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Purpose: The purpose of the study was to review and summarize current literature concerning the validation and application of lung ultrasound (LUS) in critically ill patients with acute respiratory distress syndrome (ARDS). Materials and Methods: An extensive literature search was conducted using PubMed, Cochrane Review, Google Scholar, and Ohio State University Link based on the question if LUS should be considered a reliable investigational technique for ARDS diagnosis, treatment, and prognosis in pediatric and adult population. Results: LUS has been successfully validated for facilitating early diagnosis and diagnosis of simultaneous lung conditions, predicting lung recruitment treatment effect, and evaluating the prognosis in ARDS patients. Whether lung US is a useful tool in the prediction of prone position and oxygenation response in patients with ARDS is conflicting. Conclusions: LUS is a noninvasive, radiation-free, cheap, and easy to perform tool for critically ill patients with ARDS and might be a promising technique used in the Intensive Care Unit for ARDS management.

Postoperative cognitive dysfunction (POCD), a common clinical in aged patients, is characterized by deficits in cognitive functions in patients following anesthesia and surgery. It has been demonstrated that isoflurane may lead to cognitive impairment in aged rats; however, effective clinical interventions for preventing this disorder are limited. Tumor necrosis factor (TNF)-α has been suggested to be involved in neuroinflammation as well as the development of POCD. Accordingly, the present study aimed to investigate whether TNF-α signaling is involved in the isoflurane-induced cognitive impairment in aged rats, and whether TNF-α receptor antagonist are able to attenuate isoflurane-induced cognitive impairment in aged rats. A population of 20-month-old rats were administered TNF-α receptor antagonist R-7050 or an equal volume of saline by intraperitoneal injection 12 h prior to exposure to isoflurane to model cognitive impairment following anesthesia in old patients. Then the rats were exposed to 1.3% isoflurane for 4 h. In the control group, rats showed impaired cognitive functions evaluated by Morris water maze assay after isoflurane exposure. Furthermore, isoflurane exposure induced marked upregulation of proinflammatory cytokines, including interleukin (IL)-1β, TNF-α, IL-6 and IL-8 in the hippocampus tissue. In the experimental group, intracisternal administration of TNF-α receptor antagonist R-7050 significantly attenuated isoflurane-induced cognitive impairment and upregulation of proinflammatory cytokines. Further investigation revealed that intracisternal administration of TNF-α receptor antagonist R-7050 notably suppressed isoflurane-induced activation of NF-κB and MAPK signaling. Collectively, the present results suggest that TNF-α receptor antagonist may serve as a potential agent for the prevention of anesthesia-induced cognitive decline in aged patients.

Background and Objectives The analgesic effect and duration of a transversus abdominis plane (TAP) block remain controversial. Transversus abdominis plane blocks are effective for somatic/incisional pain but do not provide analgesia for visceral pain from intra-abdominal procedures. The purpose of this study was to assess the area and extent of cutaneous sensory blockade and the regression of dermatomal anesthesia after bilateral oblique subcostal TAP block. Methods This observational, prospective clinical study consisted of 12 healthy volunteers. All volunteers received a bilateral oblique subcostal TAP block under real-time ultrasound guidance with 20 mL of 0.375% ropivacaine. The anterior abdominal cutaneous area was divided into 3 parts (midabdomen, left-lateral abdomen, right-lateral abdomen) using 2 lines drawn in a parasagittal fashion 5 cm lateral to the midline. The area of cutaneous sensory blockade involving the anterior abdomen was assessed 30 minutes after institution of the block using a cold stimulus. This was followed by repeated measurements using a cold stimulus applied along parasagittal lines drawn 3 cm lateral to the midline at 0.5, 6, 10, 14, 18, 22, and 26 hours after blockade. Results The area of cutaneous sensory blockade of the abdomen was 332 (SD, 73) cm2; that of the midabdomen was 253 (SD, 29) cm2, which represented an average of 90% of the area of the midabdomen; and that of the lateral abdominal wall (combination of left-lateral abdomen and right-lateral abdomen) was 79 (SD, 62) cm2, which represented an average of 26% of total lateral abdominal area. Dermatomes T7–T12 of the midabdomen were successfully blocked in all volunteers after using the bilateral oblique subcostal technique. However, T6 and L1 were only variably blocked. The area of cutaneous sensory block of the anterior abdomen regressed over the ensuing 22 hours in the following manner: 90%, 87%, 73%, 50%, 22%, 3%, and 0% at 0.5, 6, 10, 14, 18, 22, and 26 hours, respectively. Conclusions Bilateral oblique subcostal TAP block produces a widespread cutaneous sensory blockade with a consistent dermatomal distribution in the midabdomen for a considerable effective duration.

