简介：Acutepancreatitis(AP)isafrequentdiseasewithdegreesofincreasingseverityresponsibleforhighmorbidity.Despitecontinuousimprovementincare,mortalityremainssignificant.Becausehypovolemia,togetherwithmicrocirculatorydysfunctionleadtopooroutcome,fluidtherapyremainsacornerstoneofthesupportivetreatment.However,poorclinicalevidenceactuallysupporttheaggressivefluidtherapyrecommendedinrecentguidelinessinceavailabledataarecontroversial.Fluidmanagementremainsunclearandleadstocurrentheterogeneouspractice.DifferentstrategiesmayhelptoimprovefluidresuscitationinAP.Ononehand,integrationoffluidtherapyinaglobalhemodynamicresuscitationhasbeendemonstratedtoimproveoutcomeinsurgicalorsepticpatients.Tailoredfluidadministrationafterearlyidentificationofpatientswithhigh-riskofpooroutcomepresentinginadequatetissueoxygenationisamajorpartofthisstrategy.Ontheotherhand,newdecisionparametershavebeendevelopedrecentlytoimprovesafetyandefficiencyoffluidtherapyincriticallyillpatients.Inthisreview,weproposeapersonalizedstrategyintegratingthesenewconceptsintheearlyfluidmanagementofAP.ThisnewapproachpavesthewaytoawiderangeofclinicalstudiesinthefieldofAP.

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简介："Sightcanbeacquired,Visioncannot".OrindRefractoriesLimited(ORIND),Chinawasformedwiththisrarevision.AtatimewhentheworldwastestingthetepidwatersofChina;Mr.RavinJhunjhunwala,ChairmanofORINDandthemanagementofORINDIndiahadlookedovertheGreatWalltobeginajourneyofsuccess.Incorportedon18thAugust1994withaninitialinvestmentofUSD5million,ORLcaterstotheever-demandingneedsofthesteelindustryandbeyond.IncidentallyORINDwasthefirstwhollyownedIndiacompanytosetupbaseinChina.Pesently,ORINDChinahasa616strongworkforceincluding23expatriates.

简介：ThePacificTunasPrivateLimitedisajoint-venturecompanyregisteredinSingaporewithajointinvestmentfromSingaporcTunasPteLtd.andtheCIECExhibitionCompany(H.K.)Ltd.,asuhsidiaryoftheChinaInternationalExhibitionCorporationundertheChinaCouncilforthePromotionofInternationalTrade.

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简介：AbstractFluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

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简介：Tofindouttheoptimalconcentration,infusionrateanddosageofsalineforresuscitation.Methods:Forty-fivedogswereusedtoestablishhypovolemicshockmodels.Thedogswereresuscitatedwithsalineofdifferentconcentrationsanddifferentdosagesunderdifferentinfusionrates,andtheresuscitationresultswerecompared.Results:Thebestconcentrationwas7.5%,thebestrateofinfusion20ml/min(avolumeequivalentto15%oftheshedblood)andthebestdosage5.71ml/kg.Themethodwaseffectiveforresuscitation,themeanarterialpressure(MAP)couldbeelevatedto89%ofthebaseline,andthisMAPcouldbekeptformorethanonehour.Conclusions:Using7.5%sodiumchloridesolutionequivalentto15%oftheshedbloodataninfusionrateof20ml/mincanachieveabestresuscitationresult.

简介：TheAmericanHeartAssociationandtheEuropeanResuscitationCouncilrecentlyrecommendedthatvasopressincanbeusedforcardiopulmonaryresuscitation,insteadofepinephrine.However,theguidelinesdonotdiscusstheeffectsofvasopressinduringcerebralresuscitation.Inthisstudy,weintraperitoneallyinjectedepinephrineand/orvasopressinduringcardiopulmonaryresuscitationinaratmodelofasphyxialcardiacarrest.Theresultsdemonstratedthat,comparedwithepinephrinealone,thepathologicaldamagetonervecellswaslessened,andthelevelsofc-JunN-terminalkinaseandp38expressionweresignificantlydecreasedinthehippocampusaftertreatmentwithvasopressinaloneorthevasopressinandepinephrinecombination.Nosignificantdifferenceinresuscitationeffectswasdetectedbetweenvasopressinaloneandthevasopressinandepinephrinecombination.Theseresultssuggestthatvasopressinaloneorthevasopressinandepinephrinecombinationsuppresstheactivationofmitogen-activatedproteinkinaseandc-JunN-terminalkinasesignalingpathwaysandreduceneuronalapoptosisduringcardiopulmonaryresuscitation.

简介：1定义及抢救意义心脏的有效收缩停止，引起全身组织缺血、缺氧，继之呼吸停止及意识丧失。心肺复苏(CPR)的目的是为了保证脑的复苏，因此，CPR不如CPCR更为确切。

