Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Effect of Pressure-Controlled Inverse Ratio Ventilation on WBC,PCT and CRP in Rats Undergoing Radical Gastrectomy and Related Mechanism

Objective:To explore the effect of pressure-controlled inverse ratio ventilation on partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaC O2),dynamic lung compliance(Cdyn),white blood cell(WBC),procalcitonin(PCT),C-reactive protein(CRP),and other indicators.Methods:A total of 100 healthy Wistar rats,aged 6-8 weeks and weighing 300-356 g,were used to establish gastric cancer models with 1-methyl-3-nitro-1-nitrosoguanidine(MNNG).60 gastric cancer rats were randomly divided into three groups and treated with laparoscopic radical gastrectomy after anesthesia.Rats in the VCV group were given volume control ventilation,rats in the PCV group were given pressure control ventilation,and rats in the PC-IRV group were given pressure control inverse ratio ventilation.The levels of WBC,PCT and CRP in the three groups were observed and compared on the 1st,3rd and 5th day after operation.Results:There were significant differences in PaO_(2)levels at 15 min after ventilation mode change and at the time of pneumoperitoneum closure,and in PaCO_(2)and Cdyn levels at 10 min after induction and at 15 min after ventilation mode change among the three groups(P<0.05).The PaO_(2)levels in PC-IRV group were higher than those in VCV group and PCV group at 15 min after the ventilation mode was changed and at the time of closing the pneumoperitoneum.The level of PaCO_(2)in PC-IRV group was lower than that in VCV group and PCV group 10 min after induction and 15 min after ventilation mode change,and the level of PaCO_(2)in PC-IRV group was lower than that in VCV group when pneumoperitoneum was turned off.The level of Cdyn in PC-IRV group was higher than that in VCV group and PCV group at 10 min after induction and 15 min after ventilation mode change.The level of Cdyn in PC-IRV group was higher than that in PCV group at the time of closing pneumoperitoneum.The Cdyn level in PCV group was lower than that in VCV group at 15 min after ventilation mode change.There were significant differences in WBC levels among the three groups on the 1st day after operation(P<0.05),and there were no significant differences in PCT and CRP levels among the three groups on the 1st day after operation(P>0.05).There were significant differences in WBC,PCT and CRP levels in the three groups of rats on the 3rd and 5th days after surgery(P<0.05).Except for PCT and CRP on the 1st day after operation,the WBC on the 1st,3rd and 5th days after operation,PCT and CRP on the 3rd and 5th days after operation in PCV group and PC-IRV group were lower than those in VCV group(P<0.05).Except for WBC,PCT and CRP on 1st day after operation,the levels of WBC,PCT and CRP on the 3rd and 5th days after operation in PC-IRV group were lower than those in PCV group(P<0.05).Conclusion:During laparoscopic radical gastrectomy for gastric cancer,pressure-controlled inverse ratio ventilation can help rats maintain good respiratory status and lung compliance during the operation,which can effectively alleviate the postoperative inflammatory response.

Comparative study of pressure-control ventilation and volume-control ventilation in treating traumatic acute respiratory distress syndrome

Objective: To observe the clinical therapeutic effect and side effect of pressure-control ventilation (PCV) on traumatic acute respiratory distress syndrome (ARDS) compared with volume-control ventilation (VCV). Methods: Forty patients with traumatic ARDS were hospitalized in our department from June 1996 to December 2002. Twenty were treated with PCV (PCV group) and 20 with VCV (VCV group). The changes of the peak inflating pressure and the mean pressure of the airway were observed at the very beginning of the mechanical ventilation and the following 12 and 24 hours, respectively. The transcutaneous saturation of oxygen pressure, the pressure of oxygen in artery, the mean blood pressure, the central venous pressure, the heart rate and the incidence of the pressure injury were also monitored before ventilation and 12 hours after ventilation. Results: The pressure of oxygen in artery, the transcutaneous saturation of oxygen pressure, the heart rate and the respiratory rate in the PCV group were obviously improved after ventilation treatment. The peak inflating pressure, the mean pressure of the airway and the central venous pressure in the PCV group were lower than in the VCV group. The incidence of pressure injury was 0 in the PCV group while 10% in the VCV group. Conclusions: The clinical effect of PCV on traumatic ARDS is better and the incidence rate of pressure injury is lower than that of VCV. PCV has minimal effects on the hemodynamics.

