Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fl...Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.展开更多
Direct numerical simulations(DNSs) of purely elastic turbulence in rectilinear shear flows in a three-dimensional(3D) parallel plate channel were carried out,by which numerical databases were established.Based on ...Direct numerical simulations(DNSs) of purely elastic turbulence in rectilinear shear flows in a three-dimensional(3D) parallel plate channel were carried out,by which numerical databases were established.Based on the numerical databases,the present paper analyzed the structural and statistical characteristics of the elastic turbulence including flow patterns,the wall effect on the turbulent kinetic energy spectrum,and the local relationship between the flow motion and the microstructures' behavior.Moreover,to address the underlying physical mechanism of elastic turbulence,its generation was presented in terms of the global energy budget.The results showed that the flow structures in elastic turbulence were 3D with spatial scales on the order of the geometrical characteristic length,and vortex tubes were more likely to be embedded in the regions where the polymers were strongly stretched.In addition,the patterns of microstructures' elongation behave like a filament.From the results of the turbulent kinetic energy budget,it was found that the continuous energy releasing from the polymers into the main flow was the main source of the generation and maintenance of the elastic turbulent status.展开更多
<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-fami...<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">membrane oxygenation is a rescue life support technique used in life threatening</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">depends on age and varies from pulmonary to cardiac pathologies. In some cases</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it may be used as a bridge to a</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">therapeutic procedure.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">exchange. The latter can result in respiratory failure and consequent asphyxia.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">When hemoptysis occurs in a patient with a univentricular</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">heart and a Fontan circulation, management of this</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair which constitutes Fontan circulation as a definitive treatment in patients with a univentricular heart. </span><u><span style="font-family:Verdana;">Methods:</span></u><span style="font-family:Verdana;"> Case report description of a 16 year-old boy with a univentricular heart and a Fontan circulation</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">who presented hemoptysis managed with a veno-venous extracorporeal membrane oxygenation (ECMO) as a</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bridge to angio-embolization. </span><u><span style="font-family:Verdana;">Results:</span></u><span style="font-family:Verdana;"> Hemoptysis due to diffuse intra-alveolar hemorrhage from collateral circulation was successfully treated</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">in this young patient with pulmonary vascular embolization. This allowed to wean the patient from</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">extra-corporeal membrane oxygenation. </span><u><span style="font-family:Verdana;">Conclusion:</span></u><span style="font-family:Verdana;"> Veno-venous ECMO can be life-saving as a bridge to angio-embolization for severe hemoptysis in</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">patients with Fontan circulation. The reported case allows to underline that </span><span style="font-family:Verdana;">our multidisciplinary approach in</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">this complex pediatric patient surely</span><span style="font-family:Verdana;"> participated to improve outcome.</span>展开更多
By revisiting the three stage theory for the progress of science proposed by Taketani in 1942, the footmarks of fluidization research are examined. The bubbling and fast fluidization issues were emphasized so that the...By revisiting the three stage theory for the progress of science proposed by Taketani in 1942, the footmarks of fluidization research are examined. The bubbling and fast fluidization issues were emphasized so that the future offluidization research can be discussed among scientists and engineers in a wider perspective. The first cycle of fluidization research was started in the early 1940s by an initial stage of phenomenology. The second stage of structural studies was kicked off in the early 1950s with the introduction of the two phase theory. The third stage of essential studies occurred in the early 1960s in the form of bubble hydrodynamics. The second cycle, which confirmed the aforementioned three stages closed at the turn of the century, established a general understanding of suspension structures including agglomerating fluidization, bubbling, turbulent and fast fluidizations and pneumatic transport; also established powerful measurement and numerical simulation tools.After a general remark on science, technology and society issues the interactions between fluidization technology and science are revisited. Our future directions are discussed including the tasks in the third cycle, particularly in its phenomenology stage where strong motivation and intention are always necessary, in relation also to the green reforming of the present technology. A generalized definition of 'fluidization' is proposed to extend fluidization principle into much wider scientific fields, which would be effective also for wider collaborations.展开更多
文摘Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.
