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Objective Neuraxial block is the most common anesthesia method for cesarean section (CS). However, for some urgent and high-risk cesarean delivery, general anesthesia (GA) also plays a very important role. We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2016. Clinical data (baseline maternal status, preoperative status, perioperative information, maternal and fetal outcomes) of parturients and neonates were collected and analyzed. We summarized the common reasons for applying general anesthesia, and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists (ASA) grade, gestational weeks and intraoperative blood loss, as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study. Among the maternal and fetal factors, pregnancy with internal or surgical diseases is the most common reason (59 cases, 60.2%) for choosing GA, followed by the placenta and fetal membrane abnormalities (38 cases, 38.8%) and the pregnancy-specific disorders (36 cases, 36.7%). ASA grade Ⅲ-Ⅳ of parturients (χ 2=44.3, P 800 ml (χ 2=5.5, P

Genetic polymorphisms in the MTNR1B gene is associated with type 2 diabetes mellitus (T2DM); however, there is no evidence about its impact on the therapeutic efficacy of nateglinide. This prospective case–control study was designed to investigate the effect of MTNR1B rs10830963 gene variant on the therapeutic efficacy of nateglinide in treating T2DM. We genotyped untreated T2DM patients (N = 200) and healthy controls (N = 200) using the method of the high resolution of melting curve (HRM). Newly diagnosed T2DM patients (n = 60) with CYP2C9*1 and SLCO1B1 521TT genotypes were enrolled and given oral nateglinide (360 mg/d) for 8 weeks. The outcome was measured by collecting the venous blood samples before and at the 8th week of the treatment. The risk G allelic frequency of MTNR1B rs10830963 was higher in T2DM patients than the healthy subjects (P P MTNR1B rs10830963 polymorphism was associated with the therapeutic efficacy of nateglinide in T2DM patients. Also, the CC homozygotes had a better effect than G allele carriers.Trial registration Chinese Clinical Trial Register ChiCTR13003536, date of registration: May 14, 2013.

This paper describes the establishment and verification of an accurate pointing model for a 1.2 m aperture slant-axis terahertz antenna. A new analytical pointing model for the slant-axis antenna is presented based on an analogy to that of the alt-azimuth antennas. Furthermore, extra error terms are added to the pointing model based on the structure and mechanical analysis of the slant-axis antenna. To verify the pointing model experimentally, a pointing error measurement method based on photogrammetric techniques is proposed. Using this method, pointing behaviors of the antenna are accurately measured without the aid of astronomical observations, and major sources of the pointing errors are measured individually by photogrammetry and their respective coefficients are compared with those in the analytical pointing model. The results show that an extended pointing model consisting 21 error terms can significantly reduce the residual systematic errors compared with the traditional model, more details are given in the following sections.

Diarrhea can occur at an early or advanced stage of acquired immunodeficiency syndrome (AIDS) as a usual symptom in people with human immunodeficiency virus (HIV) infection. While it is usually not fatal, it can influence patients' quality of life seriously. It has shown to be efficacious and improves people's immune status to a certain extent to treat HIV/AIDS-related diarrhea on the basis of syndrome differentiation and treatment or Chinese herbs plus conventional treatment. Therefore, it may have a good application potential. Here, we outline a protocol for the systematic review of this health-care intervention, with the aim to evaluate the beneficial effects and safety of Traditional Chinese Medicine (TCM) for patients who suffer from HIV/AIDS-associated diarrhea. Randomized controlled trials that compare Chinese herbs with placebo or other effective treatments will be searched and included, in spite of publication status or language. The primary outcomes include diarrhea frequency and fecal character. The databases we will search as follows: China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), Wanfang Data, China National Knowledge Infrastructure, PubMed and the CENTRAL in Cochrane Library. Two authors will respectively conduct the screening of trials, data extraction, and use the Cochrane risk of bias tool to assess the methodological quality. We will analyze the data and perform a meta-analysis if possible. We intend to identify potential therapeutic modalities that may be of benefit to inform clinical practice by supplying existing evidence of the helpful effects and safety of TCM to treat patients suffering from HIV/AIDS-associated diarrhea.

