Total Fluid Volume Research Articles

Dicarbonyl stress in clinical obesity.

The glyoxalase system in the cytoplasm of cells provides the primary defence against glycation by methylglyoxal catalysing its metabolism to D-lactate. Methylglyoxal is the precursor of the major quantitative advanced glycation endproducts in physiological systems - arginine-derived hydroimidazolones and deoxyguanosine-derived imidazopurinones. Glyoxalase 1 of the glyoxalase system was linked to anthropometric measurements of obesity in human subjects and to body weight in strains of mice. Recent conference reports described increased weight gain on high fat diet-fed mouse with lifelong deficiency of glyoxalase 1 deficiency, compared to wild-type controls, and decreased weight gain in glyoxalase 1-overexpressing transgenic mice, suggesting a functional role of glyoxalase 1 and dicarbonyl stress in obesity. Increased methylglyoxal, dicarbonyl stress, in white adipose tissue and liver may be a mediator of obesity and insulin resistance and thereby a risk factor for development of type 2 diabetes and non-alcoholic fatty liver disease. Increased methylglyoxal formation from glyceroneogenesis on adipose tissue and liver and decreased glyoxalase 1 activity in obesity likely drives dicarbonyl stress in white adipose tissue increasing the dicarbonyl proteome and related dysfunction. The clinical significance will likely emerge from on-going clinical evaluation of inducers of glyoxalase 1 expression in overweight and obese subjects. Increased transcapillary escape rate of albumin and increased total body interstitial fluid volume in obesity likely makes levels of glycation of plasma protein unreliable indicators of glycation status in obesity as there is a shift of albumin dwell time from plasma to interstitial fluid, which decreases overall glycation for a given glycemic exposure.

The relationship between trace mineral concentrations of amniotic fluid with placenta traits in the pregnancy toxemia Ghezel ewes

ObjectiveThis study was conducted to investigate the trace mineral concentrations (Mg, Se, Zn, Cu and Fe) in amniotic fluid (AF) in 40 pregnancy toxemia Ghezel ewes at the time of parturition phase and its association with placental traits. MethodsAnimals were treated with controlled internal drug release for 14 d and injected 400 IU pregnant mare serum gonadotropin at the time of controlled internal drug release removal. After the detection of estrus by use of teaser rams, ewes were hand-mated. Ewes were classified as having subclinical pregnancy toxemia on the basis of beta-hydroxy butyrate (BHBA) results (BHBA > 0.86 mmol/L). ResultsThe overall mean AF traces of mineral concentrations were 3.13 ng/mL, 22.1 μg/dL, 134.7 μg/dL, 122.5 μg/dL and 166.6 μg/dL, respectively. There was a significant positive correlation between placental efficiency and Zn concentration in AF ewes (r = 0.633, P < 0.01), while the relationship was significantly negative between total volume of amniotic fluid and Fe concentration in AF ewes (r = −0.717, P < 0.01). In this research, no relationship between Se, Mg and Cu trace minerals was observed in AF ewes with placental traits ewes. Results of laboratory analyses demonstrated no relationship between BHBA concentrations and placental traits (P > 0.01), except for placental weight (r = 0.808, P < 0.01). Also, no significant correlation was detected between BHBA with the above trace minerals. ConclusionsOverall, determinations of these trace minerals in the AF ewes could have been used to obtain information on nutritional and reproductive status for the diagnosis of pregnancy toxemia in Ghezel ewes.

The influence of left ventricular-arterial coupling on the prognosis of elderly patients with septic shock

