Ultrasound-Guided Lumbar Plexus Block Reduces Emergence Agitation in Children Undergoing Hip Surgery: A Prospective Randomized Controlled Trial

Background Emergence agitation (EA) is a common and challenging postoperative problem in children emerging from general anesthesia. It is associated with self-injury, increases stress on healthcare team members and postoperative maladaptive behavioral changes. However, no completely effective prevention has been found for EA. Pain is considered to be an important contributor to EA. Ultrasound-guided lumbar plexus block is a safe and effective anesthetic technique that can provide satisfactory pain relief in pediatric hip surgery. We aim to investigate the effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery. Methods This prospective, randomized, controlled study was conducted in children aged 1-6 yr undergoing elective hip surgery. Subjects were randomly assigned to receive either ultrasound-guided lumbar plexus block combined with general anesthesia (Group Block, n=60) or routine general anesthesia (Group Control, n=60). The primary outcome was the incidence of EA at 30 min after emergence from general anesthesia, assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included the incidence of severe EA, postoperative pain evaluated by the Children’s Hospital of eastern Ontario Pain Scale (CHEOPS) and the incidence of postoperative adverse complications. PAED, CHEOPS were measured at 0, 5, 10, 20, and 30 min after emergence from anesthesia. Results The incidence of EA was significantly lower in Group Block than in Group Control [13.3% vs. 43.3%, odds ratio (OR) 0.201, 95% confidence interval (CI) 0.082to 0.496, p<0.001]. Group Block had a lower incidence of severe EA than Group Control [3.3% vs. 18.3%, odds ratio (OR) 0.154, 95% confidence interval (CI) 0.032 to 0.727, p=0.019]. CHEOPS was lower in Group Block than in Group Control [mean (95%CI), 4.5(4.4-4.6) vs.4.9 (4.8-5.0), p<0.001]. Conclusion Ultrasound-guided lumbar plexus block could decrease the incidence and severity of emergence agitation in children undergoing hip surgery effectively. Trial registration: Chinese Clinical Trial Registry: ChiCTR-INR-17011525 (30/05/2017)

The Psychological Aspect of Polypharmacy in Patients with Chronic Diseases. A Case Control Study about The Impact of Polypharmacy Regime Amongst Patients in Kurdistan Region of Iraq.

Background:Patients on Polypharmacy regime due to having a chronic illness are at a higher risk of developing some form of negative psychological outcome as a result of their disease. This study aims to determine the impact of polypharmacy on the psychological aspects of a patient living with a chronic disease.Method:A case-control study conducted amongst patients in an outpatient clinic of an Internist (July 1st to September 1st, of 2021) in the city of Erbil, Iraq. Data was extracted from a self-assessed questioner. 200 participants were divided into polypharmacy (case group) and non-polypharmacy group (control group). Polypharmacy, being defined as the use of 5 or more medication which meant that participants in the case group must fit into these criteria. A ‘Hospital Anxiety and Depression Scale’ (HADS) was used to determine the presence of symptoms of depression and/or anxiety.Results:A totally of 200 patients were included in the study. Of these 100 participants were from the non-polypharmacy group while the remaining 100 were from the polypharmacy group. Of these, depression among non-polypharmacy group (control) participants were 11% while 76% were found to be non-cases of depression. Compared to that, 31% of the polypharmacy group had depression while 51% were non-cases for depression. Also. the prevalence of depression and anxiety was increasing with an increase in number of medications taken by the patients. Depression was present in 11% of patients who took 4 or less medications while the prevalence increased to 21.1%, 34.9% and 42.1% in patients who took five, six to eight, and more than nine medications, respectively.Conclusion: There is a significant link between polypharmacy and psychological distress in patients with chronic diseases with a focus on depression and anxiety. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimes and reducing the outcomes of chronic diseases. Trial registration: - This article doesn’t contain any health care intervention on human participants.

Cognitive Defusion as Strategy to Reduce the Intensity of Craving Episodes and Improve Eating Behavior

The elaborated intrusion theory of desire proposes that craving is a cognitive motivational process involving intrusive thoughts. Changing the way we react to them, cognitive defusion (CD), should limit thought elaboration and craving. We induced chocolate craving in female chocolate cravers before CD (Study 1). A decrease in craving measured by a single-item scale, Visual Analogical Scale (VAS; p < .001, ηp2 = .449) and as a state, State Food Craving Questionnaire (FCQ-S; p = .029, ηp2 = .106) were found in the experimental group, while similar results were also found in group control. The reduction in craving (VAS) in group CD correlated negatively with chocolate consumption on a bogus taste test (r = –.439, p = .036), while the correlation was positive in the case of group control (r = .429, p = .047). Food craving as a trait, measured by the Trait Food Craving Questionnaire (FCQ-T), showed negative correlations with measures of CD and mindfulness skills (lowest r = –.313, p = .018). In Study 2 participants made use of a smartphone application implementing the CD procedure in real contexts whenever they experienced food craving. A corresponding decline in self-reported craving was found, as well as in consumption of the craved food (indulgence) compared with the control condition. Our findings indicate that CD may be a promising intervention for tackling the elaboration of intrusive thoughts and eating behavior in young female food cravers, both in a controlled laboratory environment after a cue-food exposure craving induction procedure, as well as responding to naturally occurring food cravings in real-life settings.

