Operative Site Research Articles

NCMP-13. CONCURRENT WOUNDED GLIOMA SYNDROME AND DISTANT WOUNDED GLIOMA SYNDROME FOLLOWING A GROSS TOTAL RESECTION OF GLIOBLASTOMA MULTIFORME – A CASE REPORT

Abstract Surgery is the initial form of treatment for glioblastoma, and a maximum resection without impairing neurological function improves survival. Wounded Glioma Syndrome (WGS) is a clinical picture observed after the resection of high-grade tumors. This syndrome, developing within hours or a few days after glioma surgery, is characterized by hemorrhage into the surgical bed and cerebral edema, and at times occurring in areas distant from the site of the resection, i.e., Distant WGS. We report a case of an elderly male presenting with an acute-onset left leg weakness, with a large peripherally-enhancing mass with central non-enhancement suggestive of necrosis in the right frontal lobe. A gross total resection of the tumor was done, and the histopathologic evaluation yielded a high-grade glioma, favoring a diagnosis of Glioblastoma WHO Grade-IV. During the postoperative period, he was drowsy and was able to move the right extremities. He had a series of generalized tonic-clonic seizures three hours after the operation. After eight hours, the patient became comatose with signs of increasing intracranial pressure. A cranial CT revealed diffuse cerebral edema, and hemorrhage into the operative site in the right frontal lobe, as well as subarachnoid hemorrhages in the bilateral fronto-parietal sulci. There were also small hemorrhages seen in the left caudate head, midbrain and left hemipons. Death occurred the following day. This case report demonstrates an unusual case of a WGS with a concurrent Distant WGS in the brainstem after a gross total resection of a frontal lobe glioma. This case shows a significant uncommon sequela that a patient undergoing glioma surgery can present, leading to rapid deterioration and death. Resection of a glioma carries a significant risk, and its impact in the immediate postoperative period merits evaluation when planning the perioperative management, taking prompt action if these syndromes occur.

Insights into the Biological Properties of Ligands and Identity of Operator Site for LanK Protein Involved in Landomycin Production.

LanK is a TetR type regulatory protein that coordinates the late steps of the biosynthesis of the landomycin family of antitumor angucyclic polyketides and their export from the cells of Streptomyces cyanogenus S136. We recently described the structure of LanK and showed that it is the carbohydrate portion of the landomycins that is responsible for abrogating the repressing effect of LanK on landomycin production and export. The effect has been established in a series of in vitro tests using synthetic analogs of the landomycin carbohydrate chains. Whether such synthetic compounds would function as effector molecules for LanK under in vivo conditions remained unknown. Furthermore, the location and identity of LanK operator sites within the lanK-lanJ intergenic region (lanKJp) was unknown. Here we report that methoxyphenyl analogs of tri- and hexasaccharide chains of landomycins cannot function as LanK ligands when applied externally to the reporter strain. The lability of these compounds to cellular media and/or their poor penetration into the cells could explain our observations. The LanK operator site has been mapped to a 14-bp region of lanKJp that includes a plausible -35 site upstream of the lanK start codon in a series of electrophoretic DNA mobility shift assays. This opens the door to studies of the DNA-LanK interaction at a single nucleotide resolution level.

Phage Milagro: a platform for engineering a broad host range virulent phage for Burkholderia.

Burkholderia infections are a significant concern in people with CF and other immunocompromising disorders, and are difficult to treat with conventional antibiotics due to their inherent drug resistance. Bacteriophages, or bacterial viruses, are now seen as a potential alternative therapy for these infections, but most of the naturally occurring phages are temperate and have narrow host ranges, which limit their utility as therapeutics. Here we describe the temperate Burkholderia phage Milagro and our efforts to engineer this phage into a potential therapeutic by expanding the phage host range and selecting for phage mutants that are strictly virulent. This approach may be used to generate new therapeutic agents for treating intractable infections in CF patients.