Category: Hindfoot Introduction/Purpose: The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. Methods: From May 2005 to November 2016, 85 patients (88 feet) with calcaneal malunions after a displaced intraarticular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 8.9 months (95% confidence interval, 4.5-11.6 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the lateral exostosis that had been removed, iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Sixty two patients (63 feet) were followed for a mean of 45.4 months (29.0-52.3 months). Results: According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 81.6 points (95% confidence interval, 78.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Eight patients had wound edge necrosis, and 4 had superficial infection. Two patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. Conclusion: Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.

In the background of the service industry transformation and upgrading about the new retail, new model, new technology and new logistics, big data, cloud computing and Internet of things are widely used. it's important to improve the urban distribution system using the means and mode of modern logistics. This study selected the city distribution system as the research object, to build the distribution system of city, According to the new technology and new model of logistics, the paper puts forward the framework, construction path and configuration of the distribution system.

Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is a newly recognized neuro-autoimmune disease. Patients usually present with a series of neurological and psychiatric syndromes including memory impairment, seizures, dyskinesia, autonomic nervous system dysfunction, etc. Anti-NMDA-R encephalitis usually affects young women with teratoma being a common co-existing condition in nearly 47% of the diagnosed patients. Previous studies have shown that teratoma removal, being the current first-line therapy, may enhance the effectiveness of autoimmune therapy and decrease the incidence of relapse.[1] However, poorly controlled encephalitis poses as a perioperative anesthetic risk. Therefore, timing of the surgery is of great concern and is a question yet to be answered. Due to low incidence of anti-NMDA-R encephalitis in general population, literature of the perioperative management in these group of patients is scarce. Only few case reports were found yet, none has discussed the issue of surgery timing. In this study, 6 patients with anti-NMDA-R encephalitis undergoing teratoma removal were reviewed, and timing of surgery and anesthetic management for these patients were discussed. A computerized search of the Medical Records Database was conducted from June 2011 to May 2014 to identify patients with anti-NMDA-R encephalitis and ovarian teratoma. Approval from Institutional Review Board of Peking Union Medical College Hospital (PUMCH) was obtained. Patients who underwent tumor removal under general anesthesia were included. Data record include age, sex, clinical presentations, laboratory findings, diagnostic modalities (electroencephalogram [EEG], cranial magnetic resonance imaging [MRI], serum/cerebrospinal fluid [CSF] autoantibody test, and abdominal ultrasound), preoperation immunotherapy (drugs and dosage) and status of disease control, anesthesia course (anesthetic and emergence), and postoperative course (postoperative mechanical ventilation time, Intensive Care Unit [ICU] length of stay [LOS], and postoperative LOS). Diagnosis of anti-NMDA-R encephalitis as well as evaluating status of disease was double confirmed by a senior neurologist from PUMCH specializing in autoimmune encephalitis. Six female patients with anti-NMDA-R encephalitis were identified from the electronic database. They were numbered as Patient 1 to Patient 6 randomly. The age of the six patients was 22, 26, 28, 32, 10, and 30 years, respectively. They were generally in good health otherwise from teratoma and encephalitis. All six patients were diagnosed with anti-NMDA-R encephalitis by the combination of clinical presentation, EEG, MRI, and serum/CSF anti-NMDA-R antibody test. All the patients present with psychiatric symptoms, seizures, and disturbances of consciousness during the course of disease; four (Patient 1, 3, 4, and 5) had autonomic instability including arrhythmia (sinus tachycardia or sinus bradycardia) and central hypoventilation. Before the operation, three patients (Patient 1, 2, and 3) received intravenous immunoglobulin (IVIg), two patients (Patient 4, 5) received IVIg and corticosteroids. One patient (Patient 6) received IVIg, corticosteroids, plasma exchange therapy, as well as cyclophosphamide treatment. After immunotherapy, two patients (Patient 4, 6) experienced near-complete recovery and other four patients still have psychiatric symptoms and seizures. One patient was transferred to ICU with cardio-respiratory support due to respiratory insufficiency [Table 1]. Table 1 Autoimmune therapy, status of preoperative symptom control and postoperative recovery of the six patients All six patients underwent laparoscopic ovarian cystectomy under general anesthesia. For the two near-complete-recovery patients, induction was carried out with propofol, morphine, and cisatracurium for Patient 4 and propofol, midazolam, fentanyl, and rocuronium for Patient 6. Anesthesia was maintained with targeted controlled infusion of propofol (effect-site concentration of 3–4 μg/ml) + 1:1 air in oxygen for Patient 4, and sevoflurane + 1:1 N2O in oxygen for Patient 6. Both of the patients emerged from anesthesia uneventfully and were extubated right after the operation. They were sent back to general ward. No anesthesia-related complications or exacerbation of neurological symptoms were noted after the surgery. For the rest four patients whose symptoms were not well-controlled, anesthesia induction was with propofol, fentanyl, and rocuronium. Anesthesia maintenance was with sevoflurane + 1:1 air in oxygen for Patient 3, 5 and with sevoflurane + 1:1 N2O in oxygen for Patient 1, 2. All of them were transferred to ICU with tracheal intubation. Patient 3 