BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(...BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were 展开更多
Separate treatment of high-nutrient sidestream is an efficient and cost effective way to decrease the loading on the main plant, resulting in lower effluent nutrient concentration. This study investigated the use of a...Separate treatment of high-nutrient sidestream is an efficient and cost effective way to decrease the loading on the main plant, resulting in lower effluent nutrient concentration. This study investigated the use of a combined forward osmosis-membrane distillation (FO-MD) system for the removal of nitrogen present in high concentration in sidestream from anaerobic digestion process. The combined system was able to achieve almost 100% rejection of solids and acetic acid, and more than 98% rejection of NH3-N from the sidestream. The high rejection of NH3-N was mainly achieved by the FO process. The solids in the feed solution contributed to fouling problem in both FO and MD, resulting in significant decline in flux. However, 76% or higher flux recovery was achieved for FO membrane by cleaning with tap water. We observed that flux recovery was due to removal of solids from the membrane surface by the cleaning process. FO membrane also demonstrated excellent performance for continuous operation when cleaned for 15 min in every 24 h interval. Overall, the combined FO-MD system was found to be an effective solution for treatment of nutrient rich sidestream.展开更多
Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FC...Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FCD） of ileal mucosa in healthy mechanically-ventilated pigs and if there is any correlation between changes in FCD of ileal and sublingual mucosas during HHD. Methods： Sixteen domestic female pigs were anesthetized, mechanically-ventilated, and randomly assigned to the HHD （20 ml/（kg.h） Hartmann＇s solution for 3 h） or fluid restrictive （5 ml/（kg-h） Hartmann＇s solution for 3 h） group. Microcirculations of sublingual and ileal mucosas via ileostomy were visualized using sidestream dark-field （SDF） imaging at baseline conditions （t=0 h） and at selected time intervals of fluid therapy （t=-l, 2, and 3 h）. Results： A significant decrease of ileal FCD （285 （278-292） cm/cm^2） in the HHD group was observed after the third hour of HHD when compared to the baseline （360 （350-370） cm/cm2） （P〈0.01）. This trend was not observed in the restrictive group, where the ileal mucosa FCD was significantly higher after the third hour of fluid therapy as compared to the HHD group （P〈0.01）. No correlation between microhemodynamic parameters obtained from sublingual and ileal mucosas was found throughout the study. Conclusions： Prolonged HHD established by crystalloid solution significantly decreased ileal villus FCD when compared to restrictive fluid regimen. An inappropriate degree of HHD can be harmful during uncomplicated abdominal surgery.展开更多
Background:This study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy.The overarching aim of the work was to vali...Background:This study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy.The overarching aim of the work was to validate the pig as an experimental model of changes in microcirculatory function following traumatic haemorrhagic shock and resuscitation.Methods:Fourteen large white pigs and 14 humans were recruited for the study.Sublingual sidestream darkfield videomicroscopy clips were captured in anesthetized pigs and conscious humans.Clips underwent manual analysis in Automated Vascular Analysis 3.2 software.The total vessel density(TVD),perfused vessel density(PVD),proportion of perfused vessels(PPVs)and microvascular flow index(MFI)were quantified.An independent samples t test was used for between species comparison of microcirculatory parameters.Results and Conclusions:Conscious humans had a significantly lower TVD,PVD and MFI than anesthetized pigs.No significant difference in PPVs was observed between the species.Perfusion of the microcirculation is a critical determinant of tissue metabolic function and viability.Whilst it may not be surprising that some inter species differences in the sublingual microcirculatory anatomy were identified between pig and human subjects,it is interesting to report the insignificant difference in PPVs.This direct microcirculatory measure represents a relative change which should hold translatable value across species.We therefore conclude the pig is a suitable model for microcirculatory research and may be a suitable species to investigate changes in microcirculatory perfusion following perturbations in cardiovascular homeostasis,for example during traumatic haemorrhagic shock and resuscitation.展开更多
Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients ...Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.展开更多
