Application of dezocine patient-controlled epidural analgesia in postoperative analgesia in patients with total myomectomy

BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.

Rare giant intradural epidural hemolymphangioma:A case report

BACKGROUND Hemolymphangioma is a rare,noninvasive benign tumor that originates from vascular and lymphatic malformations.It is usually congenital and can present with varying symptoms depending on its location and size.There are very few reports of hemolymphangiomas within the spinal canal,and giant lesions are exceptionally rare.CASE SUMMARY In July 2023,a 64-year-old male with a giant intravertebral epidural hemolymphangioma from thoracic 11 to lumbar 2(T11-L2)was admitted to the Department of Spine Surgery at the People's Hospital of Binzhou City,China.The patient experienced progressive lumbar and left lower limb pain,numbness,weakness in both lower limbs,and difficulty with urination and defecation.Imaging studies revealed a large cystic mass in the spinal canal at T11-L2.Surgical decompression was performed,and the pathology confirmed hemolymphangioma.CONCLUSION Complete resection of hemolymphangiomas has the best prognosis,and final diagnosis relies on pathologic diagnosis.In this case,the mass was removed intact with a pedicle nail rod system,leading to adequate spinal decompression and restoration of spinal stability.

Why do thoracic epidurals fail?A literature review on thoracic epidural failure and catheter confirmation

Thoracic epidural anesthesia(TEA)has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries.However,misplaced or displaced catheters,along with other factors such as technical challenges,equipment failure,and anatomic variation,lead to a high incidence of unsatisfactory analgesia.This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters.A literature search of PubMed,Medline,Science Direct,and Google Scholar was done.The search results were limited to randomized controlled trials.Literature suggests techniques such as electrophysiological stimulation,epidural waveform monitoring,and x-ray epidurography for identifying thoracic epidural placement,but there is no one particular superior confirmation method;clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.

Catheter-Assisted Interlaminar Approach for Cervical Epidural Steroid Injection in Patient with Cervical Stenosis Caused by Ossification of Posterior Longitudinal Ligament: A Case Report

We present the case of a 64-year-old man with cervical ossification of the posterior longitudinal ligament (OPLL) experiencing chronic neck pain and radiculopathy for 6 months. A catheter-assisted interlaminar Cervical Epidural Steroid Injection (CESI) was performed under fluoroscopic guidance, targeting the affected C2-C6 levels. Significant improvement was observed after this procedure, with decreased pain scores (visual analogue scale (VAS) 8 to 2) and improved mobility. This technique not only enhances the effectiveness of CESI but also reduces the likelihood of complications such as stroke or epidural hematoma and thus provides an alternative treatment option for patients with multiple stenotic levels who are unsuitable for surgery or are unresponsive to conservative therapy such as medication or physical therapy.

Developing Operational Model for Heat Pumps as Space Heating and Domestic Hot Water Provider

In the United Kingdom, means of meeting domestic heating is being electrified to decarbonise in effort to reduce the greenhouse gases emissions from the burning of natural gas. Therefore, the uptake of heat pumps is on the increase. The operation and working principle of heat pumps must be well understood in the investigations of their impacts on the grid and the grid assets, especially distribution transformers which could be overloaded due to higher peak load demand. This work develops an operational model of heat pumps as combined space heating and domestic hot water provider implemented in MATLAB. The developed operational model of heat pumps is adaptable and repeatable for different input parameters. The developed model is used to generate daily average demand profiles of heat pumps for a typical winter weekday and a typical summer weekday. The generated demand profiles of heat pumps by the developed model compared well with the demand profiles of heat pumps generated from actual field projects which are usually expensive and time-tasking.

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.

Dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25 years:a case report and literature review

Dear Editor,We present a case of dacryocystitis and canaliculitis secondary to residual of epidural catheter remaining in lacrimal duct for 25y.A 56-year-old male patient was admitted to our medical center on February 16,2023.We obtained the written informed consent from the patient,and this case study was in accordance with the tenets of the Declaration of Helsinki.The main complaint was that the right eye had suffered from persistent tears for more than 25y and discharge for more than 1y.

A Structured Method of Teaching Epidural Block reduces the incidence of accidental dural puncture in inexperienced trainees.

Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.

Unique method for removal of knotted lumbar epidural catheter: A case report

BACKGROUND Combined spinal-epidural(CSE)anesthesia is the preferred anesthesia method for cesarean delivery.The use of an epidural catheter is essential for administering additional drugs intraoperatively and managing postoperative pain.However,the insertion of epidural catheters is associated with various complications,such as total spinal anesthesia,symptoms indicative of spinal nerve root irritation,and challenges in epidural catheter removal.CASE SUMMARY We present a case report of a challenging epidural catheter removal due to knotting.The lumbar computed tomography scan results revealed that the catheter formed a tight knot in the epidural space.We used a novel extubation method and successfully removed the catheter.CONCLUSION The operator can use opposite forces to"spiral"apart the spinal joints by positioning the patient's body in a specific position.The findings indicate that,when combined with imaging examination results,this method is effective for the removal of epidural catheters.

