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1.
Crit Care Med ; 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38578158

RESUMO

OBJECTIVES: Quantify the relationship between perioperative anaerobic lactate production, microcirculatory blood flow, and mitochondrial respiration in patients after cardiovascular surgery with cardiopulmonary bypass. DESIGN: Serial measurements of lactate-pyruvate ratio (LPR), microcirculatory blood flow, plasma tricarboxylic acid cycle cycle intermediates, and mitochondrial respiration were compared between patients with a normal peak lactate (≤ 2 mmol/L) and a high peak lactate (≥ 4 mmol/L) in the first 6 hours after surgery. Regression analysis was performed to quantify the relationship between clinically relevant hemodynamic variables, lactate, LPR, and microcirculatory blood flow. SETTING: This was a single-center, prospective observational study conducted in an academic cardiovascular ICU. PATIENTS: One hundred thirty-two patients undergoing elective cardiovascular surgery with cardiopulmonary bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients with a high postoperative lactate were found to have a higher LPR compared with patients with a normal postoperative lactate (14.4 ± 2.5 vs. 11.7 ± 3.4; p = 0.005). Linear regression analysis found a significant, negative relationship between LPR and microcirculatory flow index (r = -0.225; ß = -0.037; p = 0.001 and proportion of perfused vessels: r = -0.17; ß = -0.468; p = 0.009). There was not a significant relationship between absolute plasma lactate and microcirculation variables. Last, mitochondrial complex I and complex II oxidative phosphorylation were reduced in patients with high postoperative lactate levels compared with patients with normal lactate (22.6 ± 6.2 vs. 14.5 ± 7.4 pmol O2/s/106 cells; p = 0.002). CONCLUSIONS: Increased anaerobic lactate production, estimated by LPR, has a negative relationship with microcirculatory blood flow after cardiovascular surgery. This relationship does not persist when measuring lactate alone. In addition, decreased mitochondrial respiration is associated with increased lactate after cardiovascular surgery. These findings suggest that high lactate levels after cardiovascular surgery, even in the setting of normal hemodynamics, are not simply a type B phenomenon as previously suggested.

2.
J Cardiothorac Vasc Anesth ; 38(4): 895-904, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38307740

RESUMO

OBJECTIVE: To test the correlation of ejection fraction (EF) estimated by a deep-learning-based, automated algorithm (Auto EF) versus an EF estimated by Simpson's method. DESIGN: A prospective observational study. SETTING: A single-center study at the Hospital of the University of Pennsylvania. PARTICIPANTS: Study participants were ≥18 years of age and scheduled to undergo valve, aortic, coronary artery bypass graft, heart, or lung transplant surgery. INTERVENTIONS: This noninterventional study involved acquiring apical 4-chamber transthoracic echocardiographic clips using the Philips hand-held ultrasound device, Lumify. MEASUREMENTS AND MAIN RESULTS: In the primary analysis of 54 clips, compared to Simpson's method for EF estimation, bias was similar for Auto EF (-10.17%) and the experienced reader-estimated EF (-9.82%), but the correlation was lower for Auto EF (r = 0.56) than the experienced reader-estimated EF (r = 0.80). In the secondary analyses, the correlation between EF estimated by Simpson's method and Auto EF increased when applied to 27 acquisitions classified as adequate (r = 0.86), but decreased when applied to 27 acquisitions classified as inadequate (r = 0.46). CONCLUSIONS: Applied to acquisitions of adequate image quality, Auto EF produced a numerical EF estimate equivalent to Simpson's method. However, when applied to acquisitions of inadequate image quality, discrepancies arose between EF estimated by Auto EF and Simpson's method. Visual EF estimates by experienced readers correlated highly with Simpson's method in both variable and inadequate imaging conditions, emphasizing its enduring clinical utility.


