Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Mechanism of internal thermal runaway propagation in blade batteries

Blade batteries are extensively used in electric vehicles,but unavoidable thermal runaway is an inherent threat to their safe use.This study experimentally investigated the mechanism underlying thermal runaway propagation within a blade battery by using a nail to trigger thermal runaway and thermocouples to track its propagation inside a cell.The results showed that the internal thermal runaway could propagate for up to 272 s,which is comparable to that of a traditional battery module.The velocity of the thermal runaway propagation fluctuated between 1 and 8 mm s^(-1),depending on both the electrolyte content and high-temperature gas diffusion.In the early stages of thermal runaway,the electrolyte participated in the reaction,which intensified the thermal runaway and accelerated its propagation.As the battery temperature increased,the electrolyte evaporated,which attenuated the acceleration effect.Gas diffusion affected thermal runaway propagation through both heat transfer and mass transfer.The experimental results indicated that gas diffusion accelerated the velocity of thermal runaway propagation by 36.84%.We used a 1D mathematical model and confirmed that convective heat transfer induced by gas diffusion increased the velocity of thermal runaway propagation by 5.46%-17.06%.Finally,the temperature rate curve was analyzed,and a three-stage mechanism for internal thermal runaway propagation was proposed.In Stage I,convective heat transfer from electrolyte evaporation locally increased the temperature to 100℃.In Stage II,solid heat transfer locally increases the temperature to trigger thermal runaway.In StageⅢ,thermal runaway sharply increases the local temperature.The proposed mechanism sheds light on the internal thermal runaway propagation of blade batteries and offers valuable insights into safety considerations for future design.

Relative Impacts of Sea Ice Loss and Atmospheric Internal Variability on the Winter Arctic to East Asian Surface Air Temperature Based on Large-Ensemble Simulations with NorESM2

To quantify the relative contributions of Arctic sea ice and unforced atmospheric internal variability to the “warm Arctic, cold East Asia”(WACE) teleconnection, this study analyses three sets of large-ensemble simulations carried out by the Norwegian Earth System Model with a coupled atmosphere–land surface model, forced by seasonal sea ice conditions from preindustrial, present-day, and future periods. Each ensemble member within the same set uses the same forcing but with small perturbations to the atmospheric initial state. Hence, the difference between the present-day(or future) ensemble mean and the preindustrial ensemble mean provides the ice-loss-induced response, while the difference of the individual members within the present-day(or future) set is the effect of atmospheric internal variability. Results indicate that both present-day and future sea ice loss can force a negative phase of the Arctic Oscillation with a WACE pattern in winter. The magnitude of ice-induced Arctic warming is over four(ten) times larger than the ice-induced East Asian cooling in the present-day(future) experiment;the latter having a magnitude that is about 30% of the observed cooling. Sea ice loss contributes about 60%(80%) to the Arctic winter warming in the present-day(future) experiment. Atmospheric internal variability can also induce a WACE pattern with comparable magnitudes between the Arctic and East Asia. Ice-lossinduced East Asian cooling can easily be masked by atmospheric internal variability effects because random atmospheric internal variability may induce a larger magnitude warming. The observed WACE pattern occurs as a result of both Arctic sea ice loss and atmospheric internal variability, with the former dominating Arctic warming and the latter dominating East Asian cooling.

Suppressed Internal Intrinsic Stress Engineering in High-Performance Ni-Rich Cathode Via Multi layered In Situ Coating Structure

