotics supported by early intensive rehabilitation.Outcomes:Complete recovery was achieved.Lessons:This case report highlights the importance of considering scrub typhus as a potential cause of LETM in endemic regions,particularly in patients presenting with febrile illness and neurological symptoms.

The Effect of Transverse Tibial Bone Transfer in the Treatment of Diabetic Foot

To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.

Application Effect of External Diaphragm Pacemaker Combined with Active Respiratory Circulation Technology in Pulmonary Rehabilitation of Perioperative Lung Cancer Patients

Aim: To explore the application effect of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients. Methods: A total of 98 lung cancer patients admitted to our hospital from April 2020 to November 2021 were selected as the observation objects, and then divided into a control group and an observation group using the random number table method, with 49 cases in each group. The control group received routine admission guidance and active respiratory circulation training, while the observation group was supplemented with external diaphragm pacemaker on the basis of the control group. The intervention effect was evaluated by blood gas indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators before and after intervention. Results: Before intervention, there were no significant differences in blood gas analysis indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators between the two groups (P > 0.05). After intervention, the improvement degree of the above indicators in the observation group was higher than that in the control group (P < 0.05). Conclusions: The application of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients is significant, which can effectively improve the pulmonary function, blood gas function, and diaphragm function of lung cancer patients after surgery, and improve the activities of daily living and quality of life of patients.

Impact of tibial transverse transport in tissue regeneration and wound healing with perspective on diabetic foot ulcers

In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.

Determining beam transverse absolute position by triangulation of multi-electrode signal phase differences

Accurate measurement of the transverse position of a beam is crucial in particle accelerators because it plays a key role in determining the beam parameters.Existing methods for beam-position measurement rely on the detection of image currents induced on electrodes or narrow-band wake field induced by a beam passing through a cavity-type structure.However,these methods have limitations.The indirect measurement of multiple parameters is computationally complex,requiring external calibration to determine the system parameters in advance.Furthermore,the utilization of the beam signal information is incomplete.Hence,this study proposes a novel method for measuring the absolute electron beam transverse position.By utilizing the geometric relationship between the center position of the measured electron beam and multiple detection electrodes and by analyzing the differences in the arrival times of the beam signals detected by these electrodes,the absolute transverse position of the electron beam crossing the electrode plane can be calculated.This method features absolute position measurement,a position sensitivity coefficient independent of vacuum chamber apertures,and no requirement for a symmetrical detector electrode layout.The feasibility of this method is validated through numerical simulations and beam experiments.

Early postoperative complications after transverse colostomy closure,a retrospective study

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.

Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication:Two case reports

BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Acute Transverse Myelitis in Pregnancy—A Case Report and a Literature Review

Purpose: This case report highlights a rare instance of a 26-week pregnant woman presenting with limb numbness, diagnosed with acute transverse myelitis (ATM) following COVID-19 vaccination. Notably, she tested positive for neuromyelitis optica (NMO) but did not exhibit the typical symptoms of blurred vision. Methods: Data were collected from I Seha in governmental hospitals in Bahrain, providing a comprehensive overview of the patient’s clinical journey. Results: The patient was treated with carbamazepine, steroids, and clexane, leading to the successful delivery of a healthy baby at 34 weeks. However, two years postpartum, she reported new episodes of blurred vision and numbness. Subsequent treatment with Rituximab resulted in significant improvement, with a diagnosis of Devic’s disease established. Conclusion: Acute transverse myelitis is a rare condition, particularly during pregnancy, and in this case, symptoms of Devic’s disease were masked by the absence of blurred vision. This condition predominantly affects females in their 20s during childbearing years and can lead to complications such as premature delivery. Effective management includes steroids and antiepileptic drugs, with clexane playing a crucial role in preventing embolisms. A delivery mode may vary based on obstetric factors, and MRI remains the gold standard for diagnosis. Close follow-up is essential for optimal patient outcomes.

Winding Function Model-based Performance Evaluation of a PM Transverse Flux Generator for Applications in Direct-drive Systems

The magnetic flux in a permanent magnet transverse flux generator(PMTFG) is three-dimensional(3D), therefore, its efficacy is evaluated using 3D magnetic field analysis. Although the 3D finite-element method(FEM) is highly accurate and reliable for machine simulation, it requires a long computation time, which is crucial when it is to be used in an iterative optimization process. Therefore, an alternative to 3DFEM is required as a rapid and accurate analytical technique. This paper presents an analytical model for PMTFG analysis using winding function method. To obtain the air gap MMF distribution, the excitation magneto-motive force(MMF) and the turn function are determined based on certain assumptions. The magnetizing inductance, flux density, and back-electro-magnetomotive force of the winding are then determined. To assess the accuracy of the proposed method, the analytically calculated parameters of the generator are compared to those obtained by a 3D-FEM. The presented method requires significantly shorter computation time than the 3D-FEM with comparable accuracy.

Laminated Solid Timber Slab with Transverse Prestressing Using the Strategy of Interleaved Vertical Displacement of Lamellae

This article presents a study on the structural behavior of transversely prestressed laminated timber slabs,focusing on an innovative approach:vertically misaligned lamellae.This misalignment,achieved by sliding vertically the wooden lamellae rather than aligning them,enhances the slab’s cross-section moment of inertia,thereby improving load-bearing capacity and stiffness.Testing involved two groups of structural size specimens:one with vertically aligned lamellae(control group)and the other with misaligned lamellae(study group).Results showed the study group exhibited 42%superior stiffness and 10%less load capacity compared to the control.Failures typically occurred individually in the lamellae,particularly in those with defects or lower modulus of elasticity,concentrated in the middle third of the slabs’free span where tensile stresses peak.Despite a higher number of failed lamellae,the study group demonstrated promising performance.Analysis of prestressing bar indicated no damage at all in the thread,suggesting potential for reducing bar diameter.These findings offer crucial insights into applying these slabs in timber construction as well as to any kind of construction.