To investigate the influence of left ventricular-arterial coupling(VAC) on clinical prognosis of elderly patients with septic shock. A total of 56 elderly septic shock patients were enrolled in this study, all of whom were admitted to Department of Intensive Care Unit in Zhejiang Hospital from August 2014 to October 2015.The patients were divided into two groups according to the status of left ventricular-arterial coupling when septic shock was diagnosed, which were left ventricular-arterial uncoupling group(UC group) and left ventricular-arterial coupling group(C group). Various parameters were recorded, including blood lactate level, central venous oxygen saturation(ScvO2), serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP) and cardiac troponin Ⅰ(cTNⅠ), dose of vasoactive drugs, the total fluid volume and urine volume per hour within 24 hours. The 28-day survival rate was a key index of prognosis. Multivariate logistic regression was taken to analyze risk factors related to death within 28 day. Compared with C group, UC group had lower values of left ventricular ejection fraction[(42.43±4.76)% vs (53.17±3.01)%; P<0.01] and cardiac index[(2.36±0.68) L·min(-1)·m(-2) vs (2.93±0.45)L·min(-1)·m(-2); P<0.01]. Yet serum levels of NT-proBNP[lg NT-proBNP 3.93±0.53 vs 3.40±0.63; P=0.004] and cTNⅠ [lg cTNⅠ-0.16±0.68 vs-1.03±0.69; P<0.001] in UC group were higher than those in C group. Moreover, the total fluid volume within 24 hours [(3 806.3±831.4) ml vs (3 142.0±770.0) ml; P=0.016], blood lactate level[(5.61±2.68) mmol/L vs (3.93±1.59) mmol/L; P=0.043] and dose of norepinephrine[(0.630±0.300)μg·kg(-1)·min(-1) vs (0.292±0.234)μg·kg(-1)·min(-1;) P=0.001] in UC group were greater than those in C group, while ScvO2[(60.75±2.91)% vs (64.42±2.19)%; P<0.001] and urine volume per hour[(0.518±0.358)ml vs (0.926±0.678)ml; P=0.007] were less than those in C group. Compared with C group, UC group had a lower 28-day survival rate[43.2%(19/44) vs 9/12; P=0.049]. Ea/Ees ratio was negatively correlated with LVEF, ScvO2(r=-0.686, P<0.001; r=-0.411, P=0.002), positively correlated with NT-proBNP, cTNⅠ(r=0.294, P=0.028; r=0.363, P=0.006), yet no obvious correlation was noticed with blood lactate level(r=0.170, P=0.21). Multiple logistic regression analysis showed that VAC(OR=11.187, 95%CI 2.489-50.285; P=0.002), lactate level (OR=1.727, 95%CI 1.164-2.563; P=0.007) and lg cTNⅠ(OR=0.247, 95%CI 0.079-0.779; P=0.017) were independent risk factors affecting 28-day mortality. Conclutions: In elderly patients with septic shock, left ventricular-arterial uncoupling indicates a lower 28-day survival rate, worse cardiac function and tissue perfusion. Ea/Ees ratio might sever as a predictive indicator of 28-day mortality.

The incidences of organ dysfunction in the early resuscitation of severe sepsis and septic shock patients:a retrospective analysis

To investigate the potential risk factors of organ dysfunction and mortality in the early resuscitation of severe sepsis and septic shock patients. Data were retrospectively analyzed from patients with severe sepsis and septic shock receiving non-cardiac operation and admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from January 1st,2013 to December 31st,2015.The patients were divided into the senior group (≥ 65 years old) and the younger group (＜ 65 years old),the high-procalcitonin (PCT) group (PCT ＞ 100 μg/L) and the control group (PCT ≤ 100 μg/L).The stage of early resuscitation was set to the first 6 hours. The diagnostic time and the incidence of acute respiratory distress syndrome (ARDS),acute kidney injury (AKI),and cardiac insufficiency were observed, which also included the usage of continuous renal replacement therapy (CRRT).The total fluid volume and the time of vasopressor usage during the first 6 hours of early goal-directed therapy (EGDT) were also recorded, which aslo included the 28-day mortality. 512 patients with severe sepsis and septic shock receiving non-cardiac operation were treated according to the guidelines of "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock:2012".EGDT was used during the early resuscitation. The incidence of ARDS, AKI, and cardiac insufficiency was 80.9％ (414/512),71.3％ (365/512),and 61.9％ (317/512) respectively. There were 205 senior patients and 307 younger, as well as 154in high-PCT group and 358 in control group. The 28-day mortality was 30.3％ (155 died).90.8％ of patients (376/414)combined with ARDS were diagnosed before EGDT.95.1％ of patients (347/365) combined with AKI were diagnosed before EGDT, among whom 14.0％ (51/365) were treated with CRRT.153 senior patients combined with cardiac insufficiency were diagnosed no longer than 12 hours after EGDT. Compared with the younger group, the incidences of ARDS and cardiac insufficiency were higher in the senior group [85.9％ (176/205) vs.77.5％ (238/307),82.9％(170/205) vs.32.9％ (147/307),both P ＜ 0.05],so were the time of vasopressor usage during EGDT (hours:5.81 ±0.28vs.5.68 ± 0.52,P ＜ 0.05) was prolonged markedly and the 28-day mortality [42.9％ (88/205) vs.21.8％ (67/307),P ＜0.05] was increased significantly. But the incidence of AKI and the total fluid volume during EGDT were not significantly different between the senior group and the younger group [incidence of AKI:74.1％ (152/205) vs.69.4％ (213/307),total fluid volume (mL):2 769 ± 1 589 vs.2 804± 1 611,both P ＞ 0.05].Compared with the control group, the incidence of ARDS was higher in the high-PCT group [86.4％ (133/154) vs.78.5％ (281/358),P ＜ 0.05].But the incidences of AKI and cardiac insufficiency were not significantly differentiated between the high-PCT group and the control group [77.9％ (120/154) vs.68.4％ (245/358),58.4％ (90/154) vs.63.4％ (227/358),both P ＞ 0.05].Multiple logistic regression analysis showed that the risk factors of increase in mortality in patients with severe sepsis and septic shock included old age [odds ratio (OR) =1.782,95％ confidence interval (95％CI) =1.173-2.708,P =0.007],ARDS (OR =1.786,95％CI =1.028-3.102,P =0.040),AKI (OR =1.878,95％CI =1.145-3.079,P =0.012),and cardiac insufficiency (OR =4.177,95％CI =2.505-6.966,P =0.000),except for gender (OR =1.112,95％CI =0.736-1.680,P =0.614). In the senior postoperative patients with severe sepsis or septic shock, the incidence of ARDS and cardiac insufficiency, and the mortality were increased. The incidence of ARDS was correlated to the severity of infection.Old age, surgery, and EGDT could be the potential risk factors of cardiac insufficiency.

