Improving pressure ulcer care in intensive care units:Evaluating the impact of bundled care and silver nanoparticle dressings

BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated.AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients.METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this study.Patients were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over time.Assessments were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day 12.Family satisfaction was assessed using the Family Satisfaction ICU 24 ques-tionnaire.RESULTS No significant differences in baseline characteristics were observed between the two groups.In the intervention group,there were significant reductions in total PUSH scores over the assessment period.Specifically,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control group.Family satisfaction with care and decision-making was notably higher in the intervention group.Overall family satisfaction was significantly better in the intervention group.CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients.This approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.

Analysis of The Effect of Bundled Nursing Intervention on Lung Cancer Patients with a High Risk of PICC-Related Thrombosis

Objective: To explore the effect of bundled nursing intervention on lung cancer patients with a high risk of PICC-related thrombosis. Methods: Eighty-six PICC patients were selected and randomly divided into a control group and an observation group of 43 patients each. The control group received general nursing care and the observation group received bundled nursing intervention based on the control group. The occurrence of venous thrombosis, quality of life score, Zung self-rating depression scale (SDS) score, self-rating anxiety (SAS) score, and nursing satisfaction after treatment were compared between the two groups. Results: The incidence rate of PICC-related venous thrombosis in the observation group (2/4.652%) was lower than that of the control group (13/30.231%) after nursing intervention (P < 0.05). After the intervention, the quality-of-life scores of the observation group were higher than those of the control group (P < 0.001). After the intervention, the SDS and SAS scores of the observation group were lower than those of the control group (P < 0.001). The nursing satisfaction rate of the observation group (41/ 4.652%) was higher than that of the control group (35/18.604%) (P < 0.05). The difference is statistically significant. Conclusion: In the care of lung cancer patients with a high risk of PICC-related thrombosis, bundled nursing care achieved better results.

COMPLETE KAHLER METRICS WITH POSITIVE HOLOMORPHIC SECTIONAL CURVATURES ON CERTAIN LINE BUNDLES(RELATED TO A COHOMOGENEITY ONE POINT OF VIEW ON A YAU CONJECTURE)

In this article,we study Kahler metrics on a certain line bundle over some compact Kahler manifolds to find complete Kahler metrics with positive holomorphic sectional(or bisectional)curvatures.Thus,we apply a strategy to a famous Yau conjecture with a co-homogeneity one geometry.

Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

A new interacting capillary bundle model on the multiphase flow in micropores of tight rocks

Surfactants are widely used in the fracturing fluid to enhance the imbibition and thus the oil recovery rate. However, current numerical models cannot capture the physics behind capillary imbibition during the wettability alteration by surfactants. Although the interacting capillary bundle(ICB) model shows potential in characterizing imbibition rates in different pores during wettability alteration, the existing ICB models neglect the influence of wettability and viscosity ratio on the imbibition behavior, making it difficult to accurately describe the oil-water imbibition behavior within the porous media. In this work,a new ICB mathematical model is established by introducing pressure balance without assuming the position of the leading front to comprehensively describe the imbibition behavior in a porous medium under different conditions, including gas-liquid spontaneous imbibition and oil-water imbibition.When the pore size distribution of a tight rock is known, this new model can predict the changes of water saturation during the displacement process in the tight rock, and also determine the imbibition rate in pores of different sizes. The water saturation profiles obtained from the new model are validated against the waterflooding simulation results from the CMG, while the imbibition rates calculated by the model are validated against the experimental observations of gas-liquid spontaneous imbibition. The good match above indicates the newly proposed model can show the water saturation profile at a macroscopic scale while capture the underlying physics of the multiphase flow in a porous medium at a microscopic scale. Simulation results obtained from this model indicate that both wettability and viscosity ratio can affect the sequence of fluid imbibition into pores of different sizes during the multiphase flow, where less-viscous wetting fluid is preferentially imbibed into larger pores while more-viscous wetting fluid tends to be imbibed into smaller pores. Furthermore, this model provides an avenue to calculate the imbibition rate in pores of different sizes during wettability alteration and capture the non-Darcy effect in micro-and nano-scale pores.

Left bundle branch area pacing combined with implantable cardioverter-defibrillator treatment for heart failure after myocardial infarction

Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).

