A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotension subsequent to propofol administration.

Anesthetics management of a renal angiomyolipoma using pulse pressure variation and non-invasive cardiac output monitoring: A case report

BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.

Characterization and modeling of supercritical CO_(2) pulse pressures:Effects of activator mass and discharge plate thickness

Utilizing a bespoke CO_(2) phase transition pulse pressure experimental system,we conducted pulse pressure characterization tests across various activator masses,CO_(2) filling pressures,and energy discharge plate thick-nesses.This approach enabled us to ascertain the pulse pressure's response characteristics and variation patterns under diverse conditions.The formula for calculating the peak supercritical CO_(2) pulse pressure was deduced by modeling the ultimate load calculation of the clamped circular plate,and then the time-course expression of the supercritical CO_(2) phase transition pulse pressure and energy was carried out by introducing the time factor and taking into account the parameters of the activator mass and the thickness of the energy discharging plate.Our findings reveal a four-stage pressure evolution in the cracking tube during initiation:a gradual increase,a rapid spike,swift attenuation,and eventual negative pressure formation.The activator mass and discharge plate thickness critically influence the peak pressure's timing and magnitude.Specifically,increased activator mass hastens peak pressure onset,while a thicker discharge plate amplifies it.The errors between calculated and experimental values for peak supercritical CO_(2) phase transition pressure fall within5%–5%.Furthermore,the pressure peak and arrival time model demonstrates less than 10%error compared to experimental data,affirming its strong applicability.These insights offer theoretical guidance for controlling phase transition pressure and optimizing energy in supercritical CO_(2) systems.

A Novel Particle Filtering Method for Estimation of Pulse Pressure Variation during Spontaneous Breathing

The first automatic algorithm was designed to estimate the pulse pressure variation (PPVPPV) from arterial blood pressure (ABP) signals under spontaneous breathing conditions. While currently there are a few publicly available algorithms to automatically estimate PPVPPV accurately and reliably in mechani-cally ventilated subjects, at the moment there is no automatic algorithm for estimating PPVPPV on sponta-neously breathing subjects. The algorithm utilizes our recently developed sequential Monte Carlo method (SMCM), which is called a maximum a-posteriori adaptive marginalized particle filter (MAM-PF). The performance assessment results of the proposed algorithm on real ABP signals from spontaneously breath-ing subjects were reported.

Characteristics of wind pressure pulse on large-span flat roofs

The wind pressure pulse events, among the most important characteristics of wind pressure fluctuations on large-span flat roofs, were investigated by wind tunnel tests in this paper. Incorporating the formation mechanism of wind pressure pulse events, the peak over threshold method was employed to study properties of this kind of events. The event duration time, the energy contribution, the number of the pulse events, and the distribution of average peak pressure were calculated. Probability density functions of some typical samples in separation region were also given. Results show that the non-Gaussian roof pressure is strong in the flow separation region owing to the wind pressure pulse events. Evaluations of the extreme peak pressures, which can be determined by the peak over threshold method effectively, are important to the design of building cladding.

INFLUENCES OF TWO CARIES REMOVAL METHODS ON BLOOD PRESSURE AND PULSE IN CHILDREN

Objective To compare the effect of chemomechanical caries removal （CMCR） to traditional drilling （TD） on blood pressure and pulse in children. Methods Of all 105 subjects, 53 were randomly assigned to CMCR group; 52, to TD group. For each subject, the systolic pressure （SP）, diastolic pressure （DP） and pulse （ P ） were measured at five time-point： pre-treatment, initiation of carious removal, the end of carious removal, the end of the cavity restoration, and the end of the dental care. They were recorded as To, T1 , T2, T3, and TE, respectively. The difference of SP, DP, and P within each group were analyzed. Results Of all 105 subjects, 14 were administered local anesthesia. Since local anesthesia may be a confounding factor for changes in blood pressure and pulse, only the data of the other 91 subjects that local anesthesia were not administered were analyzed. Regarding the SP, DP, and P for TD, the difference between TO and T1 was significant （ P = 0. 013, 0. 015, 0. 012 respectively）, while not significant between T1 and T2, T2 and T3, T3 and TE（ P 〉0. 05）. Regarding the SP, DP, and P for CMCR, the differences were not significant between every two consecutive time-points （ P 〉 0. 05）. The differences of the SP, DP, and P between CMCR and TD were not significant for time-points T0, T3 and Te （p 〉 0. 05 ）, while significant for T1 and T2 （ P 〈 0. 05 ）. Conclusion In general, CMCR induces less increase of blood pressure and pulse in children compared to traditional drilling （TD）. It may be inferred that CMCR is less distressing than TD.