基金Project supported by the National Natural Science Foundation of China(Grant Nos.51276046 and 51506037)the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(Grant No.51421063)+2 种基金the China Postdoctoral Science Foundation(Grant No.2016M591526)the Heilongjiang Postdoctoral Fund,China(Grant No.LBH-Z15063)the China Postdoctoral International Exchange Program
文摘Direct numerical simulations(DNSs) of purely elastic turbulence in rectilinear shear flows in a three-dimensional(3D) parallel plate channel were carried out,by which numerical databases were established.Based on the numerical databases,the present paper analyzed the structural and statistical characteristics of the elastic turbulence including flow patterns,the wall effect on the turbulent kinetic energy spectrum,and the local relationship between the flow motion and the microstructures' behavior.Moreover,to address the underlying physical mechanism of elastic turbulence,its generation was presented in terms of the global energy budget.The results showed that the flow structures in elastic turbulence were 3D with spatial scales on the order of the geometrical characteristic length,and vortex tubes were more likely to be embedded in the regions where the polymers were strongly stretched.In addition,the patterns of microstructures' elongation behave like a filament.From the results of the turbulent kinetic energy budget,it was found that the continuous energy releasing from the polymers into the main flow was the main source of the generation and maintenance of the elastic turbulent status.
文摘<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">membrane oxygenation is a rescue life support technique used in life threatening</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">depends on age and varies from pulmonary to cardiac pathologies. In some cases</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it may be used as a bridge to a</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">therapeutic procedure.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">exchange. The latter can result in respiratory failure and consequent asphyxia.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">When hemoptysis occurs in a patient with a univentricular</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">heart and a Fontan circulation, management of this</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair which constitutes Fontan circulation as a definitive treatment in patients with a univentricular heart. </span><u><span style="font-family:Verdana;">Methods:</span></u><span style="font-family:Verdana;"> Case report description of a 16 year-old boy with a univentricular heart and a Fontan circulation</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">who presented hemoptysis managed with a veno-venous extracorporeal membrane oxygenation (ECMO) as a</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bridge to angio-embolization. </span><u><span style="font-family:Verdana;">Results:</span></u><span style="font-family:Verdana;"> Hemoptysis due to diffuse intra-alveolar hemorrhage from collateral circulation was successfully treated</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">in this young patient with pulmonary vascular embolization. This allowed to wean the patient from</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">extra-corporeal membrane oxygenation. </span><u><span style="font-family:Verdana;">Conclusion:</span></u><span style="font-family:Verdana;"> Veno-venous ECMO can be life-saving as a bridge to angio-embolization for severe hemoptysis in</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">patients with Fontan circulation. The reported case allows to underline that </span><span style="font-family:Verdana;">our multidisciplinary approach in</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">this complex pediatric patient surely</span><span style="font-family:Verdana;"> participated to improve outcome.</span>
文摘By revisiting the three stage theory for the progress of science proposed by Taketani in 1942, the footmarks of fluidization research are examined. The bubbling and fast fluidization issues were emphasized so that the future offluidization research can be discussed among scientists and engineers in a wider perspective. The first cycle of fluidization research was started in the early 1940s by an initial stage of phenomenology. The second stage of structural studies was kicked off in the early 1950s with the introduction of the two phase theory. The third stage of essential studies occurred in the early 1960s in the form of bubble hydrodynamics. The second cycle, which confirmed the aforementioned three stages closed at the turn of the century, established a general understanding of suspension structures including agglomerating fluidization, bubbling, turbulent and fast fluidizations and pneumatic transport; also established powerful measurement and numerical simulation tools.After a general remark on science, technology and society issues the interactions between fluidization technology and science are revisited. Our future directions are discussed including the tasks in the third cycle, particularly in its phenomenology stage where strong motivation and intention are always necessary, in relation also to the green reforming of the present technology. A generalized definition of 'fluidization' is proposed to extend fluidization principle into much wider scientific fields, which would be effective also for wider collaborations.