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

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

Corneal collagen cross-linking in patients with keratoconus from the Dresden protocol to customized solutions:theoretical basis

Keratoconus is an ectatic condition characterized by gradual corneal thinning,corneal protrusion,progressive irregular astigmatism,corneal fibrosis,and visual impairment.The therapeutic options regarding improvement of visual function include glasses or soft contact lenses correction for initial stages,gas-permeable rigid contact lenses,scleral lenses,implantation of intrastromal corneal ring or corneal transplants for most advanced stages.In keratoconus cases showing disease progression corneal collagen crosslinking(CXL)has been proven to be an effective,minimally invasive and safe procedure.CXL consists of a photochemical reaction of corneal collagen by riboflavin stimulation with ultraviolet A radiation,resulting in stromal crosslinks formation.The aim of this review is to carry out an examination of CXL methods based on theoretical basis and mathematical models,from the original Dresden protocol to the most recent developments in the technique,reporting the changes proposed in the last 15y and examining the advantages and disadvantages of the various treatment protocols.Finally,the limits of non-standardized methods and the perspectives offered by a customization of the treatment are highlighted.

Quantitatively characterizing sandy soil structure altered by MICP using multi-level thresholding segmentation algorithm

The influences of biological,chemical,and flow processes on soil structure through microbially induced carbonate precipitation(MICP)are not yet fully understood.In this study,we use a multi-level thresholding segmentation algorithm,genetic algorithm(GA)enhanced Kapur entropy(KE)(GAE-KE),to accomplish quantitative characterization of sandy soil structure altered by MICP cementation.A sandy soil sample was treated using MICP method and scanned by the synchrotron radiation(SR)micro-CT with a resolution of 6.5 mm.After validation,tri-level thresholding segmentation using GAE-KE successfully separated the precipitated calcium carbonate crystals from sand particles and pores.The spatial distributions of porosity,pore structure parameters,and flow characteristics were calculated for quantitative characterization.The results offer pore-scale insights into the MICP treatment effect,and the quantitative understanding confirms the feasibility of the GAE-KE multi-level thresholding segmentation algorithm.

Falcon Optimization Algorithm-Based Energy Efficient Communication Protocol for Cluster-Based Vehicular Networks

Rapid development in Information Technology(IT)has allowed several novel application regions like large outdoor vehicular networks for Vehicle-to-Vehicle(V2V)transmission.Vehicular networks give a safe and more effective driving experience by presenting time-sensitive and location-aware data.The communication occurs directly between V2V and Base Station(BS)units such as the Road Side Unit(RSU),named as a Vehicle to Infrastructure(V2I).However,the frequent topology alterations in VANETs generate several problems with data transmission as the vehicle velocity differs with time.Therefore,the scheme of an effectual routing protocol for reliable and stable communications is significant.Current research demonstrates that clustering is an intelligent method for effectual routing in a mobile environment.Therefore,this article presents a Falcon Optimization Algorithm-based Energy Efficient Communication Protocol for Cluster-based Routing(FOA-EECPCR)technique in VANETS.The FOA-EECPCR technique intends to group the vehicles and determine the shortest route in the VANET.To accomplish this,the FOA-EECPCR technique initially clusters the vehicles using FOA with fitness functions comprising energy,distance,and trust level.For the routing process,the Sparrow Search Algorithm(SSA)is derived with a fitness function that encompasses two variables,namely,energy and distance.A series of experiments have been conducted to exhibit the enhanced performance of the FOA-EECPCR method.The experimental outcomes demonstrate the enhanced performance of the FOA-EECPCR approach over other current methods.

Cell replacement with stem cell-derived retinal ganglion cells from different protocols

Glaucoma,characterized by a degenerative loss of retinal ganglion cells,is the second leading cause of blindness worldwide.There is currently no cure for vision loss in glaucoma because retinal ganglion cells do not regenerate and are not replaced after injury.Human stem cell-derived retinal ganglion cell transplant is a potential therapeutic strategy for retinal ganglion cell degenerative diseases.In this review,we first discuss a 2D protocol for retinal ganglion cell differentiation from human stem cell culture,including a rapid protocol that can generate retinal ganglion cells in less than two weeks and focus on their transplantation outcomes.Next,we discuss using 3D retinal organoids for retinal ganglion cell transplantation,comparing cell suspensions and clusters.This review provides insight into current knowledge on human stem cell-derived retinal ganglion cell differentiation and transplantation,with an impact on the field of regenerative medicine and especially retinal ganglion cell degenerative diseases such as glaucoma and other optic neuropathies.

