Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients

The use of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) to diagnose and manage pulmonary complications has been shown to be safe in adult cancer patients, but whether its use is safe in pediatric cancer patients remains unclear. Thus, to describe the landscape of FB outcomes in pediatric cancer patients and to help define the populations most likely to benefit from the procedure, we undertook a retrospective review of FBs performed in patients younger than 21 years treated at our institution from 2002 to 2017. We found that a greater volume of total fluid instilled during BAL was significantly associated with increased probabilities of positive BAL culture (p=0.042), positive bacterial BAL culture (p=0.037), and positive viral BAL culture (p=0.0496). In more than half of the FB cases, findings resulted in alterations in antimicrobial treatment. Our study suggests that for pediatric cancer patients, FB is safe, likely provides diagnostic and/or therapeutic benefits, and has implications for treatment decisions.

Experimental study of the flows in a non-axisymmetric ellipsoid under precession

Precession driven flows are of great interest for both, industrial and geophysical applications. While cylindrical, spherical and spheroidal geometries have been investigated in great detail, the numerically and theoretically more challenging case of a non-axisymmetric cavity has received less attention. We report experimental results on the flows in a precessing triaxial ellipsoid, with a focus on the base flow of uniform vorticity, which we show to be in good agreement with existing theoretical models. As predicted, the uniform vorticity component exhibits two branches of solutions leading to a hysteresis cycle as a function of the Poincaré number. The first branch is observed at low forcing and characterized by large amplitude of the total fluid rotation and a moderate tilt angle of the fluid rotation axis. In contrast, the second branch displays only a moderate fluid rotation and a large tilt angle of the fluid rotation axis, which tends to align with the precession axis. In addition, we observe the occurrence of parametric instabilities early in the first branch, which saturate in the second branch, where we observe the same order of the kinetic energy in the base flow and instabilities.

The body water compartments in women with preeclampsia in the peripartum period

Background. Preeclampsia in pregnant women is a threatening condition that causes significant water imbalance, particularly hyperhydration of the extracellular fluid compartment. The condition is the result of the main pathogenetic processes — endothelial dysfunction and the subsequent development of hypoproteinemia. The changes can be detected by measuring body water compartments. Objective: to investigate the effect of a standard intensive care on the body water compartment indicators in women with moderate to severe preeclampsia. Materials and methods. Ninety patients divided into three groups were examined: non-pregnant healthy women, pregnant women with healthy pregnancy, and women whose pregnancy was complicated by moderate to severe preeclampsia. Body water compartments were measured by non-invasive bioelectrical impedance analysis. Results. Pregnancy complicated by preeclampsia is accompanied by an increase in total fluid volume at 34–40 weeks due to an increase in both the extracellular and intracellular water compartments, but with a predominance of the extracellular compartment. By the 7th day of the postpartum period, there is a tendency to decrease the total fluid volume, however, interstitial and intracellular edema can be still observed. Conclusions. The results of the bioelectrical impe-dance analysis of the body water compartments show that additional methods of treatment are needed to correct the body water compartments in women with preeclampsia.

Effect of A Positive Cumulative Fluid Balance On The Prognosis of Patients With Sepsis In The Xining Area

Background: The aim of this work is to analyze the effect of a positive cumulative fluid balance and relative clinical indicators on the prognosis of patients with sepsis in the Xining area, China.Methods: The clinical data of 480 sepsis patients (313 males and 167 females, aged 52–77 (65) years) admitted between January 2017 and December 2019 were retrospectively analyzed. The APACHE II score, SOFA score, SIRS score and clinical laboratory test indicators of the patients were collected. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of each indicator in predicting the poor prognosis of patients with sepsis, and the maximum Youden index was used to determine threshold values. Cox regression analysis was performed to assess patient prognosis using data from patients with different fluid balances. Results: The following clinical indicators were significantly different between the 2 groups (P<0.05): APACHE II score, SOFA score, SIRS score, PCT, IL-6, BNP, CRP, PLT, BUN, CREA, Lac and total fluid balance from days 1 to 5. The area under the ROC curve (AUC) for total fluid balance from days 1 to 5 was 0.558, the cut-off value was 2120.5 mL, the sensitivity was 54.0%, and the specificity was 58.1%. The survival rates were different between the 2 groups (60.9% vs 48.9%, P<0.05). Total fluid balance was significantly higher in patients with septic shock and with Lac>2.0 mmol/L (P<0.05). Cox regression analysis indicated that APACHE II score, SOFA score, PLT score, Lac, and total fluid balance from days 1 to 5 were independent risk factors for poor prognosis.Conclusion: A positive fluid balance from days 1 to 5 after ICU admission was associated with poor patient outcomes and was an independent risk factor for poor patient prognosis.

