Application of Propofol Target-Controlled Infusion for Optimized Hemodynamic Status in ESRD Patients Receiving Arteriovenous Access Surgery: A Randomized Controlled Trial.

Background and Objectives: End-stage renal disease (ESRD) is associated with increased anesthetic risks such as cardiovascular events resulting in higher perioperative mortality rates. This study investigated the perioperative and postoperative outcomes in ESRD patients receiving propofol target-controlled infusion with brachial plexus block during arteriovenous (AV) access surgery. Materials and Methods: We recruited fifty consecutive patients scheduled to receive AV access surgery. While all patients received general anesthesia combined with ultrasound-guided brachial plexus block, the patients were randomly assigned to one of two general anesthesia maintenance groups, with 23 receiving propofol target-controlled infusion (TCI) and 24 receiving sevoflurane inhalation. We measured perioperative mean arterial pressure (MAP), heart rate, and cardiac output and recorded postoperative pain status and adverse events in both groups. Results: ESRD patients receiving propofol TCI had significantly less reduction in blood pressure than those receiving sevoflurane inhalation (p < 0.05) during AV access surgery. Perioperative cardiac output and heart rate were similar in both groups. Both groups reported relatively low postoperative pain score and a low incidence of adverse events. Conclusions: Propofol TCI with brachial plexus block can be used as an effective anesthesia regimen for ESRD patients receiving AV access surgery. It can be used with less blood pressure fluctuation than inhalational anesthesia.

The influence of Chinese scholars on global research.

The rise of China as a scientific research superpower has been frequently discussed in media and literature. However, past analyses are usually based on the geographical database and they ignore how the millions of emigrated Chinese students, who are now being considered the major research workforce in many countries, affect their academic outputs. Here we quantitatively analyze the contribution of Chinese scholars in physical science around the globe by their publications in a country's papers from 2010 to 2021 as well as their citations. Contrary to common perception, we find that increasing the number of Chinese scholars does not correlate with the net publication growth or decline in their host countries before the Chinese population exceeds a critical value. On the other hand, increasing Chinese authors in a paper improves its citations. The phenomena, though anomalous, are observed in many subfields of physics across the globe. Our analysis suggests that although Chinese scholars do not change the perceived publication capabilities of many countries but may have reshaped their research culture as well as workforce distributions. The results would be valuable for R&D, higher education, and immigration policymakers.

Resilient monitoring systems: architecture, design, and application to boiler/turbine plant.

Resilient monitoring systems, considered in this paper, are sensor networks that degrade gracefully under malicious attacks on their sensors, causing them to project misleading information. The goal of this paper is to design, analyze, and evaluate the performance of a resilient monitoring system intended to monitor plant conditions (normal or anomalous). The architecture developed consists of four layers: data quality assessment, process variable assessment, plant condition assessment, and sensor network adaptation. Each of these layers is analyzed by either analytical or numerical tools. The performance of the overall system is evaluated using a simplified boiler/turbine plant. The measure of resiliency is quantified based on the Kullback-Leibler divergence and shown to be sufficiently high in all scenarios considered.