Choosing ankle tourniquets in foot and ankle surgery: Beyond postoperative pain considerations

This editorial critically explores the use of ankle vs thigh tourniquets in foot and ankle surgery based on a recent study that found no significant difference in postoperative pain between the two placement techniques.Despite these findings,we argue for the preferential use of ankle tourniquets,highlighting their potential benefits in reducing venous blood stasis and minimizing soft tissue injury.This approach underscores the importance of considering long-term patient outcomes and vascular health beyond immediate postoperative pain.By integrating study findings with broader clinical considerations,we hereby advocate for a nuanced approach to tourniquet use that prioritizes patient safety and long-term recovery in conjunction with immediate postoperative pain.

Creation of "Regional Characteristic" in Planning and Design of Farmers' Residential Area at the South of Lower Reaches of the Yangtze River

After analysis of location feature of the south of lower reaches of Yangtze River and its construction of urban and rural integration,the paper pointed out harmonious combination between natural and artificial factors had been neglected in planning and design of farmers' residential area at the south of lower reaches of Yangtze River,"regional characteristic" losing,residential area in the form of "city community" and buildings in European style.In view of these problems,relevant planning and design thoughts and methods had been proposed as to how to create "regional characteristic" from the perspective of planning,architecture and landscape design.It discussed with emphasis the importance of construction base type and combination of environment with residential area construction;inspirations and design methods obtained from traditional architectures;and the content of landscape overall planning and specific design.It was hoped to enlighten designers to shoulder social and historical responsibility,make exploration unremittingly,and construct beautiful homelands for people.

Lowering ash slagging and fouling tendency of high-alkali coal by hydrothermal pretreatment

High-alkali species in coal are notorious for causing ash slagging and fouling incidents.In this paper,four high-alkali coals were individually subject to hydrothermal pretreatment(HTP),within a batch-type autoclave at 300 -C for 1 h,and the treated coals were analyzed,along with the oxygen-containing functional groups determined by Fourier transform infrared spectrometer(FT-IR).Then the alkali species and other components in the coal ash were quantified by X-ray fluorescence(XRF)for evaluating the ash slagging and fouling tendency.Apart from this,FactSage was adopted to simulate the occurrence and transformation of alkali species during coal thermal conversion ending at various temperatures.The findings indicate that the treated coals are superior to the parent ones in terms of certain remarkable changes via HTP.The moisture,oxygen and sulfur of the hydrothermally treated coals decline obviously,while the calorific value rises sharply.HTP could reduce the alkali species to less than 2%(%,by weight,equivalent to Na2O in dry ash),with a maximum removal ratio of 88.9%,lowering the ash slagging and fouling tendency.The proposed mechanism of HTP was that the alkali species in coal matrix became released due to the breakage of the coal functional groups and micropores during HTP.

Insulin plus incretin:A glucose-lowering strategy for type 2-diabetes

There are many advantages of combining incretin therapy[glucagon-like peptide-1(GLP-1)receptor agonists and dipeptidyl peptidase-4(DPP-4)inhibitors]with insulin therapy as a glucose-lowering strategy in type2 diabetes.One important advantage is the complementary mode of the mechanistic action of incretin and insulin therapy.Another advantage is the reduction in risk of hypoglycemia and weight gain when adding incretin therapy to insulin.Several clinical trials have studied the addition of GLP-1 receptor agonists[exenatide BID(twice daily),lixisenatide,albiglutide]or DPP-4inhibitors(vildagliptin,sitagliptin,saxagliptin,alogliptin,linagliptin)to ongoing insulin therapy or adding insulin to ongoing therapy with a GLP-1 receptor agonist(liraglutide).These studies show improved glycemia in the presence of limited risk for hypoglycemia and weight gain with the combination of incretin therapy with insulin.This article reviews the background and clinical studies on this combination.