LiNi_(x)Co_(y)Al_(z)O_(2)(NCA)cathode materials are drawing widespread attention,but the huge gap between the ideal and present cyclic stability still hinders their further commercial application,especially for the Ni-rich LiNi_(x)Co_(y)Al_(z)O_(2)(x>0.8,x+y+z=1)cathode material,which is owing to the structural degradation and particles'intrinsic fracture.To tackle the problems,Li_(0.5)La_(2)Al_(0.5)O_(4)in situ coated and Mn compensating doped multilayer LiNi_(0.82)Co_(0.14)Al_(0.04)O_(2)was prepared.XRD refinement indicates that La-Mn co-modifying could realize appropriate Li/Ni disorder degree.Calculated results and in situ XRD patterns reveal that the LLAO coating layer could effectively restrain crack in secondary particles benefited from the suppressed internal strain.AFM further improves as NCA-LM2 has superior mechanical property.The SEM,TEM,XPS tests indicate that the cycled cathode with LLAO-Mn modification displays a more complete morphology and less side reaction with electrolyte.DEMS was used to further investigate cathode-electrolyte interface which was reflected by gas evolution.NCA-LM2 releases less CO_(2)than NCA-P indexing on a more stable surface.The modified material presents outstanding capacity retention of 96.2%after 100 cycles in the voltage range of 3.0-4.4 V at 1C,13%higher than that of the pristine and 80.8%at 1 C after 300 cycles.This excellent electrochemical performance could be attributed to the fact that the high chemically stable coating layer of Li_(0.5)La_(2)Al_(0.5)O_(4)(LLAO)could enhance the interface and the Mn doping layer could suppress the influence of the lattice mismatch and distortion.We believe that it can be a useful strategy for the modification of Ni-rich cathode material and other advanced functional material.

Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?

Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

Adaptive Optimal Discrete-Time Output-Feedback Using an Internal Model Principle and Adaptive Dynamic Programming

In order to address the output feedback issue for linear discrete-time systems, this work suggests a brand-new adaptive dynamic programming(ADP) technique based on the internal model principle(IMP). The proposed method, termed as IMP-ADP, does not require complete state feedback-merely the measurement of input and output data. More specifically, based on the IMP, the output control problem can first be converted into a stabilization problem. We then design an observer to reproduce the full state of the system by measuring the inputs and outputs. Moreover, this technique includes both a policy iteration algorithm and a value iteration algorithm to determine the optimal feedback gain without using a dynamic system model. It is important that with this concept one does not need to solve the regulator equation. Finally, this control method was tested on an inverter system of grid-connected LCLs to demonstrate that the proposed method provides the desired performance in terms of both tracking and disturbance rejection.

Flow Regimes in Bubble Columns with and without Internals: A Review

Hydrodynamics characterization in terms offlow regime behavior is a crucial task to enhance the design of bubble column reactors and scaling up related methodologies.This review presents recent studies on the typicalflow regimes established in bubble columns.Some effort is also provided to introduce relevant definitions pertaining to thisfield,namely,that of“void fraction”and related(local,chordal,cross-sectional and volumetric)variants.Experimental studies involving different parameters that affect design and operating conditions are also discussed in detail.In the second part of the review,the attention is shifted to cases with internals of various types(perfo-rated plates,baffles,vibrating helical springs,mixers,and heat exchanger tubes)immersed in the bubble columns.It is shown that the presence of these elements has a limited influence on the global column hydrodynamics.However,they can make the homogeneousflow regime more stable in terms of transition gas velocity and transi-tion holdup value.The last section is used to highlight gaps which have not beenfilled yet and future directions of investigation.

Effect of internal structure of a batch-processing wet-etch reactor on fluid flow and heat transfer

Batch-processing wet-etch reactors are the key equipment widely used in chip fabrication,and their performance is largely affected by the internal structure.This work develops a three-dimensional computational fluid dynamics(CFD)model considering heat generation of wet-etching reactions to investigate the fluid flow and heat transfer in the wet-etch reactor.The backflow is observed below and above the wafer region,as the flow resistance in this region is high.The temperature on the upper part of a wafer is higher due to the accumulation of reaction heat,and the average temperature of the side wafer is highest as its convective heat transfer is weakest.Narrowing the gap between wafer and reactor wall can force the etchant to flow in the wafer region and then facilitate the convective heat transfer,leading to better within-wafer and wafer-to-wafer etch uniformities.An inlet angle of 60°balances fluid by-pass and mechanical energy loss,and it yields the best temperature and etch uniformities.The batch with 25wafers has much wider flow channels and much lower flow resistance compared with that with 50wafers,and thus it shows better temperature and etch uniformities.These results and the CFD model should serve to guide the optimal design of batch-processing wet-etch reactors.

