Biomechanical evaluation of porcine lens capsule with and without nucleus after capsulotomy - Finite element analysis.

Previous studies have shown that the nucleus could offer structural support to the lens capsule. This study investigated the biomechanical performance of porcine lens with and without nucleus for 4 mm, 4.5 mm, 5 mm, 5.5 mm and 6 mm capsulotomy and its potential impact on the stretch ratio of capsular bag when the anterior capsulotomy edge was stretched. Our simulation results showed higher strain for the capsular bag with nucleus, which is crucial for the porcine lens to tolerate more stretch without failure. This simulation could support future study on the optimization of capsulotomy based on patient specific condition, that is, the geometry of lens.

miR-204 suppresses cancer stemness and enhances osimertinib sensitivity in non-small cell lung cancer by targeting CD44.

Osimertinib is an effective treatment option for patients with advanced non-small cell lung cancer (NSCLC) with EGFR activation or T790M resistance mutations; however, acquired resistance to osimertinib can still develop. This study explored novel miRNA-mRNA regulatory mechanisms that contribute to osimertinib resistance in lung cancer. We found that miR-204 expression in osimertinib-resistant lung cancer cells was markedly reduced compared to that in osimertinib-sensitive parental cells. miR-204 expression levels in cancer cells isolated from treatment-naive pleural effusions were significantly higher than those in cells with acquired resistance to osimertinib. miR-204 enhanced the sensitivity of lung cancer cells to osimertinib and suppressed spheroid formation, migration, and invasion of lung cancer cells. Increased miR-204 expression in osimertinib-resistant cells reversed resistance to osimertinib and enhanced osimertinib-induced apoptosis by upregulating BIM expression levels and activating caspases. Restoration of CD44 (the direct downstream target gene of miR-204) expression reversed the effects of miR-204 on osimertinib sensitivity, recovered cancer stem cell and mesenchymal markers, and suppressed E-cadherin expression. The study demonstrates that miR-204 reduced cancer stemness and epithelial-to-mesenchymal transition, thus overcoming osimertinib resistance in lung cancer by inhibiting the CD44 signaling pathway.

Effect of spinal orthosis on clinical outcomes of patients after oblique lumbar interbody fusion: a randomized controlled trial study protocol.

BACKGROUND: Oblique lumbar interbody fusion (OLIF) is an internationally popular minimally invasive technology for the treatment of various lumbar diseases. Since its introduction to China in 2014, OLIF technology has clearly shown its superiority in reconstructing intervertebral stability, restoring intervertebral space height, achieving indirect decompression, and restoring normal lumbar sequence. However, some patients still suffer from persistent symptoms after OLIF, including low back pain and soreness, which indirectly affect the overall surgical efficacy and patient satisfaction. Therefore, some clinicians recommend that patients routinely use spinal orthoses after OLIF to reduce the stress on the lower back muscles and ligaments, thereby relieving or avoiding postoperative residual symptoms or new symptoms. Accordingly, spinal orthosis use after OLIF has emerged as an essential option. However, the role of spinal orthoses in OLIF and their specific impact on postoperative patient clinical outcomes have remained unclear, and there is a lack of strong clinical evidence to indirectly or directly support the role of spinal orthoses in OLIF and demonstrate their impact on patient clinical outcomes. This study aims to investigate the role of spinal orthoses in OLIF by grouping patients based on the use or nonuse of spinal orthosis after OLIF, thus providing a better basis for the majority of patients and physicians. METHODS/DESIGN: We plan to conduct a 1-year randomized controlled trial involving 60 subjects. The subjects will be randomized into two groups: group A (those wearing spinal orthoses after surgery) and group B (those not wearing spinal orthoses after surgery). The clinical outcomes of these patients will be evaluated using the Oswestry disability index, visual analog scale, and Brantigan, Steffee, Fraser 1 day before surgery and 2 weeks and 1, 6, and 12 months after surgery. DISCUSSION: This randomized controlled trial aims to provide a reference for further comprehensive trial design. The findings of this study will provide a better and more scientific basis for the choice of postoperative rehabilitation and treatment for patients undergoing such a procedure. TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry (Registration No.: ChiCTR2200059000). Registration date: April 22, 2022. Registration website: http://www.chictr.org.cn/showproj.aspx?proj=166310.

Exogenous plant hormones alleviate As stress by regulating antioxidant defense system in Oryza sativa L.