The Effect Of Ad Libitum Intake Of Different Commercial Beverages And Snack Foods Following Exercise-induced Fluid Loss.

PURPOSE: This study compared the effects of ad libitum consumption of different beverages and foods on fluid restoration and nutrient consumption following exercise. METHODS: Ten endurance trained males (VO2max, 62.95±7.20 ml/kg/min) performed four trials employing a randomised, crossover design. Following 60 minutes of standardised exercise (matched for energy expenditure and fluid loss) participants consumed either water (W1 and W2), a sports drink (Powerade (P)) or a milk-based liquid meal supplement (Sustagen Sport (SS)). Additionally, participants had access to snack foods at two time points within the first two hours of recovery. All beverages and food were consumed ad libitum. Total nutrient intake, urine volume, USG, body weight as well as subjective measures of gastrointestinal tolerance and thirst were obtained hourly. Plasma osmolality was measured pre, post, one and four hours after exercise. Results: Total fluid volume ingested from food and beverages in W1 (2.28±0.42 L) and P (2.82±0.80 L) trials was significantly greater than the SS (1.94±0.54 L) trial. No difference was observed between W2 (2.21±0.62 L) and SS. Total urine output was not different between trials (W1 644±202 mL, W2 602±352 mL, P 879±751 mL, SS 466±129 mL). Total energy intake was higher on the P (9695±1974 kJ) and SS (10577±2210 kJ) compared to both water trials (W1 = 7826±888 kJ, W2 = 7578±1112 kJ). CONCLUSION: Beverages with different nutrient profiles appear equally effective at replacing exercise induced fluid losses when consumed ad libitum with food. Therefore, choosing a post-exercise recovery beverage should consider hydration properties in the context of an individual’s post-exercise energy requirements and overall dietary goals.

Higher perioperative fluid administration is associated with increased rates of complications following head and neck microvascular reconstruction with fibular free flaps.

The purpose of this study is to evaluate the impact of perioperative fluid administration on the rates of postoperative complications following head and neck reconstruction with fibular free flaps (FFF). A retrospective cohort study of subjects undergoing head and neck reconstruction with FFF was completed. The primary predictor variable was the total volume of perioperative fluids administered on the day of surgery. The primary outcome variable was the presence of medical and surgical complications occurring within 30 days of surgery. Medical and surgical complications were stratified as major or minor based on severity level. Basic demographic information, comorbidity indices, and intraoperative parameters were abstracted as covariates. Univariable and multivariable models were developed to assess for associations between total fluid volume administered on the day of surgery and postoperative medical/surgical complications occurring within 30 days of surgery. In 154 subjects, the partial flap failure rate was 3% and there were no complete flap failures. Total fluid volume was significantly associated with the presence of postoperative medical/surgical complications (OR = 1.21; 95% CI: 1.02-1.44; p = 0.032). A cutpoint for total fluid volume predicting any severity level of postoperative complication was identified at 5,500 mL. A cutpoint for total fluid volume predicting major postoperative complications was identified at 7,000 mL. The results of this study suggest that liberal fluid administration is associated with increased rates of medical/surgical complications following head and neck reconstruction with FFF. © 2016 Wiley Periodicals, Inc. Microsurgery 37:128-136, 2017.