简介：Ultrapureferriticstainlesssteelisakindofnewstainlesssteelgradewithhighqualitydevelopedinthemid-twentiethcentury,itischaracterizedbyultralowCarbonandNitrogencontentandmicro-alloyingwithTi,Nb,V,Cuetc.,soitovercomesalotofuseshortcomingsoftheordinaryferriticstainlesssteel,suchasintergranularcorrosionsensitivity,lowductilityandtoughnessunderatmospheretemperature,crackincliningattheweldzoneetc.,namely,ithasbetterperformancethantheordinaryferriticstainlesssteelintheaspectofcorrosionresistance,toughnessandweldabilityetc.Furthermore,aseriesofsecondaryrefiningequipmentsandtechnologieshavebeeninventedfromthe1960s,loworultralowCarbonandNitrogencontentinthemoltenstainlesssteelcanbeobtainedduringmanufacturingproduction.Therefore,suchsteelhasbeenappliedinmanyfields,leadingtotheveryrapiddevelopmentoverthepasthalfcentury.Thispaperfocusesonthesecondaryrefiningprocesswhichisthemostimportantstepofthewholesteel-makingprocessfortheultrapureferriticstainless.Firstly,somedifficultiesofthesecondaryrefiningprocessaredescribed,includingthehighpurificationintermsofbothCarbonandNitrogencontents,highefficientandstablecontrol.Secondly,thedevelopmentandprogressofthesecondaryrefiningtechnologyforultrapureferriticstainlessisintroducedintermsoftherefiningequipments,metallurgicalprocessandassistanttechnologies.SomemostfamoussecondaryrefiningequipmentsandmetallurgicaltechnologiesforultrapureferriticstainlesssteelhadbeeninventedmainlybyJapanandEuropeancompaniesfrom1960sto1990s,suchasVOD,SS-VOD,AOD-VCR,VOD-PBetc..Duringthesametimeofwideapplicationofthesesecondaryrefiningequipmentsandtechnologies,inordertostrengthenthefunctionandcapacityoftheserefiningequipments,someadvancedassistanttechnologieswerealsointroducedandapplied,whichconsistsoftoplance,specialrawmaterials,ladlerefracto

简介：Thispaperanalyzesaqueuemode]ofthepollingsystemwithlimitedservice(K=1)indiscretetime.BytheimbeddedMarkovchaintheoryandtheprobabilitygeneratingfunctionmethod,themeanvaluesofqueuelengthandmessagewaitingtimeareexplicitlyobtained.Also,wegivethesimulationresults.TheresultsobtainedbyH.Tagai(1985)arerevised.

简介：Objective:Toestablishagoodrecoverableratmodelofcardiopulmonarybypass(CPB)tolaythefoundationforstudyingthepathophysiologyofCPB.Methods:TwentyadultmaleSprague-Dawleyratsweighing480g±20gwererandomlydividedintoCPBgroup(n=10)andShamgroup(n=10).Allratswereanaesthetized,intubatedandventilated.Thecarotidarteryandjugularveinwerecannulated.Thebloodwasdrainedfromtherightatriumviatherightjugularveinandfurthertransferredbyaminiaturizedrollerpumptoahollowfiberoxgenatorandbacktotheratviatheleftcarotidartery.Primingconsistedof8mlofhomologousbloodand6mlofcolloid.Thesurfaceofthehollowfiberoxgenatorwas0.075m~2.Ratswerecatheterizedandbroughtinbypassfor120minataflowrateof100-120ml/kg/min.Oxygenflow/perfusionflowwas0.8to1.0,themeanarterialpressure(MAP)keptin60-80mmHg.Bloodgasanalysis,lactatedehydrogenase(LDH),andsurvivalratewereexaminedsubsequently.Resnits:AllCPBratsrecoveredfromtheoperativeprocesswithoutincidentandremaineduneventfulwithinoneweek.Normalcardiacfunctionaftersuccessfulweaningwasconfirmedbyelectrocardiographyandbloodpressuremeasurements.MAPremainedstable.Theresultsofbloodgasanalysisatdifferenttimepointswerewithinanormalrange.NosignificanthaemolysiscouldbedetectedinthegiventimeframeunderbypassconditionbyusingLDH.Conclusions:TheratmodelofCPBcanprincipallysimulatetheclinicalsettingofhumanCPB.Thenon-transthoracicmodeliseasytoestablishandisassociatedwithexcellentrecovery.ThiswellreproduciblemodelmayopenthefieldforvariousstudiesonpathophysiologicalprocessofCPBandalsoofsystemicischemia-reperfusioninjuryinvivo.

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简介：我们在场散开的一个计算机模型与线arseed限制了聚集。有改变线性种子长度的簇被模仿，并且他们的模式结构，分数维的尺寸和多分数维的光谱被获得。如果它的长度比较地更短，模拟结果证明线性种子长度在聚集簇的模式结构上有小效果。与它的增加，线性种子长度有更强壮的效果在模式结构，当尺寸D-f减少时。当线性种子长度更大时，相应模式结构同样地是生气的。线性种子长度越大，越多明显有在二点聚类的更多的粒子的跨like结构线性种子并且沿着垂直方向结束到线性种子的中心。而且，multifractralspectra曲线变得更低并且奇特的范围更狭窄。线arseed的长度越长，模式变得越不不规则、不一致。

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简介：Dropshaftsareverticalstructureswidelyusedinurbandrainagesystemsandbuildingsforwatertransportation.Inthispaper,aphysicalmodelstudywasconductedtoinvestigatetheairentrainmentinthedropshaftundervariousflowregimeswithandwithoutairventilation.Observedfromtheexperiments,theairentrainmentmechanismsvariedwiththewaterflowregimesinthedropshaft.Whentherewasnowaterplugformedinthedropshaft,aircouldbesupplieddirectlyfromdownstream.Oncethewaterplugwasformed,whilewithoutventing,theairwasreplenishedonlyfromdownstreamintermittentlyandthenintheformoflargeairbubbletravelingupwardstotheairspaceatthetop;whilewithventing,airwasmainlyreplenishedfromthedropshafttopandnolargeairbubblewasobserved.Theexperimentalresultsalsoshowedthattheamountofentrainedairinthedropshaftwithventingwasgreaterthanthatwithoutventing.

简介：AbstractBackground:It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed.Methods:Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion.Results:Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086).Conclusion:In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness.Trial registration:ClinicalTrials.gov, NCT04515511