Plant hormones play essential roles in plant growth regulation and resistance to environmental pressure. A hydroponic experiment was conducted using Zhongjiazao 17 rice to explore the effects of exogenous plant hormones on antioxidant response and As accumulation in rice under As stress. Melatonin (MT), 2,4-epibrassinolide (EBL), and jasmonic acid (JA) reduced the As content in seedlings significantly by 13.4% (MT)-32.5% (EBL) under 5 µM As stress. Three hormones increased superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) activities, and glutathione (GSH) content significantly (2.2%-82.9%) in 5 µM As stress condition, whereas the levels of H2O2 and malondialdehyde (MDA) were reduced significantly (32.3%-78.1%). Plant hormone addition reduced the As content in seedlings significantly by 18.2% (JA)-33.3% (MT) under 25 µM As stress. SOD, POD, and CAT activities and GSH content in seedlings increased significantly (5.6-90.4%) with three hormones addition in 25 µM As stress, whereas the levels of H2O2, O2˙¯, and MDA reduced significantly (20.9-73.0%). Staining with 2',7'-dichlorodihydrofluorescein diacetate and nitroblue tetrazolium showed that green fluorescence and blue spots decreased gradually in hormone-treated seedlings, further confirming that the exogenous addition of hormones weakened the oxidative stress of As to seedlings. Oxidative damage by As stress was reduced more by EBL than by the other hormones MT or JA. Totally, exogenous plant hormone can alleviate As stress in rice by activating enzyme activity of antioxidant defense system and scavenging reactive oxygen species, thus reducing oxidative damage and As accumulation in rice seedlings.

[Effect of Chelating Agents and Organic Acids on Remediation of Cadmium and Arsenic Complex Contaminated Soil Using Xanthium sibiricum].

In order to improve the phytoextraction efficiency of Xanthium sibiricum on farmland soil that had been contaminated by Cd and As, this study explored the effects of chelating agents and organic acids (EDTA, SAP, CA, and MA) on the extraction of Cd and As heavy metals using X. sibiricum. The results showed that the four different chelating agents and organic acids had little effect on the biomass of the roots, stems, and leaves of X. sibiricum. However, they had different effects on the concentrations and accumulation of Cd and As in various organs of X. sibiricum. Compared with the those in the CK treatment, EDTA, SAP, CA, and MA significantly increased the Cd concentrations in the leaves of X. sibiricum by 44.1%, 32.4%, 41.2%, and 38.2% and the As concentrations in the roots of X. sibiricum by 89.6%, 7.4%, 94.8%, and 61.5%, respectively. The four treatments (EDTA, SAP, CA, and MA) improved the total Cd accumulation of X. sibiricum, with increasing ranges, respectively, of 70.2%, 29.4%, 28.9%, and 33.1%, and the As accumulation increased by 67.0%, 19.6%, 81.9%, and 40.8%, respectively, compared with that of the CK treatment. The four chelating agents and organic acids had different effects on the Cd and As bioconcentration factor and transfer factor of various organs of X. sibiricum. Treatments with EDTA, SAP, CA, and MA resulted in a decrease of 32.7%-38.2% in soil Cd concentrations and a decrease of 14.6%-20.5% in soil As concentrations. These four chelating agents can be used for enhancing the efficiency of extraction Cd and As heavy metals by X. sibiricum.

The Characteristics of Real-time Transvaginal Sono-elastography in Endometrial Cancer.

Background: Endometrial cancer is the most common gynecological cancer among women in developed countries. Sono-elastography is an extended ultrasonographic technique that has been shown to be useful in a wide range of conditions ranging from breast, prostate, and thyroid nodules to chronic liver disease and musculoskeletal conditions. The aim of this study is to compare the sonoelastographic features of endometrial malignancy and normal endometrium. Methods: This case-control observational study was conducted at a single institution. Participants with histologically proven endometrial cancer according to the results from microcurettage or hysteroscopic biopsy and scheduled for total hysterectomy were included as cases, while asymptomatic women scheduled for routine screening ultrasound examination were recruited as controls. Both cases and controls underwent conventional B-mode transvaginal ultrasonography and strain elastography. Demographic, ultrasonographic, and histopathologic findings were analyzed. Results: A total of 29 endometrial cancer patients (cases) and 28 normal females (controls) were included in the analysis. There was no significant difference in the mean age between the two groups, but the mean body weight was significantly higher in the case group (P < 0.001). The strain ratio and elastographic thickness ratio of the endometrium were statistically significantly different between the case and the control group (P ≤ 0.05) due to increased endometrial stiffness in cancer patients as compared to the normal group. Conclusion: Our results suggest that endometrial cancer can result in increased stiffness that is detectable by transvaginal sonoelastography. Sonoelastography may serve as an adjunct to conventional ultrasound in evaluating the endometrium of women with abnormal uterine bleeding.