Data-driven modeling on anisotropic mechanical behavior of brain tissue with internal pressure

Brain tissue is one of the softest parts of the human body,composed of white matter and grey matter.The mechanical behavior of the brain tissue plays an essential role in regulating brain morphology and brain function.Besides,traumatic brain injury(TBI)and various brain diseases are also greatly influenced by the brain's mechanical properties.Whether white matter or grey matter,brain tissue contains multiscale structures composed of neurons,glial cells,fibers,blood vessels,etc.,each with different mechanical properties.As such,brain tissue exhibits complex mechanical behavior,usually with strong nonlinearity,heterogeneity,and directional dependence.Building a constitutive law for multiscale brain tissue using traditional function-based approaches can be very challenging.Instead,this paper proposes a data-driven approach to establish the desired mechanical model of brain tissue.We focus on blood vessels with internal pressure embedded in a white or grey matter matrix material to demonstrate our approach.The matrix is described by an isotropic or anisotropic nonlinear elastic model.A representative unit cell(RUC)with blood vessels is built,which is used to generate the stress-strain data under different internal blood pressure and various proportional displacement loading paths.The generated stress-strain data is then used to train a mechanical law using artificial neural networks to predict the macroscopic mechanical response of brain tissue under different internal pressures.Finally,the trained material model is implemented into finite element software to predict the mechanical behavior of a whole brain under intracranial pressure and distributed body forces.Compared with a direct numerical simulation that employs a reference material model,our proposed approach greatly reduces the computational cost and improves modeling efficiency.The predictions made by our trained model demonstrate sufficient accuracy.Specifically,we find that the level of internal blood pressure can greatly influence stress distribution and determine the possible related damage behaviors.

Experimental Study on the Variation of Optical Imaging Characteristics with Zenith Angle due to Internal Solitary Waves in Sunglint

Internal solitary waves(ISWs)change the roughness of the sea surface,thus producing dark and bright bands in optical images.However,reasons for changes in imaging characteristics with the solar zenith angle remain unclear.In this paper,the optical imaging pattern of ISWs in sunglint under different zenith angles of the light source is investigated by collecting optical images of ISWs through physical simulation.The experiment involves setting 10 zenith angles of the light source,which are divided into area a the optical images of ISWs in the three areas show dark-bright mode,single bright band,and bright-dark mode,which are consistent with those observed by optical remote sensing.In addition,this study analyzed the percentage of the dark and bright areas of the bands and the change in the relative gray difference and found changes in both areas under different zenith angles of the light source.The MODIS and ASAR images display a similar brightness-darkness distance of the same ISWs.Therefore,the relationship between the brightness-darkness distance and the characteristic half-width of ISWs is determined in accordance with the eKdV theory and the imaging mechanism of ISWs of the SAR image.Overall,the relationship between them in the experiment is almost consistent with the theoretical result.

Crack propagation and damage evolution of metallic cylindrical shells under internal explosive loading

This paper investigates the three-dimensional crack propagation and damage evolution process of metallic column shells under internal explosive loading.The calibration of four typical failure parameters for 40CrMnSiB steel was conducted through experiments and subsequently applied to simulations.The numerical simulation results employing the four failure criteria were compared with the differences and similarities observed in freeze-recovery tests and ultra-high-speed tests.This analysis addressed the critical issue of determining failure criteria for the fracture of a metal shell under internal explosive loads.Building upon this foundation,the damage parameter D_(c),linked to the cumulative crack density,was defined based on the evolution characteristics of a substantial number of cracks.The relationship between the damage parameter and crack velocity over time was established,and the influence of the internal central pressure on the damage parameter and crack velocity was investigated.Variations in the fracture modes were found under different failure criteria,with the principal strain failure criterion proving to be the most effective for simulating 3D crack propagation in a pure shear fracture mode.Through statistical analysis of the shell penetration fracture radius data,it was determined that the fracture radius remained essentially constant during the crack evolution process and could be considered a constant.The propagation velocity of axial cracks ranged between 5300 m/s and 12600 m/s,surpassing the Rayleigh wave velocity of the shell material and decreasing linearly with time.The increase in shell damage exhibited an initial rapid phase,followed by deceleration,demonstrating accelerated damage during the propagation stage of the blast wave and decelerated damage after the arrival of the rarefaction wave.This study provides an effective approach for investigating crack propagation and damage evolution.The derived crack propagation and damage evolution law serves as a valuable reference for the development of crack velocity theory and the construction of shell damage evolution modes.