Obstructive sleep apnea (OSA) is one of the important risk factors contributing to postoperative airway complications. OSA alters the respiratory physiology and increases the sensitivity of muscle tone of the upper airway after surgery to residual anesthetic medication. In addition, the prevalence of OSA was reported to be much higher among surgical patients than the general population. Therefore, appropriate monitoring to detect early respiratory impairment in postoperative extubated patients with possible OSA is challenging. Based on the comprehensive clinical observation, several equipment have been used for monitoring the respiratory conditions of OSA patients after surgery, including the continuous pulse oximetry, capnography, photoplethysmography (PPG), and respiratory volume monitor (RVM). To date, there has been no consensus on the most suitable device as a recommended standard of care. In this review, we describe the advantages and disadvantages of some possible monitoring strategies under certain clinical conditions. According to the literature, the continuous pulse oximetry, with its high sensitivity, is still the most widely used device. It is also cost-effective and convenient to use but has low specificity and does not reflect ventilation. Capnography is the most widely used device for detection of hypoventilation, but it may not provide reliable data for extubated patients. Even normal capnography cannot exclude the existence of hypoxia. PPG shows the state of both ventilation and oxygenation, but its sensitivity needs further improvement. RVM provides real-time detection of hypoventilation, quantitative precise demonstration of respiratory rate, tidal volume, and MV for extubated patients, but no reflection of oxygenation. Altogether, the sole use of any of these devices is not ideal for monitoring of extubated patients with or at risk for OSA after surgery. However, we expect that the combined use of continuous pulse oximetry and RVM may be promising for these patients due to their complementary function, which need further study.

This study is aimed to investigate the efficacy and underlying the mechanism of propofol in treatment of ischemia reperfusion (IR)-induced lung injury in rats, providing a novel insight of therapeutic strategy for IR-induced lung injury. 120 healthy SD rats were selected and randomly divided into sham operation group, IR group, and propofol group (40 rats per group). Bronchoalveolar lavage fluid (BALF) protein content, serum protein content, lung permeability index, lung water content rate, methane dicarboxylic aldehyde (MDA) in lung tissue, superoxide dismutase (SOD), nitric oxide (NO), endothelin (ET-1), toll-like receptor 4 (TLR4), nuclear factor (NF-κB), and tumor necrosis factor-α (TNF-α) were examined and compared among different groups to evaluate the therapeutical effects of propofol on IR-induced lung injury and analyze the mechanism. In sham operation group, neither change in lung tissue nor pulmonary interstitial edema or alveolar wall damage was found under microscope; in IR group, marked pulmonary interstitial edema and alveolar wall damage complicated with inflammatory cell infiltration and hemorrhage were found; in propofol group, alveolar wall widening was observed, however, hemorrhage in alveolar cavity, inflammatory infiltration and tissue damage were less significant than in IR group. At 3 h after reperfusion, BALF protein content, lung permeability index, and lung water content rate were all significantly increased in IR group and propofol group, while the serum protein content was significantly lower than sham operation group (p0.05). Moreover, we found that the change of above parameters in propofol group was less significant than in IR group (p0.05). No statistically significant difference was found in ET-1 levels in different groups (p0.05). In contrast, MDA and NO in IR group and propofol group were significantly increased, while SOD activity was significantly decreased (p0.05). Furthermore, the change of above parameters in propofol group was less significant than in IR group (p0.05). In addition, mRNAs of TLR4, NF-κB, and TNF-α were significantly increased in IR group and propofol group (p0.05) with more significant change in IR group compared with propofol group (p0.05). Propofol has protective effects against IR-induced lung injury by improving activity of oxygen radical and restoring NO/ET-1 dynamic balance. Besides, regulation of TLR4, NF-κB, and TNF-α by propofol also play important role in alleviating IR-induced lung injury.

