Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes

BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.

Versatile and controlled quantum teleportation network

A quantum teleportation network involving multiple users is essential for future quantum internet.So far,controlled quantum teleportation has been demonstrated in a three-user network.However,versatile and controlled quantum teleportation network involving more users is in demand,which satisfies different combinations of users for practical requirements.Here we propose a highly versatile and controlled teleportation network that can switch among various combinations of different users.We use a single continuous-variable six-partite Greenberger-Horne-Zeilinger(GHZ)state to realize such a task by choosing the different measurement and feedback operations.The controlled teleportation network,which includes one sub-network,two sub-networks and three sub-networks,can be realized for different application of user combinations.Furthermore,the coherent feedback control(CFC)can manipulate and improve the teleportation performance.Our approach is flexible and scalable,and would provide a versatile platform for demonstrations of complex quantum communication and quantum computing protocols.

How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

Purpose:The study aimed to examine the reporting completeness of randomized controlled trials(RCTs)of non-pharmacological interventions following concussion.Methods:We searched MEDLINE,Embase,PsycInfo,CINAHL,and Web of Science up to May 2022.Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication(TIDieR),Consensus on Exercise Reporting Template(CERT),and international Consensus on Therapeutic Exercise aNd Training(i-CONTENT)checklists.Additional information was sought my study authors where reporting was incomplete.Risk of bias(ROB)was assessed with the Cochrane ROB-2 Tool.RCTs examining non-pharmacological interventions following concussion.Results:We included 89 RCTs(n=53 high ROB)examining 11 different interventions for concussion:sub-symptom threshold aerobic exercise,cervicovestibular therapy,physical/cognitive rest,vision therapy,education,psychotherapy,hyperbaric oxygen therapy,transcranial magnetic stimulation,blue light therapy,osteopathic manipulation,and head/neck cooling.Median scores were:TIDieR 9/12(75%;interquartile range(IQR)=5;range:5-12),CERT 17/19(89%;IQR=2;range:10-19),and i-CONTENT 6/7(86%;IQR=1;range:5-7).Percentage of studies completely reporting all items was TIDieR 35%(31/89),CERT 24%(5/21),and i-CONTENT 10%(2/21).Studies were more completely reported after publication of TIDieR(t_(87)=2.08;p=0.04)and CERT(t_(19)=2.72;p=0.01).Reporting completeness was not strongly associated with journal impact factor(TIDieR:rs=0.27;p=0.01;CERT:r_(s)=-0.44;p=0.06;i-CONTENT:r_(s)=-0.17;p=0.48)or ROB(TIDieR:rs=0.11;p=0.31;CERT:rs=0.04;p=0.86;i-CONTENT:rs=0.12;p=0.60).Conclusion:RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness,but are often missing key components,particularly modifications,motivational strategies,and qualified supervisor.Reporting completeness improved after TIDieR and CERT publication,but publication in highly cited journals and low ROB do not guarantee reporting completeness.

Efficacy of a Nutritional Cream Intervention to Treat Depression in Rescuers:A Randomized Controlled Trial

Objective To explore the effectiveness of a nutritional intervention in rescuers who screened positive for depression.Methods A randomized controlled trial design was employed.From June to August,2022,4,460 rescuers were screened using the Self-Rating Depression Scale(SDS),and 1,615 positive cases were identified.Thirty-one volunteers were recruited and randomly divided into a nutritional intervention group and a control group.The intervention group received health education and nutritional intervention(a compound paste therapy primarily composed of red roses and Seville orange flowers),while the control group received psychological education.SDS scores were assessed before and after the intervention.Results There was a statistically significant decline in SDS scores in the nutritional intervention group after the intervention(P<0.05).Furthermore,the SDS scores of the intervention group were significantly lower than those of the control group,both before and after the intervention(P<0.05).No severe adverse reactions were observed during safety evaluation.Conclusion The nutritional intervention effectively reduced the depression scores in rescuers.Early nutritional intervention is recommended for rescuers who initially screen positive for depression.

