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In this paper, a high-speed low-power CMOS synchronous up/down counter with a novel compact toggle flip-flop is proposed to achieve energy- and area-efficient speed enhancement. It adopts a high-speed local clock generation based on a single Manchester carry chain to improve counting speed. The counter embeds clock gating in the local clock generation to eliminate redundant power consumption. A compact toggle flip-flop is incorporated for device count and power reduction. Both the up- and down-counting capabilities are supported. A 16-bit proposed counter was fabricated in a 28-nm CMOS process. Performance evaluation results indicate that the proposed counters can provide up to 55% speed improvement as compared to conventional designs. It also indicates that up to 28% performance gain is obtained in terms of power-delay product compared to conventional clock-gated CMOS counters.

Quadriceps muscles play a pivotal role in knee osteoarthritis (OA) progression and symptom manifestation, particularly pain. This research investigates the therapeutic effectiveness of muscle enhancement and support therapy (MEST), a recently developed device intended for intramuscular insertion of cog polydioxanone filaments, in quadriceps restoration to alleviate OA pain. Knee OA was induced in Sprague Dawley rats via monoiodoacetate injections. MEST or sham treatment was performed in OA or Naive rat quadriceps. Pain was assessed using paw withdrawal threshold and weight bearing. Quadriceps injury and recovery via MEST were evaluated using biomarkers, tissue morphology, muscle mass, contractile force and hindlimb torque. Satellite cell and macrophage activation, along with their activators, were also assessed. Data were compared at 1- and 3-weeks post-MEST treatment (M-W1 and M-W3). MEST treatment in OA rats caused muscle injury, indicated by elevated serum aspartate transferase and creatinine kinase levels, and local β-actin changes at M-W1. This injury triggered pro-inflammatory macrophage and satellite cell activation, accompanied by heightened interleukin-6 and insulin-like growth factor-1 levels. However, by M-W3, these processes gradually shifted toward inflammation resolution and muscle restoration. This was seen in anti-inflammatory macrophage phenotypes, sustained satellite cell activation and injury markers regressing to baseline. Quadriceps recovery in mass and strength from atrophy correlated with substantial OA pain reduction at M-W3. This study suggests that MEST-induced minor muscle injury triggers macrophage and satellite cell activation, leading to recovery of atrophied quadriceps and pain relief in OA rats.

Objective Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.Methods This prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.Results Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.Conclusion A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia. Trial Registration:Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979; Registration number NCT02604979

Although laparoscopic surgery significantly reduces surgical trauma compared to open surgery, postoperative ileus is a frequent and significant complication after abdominal surgery. Unlike laparoscopic colorectal surgery, the effects of epidural analgesia on postoperative recovery after laparoscopic gastrectomy are not well established. We compared the effects of epidural analgesia to those of conventional intravenous (IV) analgesia on the recovery of bowel function after laparoscopic gastrectomy. Eighty-six patients undergoing laparoscopic gastrectomy randomly received either patient-controlled epidural analgesia with ropivacaine and fentanyl (Epi PCA group) or patient-controlled IV analgesia with fentanyl (IV PCA group), beginning immediately before incision and continuing for 48 h thereafter. The primary endpoint was recovery of bowel function, evaluated by the time to first flatus. The balance of the autonomic nervous system, pain scores, duration of postoperative hospital stay, and complications were assessed. The time to first flatus was shorter in the epidural PCA group compared with the IV PCA group (61.3 ± 11.1 vs. 70.0 ± 12.3 h, P= 0.001). Low-frequency/high-frequency power ratios during surgery were significantly higher in the IV PCA group, compared with baseline and those in the epidural PCA group. The epidural PCA group had lower pain scores during the first 1 h postoperatively and required less analgesics during the first 6 h postoperatively. Compared with IV PCA, epidural PCA facilitated postoperative recovery of bowel function after laparoscopic gastrectomy without increasing the length of hospital stay or PCA-related complications. This beneficial effect of epidural analgesia might be attributed to attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.