Phosphorus and nutrient recovery from wastewater as mineral salts can support local replenishment of fertilisers and reduce mining,contributing to the circular economy.Wastewater and related streams are rich in nutrie...Phosphorus and nutrient recovery from wastewater as mineral salts can support local replenishment of fertilisers and reduce mining,contributing to the circular economy.Wastewater and related streams are rich in nutrients,however;there is need to develop bio-based processes to recover them.This study investigates the fractions of phosphorus(P)used by Brevibacterium antiquum to form struvite biominerals(bio-struvite)in wastewater sludge dewatering liquors.After 72h of incubation,25.6 mg P/L were recovered as bio-struvite from 12.4 mg P/L organic plus condensed P and 13.2 mg P/L of orthophosphate.The potential of sludge dewatering liquors to recover nutrients as struvite was investigated by characterising ten types of sludge liquors(originating from primary,secondary sludge,feed to anaerobic digester and digestate,from 3 types of wastewater treatment plants)for their P fractions together with other parameters relevant for B.antiquum growth.Results indicated that liquors obtained from primary sludge,feed to anaerobic digesters and digestate were the most suitable to produce biostruvite,as these were found to frequently have a high content of organic and condensed P,between to 276-732 mg P/L.Liquors,from all the investigated sites,presented a higher potential for bio-struvite production than with conventional struvite precipitation.This study demonstrated that B.antiquum could convert organic and condensed P into bio-struvite,and this opens up a completely new way to recover forms of phosphorus that are not typically available for nutrient recovery in a single process.展开更多
文摘BACKGROUND:This study aimed to observe the effect of early goal directed therapy(EGDT)on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.METHODS:Patients with early septic shock(<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled(research time:12 months),and they didn't meet the criteria of EGDT.Patients who had one of the following were excluded:stroke,brain injury,other types of shock,severe heart failure,acute myocardial infarction,age below 18 years,pregnancy,end-stage disease,cardiac arrest,extensive burns,oral bleeding,difficulty in opening the mouth,and the onset of septic shock beyond 24 hours.Patients treated with the standard protocol of EGDT were included.Transcutaneous pressure of oxygen and carbon dioxide(PtcO_2,PtcCO_2) were monitored and hemodynamic measurements were obtained.Side-stream dark field(SDF) imaging device was applied to obtain sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before and after EGDT.If the variable meets the normal distribution,Student's t test was applied.Otherwise,Wilcoxon's rank-sum test was used.Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method.RESULTS:Twenty patients were involved,but one patient wasn't analyzed because he didn't meet the EGDT criteria.PtcO_2 and PtcCO_2 were monitored in 19 patients,of whom sublingual microcirculation was obtained.After EGDT,PtcO_2 increased from 62.7+24.0 mmHg to 78.0±30.9mmHg(P<0.05) and tissue oxygenation index(PtcO_2/FiO_2) was 110.7+60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT(P<0.05).The difference between PtcCO_2 and PCO_2 decreased significantly after EGDT(P<0.05).The density of perfused small vessels(PPV) and microcirculatory flow index of small vessels(MFI) tended to increase,but there were no significant differences between them(P>0.05).PtcO_2,PtcO_2/FiO_2,and PtcCO_2 were
文摘Separate treatment of high-nutrient sidestream is an efficient and cost effective way to decrease the loading on the main plant, resulting in lower effluent nutrient concentration. This study investigated the use of a combined forward osmosis-membrane distillation (FO-MD) system for the removal of nitrogen present in high concentration in sidestream from anaerobic digestion process. The combined system was able to achieve almost 100% rejection of solids and acetic acid, and more than 98% rejection of NH3-N from the sidestream. The high rejection of NH3-N was mainly achieved by the FO process. The solids in the feed solution contributed to fouling problem in both FO and MD, resulting in significant decline in flux. However, 76% or higher flux recovery was achieved for FO membrane by cleaning with tap water. We observed that flux recovery was due to removal of solids from the membrane surface by the cleaning process. FO membrane also demonstrated excellent performance for continuous operation when cleaned for 15 min in every 24 h interval. Overall, the combined FO-MD system was found to be an effective solution for treatment of nutrient rich sidestream.