Quantitative risk assessment of industrial hot work using Adaptive Bow Tie and Petri Nets

Hot work poses great hazards to industrial operation site. Although regulatory and guidance exist, accidents caused by hot work continue to occur. Risk assessment has proved to be an effective method for risk control. However, current studies paid less attention to the evolution process of industrial hot work accidents and the quantitative risk assessment seems to be insufficient. In this context, we aimed to perform comprehensive risk evolution analysis and quantitative risk assessment of hot work using adaptive bow tie (ABT) and Petri nets (PNs). The ABT model is improved to analyze deep causes, consequences, and their relationships. PNs are employed to conduct quantitative risk assessment. To address uncertainties, the triangular membership function and improved regional center method are proposed to calculate the confidences of all places and transitions in the PNs. The probabilities are finally obtained by data fitting method. The study found that the most likely consequence of hot work accident is near miss. The results also indicate that hot work accident prevention measures should emphasize on the isolation of workplace, combustible gases test, removal of combustible substances, job organization, and job training. Besides, emergency devices maintenance and emergency drilling are critical to prevent accidents from expanding.

Dreams of Declassification: The Early Cold War Quest for Nuclear Knowledge in The Netherlands and Norway

This article seeks to explore the relation between nuclear physics and secrecy in early Cold War Europe. After World War II, nuclear physics re-emerged from the Manhattan Project as a largely classified field. Over time, the boundary between secret and unclassified information set by the United States moved due to both political and scientific developments. This shifting boundary of secrecy is taken as a place to investigate power relations in the context of Cold War Science. The Netherlands and Norway are two countries with early nuclear programs that tried to move this boundary, in part by building a joint reactor in 1951. Whereas they requested classified information from the US in 1946, their programs developed to a point where the US made requests to classify nuclear information in Europe by 1960. Between 1954 and 1960, the joint reactor program became the site of a multilateral intelligence operation. Secrecy was used as an intelligence tool to spread nuclear disinformation to the Soviet Union. This history shows how (de)classification opened and closed windows of opportunity and sheds light on the effectiveness of classification.

Masculinized femininity of women characters on the Kabuki stage: Female Onnagata's “cross-gender” performance in the “all-male” theatre

This article explores four-century-old “all-male” kabuki theatre of Japan as the site of logics, mechanisms, and operations of onnagata's gender performance. The term onnagata signifies actors performing women's roles in kabuki, and since the first two and a half centuries of kabuki history overlapped with the time when women were legally expelled from performance activities, male onnagata mostly developed and established the artistry and traditions of onnagata acting. Women resumed kabuki performance when it was still illegal, but that did not cancel this fact. The present article studies kabuki in this historical context in order to investigate how dynamically genders are taking shape on the kabuki stage and off. To that end, this paper uses “cultivation” (a training methodology called shugyô) as a key point of investigation, while paying special attention to female onnagata as a main subject of examination. Cultivation is the training methodology of weight that has long been used and systematized in many circles engaged in activities established in premodern times, such as Buddhism, martial arts, and performing arts, and constitutes a blanket regime for these wide-ranging areas. Cultivation is to obtain and internalize second nature to the extent that it could function as if it were natural, the process of which takes place through two stages: (1) repetitive, long-lasting, personal, and somatic training in, e.g., posture, movements, and the like, and (2) internalization of said technique as second nature. That this cultivation process is congruous with the concept of performativity in contemporary critical theory suggests that an analysis of how female kabuki actors go through cultivation in order to internalize kabuki body grammar, including gender related code can contribute not only to kabuki studies but also to gender studies.

LOWER EXTREMITY ARTERY ANEURYSMS AND THEIR MANAGEMENT-AN INSTITUTIONAL EXPERIENCE

Objective: To study the clinical presentation, etiology and outcomes of Lower extremity aneurysms management at a teritiary care centre. Methodology: This is a retrospective study covering a period of 5 years from june 2018 to july 2023 conducted at the Institute of Vascular Surgery, Madras Medical College, Chennai. Case sheets were retrieved and reviewed from CMCHS database. Inclusion criteria: Patients with true aneurysms and pseudoaneurysms involving lower limb who were managed by surgery or endovascular means were included in the study. Exclusion Criteria: Pseudoaneurysms related to dialysis and Iliac artery aneurysms Results There were 23 patients who presented with aneurysms of the extremities that fell in the inclusion criteria. Of these 14 patients were male and 09 were female. Children (<18 years) constituted 14.2 % of patients. Youngest- 7-month-old boy- Right PFA Pseudoaneurysm Oldest - 72yrs old male- Left PFA Pseudoneurysm • Major vessels involved were SFA-8/23(34.7%) and common femoral artery 5/23(21.7%.). Complications developed in 4 of the 23 cases (17.4%), which included recurrent pseudoaneurysm, surgical site infection, post- operative hematoma and surgical site infection ending up in AK amputation. Limb salvage rate was- 95.6% Amputation rate- 4% (1 patient). Conclusion: Extremity artery aneurysms are uncommon. Majority are pseudoaneurysms. Results of both open surgery and endovascular management are excellent.