Production and optimization of curdlan produced by Pseudomonas sp. QL212

Curdlan is a polysaccharide that consists of β-1,3-linked glucose residues. A polysaccharide-producing bacterium isolated from soil samples was identified as Pseudomonas sp. QL212. The polysaccharide was purified to homogeneity via sequential ethanol precipitation, deproteinization, CM ion-exchange, and gel chromatography sequentially. Analysis of the purified polysaccharide revealed that it consisted of many glucosyl residues, and its molecular weight was only 6.18×105Da. This low molecular weight endowed it with excellent solubility. Infrared and nuclear magnetic resonance spectral analysis confirmed that the polysaccharide was curdlan. Single-factor and Response surface methodology experiments were used to optimize the culture medium and conditions. The optimal culture conditions consisted of seed culture age of 12h, and an incubation temperature of 30°C, with 10% inoculum and a total fluid volume of 75mL in a 250-mL Erlenmeyer flask. The maximum curdlan yield of about 5.92gL−1 was achieved with an optimal medium consisting of 30.11gL−1 of sucrose, 5.94gL−1 of yeast extract, and an initial pH of 8.03. To our best knowledge, this is the highest reported yield of curdlan produced by Pseudomonas sp., and the curdlan production medium components were much simpler than those in previous reports.

Increased Intraoperative Fluid Administration Is Associated with Severe Primary Graft Dysfunction After Lung Transplantation.

Severe primary graft dysfunction (PGD) is a major cause of early morbidity and mortality in patients after lung transplantation. The etiology and pathophysiology of PGD is not fully characterized and whether intraoperative fluid administration increases the risk for PGD remains unclear from previous studies. Therefore, we tested the hypothesis that increased total intraoperative fluid volume during lung transplantation is associated with the development of grade-3 PGD. This retrospective cohort analysis included patients who had lung transplantation at the Cleveland Clinic between January 2009 and June 2013. We used multivariable logistic regression with adjustment for donor, recipient, and perioperative confounding factors to examine the association between total intraoperative fluid administration and development of grade-3 PGD in the initial 72 postoperative hours. Secondary outcomes included time to initial extubation and intensive care unit length of stay. Grade-3 PGD occurred in 123 of 494 patients (25%) who had lung transplantation. Patients with grade-3 PGD received a larger volume of intraoperative fluid (median 5.0 [3.8, 7.5] L) than those without grade-3 PGD (3.9 [2.8, 5.2] L). Each intraoperative liter of fluid increased the odds of grade-3 PGD by approximately 22% (adjusted odds ratio, 1.22; 95% confidence interval [CI], 1.12-1.34; P <0.001). The volume of transfused red blood cell concentrate was associated with grade-3 PGD (1.1 [0.0, 1.8] L for PGD-3 vs 0.4 [0.0, 1.1 for nongrade-3 PGD] L; adjusted odds ratio, 1.7; 95% CI, 1.08-2.7; P = 0.002). Increased fluid administration was associated with longer intensive care unit stay (adjusted hazard ratio, 0.92; 97.5% CI, 0.88-0.97; P < 0.001) but not with time to initial tracheal extubation (hazard ratio, 0.97; 97.5% CI, 0.93-1.02; P = 0.17). Increased intraoperative fluid volume is associated with the most severe form of PGD after lung transplant surgery. Limiting fluid administration may reduce the risk for development of grade-3 PGD and thus improve early postoperative morbidity and mortality after lung transplantation.

PD29-06 ASSESSMENT OF LONG TERM FUNCTIONAL OUTCOMES IN MORE THAN 1000 PATIENTS TREATED WITH MINIMALLY ISCHEMIC PARTIAL NEPHRECTOMY

use nor type of HA was significantly associated with blood transfusion (p1⁄4.468 and p1⁄4.413, respectively), but they were associated with hemoglobin decline (p1⁄4.003 and p1⁄4.008, respectively). Other variables associated with hemoglobin decline were age, tumor size, RENAL score, estimated blood loss, and total intraoperative intravenous fluid volume. After adjusting for these factors, HA use was not significantly associated with postoperative hemoglobin decline (p1⁄4.942). Using multiple HA types was associated with a slightly increased hemoglobin decline (p1⁄4.035). Median cost of HA was $234 per case (IQR $198-672). CONCLUSIONS: Hemostatic agents are costly and do not appear to be associated with improved outcomes, namely the need for transfusion or hemoglobin decline, following RPN. Prospective validation of these findings is warranted.

