Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

NEAR-INFRARED IMAGING SENSOR WITH IMPROVED HANDLING AND DIRECT LOCALIZATION IN SIMULTANEOUS MAGNETIC RESONANCE IMAGING MEASUREMENTS

We present a novel optical sensor to acquire simultaneously functional near-infrared imaging(fNIRI)and functional magnetic resonance imaging(fMRI)data with an improved handling and direct localization in the MRI compared to available sensors.Quantitative phantom and interference measurements showed that both methods can be combined without reciprocal adverse effects.The direct localization of the optical sensor on MR images acquired with a T1-weighted echo sequence simplifies the co-registration of NIRI and MRI data.In addition,the optical sensor is simple to attach,which is crucial for measurements on vulnerable subjects.The fNIRI and T2^(*)-weighted fMRI data of a cerebral activation were simultaneously acquired proving the practicability of the setup.

Efficacy of different doses of sugammadex after continuous infusion of rocuronium

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively.The estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-OfFour is reached.

A Moving Mesh Method for the Euler Flow Calculations Using a Directional Monitor Function

This paper is concerned with the adaptive grid method for computations of the Euler equations in fluid dynamics.The new feature of the present moving mesh algorithm is the use of a dimensional-splitting type monitor function,which is to increase grid concentration in regions containing shock waves and contact discontinuities or their interactions.Several two–dimensional flow problems are computed to demonstrate the effectiveness of the present adaptive grid algorithm.

Balanced Monitoring of Flow Phenomena in Moving Mesh Methods

Adaptive moving mesh research usually focuses either on analytical deriva-tions for prescribed solutions or on pragmatic solvers with challenging physical appli-cations. In the latter case, the monitor functions that steer mesh adaptation are oftendefined in an ad-hoc way. In this paper we generalize our previously used moni-tor function to a balanced sum of any number of monitor components. This avoidsthe trial-and-error parameter fine-tuning that is often used in monitor functions. Thekey reason for the new balancing method is that the ratio between the maximum andaverage value of a monitor component should ideally be equal for all components.Vorticity as a monitor component is a good motivating example for this. Entropy alsoturns out to be a very informative monitor component. We incorporate the monitorfunction in an adaptive moving mesh higher-order finite volume solver with HLLCfluxes, which is suitable for nonlinear hyperbolic systems of conservation laws. Whenapplied to compressible gas flow it produces very sharp results for shocks and otherdiscontinuities. Moreover, it captures small instabilities (Richtmyer-Meshkov, Kelvin-Helmholtz). Thus showing the rich nature of the example problems and the effective-ness of the new monitor balancing.

Explorations and Expectations of Equidistribution Adaptations for Nonlinear Quenching Problems

Finite difference computations that involve spatial adaptation commonly employ an equidistribution principle.In these cases,a new mesh is constructed such that a given monitor function is equidistributed in some sense.Typical choices of the monitor function involve the solution or one of its many derivatives.This straightforward concept has proven to be extremely effective and practical.However,selections of core monitoring functions are often challenging and crucial to the computational success.This paper concerns six different designs of the monitoring function that targets a highly nonlinear partial differential equation that exhibits both quenching-type and degeneracy singularities.While the first four monitoring strategies are within the so-called primitive regime,the rest belong to a later category of the modified type,which requires the priori knowledge of certain important quenching solution characteristics.Simulated examples are given to illustrate our study and conclusions.

NUMERICAL ANALYSIS OF A NONLINEAR SINGULARLY PERTURBED DELAY VOLTERRA INTEGRO-DIFFERENTIAL EQUATION ON AN ADAPTIVE GRID

In this paper,we study a nonlinear first-order singularly perturbed Volterra integro-differential equation with delay.This equation is discretized by the backward Euler for differential part and the composite numerical quadrature formula for integral part for which both an a priori and an a posteriori error analysis in the maximum norm are derived.Based on the a priori error bound and mesh equidistribution principle,we prove that there exists a mesh gives optimal first order convergence which is robust with respect to the perturbation parameter.The a posteriori error bound is used to choose a suitable monitor function and design a corresponding adaptive grid generation algorithm.Furthermore,we extend our presented adaptive grid algorithm to a class of second-order nonlinear singularly perturbed delay differential equations.Numerical results are provided to demonstrate the effectiveness of our presented monitor function.Meanwhile,it is shown that the standard arc-length monitor function is unsuitable for this type of singularly perturbed delay differential equations with a turning point.