The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial

BackgroundWhether nasal administration of esketamine can provide effective analgesia is unclear in patients with acute pain after preoperative CT-guided needle localization.MethodsIn this double-blind, randomized, placebo-controlled trial, patients were assigned to receive either nasal administration of esketamine (0.3 mg/kg or 0.5 mg/kg) or saline (identical in appearance to esketamine) when they had visual analog scale (VAS) pain scores >3/10 during deep breathing after preoperative CT-guided needle localization. The primary outcome was the percentage of patients with satisfactory pain relief, which was defined as VAS pain scores ≤3/10 measured 15 min after intranasal of esketamine or saline. Secondary outcomes included VAS measured following esketamine or saline, the incidence and cumulative dose of rescue hydromorphone use, and related adverse events.ResultsA total of 90 patients were included in the final analysis. Following intranasal treatment, the percentage of patients with satisfactory pain relief was 16.7% (5/30) in the saline group, 56.7% (17/30) in the 0.3 mg/kg esketamine group, and 53.3% (16/30) in the 0.5 mg/kg esketamine group (p = 0.002). The median VAS during deep breathing was less after the intranasal administration of esketamine {median (IQR), 3 (3, 5) in 0.3 mg/kg or 0.5 mg/kg esketamine compared to the saline group [5 (4, 6)], p = 0.009}. The incidence of rescue hydromorphone use was detected less in the esketamine group compared to the saline group (43.3% in the 0.3 mg/kg esketamine group, 36.7% in the 0.5 mg/kg esketamine group, and 73.3% in the saline group, p = 0.010). The adverse events were similar among the three groups (p > 0.05).ConclusionIntranasal administration of esketamine is easier and more effective in alleviating acute pain in patients after preoperative CT-guided needle localization without significant adverse effects

MB-TaylorFormer: Multi-branch Efficient Transformer Expanded by Taylor Formula for Image Dehazing

In recent years, Transformer networks are beginning to replace pure convolutional neural networks (CNNs) in the field of computer vision due to their global receptive field and adaptability to input. However, the quadratic computational complexity of softmax-attention limits the wide application in image dehazing task, especially for high-resolution images. To address this issue, we propose a new Transformer variant, which applies the Taylor expansion to approximate the softmax-attention and achieves linear computational complexity. A multi-scale attention refinement module is proposed as a complement to correct the error of the Taylor expansion. Furthermore, we introduce a multi-branch architecture with multi-scale patch embedding to the proposed Transformer, which embeds features by overlapping deformable convolution of different scales. The design of multi-scale patch embedding is based on three key ideas: 1) various sizes of the receptive field; 2) multi-level semantic information; 3) flexible shapes of the receptive field. Our model, named Multi-branch Transformer expanded by Taylor formula (MB-TaylorFormer), can embed coarse to fine features more flexibly at the patch embedding stage and capture long-distance pixel interactions with limited computational cost. Experimental results on several dehazing benchmarks show that MB-TaylorFormer achieves state-of-the-art (SOTA) performance with a light computational burden. The source code and pre-trained models are available at https://github.com/FVL2020/ICCV-2023-MB-TaylorFormer.Comment: ICCV 202

An Isothermal Outflow in High-mass Star-forming Region G240.31+0.07

We present Atacama Pathfinder EXperiment (APEX) observations toward the massive star-forming region G240.31+0.07 in the CO J = 3--2, 6--5, and 7--6 lines. We detect a parsec-sized, bipolar, and high velocity outflow in all the lines, which allow us, in combination with the existing CO J = 2--1 data, to perform a multi-line analysis of physical conditions of the outflowing gas. The CO 7--6/6--5, 6--5/3--2, and 6--5/2--1 ratios are found to be nearly constant over a velocity range of $\sim$5--25 km s$^{-1}$ for both blueshifted and redshifted lobes. We carry out rotation diagram and large velocity gradient (LVG) calculations of the four lines, and find that the outflow is approximately isothermal with a gas temperature of $\sim$50 K, and that the the CO column density clearly decreases with the outflow velocity. If the CO abundance and the velocity gradient do not vary much, the decreasing CO column density indicates a decline in the outflow gas density with velocity. By comparing with theoretical models of outflow driving mechanisms, our observations and calculations suggest that the massive outflow in G240.31+0.07 is being driven by a wide-angle wind and further support a disk mediated accretion at play for the formation of the central high-mass star.Comment: Accepted for publication in the Ap