was extubated 1-day after surgery without anesthesia-related complications. Patient 1, 2, and 5 were kept intubated after surgery for 46, 4, and 21 days, respectively, and all of them developed ventilator-associated pneumonia or pulmonary infection due to prolonged intubation. Two patients (Patient 1, 5) received tracheotomy and Patient 1 underwent unexpected tube prolapse due to dysphoria. Patients who got pneumonia recovered after treatment with antibiotics and the tracheostoma healed up before discharge [Table 2]. Table 2 Anesthetic management for the six patients with anti-NMDA-R encephalitis Postoperative ventilation time, ICU LOS, and postoperative LOS were longer in the patients whose symptoms were poorly controlled after autoimmune therapy (Patient 1, 2, and 5) than well-controlled ones (Patient 4, 6). Management of anti-NMDA-R encephalitis mainly involves immunotherapy and removal of the teratoma if present together. Early tumor removal was strongly advocated for patients with anti-NMDA-R encephalitis by some authors,[1] but the appropriate timing for surgery is still unknown. This study highlights the importance of adequate immunotherapy before surgery. Patients with poor disease control had longer postoperative invasive ventilation time, ICU LOS, postoperative LOS, or higher incidence of pulmonary complications while patients with better disease control had a smoother recovery. Therefore, it is assumed that although tumor removal may enhance the effectiveness of drug therapy, inadequate preoperative therapy may prolong postoperative ventilation time and result in unwanted pulmonary complications. This suggests that it may be appropriate to provide adequate immunotherapy for patients with anti-NMDA-R encephalitis before the surgery. Patient 1 and Patient 5 share similar status of preoperative disease control, but Patient 5 who received both IVIG and methylprednisolone led a relatively better recovery than Patient 1 who received only IVIG. This suggested that intensive combined treatment might be beneficial to patients with severe anti-NMDA-R encephalitis. Many anesthetic drugs can inhibit NMDA-R, and may induce the same symptoms as those observed in anti-NMDA-R encephalitis. NMDA-R can be strongly inhibited by nitrous oxide and ketamine. Therefore, it is presumed that patients with anti-NMDA-R encephalitis may be more sensitive to ketamine and nitrous oxide, which may aggravate the symptoms of encephalitis transiently during or after the operation. As a consequence, most authors suggested that ketamine and nitrous oxide should be avoided during the anesthesia.[2] But in our cases, nitrous oxide had been used in three patients. The effect of nitrous oxide on encephalitis could not be accessed due to continued sedation in ICU. In one patient whose symptom had been well-controlled before surgery thus was transferred to general ward without further sedation, no symptom deterioration was noted after anesthesia. Inhalational anesthetics are strong inhibitors of NMDA-R but not specific. They can also act on other ligand-gated ion channels such as GABAA and glycine receptors. Propofol seems to produce general anesthesia mainly by enhancing GABA pathway.[2] But a recent in vitro study showed that propofol may also block NMDA-R at the concentrations routinely used in general anesthesia[3] although the clinical relevance of this inhibition is not established. Therefore, the clinical effect of inhalational anesthetics and propofol on anti-NMDA-R encephalitis is still eluding. However, Lapebie et al.[4] did report a case of symptom deterioration after general anesthesia with propofol and sevoflurane. Splinter and Eipe[5] reported pronounced hypotension secondary to propofol injection at induction of anesthesia for diagnostic lumbar puncture. These suggest that patients with anti-NMDA-R antibody may be sensitive to propofol and sevoflurane. Interestingly, Splinter and Eipe[5] also reported that another lumber puncture was performed several months later for the same patient with propofol and no hypotension happened. In this study, propofol and sevoflurane were separately used for two patients whose symptoms had been well-controlled. Both of them were extubated immediately and emerged uneventfully after the surgery. Neither hypotension nor symptom deterioration had been found. So, we hypothesize that patients without disease control may be sensitive to anesthesia agents such as sevoflurane and propofol. While in patients whose preoperative symptom is under control, it may be safer to use sevoflurane, propofol, and nitrous oxide. But further investigation with more cases is needed to validate our findings. Our study shows that adequate preoperative immunotherapy and good disease control may be critical to anesthetic and postoperative management of patients with anti-NMDA-R encephalitis. Limited data show that commonly used anesthetics such as propofol, sevoflurane, and N2O may be safe for patients whose encephalitis had been well-controlled with immunotherapy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The drag-type vertical axis wind turbines (VAWTs) have advantages of simple structure, self-starting at low wind speed and low cost, but they show low wind energy conversion efficiencies. A novel vertical axis wind turbine is proposed aiming to improve the disadvantage of the traditional wind turbines based on bionic principle in this paper. The structure of the novel vertical axis wind rotor is designed by combining traditional Savonius wind rotor structure and fish's ridge structure. Aerodynamic performance of the novel wind rotor and a traditional Savonius wind rotor are numerically explored and predicted by numerical simulation method for their non-linear two-dimensional unsteady flows. Performance comparison of the two wind rotors is also carried out. The results show that the novel wind rotor has better performance for torque and power coefficient on lower tip speed ratio (TSR) conditions than traditional Savonius rotor. Based on the simulation analysis of the two different types of wind rotors, we present the approach of changing and reconstructing different curvatures to obtain higher efficiency.