Permutation entropy (PE) has been proposed to reflect the complexity of time series in recent years, and it has a wide range of applications. In this paper, we extend PE to the fractional order through the parameter α, and then obtain fractional permutation entropy (FPE). FPE can increase the sensitivity of the complex system by adjusting the fractional order. We combine FPE with fractional Jensen–Shannon divergence (FJSD) to construct the entropy plane and discover that the entropy plane can classify various time series. In particular, it can distinguish the stock indices of developing countries and developed countries. We introduce FPE and FJSD to multiscale, and gain multiscale fractional permutation entropy (MFPE) and multiscale fractional Jensen–Shannon divergence (MFJSD). We employ simulated data and financial stock data to explore the relationship of MFPE and MFJSD under different scales, and the results show that some data are similar to direct proportion relationship and others data are sharply increasing curves, which portrays the internal mechanism of the stock market excellently.

This paper introduces the DC power obtained from photovoltaic power generation, and then boosts it by the boost chopper circuit. Finally, it is inverted by a single-phase full-bridge inverter circuit into 220V, 50Hz single-phase AC power that meets the normal working requirements of household appliances. Give the load. Among them, the inverter is the most important part, which can convert direct current into alternating current. Before this, it is necessary to increase the DC voltage through a boost chopper circuit and then invert it.

With a sustainable development of export-oriented economy in China, the overall size of port logistics is continuously expanded. Based on the developing trend and characteristics of port logistics in China, the significance and advantages of China E-port are analyzed. Meanwhile, the data center and some main application systems of China E-port are introduced in this paper as well, such as Manifest, ATA, Customs Agency, Online Payment, E-account book, and Identity Authentication. Finally, it is proposed that the main feature of E-port system is information sharing which is significant on improving the whole efficiency of port logistics compared with major projects in China E-port. It is especially analyzed how to improve the economic effectiveness and social benefits of local international logistics informationization since the implementation of Shanghai e-port, such as strengthening the customs supervision, speeding up the flow of imports and exports, expanding the scope of Shanghai logistics center, etc. Some measures are proposed to further expand the value of Shanghai e-port system, including the port innovative model, and other regional collaboration strategies.

To compare paravertebral block under thoracoscopy with wound infiltration at an early stage after video-assisted thoracic lobectomy surgery.A prospective, randomized, triple-blinded, placebo-controlled trial.A single-center university hospital.Patients scheduled for video-assisted thoracic lobectomy surgery between February 20, 2014 and June 1, 2014 randomly were allocated into paravertebral block (PVB) (n = 35) and infiltration (n = 35) groups.In the PVB group, 0.5% ropivacaine was injected into the paravertebral space by the surgeon under direct vision with placebo infiltration of saline in the wounds. In the infiltration group, the wounds were infiltrated with 0.5% ropivacaine by the surgeon with a placebo paravertebral block. Subsequently, patient-controlled intravenous morphine analgesia and paracoxib were administered.The primary endpoints were visual analog scale (VAS) pain scores at rest and on cough 0, 2, 6, and 24 hours after surgery. The secondary endpoints were the total morphine during postoperative 0 hours to 24 hours, adverse events, and patient satisfaction with the analgesia. Sixty-one patients completed the study. VAS score on cough at each time point was significantly lower (p0.05) and median (25th, 75th) morphine consumption was lower in the PVB group than in the infiltration group (26 [10, 35] mg and 42 [29, 58] mg, p0.001, respectively). There was no difference in VAS score at rest. Patients in the PVB group had higher satisfaction with analgesia than in the infiltration group (p = 0.003).As part of the multimodal postoperative analgesia, intraoperative paravertebral block provided better dynamic pain relief and reduced morphine consumption compared with local wound infiltration.