Irrigation regimes modulate non-structural carbohydrate remobilization and improve grain filling in rice(Oryza sativa L.)by regulating starch metabolism

Recently developed ‘super’ rice cultivars with greater yield potentials often suffer from the problem of poor grain filling, especially in inferior spikelets. Here, we studied the activities of enzymes related to starch metabolism in rice stems and grains, and the microstructures related to carbohydrate accumulation and transportation to investigate the effects of different water regimes on grain filling. Two ‘super’ rice cultivars were grown under two irrigation regimes of well-watered(WW) and alternate wetting and moderate soil drying(AWMD). Compared with the WW treatment,the activities of ADP glucose pyrophosphorylase(AGPase), starch synthase(StSase) and starch branching enzyme(SBE), and the accumulation of non-structural carbohydrates(NSCs) in the stems before heading were significantly improved, and more starch granules were stored in the stems in the AWMD treatment. After heading, the activities of α-amylase, β-amylase, sucrose phosphate synthase(SPS) and sucrose synthase in the synthetic direction(SSs)were increased in the stems to promote the remobilization of NSCs for grain filling under AWMD. During grain filling, the enzymatic activities of sucrose synthase in the cleavage direction(SSc), AGPase, StSase and SBE in the inferior spikelets were increased, which promoted grain filling, especially for the inferior spikelets under AWMD.However, there were no significant differences in vascular microstructures. The grain yield and grain weight could be improved by 13.1 and 7.5%, respectively, by optimizing of the irrigation regime. We concluded that the low activities of key enzymes in carbon metabolism is the key limitation for the poor grain filling, as opposed to the vascular microstructures, and AWMD can increase the amount of NSC accumulation in the stems before heading, improve the utilization rate of NSCs after heading, and increase the grain filling, especially in the inferior spikelets, by altering the activities of key enzymes in carbon metabolism.

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.

Pacemaker post transcatheter aortic valve replacement:A multifactorial risk?

Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.

Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!

Several anatomical,demographic,clinical,electrocardiographic,procedural,and valve-related variables can be used to predict the probability of developing con-duction abnormalities after transcatheter aortic valve replacement(TAVR)that necessitate permanent pacemaker(PPM)implantation.These variables include calcifications around the device landing zone and in the mitral annulus;pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks(BBB),first-and second-degree atrioventricular blocks,as well as bifas-cicular and trifascicular blocks;male sex;diabetes mellitus(DM);hypertension;history of atrial fibrillation;renal failure;dementia;and use of self-expanding valves.The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR.Regardless of the side of the BBB,this study demonstrated,for the first time,a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration(above 100 ms).After a 1-year follow-up,patients who received PPM post-TAVR had a higher rate of hospital-ization for heart failure and nonfatal myocardial infarction.

The Green Wall of Aksu

An afforestation project transforms a desert prefecture in Xinjiang into an oasis.YUSUPJAN Alim would win any reality show like Survivor hands down.The 36-year-old forest ranger started his career planting trees in the bleak and blazing Gobi Desert in 2004 in circumstances entirely different from today’s.At that time,there were no mobile phones,no GPS or transportation.The team would drive deep into the desert in a truck,carrying naans,the flatbread of Xinjiang that keeps for days.It was their staple,if not only,food.“We lived on Xinjiang naans and water for 15-20 days while working in the desert,”Yusupjan said.“We would dip the naan into water to make it soft.”When they worked,they tied their food in a bundle around their body so that if they got separated or even lost in the hostile desert,they would still have food.Every time they went in,Yusupjan would note the way carefully so that even if he got separated from his co-workers,he could still walk out of the desert alive.

Optimized CUDA Implementation to Improve the Performance of Bundle Adjustment Algorithm on GPUs

