The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study

Background: Patients with critical limb ischemia (CLI) often suffer from severe pain. A continuous peripheral nerve block has been shown to provide effective analgesia for patients having lower limb surgery. We have been administering continuous sciatic nerve block (CSNB) for patients with CLI whose pain could not be relieved by other analgesic tools. The aim of this retrospective study was to investigate the efficacy and safety of CSNB for patients with CLI. Method: We retrospectively investigated 99 patients who received CSNB for the relief of severe pain in the lower limb associated with CLI. Patient demographics, neurological history, complications, and subjective evaluation of the effectiveness of CSNB were investigated from their clinical records. The distal tips of 108 catheters were cultured. Result: One hundred and seventy-two catheters were placed in 99 patients. More than 90% of the patients enjoyed considerable relief of severe pain. The analgesic effect of CSNB was greater in patients with older age and hemodialysis. Thirty-one catheters had positive bacterial colonization. However, no severe infectious complication was found. There was no relationship between the co-existence of diabetes and positive bacterial colonization. We encountered a patient with ASO and diabetes who suffered from persistent motor weakness and hypesthesia even after 3 months of CSNB placement. Conclusions: CSNB provided good pain control for patients with severe pain caused by CLI. Although catheters were frequently found to be colonized, infection at the catheter site was self-limiting even in patients with diabetes.

A New One-Twelfth Step Continuous Block Method for the Solution of Modeled Problems of Ordinary Differential Equations

In this paper, we developed a new continuous block method by the method of interpolation and collocation to derive new scheme. We adopted the use of power series as a basis function for approximate solution. We evaluated at off grid points to get a continuous hybrid multistep method. The continuous hybrid multistep method is solved for the independent solution to yield a continuous block method which is evaluated at selected points to yield a discrete block method. The basic properties of the block method were investigated and found to be consistent, zero stable and convergent. The results were found to compete favorably with the existing methods in terms of accuracy and error bound. In particular, the scheme was found to have a large region of absolute stability. The new method was tested on real life problem namely: Dynamic model.

A Retrospective Comparison of Interscalene Continuous Catheter Verse Single-Injection with Liposomal Bupivacaine in Total Shoulder Arthroplasty

Background: One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. Methods: We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. Results: We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. Conclusion: Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.

Research Progress on Anti-clogging Technology of Submerged Entry Nozzles for Continuous Casting

The causes, the formation process, and the prevention of submerged entry nozzle(SEN) clogging were introduced. The influence of electric field on the SEN clogging was focused on, including the basic theory and measurement of SEN charging,the preliminary research on SEN charging, the influence of molten steel on the wetting behavior of refractory materials in electric field, and the influence of electric field on the oxide inclusions in molten steel. Based on the influence of the hydrodynamics, chemistry and other factors on refractory materials, structure, inclusion particle transfer and adhesion, many anti-clogging researches have been carried out, such as optimizing process conditions, compositing anti-clogging inner lining materials, innovating SEN structure and applying physical fields, which solve the problem of SEN clogging to a certain extent.However, the problems of weak adaptability and superficial study on clogging mechanism are still prominent. The electric field control is a new technology to prevent clogging. Although it has achieved certain results in on-site continuous casting trials,some problems such as the method of applying electric field, the electric field parameters and the equipment still need to be gradually improved, and the surface characteristics of inclusions and SEN materials at high temperatures need to be further studied. It was pointed out that the combination of materials and applied electric field will become an important direction for SEN anti-clogging technology.

Four Steps Continuous Method for the Solution of <i>y″</i>= <i>f</i>(<i>x, y, y′</i>)

This paper proposes a continuous block method for the solution of second order ordinary differential equation. Collocation and interpolation of the power series approximate solution are adopted to derive a continuous implicit linear multistep method. Continuous block method is used to derive the independent solution which is evaluated at selected grid points to generate the discrete block method. The order, consistency, zero stability and stability region are investigated. The new method was found to compare favourably with the existing methods in term of accuracy.

A continuous/discontinuous deformation analysis(CDDA)method based on deformable blocks for fracture modeling

In the framework of finite element meshes,a novel continuous/discontinuous deformation analysis(CDDA)method is proposed in this paper for modeling of crack problems.In the present CDDA,simple polynomial interpolations are defined at the deformable block elements,and a link element is employed to connect the adjacent block elements.The CDDA is particularly suitable for modeling the fracture propagation because the switch from continuous deformation analysis to discontinuous deformation analysis is natural and convenient without additional procedures.The SIFs(stress intensity factors)for various types of cracks,such as kinked cracks or curved cracks,can be easily computed in the CDDA by using the virtual crack extension technique(VCET).Both the formulation and implementation of the VCET in CDDA are simple and straightforward.Numerical examples indicate that the present CDDA can obtain high accuracy in SIF results with simple polynomial interpolations and insensitive to mesh sizes,and can automatically simulate the crack propagation without degrading accuracy.

