Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Cardiovascular Function during First 24 Hours after Off-Pump and On-Pump CABG—A Prospective Observational Comparative Study

Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting： which is better in patients with chronic obstructive pulmonary disease？

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

Comparison of plasma NSE, protein S-100b and EEG changes in traditional arrested-heart procedures and on-pump beating-heart procedures

Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients, 20 with congenital heart disease (CHD) and 20 of rheumatic heart disease (RHD) , were divided into 2 groups: Control group (group A, n =20) including 10 patients suffering from CHD as group Al and the left 10 from RHD as group A2; and experiment group (group B, n =20) which consisting of group B1 (10 with CHD) and group B2 (10 of RHD). The patients in group A underwent traditional arrested-heart procedures, and those in group B were operated on with beating-heart procedures. Arterial blood samples were collected at preoperation (time A) , 20 min after cardiopul-monary bypass (CPB) starting (time B) , 1 h after CPB (time C) and 24 h postoperation (time D) respectively. Plasma contents of neuron-specific enolase (NSE) and protein S-100b were measured with sensitive ELISA. All the patients received echoencephalography (EEG) before and 1 week after operation. Results: The plasma contents of protein S-lOOb were increased very significantly at time B, C and D in comparison with those at time A (P<0.01) , and that of patients in group Al was significantly higher than that in group B at time B (P < 0. 05 ). There was no significant difference at other time points. At time B, the plasma contents of NSE were significantly higher in group A than in group B, and in group Al and Bl than in group A2 and B2. What's more, at time B, the former fell back to their pre-operative levels, but the latter remained still higher levels than the preoperative ones ( P < 0.01). No significant difference was found in the abnormality rates of postoperative EEG between 2 groups. Conclusion: The perioperative plasma contents of NSE and protein S-100b are not significantly higher in group B than in group A. On-pump beating-heart procedures do not make more serious cerebral dysfunction than the traditional arrested-heart procedures.

Comparison of long-term graft patency of on-pump versus off-pump coronary artery bypass grafting

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However,there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting (CCABG) .

柱塞式注肥泵内流动瞬态特性数值模拟与试验

柱塞式注肥泵是水肥一体化系统肥液注入的关键设备,为探明柱塞往复运动过程中柱塞式注肥泵的内部流动特征及外特性,该研究基于RNG k-ε湍流模型和动网格技术,构建注肥泵内流动三维动态数值模拟模型,对不同柱塞行程比和往复频率工况的泵内瞬态流动进行非定常数值模拟,预测柱塞泵外特性并分析额定工况的泵内流场特征,通过与试验数据及理论计算结果的对比,验证数值模拟模型的可靠性。结果表明:不同行程下模拟所得的时间平均流量与试验结果最大相对误差为3.58%,数值模拟所得瞬时流量大小及变化趋势与理论计算结果吻合良好,最大相对误差为3.17%;泵排出、吸入过程的初始阶段,分别存在进、出口单向阀阀芯闭合滞后现象,伴随形成回流;受阀芯闭合滞后导致的回流影响,注肥泵瞬时流量存在突变,其突变时刻与阀芯闭合时刻一致;注肥泵平均流量与柱塞行程和往复频率均呈线性正相关,泵容积系数随柱塞行程的减小而降低,但随柱塞往复频率的变化不明显,变频调控可更准确调节注肥泵流量,是水肥一体化系统中注肥流量调节的优选方式。研究结果可为柱塞式注肥泵设计与运行调控提供依据。

170m以下超高层建筑(群)消防给水设计探讨

对“一泵到顶”供水方式的极限应用高度进行探讨,研究“临时高压重力消防给水系统”的可行性,并针对170m以下超高层建筑或建筑群,探讨一种相对经济合理的消防给水系统设计方案。“临时高压重力消防给水系统”取消低区独立的消防加压泵组,低区消防系统由高位水箱重力供给,简化了系统形式,提高了系统的经济性,对于此类建筑的消防给水系统优化具有积极意义。

一机一泵组合的冷却水泵工作区与变频运行分析

根据深圳前海10号制冷站区域供冷系统,建立了一机一泵组合的冷却水系统水力计算模型,包括共享的总管+冷却塔压降模型,以及各支路的压降模型。针对不同运行模式,得到了水泵工作区;结合水泵变频特性曲线,得到了每个水泵工作区不同流量对应的水泵运行频率范围,可用于水泵变频控制,简化水泵运行控制策略。本文提出的水泵工作区还可用于水泵选型,校核水泵在所有工况是否运行在高效区。