[Comparison of Available Nitrogen and Phosphorus Characteristics in the Land-Water Transition Zone of Different Watersheds and Their Environmental Significance].

In order to explore the characteristics and environmental significance of available nitrogen and phosphorus in different land-water transition zones, soil and sediment samples from three study areas, including the upstream watershed of Minjiang River (MJU), western watershed of Hongze Lake (HZW), and western watershed of Taihu Lake (THW), were collected and analyzed. The results showed that the contents of total nitrogen and phosphorus in THW were higher than those of other two study areas. The contents of nitrogen and phosphorus in sediments were higher than those in soils of HZW. The distribution trend of available nitrogen and available phosphorus was generally consistent with the distribution trend of total nitrogen and phosphorus. The proportions of available nitrogen and phosphorus in THW and HZW were much higher than those in MJU, and the proportions of available nitrogen and phosphorus in sediments were higher than those in soils. The physiochemical properties such as pH value, organic matter, and iron and aluminum oxides were related to the available nitrogen and phosphorus in the soil and sediment, but correlations between them were complex. The distribution patterns of available nitrogen and phosphorus in the soil and sediments of the land-water transition zone reflect the impacts of the natural environment and human activities, particularly those of the latter.

The Association Between Preoperative Pain Catastrophizing and Chronic Pain After Hysterectomy - Secondary Analysis of a Prospective Cohort Study.

PURPOSE: Hysterectomy is associated with a high incidence of chronic post-hysterectomy pain (CPHP). Pain catastrophizing, a negative cognitive-affective response to pain, is associated with various pain disorders but its role in CPHP is unclear. We aimed to determine the association of high preoperative pain catastrophizing with CPHP development and functional impairment 4 months after surgery. PATIENTS AND METHODS: Secondary analysis of a prospective cohort study of women undergoing abdominal/laparoscopic hysterectomy to investigate the association between high pain catastrophizing (pain catastrophizing scale, PCS≥20) with CPHP and associated functional impairment (defined as impairment with standing for ≥30 minutes, sitting for ≥30 minutes, or walking up or down stairs). CPHP and functional impairment were assessed via 4- and 6-month phone surveys. RESULTS: Of 216 patients, 72 (33.3%) had high PCS, with mean (SD) of 30.0 (7.9). In contrast, 144 (66.7%) patients had low PCS, with mean (SD) of 9.0 (4.7). At 4 months, 26/63 (41.3%) patients in the high PCS group developed CPHP, compared to 24/109 (22.0%) in the low PCS group. At 6 months, 14/53 (26.4%) high PCS patients developed CPHP, compared to 10/97 (10.3%) patients with low PCS. High PCS was independently associated with CPHP at 4 months (OR 2.49 [95% CI 1.27 to 4.89], p=0.0082) and 6 months (OR 3.12 [95% CI 1.28 to 7.64], p=0.0126) but was not associated with functional impairment. High PCS≥20, presence of evoked mechanical temporal summation (MTS), and history of abdominal/pelvic surgery predict CPHP at 4 months with area under the curve (AUC) of 0.69. Similarly, PCS≥20 and increasing MTS magnitude predicted CPHP at 6 months with AUC of 0.76. CONCLUSION: High PCS was independently associated with CPHP. Future studies should identify other CPHP associated factors to formulate a risk-prediction model and investigate the effectiveness of early intervention for pain catastrophizers in improving pain-related outcomes.

[Effects of Exogenous Spermidine on Seed Germination and As Uptake and Accumulation of Rice Under As5+ Stress].