Real-time model correction using Kalman filter for Raman-controlled cell culture processes

Raman spectroscopy has found extensive use in monitoring and controlling cell culture processes.In this context,the prediction accuracy of Raman-based models is of paramount importance.However,models established with data from manually fed-batch cultures often exhibit poor performance in Raman-controlled cultures.Thus,there is a need for effective methods to rectify these models.The objective of this paper is to investigate the efficacy of Kalman filter(KF)algorithm in correcting Raman-based models during cell culture.Initially,partial least squares(PLS)models for different components were constructed using data from manually fed-batch cultures,and the predictive performance of these models was compared.Subsequently,various correction methods including the PLS-KF-KF method proposed in this study were employed to refine the PLS models.Finally,a case study involving the auto-control of glucose concentration demonstrated the application of optimal model correction method.The results indicated that the original PLS models exhibited differential performance between manually fed-batch cultures and Raman-controlled cultures.For glucose,the root mean square error of prediction(RMSEP)of manually fed-batch culture and Raman-controlled culture was 0.23 and 0.40 g·L^(-1).With the implementation of model correction methods,there was a significant improvement in model performance within Raman-controlled cultures.The RMSEP for glucose from updating-PLS,KF-PLS,and PLS-KF-KF was 0.38,0.36 and 0.17 g·L^(-1),respectively.Notably,the proposed PLS-KF-KF model correction method was found to be more effective and stable,playing a vital role in the automated nutrient feeding of cell cultures.

Coexisting and multiple scroll attractors in a Hopfield neural network with a controlled memristor

A method of generating multi-double scroll attractors is proposed based on the memristor Hopfield neural network(HNN)under pulse control.First,the original hyperbolic-type memristor is added to the neural network mathematical model,and the influence of this memristor on the dynamic behavior of the new HNN is analyzed.The numerical results show that after adding the memristor,the abundant dynamic behaviors such as chaos coexistence,period coexistence and chaos period coexistence can be observed when the initial value of the system is changed.Then the logic pulse is added to the external memristor.It is found that the equilibrium point of the HNN can multiply and generate multi-double scroll attractors after the pulse stimulation.When the number of logical pulses is changed,the number of multi-double scroll attractors will also change,so that the pulse can control the generation of multi-double scroll attractors.Finally,the HNN circuit under pulsed stimulation was realized by circuit simulation,and the results verified the correctness of the numerical results.

Distribution rules of remaining oil by bottom water flooding and potential exploitation strategy in fault-controlled fractured-vuggy reservoirs

Based on the tectonic genesis and seismic data of fault-controlled fractured-vuggy reservoirs,the typical fractured-vuggy structure features were analyzed.A 3D large-scale visual physical model of“tree-like”fractured-vuggy structure was designed and made.The experiments of bottom-water flooding and multi-media synergistic oil displacement after bottom-water flooding were conducted with different production rates and different well-reservoir configuration relationships.The formation mechanisms and distribution rules of residual oil during bottom-water flooding under such fractured-vuggy structure were revealed.The producing characteristics of residual oil under different production methods after bottom-water flooding were discovered.The results show that the remaining oil in"tree-like"fractured-vuggy structure after bottom-water flooding mainly include the remaining oil of non-well controlled fault zones and the attic remaining oil at the top of well controlled fault zones.There exists obvious water channeling of bottom-water along the fault at high production rate,but intermittent drainage can effectively weaken the interference effect between fault zones to inhibit water channeling.Compared with the vertical well,horizontal well can reduce the difference in flow conductivity between fault zones and show better resistance to water channeling.The closer the horizontal well locates to the upper part of the“canopy”,the higher the oil recovery is at the bottom-water flooding stage.However,comprehensive consideration of the bottom-water flooding and subsequent gas injection development,the total recovery is higher when the horizontal well locates in the middle part of the“canopy”and drills through a large number of fault zones.After bottom water flooding,the effect of gas huff and puff is better than that of gas flooding,and the effect of gas huff and puff with large slug is better than that of small slug.Because such development method can effectively develop the remaining oil of non-well controlled fault zones and the attic remaining oil at the top of well controlled fault zones transversely connected with oil wells,thus greatly improving the oil recovery.

Complete-basis-reprogrammable coding metasurface for generating dynamicallycontrolled holograms under arbitrary polarization states

Reprogrammable metasurfaces,which establish a fascinating bridge between physical and information domains,can dynamically control electromagnetic(EM)waves in real time and thus have attracted great attentions from researchers around the world.To control EM waves with an arbitrary polarization state,it is desirable that a complete set of basis states be controlled independently since incident EM waves with an arbitrary polarization state can be decomposed as a linear sum of these basis states.In this work,we present the concept of complete-basis-reprogrammable coding metasurface(CBR-CM)in reflective manners,which can achieve independently dynamic controls over the reflection phases while maintaining the same amplitude for left-handed circularly polarized(LCP)waves and right-handed circularly polarized(RCP)waves.Since LCP and RCP waves together constitute a complete basis set of planar EM waves,dynamicallycontrolled holograms can be generated under arbitrarily polarized wave incidence.The dynamically reconfigurable metaparticle is implemented to demonstrate the CBR-CM’s robust capability of controlling the longitudinal and transverse positions of holograms under LCP and RCP waves independently.It’s expected that the proposed CBR-CM opens up ways of realizing more sophisticated and advanced devices with multiple independent information channels,which may provide technical assistance for digital EM environment reproduction.