Initial Results of the American Burn Association (ABA) Observational Multi-Center Evaluation on the Effectiveness of the Burn Navigator

The objective of this multi-center observational study was to evaluate resuscitation volumes and outcomes of patients who underwent fluid resuscitation utilizing the Burn Navigator (BN), a resuscitation clinical decision support tool. Two analyses were performed: examination of the first 24 hours of resuscitation, and the first 24 hours post-burn regardless of when the resuscitation began, to account for patients who presented in a delayed fashion. Patients were classified as having followed the BN (FBN) if all hourly fluid rates were within ±20 mL of BN recommendations for that hour at least 83% of the time, otherwise they were classified as not having followed BN (NFBN). Analysis of resuscitation volumes for FBN patients in the first 24 hours resulted in average volumes for primary crystalloid) and total fluids administered of 4.07 ± 1.76 mL/kg/TBSA (151.48 ± 77.46 mL/kg), and 4.68 ± 2.06 mL/kg/TBSA (175.01 ± 92.22 mL/kg), respectively. Patients who presented in a delayed fashion revealed average volumes for primary and total fluids of 5.28 ± 2.54 mL/kg/TBSA (201.11 ± 106.53 mL/kg), 6.35 ± 2.95 mL/kg/TBSA (244.08 ± 133.5 mL/kg), respectively. There was a significant decrease in the incidence of burn shock in the FBN group (p&lt; 0.05). This study shows that the BN provides comparable resuscitation volumes of primary crystalloid fluid to the Parkland Formula, recommends total fluid infusion less than the Ivy Index, and was associated with a decreased incidence of burn shock. Early initiation of the BN device resulted in lower overall fluid volumes.

Effects of Combined Epidural Anesthesia and General Anesthesia on Cognitive Function and Stress Responses of Elderly Patients Undergoing Liver Cancer Surgery

This study aimed at exploring the effects of combined epidural anesthesia and general anesthesia on the cognitive function and stress responses of elderly patients undergoing liver cancer surgery. One hundred and fifteen elderly patients were enrolled as research subjects. They were admitted to our hospital and underwent liver cancer surgery from August 2017 to May 2019. Fifty five cases were treated with general anesthesia (GA) (GA group), while the other sixty cases were treated with combined epidural anesthesia and general anesthesia (joint group). Scoring standards of Mini-Mental State Examination (MMSE) were used to evaluate the patients before and after operation. Their operating time, total fluid input (TFI), spontaneous breathing recovery time (SBRT), preoperative and postoperative indices of stress responses (epinephrine (EPI), cortisol (Cor), and norepinephrine (NE)), and postoperative adverse reactions were observed. There were statistically significant differences between the two groups with respect to anesthesia time, TFI, postoperative SBRT, and postoperative directional recovery time (DRT) (c P < 0.05 ). There was no difference in operating time, total fluid loss (TFL), and hospitalization time ( P > 0.05 ). After operation, patients in both groups experienced a cognitive decline of different degrees and the MMSE scores decreased. There was no significant difference in the score between the two groups before operation and 3 days and 7 days after operation ( P > 0.05 ). The score was significantly better in the joint group than that in the GA group at 6 hours and 1 day after operation ( P < 0.05 ). There were no significant differences in levels of EPI, Cor, and NE between the two groups before operation ( P > 0.05 ), but there were significant differences after operation. The total incidence of postoperative adverse reactions was 11.67% in the joint group and 25.45% in the GA group. In conclusion, combined epidural anesthesia and general anesthesia can significantly reduce postoperative cognitive dysfunction and inhibit postoperative stress responses in elderly patients undergoing liver cancer surgery. It has good application value in clinical practice.

The predicting factors for indication of surgery in patients with hemoperitoneum caused by corpus luteum cyst rupture

The aim of the study was to determine the risk factors for surgery in patients with hemoperitoneum caused by corpus luteum cyst rupture. A retrospective review of medical records of 155 patients diagnosed with hemoperitoneum caused by corpus luteum cyst rupture was conducted between January 2010 and March 2015. The patients were divided into two groups: surgical and conservative management. The differences in characteristics between the two groups were compared. The indicators that determine the need of a surgery at the initial visit were also compared between the two groups. Initial hemoglobin level was lower (11.3 ± 1.4 g/dL vs. 12.2 ± 1.2 g/dL; p = 0.007) in the surgery group. There were significant differences in posterior cul-de-sac (PCDS) fluid collection depth (6.2 ± 2.5 cm vs. 4.5 ± 1.6 cm, p = 0.000), total fluid collection depth (8.4 ± 1.8 cm vs. 6.5 ± 2.1 cm, p = 0.000), single deepest pocket depth (6.7 ± 2.2 cm vs. 5.1 ± 1.5 cm, p = 0.006), liver-dome fluid (78.9% vs. 35.6%; p = 0.002), and estimated intrapelvic bleeding amount (325 ± 250 cc vs. 206 ± 146.5 cc, p = 0.002). The extravasation over grade 2 was more often in surgery group (68.4% vs. 30.1%; p = 0.001). PCDS fluid collection depth, the presence of liver-dome fluid, and the severity of contrast extravasation through ultrasonography and computed tomography are good indicators for determining the management of hemoperitoneum resulting from corpus luteum cyst rupture in healthy women.