To develop the control system of multi-range hydro-mechanical continuously variable transmission (HMCVT), a model of a multi-range HMCVT is built using the principle of dynamics. According to the characteristic of power split, HMCVT is separated as axes set, variable displacement pump-motor system, clutch set. With wheel tractor as application instance, the whole model of vehicle power train is made, which includes the engine, HMCVT, running system and control system. Based on the theory of Finite State Machine, an automatic control method of speed change and range shift is present, which employs the throttle value, engine speed, range number and transmission ratio as the control parameters. The dynamic characteristic of automatic speed changing and ranges shifting is simulated. The result indicates that the model can correctly represent the dynamic characteristic of HMCVT, the engine can run at the optimal working point, the multi-range HMCVT can shift range steadily and change transmission ratio continuously when the load changes, the circularly shift range is avoided. The model can be used conveniently for the analysis of vehicle dynamic performance and the research of multi-range HMCVT control method.

Based on the hydro-mechanical continuous variable transmission (HMCVT) of 400 house-power of Dongfanghong, the synchronization in period of contions to content to multiple period of HMCVT was established by analyzing its transmission principle, and the relation fomulas of power distributing ratio and efficiency was presented. That results showed that the characteristics of power flow at the first half and at the second half were different, when it was within the certain grade to do the boundary of e equaled with zero; while it was each grade in section points, that characters were the same; the more grades, the greater HMCVT system transmitting power and the higher the transmission efficiency of the entire system. The high efficiency features of multiple range hydro-mechanical stepless transmission, meet the requirement of tractor operation.