Assuntos
Aprendizado Profundo , Salas Cirúrgicas , Humanos , Volume Sistólico , Sistemas Automatizados de Assistência Junto ao Leito , Ecocardiografia/métodos , Algoritmos , Reprodutibilidade dos Testes , Função Ventricular Esquerda
3.
Patient Prefer Adherence ; 17: 3015-3031, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38027077

RESUMO

Background: Maintaining mobility is fundamental to active aging, allowing older adults to lead dynamic and independent lives. The perception of mobility among older adults significantly impacts their overall well-being and quality of life. Given the aging population, mobility has become an increasingly pressing issue. Aim: This study focused on the perception of urban neighborhoods, including considerations of urban tissue (crossings and sidewalk maintenance), urban scenes (benches and traffic), and safety (fears and street lighting quality). We investigated the differences in the perception of the surroundings of residences by urban and rural seniors concerning their demographic and social characteristics and environmental determinants. Methods: A quantitative study design utilizing a questionnaire survey was employed. Data were collected mainly through face-to-face interviews in the field (PAPI) and via an online questionnaire (CAWI). The final sample comprised 525 participants. Hypotheses regarding the influence of gender, age, social status, level of physical activity, degree of urbanization, and region on environmental perception were tested using ordinal regression. Results: The hypothesis regarding the dependence of the perception of the surroundings on the level of urbanization was confirmed; that regarding the dependence of the perception of the residence surroundings on seniors' age was not confirmed. The other hypotheses were partially confirmed. For the seven investigated environmental attributes, gender was significant in two cases, social status and physical activity in three cases, and region in four cases. Conclusion: While most studies have focused on urban settings, this study highlights the situation in rural municipalities. Substantially worse pedestrian conditions in availability of pedestrian crossings, benches, and lighting were recognized in rural municipalities versus cities. Understanding the complexity of mobility and the spatial locations relevant for older persons concerning potential barriers and facilitators for mobility aids in planning and adapting neighborhood environments to promote active and healthy aging in place.

4.
Microvasc Res ; 150: 104595, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37619889

RESUMO

INTRODUCTION: Microcirculatory dysfunction after cardiovascular surgery is associated with significant morbidity and worse clinical outcomes. Abnormal capillary blood flow can occur from multiple causes, including cytokine-mediated vascular endothelial injury, microthrombosis, and an inadequate balance between vasoconstriction and vasodilation. In response to proinflammatory cytokines, endothelial cells produce cellular adhesion molecules (CAMs) which regulate leukocyte adhesion, vascular permeability, and thus can mediate tissue injury. The relationship between changes in microcirculatory flow during circulatory shock and circulating adhesion molecules is unclear. The objective of this study was to compare changes in plasma soluble endothelial cell adhesion molecules (VCAM-1, ICAM-1, and E-Selectin) in patients with functional derangements in microcirculatory blood flow after cardiovascular surgery. METHODS: Adult patients undergoing elective cardiac surgery requiring cardiopulmonary bypass who exhibited postoperative shock were enrolled in the study. Sublingual microcirculation imaging was performed prior to surgery and within 2 h of ICU admission. Blood samples were taken at the time of microcirculation imaging for biomarker analysis. Plasma soluble VCAM-1, ICAM-1, and E-selectin in addition to plasma cytokines (IL-6, IL-8, and IL-10) were measured by commercially available enzyme-linked immunoassay. RESULTS: Of 83 patients with postoperative shock who were evaluated, 40 patients with clinical shock had a postoperative perfused vessel density (PVD) >1 SD above (High PVD group = 28.5 ± 2.3 mm/mm2, n = 20) or below (Low PVD = 15.5 ± 2.0 mm/mm2, n = 20) the mean postoperative PVD and were included in the final analysis. Patient groups were well matched for comorbidities, surgical, and postoperative details. Overall, there was an increase in postoperative plasma VCAM-1 and E-Selectin compared to preoperative levels, but there was no difference between circulating ICAM-1. When grouped by postoperative microcirculation, patients with poor microcirculation were found to have increased circulating VCAM-1 (2413 ± 1144 vs. 844 ± 786 ng/mL; p < 0.0001) and E-Selectin (242 ± 119 vs. 87 ± 86 ng/mL; p < 0.0001) compared to patients with increased microcirculatory blood flow. Microcirculatory flow was not associated with a difference in plasma soluble ICAM-1 (394 ± 190 vs. 441 ± 256; p = 0.52). CONCLUSIONS: Poor postoperative microcirculatory blood flow in patients with circulatory shock after cardiac surgery is associated with increased plasma soluble VCAM-1 and E-Selectin, indicating increased endothelial injury and activation compared to patients with a high postoperative microcirculatory blood flow. Circulating endothelial cell adhesion molecules may be a useful plasma biomarker to identify abnormal microcirculatory blood flow in patients with shock.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Molécula 1 de Adesão Intercelular , Adulto , Humanos , Selectina E , Microcirculação , Molécula 1 de Adesão de Célula Vascular , Células Endoteliais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos
5.
BMC Geriatr ; 23(1): 447, 2023 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-37474928