Reviewing the UK's exploited hydropower resource (onshore and offshore)

Hydropower and tidal energy are valuable renewable energy resources that can assist in meeting the United Kingdom's net zero greenhouse gas emissions target. Existing studies have attempted to assess what the future energy resource potential is that can be harnessed from the water environment. Although schemes harnessing this energy, particularly hydropower, have been widely developed across the UK, few of the resource assessments account for already operational sites. This study takes the initial step required to holistically assess an accurate available potential by determining where and how much of the combined resource has already been exploited.During the research it was noted that the extent of development in terms of installed capacity and locations of sites has been poorly recorded. Data collection shows that there is not a single comprehensive database of hydropower and tidal energy schemes. This study has therefore addressed this research gap collating operational hydropower and tidal energy projects.This research determines the total installed capacity of hydropower is 4.66 GW, with 82 % of the powerhouses' locality identified. The contribution of tidal energy is much smaller at 10.63 MW. This research now makes it possible to fully understand the existing hydropower picture for the UK for the first time, allowing for more accurate resource assessments to be undertaken and for a better understanding of what the current contribution of these renewable energy sources (approximately 14 %) can be towards meeting the UK's energy demand (averaging 33 GW in 2020).

Dual erector spinae plane block for complex traumas of upper and lower limb: an opioid reduction strategy—a case series

BackgroundPatients with polytrauma (fractures of the humerus and the femur) require concurrent operative fixation. Pain originating from multiple operative sites leads to increasing doses of opioid-based analgesia, which has detrimental effects in the form of longer hospital stays, higher costs, and increased mortality.Case presentationIn twelve patients with humerus and femur fractures, a cervical erector spinae plane block (ESPB) at the level of T1 and a lumbar ESPB at the level of L2 were administered with a catheter and continuous infusion technique for postoperative analgesia. None of these patients required opioids in the postoperative period. The catheters were removed after 48 h.ConclusionsA dual ESPB can be used successfully in patients with multiple injuries by appropriately selecting the level of intervention, and opioid-sparing analgesia can be effectively delivered to these patients.

Study on Fracturing Parameters Optimization of Horizontal Wells in Low-Permeability Reservoirs in South China Sea

The oil and gas resources in the deep Paleogene system of the South China Sea are abundant. However, due to its poor reservoir physical properties and strong heterogeneity, the deep Paleogene system needs to be commercially exploited by hydraulic fracturing technology. In view of the challenges of offshore low-permeability reservoirs, large-scale fracturing is not allowed because of the limited operation sites and complex string structure. Taking the H oilfield in the South China Sea as the target, based on the concept of the integration of geologic and engineering techniques, parameters such as the number of fracturing stages and the fracture length were optimized by a numerical simulation, and a study on the slurry rate and fracturing scale was carried out based on the type of fracturing and the pipe string structure. The results show that multistage fracturing technology is available in low-permeability offshore oil fields. It is suggested to adopt networking fracturing technology with a “slick water + high slurry rate” framework. A higher rate is recommended, and the fracturing scale of each stage should be 50 m3 of the sands and 700 m3 of the fluids. This research provides a new model for offshore low-permeability oilfield development.

Effect of intramedullary nail fixation and internal plate fixation in distal tibia fracture surgery on post-operative wound infection in patients: A meta-analysis.

Distal tibial fracture is the most commonly seen type of fracture of the lower extremities. Both intramedullary nail fixation (INF) and plate fixation (PF) have been used to treat distal tibial fractures, but the best way to treat them is still in dispute. The purpose of this meta-analysis is to compare INF versus PF fixation with respect to the incidence of injury. For studies that have been published between inception and June 2023, a systematic review has been carried out on PubMed, Embase, Cochrane Library and Web of Scientific databases. All of the trials that looked at INF and PF-related complications were enrolled. Data from the 13 primary results were analysed with RevMan 5.3. The meta-analyses comprised 13 randomized controlled trials (RCTs). INF indicates that there is a tendency for patients with distal tibia fractures to reduce the risk of operative site infection (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.40, 3.13; p = 0.0003) after surgery compared with PF. INF resulted in a reduction in total wound complications (OR, 14.20; 95% CI, 1.81, 111.57; p = 0.01) but shortened operation time (mean difference, 13.03; 95% CI, 2.08, 23.99; p = 0.02). In view of these findings, INF seems to be a preferred method of surgery for the treatment of distal tibial fractures with respect to the reduction of post-operative wound complications.