As pollution in farmland has a toxic effect on the growth of crops, which reduces their yield and quality. The effects of exogenous spermidine (Spd) on rice seed germination and seedling growth under As5+ stress were studied. The results showed that exogenous Spd could promote the germination of rice seeds under As5+ stress, improve the germination potential and germination rate of seeds, and promote the growth of seedling roots. The addition of Spd could increase the activity of catalase (CAT), peroxidase (POD), and superoxide dismutase (SOD) of rice seedlings and roots under As5+ stress, and reduce the content of malondialdehyde (MDA) in rice buds and roots. When As5+ concentration was 25 µmol·L-1, adding 500 µmol·L-1 and 1000 µmol·L-1 Spd, MDA content in rice roots was decreased by 12.3% and 31.3% and CAT activity of rice shoots was increased by 105.1% and 101.4%, and CAT activity of rice roots was increased by 29.9% and 57.1%, respectively. The addition of Spd also affected the uptake and accumulation of As in rice. When the concentration of As5+ was 25 µmol·L-1, adding 500 µmol·L-1 and 1000 µmol·L-1 Spd, the concentration of As in rice shoots decreased by 69.4% and 75.1%, and As concentration in rice roots decreased by 7.6% and 24.4%, respectively. Spd could therefore effectively alleviate the toxic effect of As5+ on rice.

[Effects of Biochar Input on Changes of Available Nutrient Elements in Riparian Soils with Different Landuse Types].

Biochar, as a new environmentally friendly material, has been used to improve soil quality and for pollution remediation. Biochar input has a significant impact on available nutrients in the soil. Based on the different land use types (forestland, grassland, cultivated land, and barren land) in the riparian zone of Taihu Lake, the effects of biochar application on the available content of nutrients in different land use types of soil were compared, and the dynamics of nutrient change was also discussed. Results show that the addition of biochar can significantly affect the available nutrient content in riparian soil, however the influential degrees for carbon, nitrogen, and phosphorus were different. After the input of biochar, dissolved organic carbon in riparian soils showed a clear downward trend, while the available nitrogen increased slightly, and the available phosphorus increased significantly. For woodland, grassland, arable land and wasteland soils, the contents of dissolved organic carbon decreased by 33.3%, 27.4%, 29.5%, and 51.4%, while the contents of available nitrogen increased by 10.8%, 18.2%, 16.4%, and 15.2%, and the contents of available phosphorus increased by 40.0%, 50.2%, 34.0%, and 43.6%, respectively. Compared with the concentrations between the control group soil (CK) and the biochar additive group soil (BC), the concentrations of dissolved organic carbon and available phosphorus exhibited large differences between the two groups regarding available nitrogen concentrations. Among the four types of riparian soils, the effects of biochar on the availability of different nutrients were different.

A preliminary assessment of vital-signs-integrated patient-assisted intravenous opioid analgesia (VPIA) for postsurgical pain.

BACKGROUND: We developed a Vital-signs-integrated Patient-assisted Intravenous opioid Analgesia (VPIA) analgesic infusion pump, a closed-loop vital signs monitoring and drug delivery system which embodied in a novel algorithm that took into account patients' vital signs (oxygen saturation, heart rate). The system aimed to allow responsive titration of personalized pain relief to optimize pain relief and reduce the risk of respiratory depression. Moreover, the system would be important to enable continuous monitoring of patients during delivery of opioid analgesia. METHODS: Nineteen patients who underwent elective gynecological surgery with postoperative patient controlled analgesia (PCA) with morphine were recruited. The subjects were followed up from their admission to the recovery room/ ward for at least 24 h until assessment of patient satisfaction on the VPIA analgesic infusion pump. RESULTS: The primary outcome measure of incidence of oxygen desaturation showed all patients had at least one episode of oxygen desaturation (< 95%) during the study period. Only 6 (31.6%) patients had oxygen desaturation that persisted for more than 5 min. The median percentage time spent during treatment that oxygen saturation fell below 95% was 1.9%. Fourteen (73.7%) out of 19 patients encountered safety pause, due to transient oxygen desaturation or bradycardia. The patients' median [IQR] pain scores at rest and at movement after post-op 24 h were 0.0 [2.0] and 3.0 [2.0], respectively. The average morphine consumption in the first 24 h was 12.5 ± 7.1 mg. All patients were satisfied with their experience with the VPIA analgesic infusion pump. CONCLUSIONS: The use of VPIA analgesic infusion pump, when integrated with continuous vital signs monitor and variable lockout algorithm, was able to provide pain relief with good patient satisfaction. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov registry (NCT02804022) on 28 Feb 2016.

Spatial distribution, source analysis, and ecological risk assessment of PBDEs in river sediment around Taihu Lake, China.