导叶安装角度对离心泵叶轮结构特性的影响

为提高带导叶蜗壳式离心泵的运行稳定性,研究了不同导叶安装角度对离心泵性能及叶轮结构力学响应的影响.以某带导叶蜗壳泵为研究对象,首先对其进行流场数值模拟,再通过静态和瞬态结构分析模块将水压力载荷导入叶轮结构,以实现单向流固耦合分析,研究不同导叶安装角度下叶轮变形与等效应力变化规律,最后通过模态分析研究叶轮结构的振动特性.结果表明:随着导叶安装角度减小,泵的高效区向小流量工况偏移,并且最高效率逐渐增大,最大提高2.1%;单向流固耦合分析得到的稳态结果与瞬态结果规律一致,其中叶轮最大变形量和最大等效应力值都随流量的增大而减小,在设计工况附近,都随导叶安装角度的减小而减小,最大差值为3.3%,且最大等效应力值变化的幅值较小;预应力对叶轮干模态固有频率的影响可忽略不计,与干模态对比,湿模态下的固有频率有较显著下降.

基于一维计算模型的斜盘式柱塞泵流动特性分析

斜盘式柱塞泵广泛应用在直升机疲劳试验的液压系统中,其流动特性对液压系统稳定性有着至关重要的作用。文中使用立体几何方法分析了斜盘式柱塞泵柱塞运动轨迹,基于图形解析法推导了过流面积公式,并编写相应Matlab程序实现吸排油过流面积自动化计算;构建了考虑流量倒灌及泄漏的单柱塞流动模型,结合AMESim软件实现柱塞泵三维计算模型向一维计算模型的转变;依据初始工况计算结果分析了柱塞泵的流动特性及其产生流量脉动的原因,并使用基于计算流体力学(CFD)方法的三维模型所获得的流量脉动计算结果验证了一维计算模型的准确性。在此基础上分析了不同运行工况(包含运行温度、工作压力及柱塞泵调节参数)对出口流量脉动率的影响,从降低流量脉动率进而提高直升机疲劳试验精度的角度分析了试验中柱塞泵调节控制要点。文中提出的一维计算模型可显著提高柱塞泵仿真计算速率,便于后续柱塞泵的改进设计以及将其作为子系统添加到虚拟数字试验平台中。

基于DPM固液两相流仿真的单向阀冲蚀特性研究

基于计算流体力学(CFD-DPM),结合k-ε湍流模型,建立了一种颗粒-流场双向耦合冲蚀磨损模型,以单向阀为研究对象,分析阀芯开度、颗粒粒径和浓度对过流部件壁面的冲蚀磨损影响。结果表明:阀隙是颗粒运动的高速区,磨损严重部位是阀芯底角和阀座锥面,且阀座锥面处磨损相对严重;随阀芯开度的增大,颗粒在阀隙内速度降低,对过流壁面磨损量减少;阀芯冲蚀速率随粒径增大而减小,阀座冲蚀速率随粒径增大而增大,当粒径为0.5 mm时,阀座最大冲蚀速率和平均冲蚀速率接近极大值;阀芯与阀座冲蚀速率与颗粒浓度呈正相关,阀座处磨损面积随浓度增大而增大。

基于双机一塔循环水系统供暖季单循环水泵应用研究

针对双机一塔循环水系统采暖循环水泵耗电量大问题,提出单循环水泵运行方式,结合供暖机组低压缸零出力运行,定量分析了凝汽器压力报警工况、凝汽器额定压力工况、低压缸零出力运行1台工况,低压缸零出力运行2台工况下循环水流量与循环水泵的匹配性。结果表明,机组负荷<75%时,4种工况均满足单循环水泵运行要求,机组负荷>75%时,凝汽器额定压力工况不满足,需启动双泵运行。通过对单循环水泵运行措施调整,保证了单循环水泵的安全稳定运行,节能效果显著,具有一定推广价值。

用于混合动力变速器的双向摆线转子泵设计

叙述了应用于混合动力变速器的油泵的设计难点,介绍了传统摆线转子油泵的结构与工作原理。在传统摆线转子油泵的基础上,设计了一种新型双向摆线转子泵,可以在驱动轴旋转方向改变时,保证吸油油腔与排油油腔位置不变。介绍了这种双向油泵的结构与工作原理,对双向油泵的内外转子进行参数设计,校核了油泵的排量与油液流速。

Off-pump versus on-pump coronary-artery bypass grafting in elderly patients

The benefits of coronary-artery bypass grafting （CABG） without cardiopulmonary bypass in the elderly are still undetermined. METHODS We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass （off-pump CABG） or with it （on-pump CABG）. The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.

