Abstract Background : This study aimed to investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. Methods : A total of 80 patients undergoing radical prostatectomy were randomly divided into two groups: general anaesthesia with QLB (QLB group; n = 40) and general anaesthesia with sham QLB (normal saline [NS] group; n = 40). QLB or sham QLB was performed before the induction of anaesthesia. Sufentanil was intravenously administered for postoperative analgesia. The primary outcome was the pain score (measured using a numerical rating scale [NRS]) at different time points within 48h postoperatively. Secondary outcomes included the cumulative dose of sufentanil within 48 h postoperatively, subjective comfort, grip strength, first time of exhaustion, first fluid intake time, time to get out of bed, length of postoperative hospital stay and overall satisfaction. The SPSS software, version 17.0, was used for all statistical analyses. Results: Postoperative NRS at rest was significantly lower at 2 h (1.7 ± 1.1 versus 3.0 ± 2.1), 4 h (1.8 ± 1.2 versus 4.1 ± 2.3), 6 h (1.9 ± 2 versus 4.4 ± 2) and 12 h (3.5 ± 2.3 versus 5 ± 3.3) and was also lower when coughing at 2 h (2.3 ± 1.1 versus 4 ± 2.1), 4 h (2.3 ± 1. 1 versus 4.3 ± 2) and 6 h (2.4 ± 1.1 versus 5.9 ± 2.3) in the QLB than that in the NS group. The cumulative dose of sufentanil was significantly lower in the QLB than that in the NS group at 4 h, 6 h, 12 h, 24 h and 48 h. The nausea score was significantly lower in the QLB group at 24 h postoperatively, and the first time of exhaustion and time to get out of bed were significantly shorter (P < 0.05). The overall satisfaction score was significantly higher in the QLB than in the NS group (4 ± 0.7 versus 2.6 ± 0.9). Conclusion : Ultrasound-guided bilateral QLB can provide effective postoperative analgesia for patients undergoing radical prostatectomy, reduce the need for sufentanil, facilitate comfort and improve postoperative outcomes. QLB can be a good component of multimodal analgesia. Trial registration : The clinical trial is registered in the Chinese Clinical Trial Registry (ChiCTR). Current Controlled Trials：ChiCTR1900022009. the date of registration：2019/03/20. http://www.chictr.org.cn/edit.aspx?pid=30934&htm=4
Miter gates are vital civil infrastructure components in inland waterway transportation networks. To provide risk-informed insights for decisions related to repair and maintenance, sensors have been installed on some miter gates for monitoring. Despite the monitoring system's ability in collecting a large volume of monitoring data, accurately diagnosing damage state in such large structures remains challenging due to the lack of labeled monitoring data, since these structures are designed with high reliability and for a long operation life. This paper addresses this challenge by proposing a damage diagnostics approach for miter gates based on domain adaptation. The proposed approach consists of two main modules. In the first module, Cycle-Consistent generative adversarial network (CycleGAN) is employed to map monitoring data of a miter gate of interest and other similar yet different miter gates into the same analysis domain. Subsequently, a normalizing flow-based likelihood-free inference model is constructed within this common domain using data from source miter gates whose damage states are labeled from historical inspections. The trained normalizing flow model is then used to predict the damage state of the target miter gate based on the translated monitoring data. A case study is presented to demonstrate the effectiveness of the proposed method. The results indicate that the proposed method in general can accurately estimate the damage state of the target miter gate in the presence of uncertainty.
Objective To compare the healing process and adhesion formation in autogenous and allogeneic intrasynovial tendon (IT) grafts and extrasynovial tendon (ET) grafts. Methods The fresh autografts and deep freeze preserved allografts from the flexor digitorum profundus tendon (IT) and the long peroneal tendon (ET) were grafted intrathecally to repair the defect of flexor digitorum profundus tendon of the 2nd (IT) and the 4th (ET) toe in rabbits. Histological and ultrastructural observations were performed at 10 days, 3 and 6 weeks postoperatively. Biomechanical testing of the tendons was carried out in 8 weeks. Results Slight adhesion was observed in the intrasynovial autografts and allografts. There was dense adhesion with the tendon sheath and the flexor digitorum superficialis tendon in the extrasynovial autografts and allografts. Excursion of the extrasynovial autografts and allografts was inferior to that of the intrasynovial ones ( F =14.10, P 0.01 ). By eight weeks, the maximum tensile load of the allografts was less than that of the autografts ( F = 10.11, P 0.01 ). Conclusions The healing process of the intrathecally grafted tendons is donor tissue specific in both autografts and allografts. The intrasynovial origin tendon grafts demonstrate significantly improved excursion function. The healing process of the allografts is slower than that of the autografts.
A 15-bit quadrature digital power amplifier (DPA) is presented for wide efficiency enhancement coverage on the IQ complex plane and high dynamic power range. Complex-domain Doherty is proposed with IQ -cell-sharing and single-supply Class-G techniques to provide 32 power-added efficiency (PAE) peaks, good linearity, and simplified power management design. The efficiency enhancement and average efficiency of modulation signal can be verified and evaluated by a theoretical analysis using a switched-capacitor power amplifier (SCPA) model. The special control logic scheme enabling the combination of IQ -cell-sharing and Class-G techniques is implemented at a low cost. Fabricated in a 28-nm CMOS technology, the proposed DPA occupies a 0.74-mm $^{\text{2}}$ compact die size with a single-transformer footprint. The DPA achieves a peak output power of 29.9 dBm with a PAE of 38.0% at 2.3 GHz. For long-term evolution (LTE) 20-MHz 64-QAM signal, the DPA obtains 24.5-dBm average output power ( $P_{\mathbf{avg}}$ ), 25.3% average PAE with 70.4-dB dynamic power range, and $-$ 47.3-dB error vector magnitude (EVM) floor at 2.3 GHz. For the 802.11ax 40-MHz 256-QAM signal, it achieves 19.3-dBm Pavg, 19.2% average PAE with 50.4-dB dynamic power range, and $-$ 43.0-dB EVM floor at 2.4 GHz.
Although a number of studies have been conducted to address the relation between a gene deletion polymorphism of glutathione S-transferase M1 (GSTM1) and breast cancer, no definite conclusion has been reached and no clear risk pattern has yet to emerge for GSTM1. We first conducted case-control studies that included 1920 subjects using a genotyping method allowing the definition of GSTM1-null (-/-), homozygous wild-type (+/+), and heterozygous (+/-) genotypes. The results show that GSTM1(-/-) confers an increased risk for breast cancer development compared with that in GSTM1-present individuals (+/+ and +/-), which was subsequently confirmed by a meta-analysis of all of the 41 relevant studies (odds ratio: 1.10, P<0.001). Unexpectedly, we found that GSTM1(+/+) is also a risk genotype compared with GSTM1(+/-). Furthermore, we identified a functional polymorphism in the GSTM1 promoter region associated with breast cancer. The variant allele modifies DNA binding to the AP-2alpha transcription factor, resulting in reduced promoter activity and mRNA expression. However, this low-activity allele is associated with reduced breast cancer risk. It seems that approximately 60-70% expression from one allele of GSTM1 could suffice for protection against breast cancer; null activity and overactivity of GSTM1 are both disadvantageous. These results indicate a U-shaped association of GSTM1 with breast cancer, which challenges the linear gene-dosage effect of GSTM1 that was previously proposed. We recommend that a more complicated role for GSTM1 should be considered in breast cancer risk prediction.
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