Management of a Retained Epidural Catheter in a Pregnant Patient: A Case Report and Review of Literature

Background: Epidural anesthesia is an effective intervention to treat labor pain and provide analgesia for orthopedic procedures. A rare complication of this technique is epidural catheter retention. Case Presentation: In this case report, we present an otherwise healthy 21-year-old G2P0010 woman at 39 weeks and 3 days gestation whose anesthetic management was complicated by a symptomatic retained epidural catheter fragment. Computed tomography (CT) imaging of her spine showed the fractured catheter within her paraspinal muscles and neurosurgery recommended no surgical intervention at that time. The patient reported resolution of back pain while in the postpartum unit which she continues to endorse two weeks after discharge. Conclusion: Retained epidural catheter is a medical emergency that requires immediate imaging and neurological evaluation. While magnetic resonance imaging is typically regarded as the standard imaging modality for this complication, in epidural sets that contain metallic components, we suggest using CT to avoid the risk of thermal nerve damage. In cases where the patient does not report any acute complaints, nonsurgical management may be appropriate but close follow-up is required to monitor for catheter migration.

Advances in epidural labor analgesia:Effectiveness and treatment strategies of butorphanol

In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.

Wear dependent virtual flow rate sensor for progressing cavity pumps with deformable stator

This contribution presents a novel wear dependent virtual flow rate sensor for single stage single lobe progressing cavity pumps. We study the wear-induced material loss of the pump components and the impact of this material loss on the volumetric efficiency. The results are combined with an established backflow model to implement a backflow calculation procedure that is adaptive to wear. We use a laboratory test setup with a highly abrasive fluid and operate a pump from new to worn condition to validate our approach. The obtained measurement data show that the presented virtual sensor is capable of calculating the flow rate of a pump being subject to wear during its regular operation.

Optimal Design of High-Speed Partial Flow Pumps using Orthogonal Tests and Numerical Simulations

To investigate the influence of structural parameters on the performances and internal flow characteristics of partial flow pumps at a low specific speed of 10000 rpm,special attention was paid to the first and second stage impeller guide vanes.Moreover,the impeller blade outlet width,impeller inlet diameter,blade inclination angle,and number of blades were considered for orthogonal tests.Accordingly,nine groups of design solutions were formed,and then used as a basis for the execution of numerical simulations(CFD)aimed at obtaining the efficiency values and heads for each design solution group.The influence of impeller geometric parameters on the efficiency and head was explored,and the“weight”of each factor was obtained via a range analysis.Optimal structural parameters were finally chosen on the basis of the numerical simulation results,and the performances of the optimized model were verified accordingly(yet by means of CFD).Evidence is provided that the increase in the efficiency and head of the optimized model was 12.11%and 23.5 m,respectively,compared with those of the original model.

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

Spinal epidural abscesses (SEA) are considerably rare and tend to present over two to five vertebral segments. Occasionally, there will be two or more noncontiguous areas of pyogenic collections [1]. Minimal cases have been reported to span the entire vertebral column;a meta-analysis estimates that 1% of all SEA are holospinal [2]. The triad of presenting symptoms includes fever, back pain (often midline), and neurologic defects [1] [2] [3]. Early detection is identified as a critical aspect of improved outcomes. Cases that do not present in this manner or with other masking symptoms can lead to delayed diagnosis, thus delaying treatment. In the event of cord compression, the occurrence of neurologic defects increases. Time from the onset of clinical manifestations to the operating room is crucial in reversing symptoms [2]. This article seeks to review a case of a 65-year-old male that presented to the emergency department (ED) due to a falling second to weakness and thigh pain. On presentation, he was also noted to have rhabdomyolysis causing acute kidney injury (AKI) with tubular necrosis. The patient was admitted to the hospital with a complex history of progressive leg weakness, pain in the lower back, incontinence, and elevated white blood cell count. Days into the admission, a magnetic resonance imaging (MRI) study was performed, which revealed a continuous posterior SEA from C4 to S2 with anterior mass effect causing spinal cord compression. Emergency neurosurgery was scheduled for laminectomies in the cervical, thoracic and lumbar spine to drain the abscess. Evaluation of this complex medical course, surgical approach to drainage of an incessant spinal column abscess, and sustained neurologic defects will be discussed.

Influence of specific speed on hydraulic performances and pressure fluctuations in mixed-flow pumps

A series of steady and unsteady numerical calculations of the internal flow in mixed-flow pumps with three different specific speeds were carried out based on the N-S equation coupled with the standard k-εturbulence model under different operating conditions to investigate the relationship between the impeller specific speed and the pump performance as well as pressure pulsations.Meanwhile,the pump performance and pressure pulsations inside the mixed-flow pump with three different specific speeds were also analyzed and compared with the corresponding test data.From the results,the averaged deviations between the predicted and tested head among different impellers are below 5%,and with respect to the equivalent impeller specific speeds of 280 and 260,the values are 4.30%and 3.69%,respectively.For all the impeller schemes,the best efficiency point of the mixed-flow pump is found at the flow rate of 1.2 Q_(d) and the higher head deviation occurs at lower flow rates.Especially,it can be found that the specific speed has a slight effect on the pressure fluctuation in the impellers.Eventually,it is determined that the pump performance curves calculated by numerical simu-lations have good agreement with the relevant experimental results,which verifies that the numerical methods used in the present study are accurate to a certain extent.Furthermore,the results also provide some references to the pressure pulsation analysis and the performance improvement of the mixed-flow pump design.