The distribution and composition of organic pollutants in sediment are affected by the source and regional environment. To understand the characteristics and risk of polybrominated diphenyl ethers (PBDEs) in the area around Taihu Lake, composite sediment samples (n = 41) were collected in rivers around Taihu Lake to explore the level, spatial distribution, and source of PBDEs. The results showed that the most abundant BDE congener in river sediment was BDE209, followed by BDE99 and BDE47, with median values of 48.7, 2.17, and 1.52 ng g-1, respectively. Concentrations of PBDEs in sediments from northern rivers were significantly higher than those from other areas, but the overall risk was at a moderate-lower level compared with research results in other references. Results of principle component analysis (PCA) and source characteristics analysis revealed that most of PBDEs in river sediments around Taihu Lake were mixture of multiple sources, which mainly originated from atmospheric deposition, industrial wastewater, and municipal sewage. TOC showed good correlations with most PBDEs, which implied that PBDE components were influenced by sediment organic matter. Meanwhile, the risk of PBDEs in river sediments in this study area is a moderate-lower level.

Lamellar Dissection Technique for Descemet Membrane Endothelial Keratoplasty Graft Preparation.

PURPOSE: To describe a novel lamellar dissection technique for Descemet membrane endothelial keratoplasty (DMEK) graft preparation, and to evaluate the rate of endothelial cell loss (ECL) and graft preparation failure associated with this technique. METHODS: We conducted an ex vivo laboratory-based study comparing ECL between the lamellar dissection and peeling techniques. Eight pairs of human donor corneas underwent calcein acetoxymethyl staining-all right eyes underwent the peeling technique and all left eyes underwent the lamellar dissection technique. ECL was quantified by image analysis with trainable segmentation software and compared between groups. We also conducted a retrospective analysis of 161 consecutive DMEK graft preparations by a single surgeon using the lamellar dissection technique from 2010 to 2018. Data on donor characteristics and graft preparation failures were obtained. RESULTS: Baseline donor characteristics were comparable in both arms of the laboratory-based study. Mean (SD) ECL with the lamellar dissection and peeling techniques was 13.8% (4.2%) and 11.2% (6.1%), respectively. There was no significant difference between the two (P = 0.327). In the clinical series, there were 2 graft preparation failures in 161 cases (1.2%). Among cases performed on diabetic donor tissue, the rate of graft preparation failure was 4.7%. CONCLUSIONS: The lamellar dissection technique has a similar rate of ECL compared with the peeling technique for DMEK graft preparation. This technique also has a low rate of graft preparation failure and may be a useful technique for diabetic donor tissue.

Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial.

BACKGROUND: The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section. METHODS: Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, fetal outcomes, and maternal side effects associated with the airway device. RESULTS: We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective cesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--ORSLMA/ETT: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: - 23.71, - 22.21 s) compared to ETT group (p <  0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration. CONCLUSIONS: SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second-line use of LMA in the management of the obstetric airway. TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov , identifier: NCT01858467 , retrospectively registered. Date of registration: May 21, 2013.

Association of Mallampati scoring on airway outcomes in women undergoing general anesthesia with Supreme™ laryngeal mask airway in cesarean section.

BACKGROUND: Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics. METHODS: This prospective cohort study was performed at a single-center: Quanzhou Women's and Children's Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes. RESULTS: The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p <  0.0001). There was no difference in maternal age, ASA status and gestational age. There was similar time to effective ventilation (mean (SD) High MP: 14.9 (4.5) vs Low MP: 15.7 (4.4) seconds, p = 0.2172), and first attempt success rate, seal pressure, and peak airway pressure. No clinical aspiration was noted. The incidence of blood on SLMA was higher in the High MP group than in Low MP (4 (6.6%) vs 4 (0.8%), p = 0.001). There was no difference in sore throat, voice hoarseness, maternal satisfaction and fetal outcomes. CONCLUSION: High MP was not associated with reduced SLMA airway outcomes in cesarean section under general anesthesia, but may increase the risk of blood found on SLMA upon removal. TRIAL REGISTRATION: This study was registered at http://www.clinicaltrials.gov , identifier: NCT02026882 , retrospectively registered. Date of registration: December 31, 2013.

[Spatial Distribution of Organic Phosphorus in Sediment and Its Environmental Implication in the Upper Stream of Minjiang River].

