Local Block Research Articles

Spatiotemporal Distribution Characteristics and Multi-Factor Analysis of Near-Surface PM2.5 Concentration in Local-Scale Urban Areas

Near-surface PM2.5 concentrations have been greatly exacerbated by urban land expansion and dense urban traffic. This study aims to clarify the effects of multiple factors on near-surface PM2.5 concentrations from three perspectives of background climatic variables, urban morphology variables, and traffic-related emission intensity. First, two case areas covering multiple local blocks were selected to conduct mobile measurements under different climatic conditions. The observed meteorological parameters and PM2.5 concentration were obtained through GIS-based imaging. These interpolation results of air temperature and relative humidity reveal highly spatiotemporal diversity, which is greatly influenced by artificial heat emissions and spatial morphology characteristics in local areas. The PM2.5 concentration on measurement days also varies considerably from the lowest value of 44~56 μg/m3 in October to about 500 μg/m3 in December in Harbin winter and ranges between about 5 μg/m3 and 50 μg/m3 in Guangzhou summer. The correlation analysis reveals that both the climatic conditions and urban morphology characteristics are significantly correlated with local PM2.5 concentration. Especially for Guangzhou summer, the PM2.5 concentration was positively correlated with the street traffic emission source intensity with correlation coefficient reaching about 0.79. Multivariate nonlinear formulas were applied to fit the association between these factors and PM2.5 concentration with higher determined coefficients. And optimization strategies are thus suggested to improve the urban air quality in local-scale areas. This attribution analysis contributes to environmentally friendly urban construction.

HAM-Transformer: A Hybrid Adaptive Multi-Scaled Transformer Net for Remote Sensing in Complex Scenes

The quality of remote sensing images has been greatly improved by the rapid improvement of unmanned aerial vehicles (UAVs), which has made it possible to detect small objects in the most complex scenes. Recently, learning-based object detection has been introduced and has gained popularity in remote sensing image processing. To improve the detection accuracy of small, weak objects in complex scenes, this work proposes a novel hybrid backbone composed of a convolutional neural network and an adaptive multi-scaled transformer, referred to as HAM-Transformer Net. HAM-Transformer Net firstly extracts the details of feature maps using convolutional local feature extraction blocks. Secondly, hierarchical information is extracted, using multi-scale location coding. Finally, an adaptive multi-scale transformer block is used to extract further features in different receptive fields and to fuse them adaptively. We implemented comparison experiments on a self-constructed dataset. The experiments proved that the method is a significant improvement over the state-of-the-art object detection algorithms. We also conducted a large number of comparative experiments in this work to demonstrate the effectiveness of this method.

Efficacy of Liposomal Bupivacaine in Managing Postoperative Pain in Foot and Ankle Surgeries: A Prospective Randomized Blinded Controlled Study

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Surgeons’ response to the nationwide opioid epidemic has included using alternatives to narcotic pain medications. Regional anesthesia has provided options to reduce narcotic consumption after surgery. Liposomal Bupivacaine (LB) is not FDA approved for use in nerve blocks in the lower extremity, though it is approved for more dangerous blocks (interscalene for example) in the upper extremity. The literature on LB in foot and ankle surgery has been limited to local infiltration and no major study has explored its efficacy when used in lower extremity peripheral nerve blocks. In this study, we compare local LB infiltration with LB used in peripheral nerve blocks in the lower extremity and compare both of these techniques with the current standard of care, a non-LB peripheral nerve block. Methods: All patients undergoing surgery in a single surgeon foot and ankle practice were enrolled in this IRB approved, prospective, randomized controlled study. Patients having surgery between January 2022 – January 2023 were randomized to one of three study arms: Group 1 Anesthesia administered ultrasound guided nerve block with local anesthetic only, Group 2 Anesthesia administered ultrasound guided nerve block with LB/local only mix, or Group 3 Surgeon administered infiltrative field block with LB/local mix. The primary outcomes collected included the amount of narcotic pain medication required in the PACU, oral morphine equivalents (OME) up to postoperative day 4 and after postoperative day 4, subjective duration of nerve block, and patient reported outcomes (PROMIS Pain Interference/Depression/Physical Function). Collection was obtained via chart review from hospital EMR, and phone calls made to patients during specific time intervals after surgery. Analysis was performed utilizing GraphPad Prism (Ver 9.0, GraphPad Software, San Diego CA USA). Results: After exclusion of 110 patients, 248 patients met inclusion criteria. Ninety-eight underwent perineural popliteal or popliteal adductor block with LB/local mix, 70 underwent popliteal or popliteal adductor block with local only (Group 2), 80 underwent surgeon administered local field block with LB/local mix (Group 3). Median PACU morphine equivalents required for pain control were significantly lower in Groups 1 and 2 (0 OME) compared to local field block (7.5 OME) (p < 0.05). Median OME utilized up to POD 4 and median OME utilized after POD 4 were both significantly lower in the LB/local mix perineural block group (p < 0.05) compared to Groups 2 and 3. Duration of block effect was significantly higher in the LB/local mix group compared to Groups 2 and 3 (p < 0.05). Conclusion: Preoperative perineural blocks containing a mix of LB and local anesthetic significantly reduce PACU, early postoperative, and mid postoperative narcotic use of patients undergoing outpatient foot and ankle surgery. The duration of effect of perineural block is significantly extended with addition of LB to the block mixture. Consideration should be given to the use of LB blocks in foot and ankle surgical procedures to reduce patient postoperative narcotic requirements.