Left-sided appendicitis:Review of 95 published cases and a case report

AIM:To give an overview of the literature on left-sided acute appendicitis (LSAA) associated with situs inversus totalis (SIT) and midgut malrotation (MM).METHODS:We present a new case of LSAA with SIT and a literature review of studies published in the English language on LSAA,accessed via PubMed and Google Scholar databases.RESULTS:Ninety-five published cases of LSAA were evaluated and a 25-year-old female,who presented to our clinic with left lower abdominal pain caused by LSAA,is reported.In the reviewed literature,fiftyseven patients were male and 38 were female with an age range of 8 to 82 years and a median age of 29.1 ± 15.9 years.Sixty-six patients had SIT,23 had MM,three had cecal malrotation,and two had a previously unnoted congenital abnormality.Fifty-nine patients had presentedto the hospital with left lower,14 with right lower and seven with bilateral lower quadrant pain,and seven subjects complained of left upper quadrant pain.The diagnosis was established preoperatively in 49 patients,intraoperatively in 19,and during the postoperative period in five;14 patients were aware of having this anomaly.The data of eight patients were not unavailable.Eleven patients underwent laparoscopic appendectomy,which was combined with cholecystectomy in two cases.Histopathological examination of the appendix specimens revealed adenocarcinoma in only two of 95 patients.CONCLUSION:The diagnosis of left lower quadrant pain is based on well-established clinical symptoms,physical examination and physician's experience.

Special considerations in the management of lower GI bleed by interventional radiology

Despite the rapid development of diagnostic and therapeutic modalities and techniques to manage LGIB patients from interventional radiology’s standpoint,a successful localization of the bleeding site that leads to an effective embolotherapy remains a significant technical challenge.The interventional radiologist’s decisions when managing patients with LGIB may significantly impact the clinical outcomes;therefore,management should be made based on careful and thorough considerations of factors such as etiology,locations,patient’s comorbidities,and potential post-procedure complications,among others.The purpose of this paper is to review the management of LGIB by interventional radiology,focusing on a few challenging and common clinical situations that require special consideration by interventional radiologists.

Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness

To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skillsare achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls' prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo(Students' t test P < 0.05). Slacklining's external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.

Curcuminoids Target Decreasing Serum Adipocyte-fatty Acid Binding Protein Levels in Their Glucose-lowering Effect in Patients with Type 2 Diabetes

Whether supplementation of curcuminoids decreases serum adipocyte-fatty acid binding protein（A-FABP） level and whether this decrease benefits glucose control is unclear.One-hundred participants（n=50 administered curcuminoids,n=50 administered placebo） from our previous report on the effect of curcuminoids on type 2 diabetes in a 3-month intervention were assessed for levels of serum A-FABP,oxidative stress,and inflammatory biomarkers.Curcuminoids supplementation led to significant decreases in serum A-FABP,C-reactive protein（CRP）,tumor necrosis factor-α,and interleukin-6 levels.Curcuminoids supplementation also significantly increased serum superoxide dismutase（SOD） activity.The change in serum A-FABP levels showed positive correlations with changes in levels of glucose,free fatty acids（FFAs）,and CRP in subjects supplemented with curcuminoids.Further stepwise regression analysis showed that A-FABP was an independent predictor for levels of FFAs,SOD,and CRP.These results suggest that curcuminoids may exert anti-diabetic effects,at least in part,by reductions in serum A-FABP level.A-FABP reduction is associated with improved metabolic parameters in human type 2 diabetes.

Plasma apo CⅢ Levels in Relation to Inflammatory Traits and Metabolic Syndrome in Patients not Treated with Lipid-lowering Drugs Undergoing Coronary Angiography

Objective Assessment of the comprehensive relationship among apolipoprotein CIII（apoCⅢ） levels, inflammation, and metabolic disorders is rare. Methods A total of 1455 consecutive patients not treated with lipid-lowering drugs and undergoing coronary angiography were enrolled in this cross-sectional study. A mediation analysis was used to detect the underlying role of apoCⅢ in the association of inflammation with metabolic syndrome（MetS）. Results Patients with MetS showed higher levels of apoCⅢ [95.1（73.1-131.4） vs. 81.7（58.6-112.4） μg/mL, P 〈 0.001] and inflammatory markers [high sensitivity C-reactive protein, 1.7（0.8-3.4） vs. 1.1（0.5-2.2） mg/L; white blood cell count,（6.48 ± 1.68） vs.（6.11 ± 1.67） × 10~9/L]. The levels of apoCⅢ and inflammatory markers increased with the number of metabolic risk components（all P 〈 0.001）. Furthermore, apoCⅢ levels were associated with virtually all individual MetS risk factors and inflammatory markers（all P 〈 0.05）. Importantly, the prevalence of MetS in each metabolic disorder rose as apoCⅢ levels increased（all P 〈 0.05）. Mediation analysis showed that apoCⅢ partially mediated the effect of inflammation on MetS independently from triglycerides. Conclusion Plasma apoCⅢ levels were significantly associated with the development and severity of MetS, and a role of apoCⅢ in the effect of inflammation on the development of MetS was identified.