The 3D reconstruction pipeline uses the Bundle Adjustment algorithm to refine the camera and point parameters. The Bundle Adjustment algorithm is a compute-intensive algorithm, and many researchers have improved its performance by implementing the algorithm on GPUs. In the previous research work, “Improving Accuracy and Computational Burden of Bundle Adjustment Algorithm using GPUs,” the authors demonstrated first the Bundle Adjustment algorithmic performance improvement by reducing the mean square error using an additional radial distorting parameter and explicitly computed analytical derivatives and reducing the computational burden of the Bundle Adjustment algorithm using GPUs. The naïve implementation of the CUDA code, a speedup of 10× for the largest dataset of 13,678 cameras, 4,455,747 points, and 28,975,571 projections was achieved. In this paper, we present the optimization of the Bundle Adjustment algorithm CUDA code on GPUs to achieve higher speedup. We propose a new data memory layout for the parameters in the Bundle Adjustment algorithm, resulting in contiguous memory access. We demonstrate that it improves the memory throughput on the GPUs, thereby improving the overall performance. We also demonstrate an increase in the computational throughput of the algorithm by optimizing the CUDA kernels to utilize the GPU resources effectively. A comparative performance study of explicitly computing an algorithm parameter versus using the Jacobians instead is presented. In the previous work, the Bundle Adjustment algorithm failed to converge for certain datasets due to several block matrices of the cameras in the augmented normal equation, resulting in rank-deficient matrices. In this work, we identify the cameras that cause rank-deficient matrices and preprocess the datasets to ensure the convergence of the BA algorithm. Our optimized CUDA implementation achieves convergence of the Bundle Adjustment algorithm in around 22 seconds for the largest dataset compared to 654 seconds for the sequential implementation, resulting in a speedup of 30×. Our optimized CUDA implementation presented in this paper has achieved a 3× speedup for the largest dataset compared to the previous naïve CUDA implementation.

Research Progress on the Application of Cluster Nursing Mode in ECMO-Assisted Patients

Cluster care,also known as cluster therapy,cluster intervention,or bundled therapy,is a series of evidence-based supportive joint care measures developed to improve the quality of care for specific patients or nursing issues.It is highly reliable and can effectively improve patient prognosis.This article summarized the application of cluster nursing care in extracorporeal membrane oxygenation(ECMO)-assisted patients and the problems faced to provide a reference for evidence-based decision-making in clinical practice.

基于iOS开发的自动化单元测试研究与运用

Xcode是苹果开发的集成开发环境,用于创建macOS、iOS、watchOS和tvOS应用程序。主要介绍了其中的单元测试集成工具,即Unit Testing Bundle单元测试和UI Testing Bundle单元测试。Unit Testing Bundle单元测试可以帮助开发人员验证和确保应用程序中各个模块的功能和逻辑的正确性,通过编写测试代码来对特定模块进行测试,并检查其预期行为是否符合预期。通过运行Unit Testing Bundle,可以快速地发现和解决潜在问题,提高应用程序的质量和可靠性。UI Testing Bundle单元测试是UI用户界面交互单元测试工具,用于编写和执行UI自动化测试。通过模拟用户操作和验证应用程序行为,开发人员可以确保应用程序的用户界面在各种情况下的预期交互。UI Testing Bundle是一个强大而全面的工具,有助于开发人员提高应用程序的稳定性和用户体验。

Simulation studies of tungsten impurity behaviors during neon impurity seeding with tungsten bundled charge state model using SOLPS-ITER on EAST

An investigation into tungsten(W)impurity behaviors with the update of the EAST lower W divertor for H-mode has been carried out using SOLPS-ITER.This work aims to study the effect of external neon(Ne)impurity seeding on W impurity sputtering with the bundled charge state model.As the Ne seeding rate increases,plasma parameters,W concentration(C_(W)),and eroded W flux(Γ_(W)^(Ero))at both targets are compared and analyzed between the highly resolved bundled model‘jett’and the full W charge state model.The results indicate that‘jett’can produce divertor behaviors essentially in agreement with the full W charge state model.The bundled scheme with high resolution in low W charge states(<W^(20+))has no obvious effect on the Ne impurity distribution and thus little effect on W sputtering by Ne.Meanwhile,parametric scans of radial particle and thermal transport diffusivities(D_(⊥)andχ_(e,i))in the SOL are simulated using the‘jett’bundled model.The results indicate that the transport diffusivity variations have significant influences on the divertor parameters,especially for W impurity sputtering.