PD29-05 HEMOSTATIC AGENTS DO NOT REDUCE BLEEDING AFTER ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2016PD29-05 HEMOSTATIC AGENTS DO NOT REDUCE BLEEDING AFTER ROBOTIC PARTIAL NEPHRECTOMY Matthew J. Maurice, Daniel Ramirez, Peter A. Caputo, Onder Kara, and Jihad H. Kaouk Matthew J. MauriceMatthew J. Maurice More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Peter A. CaputoPeter A. Caputo More articles by this author , Onder KaraOnder Kara More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.523AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hemostasis is critical during robotic partial nephrectomy (RPN). Hemostatic agents (HA) are used empirically to minimize postoperative bleeding, but supporting evidence is lacking. We sought to assess the impact of HA on bleeding after RPN. METHODS Using our retrospective database, we abstracted data on consecutive patients treated with RPN from 2011 (after the RPN learning curve) to 2015. In 2014, HA use for RPN was stopped due to cost reduction measures. Patients with preoperative hemoglobin < 11 g/dL, estimated blood loss ≥ 250 ml, or intraoperative blood transfusion were excluded to avoid confounding from chronic anemia or intraoperative bleeding (n=266). The outcomes were postoperative transfusion and hemoglobin decline prior to transfusion or at the time of the first follow-up visit. The associations between HA use and the outcomes were assessed by univariate and multivariate analyses adjusting for bleeding risk factors. Total inflation-adjusted costs in 2015 were calculated using the US Department of Labor′s Consumer Price Index. RESULTS Of 550 cases, a HA was used in 214 (38.9%). Mean number of agents used per case was 1.4±0.73, including 67 (12.2%), 48 (8.7%), and 45 (8.2%) cases in which cellulose, gelatin, or fibrin-based HA were used, respectively, and 54 (9.8%) cases in which multiple types of HA were used. Overall, 10 (1.8%) patients were transfused postoperatively, and the median postoperative hemoglobin decline was 2.3 g/dL (IQR 1.5-3.0). On univariate analysis, neither HA use nor type of HA was significantly associated with blood transfusion (p=.468 and p=.413, respectively), but they were associated with hemoglobin decline (p=.003 and p=.008, respectively). Other variables associated with hemoglobin decline were age, tumor size, RENAL score, estimated blood loss, and total intraoperative intravenous fluid volume. After adjusting for these factors, HA use was not significantly associated with postoperative hemoglobin decline (p=.942). Using multiple HA types was associated with a slightly increased hemoglobin decline (p=.035). Median cost of HA was $234 per case (IQR $198-672). CONCLUSIONS Hemostatic agents are costly and do not appear to be associated with improved outcomes, namely the need for transfusion or hemoglobin decline, following RPN. Prospective validation of these findings is warranted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e707-e708 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Matthew J. Maurice More articles by this author Daniel Ramirez More articles by this author Peter A. Caputo More articles by this author Onder Kara More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Filling Box Flows in an Axisymmetric Porous Medium

We present an analytical solution for buoyancy-driven “filling box” flows in axisymmetric porous media having closed bottom and side boundaries. The flow consists first and foremost of a descending, point source plume. When plume fluid reaches the (horizontal) bottom boundary, it begins to flow radially outward in the form of an axisymmetric gravity current. The leading edge of the gravity current advances with time as $$t^{1/2}$$ until it reaches the vertical sidewalls. At this point, the flow is characterized by a vertically ascending “first front” that steadily advects towards the plume source. We assume the plume to be in a Darcy regime, i.e. $$\text{ Re }\mathop {\sim }\limits ^{<}\mathcal {O}(10)$$ , with $$\text{ Pe }>\mathcal {O}(1)$$ , where Re and Pe are, respectively, the Reynolds and Peclet numbers, and derive a similarity solution for the plume by applying a boundary layer approximation. Formulas are therefore obtained for the vertical variation of the plume volume flux and area-averaged concentration. The former result shows important qualitative differences with the analogue equation derived in the limit $$\text{ Pe }<\mathcal {O}(1)$$ . In particular, the plume volume flux is now predicted to explicitly depend on the reservoir permeability, plume buoyancy flux and fluid viscosity. The gravity current problem is likewise solved using a self-similar solution, this time adapted from the work of Lyle et al. (J Fluid Mech 543:293–302, 2005) but connected to the outflow conditions of the plume. Finally, in solving for the motion of the first front, we apply a volume flux balance equation and therefore estimate the time scale required for the first front to advect from the bottom of the control volume to the source elevation. By synthesizing the above results, we can estimate the total volume of source fluid and mass of solute that can be injected into an axisymmetric reservoir without overflow. Predictions can also be made for the time-variable mean concentration of this contaminated fluid layer, which must obviously be less than the source concentration.