Magnetically controlled self-sealing pressure-preserved coring technology

Pressure-preserved coring is an effective means to develop deep resources. However, due to the complexity of existing pressure-preserved technology, the average success rate of pressure-preserved coring is low. In response, a novel in situ magnetically controlled self-sealing pressure-preserved coring technology for deep reserves has been proposed and validated. This innovative technology distinguishes itself from conventional methods by employing noncontact forces to replace traditional pretensioning mechanisms, thereby enhancing the mechanical design of pressure-preserved coring equipment and significantly boosting the fault tolerance of the technology. Here, we report on the design,theoretical calculations, experimental validation, and industrial testing of this technology. Through theoretical and simulation calculations, the self-sealing composite magnetic field of the pressure controller was optimized. The initial pre-tensioning force of the optimal magnetic field was 13.05 N. The reliability of the magnetically controlled self-sealing pressure-preserved coring technology was verified using a self-developed self-sealing pressure performance testing platform, confirming the accuracy of the composite magnetic field calculation theory. Subsequently, a magnetically controlled self-triggering pressure-preserved coring device was designed. Field pressure-preserved coring was then conducted,preliminarily verifying the technology's effective self-sealing performance in industrial applications.Furthermore, the technology was analyzed and verified to be adaptable to complex reservoir environments with pressures up to 30 MPa, temperatures up to 80℃, and p H values ranging from 1 to 14. These research results provide technical support for multidirectional pressure-preserved coring, thus paving a new technical route for deep energy exploration through coring.

Effect of Jianpi Shengxue Tablet on Iron Metabolism and Nutritional Status in Patients with Renal Anemia:A Prospective,Randomized,Open,Parallel Controlled and Multicenter Clinical Study

Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

Fracture-controlled fracturing mechanism and penetration discrimination criteria for thin sand-mud interbedded reservoirs in Sulige gas field,Ordos Basin,China

Considering the problems in the discrimination of fracture penetration and the evaluation of fracturing performance in the stimulation of thin sand-mud interbedded reservoirs in the eighth member of Shihezi Formation of Permian(He-8 Member)in the Sulige gas field,a geomechanical model of thin sand-mud interbedded reservoirs considering interlayer heterogeneity was established.The experiment of hydraulic fracture penetration was performed to reveal the mechanism of initiation–extension–interaction–penetration of hydraulic fractures in the thin sand-mud interbedded reservoirs.The unconventional fracture model was used to clarify the vertical initiation and extension characteristics of fractures in thin interbedded reservoirs through numerical simulation.The fracture penetration discrimination criterion and the fracturing performance evaluation method were developed.The results show that the interlayer stress difference is the main geological factor that directly affects the fracture morphology during hydraulic fracturing.When the interlayer stress difference coefficient is less than 0.4 in the Sulige gas field,the fractures can penetrate the barrier and extend in the target sandstone layer.When the interlayer stress difference coefficient is not less than 0.4 and less than 0.45,the factures can penetrate the barrier but cannot extend in the target sandstone layers.When the interlayer stress difference coefficient is greater than 0.45,the fractures only extend in the perforated reservoir,but not penetrate the layers.Increasing the viscosity and pump rates of the fracturing fluid can compensate for the energy loss and break through the barrier limit.The injection of high viscosity(50–100 mPa·s)fracturing fluid at high pump rates(12–18 m^(3)/min)is conducive to fracture penetration in the thin sand-mud interbedded reservoirs in the Sulige gas field.

Can Tibetan medicine Honghua Ruyi pills relieve endometriosisassociated dysmenorrhea?Protocol for a randomized placebocontrolled trial