An internal ballistic model of electromagnetic railgun based on PFN coupled with multi-physical field and experimental validation

To accelerate the practicality of electromagnetic railguns,it is necessary to use a combination of threedimensional numerical simulation and experiments to study the mechanism of bore damage.In this paper,a three-dimensional numerical model of the augmented railgun with four parallel unconventional rails is introduced to simulate the internal ballistic process and realize the multi-physics field coupling calculation of the rail gun,and a test experiment of a medium-caliber electromagnetic launcher powered by pulse formation network(PFN)is carried out.Various test methods such as spectrometer,fiber grating and high-speed camera are used to test several parameters such as muzzle initial velocity,transient magnetic field strength and stress-strain of rail.Combining the simulation results and experimental data,the damage condition of the contact surface is analyzed.

Alkali Tolerance of Concrete Internal Curing Agent Based on Sodium Carboxymethyl Starch

Internal curing agents (ICA) based on super absorbent polymer have poor alkali tolerance and reduce the early strength of concrete.An alkali tolerate internal curing agent (CAA-ICA) was designed and prepared by using sodium carboxymethyl starch (CMS) with high hydrophilicity,acrylic acid (AA) containing anionic carboxylic group and acrylamide (AM) containing non-ionic amide group as the main raw materials.The results show that the ratio of CAA-ICA alkali absorption solution is higher than that existing ICA,which solves the low water absorption ratio of the ICA in alkali environment.The water absorption ratio of CAA-ICA in saturated Ca(OH)_(2) solution is 95.8 g·g^(-1),and the alkali tolerance coefficient is 3.4.The application of CAA-ICA in cement-based materials can increase the internal relative humidity and miniaturize the pore structure.The compressive strength of mortar increases up to 12.95%at 28 d,which provids a solution to overcome the reduction of the early strength.

Internal phase control of fiber laser array based on photodetector array

Coherent beam combining(CBC) of fiber laser array is a promising technique to realize high output power while maintaining near diffraction-limited beam quality. To implement CBC, an appropriate phase control feedback structure should be established to realize phase-locking. In this paper, an innovative internal active phase control CBC fiber laser array based on photodetector array is proposed. The dynamic phase noises of the laser amplifiers are compensated before being emitted into free space. And the static phase difference compensation of emitting laser array is realized by interference measurement based on photodetector array. The principle of the technique is illustrated and corresponding simulations are carried out, and a CBC system with four laser channels is built to verify the technique. When the phase controllers are turned on, the phase deviation of the laser array is less than λ/20, and ~ 95% fringe contrast of the irradiation distribution is obtained. The technique proposed in this paper could provide a reference for the system design of a massive high-power CBC system.

Detection of internal crack growth in polyethylene pipe using guided wave ultrasonic testing

Despite the success of guided wave ultrasonic inspection for internal defect detection in steel pipes,its application on polyethylene(PE)pipe remains relatively unexplored.The growth of internal cracks in PE pipe severely affects its pressure-holding capacity,hence the early detection of internal cracks is crucial for effective pipeline maintenance strategies.This study extends the scope of guided wave-based ultrasonic testing to detect the growth of internal cracks in a natural gas distribution PE pipe.Laboratory experiments and a finite element model were planned to study the wave-crack interaction at different stages of axially oriented internal crack growth with a piezoceramic transducer-based setup arranged in a pitch-catch configuration.Mode dispersion analysis supplemented with preliminary experiments was performed to isolate the optimal inspection frequency,leading to the selection of the T(0,1)mode at 50-kHz for the investigation.A transmission index based on the energy of the T(0,1)mode was developed to trace the extent of simulated crack growth.The findings revealed an inverse linear correlation between the transmission index and the crack depth for crack growth beyond 20%crack depth.