Background We evaluated the efficacy of a new anesthetic technique termed ultrasound-guided capsule-sheath space block (CSSB) combined with anterior cervical cutaneous nerve block (CCNB) for thyroidectomy. Methods The study included two parts: Part one was an imaging study to determine technique feasibility. The CSSB was performed on five healthy volunteers by introducing the needle 0.5 cm lateral to the probe under in-plane needle ultrasound guidance. After puncture of the false capsule and its subsequent contraction with the true capsule of thyroid, 10 mL of contrast medium was deposited slowly in the capsule-sheath space. The CCNB was performed bilaterally as follows: Under ultrasound guidance, a subcutaneous injection was made along the sternocleidomastoid using 10 mL of contrast medium which was followed by a girdle-shaped picchu raised from the cricoid cartilage to supraclavicular region. The spreading pattern of contrast medium was imaged using computed tomographic scanning. In part two (a clinical case series) the technique efficacy was evaluated. Seventy-eight patients undergoing thyroidectomy had ultrasound-guided CSSB and CCNB with local anesthetics. The sensory onset of CCNB, intraoperative hemodynamic parameters, and analgesic effect were assessed and complications were noted. Results The distribution of contrast medium was well defined. In part two the onset time of CCNB was 2.2 ± 0.7 min, and the hemodynamic parameters remained stable intraoperatively. The recall of visual analogue scale scores during surgery was 2 [1–4] for median (range). The patients’ and surgeons’ satisfaction scores were 2 [1–4] and 1 [1–3] for median (range). No serious complications occurred. Conclusions Combining ultrasound-guided CSSB and CCNB is a feasible, effective and safe technique for thyroidectomy. Trial registration Current Controlled Trials ChiCTR-ONC-12002025. Registered 19 March 2012.

Xuezheng Zhang,1 Ying Zhou,1 Limei Chen,1 Quanguang Wang,1 Jianwu Ni,1 Le Liu,1 Chenggang Hu,2 Xuzhong Xu11Department of Anesthesiology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, People’s Republic of China; 2Department of Anesthesia, Pomerado Hospital, Poway, CA, USAObjective: To compare the clinical effects of anesthesia and postoperative analgesia for patients with unilateral lower-extremity fracture between multiple injections through catheters beside the lumbar plexus or sciatic nerve and continuous epidural analgesia.Methods: Seventy patients with unilateral lower-extremity fracture scheduled for internal fixation were randomly divided into group N (n = 35) and group E (n = 35). Patients in group N received combined lumbar plexus and sciatic nerve block, then a catheter was inserted into the psoas compartment or beside the sciatic nerve, according to the surgical site, and 25 mL 0.375% ropivacaine was injected into patients in group N through the peripheral nerve catheter 12 hours after operation. Patients in group E received combined spinal and epidural anesthesia, and when the operation was complete kept the epidural catheter and received patient-controlled epidural analgesia with an analgesia pump.Results: The visual analog scores of patients at each time point in the two groups showed no significant difference (P > 0.05). Mean arterial pressure at 30 minutes after anesthesia and 4 hours postoperation in group E decreased significantly and was significantly lower than group N (P < 0.01). Group E had significantly higher rate of urinary retention than group N (P < 0.05), and the time of first food intake of patients in group N was significantly shorter than in group E (P < 0.001).Conclusion: For patients with unilateral lower-extremity fracture receiving internal fixation, multiple injections through catheters beside the lumbar plexus or sciatic nerve can provide adequate postoperative analgesia, with very few adverse effects.Keywords: lumbar plexus, sciatic nerve, catheterization, lower extremity, analgesia