Computational Simulation of Mixing Performance in the Circulating Jet Mixing Tank

Abstract Computational fluid dynamics (CFD) was used to investigate the turbulent mixing performance in a vertical CJT in the range of Re=3,668−18,342. Energy source of hot water was centrally placed just below the top of the tank and temperature instead of concentration measurements were used to quantify mixing performance. The 95 % criterion for temperature equilibrium was employed to evaluate the local mixing degree, and the global mixing performance was evaluated based on the ratio of well-mixed volume to total fluid volume. It was obviously observed from the axial distributions of t95 % that the macro-mixing times decreased slightly for z/H &lt; 0.6 and a deep downward trends appeared with the increase of z/H with given r/R. The macro-mixing time in the jet mixing boundary layer were uniform which were a little longer than those in the bulk zones below z/H=0.5 and decreased sharply by 37.5−87.5 % than that in the bulk zone above z/H=0.5. The values of 95 % mixing time increased with the increase of r/R. The global t95 % decreased with the increasing Reynolds number, and a power correlation between the global t95 % values and Re was proposed. With the increasing logarithm of mixing time, the logarithm of segregation intensity rapidly decreased linearly in the slopes from –0.996 to –0.955. The segmentation intensity first decreased then increased with the increasing values of θ.

Conversion back to bevacizumab or ranibizumab for recurrent neovascular activity with aflibercept in age-related macular degeneration: a case series.

BackgroundNeovascular age-related macular degeneration often requires chronic therapy with anti-VEGF agents, and patients with recurrent disease are challenging to manage.MethodsThis retrospective case series evaluates patients who were switched from bevacizumab or ranibizumab to aflibercept and then back again because of recurrent fluid on optical coherence tomography (OCT) by reporting changes in OCT measurements over the course of medication changes.ResultsTwenty-one eyes in nineteen patients received an average of 20.7 bevacizumab and/or ranibizumab injections and then an average of 7.2 aflibercept injections before being switched back to bevacizumab or ranibizumab because of recurrent fluid on OCT. Median central macular thickness improved on transition from bevacizumab or ranibizumab (317 μm) to aflibercept (285 μm; p = 0.034), then worsened over the course of aflibercept treatment (296 μm; p = 0.080), but improved again with transition from aflibercept back to bevacizumab or ranibizumab (283 μm; p = 0.016). The total volume of subretinal fluid, intraretinal fluid, and pigment epithelial detachments also decreased on transition from bevacizumab or ranibizumab (2.56 mm3) to aflibercept (2.44 mm3; p = 0.080), then worsened over the course of aflibercept treatment (3.18 mm3; p = 0.019), and improved again on transition back to bevacizumab or ranibizumab (2.11 mm3; p = 0.016).ConclusionsWhile aflibercept appears initially effective, some patients develop recurrent fluid with aflibercept that improves with transition back to bevacizumab or ranibizumab. Rotating anti-VEGF agents may be beneficial with recurrent neovascular activity.

Wall suction-assisted image-guided therapeutic paracentesis: a safe and less expensive alternative to evacuated bottles.

To assess the safety and cost savings of using wall suction and plastic canisters instead of evacuated bottles, currently in short supply, to drain, and collect large amounts of fluid during image-guided paracentesis procedures. In a hospital-based practice, 551 image-guided paracenteses were performed in 191 consecutive patients over a 10-month period, using wall suction to facilitate drainage. Total volume of fluid removed and complications were recorded. Complications were graded using Common Terminology Criteria for Adverse Events. The pressure generated from the wall suction at our institution was measured using a manometer and compared to that of an empty evacuated bottle. Cost savings per procedure were estimated by calculating the difference in the price of supplies used to collect the average volume of fluid removed per procedure for each method. The mean volume of fluid removed per procedure was 3541 mL. Four (0.72%) complications occurred in 551 procedures. One grade I complication consisted of a prolonged puncture site leak of ascites. Three Grade III complications included infection, hypotension, and atrial fibrillation. All four complications appeared unrelated to the use of wall suction and were treated successfully. Maximum pressure generated from the wall suction at our institution was less than the initial pressure generated from an empty evacuated bottle. Estimated cost savings per procedure was $33.92. The use of wall suction and plastic canisters to drain and collect fluid during image-guided therapeutic paracenteses is a safe alternative to using evacuated glass bottles and reduces per-procedure costs.

23.4% Saline Decreases Brain Tissue Volume in Severe Hepatic Encephalopathy as Assessed by a Quantitative CT Marker.