Objective:To provide high-quality clinical evidence of the efficacy of Tibetan medicine Honghua Ruyi(HHRY)pills for endometriosis-associated dysmenorrhea.Methods:This study constitutes a multicenter,randomized,double-blind,placebo-controlled trial encompassing a three-menstrual cycle intervention followed by a three-menstrual cycle follow-up period.A total of 164 eligible females with endometriosis-associated dysmenorrhea were randomly divided into HHRY pills and placebo groups in a 1:1 ratio.The primary outcome included dysmenorrhea symptoms assessed using Visual Analog Scale(VAS)scores and quality of life,whereas the secondary outcome measures included the maximum VAS for non-menstrual pelvic pain,duration of pain episodes(in days),frequency and quantity of the consumption of ibuprofen sustained-release capsules(or other non-steroidal anti-inflammatory drugs),and days off work/study for staff/student due to dysmenorrhea,ovarian cyst,and/or pelvic nodule size.The safety was monitored throughout the treatment period.All the analyses were based on the intention-to-treat principle.For continuous outcomes,simple or multiple linear regressions were used to estimate the differences between the HHRY pills and placebo groups,with categorical data expressed as the number and percentage of occurrences.Differences were compared using the chi-square test or Fisher's exact test.The predefined analysis was adjusted for concomitant treatment,a variable considered to be associated with outcomes but unaffected by treatment allocation.Estimates of treatment effects were reported with 95%confidence intervals.Two-tailed P values≤.05 were considered statistically significant.Conclusion:Positive results from this trial,upon completion would provide robust evidence for the efficacy and safety of HHRY pills in treating dysmenorrhea in patients with endometriosis.

Detachable string magnetically controlled capsule endoscopy for the noninvasive diagnosis of esophageal diseases:A prospective,blind clinical study

BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.

Helicobacter pylori infection may result in poor gastric cleanliness in magnetically controlled capsule gastroscopy examination: A singlecenter retrospective study

Objective:Magnetically controlled capsule gastroscopy(MCCG)is an effective method for screening gastric diseases;however,its performance may be affected by gastric cleanliness.We aimed to explore the correlation between Helicobacter pylori infection and the degree of gastric cleanliness in the MCCG.Methods:This retrospective study enrolled 297 participants from October 2020 to April 2024 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Participant characteristics,MCCG examination results,and(13)C-urea breath test(C13-UBT)results were collected.The gastric cleanliness in MCCG examinations was assessed using a gastric cleanliness score.Binary logistic regression was used to analyze the relationships among participant characteristics,H.pylori infection,and gastric cleanliness.Chi-square tests and Fisher's exact tests were used to analyze the relationships among gastric lesions,H.pylori infection,and gastric cleanliness.Results:Among the participants,24.2%had H.pylori infection,and 17.5%had poor gastric cleanliness.Hypertension(odds ratio[OR]:2.63;95%confidence interval[CI]:1.36e5.09;p?0.004)was associated with a greater likelihood of H.pylori infection.H.pylori infection(OR:3.76;95%CI:1.99e7.09;p<0.001)was an independent risk factor for poor gastric cleanliness in the MCCG.A significant disparity was noted in the prevalence of focal erosions(p<0.001),gastric ulcers(p?0.001),and positive gastric lesions(p?0.027)between the 2 groups with and without H.pylori infection.The proportion of positive gastric lesions was not significantly different between the good gastric cleanliness group and the poor gastric cleanliness group(25.7%vs.21.2%;p?0.490).Conclusion:The findings of this study revealed that H.pylori infection was associated with hypertension.H.pylori infection may lead to poor gastric cleanliness.Institutions are advised to perform C13-UBT before MCCG,and participants should be informed of the risk of poor gastric cleanliness if the results are positive.The decision to perform H.pylori eradication before MCCG should take into account patient willingness and the benefit-to-risk ratio.

Cross-section distortion and springback characteristics of double-cavity aluminum profile in force controlled stretch-bending

3D elastic-plastic FE model for simulating the force controlled stretch-bending process of double-cavity aluminum profile was established using hybrid explicit−implicit solvent method.Considering the computational accuracy and efficiency,the optimal choices of numerical parameters and algorithms in FE modelling were determined.The formation mechanisms of cross-section distortion and springback were revealed.The effects of pre-stretching,post-stretching,friction,and the addition of internal fillers on forming quality were investigated.The results show that the stress state of profile in stretch-bending is uniaxial with only a circumferential stress.The stress distribution along the length direction of profile is non-uniform and the maximum tensile stress is located at a certain distance away from the center of profile.As aluminum profile is gradually attached to bending die,the distribution characteristic of cross-section distortion along the length direction of profile changes from V-shape to W-shape.After unloading the forming tools,cross-section distortion decreases obviously due to the stress relaxation,with a maximum distortion difference of 13%before and after unloading.As pre-stretching and post-stretching forces increase,cross-section distortion increases gradually,while springback first decreases and then remains unchanged.With increasing friction between bending die and profile,cross-section distortion slightly decreases,while springback increases.Cross-section distortion decreases by 83%with adding PVC fillers into the cavities of profile,while springback increases by 192.2%.