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with and without Triamcinolone Acetonide in the Management of Chronic Pain in Post-Operative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Neural Adaptive Loop Filtering for Video Coding: Exploring Multi-Hypothesis Sample Refinement

Adaptive loop filtering (ALF) is extensively investigated for lossy video coding to mitigate compression noise. Numerous learning-based ALFs have emerged recently and improved the coding efficiency significantly through the use of complexity-intensive, large-scale models trained on excessive samples, making it impractical for real-life applications. By contrast, lightweight, small-scale ALF models cannot promise convincing performance and model generalization. In principle, the ALF estimates the sample distortion for restoration. Instead of directly approximating the distortion as in existing solutions, we reformulate it as a Multi-hypothesis Sample Refinement (MSR) problem. To this end, we first generate multiple distortion hypotheses through a deep neural network (DNN) model. Then, these hypotheses are linearly superimposed to approximate the final distortion through the minimization of mean square error (MMSE) between the filtered reconstruction and its original, uncompressed input. Finally, the linear superimposition coefficients are explicitly signaled in the compressed bitstream. As seen, the superimposition coefficients inherently generalize the MSR to various content. And using DNNs to generate distortion hypotheses essentially models the spatial priors of a local block and its underlying compression error distribution. As a result, the MSR using a small-scale convolutional neural network (CNN) model with only 5k parameters and 5 KMACs/pixel achieves 4.35% (Intra) and 2.49% (Inter) BD-Rate (Bjontegaard Delta Rate) gains over the AV1 anchor. Ablation studies further demonstrate that the MSR can be generalized to diverse small-scale network structures, different standards (e.g., H.265/HEVC and H.266/VVC), and diverse video content (e.g., screen videos).

HiFuse: Hierarchical multi-scale feature fusion network for medical image classification

Effective fusion of global and local multi-scale features is crucial for medical image classification. Medical images have many noisy, scattered features, intra-class variations, and inter-class similarities. Many studies have shown that global and local features are helpful to reduce noise interference in medical images. It is difficult to capture the global features of images due to the fixed size of the receptive domain of the convolution kernel. Although the self-attention-based Transformer can model long-range dependencies, it has high computational complexity and lacks local inductive bias. In this paper, we propose a three-branch hierarchical multi-scale feature fusion network structure termed as HiFuse, which can fuse multi-scale global and local features without destroying the respective modeling, thus improving the classification accuracy of various medical images. There are two key characteristics: (i) a parallel hierarchical structure consisting of global and local feature blocks; (ii) an adaptive hierarchical feature fusion block (HFF block) and inverted residual multi-layer perceptron(IRMLP). The advantage of this network structure lies in that the resulting representation is semantically richer and the local features and global representations can be effectively extracted at different semantic scales. Our proposed model’s ACC and F1 values reached 85.85% and 75.32% on the ISIC2018 dataset, 86.12% and 86.13% on the Kvasir dataset, 76.88% and 76.31% on the Covid-19 dataset, 92.31% and 88.81% on the esophageal cancer pathology dataset. The HiFuse model performs the best compared to other advanced models. Our code is open source and available from https://github.com/huoxiangzuo/HiFuse.