Home Monitoring of Estrone-3-Glucuronide (E1-3G) Levels in Two Different Ovarian Stimulation Protocols: A Pilot Study

Background: Studies have shown a strong correlation between the growth of E2 in serum and estrone-3-glucuronide (E1-3G) in urine during ovarian stimulation. Thus, we developed theoretical models for using urinary E1-3G in ovarian stimulation and focused on their experimental verification and analysis. Methods: A prospective, observational pilot study was conducted involving 54 patients who underwent 54 cycles of ovarian stimulation. The goal was to establish the growth rate of urinary E1-3G during the course of stimulation and to determine the daily upper and lower limits of growth rates at which stimulation is appropriate and safe. Controlled ovarian stimulation was performed using two different stimulation protocols—an antagonist protocol in 25 cases and a progestin-primed ovarian stimulation protocol (PPOS) in 29 cases, with fixed doses of gonadotropins. From the second day of stimulation, patients self-measured their daily urine E1-3G levels at home using a portable analyzer. In parallel, a standard ultrasound follow-up protocol accompanied by a determination of E2, LH, and P levels was applied to optimally control stimulation. Results: The average daily growth rates in both groups were about 50%. The daily increase in E1-3G for the antagonist protocol ranged from 14% to 79%, while they were 28% to 79% for the PPOS protocol. Conclusion: This is the first study to analyze the dynamics of E1-3G in two different protocols and to estimate the limits of its increase during the entire course of the stimulation. The results confirm our theoretical model for the viability of using urinary E1-3G for monitoring ovarian stimulation.

Design of an Efficient and Provable Secure Key Exchange Protocol for HTTP Cookies

Cookies are considered a fundamental means of web application services for authenticating various Hypertext Transfer Protocol(HTTP)requests andmaintains the states of clients’information over the Internet.HTTP cookies are exploited to carry client patterns observed by a website.These client patterns facilitate the particular client’s future visit to the corresponding website.However,security and privacy are the primary concerns owing to the value of information over public channels and the storage of client information on the browser.Several protocols have been introduced that maintain HTTP cookies,but many of those fail to achieve the required security,or require a lot of resource overheads.In this article,we have introduced a lightweight Elliptic Curve Cryptographic(ECC)based protocol for authenticating client and server transactions to maintain the privacy and security of HTTP cookies.Our proposed protocol uses a secret key embedded within a cookie.The proposed protocol ismore efficient and lightweight than related protocols because of its reduced computation,storage,and communication costs.Moreover,the analysis presented in this paper confirms that proposed protocol resists various known attacks.

Scheme Based on Multi-Level Patch Attention and Lesion Localization for Diabetic Retinopathy Grading

Early screening of diabetes retinopathy(DR)plays an important role in preventing irreversible blindness.Existing research has failed to fully explore effective DR lesion information in fundus maps.Besides,traditional attention schemes have not considered the impact of lesion type differences on grading,resulting in unreasonable extraction of important lesion features.Therefore,this paper proposes a DR diagnosis scheme that integrates a multi-level patch attention generator(MPAG)and a lesion localization module(LLM).Firstly,MPAGis used to predict patches of different sizes and generate a weighted attention map based on the prediction score and the types of lesions contained in the patches,fully considering the impact of lesion type differences on grading,solving the problem that the attention maps of lesions cannot be further refined and then adapted to the final DR diagnosis task.Secondly,the LLM generates a global attention map based on localization.Finally,the weighted attention map and global attention map are weighted with the fundus map to fully explore effective DR lesion information and increase the attention of the classification network to lesion details.This paper demonstrates the effectiveness of the proposed method through extensive experiments on the public DDR dataset,obtaining an accuracy of 0.8064.