Perspectives of nuclear energy development in Ukraine on the global trends basis

The article examines global trends in the development of the nuclear power industry. It includes the following: extending the operating life of nuclear power units; development of atomic energy in the context of the Paris Agreement; development of nuclear-hydrogen energy; synergistic interaction of renewable energy sources and nuclear power plants; introduction of new reactor technologies. The attitude of different countries of the world to atomic energy is described. It is determined that China and India are the leaders in developing nuclear power. It was determined that small modular reactors are considered transformative reactors that will contribute to the further development of atomic energy in the world. The advantages of small modular reactors in comparison with reactors of large capacity are described, and recommendations for selecting small modular reactors for Ukraine are formulated. Installation of small modular reactors at the operational sites of the NPPs of Ukraine can reduce the financial costs of their construction. Therefore, it will contribute to the sustainable development of the nuclear energy industry of Ukraine.

Efficacy of Eutectic Mixture of Local Anesthetics (EMLA) Versus Ice as Topical Anesthetics Prior to Long Buccal Nerve Blocks: A Prospective Comparative Study.

Background Dental extraction is one of the common procedures in the field of dentistry. However, fear and anxiety about local anesthetic injections are unavoidable for most patients.Topical anesthetics, distraction techniques, acupuncture, and the application of heat or cold have been used in practice to alleviate injection-related pain. The specific aim of this study was to compare the pain-relieving efficacy of eutectic mixture of local anesthetics (EMLA) vs. ice during the administration of a long buccal nerve block (LBNB) before dental extraction. Materials and Methods In total, 20 healthy adult patients who required bilateral mandibular posterior teeth extraction under local anesthesia were enrolled.The study was conducted in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, from January 2023 to May 2023. It was a prospective split-mouth study in which each participant was divided into two groups according to the operative site: Group 1, which received a 5% EMLA cream, and Group 2, which received an application of ice before administration of LBNB. There was a one-week interval between the two interventions. The levels of pain and satisfaction were assessed using the visual analogue scale (VAS) and pain perception was evaluated by the sound, eye, motor (SEM) scale. Mann-Whitney U test was applied for the statistical analysis. Results The study included a total of 20 participants, with 14 being male and six being female. The mean age of the study population was 42 ± 15 years. When analyzing the pain scores using the VAS, it was found that Group 1 had a mean score of 2.4 ± 0.44, while Group 2 had a mean score of 3.0 ± 0.44. This differencebetween the two groups wasstatistically significant (P = 0.001). It was also found that the mean patient satisfaction score for Group 1 was 9.8 ± 0.22 and for Group 2 was 9.2 ± 0.40 which wasstatistically significant (p = 0.003). Similarly, Group 1 had a mean SEM score of 1.1 ± 0.1, while Group 2 had a mean SEM score of 1.30 ± 0.46 which was also statistically significant (P =0.016). Conclusion The study results revealed that EMLA has asignificant advantage over ice in terms of lower levels of pain, more patient satisfaction, and higher comfort levels.EMLA can be considered the first choice of topical anesthetics, however, ice is recommended in resource-constrained dental set-upsas it is cost-effective.

A computer vision approach to improve maintenance automation for thermal power plants lubrication systems

PurposeLubricating oil leakage is a common issue in thermal power plant operation sites, requiring prompt equipment maintenance. The real-time detection of leakage occurrences could avoid disruptive consequences caused by the lack of timely maintenance. Currently, inspection operations are mostly carried out manually, resulting in time-consuming processes prone to health and safety hazards. To overcome such issues, this paper proposes a machine vision-based inspection system aimed at automating the oil leakage detection for improving the maintenance procedures.Design/methodology/approachThe approach aims at developing a novel modular-structured automatic inspection system. The image acquisition module collects digital images along a predefined inspection path using a dual-light (i.e. ultraviolet and blue light) illumination system, deploying the fluorescence of the lubricating oil while suppressing unwanted background noise. The image processing module is designed to detect the oil leakage within the digital images minimizing detection errors. A case study is reported to validate the industrial suitability of the proposed inspection system.FindingsOn-site experimental results demonstrate the capabilities to complete the automatic inspection procedures of the tested industrial equipment by achieving an oil leakage detection accuracy up to 99.13%.Practical implicationsThe proposed inspection system can be adopted in industrial context to detect lubricant leakage ensuring the equipment and the operators safety.Originality/valueThe proposed inspection system adopts a computer vision approach, which deploys the combination of two separate sources of light, to boost the detection capabilities, enabling the application for a variety of particularly hard-to-inspect industrial contexts.