Pressure-controlled elliptical cavity expansion under anisotropic initial stress: Elastic solution and its application

This paper presents an elastic solution to the pressure-controlled elliptical cavity expansion problem under the anisotropic stress conditions. The problem is formulated by the assumption that an initial elliptical cavity is expanded under a uniform pressure and subjected to an in-plane initial horizontal pressure Kσ_0 and vertical pressure σ_0 at infinity. A conformal mapping technique is used to map the outer region of the initial elliptical cavity in the physical plane onto the inner region of a unit circle in the phase plane. Using the complex variable theory, the stress functions are derived; hence, the stress and displacement distributions around the elliptical cavity wall can be obtained. Furthermore, a closed-form solution to the pressure-expansion relationship is presented based on the elastic solution to the stress and displacement. Next, the proposed analytical solutions are validated by comparing with the Kirsch's solution and the finite element method(FEM). The solution to the presented pressure-controlled elliptical cavity expansion can be applied to two cases in practice. One is to employ the solution to the interpretation of the shear modulus of the soil or rocks and the in-situ stress in the pre-bored pressuremeter test under the lateral anisotropic initial stress condition. The other is the interpretation of the membrane expansion of a flat dilatometer test using the pressure-controlled elliptical cavity expansion solution. The two cases in practice confirm the usefulness of the present analytical solution.

Experimental research on charging characteristics of a pressure-controlled VRLA battery in high-temperature environments

Valve-regulated-lead-acid (VRLA) battery charging performed in high-temperature environments is extremely risky under overcharge conditions, and may lead to a subsequent thermal runaway. A new pressure-controlled charging method was adopted and the charging characteristics of the pressure-controlled VRLA battery in high-temperature environments were ex-perimentally studied. The concept was tested in a large temperature gradient to obtain more details about the effects of users' accustomed charging and discharging modes on battery capacity. The premature capacity loss (PCL) phenomenon under high temperature exposure was analyzed. The results showed that the capacity loss could be recovered by charging using a large current.

Experimental research on charging characteristics of a solar photovoltaic system by the pressure-control method

The charging characteristics of the valve-regulated lead acid(VRLA) battery driven by solar energy were experimentally studied through the pressure-control method in this paper.The aims of the research were to increase charging efficiency to make the most of solar energy and to improve charging quality to prolong life of battery.The charging process of a 12 V 12 A·h VRLA battery has been tested under the mode of a stand-alone photovoltaic(PV) system.Results show that the pressure-control method can effectively control PV charging of the VRLA battery and make the best of PV cells through the maximum power point tracking(MPPT).The damage of VRLA battery by excess oxygen accumulation can be avoided through the inner pressure control of VRLA battery.Parameters such as solar radiation intensity,charging power,inner pressure of the battery,and charging current and voltage during the charging process were measured and analyzed.

Determination of full-scale pore size distribution of Gaomiaozi bentonite and its permeability prediction

Gaomiaozi(GMZ)bentonite is a potential buffer/backfill material for a deep geological disposal of highlevel radioactive waste.It has a wide pore size distribution(PSD)with sizes ranging from several nanometers to more than one hundred microns.Thus,properly characterizing the pore structures of GMZ bentonite is a challenging issue.In this study,pressure-controlled porosimetry(PCP),ratecontrolled porosimetry(RCP),and scanning electron microscopy(SEM)were used to investigate the PSD of GMZ bentonite,The results indicate that each method has its limitation,and a combined use of PCP and RCP is suitable to obtain the full-scale PSD of GMZ bentonite.Moreover,we also compared the full-scale PSD with nuclear magnetic resonance(NMR)result.It is found that there is no significant difference in the range of PSD characterization between NMR and mercury intrusion method(PCP and RCP).However,in a ce rtain range,the detection accuracy of NMR is higher than that of mercury injection method.Finally,permeability prediction based on PCP and SEM data was conducted,and both of the two methods were found to be able to predict the permeability.The combined method is effective to obtain the full-scale PSD of GMZ bentonite,which is the key to estimation of the sealing ability of bentonite buffer.