Inhomogeneous Dielectric Target Properties for Increased Non-thermal Pressure in Laser Boron Fusion by CPA-Pulses

Based on the documentation of the invited paper and the subsequent discussion at a virtual conference,discoveries are indicated,which are summarized in the following paper for further evaluation on the topic of non-thermal forces using terms of extremely powerful components of Maxwell’s stress tensor at the interaction of CPA(chirped pulse amplification)laser pulses in the fusion plasmas of hydrogen with the isotope 11 of boron.This is caused by a recoil mechanism given by the Fresnel formulas of the suppression of the reflectivity of inhomogeneous plasma given by optical constants of the plasma properties.

Natural Characteristic of Thin-Wall Pipe under Uniformly Distributed Pressure

Natural characteristics of thin?wall pipe of the compressor under uniformly distributed pressure were presented in this paper based on a cylindrical shell model. In the traditional method, the beam model was usually used to analyze the pipe system. In actual fact, the pipe segment of the compressor was always broken in the form of a long crack or a partial hole and the phenomenon was hardly explained by beam model. According to the structure characteristic of compressor pipe segment, whose radius is large and thickness is little, shell model shows the advantage in this kind of pipe problem. Based on Sanders’ shell theory, the vibration di erential equation of pipe was established by apply?ing the energy method. The influences of length to radius ratio(L/R), thickness to radius ratio(h/R), circumferential wave number(n) and pressure(q) on the natural frequencies of pipe were analyzed. The study shows: Pressure and structural parameters have a great e ect on the natural characteristics of the pipe. Natural frequency increases as the pressure increases, especially for the higher mode. The sensitivity of natural frequency on pressure becomes stronger with h/R ratio increases; when L/R ratio is greater than a certain critical value, the influence of the pressure on natural frequency will no longer be obvious. The value of n corresponding to the minimum natural frequency also depends on the value of pressure. In the end, analysis of the forced vibration of a specific pipeline model was given and the modal shapes were illustrated to understand the break of the pipe. The research here will provide the theory support for the dynamic design of related pressure pipe and further experiment study should be employed.

Design aspect of a novel L-shaped pulsed column for liquid–liquid extraction applications: Energy consumption and the characteristics velocity concept

This article deals with the evaluation of the consumption of energy for a steady state solvent extraction in a novel L-shaped pulsed sieve-plate column, which is highly required for design and optimization of the periodic flow processes for industrial applications. In this regard, a comprehensive evaluation on the energy consumption in case of a pulsed flow for three different chemical systems is conducted and besides the influence of pulsation intensity, the effect of geometrical parameters including the plate spacing and the plate free area is investigated as well. Moreover, the concept of characteristic velocity models at flooding points is evaluated with respect to the variation of pressure drop along the column at different operational conditions.

Dynamic Pressures on Tunnel Roofs due to Vehicle Passages

Pressure and proximity measurements made in a tunnel indicate that a typical vehicle passage produced on the tunnel roof an initial pressure increase of small magnitude,followed by a sharp and more substantial drop in pressure below atmospheric.The magnitude of the pressure drop was found to increase with smaller clearances between the vehicle top and the tunnel roof,consistent with the Bernoulli relation and the vehicle speed.The dynamic pressures potentially may have significant effects on the vibration and noise environments on the lower floors of“air rights construction”buildings that span highways.

Modeling, analysis, and screening of cyclic pressure pulsing with nitrogen in hydraulically fractured wells

Cyclic pressure pulsing with nitrogen is studied for hydraulically fractured wells in depleted reservoirs.A compositional simulation model is constructed to represent the hydraulic fractures through local-grid refinement.The process is analyzed from both operational and reservoir/hydraulic-fracture perspectives.Key sensitivity parameters for the operational component are chosen as the injection rate,lengths of injection and soaking periods and the economic rate limit to shut-in the well.For the reservoir/hydraulic fracturing components,reservoir permeability,hydraulic fracture permeability,effective thickness and half-length are used.These parameters are varied at five levels.A full-factorial experimental design is utilized to run 1250 cases.The study shows that within the ranges studied,the gas-injection process is applied successfully for a 20-year project period with net present values based on the incremental recoveries greater than zero.It is observed that the cycle rate limit,injection and soaking periods must be optimized to maximize the efficiency.The simulation results are used to develop a neural network based proxy model that can be used as a screening tool for the process.The proxy model is validated with blind-cases with a correlation coefficient of 0.96.