Patients’ caring experience during procedures under regional anesthesia in Mainland China: A phenomenology study

BackgroundAlthough regional anesthesia is common, the procedure results in feelings of uncertainty and anxiety in some patients. Increased care is needed for these patients under general anesthesia. Few studies have focused on the intraoperative caring experience of patients during regional anesthesia. This study focused on the caring experience of patients during procedures involving regional anesthesia. MethodsThe descriptive phenomenology method of Husserl was employed. Semi-structured interviews were conducted with a purposive sample in five Grade III-A hospitals in Zhengzhou City, Henan Province. The seven-step analysis method of Colaizzi was applied for the analysis, summation, and theme refinement of the interview data. ResultsA total of 14 patients from five hospitals participated in the interviews. Four domains and 16 themes emerged during analysis: be informed (about the operation site, progression of the operation, informed in advance, receive explanation for abnormal experience); take care of my body (painless, gentle movements, special care); be protected (work seriously, favorable atmosphere, skilled, authority); and treated as an individual (pay attention, accompany, ask for opinions, encourage patient expression, humorous). ConclusionPatients during procedure under regional anesthesia had specific caring experiences relative to other patients. Medical staff should recognize the importance of regional anesthesia patients’ intraoperative caring experience. Hospital administrators should offer support to allow healthcare staff to provide targeted caring for patients during procedure under regional anesthesia.

Roles of ageing on the physical, chemical and mechanical parameters of a prototype municipal solid waste

ABSTRACT This study is mainly aimed at exploring effects of the aging-induced chemical decomposition of Municipal Solid Waste (MSW) on the shear response and physical properties of locally available MSW of Fars province, Iran, at its in-situ condition. To this end, a large direct shear device (1×1×1.1 m3) is designed, fabricated and employed to evaluate the parameters of the failure envelop at plane strain condition representing slopes of engineered landfills. Bulk disturbed samples of fresh MSW are exhumed from an operational disposal site to be implemented into the study and subsequently remolded in the large-scale shear box. Four drained shear tests are performed under a variety of vertical stresses. Next, intact components of MSW are landfilled over a period of 3, 6, and 9 months. Similar shear experiments are conducted at the end of each mentioned time interval. Mechanical behavior of MSW is completely frictional and internal friction angle of the studied MSW non-linearly increases with time from 44.2º to 55.7º. The stress-strain response is almost bilinear over a wide range of displacement. The decomposition process is further clarified in light of results of pH tests conducted on the leachate of the MSW at the end of various landfilling time intervals.

Histopathological Study of the Effect of Xenogeneic Platelet-Rich Fibrin on Achilles Tendon Healing in Rabbit

Tendon is a mechanical bridge that transforms the force generated by muscle contraction into movement. This tissue is well known for its low cellularity and vascularity; therefore, any tendon damage is characterized by a slow and inefficient healing process resulting in mechanically, structurally, and functionally inferior tissue. The current study aimed to evaluate the effect of the regenerative capacity of xenogeneic platelet-rich fibrin on the acceleration of Achilles tendon healing in rabbits. 24 adult rabbits weighing (1.5-2) kg were used in this study. The animals were divided equally into three groups: A-PRF group, in which the tendon defect was treated with xenogeneic Advance-platelet rich fibrin; L-PRF group, which used xenogeneic for tendon defect treatment; and control groups treated with normal saline. Clinical investigation of the rabbits during the experiment period revealed improvement of lameness and disappearance of swelling and redness at the operation site in the A-PRF and L-PRF groups compared to the control group at the same period. Histopathological examination revealed a good tendon healing process in the A-PRF group characterized by a highly organized Achilles tendon and lightly stained collagen fibers arranged in parallel. At the same time, these are less evident in the L-PRF group. In conclusion, this study suggests that xenogeneic Advanced platelet-rich fibrin treatment can be useful as a biomaterial for accelerating Achilles tendon healing in rabbits and this biomaterial. Keywords: Xenogeneic platelet-rich fibrin; Rabbit Achilles tendon; tendon healing; Advanced platelet-rich fibrin; Iraq.