Enhancing Network Design through Statistical Evaluation of MANET Routing Protocols

This paper contributes a sophisticated statistical method for the assessment of performance in routing protocols salient Mobile Ad Hoc Network(MANET)routing protocols:Destination Sequenced Distance Vector(DSDV),Ad hoc On-Demand Distance Vector(AODV),Dynamic Source Routing(DSR),and Zone Routing Protocol(ZRP).In this paper,the evaluation will be carried out using complete sets of statistical tests such as Kruskal-Wallis,Mann-Whitney,and Friedman.It articulates a systematic evaluation of how the performance of the previous protocols varies with the number of nodes and the mobility patterns.The study is premised upon the Quality of Service(QoS)metrics of throughput,packet delivery ratio,and end-to-end delay to gain an adequate understanding of the operational efficiency of each protocol under different network scenarios.The findings explained significant differences in the performance of different routing protocols;as a result,decisions for the selection and optimization of routing protocols can be taken effectively according to different network requirements.This paper is a step forward in the general understanding of the routing dynamics of MANETs and contributes significantly to the strategic deployment of robust and efficient network infrastructures.

Deep neural network based on multi-level wavelet and attention for structured illumination microscopy

Structured illumination microscopy(SIM)is a popular and powerful super-resolution(SR)technique in biomedical research.However,the conventional reconstruction algorithm for SIM heavily relies on the accurate prior knowledge of illumination patterns and signal-to-noise ratio(SNR)of raw images.To obtain high-quality SR images,several raw images need to be captured under high fluorescence level,which further restricts SIM’s temporal resolution and its applications.Deep learning(DL)is a data-driven technology that has been used to expand the limits of optical microscopy.In this study,we propose a deep neural network based on multi-level wavelet and attention mechanism(MWAM)for SIM.Our results show that the MWAM network can extract high-frequency information contained in SIM raw images and accurately integrate it into the output image,resulting in superior SR images compared to those generated using wide-field images as input data.We also demonstrate that the number of SIM raw images can be reduced to three,with one image in each illumination orientation,to achieve the optimal tradeoff between temporal and spatial resolution.Furthermore,our MWAM network exhibits superior reconstruction ability on low-SNR images compared to conventional SIM algorithms.We have also analyzed the adaptability of this network on other biological samples and successfully applied the pretrained model to other SIM systems.

Designing Proportional-Integral Consensus Protocols for Second-Order Multi-Agent Systems Using Delayed and Memorized State Information

This paper is concerned with consensus of a secondorder linear time-invariant multi-agent system in the situation that there exists a communication delay among the agents in the network.A proportional-integral consensus protocol is designed by using delayed and memorized state information.Under the proportional-integral consensus protocol,the consensus problem of the multi-agent system is transformed into the problem of asymptotic stability of the corresponding linear time-invariant time-delay system.Note that the location of the eigenvalues of the corresponding characteristic function of the linear time-invariant time-delay system not only determines the stability of the system,but also plays a critical role in the dynamic performance of the system.In this paper,based on recent results on the distribution of roots of quasi-polynomials,several necessary conditions for Hurwitz stability for a class of quasi-polynomials are first derived.Then allowable regions of consensus protocol parameters are estimated.Some necessary and sufficient conditions for determining effective protocol parameters are provided.The designed protocol can achieve consensus and improve the dynamic performance of the second-order multi-agent system.Moreover,the effects of delays on consensus of systems of harmonic oscillators/double integrators under proportional-integral consensus protocols are investigated.Furthermore,some results on proportional-integral consensus are derived for a class of high-order linear time-invariant multi-agent systems.