基金Project (No. MZO 00179906) supported by the Ministry of Health,Czech Republic
文摘Objective： Hemodilution changes the physical properties of blood by reducing its hematocrit and blood viscosity. We tested whether prolonged hypervolemic hemodilution （HHD） impairs functional capillary density （FCD） of ileal mucosa in healthy mechanically-ventilated pigs and if there is any correlation between changes in FCD of ileal and sublingual mucosas during HHD. Methods： Sixteen domestic female pigs were anesthetized, mechanically-ventilated, and randomly assigned to the HHD （20 ml/（kg.h） Hartmann＇s solution for 3 h） or fluid restrictive （5 ml/（kg-h） Hartmann＇s solution for 3 h） group. Microcirculations of sublingual and ileal mucosas via ileostomy were visualized using sidestream dark-field （SDF） imaging at baseline conditions （t=0 h） and at selected time intervals of fluid therapy （t=-l, 2, and 3 h）. Results： A significant decrease of ileal FCD （285 （278-292） cm/cm^2） in the HHD group was observed after the third hour of HHD when compared to the baseline （360 （350-370） cm/cm2） （P〈0.01）. This trend was not observed in the restrictive group, where the ileal mucosa FCD was significantly higher after the third hour of fluid therapy as compared to the HHD group （P〈0.01）. No correlation between microhemodynamic parameters obtained from sublingual and ileal mucosas was found throughout the study. Conclusions： Prolonged HHD established by crystalloid solution significantly decreased ileal villus FCD when compared to restrictive fluid regimen. An inappropriate degree of HHD can be harmful during uncomplicated abdominal surgery.
基金UQ Midwinter Group funds.RL received PhD candidature funding from the Australian Government Research Training Program.
文摘Background:This study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy.The overarching aim of the work was to validate the pig as an experimental model of changes in microcirculatory function following traumatic haemorrhagic shock and resuscitation.Methods:Fourteen large white pigs and 14 humans were recruited for the study.Sublingual sidestream darkfield videomicroscopy clips were captured in anesthetized pigs and conscious humans.Clips underwent manual analysis in Automated Vascular Analysis 3.2 software.The total vessel density(TVD),perfused vessel density(PVD),proportion of perfused vessels(PPVs)and microvascular flow index(MFI)were quantified.An independent samples t test was used for between species comparison of microcirculatory parameters.Results and Conclusions:Conscious humans had a significantly lower TVD,PVD and MFI than anesthetized pigs.No significant difference in PPVs was observed between the species.Perfusion of the microcirculation is a critical determinant of tissue metabolic function and viability.Whilst it may not be surprising that some inter species differences in the sublingual microcirculatory anatomy were identified between pig and human subjects,it is interesting to report the insignificant difference in PPVs.This direct microcirculatory measure represents a relative change which should hold translatable value across species.We therefore conclude the pig is a suitable model for microcirculatory research and may be a suitable species to investigate changes in microcirculatory perfusion following perturbations in cardiovascular homeostasis,for example during traumatic haemorrhagic shock and resuscitation.
文摘Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.
基金the financial support and contribution from Severn Trent Water Ltd(Coventry,UK)the financial support from POPH/FSE as a PhD grant(SFRH/BD/84116/2012)awarded by the Fundacao para a Ciencia e Tecnologia(FCT,Portugal).
文摘Phosphorus and nutrient recovery from wastewater as mineral salts can support local replenishment of fertilisers and reduce mining,contributing to the circular economy.Wastewater and related streams are rich in nutrients,however;there is need to develop bio-based processes to recover them.This study investigates the fractions of phosphorus(P)used by Brevibacterium antiquum to form struvite biominerals(bio-struvite)in wastewater sludge dewatering liquors.After 72h of incubation,25.6 mg P/L were recovered as bio-struvite from 12.4 mg P/L organic plus condensed P and 13.2 mg P/L of orthophosphate.The potential of sludge dewatering liquors to recover nutrients as struvite was investigated by characterising ten types of sludge liquors(originating from primary,secondary sludge,feed to anaerobic digester and digestate,from 3 types of wastewater treatment plants)for their P fractions together with other parameters relevant for B.antiquum growth.Results indicated that liquors obtained from primary sludge,feed to anaerobic digesters and digestate were the most suitable to produce biostruvite,as these were found to frequently have a high content of organic and condensed P,between to 276-732 mg P/L.Liquors,from all the investigated sites,presented a higher potential for bio-struvite production than with conventional struvite precipitation.This study demonstrated that B.antiquum could convert organic and condensed P into bio-struvite,and this opens up a completely new way to recover forms of phosphorus that are not typically available for nutrient recovery in a single process.