CAPN: a Combine Attention Partial Network for glove detection.

Accidents caused by operators failing to wear safety gloves are a frequent problem at electric power operation sites, and the inefficiency of manual supervision and the lack of effective supervision methods result in frequent electricity safety accidents. To address the issue of low accuracy in glove detection with small-scale glove datasets. This article proposes a real-time glove detection algorithm using video surveillance to address these issues. The approach employs transfer learning and an attention mechanism to enhance detection average precision. The key ideas of our algorithm are as follows: (1) introducing the Combine Attention Partial Network (CAPN) based on convolutional neural networks, which can accurately recognize whether gloves are being worn, (2) combining channel attention and spatial attention modules to improve CAPN's ability to extract deeper feature information and recognition accuracy, and (3) using transfer learning to transfer human hand features in different states to gloves to enhance the small sample dataset of gloves. Experimental results show that the proposed network structure achieves high performance in terms of detection average precision. The average precision of glove detection reached 96.59%, demonstrating the efficacy of CAPN.

Exploring the Gender-Specific Impact of Intraperitoneal Bupivacaine on Early Postoperative Pain in Sleeve Gastrectomy.

Background: Early postoperative pain is a significant problem in bariatric and metabolic surgery. Our study aimed to investigate the potential role of intraperitoneal bupivacaine hydrochloride in pain management in the early postoperative period after bariatric and metabolic surgery. Methods: This double-blind, prospective, randomized, controlled study included 68 individuals who underwent bariatric and metabolic surgery at the Department of Surgery, Istanbul Aydin University Hospital. The study group received 20 mL of 0.5% bupivacaine hydrochloride intraperitoneally at the operative site, and the control group received 20 mL of normal saline. Visual analog scale (VAS) scores of each patient were recorded at 2nd, 4th, and 6th hours postoperatively. Results: Our study found significant differences in VAS scores of patients between study group and control group at 2nd, 4th, and 6th hours postoperatively. Significant differences were found between male and female patients in the control group at 2nd, 4th, and 6th hours postoperatively. Interestingly, no significant difference was found between female patients in the study group and control group at 2nd, 4th, and 6th hours postoperatively. Conclusions: Our study suggests that intraperitoneal administration of bupivacaine hydrochloride is effective in reducing early postoperative pain in male patients. However, no significant difference was found between the study group and the control group in female patients. Our results indicate that there may be a gender-related difference in the response to bupivacaine administration. Further research is needed to confirm these findings and determine the optimal dosing and administration of local anesthetics for postoperative pain management.

Insight into coupled Ni-Co dual-metal atom catalysts for efficient synergistic electrochemical CO2 reduction

The development of highly active, selective, and stable electrocatalysts can facilitate the effective implementation of electrocatalytic CO2 conversion into fuels or chemicals for mitigating the energy crisis and climate problems. Therefore, it is necessary to achieve the goal through reasonable material design based on the actuality of the operational active site at the molecular scale. Inspired by the stimulating synergistic effect of coupled heteronuclear metal atoms, a novel Ni-Co atomic pairs configuration (denoted as NiN3©CoN3-NC) active site was theoretically screened out for improving electrochemical CO2 reduction reaction (CO2RR). The structure of NiN3©CoN3-NC was finely regulated by adjusting Zn content in the precursors Zn/Co/Ni-zeolite imidazolate frameworks (Zn/Co/Ni-ZIFs) and pyrolysis temperature. The structural features of NiN3©CoN3-NC were systematically confirmed by aberration-corrected HAADF-STEM coupled with 3D atom-overlapping Gaussian-function fitting mapping, XAFS, and XRD. The results of theoretical calculations reveal that the synergistic effect of Ni-Co atomic pairs can effectively promote the *COOH intermediate formation and thus the overall CO2RR kinetic was improved, and also restrained the competitive hydrogen evolution reaction. Due to the attributes of Ni-Co atomic pairs configuration, the developed NiN3©CoN3-NC with superior catalytic activity, selectivity, and durability, with a high turnover frequency of 2265 h−1 at −1.1 V (vs. RHE) and maximum Faradaic efficiency of 97.7% for CO production. This work demonstrates the great potential of DACs as highly efficient catalysts for CO2RR, provides a useful strategy to design heteronuclear DACs, exploits the synergistic effect of multiple metal sites to facilitate complex CO2RR catalytic reactions, and inspires more efforts to develop the potential of DACs in various fields.