In this paper, a robot handling system was developed with the functions of visual positioning and position adjustment by using the MOTOMAN-SV3X robot. System components, workflow, robot pose and the method of solving the problem of pick-up position deviation were detailed. An automated and flexible application program was provided for robot handling technology, and the problem that there was pick-up position deviation in the process of transporting workpiece can be effectively resolved, thereby handling precision and efficiency can be improved.

Coal gas accident is the main threat to the safety production in coal mine,it needs a safe and efficient drilling equipment to detection and drainage in the gas area.At present,the equipments detect and drainage in underground coal mines are mainly fission rigs,which move time-consuming, and the efficiency of drilling is low.This paper introduces a new kind of full hydraulic drill car used in coal,it includes the integral design of the car, the structure layout, the drilling arm and the main parts of design ideas.The new drill carriage adopts the caterpillar vehicle structures,full hydraulic pressure drives,it can automatically change the drill rod, prevent bit-stuck device,can freely passage in the narrow roadway,arrived at the reservation of the drilling position and carries on the omni-directional drilling,it can meets various mine construction requirements, and it has a broad market prospect.

In view of the processing characteristic of large equipment, The CNC system of the fine milling machine tool for the large double-sided of aluminum ingot is designed, the hardware of the system is introduced, the software is illuminated mainly, the system is configured based on SCOUT, and the control programs of the manual and automatic processing are designed. Based on WINCC Flexible, the operating system which can meet the multi-interface easy to operate and live real-time monitoring is designed. As the result of the commissioning, the system is stable and reliable.

In this paper a PLC control system is designed to control the sorting, transmission and loading/unloading in the manufacturing, in view of the defects of the relay control system which usually has poor reliability and bad flexibility in use. On the basis of the superior performance of PLC control system and the working principle of frequency converter, AC transducer drive technology is applied to achieve stable starting, reliable operation and low breakdown rate in the assembly line of manufacturing. In the design of the upper monitoring system, the functions of parameter settings, process monitoring and control, data processing, fault location can be well implemented via configuration software. The research work of this paper will lay a solid foundation for the design of material automatic sorting system based on the PLC controller.

This paper mainly introduces the principle of preparation for nano-materials via vapor-phase technics, the design and assembly of nano-material synthesizer. Vapor-phase techniques include physical and chemical vapor synthesis, which involves vapor particle nucleation, nuclei growth, cohesion and a series of basic process in particle growth. Based on the principle of vapor-phase, this paper also details the invention of the process equipment for nano-material synthesis, which realizes an adjustable process in automatic control. The design aims to achieve a synthesizer being adjustable, automatic, intuitive and easy to operate. It mainly includes the following features. First, the invention helps show that preparation for nano-materials via vapor-phase technics is feasible. Second, with the high output of vapor-phase reaction, the synthesizer can not only be carried out in the experimental environment to demonstrate the synthesis of nano-materials, but also be applied in industrial production.

Automobile traffic has become the financial, entertainment, office and communications function as one of the mobile sites. In automotive design and manufacturing and modification, eliminating the noise of car audio systems to improve driving safety and the occupants enjoy audio and video quality is very important. This paper analyzes the car audio system composition, explains automobile noise is divided into mechanical noise and circuit system inner noise, circuit system noise inside mainly includes thermal noise, induction noise and transmission noise, and puts forward the relevant measures to reduce noise.

In this paper, we introduce a new test method for friction performance of wind turbine pitch bearing. Four loading devices are used to put on load on the pitch bearing from different directions through load board. It can accurately simulate the axial force, radial force and overturning moment of wind turbine pitch bearing. The data acquisition device can measure the value of speed, torque and actual output load of loading hydraulic cylinder. After analysis and calculation, the influence of additional friction torque produced by loading device can be obviated, the friction torque of wind turbine pitch bearing under different loads can be test accurately in the laboratory. The research shows that the structure of test bed is compact, mechanical rigidity is good, the replacement of bearing model is expedient. It puts on load easily and can measure the frictional torque of wind turbine pitch bearing under different loads more accurately. It can provide data for performance analysis of wind turbine pitch bearing and ensure the pitch bearing satisfying the application requirements.

