Purpose:This study aimed to compare the analgesic efficacy of liposomal bupivacaine with that of traditional ropivacaine in adductor canal blocks for patients undergoing knee arthroplasty. Patients and Methods:A total of 119 consenting participants, who were scheduled for elective knee arthroplasty (including total knee replacement and unicompartmental knee replacement) under general anesthesia, were randomly assigned to either receive an ultrasound-guided adductor canal block with ropivacaine or liposomal bupivacaine. The primary endpoint of this study was the pain scores at 2, 24, 48, and 72 hours post-surgery. Secondary outcomes included nausea, vomiting, and pruritis, the ability to engage in physiotherapy on the first day after surgery, postoperative exercise, patient satisfaction with anesthesia, postoperative recovery index, and patient-controlled analgesic presses (12-48 hours) for both groups. Results:The Visual Analog Scale (VAS), assessed from 24 to 72 hours post-follow-up, demonstrated that patients receiving ropivacaine had higher median VAS scores compared to those in the liposomal bupivacaine group, both at rest and during exercise. The weighted AUC numerical rating scale pain scores whether at rest or move in the liposomal bupivacaine group was lower than the standard bupivacaine group with statistical significance. Whether it is 0-24 hours (Rest 58.00 [53.75, 69.00] vs 48.00 [46.50, 58.00]; Move:57.00 [46.00, 59.00] vs 36.00 [35.00, 48.00]) or 0-72 hours (Rest 214.00 [197.75, 237.00] vs 165.00 [143.50, 180.00]; Move:202.00 [190.00, 215.75]vs.156.00 [131.00, 178.00]) From 12 to 48 hours, the ropivacaine group had a significantly higher number of PCIA presses. The liposomal bupivacaine group also achieved greater pain-free bending angles and walking distances compared to the ropivacaine group. Conclusion:Liposomal bupivacaine used in adductor canal block provides extended pain relief in knee arthroplasty patients, aiding early rehabilitation.

Insufficient training in firefighting techniques increases the risk of injuries and fatalities among firefighters. Human activity recognition methods show promising potential for performance monitoring and evaluation. However, the present studies focus mainly on individual modalities. This limited scope presents challenges in effectively distinguishing between intricate tasks, such as those encountered in firefighting operations. This study introduces an innovative multimodal decision-fusion network designed to overcome this limitation. This is achieved by integrating vision data sourced from three distinct cameras and sensor data collected from four wearable devices. The proposed network combines a vision-focused Video Swin network with a sensor-driven Sensor Transformer network where the results show that the use of only vision-based methods is insufficient to accurately classify firefighting training activities. The proposed decision-fusion network improves classification with a mean F1-score of 95.73%, outperformed the existing hybrid machine learning network.

This study aims to explore the relationship between preoperative and postoperative pain in patients with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR), and to assess the mediating roles of central and peripheral sensitization. This prospective cohort study enrolled a total of 105 eligible KOA patients. The Visual Analog Scale (VAS) was used to assess preoperative and postoperative pain levels. Multivariate linear regression analysis and Bootstrap mediation analysis were conducted to investigate the impact of preoperative pain intensity on postoperative pain. This study revealed a significant positive correlation between preoperative VAS scores during movement and pain scores 3 days postoperatively (β = 0.4018, p = 0.0017), as well as a significant correlation with pain scores 6 months postoperatively (β = 0.735, p = 0.004). Central sensitization (β = 0.0446, p < 0.0001) and peripheral sensitization (β = 0.0333, p = 0.0015) exhibited significant mediation effects between preoperative and postoperative pain. Additionally, preoperative VAS scores (B = 1.107, p = 0.014, OR = 3.027), age (B = 0.207, p = 0.036, OR = 1.229), and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were significant predictors of postoperative analgesic demand. This study demonstrates that preoperative pain intensity is closely related to postoperative pain in KOA patients undergoing TKA and UKR, with central and peripheral sensitization playing significant mediating roles in this process. In particular, preoperative pain management is crucial for alleviating postoperative pain and improving patients' quality of life. Therefore, when formulating individualized pain management strategies, the central and peripheral sensitivity of patients should be comprehensively considered. Future research is necessary to develop and evaluate innovative pain control methods integrating central and peripheral mechanisms to optimize postoperative rehabilitation and long-term health outcomes.