RESUMO

BACKGROUND: Attention is focused on the health and physical fitness of older adults due to their increasing age. Maintaining physical abilities, including safe walking and movement, significantly contributes to the perception of health in old age. One of the early signs of declining fitness in older adults is limited mobility. Approximately one third of 70-year-olds and most 80-year-olds report restrictions on mobility in their apartments and immediate surroundings. Restriction or loss of mobility is a complex multifactorial process, which makes older adults prone to falls, injuries, and hospitalizations and worsens their quality of life while increasing overall mortality. OBJECTIVE: The objective of the study is to identify the factors that have had a significant impact on mobility in recent years and currently, and to identify gaps in our understanding of these factors. The study aims to highlight areas where further research is needed and where new and effective solutions are required. METHODS: The PRISMA methodology was used to conduct a scoping review in the Scopus and Web of Science databases. Papers published from 2007 to 2021 were searched in November 2021. Of these, 52 papers were selected from the initial 788 outputs for the final analysis. RESULTS: The final selected papers were analyzed, and the key determinants were found to be environmental, physical, cognitive, and psychosocial, which confirms the findings of previous studies. One new determinant is technological. New and effective solutions lie in understanding the interactions between different determinants of mobility, addressing environmental factors, and exploring opportunities in the context of emerging technologies, such as the integration of smart home technologies, design of accessible and age-friendly public spaces, development of policies and regulations, and exploration of innovative financing models to support the integration of assistive technologies into the lives of seniors. CONCLUSION: For an effective and comprehensive solution to support senior mobility, the determinants cannot be solved separately. Physical, cognitive, psychosocial, and technological determinants can often be perceived as the cause/motivation for mobility. Further research on these determinants can help to arrive at solutions for environmental determinants, which, in turn, will help improve mobility. Future studies should investigate financial aspects, especially since many technological solutions are expensive and not commonly available, which limits their use.


Assuntos
Qualidade de Vida , Caminhada , Idoso , Humanos , Bases de Dados Factuais , Exercício Físico , Aptidão Física
8.
Sci Rep ; 12(1): 15257, 2022 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088474

RESUMO

Persistent abnormalities in microcirculatory function are associated with poor clinical outcomes in patients with circulatory shock. We sought to identify patients with acutely reversible microcirculatory dysfunction using a low-dose topical nitroglycerin solution and handheld videomicroscopy during circulatory shock after cardiac surgery. Forty subjects were enrolled for the study, including 20 preoperative control and 20 post-operative patients with shock. To test whether microcirculatory dysfunction is acutely reversible during shock, the sublingual microcirculation was imaged with incident dark field microscopy before and after the application of 0.1 mL of a 1% nitroglycerin solution (1 mg/mL). Compared to the control group, patients with shock had a higher microcirculation heterogeneity index (MHI 0.33 vs. 0.12, p < 0.001) and a lower microvascular flow index (MFI 2.57 vs. 2.91, p < 0.001), total vessel density (TVD 22.47 vs. 25.90 mm/mm2, p = 0.005), proportion of perfused vessels (PPV 90.76 vs. 95.89%, p < 0.001) and perfused vessel density (PVD 20.44 vs. 24.81 mm/mm2, p < 0.001). After the nitroglycerin challenge, patients with shock had an increase in MFI (2.57 vs. 2.97, p < 0.001), TVD (22.47 vs. 27.51 mm/mm2, p < 0.009), PPV (90.76 vs. 95.91%, p < 0.001), PVD (20.44 vs. 26.41 mm/mm2, p < 0.001), venular RBC velocity (402.2 vs. 693.9 µm/s, p < 0.0004), and a decrease in MHI (0.33 vs. 0.04, p < 0.001. Thirteen of 20 patients showed a pharmacodynamic response, defined as an increase in PVD > 1.8 SD from shock baseline. Hemodynamics and vasoactive doses did not change during the 30-min study period. Our findings suggest a topical nitroglycerin challenge with handheld videomicroscopy can safely assess for localized recruitment of the microcirculatory blood flow in patients with circulatory shock and may be a useful test to identify nitroglycerin responsiveness.