A Formal Model for Analyzing Fair Exchange Protocols Based on Event Logic

Fair exchange protocols play a critical role in enabling two distrustful entities to conduct electronic data exchanges in a fair and secure manner.These protocols are widely used in electronic payment systems and electronic contract signing,ensuring the reliability and security of network transactions.In order to address the limitations of current research methods and enhance the analytical capabilities for fair exchange protocols,this paper proposes a formal model for analyzing such protocols.The proposed model begins with a thorough analysis of fair exchange protocols,followed by the formal definition of fairness.This definition accurately captures the inherent requirements of fair exchange protocols.Building upon event logic,the model incorporates the time factor into predicates and introduces knowledge set axioms.This enhancement empowers the improved logic to effectively describe the state and knowledge of protocol participants at different time points,facilitating reasoning about their acquired knowledge.To maximize the intruder’s capabilities,channel errors are translated into the behaviors of the intruder.The participants are further categorized into honest participants and malicious participants,enabling a comprehensive evaluation of the intruder’s potential impact.By employing a typical fair exchange protocol as an illustrative example,this paper demonstrates the detailed steps of utilizing the proposed model for protocol analysis.The entire process of protocol execution under attack scenarios is presented,shedding light on the underlying reasons for the attacks and proposing corresponding countermeasures.The developedmodel enhances the ability to reason about and evaluate the security properties of fair exchange protocols,thereby contributing to the advancement of secure network transactions.

Hyperbolic Tangent Function-Based Protocols for Global/Semi-Global Finite-Time Consensus of Multi-Agent Systems

This paper investigates the problem of global/semi-global finite-time consensus for integrator-type multi-agent sys-tems.New hyperbolic tangent function-based protocols are pro-posed to achieve global and semi-global finite-time consensus for both single-integrator and double-integrator multi-agent systems with leaderless undirected and leader-following directed commu-nication topologies.These new protocols not only provide an explicit upper-bound estimate for the settling time,but also have a user-prescribed bounded control level.In addition,compared to some existing results based on the saturation function,the pro-posed approach considerably simplifies the protocol design and the stability analysis.Illustrative examples and an application demonstrate the effectiveness of the proposed protocols.

Protocol for lower back pain management: Insights from the French healthcare system

In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.

A Multi-Token Sector Antenna Neighbor Discovery Protocol for Directional Ad Hoc Networks

In this paper,we propose a Multi-token Sector Antenna Neighbor Discovery(M-SAND)protocol to enhance the efficiency of neighbor discovery in asynchronous directional ad hoc networks.The central concept of our work involves maintaining multiple tokens across the network.To prevent mutual interference among multi-token holders,we introduce the time and space non-interference theorems.Furthermore,we propose a master-slave strategy between tokens.When the master token holder(MTH)performs the neighbor discovery,it decides which 1-hop neighbor is the next MTH and which 2-hop neighbors can be the new slave token holders(STHs).Using this approach,the MTH and multiple STHs can simultaneously discover their neighbors without causing interference with each other.Building on this foundation,we provide a comprehensive procedure for the M-SAND protocol.We also conduct theoretical analyses on the maximum number of STHs and the lower bound of multi-token generation probability.Finally,simulation results demonstrate the time efficiency of the M-SAND protocol.When compared to the QSAND protocol,which uses only one token,the total neighbor discovery time is reduced by 28% when 6beams and 112 nodes are employed.

Distributed Fault Estimation for Nonlinear Systems With Sensor Saturation and Deception Attacks Using Stochastic Communication Protocols

This paper is aimed at the distributed fault estimation issue associated with the potential loss of actuator efficiency for a type of discrete-time nonlinear systems with sensor saturation.For the distributed estimation structure under consideration,an estimation center is not necessary,and the estimator derives its information from itself and neighboring nodes,which fuses the state vector and the measurement vector.In an effort to cut down data conflicts in communication networks,the stochastic communication protocol(SCP)is employed so that the output signals from sensors can be selected.Additionally,a recursive security estimator scheme is created since attackers randomly inject malicious signals into the selected data.On this basis,sufficient conditions for a fault estimator with less conservatism are presented which ensure an upper bound of the estimation error covariance and the mean-square exponential boundedness of the estimating error.Finally,a numerical example is used to show the reliability and effectiveness of the considered distributed estimation algorithm.