Effect of subarachnoid nerve block anesthesia on glutamate transporte GLAST and GLT-1 expressions in rabbits

Objective: To observe the effect of subarachnoid nerve block anesthesia on glutamate transporter glutamate-aspartate transporter(GLAST) and GLT-1 expressions in rabbits, and to investigate the effect of peripheral nerve anesthesia on the morphology and function of the spinal cord. Methods: Twenty healthy New Zealand white rabbits were randomly divided into two groups: the experimental group and control group; with 10 rabbits in each group. For spinal nerve anesthesia, 5 g/L of bupivacaine was used in the experimental group, and sterile saline was used in the control group. After 30 min of cardiac perfusion, GLAST and GLT-1 protein expression in spinal neurons were detected by immunohistochemistry and immunofluorescence staining. Results: GLAST and GLT-1 protein-positive cells increased in neurons in the experimental group, compared with the control group(P<0.05). Conclusions: After subarachnoid nerve block anesthesia, rabbit glutamate transporter GLAST and GLT-1 expression is increased; and spinal cord nerve cell function is inhibited.

A New Block-Predictor Corrector Algorithm for the Solution of y’’’=f(x, y, y’, y’’)

We consider direct solution to third order ordinary differential equations in this paper. Method of collection and interpolation of the power series approximant of single variable is considered to derive a linear multistep method (LMM) with continuous coefficient. Block method was later adopted to generate the independent solution at selected grid points. The properties of the block viz: order, zero stability and stability region are investigated. Our method was tested on third order ordinary differential equation and found to give better result when compared with existing methods.

Analysis of Waste in the Production of Concrete Blocks---A Case Study in the Goias Industry

An ever more demanding consumer market and the need for companies to be more competitive have led organizations to try to eliminate waste. This research is a case study which presents a proposal for intervention in order to improve performance of a pre-cast concrete block factory in outer Goihnia. As a first step, waste in the production process was identified through analysis of data on time involved in each step of the process. Then, applying the concepts of lean production, a list of activities was drawn up with a view to eliminating non-value-added work, identifying waste, decreasing cycle time, streamlining the production process and increasing the flexibility and transparency of the process. From the results, it was possible to identify the sources of waste and provide management with information for strategic decisions about production. Finally, various suggestions were made with a view to eliminating or mitigating bottlenecks in the production process.

General Structures of Block Based Interpolational Function

We construct general structures of one and two variable interpolation function, without depending on the existence of divided difference or inverse differences, and we also discuss the block based osculatory interpolation in one variable case. Clearly, our method offers marly flexible interpolation schemes for choices. Error terms for the interpolation are determined and numerical examples are given to show the effectlveness of the results.

单节段椎旁神经阻滞在老年患者腹股沟疝修补术中的应用

目的探讨单节段椎旁神经阻滞(pavavertebral nerve block,PVNB)在老年患者腹股沟疝修补术中应用的安全性和可行性。方法回顾性分析2016年1月~2022年12月58例老年患者接受开放式无张力腹股沟疝修补术的临床资料,依据麻醉方式分为2组:单节段PVNB组(P组)和单次蛛网膜下腔阻滞组(S组),每组29例。P组在超声联合外周神经刺激器或单纯外周神经刺激器引导下行L1单节段PVNB,给予0.4%罗哌卡因20 ml。S组在L3/4棘突间隙进行穿刺,给予0.5%布比卡因10 mg。记录患者麻醉前(T_(0))、手术切皮时(T_(1))、疝囊剥离时(T_(2))和关切口时(T_(3))患者的平均动脉压和心率,麻醉阻滞平面、麻醉效果、芬太尼补救率、局麻药毒性反应、外周神经损伤、尿潴留、谵妄和恶心呕吐的发生情况,随访患者的麻醉满意度。结果58例均顺利完成手术。2组患者麻醉阻滞平面差异有显著性(Z=-4.144,P=0.000),芬太尼补救率、麻醉效果和麻醉满意度差异均无统计学意义(χ^(2)=0.269,P=0.604;Z=-1.430,P=0.153;Z=-1.395,P=0.163)。2组患者不同时点的平均动脉压和心率变化差异无统计学意义(F=0.002,P=0.960;F=0.260,P=0.612)。P组患者尿潴留发生率显著低于S组(0.0%vs.24.1%,Fisher精确检验,P=0.010)。2组患者谵妄和恶心呕吐发生率差异无统计学意义(P>0.05)。所有患者围术期均未发生局麻药毒性反应和外周神经损伤。结论单节段PVNB可以为接受腹股沟疝修补术的老年患者提供完善的麻醉与镇痛,有助于维持术中血流动力学状态的稳定,并降低术后不良反应的发生风险。