Assuntos
Nitroglicerina , Choque , Hemodinâmica/fisiologia , Humanos , Microcirculação/fisiologia , Microscopia de Vídeo
10.
Environ Sci Pollut Res Int ; 29(29): 44297-44307, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35128609

RESUMO

Waste combustion in residential small-scale combustion units is not legal in the Czech Republic or other European Union countries. The resulting gaseous and particulate pollutants expose inhabitants to smells and toxic compounds and may damage their property and health. This study is designed to define the emissions of gaseous and particulate pollutants and determine the influence of municipal waste combustion on emission factors. Different types of solid fuels, municipal wood wastes (window frames, furniture chipboard), and mixtures of solid fuels with municipal wastes (namely, textiles, plastics, PET briquettes comprising a mixture of PET bottles + wood pellets + frying oil, paper, and floor coverings) were combusted in residential combustion units (such as gasification boiler, boiler with down-draft combustion, overfire boiler, and stove). Studies describing such an extensive range of waste samples combusted in different small-scale combustion units have not yet been published. Emission factors (EFs) for products of incomplete combustion (carbon monoxide (CO), organic gaseous compounds (OGC), and polycyclic aromatic hydrocarbons (PAHs) in gaseous and particulate phases) and particulate matter (PM) were within narrow intervals and lowest for standardized wood fuel (dry wood logs only) and 2-4 times higher on average for unsuitable coal samples (coal unsuitable for the particular boiler type used and coal combined with waste), for which values fell within broad intervals.The EFs of pollutants resulting from incomplete combustion (CO, OGC, and 16 PAHtotal) and PM were lowest for standardized wood fuel (dry wood logs only) and almost two or four times higher on average for unsuitable coal fuels (coal unsuitable for the particular boiler type used and coal combined with waste).


Assuntos
Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Atmosféricos/análise , Carvão Mineral/análise , Gases , Material Particulado/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Madeira/química
12.
PeerJ ; 9: e11837, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34589291

RESUMO

Acoustic individuality may well play a big role during the mating season of many birds. Black grouse (Lyrurus tetrix) produces two different long-distance calls during mating on leks: rookooing and hissing calls. The first one represents low frequency series of bubbling sounds and the second one represents hissing sound. This hissing represents a signal not produced by the syrinx. We analyzed 426 hissing calls from 24 individuals in Finland and Scotland. We conducted cross-validated discrimination analyses (DFA). The discrimination model classified each call with almost 78% accuracy (conventional result) and the validated DFA revealed 71% output, that is much higher than classification by chance (4%). The most important variables were Frequency 95%, 1st Quartile Frequency, Aggregate Entropy and Duration 90%. We also tested whether between individual variation is higher than within individual variation using PIC (Potential for individual coding) and we found that all acoustic parameters had PIC > 1. We confirmed that hissing call of black grouse is individually distinct. In comparison to the signals produced by the syrinx, non-vocal sounds have been studied rarely and according to our knowledge, this is the second evidence of vocal individuality in avian hissing sounds which are not produced by syrinx. Individuality in the vocalization of the male black grouse may aid females in mating partner selection, and for males it may enable competitor recognition and assessment. Individually distinct hissing calls could be of possible use to monitor individuals on leks. Such a method could overcome problems during traditional monitoring methods of this species, when one individual can be counted multiple times, because catching and traditional marking is problematic in this species.