Entropy Exchange and Entanglement in Superconducting Charge Qubit Inside a Resonant Cavity with Intrinsic Decoherence

By considering the intrinsic decoherence effect, we investigate the entropy exchange and entanglement in the interacting system of a superconducting charge qubit coupled to a single-mode optical cavity. We found that although the intrinsic decoherence leads to an irreversible evolution of the interacting system due to a suppression of coherent quantum features through the decay of off-diagonal matrix elements of the density operator, and has an apparently influence on the partial entropies of the two-component subsystems, it dose not destroy entropy exchange behavior. In addition, the lower bound of the concurrence, as the measure of entanglement of the coupling system, is calculated. It is shown that the evolution of entanglement is sensitive to the change of the intrinsic decoherence.

Obsolescence optimization of electronic and mechatronic components by considering dependability and energy consumption

Nowadays, rapid technological progress influences the dependability of equipments and also causes rapid obsolescence. The mechatronic and electronic equipment components are mostly affected by obsolescence. A new challenger unit possesses identical functionalities, but with higher performances. This work aims to find the optimal number of components which should be replaced by new-type units, under budgetary constraints. In this work, the new challenger unit is characterized by lower energy consumption and the optimization steps are based on genetic algorithm (GA). The result shows the importance of this type of replacement in order to economize energy consumption and to deal with obsolescence.

Three-stage tectonic subsidence and its implications for the evolution of conjugate margins of the southwest subbasin,South China Sea

To reveal the tectonic characteristics of the continental margins in the southwest subbasin(SWB)of the South China Sea,a long high-resolution seismic profile was studied using empty basin subsidence.We find that tectonic subsidence features on both margins are uniformly divided into three stages:(1)slow subsidence from Tg to 18.5 Ma(synrift stage);(2)extremely slow subsidence/uplift from18.5 to 16 Ma(spreading stage);and(3)accelerated subsidence from 16 to 0 Ma(post-spreading stage).This feature differs from the classic tectonic subsidence pattern of rifted basins,which exhibits fast subsidence during synrift stage and slow subsidence during the post-rift stage.The tectonic uplift occurred during the spreading stage and the magnitude increased from the continent to the ocean,which is likely related to mantle flow during seafloor spreading.We propose that lower crustal flow played a significant role in the tectonic evolution of the continental margins of the SWB.The lower crust of the SWB margins was warmer and therefore weaker,and more prone to flow beneath the faulting center,which compensated for the upper crustal thinning caused by brittle faulting during the synrift period and thus reduced the tectonic subsidence rate.During the spreading stage,faulting attenuated rapidly,and a necking zone appeared at the continentocean transition formed by lithospheric extension.With upwelling asthenosphere,small-scale secondary mantle convection occurred under the necking zone,which raised the continental margin isotherms and increased the buoyancy.Simultaneously,secondary mantle convection lifted the overriding crust,thus the overall subsidence rate decreased sharply or even reversed to uplift.After seafloor spreading,the effect of mantle convection faded away,and sediment loading drove the lower crust to flow landward.Thermal relaxation,lower crust flow,and vanish of secondary mantle convection together led to rapid subsidence in this stage.

Frequency-locking and threshold current-lowering effects of a quantum cascade laser and an application in gas detection field

In this paper,the frequency-locking and threshold current-lowering effects of a quantum cascade laser are studied and achieved.Combined with cavity-enhanced absorption spectroscopy,the noninvasive detection of H_2 with a prepared concentration of 500 ppm in multiple dissolved gases is performed and evaluated.The high frequency selectivity of 0.0051 cm^-1 at an acquisition time of 1 s allows the sensitive detection of the（1-0） S（l） band of H_2 with a high accuracy of（96.53±0.29）%and shows that the detection limit to an absorption line of 4712.9046 cm^-1 is approximately（17.26±0.63） ppm at an atmospheric pressure and a temperature of 20 ℃.

The influence and explanation of fringing-induced barrier lowering on sub-100 nm MOSFETs with high-k gate dielectrics

The fringing-induced barrier lowering（FIBL） effect of sub-100 nm MOSFETs with high-k gate dielectrics is investigated using a two-dimensional device simulator.An equivalent capacitance theory is proposed to explain the physics mechanism of the FIBL effect.The FIBL effect is enhanced and the short channel performance is degraded with increasing capacitance.Based on equivalent capacitance theory,the influences of channel length,junction depth,gate/lightly doped drain（LDD） overlap length,spacer material and spacer width on FIBL is thoroughly investigated.A stack gate dielectric is presented to suppress the FIBL effect.