The Effectiveness of Medial Branch Blocks and Radiofrequency Neurotomy in Managing Chronic Thoracic Pain: A Systematic Review and Meta-Analysis

BACKGROUND: Extensive research into potential sources of thoracic pain with or without referred pain into the chest wall has demonstrated that thoracic facet joints can be a potential source of pain confirmed by precise, diagnostic blocks. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of medial branch blocks and radiofrequency neurotomy as a therapeutic thoracic facet joint intervention. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies of medial branch blocks and the radiofrequency neurotomy in managing thoracic pain utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was performed. A comprehensive literature search of multiple databases of RCTs and observational studies of medial branch blocks and radiofrequency neurotomy in managing chronic thoracic pain were identified from 1996 to December 2022 with inclusion of manual searches of the bibliography of known review articles and multiple databases. Methodologic quality and risk of bias assessment was also conducted. Evidence was synthesized utilizing principles of quality assessment and best evidence synthesis, with conventional and single meta-analysis. The primary outcome measure of success was 3 months of pain reduction for medial branch blocks and 6 months for radiofrequency thermoneurolysis for a single treatment. Short-term success was defined as up to 6 months and long-term was more than 6 months. RESULTS: This literature search yielded 11 studies meeting the inclusion criteria, of which 3 were RCTs and 8 were observational studies. Of the 3 RCTs, 2 of them assessed medial branch blocks and one trial assessed radiofrequency for thoracic pain. The evidence for managing thoracic pain with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 2 RCTs and 3 observational studies for medial branch blocks was Level II. For radiofrequency neurotomy, with the inclusion of one RCT of 20 patients in the treatment group and 5 observational studies, the evidence was Level III in managing thoracic pain. LIMITATIONS: There was a paucity of literature with RCTs and real-world pragmatic controlled trials. Even observational studies had small sample sizes providing inadequate clinically applicable results. In addition, there was heterogeneity of the available studies in terms of their inclusion and exclusion criteria, defining their endpoints and the effectiveness of the procedures. CONCLUSION: This systematic review and meta-analysis show Level II evidence of medial branch blocks and Level III evidence for radiofrequency neurotomy on a long-term basis in managing chronic thoracic pain. KEY WORDS: Chronic spinal pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, diagnostic accuracy, radiofrequency neurotomy

Vehicle re-identification based on grouping aggregation attention and cross-part interaction

Vehicle re-identification (Re-ID) plays an important role in intelligent transportation systems. To solve the key problem of small inter-class difference, we propose a vehicle Re-ID network based on grouping aggregation attention and cross-part interaction (GACP), which uses a channel context local interaction attention block (CCLI) and a cross-part interaction module (CPIM) to extract global and local discriminative features, respectively. The CCLI constructs the context information of each channel and performs local interaction to realize the communication of local and long-range information, thus effectively infer the weights of channels. In addition, the CCLI further reduces the number of parameters and improves the attention effect through a grouping aggregation module and an attention enhancement constraint. The CPIM enhances the correlation between vehicle parts obtained by rigid segmentation on feature maps to mine robust local information. Extensive experiments on two popular datasets VeRi776 and VehicleID demonstrate the effectiveness of the proposed method.

The diversity of hypospadias management in North America: a survey of pediatric urologists.

To determine trends in hypospadias management, including surgical techniques and perioperative care, by pediatric urologists in North America. An anonymous online survey was devised to assess approaches to hypospadias repair and management, including anesthetic considerations, catheter placement, choice of dressing, and postoperative antibiotic treatment. The survey was sent to all practicing members of the Societies for Pediatric Urology. The survey was completed by 133 (34.5%) respondents. Hypospadias repair was overwhelmingly recommended between ages 6-12months (89.5%). A local or regional anesthetic block (caudal, penile, pudendal, spinal) is performed nearly universally (96.2%). The majority of surgeons perform distal repairs outpatient (70.7%), while fewer perform outpatient staged repairs (47.4%) or redo surgery (33.8%). Nearly all respondents preferred either VicrylTM/DexonTM (50.4%) or MaxonTM/PDSTM (48.1%) for urethroplasty. All but one respondent leaves a stent for midshaft to proximal repairs whereas stenting for glanular repairs was split with 53.4% leaving a stent. Most surgeons (60.9-70.9%) prescribe postoperative antibiotics regardless of severity and the majority (72.9%) prescribe narcotics for analgesia. Approaches to hypospadias repair are extremely varied such that there is a lack of consensus among pediatric urologists regarding most aspects of hypospadias management. Investigations comparing hypospadias practice patterns are necessary to develop a standard of care for this complex pediatric urologic entity.