Cerebral edema is common in severe hepatic encephalopathy and may be life threatening. Bolus 23.4% hypertonic saline improves surveillance neuromonitoring scores, although its mechanism of action is not clearly established. We investigated the hypothesis that bolus hypertonic saline decreases cerebral edema in severe hepatic encephalopathy utilizing a quantitative technique to measure brain and cerebrospinal fluid volume changes. Retrospective analysis of serial CT scans, and clinical data for a case-control series were performed. ICUs of a tertiary care hospital. Patients with severe hepatic encephalopathy treated with 23.4% hypertonic saline and control patients who did not receive 23.4% hypertonic saline. 23.4% hypertonic saline bolus administration. We used clinically obtained CT scans to measure volumes of the ventricles, intracranial cerebrospinal fluid, and brain using a previously validated semiautomated technique (Analyze Direct, Overland Park, KS). Volumes before and after 23.4% hypertonic saline were compared with Wilcoxon signed rank test. Associations among total cerebrospinal fluid volume, ventricular volume, serum sodium, and Glasgow Coma Scale scores were assessed using Spearman rank correlation test. Eleven patients with 18 administrations of 23.4% hypertonic saline met inclusion criteria. Total cerebrospinal fluid (median, 47.6 mL [35.1-69.4 mL] to 61.9 mL [47.7-87.0 mL]; p < 0.001) and ventricular volumes (median, 8.0 mL [6.9-9.5 mL] to 9.2 mL [7.8-11.9 mL]; p = 0.002) increased and Glasgow Coma Scale scores improved (median, 4 [3-6] to 7 [6-9]; p = 0.008) after 23.4% hypertonic saline. In contrast, total cerebrospinal fluid and ventricular volumes decreased in untreated control patients. Serum sodium increase was associated with increase in total cerebrospinal fluid volume (r = 0.83, p < 0.001), and change in total cerebrospinal fluid volume was associated with ventricular volume change (r = 0.86; p < 0.001). Total cerebrospinal fluid and ventricular volumes increased after 23.4% hypertonic saline, consistent with a reduction in brain tissue volume. Total cerebrospinal fluid and ventricular volume change may be useful quantitative measures to assess cerebral edema in severe hepatic encephalopathy.

A Rapid Dialysis Method for Analysis of Stevioside and Rebaudioside A in Foods.

A rapid dialysis method for the analysis of stevioside (SS) and rebaudioside A (RS) in foods was developed. Minced samples (10 g) were packed into 30 cm net length dialysis tubing with 30% methanol to increase the dialysis efficiency. The dialysis tubing was put in a 100 mL centrifuge tube, and the total fluid volume was made up to 100 mL with 30% methanol. Dialysis was done with shaking while heating at 50℃. The dialysis times were reduced from 48-72 hr in the conventional method to 2 hr under these conditions. The dialysate was loaded on a C18 solid- phase extraction cartridge, and the cartridge was washed with 40% methanol. SS and RS were eluted from the cartridge with 80% methanol, and separated by reversed-phase HPLC. Recovery yields (%)of SS and RS, spiked at 0.02 g/kg in various foods, were 83.0-105.1% and the relative standard deviations were mostly less than 5%.

B-mode ultrasonographic measurement of inferior vena cava diameter among healthy adults in Kano, Nigeria

Background: The inferior vena cava (IVC) is thin-walled compliant vessel that adjust the body volume status by changing its diameter depending on the total body fluid volume. sonographic measurement of IVC diameter has been reported as an alternative, rapid and non-invasive method of volume assessment of body fluids. The aim of this study is to determine the normal IVC diameter among healthy adults in Kano, Nigeria. Materials and Methods: Sonographic measurement of IVC of healthy adults with age ranging between 15 and 65 years was done with the subject in the supine position. The intrahepatic portion of its diameter was measured at about 2 cm proximal to the hepatic veins in a longitudinal plane in both inspiratory and expiratory phases of respiration. Three repeated measurements were done to reduce intra-observer variability in this prospective cross-sectional study. Results: A total of 400 adults comprising 173 (43.3%) males and 227 (56.8%) females were recruited using Fisher's statistical formula for sample size determination. The mean age of the subjects was 32.4 ± standard deviation 10.9 years. The mean inspiratory diameter was 10.1 ± 2.7 mm (ranging from 4.8 mm to 18.8 mm). The overall mean IVC expiratory (IVCexp) diameter in this study was 16.7 ± 2.7 mm (range = 10.9–25.4 mm). The mean IVCexp diameter was slightly higher for males than for females (males: 17.1 ± 2.8 mm; females: 16.3 ± 2.7 mm). This difference was statistically significant ( P = 0.0022). There was a gradual decrease in IVC diameter with advancing age. Conclusion: This study was able to generate normal IVC diameter in a sample of Nigerians which may serve as a reference for normal values in Black Africans.