Research trends of clinical studies on acupuncture protocols over the past 20 years:a bibliometric analysis

Background:Acupuncture protocols are essential as they guide study design and improve the quality of clinical trial,thus preventing avoid research waste.Given the increasing number of publications on acupuncture protocols,this study aimed to assess the publications trends of acupuncture protocols over the past two decades and provided an overview for future research directions.Methods:Publications focusing on acupuncture protocols in clinical settings were retrieved and compiled from the Web of Science Core Collection spanning the period from 2004 to 2023.CiteSpace and Microsoft Excel software were used to analyze the relationship of publication with countries,institutions,authors,co-cited author,journals,references,keywords and other literature aspects.Results:This study analyzed 721 articles encompassing acupuncture protocols.A continuous yet fluctuating growth in publications volume were observed from 2004 to 2023.Notably,China stands at the forefront in contributing to acupuncture protocols,publishing 513 papers and demonstrating a high centrality score of 1.07 in cooperative network.Furthermore,China has fostered close collaborations with the USA and South Korea.Beijing University of Chinese Medicine(89),Zhishun Liu(36)and Trials(306)emerged as the top contributors in terms of institution,author,and journal,respectively.However,inter-institutional and author collaboration was relatively weak.Macpherson H was the most frequently cited author.High-frequency keywords included“randomized controlled trials”,“acupuncture”,“management”,“study protocol”,“quality of life”.Analysis of timeline diagram of keywords indicated that“functional dyspepsia”,“stroke”,“electroacupuncture”,and“colorectal cancer”were the research development trends and focus.Conclusion:Clinical acupuncture protocols have experienced robust development over the past two decades,with current research hotspots focusing on disease management and quality of life,which remain key research concerns.Moreover,we advocate for researchers to publish acupuncture protocols,which remain key research concerns.This approach allows for thorough pre-study planning of methodologies and objectives,enhancing scientific rigor through peer review,thereby laying the foundation for conducting high-quality research.

A Secure Blockchain-Based Vehicular Collision Avoidance Protocol: Detecting and Preventing Blackhole Attacks

This work aims to examine the vulnerabilities and threats in the applications of intelligent transport systems,especially collision avoidance protocols.It focuses on achieving the availability of network communication among traveling vehicles.Finally,it aims to find a secure solution to prevent blackhole attacks on vehicular network communications.The proposed solution relies on authenticating vehicles by joining a blockchain network.This technology provides identification information and receives cryptography keys.Moreover,the ad hoc on-demand distance vector(AODV)protocol is used for route discovery and ensuring reliable node communication.The system activates an adaptive mode for monitoring communications and continually adjusts trust scores based on packet delivery performance.From the experimental study,we can infer that the proposed protocol has successfully detected and prevented blackhole attacks for different numbers of simulated vehicles and at different traveling speeds.This reduces accident rates by 60%and increases the packet delivery ratio and the throughput of the connecting network by 40%and 20%,respectively.However,extra overheads in delay and memory are required to create and initialize the blockchain network.

Optimizing Recovery Following Mihata Superior Capsular Reconstruction Surgery with Tensor Fascia Lata Auto Graft: A Comprehensive Rehabilitation Protocol

Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.

An Expert System to Detect Political Arabic Articles Orientation Using CatBoost Classifier Boosted by Multi-Level Features

The number of blogs and other forms of opinionated online content has increased dramatically in recent years.Many fields,including academia and national security,place an emphasis on automated political article orientation detection.Political articles(especially in the Arab world)are different from other articles due to their subjectivity,in which the author’s beliefs and political affiliation might have a significant influence on a political article.With categories representing the main political ideologies,this problem may be thought of as a subset of the text categorization(classification).In general,the performance of machine learning models for text classification is sensitive to hyperparameter settings.Furthermore,the feature vector used to represent a document must capture,to some extent,the complex semantics of natural language.To this end,this paper presents an intelligent system to detect political Arabic article orientation that adapts the categorical boosting(CatBoost)method combined with a multi-level feature concept.Extracting features at multiple levels can enhance the model’s ability to discriminate between different classes or patterns.Each level may capture different aspects of the input data,contributing to a more comprehensive representation.CatBoost,a robust and efficient gradient-boosting algorithm,is utilized to effectively learn and predict the complex relationships between these features and the political orientation labels associated with the articles.A dataset of political Arabic texts collected from diverse sources,including postings and articles,is used to assess the suggested technique.Conservative,reform,and revolutionary are the three subcategories of these opinions.The results of this study demonstrate that compared to other frequently used machine learning models for text classification,the CatBoost method using multi-level features performs better with an accuracy of 98.14%.