Influence of experimental metabolic syndrome on bioimpedance spectroscopy indicators of rat body

The objective of this experiment was to establish sex-related differences in the parameters of bioimpedance spectroscopy of the Wistar rat’s bodies in the experimental metabolic syndrome (endocrine-salt model). Sexual dependencies of bioimpedance measurements in intact animals have been determined for the first time: males have higher amount of total fluid, but lower one of total fat. The intra/extracellular fluid balance in males is characterized with ratio 2:1, while in females is the other one - 1:1. For the first time the formation of the metabolic syndrome has already been determined on the seventh day in females which lead to decreasing in the percentage of total fat and to changing of the intra / extracellular fluid balance to ‘male’ type - 2:1. The last one should be considered as a sign of intracellular hyperhydration. In males the examined parameters have been being within the control values ​​throughout 21 days of experiment.

Sexual dimorphism and biology of the large deepwater mastigoteuthid squid Idioteuthis cordiformis (Cephalopoda, Mastigoteuthidae) off Tasmania, Australia

This study provided biological information on 146 specimens of the poorly known deepwater mastigoteuthid squid Idioteuthis cordiformis. Mantle length ranged from 200–500 mm for males and 270–702 mm for females. The largest female weighed just under 12 kg. The majority of males were mature and all females were immature. The fins were larger and thicker than the mantle. Mantle weight of males and females was 44.8% and 55.2% of fin weight, respectively, and were significantly different. There was a significant sex effect on mantle length, total weight, mantle weight and fin weight, with females having greater values in all categories. There was a small season effect for mantle weight and fin weight. There was little ingested prey material except fluid and oil in the caecum that was typically bright orange or red. Total fluid volume ranged from 23–230 ml and 20–550 ml for males and females, respectively. The per cent oil component of total fluids in the caecum ranged from 6.9–50% and 10.8–50% for males and females, respectively, with no significant difference in per cent oil between males and females. There was a significant positive relationship between total weight and oil volume for females, and for males and females combined. The function of the oil is uncertain. While this study provided information on sex differences in the body size, sexual dimorphism and caecum oil content, information is still incomplete regarding reproduction due to the lack of any mature females captured in this study.

Triple MPD Technique for Drilling and Intelligent Completion Deployment on an Abandoned Deepwater Well

This is a case study of a presalt well that required the use of 3 different MPD techniques to achieve its goals. The well was temporary abandoned when conventional techniques failed to reach the final depth. Total fluid losses in the reservoir section required changing the well design and its completion architecture. The new open hole intelligent completion design had to be used to deliver the selective completion in this challenging scenario. From the hundreds of wells drilled in the Santos basin presalt, there are some wells with tight or no operational drilling window. In order to drill these wells different MPD techniques are used. In most cases, the use of Surface Backpressure (SBP) technique is suitable for drilling the wells to its final depth. For the more complex cases, when higher fluid loss rates occur, the use of SBP and Pressurized Mud Cap Drilling (PMCD) enables the achievement of the drilling and completion objectives. After the temporary abandonment of this specific well in 2018, the uncertainty of the pore pressure could not ensure that the SBP and PMCD techniques would be applicable when reentering the well. To avoid difficult loss control operations, the completion team changed the intelligent completion design to include a separated lower completion, enabling its installation with the MPD system. Besides the previously used MPD techniques, the integrated final project considered an additional technique, Floating Mud Cap Drilling (FMCD), as one of the possible contingencies for the drilling and completion phases. Well reentry and drilling of the remaining reservoir section included the use all the previously mentioned MPD techniques (SBP, PMCD and FMCD). The lower completion deployment utilized the FMCD technique to isolate the formation quickly and efficiently, without damaging the reservoir. The planning and execution of the well faced additional difficulties due to the worldwide pandemic and personnel restrictions. The success from the operation was complete with no safety related events and within the planned budget. At the end, the execution team delivered a highly productive well with an intelligent completion system fully functional, through an integrated and comprehensive approach. MPD use on deepwater wells is relatively new. Different operators used several approaches and MPD techniques to ensure safety and success during wells constructions over the last decade. This paper demonstrates the evolution of MPD techniques usage on deepwater wells.