Neoarchaean-Palaeoproterozoic Mafic Dyke Swarms from the Singhbhum Granite Complex,Singhbhum Craton,Eastern India:Implications for Identification of Large Igneous Provinces and Their Possible Continuation on Other Formerly Adjacent Crustal Blocks

The Singhbhum craton of the eastern India consists of the Singhbhum Granite Complex(SGC)and the Chotanagpur Gneissic Complex(CGC)separated by the Singhbhum Mobile Belt(SMB).The CGC is intruded by Mesoproterozoic as well as Cretaceous mafic dykes;in

复杂结构内爆炸冲击波传播的大规模计算方法研究

为研究爆炸冲击波在矿井巷道等复杂地下密闭空间内的传播过程及衰减规律,提出了一种基于数据流的分块续算方法.该方法解决了计算资源的大量浪费问题,实现了大尺寸复杂地下密闭空间内冲击波传播的大规模、高效率、高精度数值模拟.方形坑道内爆过程的数值结果与实验结果基本一致,证明了该计算方法的准确性.标准模型算例全尺寸计算与分块续算数值模拟结果的误差在0.33%以内,且续算方法在给定算例下相比普通全尺寸计算节约了88.68%的计算核时,证明该方法不仅能保证计算过程的准确性,而且还极大地提高了计算效率.同时,对一个包含长方体型工房和圆柱形分叉泄压洞的大尺寸复杂结构内的爆炸问题进行了数值模拟,结果表明:冲击波超压在泄压洞内是以波动衰减的趋势逐渐减小的,且其衰减速度比在自由场的小;T型分流时管道间采用直角交汇或缩小管道直径在一定程度上有利于冲击波超压的衰减.数值模拟结果表明,基于数据流的分块续算方法可用于地下空间等大尺度复杂结构防爆抗爆设计的理论指导.

Block Based Bivariate Blending Rational Interpolation via Symmetric Branched Continued Fractions

This paper constructs a new kind of block based bivariate blending rational interpolation via symmetric branched continued fractions. The construction process may be outlined as follows. The first step is to divide the original set of support points into some subsets (blocks). Then construct each block by using symmetric branched continued fraction. Finally assemble these blocks by Newton’s method to shape the whole interpolation scheme. Our new method offers many flexible bivariate blending rational interpolation schemes which include the classical bivariate Newton’s polynomial interpolation and symmetric branched continued fraction interpolation as its special cases. The block based bivariate blending rational interpolation is in fact a kind of tradeoff between the purely linear interpolation and the purely nonlinear interpolation. Finally, numerical examples are given to show the effectiveness of the proposed method.

A Novel Approach to Practical Matrix Converter Motor Drive System With Reverse Blocking IGBT (To continue)

a Pole voltage waveforms (VA20 and VA40) for modulation index 0.4 (middle trace is A-phase voltage waveform) x-axis: 1 div.=10ms, y-axis: 1 div.= 100V b Normalized harmonic spectrum for pole voltage of Fig. 9a c A-phase current and phase voltage for modulation index 0.4 (reference space vector is in inner layer)

分析多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年患者全膝关节置换术后快速康复的影响

目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。

连续臂丛阻滞镇痛的抗交感效应对预防断指再植术后血管危象的研究

目的 评价连续臂丛阻滞(continuous brachial plexus blocks, CBPB)的抗交感、扩血管效应对断指再植术后血管危象的预防作用。方法 2023年1月~2023年12月行断指再植术的病人60例,采用抽签分组法分为对照组(30例,40指,静脉自控镇痛)和研究组(30例,44指,连续臂丛阻滞镇痛)。比较两组断指再植术后即刻、24小时及48小时再植手指皮温及患肢肱动脉血流动力学参数、血管危象的发病率。结果 研究组术后24小时及48小时皮温分别为(31.29±2.14)℃和(32.16±2.34)℃,均显著高于对照组的(28.93±1.98)℃和(30.03±2.52)℃,两组比较差异有统计学意义(P<0.05);肱动脉血流动力学指标方面,研究组术后24小时和48小时的收缩期峰速度分别为(91.45±.32.13)cm/s、(90.34±.30.86)cm/s,舒张末期速度分别为(20.87±9.95)cm/s、(21.35±9.74)cm/s,平均速度分别为(38.63±12.53)cm/s、(40.53±13.30)cm/s,血流量分别为(8.95±2.57)ml/s、(8.10±2.18)ml/s,动脉面积分别为(0.23±0.08)cm^(2)、(0.21±0.06)cm^(2),阻力指数分别为0.73±0.23、0.75±0.34,对照组术后24小时和48小时的收缩期峰速度分别为(53.50±.19.24)cm/s、(52.64±.17.89)cm/s,舒张末期速度分别为(13.62±3.16)cm/s、(15.38±4.33)cm/s,平均速度分别为(20.26±8.64)cm/s、(21.36±8.36)cm/s,血流量分别为(3.95±1.49)ml/s、(4.23±1.35)ml/s,动脉面积分别为(0.18±0.05)cm^(2)、(0.17±0.05)cm^(2),阻力指数分别为0.89±0.21、0.90±0.28,两组比较差异均有统计学意义(P<0.05);研究组术后48小时内血管危象的发病率为4.55%,显著低于对照组的35.00%,两组比较差异有统计学意义(P<0.05)。结论 CBPB的抗交感效应可增加再植手指血流灌注,降低血管危象的发病率。