Background: Intraocular pressure is increased during laparoscopic surgeries performed in a steep Trendelenburg position. This study compared the effects of propofol with those of sevoflurane on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy in a 30° Trendelenburg position. Methods: Sixty-six patients were randomly allocated to a maintenance anesthetic consisting of remifentanil and sevoflurane (Sevoflurane Group) or remifentanil and propofol (Propofol Group). Intraocular pressure (IOP) was measured at nine predefined time points, including baseline (T0), five minutes after establishing pneumoperitoneum (T2), 30 min after establishing the Trendelenburg position with pneumoperitoneum (T3), five minutes after returning to the horizontal position (T4), and immediately after tracheal extubation (T6). The primary outcome was the change in intraocular pressure from T0 to T3. Results: The results of linear mixed model analysis showed that intraocular pressure differed between the two groups (P= 0.0039). At T3, the mean (SD) IOP was greater in the Sevoflurane Group [23.5 (4.3) mmHg] than in the Propofol Group [19.9 (3.8) mmHg] (P= 0.0019). At T2 and T6, IOP was also greater in the Sevoflurane Group than in the Propofol Group (P= 0.038 and P= 0.009, respectively). There was a statistically significant increase in intraocular pressure from baseline to T3 (pneumoperitoneum and steep Trendelenberg) in the Sevoflurane Group [6.0 (5.0) mmHg; P< 0.001] but not in the Propofol Group [2.1 (5.1) mmHg; P= 0.136]. None of the patients experienced ocular complications. Conclusions: Intraocular pressure increases after pneumoperitoneum and the steep Trendelenburg position are established. This increase is less with propofol than with sevoflurane anesthesia. This trial was registered at ClinicalTrials.gov: NCT01744262.

With the continuous production of the well development, sidewall instability phenomenon has become increasingly serious, mostly occurs in the shale formation, benefit for oilfield produced great harm. Water-based drilling fluid sidewall instability mechanism has been basically clear, the oil-base drilling fluid influence on sidewall stability is not yet concrete. So this paper mainly for oil-based drilling fluid hard brittle shale sidewall instability mechanism research. This article first from the perspective of chemistry, the hard brittle shale borehole wall instability is studied, the experiment tested respectively by the white oil and water treatment of hard brittle shale of cation exchange capacity (CEC) value, so as to analyze the same and the hydration of clay mineral equivalent after processing samples, through analysis of the temperature, time, media's impact on hard brittle shale wellbore stability. Secondly, from the Angle of mechanics, stress and mechanical properties of mud shale formation is analyzed, and the minimum drilling fluid density model, gives a variety of analysis and calculation formula. In addition, this paper adopted the X ray diffraction (XRD)

The isothermal solubility of the ternary system K+,Mg2+/B4O72-—H2O at 25℃ has been studied and the phase diagram is determined. The results show that the system is of the simple eutonic type and can be in metastable equilibrium state within 8—16 hours. The phase diagram consists of two solubility branches corresponding to the crystallization areas of K2B4O7•4H2O and MgB4O7•9H2O. The composition of the eutonic point is MgB4O7,0.5279%(Wt%) and K2B4O7,13.9629%(Wt%) respectively. The replicate experiments proved that the phase transformation of hungtsaoite (MgB4O7•9H2O) occurs after a 20 hours epuilibrium.

Pneumoperitoneum during laparoscopic surgery is known to affect visceral blood flow and result in oxidative stress. Whether epidural anesthesia will effectively reduce visceral ischemia and oxidative stress by blocking the sympathetic nervous system (SNS) during laparoscopic surgery has not been proven.Forty-five patients who were to undergo robot-assisted laparoscopic prostatectomy were randomly assigned to the combined general–epidural anesthesia group (group GE, n= 22) or to the general anesthesia group (group G, n= 23). Blood pressure, heart rate, and the balance between sympathetic and parasympathetic nervous system activity as measured by heart rate variability were recorded at 10 min after induction of anesthesia (T1), 60 (T2) and 120 (T3) min after intra-abdominal CO2insufflation, and 10 min after returning the patient to the supine position following CO2exsufflation (T4). Arterial blood gas analysis and blood sampling for measurements of nitrite (NO2−) and malondialdehyde (MDA) were performed at all time points.Intraoperative mean blood pressure was significantly lower in group GE compared with group G. The low-frequency to high-frequency ratio was significantly increased after induction of pneumoperitoneum in group G but was unchanged in group GE. Plasma levels of nitrite decreased after pneumoperitoneum induction in group G while there was no change in group GE. A significant increase in MDA levels was seen in group G after pneumoperitoneum induction and were higher than group GE at T3 and T4. The 24-h urine output was higher in group GE than in group G on POD 1. The 24-h CrCl was higher in group GE on POD 1 but was not different between groups on POD 2.Combined epidural and general anesthesia effectively blocks SNS stimulation during laparoscopic surgery and reduces NO inactivation and oxidative stress.