His bundle pacing versus left bundle branch pacing on ventricular function in atrial fibrillation patients referred for pacing:a prospective crossover comparison

BACKGROUND His bundle pacing(HBP)and left bundle branch pacing(LBBP)both provide physiologic pacing which maintain left ventricular synchrony.They both improve heart failure(HF)symptoms in atrial fibrillation(AF)patients.We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term.METHODS Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality.Echocardiographic measurements,New York Heart Association(NYHA)classification,quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up.Left ventricular function including the left ventricular endosystolic volume(LVESV),left ventricular ejection fraction(LVEF)and right ventricular(RV)function quantified by tricuspid annular plane systolic excursion(TAPSE)were all assessed.RESULTS Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled(69.1±8.1 years,53.6% male,LVEF 59.2%±13.7%).The LVESV was improved by both pacing modalities in all patients(n=23)and the LVEF was improved in patients with baseline LVEF at less than 50%(n=6).The TAPSE was improved by HBP but not LBBP(n=23).CONCLUSION In this crossover comparison between HBP and LBBP,LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node(AVN)ablation.HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.

MAXWELL-EINSTEIN METRICS ON COMPLETIONS OF CERTAIN C* BUNDLES

In this paper,we prove that for some completions of certain fiber bundles there is a Maxwell-Einstein metric conformally related to any given Kahler class.

Mobility-Aware Adaptive Beam Tracking for Vehicles in Mm Wave Communication Networks

The millimeter wave(mm Wave)is a potential solution for high data rate communication due to its availability of large bandwidth.However,it is challenging to perform beam tracking in vehicular mm Wave communication systems due to high mobility and narrow beams.In this paper,an adaptive beam tracking algorithm is proposed to improve the network throughput performance while reducing the training signal overhead.In particular,based on the mobility prediction at base station(BS),a novel frame structure with dynamic bundled timeslot is designed.Moreover,an actor-critic reinforcement learning based algorithm is proposed to obtain the joint optimization of both beam width and the number of bundled timeslots,which makes the beam tracking adapt to the changing environment.Simulation results demonstrate that,compared with the traditional full scan and Kalman filter based beam tracking algorithms,our proposed algorithm can improve the time-averaged throughput by 11.34%and 24.86%respectively.With the newly designed frame structure,it also outperforms beam tracking with conventional frame structure,especially in scenarios with large range of vehicle speeds.

Bundles策略在预防全麻患者术中低体温中的应用

目的:探讨Bundles策略在预防全麻患者术中低体温中的应用效果。方法:将2021年7月1日~10月31日拟行全麻腹部手术的300例成年患者随机分为G1常规保温组和G2 Bundles保温组各150例,G1常规保温组术中实施常规保温方式,G2 Bundles保温组实施基于循证干预措施和可能引发热量损失途径制订预防术中低温的Bundles干预策略。比较两组不同时间的体温、血氧饱和度(SpO_(2))、心率、血压、呼吸,统计两组寒战、低体温、躁动、术中出血、异常心律事件发生率,记录气管导管拔管时间、PACU停留时间。结果:G2 Bundles保温组术中及术后体温、SpO_(2)、心率、呼吸等均高于G1常规保温组,而同期血压低于G1常规保温组(P<0.05);G2 Bundles保温组寒战、低体温、躁动、术中出血事件、异常心律事件发生率均低于G1常规保温组(P<0.05);G2 Bundles保温组气管导管拔管时间、PACU停留时间均短于G1常规保温组(P<0.01)。结论:将Bundles策略应用于全麻患者术中,有助于预防低体温、调节患者心电指标,减少不良事件。

The application of indocyanine green in guiding prostate cancer treatment

Objective:Indocyanine green(ICG)with near-infrared fluorescence absorption is approved by the United States Food and Drug Administration for clinical applications in angiography,blood flow evaluation,and liver function assessment.It has strong optical absorption in the near-infrared region,where light can penetrate deepest into biological tissue.We sought to review its value in guiding prostate cancer treatment.Methods:All related literature at PubMed from January 2000 to December 2020 were reviewed.Results:Multiple preclinical studies have demonstrated the usefulness of ICG in identifying prostate cancer by using different engineering techniques.Clinical studies have demonstrated the usefulness of ICG in guiding sentinel node dissection during radical prostatectomy,and possible better preservation of neurovascular bundle by identifying landmark prostatic arteries.New techniques such as adding fluorescein in additional to ICG were tested in a limited number of patients with encouraging result.In addition,the use of the ICG was shown to be safe.Even though there are encouraging results,it does not carry sufficient sensitivity and specificity in replacing extended pelvic lymph node dissection during radical prostatectomy.Conclusion:Multiple preclinical and clinical studies have shown the usefulness of ICG in identifying and guiding treatment for prostate cancer.Larger randomized prospective studies are warranted to further test its usefulness and find new modified approaches.