Hemostasis testing in patients with liver dysfunction: Advantages and caveats

Due to concomitant changes in pro-and anti-coagulant mechanisms,patients with liver dysfunction have a“rebalanced hemostasis”,which can easily be tipped toward either a hypo-or a hypercoagulable phenotype.Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities.Conventional coagulation screening tests,such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures.The introduction of global coagulation assays,such as viscoelastic testing(VET),has been an important step forward in the assessment of the overall hemostasis profile.A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings.The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.

Determination of consolidation behaviour of clay slurries

The main objective of this study was to determine the consolidation behaviour of clay slurries.A finegrained clay with high consistency limits(W_L = 180%,w_P= 120%) was investigated using conventional oedometer and bench-top centrifuge tests.Results indicated that the slurry had an apparent preconsolidation(due to initial conditions,electrochemical interactions,tortuous drainage,and thixotropic strength) from e = 5.7 to e = 5.5 followed by virgin compression.Likewise,the low hydraulic conductivity(10^(-10)-10^(-12) m/s) was due to low porosity(small pore throats) and high tortuosity(long flow paths).Unlike consolidation of soils,the c_v and m_v decreased with increasing σ' but increased with increasing e and k.The data from the two tests correlated well in the range of σ' = 10-65 kPa,e = 5.5-3.86,k= 1.7 × 10^(-10)-5×10^(-11) m/s,F_c = 1-40 MN.New equations were developed to correlate the consolidation parameters(e,σ',k) with F_c.The deviation of k beyond 40 MN(e = 4.65) was due to deviation from the initial straight line portion of the settlement curve in the centrifuge test.

Characteristic stress and strain precursor information for fine-grained granite during failure process under triaxial loading and unloading conditions

The unloading effect by excavation may cause irreversible and severe damage to the surrounding rock masses in underground engineering.In this paper,both conventional triaxial compression(CTC)tests and triaxial unloading confining pressure(TUCP)tests were conducted on fine-grained granite to study its triaxial compression failure processes due to unloading.Based on the crack volumetric strain(CVS)method,the crack axial strain(CAS)method and crack radial area strain(CRAS)method were proposed to identify the failure precursor information(including stress thresholds and axial strain at the initiation point of crack connectivity stage)during the rock failure processes.The results of the CTC tests show that the stable crack development stressσsd,unstable crack development stressσusd,and crack connectivity stressσct identified by the CAS method are 6%,74%–84%,and 86%–97%of the peak stress,respectively.For the TUCP cases,as the confining pressure increases,the stress thresholds,axial pressure at failure and axial strain at the start of the crack connectivity stage increase,while the time ratio of the crack connectivity stage to the entire unloading stage decreases.This indicates that fine-grained granite is prone to generate more cracks and leads to fail suddenly under high confining pressure.Furthermore,this new method demonstrates that the point at which the derivative of the radial crack area strain transitions from stable to a sudden increase or decrease is defined as the precursor point of rock failure.The results of axial strain at the starting point of the crack connectivity stage are very close to those predicted by the AE method,withβ1 no more than 11%.