13.
Sci Total Environ ; 788: 147779, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34034186

RESUMO

Automobile friction brakes generate, in addition to coarse particles generated by mechanical processes, highly variable amount of nanoparticles from high temperature processes. The effects of braking conditions - speed, deceleration rate, brake rotor temperatures - on nanoparticle production were investigated here, aiming to provide practical guidance for reducing emissions through driving style and traffic management. Typical brake pads and a rotor from a common passenger car were subjected, on a brake dynamometer, to three runs of the WLTP brake cycle developed for brake wear particle measurements. Additionally, four sets of common brake pads were subjected to those parts of standardized brake performance tests believed to be reasonably realistic for common driving. Particle size distributions (5.6-560 nm electric mobility diameter, without removal of volatiles) show a dominant peak at 10 nm commensurate to the severity of braking and a non-linear increase of the total particle number at higher braking powers and higher total energy dissipated. The average emissions for three runs of the WLTP brake cycle were 3.3 × 1010 particles/km, while the harshest deceleration, 175-100 km/h at 5.28 m·s-2, has produced 8.4 to 38 × 1013 particles, corresponding to 2.5-11.5 thousands of km of WLTP-like driving. While previous studies have correlated higher PN production with higher average brake rotor temperature, a more complex relationship between nanoparticle emissions and a combination of initial rotor temperature, total energy dissipated and braking power has been observed here. From a driver behavior and regulatory perspective, it appears limiting harsh braking and braking from high speeds, possibly through improved driving practices, road design and traffic management, may potentially reduce brake wear nanoparticles. From the measurement perspective, it appears that "off-cycle" braking, even if relatively infrequent, may be associated with exponentially higher emissions and non-negligible share of the total emissions, and therefore should not be neglected.

14.
J Vasc Surg Cases Innov Tech ; 7(2): 189-192, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33997551

RESUMO

We describe a 69-year-old dialysis-dependent patient who developed intractable ascites after zone 2 aortic reconstruction for a type IA thoracic endovascular aneurysm repair endoleak. Investigation as to the cause of ascites revealed a unique set of clinical circumstances leading to intractable bloody ascites. Investigation included imaging and invasive testing to diagnose the culprit mechanism. Ultimately, interventional catherization of the left subclavian vein illustrated an abnormally elevated pressure in the left subclavian vein. It was thus determined that, owing to the combination of a left brachiocephalic (innominate) vein occlusion after surgical ligation and in situ left brachiobasilic arteriovenous dialysis graft, there was overcirculation through the thoracic duct. Retrograde flow through the pop-off thoracic duct led to hematogenous ascites. Ligation of the left brachiobasilic arteriovenous dialysis graft resulted in near instantaneous and complete resolution of the ascites.

15.
Chemosphere ; 278: 130402, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33839387

RESUMO

The study describes gaseous and particulate emissions from the combustion of two types of coal (hard and brown) in three types of boilers (one modern-type and two old-type boilers) used for residential heating. The importance of the heat outputs (nominal and two reduced outputs) for the emission of pollutants was also studied. Three outputs (95-108%, 58-73% and 26-50%) covered the expected operation of these boilers in real households under different outdoor air temperatures in the winter. Gaseous components (NOx, SO2, CO, CO2, OGC) and particulate organic compounds (n-alkanes, polycyclic aromatic hydrocarbons, hopanes) were determined in the emissions. In general, the emission factors (EFs) of the products of incomplete combustion were higher from the combustion of coal in old-type boilers than from that in the modern-type boilers. The EFs of particulate matter varied between 11.6 and 17.0 g kg-1 (hard coal, the oldest-type boiler), and 0.290 and 0.544 g kg-1 (brown coal, the modern-type boiler). The trends between the EFs of particulate organic compounds and the outputs of boilers were observed only with the automatic boiler (modern-type boiler). Similar trends for old-type boilers were not observed, probably due to the high instability of the combustion process as a result of the old construction of these boilers. Diagnostic ratios of the PAHs and the homohopane index, used for source apportionment of particulate matter in ambient air, were calculated. While the calculated homohopane indexes were similar to those reported in the literature, the calculated diagnostic ratios for PAHs related to coal combustion were different.