Characteristic analysis of air pressure wave generated by high-speed trains traveling through a tunnel

It is a complicated dynamic phenomenon when a transient pressure pulse is triggered by two high-speed trains passing each other in a tunnel. The air pressure pulse is a transient excitation to side wall of the car body. It can stimulate almost all vibration modes of the car body and the correlated assemblies, cause serious aerodynamic noise, and have important impacts on car body distortion, train noise, and operation safety. This article analyzes the time- frequency characteristics and main parameters of field-measured the air pressure wave, and its relationship with the train velocity as well as the vibration of the car body. Cepstrum analysis concludes that in the process of the meeting, the air pressure wave in tunnel crossing is a multiplying pressure wave instead of a superposed wave. The pressure pulse during the meeting is non-symmetrical one featured with a sharp front, large amplitude, fluctuating central sec- tion, and less sharp tail. The pulse width is inversely proportional to the train speed. As the speed increases, the impulse amplitude is amplified, and the speed of pulse front is advanced.

在斜向非定常流动中由层流向湍流转变对模型尺度螺旋桨性能和压力脉动的影响

In this paper,after the successful applications to open water propeller performance estimations,the influence of transition sensitive and modified mass transfer models tuned to account for the laminar flow in the prediction of the cavitation inception of marine propulsors is investigated from the point of view of the unsteady functioning and induced pressure pulses.The VP1304(also known as PPTC)test case,for which dedicated data were collected during several workshops,is considered first.After preliminary analyses using RANS,also Detached Eddy Simulations(DES)are included to better account for the vortex dynamics and its influence on pressure pulses.Similarly to what observed in uniform inflow,results show a better agreement with the available measurements of propeller performances and confirm the reliability of the proposed approaches for unsteady,non-cavitating,model scale propeller predictions.The overall cavitation pattern is improved too by the application of the transition sensitive correction to the mass transfer model,but the complex dynamics of bubble cavitation observed in experiments prevents quantitatively better predictions in terms of thrust/torque breakdown and induced pressure pulses levels regardless the use of RANS or DES methods.

Highlights of the physical examination in heart failure

Because decompensated heart failure(HF)patients present primarily with symptoms of congestion,the assessment of volume status is of paramount importance.Despite the addition of new technologies that can predict intracardiac filling pressures,the physical exam(PE)remains the most accessible and cost-effective tool available to clinicians.An elevated jugular venous pressure(JVP) is considered the most sensitive sign of volume overload,although the commonly used‘method of Lewis’has several limitations.A useful cutoff is that if the JVP is greater than 3 cm in vertical distance above the sternal angle,the central venous pressure is elevated.In addition to assessment of volume status,the PE in HF can reveal adverse prognostic signs,namely:elevated JVP,presence of third heart sound,elevated heart rate,low systolic BP,and low proportional pulse pressure(＜25%).This article will review the evidence for the diagnostic and prognostic utility of common PE findings in HF.

Clinical Predictors of Iron Deficiency Anemia in Emirati Population with T2DM

Aim: To establish the prevalence of iron deficiency anemia and its clinical predictors in Emirati patients with type 2 diabetes. Patients & Methods: 237 patients were included in the study. A full blood count was obtained in addition to routine blood and urine tests for all patients. Hemoglobin level and iron studies were done for diagnosis of anemia. Statistical analysis was done to find out the prevalence and independent predictors of anemia in the study population of Emirati type 2 diabetic patients. Results: Of the studied 237 patients;36.3% had iron deficiency anemia as per the WHO criteria. Independent predictors of iron deficiency anemia were age ≥ 60 years, female gender and wide pulse pressure ≥ 60 mmHg. Hemoglobin level was directly proportionate to e GFR (p < 0.001). Participants with age ≥ 60 years had 4.2 times higher odds to exhibit anemia. Female participants had 1.95 times higher odds to exhibit anemia. Participants with wide pulse pressure ≥ 60 mmHg have 2.4 higher odds to exhibit anemia. Conclusion: Iron deficiency anemia is common in type 2 diabetic patients. Testing the patient for iron deficiency anemia should be considered in type 2 diabetes patients especially with age ≥ 60 years, female patients and those with wide pulse pressure ≥ 60 mmHg.

Experimental Investigation on the Flow-induced Noise under Variable Conditions for Centrifugal Pumps

With extensively using of centrifugal pumps,noise generation in these pumps is increasingly receiving research attention in recent years.The noise sources in centrifugal pumps are mainly composed of mechanical noise and flow-induced noise.And the study of flow-induced noise has become a hotspot and important domain in the field.The flow-induced noise closely related to the inner pressure pulses and vibration of volute in pumps,therefore,it is necessary to research the interaction and mechanism among them.To investigate the relationships,a test system is designed which includes a test loop and a measurement system.The hydrophones and pressure sensors are installed on the outlet of the pump and vibration acceleration sensors are disposed on the pump body.Via these instruments,the signals of noise,pressure pulses and vibration are collected and analyzed.The results show that the level of flow-induced noise becomes smaller as the flow increment during low flow rate operations,and it is steadily close to the design point,then it increases with the growing of flow rate in high flow rate conditions.Furthermore,there are some similar peak points in the power spectrum charts of noise,pressure pulses and vibration.The broadband noise at low flow rate is mostly focused on the region of 0-40 times shaft frequency,which is mostly made by rotating stall and vortex;while the noise at high flow rate conditions is focused on the region of 60-100 times shaft frequency,which may be mostly made by cavitations.The proposed research is of practical and academic significance to the study of noise reduction for centrifugal pumps.