Denonvilliers’ fascia acts as the fulcrum and hammock for continence after radical prostatectomy

Background Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific reason. Methods A multicenter cohort of 154 consecutive patients from 2018 to 2020, who was diagnosed with localized prostate cancer underwent either modified mini-incision retropubic radical prostatectomy (Mmi-RRP) or laparoscopic radical prostatectomy (LRP) or robotic-assisted radical prostatectomy (RARP). Seventy-two patients with Denonvilliers’ fascia (DF) spared were included in DFS (Denonvilliers’ fascia sparing) group. Whereas eighty-two patients with DF completely or partially dissected were set as Group Control. The primary outcome was immediate continence (ImC). Continuous data and categorical data were analyzed with t-test and Chi-square test, respectively. Odds ratios (ORs) were calculated with logistic regression. Results Urinary continence of Group DFS was significantly better than that of Group Control at each time point within one year after operation. Incidence rate of continence in Group DFS and Group Control were 83.3% vs 13.4% (P < 0.01) for ImC, 90.3% vs 30.5% (P < 0.01) at 3 months, 91.7% vs 64.6% (P < 0.01) at 6 months, and 93.1% vs 80.5% (P = 0.02) at 1 year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P = 1.0). In multivariate analysis, DFS showed importance for ImC post RP (OR = 26.4, P < 0.01). Conclusions Denonvilliers’ fascia acted as the fulcrum and hammock for continence post RP. Preservation of DF contributed to better continence after RP without increase of PSM. Trail registration Our research was conducted retrospectively and approved by the ethical committees of Minhang Hospital, but not registered.

Multi-Level Control System for an Intelligent Robot that is Part of a Group

The article is devoted to the application of a group of robotic complexes for military purposes. The current state of control systems of single robotic complexes does not allow solving all the tasks assigned to the robot. The analysis of methods of controlling a group of robots in combat conditions is carried out. The necessity of using a multi-level control system for an intelligent combat robot is justified. A multi-level control system for an intelligent robot is proposed. Such a system assumes the possibility of controlling the robot in one of four modes: remote, supervisory, autonomous and group. Moreover, each robot, depending on the external conditions and its condition, can be in any control mode. The application of the technique is shown by the example of the movement of a group of robots with an interval along the front. The problem of the movement of slave robots behind the leader is considered. When forming the robot control algorithm, the method of finite automata was used. The algorithm controls the movement of the RTK in various operating modes: group control mode and autonomous movement mode. In the group control mode, the task is implemented: movement for the leader. For the state of "Movement in formation", an algorithm for forming the trajectory of the movement of guided robots was implemented. An algorithm for approximating the Bezier curve was used. It allows you to build a trajectory for the slave robot. On the basis of the obtained trajectory, the angular and linear velocity were calculated. In the autonomous control mode, two tasks are solved: moving to a given point and avoiding obstacles. Vector Field Histogram was used as an algorithm for detouring an obstacle, which determines the direction of movement without obstacles. The state of "Movement to a given point" is based on Pure Pursuit as a simple and reliable algorithm for solving such problems. A computer model of the movement of a group of robots was developed. The model is implemented in the MATLAB program using the Simulink and Mobile Robotics Simulation Toolbox libraries. Several different variants of the movement of the RTK group are modeled, which differ from each other in the initial location of the robots and the position of obstacles. The conducted computer simulation showed the efficiency and effectiveness of the proposed method of RTC control.

Group control of air-cooled gas apparatuses

The paper considers the possibility of reducing electric power consumption by aircooled gas apparatus of a gas compressor station. The authors propose a system with breakdown of ventilators into IV groups with five ventilators in each group. Comparison of operation modes of a traditional cooling system and a grouped one with fans speed regulation on the basis of a frequency converter showed that the grouped handling system saved up to 40% of electric power.

Low-level laser therapy and static stretching exercises for patients with knee osteoarthritis: A randomised controlled trial

Objectives To investigate the laser effect associated with stretching exercise on pain and functionality in patients with knee osteoarthritis. Design A randomised controlled trial Setting Special Rehabilitation Services. Subjects We enrolled 215 knee osteoarthritis patients (430 knees were treated). Intervention Group Laser + Stretch ( n = 43), Placebo + Stretch ( n = 43), Stretch ( n = 43), Laser ( n = 43) and Control ( n = 43) were treated with active laser and stretching exercises; placebo laser and stretching exercises; stretching exercises; active laser, and control, respectively. Interventions were conducted 3 times a week for 8 or 11 weeks. Main outcome measures The primary outcome was the change in knee pain and disability. Secondary outcomes included severity of osteoarthritis, mobility, knee range of motion, flexibility, activity, severity of osteoarthritis and medication intake for pain relief. Results The patients’ average age was 63.52 (6.8) years. Pain scores at baseline and post treatment ( p < 0.001) were 7.43 (2.10) and 2.79 (1.92) for group Laser + Stretch, 7.39 (1.98) and 4.47 (2.82) for group Placebo + Stretch, 6.83 (1.42) and 4.24 (2.43) for group Stretch, 6.61 (1.68) and 2.94 (2.65) for group Laser, 6.74 (1.75) and 6.47 (2.29) for group Control, respectively. Disability score at baseline and post treatment ( p = 0.000237) were 12.36 (5.02) and 8.08 (4.64) for group Laser + Stretch, 12.71 (5.12) and 9.90 (4.95) for group Placebo + Stretch, 11.83 (2.77) and 7.20 (5.28) for group Stretch, 11.58 (5.59) and 8.21 (6.18) for group Laser, 11.23 (4.68) and 11.45 (4.83) for group Control, respectively. Conclusion Laser therapy combined with stretching exercises improves pain during rest, activities of daily living, stiffness, muscle shortening and range of motion in patients with knee osteoarthritis.