Defect Analysis and Innovation Design of Synchronizer for Clutchless Automatic Mechanical Transmission

The synchronizer is a key component of automatic mechanical transmission(AMT)equipped in electric vehicles,but the inertial lock-ring synchronizer(ILRS)commonly used there is not suitable especially for pure electric vehicles without a clutch because of big shift impact.To make the shifting process rapid and smooth,a new synchronizer named pressure-controllable friction ring synchronizer(PCFRS)was designed.Initially,the inevitable shortcoming of ILRS was verified by simulation and test.Furthermore,the mechanical characteristics and advantages of the new synchronizer over ILRS were analyzed.Then,the formulations describing the dynamic transmission based on the working mechanism of the PCFRS were established.Finally,the shifting simulation results with PCFRS and ILRS based on the same operating conditions were compared and analyzed.The research shows that the PCFRS can meet the main shifting evaluation index of an AMT without complex control methods,as well as it takes only 0.2406 s to finish the comfortable and zero-speed-difference shifting.The shifting quality of PCFRS is better than that of the ILRS.It lays a foundation for using the new synchronizer as a part of clutchless AMTs equipped in pure electric vehicles.

Contemporary perspective on endogenous myocardial regeneration

Considering the complex nature of the adult heart, it is no wonder that innate regenerative processes, while maintaining adequate cardiac function, fall short in myocardial jeopardy. In spite of these enchaininglimitations, cardiac rejuvenation occurs as well as restricted regeneration. In this review, the background as well as potential mechanisms of endogenous myocardial regeneration are summarized. We present and analyze the available evidence in three subsequent steps. First, we examine the experimental research data that provide insights into the mechanisms and origins of the replicating cardiac myocytes, including cell populations referred to as cardiac progenitor cells(i.e., c-kit+ cells). Second, we describe the role of clinical settings such as acute or chronic myocardial ischemia, as initiators of pathways of endogenous myocardial regeneration. Third, the hitherto conducted clinical studies that examined different approaches of initiating endogenous myocardial regeneration in failing human hearts are analyzed. In conclusion, we present the evidence in support of the notion that regaining cardiac function beyond cellular replacement of dysfunctional myocardium via initiation of innate regenerative pathways could create a new perspective and a paradigm change in heart failure therapeutics. Reinitiating cardiac morphogenesis by reintroducing developmental pathways in the adult failing heart might provide a feasible way of tissue regeneration. Based on our hypothesis "embryonic recall", we present first supporting evidence on regenerative impulses in the myocardium, as induced by developmental processes.

Assessment of intraoperative oxygenation function and trauma degree of PCV-VG and VCV mode for elderly patients with laparoscopic abdominal surgery

Objective:To study the intraoperative oxygenation function and trauma degree of pressure-controlled ventilation-volume guaranteed (PCV-VG) and volume-controlled ventilation (VCV) mode for elderly patients with laparoscopic abdominal surgery. Methods:60 elderly patients with laparoscopic abdominal surgery were selected for study and randomly divided into two groups (n=30), group A received ventilation in accordance with sequential VCV-PCV-VG mode, group B received ventilation in accordance with the sequential PCV-VG-VCV mode, and the respiratory function parameters and arterial blood gas parameters and serum damage indexes were determined before the start of pneumoperitoneum (T0), 1 h after the start of the first ventilation mode after the start of pneumoperitoneum (T1), 1 h after the switch of ventilation mode (T2) and after the end of pneumoperitoneum (T3). Results:At T1, Ppeak, mean airway pressure (Pmean) and plateau airway pressure (Pplant) of group A were significantly higher than those of group B (P<0.05), partial pressure of oxygen (PaO2) was significantly lower than that of group B (P<0.05), and pulse oxygen saturation (SpO2) and partial pressure of carbon dioxide (PaCO2) were not significantly different from those of group B;at T2 and T3, Ppeak, Pmean and Pplant of group A were significantly lower than those of group B (P<0.05), PaO2 were significantly lower than those of group B (P<0.05), and SpO2 and PaCO2 were not significantly different from those of group B. At T1, serum soluble receptor for advanced glycation end-product (sRAGE), KL-6 (krebs. von den Iungen-6), tumor necrosis factor-α(TNF-α) and malondialdehyde (MDA) content of group A were significantly higher than those of group B (P<0.05);at T3, serum sRAGE, KL-6, TNF-αand MDA content of group A were significantly lower than those of group B (P<0.05). Conclusions:PCV-VG mode for elderly patients with laparoscopic abdominal surgery can reduce airway pressure, improve lung compliance and alveolar oxidation, and reduce lung injury and systemic trauma.