The transversus abdominis plane (TAP) block has been shown to provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block has also been proposed as a new technique to provide analgesia for the supraumbilical abdomen. We compared the analgesic and opioid-sparing effects of a single-injection subcostal TAP block with continuous thoracic epidural analgesia and IV opioid analgesia.Ninety patients undergoing elective radical gastrectomy were randomized to receive either combined general-subcostal TAP anesthesia (group TAP), combined general-epidural anesthesia (group EA), or general anesthesia (group GA), and were analyzed on an intention-to-treat basis. In group TAP, a bilateral subcostal TAP block was performed after induction of general anesthesia using 20 mL of 0.375% ropivacaine. In group EA, a thoracic epidural was placed between T8 and T9 and bolused with 8 mL of 0.25% ropivacaine before induction of general anesthesia. The epidural was maintained with 5 mL/h of 0.25% ropivacaine during the surgery. Group GA received standard general anesthesia. In the postanesthesia care unit (PACU), all groups received IV morphine titration for visual analog scale (VAS) pain scores3. All patients were started on IV patient-controlled analgesia with morphine after morphine titration in the PACU, while group EA also had their epidural maintained with 5 mL/h of 0.125% bupivacaine with 8 μg/mL morphine. Patients were assessed in the PACU and at 1, 3, 6, 24, 48, and 72 hours postoperatively. Primary outcomes measured were morphine consumption at 24 hours and all VAS pain scores.Data from 82 of 90 (91.1%) patients were included in the study. Group TAP demonstrated decreased cumulative morphine consumption at 24 hours (98.75% confidence intervals, -29 to -9 mg) and noninferiority on VAS pain scores at all measurement times, as compared with group GA with standard opioid analgesia. However, group EA was superior to group TAP regarding cumulative morphine consumption at 24 hours (98.75% confidence intervals, -23 to -4 mg) and noninferior to group TAP on VAS pain scores at all comparison points. Group TAP had reduced morphine consumption from PACU admission to 6 hours as compared with group GA, but increased morphine consumption for 6 to 24 hours as compared with group EA.Single-injection subcostal TAP block was more effective than IV opioid analgesia, while continuous thoracic epidural analgesia was more effective than the single-injection subcostal TAP block.

Serv-U is a widely used FTP server software. This article analyzed the problems of Serv-U and introduced an ASP.NET based solution for FTP remote management system, which is aimed to solve the existing problems and make Serv-U easier to be used and managed.

The objective of the study is to compare the different effects of flurbiprofen, lidocaine and dexamethasone on reduction of pain caused by propofol injection. 100 patients undergoing middle otoplasty surgery with general anesthesia were randomly assigned into four groups with 25 patients in each group. F, L, D, and C groups were treated with intravenous flurbiprofen 50 mg/5 ml, lidocaine 40 mg/5 ml, dexamethasone 5 mg/5 ml and saline 5 ml, respectively, with a proximal tourniquet. The injection site pain was recorded immediately with verbal rating scale (VBS), and the tourniquet was released 2 min after, followed by propofol infusion at the rate of 0.5 ml/s to reach a final dose of 0.5 mg/kg, while the pain was recorded after the infusion. The follow up was done at 30 min and 4 h after the operations with the pain recorded using visual analogue scale (VAS). The injection site pain before propofol infusion in all groups showed no difference among each other; while the F, L, and D pre-treatment reduced the pain caused by propofol infusion in comparison to group C (P

Lack of practice engineering teaching ability of young teachers is quite common in many colleges. It is useful to select school-enterprise cooperation improve the ability by school-enterprise cooperation, and this mode has a great effect on individual and colleges. Opportunities should be created by colleges to enable young teachers achieve the training. On the other hand, young teachers should locate themselves appropriately and understand their responsibility sufficiently.

A Spread Spectrum-based fragile software watermarking scheme is proposed in this paper. The algorithm extracts a vector of instruction-group frequencies from all basic blocks of original program and constructs a vector matrix. Furthermore, the scheme generates watermark based on the principal component analysis (PCA) technique and modifies the vector matrix to embed the watermark. With the system, spreading the watermark over the code provides not only a high level of stealth but also a global protection for the original program. The scheme not only can effectively detect tampering, but also has the ability to identify the type of tampering clearly.