A charge-bouncing solution to avoid the undesirable drift in a programmed memory during readout of a memristor-based non-volatile memory is proposed. A memristor memory can be programmed by using strong programming signals, and the programmed memristance can be readout by using weak readout signals. Though readout signals are weak compared to programming signals, the readout charge accumulates over time, leading to an undesirable drift of the operating point. This causes an error in the programmed memory. Memristance drift is an important problem for practical utilization of memristors as memories. The only way presented so far to avoid such a drift is by converting input signals to doublets, but non-ideal doublet signals still cause drift problems. In the proposed method, drift is avoided using a capacitor in such a way that all the charge injected into the memristor during readout is stored in the capacitor and bounced back through the memristor after the readout has been completed. Experimental results showing an excellent recovery from the temporal memristance drift when using singlet pulses rather than the conventionally-used doublet pulses for memristive memory readout are also presented.A charge-bouncing solution to avoid the undesirable drift in a programmed memory during readout of a memristor-based non-volatile memory is proposed. A memristor memory can be programmed by using strong programming signals, and the programmed memristance can be readout by using weak readout signals. Though readout signals are weak compared to programming signals, the readout charge accumulates over time, leading to an undesirable drift of the operating point. This causes an error in the programmed memory. Memristance drift is an important problem for practical utilization of memristors as memories. The only way presented so far to avoid such a drift is by converting input signals to doublets, but non-ideal doublet signals still cause drift problems. In the proposed method, drift is avoided using a capacitor in such a way that all the charge injected into the memristor during readout is stored in the capacitor and bounced back through the memristor after the readout has been completed. Experimental results showing an excellent recovery from the temporal memristance drift when using singlet pulses rather than the conventionally-used doublet pulses for memristive memory readout are also presented.

Objective We aimed to determine the physiological and hemodynamic changes in patients who were undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) cytoreductive surgeries.Methods This prospective, observational study enrolled 21 patients who were undergoing elective cytoreductive surgery with HIPEC at our hospital over 2 years. We collected vital signs, hemodynamic parameters including global end-diastolic volume index (GEVI) and extravascular lung water index (ELWI) using the VolumeView™ system, and arterial blood gas analysis from all patients. Data were recorded before skin incision (T1); 30 minutes before HIPEC initiation (T2); 30 (T3), 60 (T4), and 90 (T5) minutes after HIPEC initiation; 30 minutes after HIPEC completion (T6); and 10 minutes before surgery completion (T7).Results Patients showed an increase in body temperature and cardiac index and a decrease in the systemic vascular resistance index. GEDI was 715.4 (T1) to 809.7 (T6), and ELWI was 6.9 (T1) to 7.3 (T5).Conclusions HIPEC increased patients’ body temperature and cardiac output and decreased systemic vascular resistance. Although parameters that were extracted from the VolumeView™ system were within their normal ranges, transpulmonary thermodilution approach is helpful in intraoperative hemodynamic management during open abdominal cytoreductive surgery with HIPEC. Trial registry name:ClinicalTrials.gov Trial registration number:NCT02325648 URL: https://clinicaltrials.gov/ct2/results?cond=NCT02325648&term

An analogue synchronous mirror delay with duty cycle correction scheme (ASMDCC), to improve the data transmission performance between DRAM and system, is proposed. The ASMDCC achieves duty cycle correction and clock synchronisation at once within two clock cycles, by using a half value current source. The simulation results show the duty cycle of the internal clock is stabilised with less than ±100 ps deviation from 50% for the wide duty cycle range.

A novel bootstrapped CMOS latched driver is presented which improves the switching speed by boosting internal nodes for driving a large capacitive load at low supply voltages. The proposed driver has larger bootstrap voltages than the conventional driver, which further help to increase the speed. Moreover, the on-demand bootstrapping and the transient-overdriving capabilities reduce the power consumption and relieve the gate-oxide stress of the output transistors. The presented results indicate that the proposed driver has a better performance than the conventional bootstrapped CMOS driver in terms of speed and power.

A novel I/O divided column redundancy (IDCR) scheme that can improve the effectiveness of repair and minimise the overhead of the die area is presented. The IDCR scheme has greater flexibility than conventional schemes in multiple I/O DRAMs. Since an IDCR can share neighbouring redundant column lines (RCLs), the RCLs of neighbouring I/O blocks can be used to repair the defective column lines of a self-block. This work also shows that the IDCR scheme improves the data access speed of normal column lines or redundant column lines by reducing the data bus loading.

Sympathetic hyperactivation is one of the causes of postoperative ileus, which occurs frequently after abdominal surgery and adversely influences the patient's prognosis. We aimed to investigate whether dexmedetomidine (DEX) could attenuate postoperative ileus in patients undergoing laparoscopic gastrectomy.