Inadequate training poses a significant risk of injury among young firefighters. Although Human Activity Recognition (HAR) algorithms have shown potential in monitoring and evaluating performance, most existing studies focus on daily activities and have difficulty distinguishing complex firefighting tasks. This study introduces the Internet of things (IoT)-based wearable firefighting activity recognition (IoT-FAR) system which employs a multi-modal sensor fusion approach to achieve comprehensive activity recognition during firefighting training. The IoT-FAR comprises five wearable body sensor nodes and a coordinator node. This study explores the significance of features extracted from the surface electromyography, heart rate, and inertial measurement units in firefighting training activity recognition. A hybrid machine learning (HML)-based network is proposed, which integrates three models: one trained with all features (MA), another with upper body features (MU), and a third with lower body features (ML). The proposed HML-SVM-RBF1-RF2 network achieves superior performance, with a mean recall of 93.94%, mean precision of 90.94%, and a mean accuracy rate of 98.29%. Additionally, the study introduces the specialized firefighting training associated activities (SFTAA) dataset, which includes endurance training activities involving self-contained breathing apparatus (SCBA) conducted by eighteen firefighters. This dataset represents preliminary work towards building comprehensive dataset covering various events and scenarios for tracking firefighter activities. The IoT-FAR system also demonstrates the potential use of misclassified activities as evaluation metrics for assessing firefighter training performance.

Opioid-induced constipation is one of the most common and persistent side effect of opioid analgesics, yet the underlying neural mechanism(s) remain unclear. Here we show morphine-induced constipation is mediated by a neural circuit from glutamatergic neurons in the paraventricular nucleus of hypothalamus (PVNGlu) to acetylcholinergic neurons in the dorsal motor nucleus of the vagus (DMVAch), and subsequently to the small intestine in mice. Microendoscopic calcium imaging revealed morphine inhibits the PVNGlu→DMVAch→small intestine circuit, and this is accompanied by decreased small intestinal motility. Chemogenetic activation of this circuit, as well as pharmacological inhibition or knockdown of the μ-opioid receptor (MOR) in PVNGlu neurons alleviates morphine-induced constipation. Conversely, artificial inhibition of this circuit mimics morphine-induced constipation in naïve mice. Moreover, we show that morphine suppresses tonic NMDA receptor-mediated currents in DMVAch neurons. These findings reveal a brain-gut circuit underlying opioid-induced constipation and suggest potential therapeutic strategies to mitigate this debilitating side effect.

OBJECTIVE:Anatomical variations in the sacrococcygeal region can lead to complications such as accidental dural puncture during caudal block. This study aimed to determine the prevalence of sacrococcygeal anatomical variations using ultrasonography and to evaluate the necessity of ultrasound guidance in sacral block procedures. METHODS:Ultrasound findings of sacrococcygeal anatomy were validated against magnetic resonance imaging (MRI). A detailed ultrasound protocol was subsequently applied to assess sacrococcygeal anatomy in pediatric patients. RESULTS:Ultrasound and MRI demonstrated strong concordance in evaluating sacrococcygeal anatomy. The most common anatomical variation was a low-lying dural sac (16.2%), followed by incomplete sacral cornua (4.9%). The dural sac termination level was inversely associated with age (odds ratio: 0.996, 95% CI: 0.945-0.987; p < 0.001). Other variations included abnormal coccyx curvature (4.3%), sacral skewness (3.8%), and sacral hiatus atresia (1.1%), with no pathological abnormalities detected. CONCLUSION:Comprehensive ultrasound scanning effectively identifies anatomical variations in the sacrococcygeal region of pediatric patients, which are highly prevalent. Routine preprocedural ultrasound examinations and ultrasound guidance during caudal block procedures are strongly recommended to enhance safety and accuracy.

Background: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. Methods: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. Results: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92- 1.12]; P = 0.76; adjusted odds ratio 1.05 [0.90- 1.22]; P = 0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. Conclusions: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).