Category: Midfoot/Forefoot Introduction/Purpose: To characterize clinical treatment of the malunion after midfoot injury. Methods: 22 cases of malunion following complex midfoot injury from 2004 to 2012. They were 19 men and 3 women with mean age of 37.8. The foot deformity was categorized into 3 types and 3 subtypes, with type? indicating normal foot arch (type ?a forefoot abduction, ?b forefoot adduction and Ic forefoot normal), type? Cavus deformity (subtype is same as?), and type ? flatfoot deformity (subtype is same as?) . There were 2 cases of type?a, 4 cases of type?c, 9 cases of type?a, 4 cases of type ?a, 3 cases of type ?c in our cohort. According to the malunion typing, osteotomy, joint arthrodesis, or realignment was used to correct deformity. Clinical outcomes were evaluated by AOFAS score and VAS. Results: All the patients were followed up for average 34.7 months.The mean VAS score was 2.0 points (0-6) and mean AOFAS score was 83.9±2.3 points (73-94) at the last follow-up, giving an excellent to good rate of 81.8%. All cases obtained favorable functional outcomes without bone nonunion, except one patient who still suffered from midfoot walking discomfort 3 years after operation. Conclusion: Operative management of malunion following midfoot injury is effective and good results can only be obtained by stabilizing injured joint, realignment and recover foot arch.Our typing of the midfoot malunion is helpful in the operative treatment.

Current epidemiologic data suggest that a localized infection (periodontitis) can disseminate into the distant tissues, and subgingival bacteria can migrate in the bloodstream, thereby contributing to independent systemic disease processes. To test this hypothesis, we investigated the effect of repeated systemic inoculations with Porphyromonas gingivalis (Pg) on intimal hyperplasia in iliac arteries in a rabbit model of balloon injury.One week after single balloon injury to the iliac artery, 30 male New Zealand rabbits were randomly assigned to intravenous inoculation with 100 microl live Pg (10(7) colony-forming units; n = 15) or vehicle (n = 15) once weekly for 4, 8, or 12 consecutive weeks. Arteries were fixed by perfusion and removed for analysis of neointimal lesion formation. We measured intimal and medial lesion areas in iliac artery cross-sections as well as the intimal/medial ratio (I/M). We also analyzed Pg 16S ribosomal DNA amplification with polymerase chain reaction, systemic proinflammatory mediators with enzyme-linked immunosorbent assay, and immunolocalization of macrophages in the balloon-injured arteries.At 12 weeks, iliac intimal hyperplasia was accelerated, and I/M was significantly increased in Pg-inoculated animals (I/M 3.961 +/- 0.536 in the Pg group versus 3.585 +/- 0.353 in the control animals; P0.01). Pg-inoculated animals also had significant increases in macrophage infiltration at 12 weeks, C-reactive protein levels at all time points, and interleukin-6 levels at 12 weeks. Moreover, Pg ribosomal DNA was found in the injured arteries of Pg-inoculated animals, but only after 12 weeks.Long-term systemic challenge with Pg, an oral pathogen, may accelerate intimal hyperplasia in balloon-injured iliac arteries.

High-voltage converter technology applied in coal mining ventilator could gain a great deal of operating effectiveness and economic benefits. This paper illustrates the reformation of main ventilation system in some coal mine of Shanxi province. The defective operation conditions of previous mining ventilator and the advantage of converter control system applied in the mining ventilator are also proposed by this paper. The mathematical model of direct torque control (DTC) method used in the system is analyzed by giving dynamic model of stator flux oriented. The transformed design of converter control system with the benefits of highly enhanced energy-saving and environmental protections is involved as well as its operating statistics on energy-saving effect.