In order to explore the effect of land use pattern on phosphorus distribution and the potential release capacity of stream sediment in the upper Minjiang River, this paper presented organic phosphorus forms and their spatial distribution characteristics of sediments in the upper Minjiang River by using the IVANOFF method and discussing the effects of physicochemical properties of sediments on the distribution of organic phosphorus forms. The results show that:①nitrogen and phosphorus contents of sediments in Jianxi and Shaxi catchments are higher than those in the Futunxi catchment, probably related to the large number of farmland runoff and municipal sewage near the Jianxi and Shaxi catchments and the large forest area around the Futunxi catchment;②contents in the sediments from three catchments and TP contents in the sediments from Jianxi and Futunxi catchments showed the order of upper reaches < middle reaches < lower reaches, which may be caused by the mountainous and forested areas in the upper reaches and the intensive human activities in the middle and lower reaches;③nitrogen phosphorus in sediments of the three catchments were mainly non-active organic phosphorus, which indicated that upper reaches of the Minjiang river were generally less affected by external pollution, and the relative proportion of organic phosphorus in the sediments of different catchments was relatively large, while the change in different sections of the same river was relatively small;④physicochemical properties of sediments had a significant impact on the morphology and distribution of organic phosphorus, among which the effects of organic matter, TP, and TN were the most obvious, but the effects on sediments in different river basins were different. Therefore, to protect the water quality of the upper Minjiang River, it is necessary to strengthen the control of the living and agricultural pollution sources near the catchments.

A novel approach to neuraxial anesthesia: application of an automated ultrasound spinal landmark identification.

BACKGROUND: Neuraxial procedures are commonly performed for therapeutic and diagnostic indications. Currently, they are typically performed via palpation-guided surface landmark. We devised a novel intelligent image processing system that identifies spinal landmarks using ultrasound images. Our primary aim was to evaluate the first attempt success rate of spinal anesthesia using landmarks obtained from the automated spinal landmark identification technique. METHODS: In this prospective cohort study, we recruited 100 patients who required spinal anesthesia for surgical procedures. The video from ultrasound scan image of the L3/4 interspinous space in the longitudinal view and the posterior complex in the transverse view were recorded. The demographic and clinical characteristics were collected and analyzed based on the success rates of the spinal insertion. RESULTS: Success rate (95%CI) for dural puncture at first attempt was 92.0% (85.0-95.9%). Median time to detection of posterior complex was 45.0 [IQR: 21.9, 77.3] secs. There is good correlation observed between the program-recorded depth and the clinician-measured depth to the posterior complex (r = 0.94). CONCLUSIONS: The high success rate and short time taken to obtain the surface landmark with this novel automated ultrasound guided technique could be useful to clinicians to utilise ultrasound guided neuraxial techniques with confidence to identify the anatomical landmarks on the ultrasound scans. Future research would be to define the use in more complex patients during the administration of neuraxial blocks. TRIAL REGISTRATION: This study was retrospectively registered on clinicaltrials.gov registry ( NCT03535155 ) on 24 May 2018.

Evaluation of association factors for labor episodic pain during epidural analgesia.

PURPOSE: Epidural analgesia provides safe and effective labor pain relief. However, labor episodic pain can occur during epidural analgesia, requiring epidural top-ups, and may result in decreased patient satisfaction. The primary aim of our study was to investigate the factors associated with labor episodic pain during epidural analgesia. PATIENTS AND METHODS: Electronic and hardcopy records of labor deliveries between January 2012 and December 2015 were reviewed at KK Women's and Children's Hospital, Singapore. The primary outcome was the prevalence of episodic pain. Demographic, clinical and anesthetic data were retrieved. Univariate and multivariate logistic regression analyses were used to identify associated risk factors for labor episodic pain experienced by parturients while receiving epidural analgesia. Model performance was assessed by area under the curve (AUC) from the receiver operating characteristic curve. RESULTS: The prevalence of labor episodic pain was 14.2% (2,951 of 20,798 parturients). The risk factors associated with labor episodic pain, which are given here as factor (OR, 95% CI), are the following: need for epidural resiting (11.4, 7.53-17.28), higher pain scores intrapartum (1.34, 1.32-1.36), higher Bromage scores (1.12, 1.02-1.22), the need for instrumental delivery (1.32, 1.16-1.52), the need for cesarean delivery (1.41, 1.26-1.59), the presence of venous puncture (1.29, 1.03-1.62), the presence of dural puncture (14.28, 5.92-34.43), the presence of high block (6.05, 1.39-26.35), the need for a urinary catheter (1.17, 1.17-1.34), larger volumes of local anesthetics used (1.01, 1.01-1.01) and higher body mass index (1.01, 1.01-1.02), and decreased maternal satisfaction (0.97, 0.97-0.98). The AUC was 0.80. CONCLUSION: Knowledge of these factors may allow for future interventions in management to prevent labor episodic pain. Further research is needed to validate these association factors.