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The use of carbon fiber-reinforced plastics (CFRP) is markedly increasing, particularly for the manufacturing of automotive parts, to achieve better mechanical properties and a light weight. However, it is difficult to manufacture multi-material products because of the problems due to the adhesive between CFRP and steel. The prepreg compression molding (PCM) of laminated CFRP can reduce the production time and increase the flexibility of the manufacturing process. In this study, a new manufacturing process is proposed for CFRP reinforcement on a hot stamped B-pillar using PCM. A finite element (FE) simulation of the hot stamping process is conducted to predict the dimensions of the B-pillar. The feasibility of PCM manufacturing is explored by the simulation of the thermoforming of a CFRP set on a shaped B-pillar. The temperature conditions of the CFRP and B-pillar for the PCM are determined by considering the heat transfer between the CFRP and steel. Finally, the PCM of the B-pillar consisting of steel and CFRP was performed to compare with the analytical results for verification. The evaluation of the B-pillar was conducted by the observation of the cross-section for the B-pillar and interlayer by scanning electron microscopy (SEM). As a result, a steel/CFRP B-pillar assembly could be efficiently manufactured using the PCM process without an additional adhesive process. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (−7.60 (−12.49, −2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia. [ABSTRACT FROM AUTHOR]

Flumazenil, a gamma-aminobutyric acid receptor antagonist, can promote arousal even under general anesthesia without the use of benzodiazepines. We hypothesized that flumazenil could promote arousal and reduce emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia. One hundred and two patients were randomly allocated to the control or flumazenil group. Saline or flumazenil was administered at the end of the surgery. The incidence of emergence agitation was measured by using Aono's four-point scale, with scores of 3 and 4 indicating emergence agitation. The primary outcome was the incidence of emergence agitation. Secondary outcomes included duration of emergence agitation and time intervals between the discontinuation of anesthetics, first response, extubation, and post-anesthesia care-unit discharge readiness. The incidence of emergence agitation was 58.3% and 38.9% in the control and flumazenil groups, respectively, but it was not statistically significant. However, the duration of emergence agitation was shorter in the flumazenil group (p = 0.012). There were no significant differences in the time intervals between the discontinuation of anesthetics, first response, and extubation. Although flumazenil did not reduce the incidence of emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia, it can be considered as an option for awakening patients in terms of improving emergence profiles. [ABSTRACT FROM AUTHOR]

The present study aimed to analyze and compare the prognostic performances of the Revised Trauma Score (RTS), Injury Severity Score (ISS), Shock Index (SI), and Modified Early Warning Score (MEWS) for in-hospital mortality in patients with traumatic brain injury (TBI). This retrospective observational study included severe trauma patients with TBI who visited the emergency department between January 2018 and December 2020. TBI was considered when the Abbreviated Injury Scale was 3 or higher. The primary outcome was in-hospital mortality. In total, 1108 patients were included, and the in-hospital mortality was 183 patients (16.3% of the cohort). Receiver operating characteristic curve analyses were performed for the ISS, RTS, SI, and MEWS with respect to the prediction of in-hospital mortality. The area under the curves (AUCs) of the ISS, RTS, SI, and MEWS were 0.638 (95% confidence interval (CI), 0.603–0.672), 0.742 (95% CI, 0.709–0.772), 0.524 (95% CI, 0.489–0.560), and 0.799 (95% CI, 0.769–0.827), respectively. The AUC of MEWS was significantly different from the AUCs of ISS, RTS, and SI. In multivariate analysis, age (odds ratio (OR), 1.012; 95% CI, 1.000–1.023), the ISS (OR, 1.040; 95% CI, 1.013–1.069), the Glasgow Coma Scale (GCS) score (OR, 0.793; 95% CI, 0.761–0.826), and body temperature (BT) (OR, 0.465; 95% CI, 0.329–0.655) were independently associated with in-hospital mortality after adjustment for confounders. In the present study, the MEWS showed fair performance for predicting in-hospital mortality in patients with TBI. The GCS score and BT seemed to have a significant role in the discrimination ability of the MEWS. The MEWS may be a useful tool for predicting in-hospital mortality in patients with TBI. [ABSTRACT FROM AUTHOR]

We investigated the association between post-rewarming fever (PRF) and 6-month neurologic outcomes in cardiac arrest survivors. This was a multicenter study based on a registry of comatose adult (≥18 years) out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management between October 2015 to December 2018. PRF was defined as peak temperature ≥ 38.0 °C within 72 h after completion of rewarming, and PRF timing was categorized as within 24, 24–48, and 48–72 h epochs. The primary outcome was neurologic outcomes at six months after cardiac arrest. Unfavorable neurologic outcome was defined as cerebral performance categories three to five. A total of 1031 patients were included, and 642 (62.3%) had unfavorable neurologic outcomes. PRF developed in 389 (37.7%) patients in 72 h after rewarming: within 24 h in 150 (38.6%), in 24–48 h in 155 (39.8%), and in 48–72 h in 84 (21.6%). PRF was associated with improved neurologic outcomes (odds ratio (OR), 0.633; 95% confidence interval (CI), 0.416–0.963). PRF within 24 h (OR, 0.355; 95% CI, 0.191–0.659), but not in 24–48 h or 48–72 h, was associated with unfavorable neurologic outcomes. Early PRF within 24 h after rewarming was associated with favorable neurologic outcomes. [ABSTRACT FROM AUTHOR]

We investigated whether achieving estimated average glucose (EAG) levels versus achieving standard glucose levels (180 mg/dL) was associated with neurologic outcome in cardiac arrest survivors. This single-center retrospective observational study included adult comatose cardiac arrest survivors undergoing therapeutic hypothermia (TH) from September 2011 to December 2017. EAG level was calculated using HbA1c obtained after the return of spontaneous circulation (ROSC), and the mean glucose level during TH was calculated. We designated patients to the EAG or standard glucose group according to whether the mean blood glucose level was closer to the EAG level or 180 mg/dL. Patients in the EAG and standard groups were propensity score- matched. The primary outcome was the 6-month neurologic outcome. The secondary outcomes were hypoglycemia (≤70 mg/dL) and serum neuron-specific enolase (NSE) at 48 h after ROSC. Of 384 included patients, 137 (35.7%) had a favorable neurologic outcome. The EAG group had a higher favorable neurologic outcome (104/248 versus 33/136), higher incidence of hypoglycemia (46/248 versus 11/136), and lower NSE level. After propensity score matching, both groups had similar favorable neurologic outcomes (24/93 versus 27/93) and NSE levels; the EAG group had a higher incidence of hypoglycemia (21/93 versus 6/93). Achieving EAG levels was associated with hypoglycemia but not neurologic outcome or serum NSE level. [ABSTRACT FROM AUTHOR]