Hypersonic boundary-layer transition on a flared cone

Transition on a flared cone with zero angle of at- tack was studied in our newly established Mach 6 quiet wind tunnel （M6QT） via wall pressure measurement and flow visualization. High-frequency pressure transducers were used to measure the second-mode waves＇ amplitudes and frequencies. Using pulsed schlieren diagnostic and Rayleigh scattering technique, we got a clear evolution of the second-mode disturbances. The second-mode waves exist for a long distance, which means that the second-mode waves grow linearly in a large region. Strong Mach waves are radiated from the edge of the boundary layer. With further development, the second-mode waves reach their maximum magnitude and harmonics of the second-mode instability appear. Then the disturbances grow nonlinearly. The second modes become weak and merge with each other. Finally, the nonlinear interaction of disturbance leads to a relatively quiet zone, which further breaks down, resulting in the transition of the bound- ary layer. Our results show that transition is determined by the second mode. The quiet zone before the final breakdown is observed in flow visualization for the first time. Eventual transition requires the presence of a quiet zone generated by nonlinear interactions.

Transient simulation of a pump-turbine with misaligned guide vanes during turbine model start-up

Experimental studies of a model pump-turbine S-curve characteristics and its improvement by misaligned guide vanes （MGV） were extended to prototype pump turbine through 3-D transient flow simulations. The unsteady Reynolds-averaged Navier-Stokes equations with the SST turbulence model were used to model the transient flow within the entire flow passage of a reversible pump-turbine with and without misaligned guide vanes during turbine model start-up. The unstable S-curve and its improvement by using misaligned guide vane were verified by model test and simulation. The transient flow calculations were used to clarify the variations of pressure pulse and internal flow behavior in the entire flow passage. The use of misaligned guide vanes can eliminate the S-curve characteristics of a pump-turbine, and can significantly increase the pressure pulse amplitude in the entire flow passage and the runner radial forces during start-up. The MGV only decreased the pulse amplitude on the guide vane suction side when the rotating speed was less than 50% rated speed. The hydraulic reason is that the MGV dramatically changed the flow patterns inside the entire flow passage, and destroyed the symmetry of the flow distribution inside the guide vane and runner.

Dynamic simulation and safety evaluation of high-speed trains meeting in open air

Dynamic responses of a carriage under excitation with the German high-speed low-interference track spectrum together with the air pressure pulse generated as high-speed trains passing each other are investigated with a multi-body dynamics method.The variations of degrees of freedom（DOFs：horizontal movement,roll angle,and yaw angle）,the lateral wheel-rail force,the derailment coefficient and the rate of wheel load reduction with time when two carriages meet in open air are obtained and compared with the results of a single train travelling at specifie speeds.Results show that the rate of wheel load reduction increases with the increase of train speed and meets some safety standard at a certain speed,but exceeding the value of the rate of wheel load reduction does not necessarily mean derailment.The evaluation standard of the rate of wheel load reduction is somewhat conservative and may be loosened.The pressure pulse has significan effects on the train DOFs,and the evaluations of these safety indexes are strongly suggested in practice.The pressure pulse has a limited effect on the derailment coefficien and the lateral wheel-rail force,and,thus,their further evaluations may be not necessary.

Detachment Size Measurement of Two Interacting Bubble Plumes Formed at Neighboring Needles Using an Acoustic Method

Detachment size determination with an acoustic method has been carried out for two interacting bubble plumes formed at neighboring needles in quiescent water. Two sets of needle pairs, one with 1.5mm and 0.8mm inner diameters and the other with the equal 1.5mm inner diameters, were separately used as the bubble pair injectors in the experiments. Consequently, four typical patterns of bubble plumes interaction could be observed in the two cases of needle pair matches. Through measuring the pressure pulses radiated by the bubble pairs immediately after their 'pinching-off ' and by making use of a sophisticated relation between oscillation frequency of volume mode and radius of gas bubble, the detachment size of the bubble plumes have been determined from the amplitude/frequency spectrum of the sound pressure pulses. The experimental results demonstrate that the acoustical method is valid in both of the interacting and non-interacting circumstances in bubble field and the bubble size measurements by this acoustical method agree well with the measurements from photographic analysis. Finally, a comparison has been made on the strong and weak points of the acoustical method with the other size determination methods.