Background Off-label intranasal administration of dexmedetomidine injection has been widely applied in the pediatric sedation setting. We developed a dexmedetomidine nasal spray for pediatric pre-anaesthetic sedation. Objective To evaluate the pre-anaesthetic sedation efficacy and safety of the dexmedetomidine nasal spray in children. Methods Subjects between 2 and 6 years who were to undergo selective surgery were randomized to receive dexmedetomidine nasal spray or placebo in a 2:1 ratio. The dosage was 30 µg or 50 µg based on the body weight. The primary outcome measure was the proportion of subjects who achieved successful child-parent separation and were with Ramsay scale ≥ 3 within 45 min after administration. Secondary outcome measures included the proportions of subjects reaching successful parental separation, with Ramsay scale ≥ 3 at least once and UMSS ≥ 2 at least once within 45 min after administration, and the time from administration to the first time reaching Ramsay scale ≥ 3 and UMSS ≥ 2,. Safety was monitored via the assessments of adverse events, blood pressure, heart rate, respiratory rate and blood oxygen saturation. Results The proportion of subjects achieving successful parental separation and with Ramsay scale ≥ 3 within 45 min after administration was significantly higher in the dexmedetomidine group (94.4%) vs the placebo group (32.0%) ( P < 0.0001). As compared with placebo, dexmedetomidine treatment led to more subjects achieving Ramsay scale ≥ 3 or UMSS ≥ 2, and shorter time to reach successful parental separation, Ramsay scale ≥ 3 and UMSS ≥ 2 (all P < 0.0001). Adverse events were reported in 90.7% and 84.0% of subjects in the dexmedetomidine and placebo groups, respectively, and all the events were mild or moderate in severity. Conclusions Dexmedetomidine nasal spray presented effective pre-anaesthetic sedation in children with a favorable safety profile. Trial registration: Clinicaltrials.gov, identifier: NCT05111431(First registration date: 20/10/2021)

Venous thromboembolism (VTE) presents a significant global healthcare challenge, contributing to increased morbidity, mortality, and healthcare costs. Exercise therapy has shown effectiveness in reducing VTE incidence rates, yet traditional methods are often perceived as lengthy, strenuous, and monotonous, posing challenges to patient motivation and adherence. Technology-based interventions (TBIs) offer a promising approach to actively engage at-risk patients and enhance adherence to VTE prevention exercises. This study introduces a wearable virtual rehabilitation system (WVRS) designed to monitor and assess patient progress in exercise therapy. The WVRS provides an immersive experience through multi-sensory feedback, aiming to guide and motivate patients toward more autonomous completion of training sessions.

Venous Thromboembolism (VTE) is a severe medical condition characterized by the development of blood clots within veins, typically occurring in the deep veins of the legs or as clots that can travel to the lungs. Numerous previous studies have demonstrated the effectiveness of high-dose lower-limb physical therapy in aiding patients’ functional recovery. However, assessing the extent of patient compliance with this practice and achieving satisfactory results have proven challenging, with many issues yet to be resolved before its adoption in clinical practice. This work proposes a smart unobstructive IoT-based wearable lower-limb rehabilitation assistance system that could trace and evaluate user lower-limb rehabilitation activities in real-time manner, in the meantime, simultaneous visual guidance cues are presented through visual displays to guide user completing the rehabilitation tasks, where those tasks are based on the American Academy of Orthopedic Surgeons (AAOS). The preliminary user study presents promising benefits of the system contrasting to the typical unguided rehabilitation training approach in clinical settings.

The use of forced-air warming (FAW) blankets is widely recognized for preventing shivering and hypothermia in patients under general anesthesia. Various types of products are currently available for hospitals, and we have conducted a preliminary evaluation of insulation equipment based on expert opinions and initial parameters. However, we lack real-world experiments and accurate clinical data to validate these parameters and the accuracy of our decision-making results. This study aims to confirm the effectiveness of different FAW systems by assessing the thermal protection and operational characteristics of the equipment in both experimental and clinical settings, thereby enhancing our evaluation database. In the manikin test, we conducted six tests including heat distribution and heating rate, heater outlet temperature stability, etc. In the clinical study, patients were randomly assigned to four groups [Group A (Bair Hugger Therapy, 3 M, St. Paul, MN, USA; 63500); Group B (EQUATOR® level I, Smith Medical ASD, MN, USA; Snuggle Warm, SW-2013); Group C (Jiang Men Da Cheng Medical Devices Co., Ltd, China; IOB-006); and Group D (Shang Hai Nest Tech Medical Materials Co., Ltd, China; BH-017)], with each group comprising 30 individuals. At the start of anesthesia induction, the FAW blanket was activated and set to 43 °C until the completion of surgery. The primary endpoint was the average core body temperature during surgery. Secondary endpoints included hemodynamic and surgical variables, adverse events, and recovery metrics. In the manikin test, the observed results of the experimental parameters (heat distribution, air pressure difference, and hole observation test) for Group A are superior to those of the other groups. In the clinical study, although the mean perioperative core body temperature remained above 36 °C across all groups [Group A: 36.31 ± 0.04; Group B: 36.26 ± 0.06; Group C: 36.17 ± 0.03; Group D: 36.25 ± 0.05], patients in Group A maintained higher temperatures compared to the other groups (p < 0.001). Among patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia, all four FAW systems effectively prevented perioperative hypothermia. However, the system in Group A minimized heat loss more effectively than the others, providing superior thermal protection. ChiCTR2200065394, 03/11/2022.