海上油田注水系统扩容研究与分析

随着某油田内外挂调整井投产,以及部分电泵井由采油转注水,现有注水电力系统已无法满足注水需求。针对上述难题,油田对注水系统研究,通过新增一套注水系统转变为一用两备,以及尝试双泵运行电力系统分析,注水泵最终实现两用一备运行模式,达到油田注水需求目的。

国产中控系统实现油井“一键降频”与功能优化

海上石油生产设施在日常生产过程中,如果关断阀、控制阀等设备意外突然关闭时,生产流程将出现大幅波动,极易造成单元关断或全生产关停。为有效降低因生产流程波动造成的单生产序列关停或者全生产关停的次数,减少油井电潜泵意外停机次数,本文基于国产和利时中控系统,实现油井手动“一键降频”与自动分级停井功能优化,在安全功能不受影响的前提下,利用将电潜泵运行频率手动一键降至基准频率的功能,让中控主操有时间采取最有效的紧急操作避免关停,并且当触发某个单序列生产关停信号时,自动关停高含水井,最大限度减少原油产量损失。油井手动“一键降频”功能的创新开发与自动分级停井功能的创新优化,经济效益明显、推广性强,可推广到其他海上设施,特别是已经实施或者正在实施中控系统国产化的海上设施。

BLY1000/16型煤矿井下钻探用泥浆泵车设计

现有的泥浆泵不能有效满足顶板高位φ200 mm及以上钻孔一次性成孔的需求,该需求主要表现为大流量、高压力的钻井动力介质和设备性能高可靠性等。采用大功率钻探设备集成化的设计理念,进行了泥浆泵单元、液压控制系统以及整车布局等设计,研发了BLY1000/16型煤矿井下钻探用泥浆泵车,主要配套大功率定向钻机用于顶板高位大直径钻孔施工。该泥浆泵车能自行走,移运便捷、集成度高。现场工业性试验表明:BLY1000/16型煤矿井下钻探用泥浆泵车可靠、高效地输出大流量、高压力的钻井液,满足了煤矿井下一次性大直径高位孔成孔的需求,有效保障了用于以孔代巷的大直径高位孔施工。

高扬程长爬坡泵系统水锤的防护

针对“高扬程、长爬坡”输水系统事故停泵水锤防护问题,以某供水工程为例,基于特征线算法,分析单向调压塔、空气罐、空气阀等不同水锤防护措施联合下的过渡过程特性,重点探讨了空气罐的水锤防护特点.结果表明:在泵后布置空气罐能在爬坡段有效提高最小水锤压力,且随着空气罐体积增加,水泵倒转转速虽略有增加,但总体水锤防护效果较好;单向调压塔对安装点之后高程低于塔内水位的管线保护作用较强,对安装点之前爬坡管线几乎无保护作用;采用以空气罐-单向调压塔-空气阀相结合可以有效减小空气罐体积,最优方案下最大水锤压力为348.98 m,最小水锤压力为-2.87 m,满足水锤防护要求;对“高扬程、长爬坡”的泵系统,以空气罐为主进行联合水锤防护是一种安全、经济的防护方案.

夏热冬冷地区游泳馆除湿热泵空调系统节能性对比分析

室内游泳馆具有高温高湿的特点。因此必须对游泳馆内空气温度、相对湿度及池水温度等因素进行高精度控制,以及时除去余热余湿,维持建筑物整体正常运行。目前室内游泳馆一般采用常规空调系统或者泳池专用除湿热泵空调系统。以上海市某室内游泳馆作为夏热冬冷地区游泳馆代表,选取冬季和夏季典型日,对常规空调系统与泳池专用除湿热泵空调系统进行节能性对比分析,结果表明在同样的负荷条件下,采用泳池专用除湿热泵空调系统的运行能耗均要低于常规空调系统,冬季泳池专用除湿热泵空调系统比常规空调系统节能约22.9%,在夏季节能23.3%左右,可见泳池专用除湿热泵空调系统的节能效果显著。

水泵水轮机开机过程水力特性研究

抽水蓄能电站水泵水轮机组在开机过程中产生剧烈的压力波动,转轮内复杂流动和压力脉动是引起固定部件强烈振动的主要原因之一。因此,需要对水泵水轮机开机过程的物理机理进行深入研究。本文同时建立了厦门抽水蓄能电站管路系统的一维特征线水力模型及水泵水轮机组过水流道的三维流场计算模型,开展了机组发电开机过程一维三维耦合的数值计算,重点分析了机组开机过程瞬时流动特点,以及转轮径向力和轴向力变化与外特性的内在关联性。研究发现,机组开机至空载状态时,由于导叶开度小、转速上升快,在无叶区形成了速率很高的水环,同时转轮流道内充斥着大量复杂的漩涡结构,导致了流量与转矩的突降。导叶动作、转速对径向力、轴向力的变化规律有直接的影响,开机过程中转轮径向力的变化趋势与活动导叶动作过程基本一致。轴向力的变化趋势与机组转速变化基本一致,转速和轴向水推力数值总体上为逐渐增大的趋势。本文研究结论为抽水蓄能机组和高水头混流式水轮机的开机过程物理机理和规律提供了有价值的参考。