Effect of Glucose-lowering of Heteropolytungstogermanate β-K_6H[GeW_9V_3O_(40)]·9H_2O

Preliminary tests in rats have shown that the title complex is an efficient insulin mimic, which may be the first example of polyoxomatalates possessing insulin mimetic activity.

Analytical model including the fringing-induced barrier lowering effect for a dual-material surrounding-gate MOSFET with a high-κ gate dielectric

By solving Poisson＇s equation in both semiconductor and gate insulator regions in the cylindrical coordinates, an analytical model for a dual-material surrounding-gate （DMSG） metal-oxide semiconductor field-effect transistor （MOSFET） with a high-k gate dielectric has been developed. Using the derived model, the influences of fringing-induced barrier lowering （FIBL） on surface potential, subthreshold current, DIBL, and subthreshold swing are investigated. It is found that for the same equivalent oxide thickness, the gate insulator with high-k dielectric degrades the short-channel performance of the DMSG MOSFET. The accuracy of the analytical model is verified by the good agreement of its results with that obtained from the ISE three-dimensional numerical device simulator.

Modeling of the drain-induced barrier lowering effect and optimization for a dual-channel 4H silicon carbide metal semiconductor field effect transistor

A new analytical model to describe the drain-induced barrier lowering （DIBL） effect has been obtained by solving the two-dimensional （2D） Poisson＇s equation for the dual-channel 4H-SiC MESFET （DCFET）. Using this analytical model, we calculate the threshold voltage shift and the sub-threshold slope factor of the DCFET, which characterize the DIBL effect. The results show that they are significantly dependent on the drain bias, gate length as well as the thickness and doping concentration of the two channel layers. Based on this analytical model, the structure parameters of the DCFET have been optimized in order to suppress the DIBL effect and improve the performance.

Total-Ionizing-Dose-Induced Body Current Lowering in the 130 nm PDSOI I/O NMOSFETs

The body current lowering effect of 130 nm partially depleted silicon-on-insulator (PDSOI) input/output (I/O) n-type metal-oxide-semiconductor field-effect transistors (NMOSFETs) induced by total-ionizing dose is observed and analyzed. The decay tendency of current ratio of body current and drain current I-b/I-d is also investigated. Theoretical analysis and TCAD simulation results indicate that the physical mechanism of body current lowering effect is the reduction of maximum lateral electric field of the pinch-off region induced by the trapped charges in the buried oxide layer (BOX). The positive charges in the BOX layer can counteract the maximum lateral electric field to some extent.

Study on Response Surface Methodology Optimization for Extraction Process of Cyclocarya paliurus Extract and Its Blood Sugar-lowering Effect

[Objectives]This study was conducted to discuss the mechanism of the blood sugar-lowering effect of Cyclocarya paliurus extract.[Methods]With C.paliurus leaves as the raw material,the ethyl acetate-butyl acetate microwave extraction process of C.paliurus was studied.With the yield of C.paliurus extract as an evaluation index,single-factor experiments were carried out on such 6 factors as the dry C.paliurus leaf powder size,solid-to-liquid ratio,extraction time,microwave frequency,microwave power,and microwave extraction time,and the extraction and purification process was further optimized by response surface analysis.The normal mice and the hyperglycemic mice modeled by alloxan were injected with C.paliurus extract to study the blood sugar-lowering effects of different groups of C.paliurus extract.[Results]The optimal process combination for the extraction of C.paliurus leaves was obtained:dry C.paliurus powder size 90-100 mesh,solid-to-liquid ratio 1∶20(g/ml),extraction time 192 min,microwave frequency 2500 MHz,microwave power 490 W,and extraction time 248 s.Under these conditions,the yield of C.paliurus extract reached the maximum,95.10%,reaching 99.83%of the predicted value.The blood sugar-lowering test on mice showed that the C.paliurus extract had a good effect on lowering blood sugar,indicating that C.paliurus extract can improve the free radical scavenging capacity to a certain extent.[Conclusions]This study provides certain reference for the in-depth study of the physiological effects of C.paliurus extract and the comprehensive development and utilization of C.paliurus extract.