Postoperative delirium (POD) is a common postoperative complication, and the potential relationship between cigarette smoking and POD is still unclear. The current study evaluated the relationship between preoperative smoking status in patients suffering from osteoarthritic pain and POD after total knee arthroplasty (TKA).

[This corrects the article DOI: 10.3389/fpsyt.2022.889637.].

The Dual Foot Inertial Navigation System (DF-INS) shows promise as a practical approach for indoor location-based service (ILBS). Achieving accurate zero-velocity detection is crucial for optimal performance in zero-velocity updating and trajectory calculation. However, conventional techniques rely on fixed thresholds to identify the zero-velocity (stance) phase, which is not suitable for dynamic scenarios and diverse users. This study introduces a dual foot synergistic method to address this issue. Initially, the General Likelihood Ratio Test sequences from both feet are smoothed using a moving average filter. The points of equality within these sequences are then identified as transition points between the stance phase and the swing phase. The experiment was conducted along a closed indoor path, and the results demonstrate that the proposed method outperforms other fixed thresholding methods in terms of zero-velocity detection and DF-INS calculation.

Falling is one of the primary causes of firefighter casualties. Therefore, early fall detection, followed by reliable and timely notification, is vital to ensure the survival of firefighters. However, due to complex and diverse firefighting scenarios, current fall detection systems (FDSs) are inadequate, especially in terms of accuracy and real-time applications. Hence, in this study, a wearable pre-impact FDS (PIFDS) for firefighters is proposed. We also evaluated the feasibility of using machine learning (ML) and ensemble learning (EL) methods deployed on the edge node to simultaneously improve the real-time performance and accuracy. Moving thresholding method is introduced to overcome the class-imbalanced issue due to fewer samples acquired during the pre-impact (PI) phase. Based on 14 firefighters' data collection, the experimental results revealed that a Decision Tree classifier with optimized parameters (DT-ED4) outperformed other ML and EL methods in a tradeoff between processing time and accuracy. The results also showed that our system can detect falls before the impact with an average lead time of 447.9 ms, sensitivity of 95.10%, and specificity of 97.99%. The system's heterogeneous IoT network architecture facilitated remote monitoring and alerts that enabled the incident commander (IC) to execute the rescue mission immediately upon notification. This study enhances the practicability of PIFDS and extends the application range of PIFDS from healthcare to firefighting.

The demand for firefighting has significantly risen in recent decades, accompanied by increased risks faced by firefighters. Tragic incidents, such as the Shanghai factory fires, have resulted in the loss of over thirty firefighter lives. One of the primary contributing factors is the abrupt breakdown in communication between firefighters inside a building and the commanding officer stationed outside, attributable to the harsh and complex indoor environment. This study aims to conduct a comparative analysis of different widely used wireless transmission methods, including Wi-Fi, Bluetooth Low Energy (BLE), and Long Range (LoRa). The experiments are conducted in a two-room setup, with two brick walls acting as a barrier. A wireless data transmitter is placed in one room, while smoke is generated. A receiver placed at varying distances collects the signal strengths. The findings indicate that LoRa exhibits the least drop in signal strength compared to the other methods. In contrast, BLE shows high signal strength variation for the same distances and is not recommended for firefighting communication purposes. This study provides valuable insights for selecting suitable wireless communication modules, particularly in the design of wearable devices for assessing safety risks faced by firefighters.

