BACKGROUND Perioperative shivering is clinically common during cesarean sections under neuraxial anesthesia,and several neuraxial adjuvants are reported to have preventive effects on it.However,the results of current ...BACKGROUND Perioperative shivering is clinically common during cesarean sections under neuraxial anesthesia,and several neuraxial adjuvants are reported to have preventive effects on it.However,the results of current studies are controversial and the effects of these neuraxial adjuvants remain unclear.AIM To evaluate the effects of neuraxial adjuvants on perioperative shivering during cesarean sections,thus providing an optimal choice for clinical application.METHODS A systematic review and network meta-analysis were conducted following the PRISMA (Preferred Reported Items for Systematic Review and Meta-analysis) guidelines.Analyses were performed using Review Manager 5.3 and Stata 14.0.We searched PubMed,EMBASE,Web of Science,and Cochrane Central databases for eligible clinical trials assessing the effects of neuraxial adjuvants on perioperative shivering and other adverse events during cesarean sections.Perioperative shivering was defined as the primary endpoint,and nausea,vomiting,pruritus,hypotension,and bradycardia were the secondary outcomes.RESULTS Twenty-six studies using 9 neuraxial adjuvants for obstetric anesthesia during caesarean sections were included.The results showed that,compared with placebo,pethidine,fentanyl,dexmedetomidine,and sufentanil significantly reduced the incidence of perioperative shivering.Among the four neuraxial adjuvants,pethidine was the most effective one for shivering prevention (OR = 0.15,95%CI: 0.07-0.35,surface under the cumulative ranking curve 83.9),but with a high incidence of nausea (OR = 3.15,95%CI: 1.04-9.57) and vomiting (OR = 3.71,95%CI: 1.81-7.58).The efficacy of fentanyl for shivering prevention was slightly inferior to pethidine (OR = 0.20,95%CI: 0.09-0.43),however,it significantly decreased the incidence of nausea (OR = 0.34,95%CI: 0.15-0.79) and vomiting (OR = 0.25,95%CI: 0.11-0.56).In addition,compared with sufentanil,fentanyl showed no impact on haemodynamic stability and the incidence of pruritus.CONCLUSION Pethidine,fentanyl,dexmedetomidine,and sufentanil appear to be effective for preventing perioperative shivering in puerperae undergoing cesarean sections.Considering the risk-benefit profiles of the included neuraxial adjuvants,fentanyl is probably the optimal choice.展开更多
岩石薄片的岩性识别是地质分析中不可或缺的一环,其精准度直接影响后续地层岩石种类、性质和矿物成分等信息的确定,对于地质勘探和矿产开采具有重要意义。为了快速准确地识别岩性,本文提出了一种改进的MobileNetV2轻量化模型,通过选取5...岩石薄片的岩性识别是地质分析中不可或缺的一环,其精准度直接影响后续地层岩石种类、性质和矿物成分等信息的确定,对于地质勘探和矿产开采具有重要意义。为了快速准确地识别岩性,本文提出了一种改进的MobileNetV2轻量化模型,通过选取5种岩石类型共3 700张岩石薄片图像进行岩性识别。在MobileNetV2的倒残差结构中嵌入坐标注意力机制,融合图像中多种矿物的全局特征信息。此外,改进MobileNetV2中的分类器,降低模型的参数量和计算复杂度,从而提高模型的运算速度和效率,并采用带泄露线性整流函数(leaky rectified linear unit, Leaky ReLU)作为激活函数,避免网络训练中的梯度消失问题。实验结果表明,本文提出的改进后的MobileNetV2模型大小仅为2.30 MB,在测试集上的精确率、召回率、F_(1)值分别为91.24%、90.18%、90.70%,具有较高的准确性,相比于SqueezeNet、ShuffleNetV2等同类型的轻量化网络,分类效果最好。展开更多
目的识别乳腺癌术后化疗患者症状群,探索症状群间的桥梁症状,为症状的精准干预及护理提供参考依据。方法2022年10月—2023年10月,采用便利抽样法,选择本市某三级甲等专科医院340例乳腺癌术后化疗患者,采用安德森症状评估量表(MD Anderso...目的识别乳腺癌术后化疗患者症状群,探索症状群间的桥梁症状,为症状的精准干预及护理提供参考依据。方法2022年10月—2023年10月,采用便利抽样法,选择本市某三级甲等专科医院340例乳腺癌术后化疗患者,采用安德森症状评估量表(MD Anderson symptom inventory,MDASI)、乳腺癌患者生活质量量表(function assessment of cancer therapy breast,FACT-B)进行横断面研究。采用聚类分析法提取症状群,分层回归分析各症状群对生活质量的影响,应用网络分析法识别症状群间的桥梁症状。结果共327例乳腺癌术后化疗患者完成研究。共提取3个症状群:消化道症状群、精神心理症状群及神经相关症状群,其中消化道症状群可独立解释生活质量总变异的10.2%。网络分析中桥梁预期影响系数、强度及紧密中心性指标高的症状为苦恼(rbe=3.927,rbs=3.927,rbc=0.436),疲乏(rbe=3.907,rbs=3.907,rbc=0.434),胃口差(rbe=3.842,rbs=3.842,rbc=0.427)。结论消化道症状群对患者生活质量影响最大;疲乏、胃口差、苦恼是乳腺癌术后化疗患者症状群间的桥梁症状,医护人员可基于桥梁症状对患者进行精准干预,以便提高症状管理效能,节约医疗成本。展开更多