Abdominal compartment syndrome in traumatic hemorrhagic shock: is there a fluid resuscitation inflection point associated with increased risk?

BackgroundThe volume of fluid administered during trauma resuscitation correlates with the risk of abdominal compartment syndrome (ACS). The exact volume at which this risk rises is uncertain. We established the inflection point for ACS risk during shock resuscitation. MethodsUsing the Glue Grant database, patients aged ≥16 years with ACS were compared with those without ACS (no-ACS). Stepwise analysis of the sum or difference of the mean total fluid volume (TV)/kg, TV and/or body weight, (μ) and standard deviations (σ) vs % ACS at each point was used to determine the fluid inflection point. ResultsA total of 1,976 patients were included, of which 122 (6.2%) had ACS. Compared with no-ACS, ACS patients had a higher emergency room lactate (5.8 ± 3.0 vs 4.5 ± 2.8, P < .001), international normalized ratio (1.8 ± 1.5 vs 1.4 ± .8, P < .001), and mortality (37.7% vs 14.6%, P < .001). ACS group received a higher TV/kg (498 ± 268 mL/kg vs 293 ± 171 mL/kg, P < .001) than no-ACS. The % ACS increased exponentially with the sum of μ and incremental σ, with the sharpest increase occurring at TV and/or body weight = μ + 3σ or 1,302 mL/kg. ConclusionsThere is a dramatic rise in ACS risk after 1,302 mL/kg of fluid is administered. This plot could serve as a guide in limiting the ACS risk during resuscitation.

Pericardiocentesis versus pericardiotomy for malignant pericardial effusion: a retrospective comparison.

Treatment of malignant pericardial effusion remains controversial, because no randomized controlled trials have been conducted to determine the best approach, and results of retrospective studies have been inconsistent. The objective of the present study was to compare pericardiocentesis and pericardiotomy with respect to efficacy for preventing recurrence, and to determine, for those two procedures, diagnostic yields, complication rates, and effects on survival. We also aimed to identify clinical and procedural factors that could predict effusion recurrence. We retrospectively assessed 61 patients who underwent a procedure for treatment of a malignant pericardial effusion at the Institut universitaire de cardiologie et de pneumologie de Québec between February 2004 and September 2013. Pericardiocentesis was performed in 42 patients, and pericardiotomy, in 19 patients. The effusion recurrence rate was significantly higher in patients treated with pericardiocentesis than with pericardiotomy (31.0% vs. 5.3%, p = 0.046). The diagnostic yield of the procedures was not significantly different (92.9% vs. 86.7%, p = 0.6). The overall rate of complications was similar in the two groups, as was the median overall survival (2.4 months vs. 2.6 months, p = 0.5). In univariate analyses, the procedure type was the only predictor of recurrence that approached statistical significance. Age, sex, type of cancer, presence of effusion at the time of cancer diagnosis, prior chest irradiation, tamponade upon presentation, and total volume of fluid removed did not influence the recurrence rate. Compared with pericardiocentesis, pericardiotomy had higher success rate in preventing recurrence of malignant pericardial effusion, with similar diagnostic yields, complication rates, and overall survival.

A parallel monolithic algorithm for the numerical simulation of large‐scale fluid structure interaction problems

SummaryA novel parallel monolithic algorithm has been developed for the numerical simulation of large‐scale fluid structure interaction problems. The governing incompressible Navier–Stokes equations for the fluid domain are discretized using the arbitrary Lagrangian–Eulerian formulation‐based side‐centered unstructured finite volume method. The deformation of the solid domain is governed by the constitutive laws for the nonlinear Saint Venant–Kirchhoff material, and the classical Galerkin finite element method is used to discretize the governing equations in a Lagrangian frame. A special attention is given to construct an algorithm with exact total fluid volume conservation while obeying both the global and the local discrete geometric conservation law. The resulting large‐scale algebraic nonlinear equations are multiplied with an upper triangular right preconditioner that results in a scaled discrete Laplacian instead of a zero block in the original system. Then, a one‐level restricted additive Schwarz preconditioner with a block‐incomplete factorization within each partitioned sub‐domains is utilized for the modified system. The accuracy and performance of the proposed algorithm are verified for the several benchmark problems including a pressure pulse in a flexible circular tube, a flag interacting with an incompressible viscous flow, and so on. John Wiley &amp; Sons, Ltd.