Background We previously demonstrated that flurbiprofen increased arterial oxygen partial pressure and reduced intrapulmonary shunts. The present study aims to investigate whether flurbiprofen improves intraoperative regional cerebral oxygen saturation (rScO 2 ) and reduces the incidence of postoperative delirium (POD) in elderly patients undergoing one-lung ventilation (OLV). Methods One hundred and twenty patients undergoing thoracoscopic lobectomy were randomly assigned to the flurbiprofen-treated group ( n = 60) and the control-treated group ( n = 60). Flurbiprofen was intravenously administered 20 minutes before skin incision. The rScO 2 and partial pressure of arterial oxygen (PaO 2 ) were recorded during the surgery, and POD was measured by the Confusion Assessment Method (CAM) within 5 days after surgery. The study was registered in the Chinese Clinical Trial Registry with the number ChiCTR1800020032. Results Compared with the control group, treatment with flurbiprofen significantly improved the mean value of intraoperative rScO 2 as well as the PaO 2 value (P < 0.05, both) and significantly reduced the baseline values of the rScO 2 area under threshold (AUT) ( P < 0.01) at 15, 30, and 60 min after OLV in the flurbiprofen-treated group. After surgery, the POD incidence in the flurbiprofen-treated group was significantly decreased compared with that in the control group ( P < 0.05). Conclusion Treatment with flurbiprofen may improve rScO 2 and reduce the incidence of POD in elderly patients undergoing thoracoscopic one-lung ventilation surgery for lung cancer. Clinical trial registration http://www.chictr.org/cn/ , identifier ChiCTR1800020032.

Indoor positioning in the firefighting ground shows promising application prospects for enhancing rescue safety and efficiency. Low visibility and signal interference caused by smoke pose significant difficulties for visual Simultaneous Localization and Mapping (SLAM) systems and radio frequency-based localization methods, while the performance of existing pedestrian dead reckoning (PDR) methods is affected by unpredictable user gaits. This paper introduces a gait analysis-based PDR (GA-PDR) for deriving heading estimation in PDR to improve its localization performance. The proposed method determines the step pattern by analyzing the features of inertial measurement unit data, thereby enabling the classification of forward, left- and right-turn and around-turn from left or right-side movements. In addition, this study introduces a redundant turn elimination method to differentiate false positive patterns via a time-domain heading analysis for turn movements. The location tracking performance with the proposed GA-PDR approach is validated using a self-created dataset established under a smoke-filled experiment, the results of which indicate a lower loop closure error compared with the traditional PDR in all of the tested scenarios.

Falling has become the leading cause of non-fatal and preventable injuries. The majority of existing fall detection systems (FDSs) rely on motion sensors. However, most of the applied feature extraction methods result in longer processing time and higher computation. This study proposes a novel attitude feature extraction (AFE) method that extract five feature sets from 54 raw measurements obtained from nine inertial measurement units (IMUs) placed on the firefighter’s protective clothing. Our results indicate that the metrics of attitude feature extraction (AFEM) method outperforms the existing metrics of raw feature extraction (RFEM) method in the fall detection. In addition, the proposed method reduces the algorithm processing time and computations significantly. This enables on-device fall detection classification on constrained processing architectures.

Background Long-term smoking is a risk factor for chronic pain, and chronic nicotine exposure induces pain-like effects in rodents. The anterior cingulate cortex (ACC) has been demonstrated to be associated with pain and substance abuse. This study aims to investigate whether ACC microglia are altered in response to chronic nicotine exposure and their interaction with ACC neurons and subsequent nicotine-induced allodynia in mice. Methods We utilized a mouse model that was fed nicotine water for 28 days. Brain slices of the ACC were collected for morphological analysis to evaluate the impacts of chronic nicotine on microglia. In vivo calcium imaging and whole-cell patch clamp were used to record the excitability of ACC glutamatergic neurons. Results Compared to the vehicle control, the branch endpoints and the length of ACC microglial processes decreased in nicotine-treated mice, coinciding with the hyperactivity of glutamatergic neurons in the ACC. Inhibition of ACC glutamatergic neurons alleviated nicotine-induced allodynia and reduced microglial activation. On the other hand, reactive microglia sustain ACC neuronal excitability in response to chronic nicotine, and pharmacological inhibition of microglia by minocycline or liposome-clodronate reduces nicotine-induced allodynia. The neuron-microglia interaction in chronic nicotine-induced allodynia is mediated by increased expression of neuronal CX3CL1, which activates microglia by acting on CX3CR1 receptors on microglial cells. Conclusion Together, these findings underlie a critical role of ACC microglia in the maintenance of ACC neuronal hyperactivity and resulting nociceptive hypersensitivity in chronic nicotine-treated mice.