CT引导下脉冲射频联合连续神经阻滞治疗顽固性带状疱疹后神经痛的临床疗效研究

目的探究CT引导下脉冲射频联合连续神经阻滞治疗顽固性带状疱疹后神经痛(PHN)的临床疗效。方法选取2021年1月至2023年1月本院收治的208例顽固性PHN患者为对象,随机数表法分为联合组和对照组,每组各104例。对照组接受CT引导下脉冲射频治疗,联合组在对照组的基础上行连续硬膜外神经阻滞治疗。比较两组患者不同时间点疼痛情况、临床有效率、镇痛补救情况、睡眠质量,血清高迁移率族蛋白B1(HMGB1)、白细胞介素-1β(IL-1β)和白细胞介素-10(IL-10)水平。结果随访期间,4例患者失访。最终纳入联合组103例,对照组101例。联合组治疗总有效率为89.32%,明显高于对照组的78.22%(P<0.05)。患者疼痛视觉模拟量表(VAS)评分、阿森斯失眠量表(AIS)评分的时间、组间、时间与组间交互效应差异均具有统计学意义(P<0.05);治疗后1、2、4周联合组VAS、AIS评分均低于对照组(P<0.05);联合组镇痛补救次数低于对照组,曲马多使用剂量少于对照组(P<0.05);治疗后4周联合组血清HMGB1、IL-1β、IL-10水平均低于对照组(P<0.05)。结论CT引导下脉冲射频联合连续神经阻滞治疗顽固性PHN,能有效减轻神经炎性损伤,改善患者疼痛症状,提高睡眠质量,其镇痛效果及临床疗效优于单纯使用CT引导下脉冲射频疗法。

机体振动信号时频特性与燃烧压力相关性分析

为了探明机体振动信号与缸内燃烧状态间的相关性,本文通过改变转速、转矩、润滑油温度及配缸间隙形成不同的燃烧状态,利用连续小波变换算法得到了振动信号时频域特性,并与燃烧压力峰值进行对比分析。结果表明:随转速增加,燃烧压力峰值出现波动,8 kHz以上成分的能量总体呈增加的趋势;随转矩增加,燃烧压力峰值及振动信号的能量均增加;随润滑油温度升高,20 kHz以上主要频率成分的能量增加;随配缸间隙增加,10kHz以上频率成分的能量总体呈增加的趋势。

腰池持续引流改善动脉瘤性蛛网膜下腔出血后急性脑积水患者的预后

目的 分析腰池引流量对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage, aSAH)后急性脑积水(acute hydrocephalus, AHC)预后的影响。方法 纳入2017年1月至2022年1月就诊于重庆医科大学附属第一医院神经外科因动脉瘤性蛛网膜下腔出血发生AHC的患者82例。以出院半年后改良Rankin评分量表(modified Rankin scale, mRS)评分为预后结局,对人口学因素、入院时蛛网膜下腔出血(subarachnoid hemorrhage, SAH)严重程度、既往史、血管痉挛、腰池引流等数据进行单因素和多因素Logistic逐步回归分析,并构建列线图预测模型。结果 单因素分析发现WFNS、Hunt-Hess、mFisher、腰池引流时间、分流依赖、脑血管痉挛、腰池引流量可影响患者预后,进一步采用Logistic逐步回归分析,发现高评分WFNS(OR:3.25,95%CI:1.11~9.48)、mFisher高分级(OR:3.66, 95%CI:1.08~12.35)、发生分流依赖(OR:15.56,95%CI:1.22~198.57)与脑血管痉挛(OR:22.24,95%CI:3.08~160.68)是影响mRS的独立危险因素,腰池引流量(OR:0.57, 95%CI:0.40~0.82)是独立保护因素。ROC曲线面积显示模型具有良好的预测效果[AUC:0.898(95%CI:0.935~0.861)];通过Bootstrap方法进行内部验证,结果显示模型具很好的区分能力[C-index:0.950(95%CI:0.904~0.996);校正C-index:0.934]。结论 增加腰池引流量是aSAH术后发生AHC预后不良的独立保护因素,并可以改善SAH患者的预后。