Review:Measurement-Based Monitoring and Fault Identification in Centrifugal Pumps

Condition based maintenance(CBM) is one of the solutions to machinery maintenance requirements. Latest approaches to CBM aim at reducing human engagement in the real-time fault detection and decision making. Machine learning techniques like fuzzy-logic-based systems, neural networks, and support vector machines help to reduce human involvement. Most of these techniques provide fault information with 100% confidence. It is undeniably apparent that this area has a vast application scope. To facilitate future exploration, this review is presented describing the centrifugal pump faults, the signals they generate, their CBM based diagnostic schemes, and case studies for blockage and cavitation fault detection in centrifugal pump(CP) by performing the experiment on test rig. The classification accuracy is above 98% for fault detection. This review gives a head-start to new researchers in this field and identifies the un-touched areas pertaining to CP fault diagnosis.

Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury:study protocol for a prospective,randomized,controlled trial

Epidural electrical stimulation is a new treatment method for spinal cord injury(SCI).Its efficacy and safety have previously been reported.Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI.Considering that electromyography(EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI,we designed a study protocol for a prospective,randomized controlled trial.In this trial,on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle,patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment.Recovery of muscle strength of key muscles,quality of life,safety and therapeutic effects will be monitored.Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group.The control group will receive conventional rehabilitation treatment.The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment.After rehabilitation treatment,follow up for all patients will occur at 2 weeks and 1,3 and 6 months.The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale.Secondary outcome measures will include modified Barthel Index scores,integrated EMG values,the visual analogue scale,Spinal Cord Independence Measure scores,and modified Ashworth scale scores.The safety indicator will be the incidence of adverse events.This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment.Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation.This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital(Approval No.RKIRB2022-12)on February 15,2022 and was registered with Chinese Clinical Trial Registry(registration number:ChiCTR2200061674;date:June 30,2022).Study protocol version:1.0.

Cavitation recognition of axial piston pumps in noisy environment based on Grad-CAM visualization technique

The cavitation in axial piston pumps threatens the reliability and safety of the overall hydraulic system.Vibration signal can reflect the cavitation conditions in axial piston pumps and it has been combined with machine learning to detect the pump cavitation.However,the vibration signal usually contains noise in real working conditions,which raises concerns about accurate recognition of cavitation in noisy environment.This paper presents an intelligent method to recognise the cavitation in axial piston pumps in noisy environment.First,we train a convolutional neural network(CNN)using the spectrogram images transformed from raw vibration data under different cavitation conditions.Second,we employ the technique of gradient-weighted class activation mapping(Grad-CAM)to visualise class-discriminative regions in the spectrogram image.Finally,we propose a novel image processing method based on Grad-CAM heatmap to automatically remove entrained noise and enhance class features in the spectrogram image.The experimental results show that the proposed method greatly improves the diagnostic performance of the CNN model in noisy environments.The classification accuracy of cavitation conditions increases from 0.50 to 0.89 and from 0.80 to 0.92 at signal-to-noise ratios of 4 and 6 dB,respectively.

As Planet Warms,Heat Pumps Get Hotter

The heat pump,an old device dating back to the early 1850s[1],has captured new attention for its potential to help meet climate change goals.Driven in large part by legislated incentives and bans on fossil-fuel heating in a growing number of countries,the heightened interest has also spawned improvements in the technology’s efficiency and cost.Another unique benefit is for one device to provide,depending on seasonal needs,both heating and cooling.

Factors of Pumping Capacity in Some Different Types of Channel Brownian Pumps

The motion of particles in different channel Brownian pumps can be described by Langevin equations,and the pumping capacity is a useful indicator to demonstrate the strength of a pump’s transportation ability.Via the simulation,there is always an optimal value of temperature and unbiased external force for different pumps which make the concentration ratio between the right tube and left tube derive its maximum and minimum in two asymmetric tubes respectively.Besides,the concentration ratio will keep 1 regardless of radius,temperature or magnitude of force in the tube in a symmetric tube.To obtain more information about pumping capacity,exploring the average probability current(APC) of tubes in different conditions is necessary.Results indicate that as the concentration ratio is 1,the change of the APC when x_(0)=0 is similar to that when x_(0)=π.Also,when the concentration ratio is more than 1,there are optimal values of temperature,radius and magnitude of force where the APC gains a maximum,and the maximum decreases as the concentration in the right tube increases when x_(0)=0.