基金Supported by The Science and Technology Development Fund,Macao SAR,No.130/2017/A3 and No.0099/2018/A3
文摘BACKGROUND Perioperative shivering is clinically common during cesarean sections under neuraxial anesthesia,and several neuraxial adjuvants are reported to have preventive effects on it.However,the results of current studies are controversial and the effects of these neuraxial adjuvants remain unclear.AIM To evaluate the effects of neuraxial adjuvants on perioperative shivering during cesarean sections,thus providing an optimal choice for clinical application.METHODS A systematic review and network meta-analysis were conducted following the PRISMA (Preferred Reported Items for Systematic Review and Meta-analysis) guidelines.Analyses were performed using Review Manager 5.3 and Stata 14.0.We searched PubMed,EMBASE,Web of Science,and Cochrane Central databases for eligible clinical trials assessing the effects of neuraxial adjuvants on perioperative shivering and other adverse events during cesarean sections.Perioperative shivering was defined as the primary endpoint,and nausea,vomiting,pruritus,hypotension,and bradycardia were the secondary outcomes.RESULTS Twenty-six studies using 9 neuraxial adjuvants for obstetric anesthesia during caesarean sections were included.The results showed that,compared with placebo,pethidine,fentanyl,dexmedetomidine,and sufentanil significantly reduced the incidence of perioperative shivering.Among the four neuraxial adjuvants,pethidine was the most effective one for shivering prevention (OR = 0.15,95%CI: 0.07-0.35,surface under the cumulative ranking curve 83.9),but with a high incidence of nausea (OR = 3.15,95%CI: 1.04-9.57) and vomiting (OR = 3.71,95%CI: 1.81-7.58).The efficacy of fentanyl for shivering prevention was slightly inferior to pethidine (OR = 0.20,95%CI: 0.09-0.43),however,it significantly decreased the incidence of nausea (OR = 0.34,95%CI: 0.15-0.79) and vomiting (OR = 0.25,95%CI: 0.11-0.56).In addition,compared with sufentanil,fentanyl showed no impact on haemodynamic stability and the incidence of pruritus.CONCLUSION Pethidine,fentanyl,dexmedetomidine,and sufentanil appear to be effective for preventing perioperative shivering in puerperae undergoing cesarean sections.Considering the risk-benefit profiles of the included neuraxial adjuvants,fentanyl is probably the optimal choice.
文摘岩石薄片的岩性识别是地质分析中不可或缺的一环,其精准度直接影响后续地层岩石种类、性质和矿物成分等信息的确定,对于地质勘探和矿产开采具有重要意义。为了快速准确地识别岩性,本文提出了一种改进的MobileNetV2轻量化模型,通过选取5种岩石类型共3 700张岩石薄片图像进行岩性识别。在MobileNetV2的倒残差结构中嵌入坐标注意力机制,融合图像中多种矿物的全局特征信息。此外,改进MobileNetV2中的分类器,降低模型的参数量和计算复杂度,从而提高模型的运算速度和效率,并采用带泄露线性整流函数(leaky rectified linear unit, Leaky ReLU)作为激活函数,避免网络训练中的梯度消失问题。实验结果表明,本文提出的改进后的MobileNetV2模型大小仅为2.30 MB,在测试集上的精确率、召回率、F_(1)值分别为91.24%、90.18%、90.70%,具有较高的准确性,相比于SqueezeNet、ShuffleNetV2等同类型的轻量化网络,分类效果最好。
文摘目的识别乳腺癌术后化疗患者症状群,探索症状群间的桥梁症状,为症状的精准干预及护理提供参考依据。方法2022年10月—2023年10月,采用便利抽样法,选择本市某三级甲等专科医院340例乳腺癌术后化疗患者,采用安德森症状评估量表(MD Anderson symptom inventory,MDASI)、乳腺癌患者生活质量量表(function assessment of cancer therapy breast,FACT-B)进行横断面研究。采用聚类分析法提取症状群,分层回归分析各症状群对生活质量的影响,应用网络分析法识别症状群间的桥梁症状。结果共327例乳腺癌术后化疗患者完成研究。共提取3个症状群:消化道症状群、精神心理症状群及神经相关症状群,其中消化道症状群可独立解释生活质量总变异的10.2%。网络分析中桥梁预期影响系数、强度及紧密中心性指标高的症状为苦恼(rbe=3.927,rbs=3.927,rbc=0.436),疲乏(rbe=3.907,rbs=3.907,rbc=0.434),胃口差(rbe=3.842,rbs=3.842,rbc=0.427)。结论消化道症状群对患者生活质量影响最大;疲乏、胃口差、苦恼是乳腺癌术后化疗患者症状群间的桥梁症状,医护人员可基于桥梁症状对患者进行精准干预,以便提高症状管理效能,节约医疗成本。