Aggressive intraoperative warming and postoperative pulmonary complications in elderly patients recovering from esophageal cancer surgery: sub-analysis of a randomized trial

BackgroundElderly patients having esophagectomies often become hypothermic which may promote complications. We tested the hypothesis that aggressive warming to a core temperature of 37°C reduces postoperative pulmonary complications (PPCs) in elderly patients having esophageal cancer resections.MethodsThis study was a pre-defined sub-study of a multi-center, parallel group, superiority trial (PROTECT). Patients aged >65 years and having elective radical resection of esophageal cancer in a single center were randomly allocated into either aggressive warming group (target intraoperative core temperatures of 37°C) or routine thermal management group (target intraoperative core temperatures of 35.5°C). The primary endpoint was the incidence of PPCs. Secondary endpoints included duration of chest tube drainage and other postoperative complications.ResultsA total of 300 patients were included in the primary analysis. PPCs occurred in 27 (18%) of 150 patients in the aggressive warming group and 31 (21%) of 150 patients in the routine thermal management group. The relative risk (RR) of aggressive versus routine thermal management was 0.9 (95% CI: 0.5, 1.4; p = 0.56). The duration of chest drainage in patients assigned to aggressive warming was shorter than that assigned to routine thermal management: 4 (3, 5) days vs. 5 (4, 7) days; hazard ratio (HR) 1.4 [95% CI: 1.1, 1.7]; p = 0.001. Fewer aggressively warmed patients needed chest drainage for more than 5 days: 30/150 (20%) vs. 51/150 (34%); RR:0.6 (95% CI: 0.4, 0.9; p = 0.03). The incidence of other postoperative complications were similar between the two groups.ConclusionAggressive warming does not reduce the incidence of PPCs in elderly patients receiving esophagectomy. The duration of chest drainage was reduced by aggressive warming. But as a secondary analysis of a planned sub-group study, these results should be considered exploratory.Clinical trial registrationhttps://www.chictr.org.cn/showproj.aspx?proj=37099, ChiCTR1900022257

The incidence and risk factors of acute pain after preoperative needle localization of pulmonary nodules: a cross-sectional study

Background: The incidence, severity and associated risk factors of acute pain after preoperative needle localization of pulmonary nodules are poorly characterized. We therefore conducted a cross-sectional study to quantify the acute pain induced by preoperative needle localization of small pulmonary nodules before video-assisted thoracoscopic surgery (VATS). Methods: We conducted this study at Shanghai Chest Hospital from September 2021 through December 2021. Eligible patients were between 18 and 75 years old and had small pulmonary nodules requiring preoperative CT-guided needle localization. The intensity of acute pain was assessed using the visual analogue scale (VAS) after preoperative needle localization. A VAS score ≥4 cm indicated moderate to severe pain. Patient demographics and CT-guided localization factors were collected to identify significant predictors associated with moderate to severe pain. Results: A total of 300 patients were included in the final analysis, with a mean (SD) age of 51 (SD =12) years old; 63% were female. Moderate to severe pain occurred in 50.8% of patients during deep breathing and 45.7% of patients during movement. Multivariate logistic regression analysis showed that multiple localization needles [multiple needle localizations vs. single needle localization, odds ratio (OR): 2.363, 95% confidence interval (CI): 1.157–4.825, P=0.018] and the specific location of needle puncture on the chest wall were significant predictors of moderate to severe pain after CT-guided needle localization (lateral chest wall vs. anterior chest wall OR: 2.235, 95% CI: 1.106–4.518, P=0.025; posterior chest wall vs. anterior chest wall OR: 1.198, 95% CI: 0.611–2.349, P=0.599). Conclusions: In adult patients receiving hookwire CT-guided localization, moderate to severe pain was common. Avoiding the localization route through lateral chest wall may be helpful and pharmacological medications or regional blockade is necessitated in high-risk population