The effects of pain following disbudding on calf memory

Studies have found evidence of pain in the hours following hot-iron disbudding, but little is known about longer-lasting pain following this procedure. Work on humans and rats has shown that lasting pain can have negative effects on the formation and recall of memories. The objective of this study was to assess whether lasting pain following disbudding affects learning and memory in calves. A modified hole-board apparatus was used to assess how quickly calves were able to learn the locations of 4 bottles containing milk dispersed among 11 locations with empty bottles. At 14 d of age and after 6 d of training on this task, calves (n = 30) were randomly assigned to 3 treatments: disbudding with analgesic on the day of the procedure, disbudding with analgesic throughout the study, and sham disbudding. All calves were sedated, given a lidocaine cornual local block and a single injection of an nonsteroidal anti-inflammatory drugs. Starting on the day after their disbudding treatment, calves were tested daily using the modified hole-board apparatus. After 12 d of testing, the locations of the 4 milk-containing bottles were switched, and calves then relearned the locations of the rewarded bottles over the next 6 daily test sessions. We found general working memory (i.e., short-term memory) and reference memory (i.e., long-term memory) increased over the 12 d of testing, declined when locations were switched on d 13, and then again increased over the final 6 d of testing. We did not find an effect of treatment on any measure, perhaps because there was no lasting pain or because effects were too minor to detect using this test of spatial memory.

Res-SwinTransformer with Local Contrast Attention for Infrared Small Target Detection

Infrared small target detection for aerial remote sensing is crucial in both civil and military fields. For infrared targets with small sizes, low signal-to-noise ratio, and little detailed texture information, we propose a Res-SwinTransformer with a Local Contrast Attention Network (RSLCANet). Specifically, we first design a SwinTransformer-based backbone to improve the interaction capability of global information. On this basis, we introduce a residual structure to fully retain the shallow detail information of small infrared targets. Furthermore, we design a plug-and-play attention module named LCA Block (local contrast attention block) to enhance the target and suppress the background, which is based on local contrast calculation. In addition, we develop an air-to-ground multi-scene infrared vehicle dataset based on an unmanned aerial vehicle (UAV) platform, which can provide a database for infrared vehicle target detection algorithm testing and infrared target characterization studies. Experiments demonstrate that our method can achieve a low-miss detection rate, high detection accuracy, and high detection speed. In particular, on the DroneVehicle dataset, our designed RSLCANet increases by 4.3% in terms of mAP@0.5 compared to the base network You Only Look Once (YOLOX). In addition, our network has fewer parameters than the two-stage network and the Transformer-based network model, which helps the practical deployment and can be applied in fields such as car navigation, crop monitoring, and infrared warning.

MISSU: 3D Medical Image Segmentation via Self-Distilling TransUNet.

U-Nets have achieved tremendous success in medical image segmentation. Nevertheless, it may have limitations in global (long-range) contextual interactions and edge-detail preservation. In contrast, the Transformer module has an excellent ability to capture long-range dependencies by leveraging the self-attention mechanism into the encoder. Although the Transformer module was born to model the long-range dependency on the extracted feature maps, it still suffers high computational and spatial complexities in processing high-resolution 3D feature maps. This motivates us to design an efficient Transformer-based UNet model and study the feasibility of Transformer-based network architectures for medical image segmentation tasks. To this end, we propose to self-distill a Transformer-based UNet for medical image segmentation, which simultaneously learns global semantic information and local spatial-detailed features. Meanwhile, a local multi-scale fusion block is first proposed to refine fine-grained details from the skipped connections in the encoder by the main CNN stem through self-distillation, only computed during training and removed at inference with minimal overhead. Extensive experiments on BraTS 2019 and CHAOS datasets show that our MISSU achieves the best performance over previous state-of-the-art methods. Code and models are available at: https://github.com/wangn123/MISSU.git.

Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic

IntroductionDuring the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. MethodsRetrospective manual chart review and data collection of patients’ charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. ResultsA total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. ConclusionsIt is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.

Graph-Based Non-Sampling for Knowledge Graph Enhanced Recommendation

Knowledge graph (KG) enhanced recommendation, which aims to solve the cold start and explainability in recommender systems, has attracted considerable research interest recently. Existing recommender systems usually focus on implicit feedback such as purchase history without negative feedback. Most of them apply the negative sampling strategy to deal with the implicit feedback data, which may ignore the latent positive user-item interaction. Some other works adopt the non-sampling strategy that treats all non-observed interactions as negative samples and assigns a weight for each negative sample to represent the probability that this sample is a positive sample. However, they use a simple and intuitive weight assignment strategy and cannot catch the latent relationship from all interaction data. To address these problems, we consider graph structure information of both user-item interaction and knowledge graph, and propose a Graph-based Non-Sampling strategy to achieve efficient performance in Knowledge graph enhanced Recommendation (GNSKR). GNSKR utilizes node centrality to significantly improve recommendation performance with low computation cost. Meanwhile, we combine knowledge graph embedding and recommendation task with a local aggregation block, which efficiently catches the high-order connection information in KG enhanced recommendation. Experiments on three datasets show that GNSKR embraces the state-of-the-art with competitive efficiency.

Nasal Bone Fracture Reduction Under Local Anaesthesia: A Holistic Approach to Nasal Blocks and a Comparison with General Anaesthesia.

To compare the pain scores in closed reduction of nasal bone fractures under local anaesthesia (LA) and general anaesthesia (GA), and to outline the blocks that should be used for the same based on their nerve supply. A prospective study was conducted with 40 patients with Class 1 and 2 nasal bone and septal fracture. 20 patients underwent the procedure under LA and 20 under GA. The local blocks that should be used based on the complete nerve supply of the nose has been tabulated. Pain scores were recorded immediately after the procedure and 6h later. Additionally, all the patients undergoing reduction under LA were asked, if given the choice again, if they would prefer to undergo the procedure under LA or GA. The overall difference in the pain scores calculated by T-test showed a p-value of 0.08807 (the result was not significant at p < .05) in the immediate post operative period. At the 6h post operative period, overall difference in the pain scores showed a p-value of 0.384972 (not significant at p < .05). Of the patients who underwent the procedure under LA, 18 of 20 (90%) said that if given a choice again, they would undergo the procedure under LA, while 2 said they would prefer GA. Based on the pain score in the La vs. GA groups, there is no significant difference in the pain scores whether closed reduction is done under local or general anaesthesia. If all the blocks are given keeping the nerve supplies in mind, and both externally, and with pledgets, the entire nerve supply of the nose can be blocked.

Multi-Attention Multi-Image Super-Resolution Transformer (MAST) for Remote Sensing

Deep-learning-driven multi-image super-resolution (MISR) reconstruction techniques have significant application value in the field of aerospace remote sensing. In particular, Transformer-based models have shown outstanding performance in super-resolution tasks. However, current MISR models have some deficiencies in the application of multi-scale information and the modeling of the attention mechanism, leading to an insufficient utilization of complementary information in multiple images. In this context, we innovatively propose a Multi-Attention Multi-Image Super-Resolution Transformer (MAST), which involves improvements in two main aspects. Firstly, we present a Multi-Scale and Mixed Attention Block (MMAB). With its multi-scale structure, the network is able to extract image features from different scales to obtain more contextual information. Additionally, the introduction of mixed attention allows the network to fully explore high-frequency features of the images in both channel and spatial dimensions. Secondly, we propose a Collaborative Attention Fusion Block (CAFB). By incorporating channel attention into the self-attention layer of the Transformer, we aim to better establish global correlations between multiple images. To improve the network’s perception ability of local detailed features, we introduce a Residual Local Attention Block (RLAB). With the aforementioned improvements, our model can better extract and utilize non-redundant information, achieving a superior restoration effect that balances the global structure and local details of the image. The results from the comparative experiments reveal that our approach demonstrated a notable enhancement in cPSNR, with improvements of 0.91 dB and 0.81 dB observed in the NIR and RED bands of the PROBA-V dataset, respectively, in comparison to the existing state-of-the-art methods. Extensive experiments demonstrate that the method proposed in this paper can provide a valuable reference for solving multi-image super-resolution tasks for remote sensing.