Based on the undergraduate program in e-commerce, this paper mainly discusses how to establish the reasonable bilingual teaching course program and strengthen students’ cross-cultural communication ability of e-commerce training and practices. Combined with the common goal of bilingual teaching in higher education, it is proposed from the perspectives of e-commerce professional knowledge system and talent cultivation target that the solid specialized theory and rich practical innovation ability should be emphasized to construct e-commerce bilingual teaching courses program based on the social demand. Furthermore, the e-commerce course program of bilingual teaching is put forward including three objectives as knowledge, quality and ability, covering four areas of course, such as disciplines basics, professional cores, professional electives and practical education, and some teaching highlights. From understanding of the connotation and the bilingual teaching mode and combining with the features of Shanghai Institute of Foreign Trade e-commerce English teaching practice, it is proposed in this paper a reasonable evaluation system of bilingual teaching model based on four perspectives, the characteristics of teachers and students, course design and, curriculum organization and learning outcome based on comprehensive, motivational, subjective and instructive principle.

By adopting the theories and methods of large-scale system and beginning with the overall objectives of renewable resources industry chain harmonious development, a new idea of large system’s multi-channel control of the harmonious development of renewable resources industry chain is studied and discussed in this essay. In addition, the plan and the design of renewable resources industry chain of a waste recycling company under E-commerce environment is provided.

With a sustainable development of export-oriented economy in China, the overall size of port logistics is continuously expanded. Based on the developing trend and characteristics of port logistics in China, the significance and advantages of China E-port are analyzed. Meanwhile, the data center and some main application systems of China E-port are introduced in this paper as well, such as Manifest, ATA, Customs Agency, Online Payment, E-account book, and Identity Authentication. Finally, it is proposed that the main feature of E-port system is information sharing which is significant on improving the whole efficiency of port logistics compared with major projects in China E-port.

With the rapid development of information technology, it is easier for the international trade enterprises in China to communicate directly with their foreign businessmen. Ecommerce based on Internet is now changing the traditional way of the international trade. Some traditional trade patterns are gradually replaced by new ways of trade, such as EDI. At present, with the help of information technology, the networking of import and export enterprises with the Customs, Inspection Department, Transportation

With the development of information technology in international trade, it promotes the change of teaching method in high college courses. In this paper, it focuses on the cultivation of the innovative ability through the SIFT course of E-practice in International Trade based on the current business situation, including renewing the teaching content, innovating in practical teaching method and promoting the course achievements, etc. Especially, it greatly helps the teachers to improve the course teaching and the students to enhance practical ability with the requirements of society.

From the development and construction of e-commerce teaching in China, this paper explores a professional approach to definite the critical factors in e-commerce personnel training. Compared with the fast-growing demand for e-commerce talent, the stereoscopic teaching model is proposed from the concept and the implementation. Focused on the comprehensive analysis of the application of this model in SIFT e-commerce discipline, this paper expounds how to enhance the professional capacity of students to practice and innovation in e-commerce area.

With the development of third-party payment in China, to some extend, it alleviates the problem of e-commerce and helps the development of e-commerce as well. However, it also brings some new issues, especially about government supervision. In this paper, the necessity of government supervision from three aspects is discussed because of the financial risks caused by the third-party payment. Furthermore, the theoretical government supervision model is proposed to demonstrate the best regulatory point for policy formulation based on cost-utility analysis.

With the through application of information technology in international business and logistics, the society raises new demands to the international business professionals, which has directly leaded to a big change in college education system, especially for business schools. In this paper, based on analyzing the achievement made by the E-commerce and Logistics Laboratory of Shanghai Institute of Foreign Trade, it will show that the framework of international business school experiment and teaching system reach two purposes. On the one hand, it conducts a series of simulations based on the combination with real practices according to increase the comprehensive-skillful experiment and training the students’ major practical ability actively. On the other hand, its construction of the cross-disciplinary coordination and innovation correspond with the needs of improving comprehensive quality.

Based on the game theory, including the prisoner's dilemma game, and clever pig game and dynamic game, the revenue model of online third-party payment in China is analyzed in this paper. And it is proposed that the price competition is inevitable during the initial phrase of online payment development. But the online third-party payment companies can make appropriate business strategy to increase the revenue. For example, the XML-based payment platform can be used to strengthen the infrastructure of online third-party payment construction. Also the differentiated payment products and value-added services like EDI application will enhance the competitiveness of online third-party payment companies.