Multi-Stage Multidisciplinary Design Optimization Method for Enhancing Complete Artillery Internal Ballistic Firing Performance

To enhance the comprehensive performance of artillery internal ballistics—encompassing power,accuracy,and service life—this study proposed a multi-stage multidisciplinary design optimization(MS-MDO)method.First,the comprehensive artillery internal ballistic dynamics(AIBD)model,based on propellant combustion,rotation band engraving,projectile axial motion,and rifling wear models,was established and validated.This model was systematically decomposed into subsystems from a system engineering perspective.The study then detailed the MS-MDO methodology,which included Stage I(MDO stage)employing an improved collaborative optimization method for consistent design variables,and Stage II(Performance Optimization)focusing on the independent optimization of local design variables and performance metrics.The methodology was applied to the AIBD problem.Results demonstrated that the MS-MDO method in Stage I effectively reduced iteration and evaluation counts,thereby accelerating system-level convergence.Meanwhile,Stage II optimization markedly enhanced overall performance.These comprehensive evaluation results affirmed the effectiveness of the MS-MDO method.

Endoscopic polidocanol foam sclerobanding for the treatment of Grade II-III internal hemorrhoids:The focus of clinical practice

We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade II-III internal hemorrhoids.The authors conducted a prospective,multicenter,randomized study to evaluate the long-term sympto-matic and endoscopic efficacy of this combined intervention.In this discussion,we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.

Internal Polarization Field Induced Hydroxyl Spillover Effect for Industrial Water Splitting Electrolyzers

The formation of multiple oxygen intermediates supporting efficient oxygen evolution reaction(OER)are affinitive with hydroxyl adsorption.However,ability of the catalyst to capture hydroxyl and maintain the continuous supply at active sits remains a tremendous challenge.Herein,an affordable Ni2P/FeP2 heterostructure is presented to form the internal polarization field(IPF),arising hydroxyl spillover(HOSo)during OER.Facilitated by IPF,the oriented HOSo from FeP2 to Ni2P can activate the Ni site with a new hydroxyl transmission channel and build the optimized reaction path of oxygen intermediates for lower adsorption energy,boosting the OER activity(242 mV vs.RHE at 100 mA cm-2)for least 100 h.More interestingly,for the anion exchange membrane water electrolyzer(AEMWE)with low concentration electrolyte,the advantage of HOSo effect is significantly amplified,delivering 1 A cm^(-2)at a low cell voltage of 1.88 V with excellent stability for over 50 h.

Spatiotemporal variations of parameters of internal solitary waves in the northern South China Sea

The dynamic parameters for internal solitary waves(ISWs)derived from the extended Korteweg-de Vries(eKdV)equation play an important role in the understanding and prediction of ISWs.The spatiotemporal variations of the dynamic parameters of the ISWs in the northern South China Sea(SCS)were studied based on the reanalysis of long-term temperature and salinity datasets.The results for spectrum analysis show that there are definite geographical differences for the periodic variation of the parameters:in shallow water,all parameters vary with a wave period of one year,while in deep water wave components of the parameters at other frequencies exist.Using wavelet analysis,the wavelet power spectral densities in deep water exhibited an inter-annual variation pattern.For example,the wave component of the dispersion coefficient with a wave period of about half a year reached its power peak once every two years.Based on previous work,this inter-annual variation pattern was deduced to be caused by dynamic processes.In further work on the regulatory mechanisms,empirical orthogonal function(EOF)decomposition was performed.It was found that the modes of the dispersion coefficient have different geographical distributions,explaining the reason why the wave components in different frequencies appeared in different locations.The numerical simulation results confirm that the variations in the parameters of the ISWs derived from the eKdV equation could affect the waveforms significantly because of changes in the polarity of the ISWs.Therefore,the periodic variations of the dynamic parameters are related to the geographical location because of dynamic processes operating.