Adjunctive dexamethasone palmitate use for intercostal nerve block after video-assisted thoracoscopic surgery: A prospective, randomized control trial

ObjectivesThe efficacy of dexamethasone palmitate in extending durations of local anesthetic blocks is uncertain. In a randomized, double-blind study of patients undergoing video-assisted thoracoscopic surgery, we tested whether intravenous or perineural dexamethasone palmitate caused prolonged analgesia after intercostal nerve block. MethodsA total of 90 patients subjected to video-assisted thoracoscopic surgery between May and December 2022 were randomly assigned to one of three intercostal nerve blocks study arms (n = 30 each), requiring the addition of 0.5% ropivacaine (23 ml) as follows: controls (C group), 2 ml saline; IV-DXP group, 2 ml saline + 2 ml (8 mg) intravenous dexamethasone palmitate; and PN-DXP group, 2 ml (8 mg) perineural dexamethasone palmitate. Time to first postoperative remedial analgesia served as primary outcome measure. Secondary endpoints included postoperative opioid consumption, pain scores by Visual Analog Scale, analgesia satisfaction, and related adverse effects. ResultsCompared with controls or the IV-DXP group, time to first postoperative remedial analgesia was longer and postoperative opioid consumption for rescue analgesia was lower in the PN-DXP group (p < 0.01). Similarly, the Visual Analog Scale scores in patients at 8, 12, 18, and 24 h postoperatively were lower in the PN-DXP group than in controls and the IV-DXP group (p < 0.01). Patient satisfaction was statistically lower in the PN-DXP group, compared with either the control or IV-DXP group (p < 0.05). Clinically, the three groups did not differ significantly in occurrences of adverse effects during the 48-h postoperative monitoring period (p > 0.05). ConclusionsPerineural dexamethasone palmitate is a promising adjunct to ropivacaine intercostal nerve block by prolonging analgesia with almost no related adverse effects.

A critical reappraisal of paleomagnetic evidence for Philippine Sea Plate rotation

The kinematic history of the Philippine Sea Plate (PSP) is crucial for interpreting its geological record related to subduction initiation processes and the paleogeography of the junction between the Paleo-Pacific and Tethyan oceanic realms. However, reconstructing PSP's kinematic history is difficult because the plate has been surrounded by subduction zones for most of its history. In absence of marine magnetic anomalies to constrain PSP's motion relative to its neighboring plates, paleomagnetic data may be used as quantitative constraints on its motion. Previous paleomagnetic studies interpreted easterly deflected declinations to infer clockwise rotations of up to 90° since the Eocene. However, rotations inferred from these datasets may also reflect local block rotations related to plate margin deformation. We here re-evaluate to what extent paleomagnetic data from the PSP unequivocally demonstrate plate motion rather than local rotation. To this end, we provide new data from Guam, in the Mariana forearc, and reassess published paleomagnetic data. Our new data from Guam come from two localities in the Eocene, two in the Oligocene, and two in the Miocene. Our compilation assesses data quality against recently defined criteria. Our new results demonstrate that in Guam, declination differences of up to 35° exist in rocks of Eocene age, indicating local rotations. Our compilation identifies both clockwise and counterclockwise rotations from the plate margins, with little confidence which of these would reflect plate-wide rotation. We compiled paleolatitude data from igneous rocks, which we correct for microplate rotation constrained by intra-PSP marine magnetic anomalies and show a northward drift of the PSP of ∼15° since the Eocene, but without a paleomagnetic necessity for major vertical axis rotation. Hence, with the currently available data, rotations of the PSP may be permitted, but are not required. Plate motion is currently better reconstructed from geological constraints contained in circum-PSP orogenic belts.