Effects of Lycium barbarum polysaccharide on cytokines in adolescents with subthreshold depression:a randomized controlled study

Strong evidence has accumulated to show a correlation between depression symptoms and inflammatory responses.Moreover,anti-inflammatory treatment has shown partial effectiveness in alleviating depression symptoms.Lycium barbarum polysaccharide(LBP),derived from Goji berries,exhibits notable antioxidative and anti-inflammatory properties.In our recent double-blinded randomized placebo-controlled trial,we found that LBP significantly reduced depressive symptoms in adolescents with subthreshold depression.It is presumed that the antidepressant effect of LBP may be associated with its influence on inflammatory cytokines.In the double-blinded randomized controlled trial,we enrolled 29 adolescents with subthreshold depression and randomly divided them into an LBP group and a placebo group.In the LBP group,adolescents were given 300 mg/d LBP.A 6-week follow up was completed by 24 adolescents,comprising 14 adolescents from the LBP group(15.36±2.06 years,3 men and 11 women)and 10 adolescents from the placebo group(14.9±1.6 years,2 men and 8 women).Our results showed that after 6 weeks of treatment,the interleukin-17A level in the LBP group was lower than that in the placebo group.Network analysis showed that LBP reduced the correlations and connectivity between inflammatory factors,which were associated with the improvement in depressive symptoms.These findings suggest that 6-week administration of LBP suppresses the immune response by reducing interleukin-17A level,thereby exerting an antidepressant effect.

Propofol sedation in routine endoscopy:A case series comparing target controlled infusion vs manually controlled bolus concept

BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.

Acupuncture for overactive bladder in adults:Study protocol for a randomized controlled trial

Background:Overactive bladder(OAB)is a prevalent condition that substantially degrades patient quality of life.Acupuncture is recognized as an effective therapeutic approach for various urological diseases.However,there is limited evidence validating the effectiveness and safety of acupuncture for OABs.Objective:To assess the therapeutic efficacy of acupuncture for OAB and to investigate the potential mechanisms by analyzing its effects on relevant urinary biomarkers.Methods:This is a randomized,participants and outcome assessors blinded,sham acupuncture controlled trial.A total of 110 patients with OABs will be randomly divided in a 1:1 ratio between the acupuncture and sham acupuncture groups.Participants in the acupuncture group will undergo 30-min authentic acupuncture,while their counterparts in the sham acupuncture group will undergo sham acupuncture needling non-acupoints superficially three times weekly for a duration of 8 weeks.The two co-primary outcomes will be the change in the mean number of micturitions per 24 h from baseline to the end of the 8-week treatment and 20-week follow-up.The secondary outcomes will encompass the change in Overactive Bladder Symptom Score,Overactive Bladder Questionnaire Short Form,and average 24 h values of urgency,daytime micturition,nocturia,and mean volume voided per micturition from baseline to weeks 8 and 20.Urinary nerve growth factor,brain-derived neurotrophic factor,and monocyte chemoattractant protein-1 levels will be measured at baseline and week 8.Adverse events will also be documented.Discussion:The results of this trial will provide evidence for the effectiveness and safety of acupuncture in the management of OAB.

Electroacupuncture with different waveforms for primary dysmenorrhea:A randomized controlled trial

Objective:To observe and compare the clinical effects of different electroacupuncture waveforms on primary dysmenorrhea.Methods: This was a prospective,randomized,three-group,parallel-controlled trial.Participants with primary dysmenorrhea were randomly divided into dense-sparse wave,continuous wave,and discontinuous wave groups in a 1:1:1 ratio.Two lateral Ciliao(BL 32)points were used.All three groups started treatment 3–5 days before menstruation,once a day for six sessions per course of treatment,one course of treatment per menstrual cycle,and three menstrual cycles.The primary outcome measure was the proportion with an average visual analog scale(VAS)score reduction of≥50%from baseline for dysmenorrhea in the third menstrual cycle during treatment.The secondary outcome measures included changes in dysmenorrhea VAS scores,Cox Menstrual Symptom Scale scores and the proportion of patients taking analgesic drugs.Results: The proportion of cases where the average VAS score for dysmenorrhea decreased by≥50%from baseline in the third menstrual cycle was not statistically significant(P>.05).Precisely 30 min after acupuncture and regarding immediate analgesia on the most severe day of dysmenorrhea,there was a statistically significant difference in the dense-sparse wave group compared with the other two groups during the third menstrual cycle(P<.05).Additionally,there was a statistically significant difference between the dense-sparse wave and discontinuous wave groups 24 h after acupuncture(P<.05).Conclusions: Waveform electroacupuncture can alleviate primary dysmenorrhea and its related symptoms in patients.The three groups showed similar results in terms of short-and long-term analgesic efficacy and a reduction in the number of patients taking analgesic drugs.Regarding achieving immediate analgesia,the dense-sparse wave group was slightly better than the other two groups.