Assuntos
Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Atmosféricos/análise , China , Carvão Mineral/análise , Gases , Calefação , Material Particulado/análise , Hidrocarbonetos Policíclicos Aromáticos/análise
16.
Shock ; 56(2): 245-254, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394972

RESUMO

INTRODUCTION: Lactic acidosis after cardiac surgery with cardiopulmonary bypass is common and associated with an increase in postoperative morbidity and mortality. A number of potential causes for an elevated lactate after cardiopulmonary bypass include cellular hypoxia, impaired tissue perfusion, ischemic-reperfusion injury, aerobic glycolysis, catecholamine infusions, and systemic inflammatory response after exposure to the artificial cardiopulmonary bypass circuit. Our goal was to examine the relationship between early abnormalities in microcirculatory convective blood flow and diffusive capacity and lactate kinetics during early resuscitation in the intensive care unit. We hypothesized that patients with impaired microcirculation after cardiac surgery would have a more severe postoperative hyperlactatemia, represented by the lactate time-integral of an arterial blood lactate concentration greater than 2.0 mmol/L. METHODS: We measured sublingual microcirculation using incident darkfield video microscopy in 50 subjects on intensive care unit admission after cardiac surgery. Serial measurements of systemic hemodynamics, blood gas, lactate, and catecholamine infusions were recorded each hour for the first 6 h after surgery. Lactate area under the curve (AUC) was calculated over the first 6 h. The lactate AUC was compared between subjects with normal and low perfused vessel density (PVD < 18 mm/mm2), high microcirculatory heterogeneity index (MHI > 0.4), and low vessel-by-vessel microvascular flow index (MFIv < 2.6). RESULTS: Thirteen (26%) patients had a low postoperative PVD, 20 patients (40%) had a high MHI, and 26 (52%) patients had a low MFIv. Patients with low perfused vessel density had higher lactate AUC compared with subjects with a normal PVD (22.3 [9.4-31.0] vs. 2.6 [0-8.8]; P < 0.0001). Patients with high microcirculatory heterogeneity had a higher lactate AUC compared with those with a normal MHI (2.5 [0.1-8.2] vs. 13.1 [3.7-31.1]; P < 0.001). We did not find a difference in lactate AUC when comparing high and low MFIv. CONCLUSION: Low perfused vessel density and high microcirculatory heterogeneity are associated with an increased intensity and duration of lactic acidosis after cardiac surgery with cardiopulmonary bypass.


Assuntos
Acidose Láctica/fisiopatologia , Ponte Cardiopulmonar , Hemodinâmica , Microcirculação , Complicações Pós-Operatórias/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
17.
J Cardiothorac Vasc Anesth ; 35(1): 106-115, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32505603

RESUMO

OBJECTIVE: Resuscitation after cardiac surgery needs to address multiple pathophysiological processes that are associated with significant morbidity and mortality. Functional microcirculatory derangements despite normal systemic hemodynamics have been previously described but must be tied to clinical outcomes. The authors hypothesized that microcirculatory dysfunction after cardiac surgery would include impaired capillary blood flow and impaired diffusive capacity and that subjects with the lowest quartile of perfused vessel density would have an increased postoperative lactate level and acute organ injury scores. DESIGN: Prospective, observational study. SETTING: A single, tertiary university cardiovascular surgical intensive care unit. PARTICIPANTS: 25 adults undergoing elective cardiac surgery requiring cardiopulmonary bypass. INTERVENTION: Sublingual microcirculation was imaged using incident dark field microscopy before and 2 to 4 hours after surgery in the intensive care unit. MEASUREMENTS AND MAIN RESULTS: Compared with baseline measurements, postoperative vessel-by-vessel microvascular flow index (2.9 [2.8-2.9] v 2.5 [2.4-2.7], p < 0.0001) and perfused vessel density were significantly impaired (20.7 [19.3-22.9] v 16.3 [12.8-17.9], p < 0.0001). The lowest quartile of perfused vessel density (<12.8 mm/mm2) was associated with a significantly increased postoperative lactate level (6.0 ± 2.9 v 1.8 ± 1.2, p < 0.05), peak lactate level (7.6 ± 2.8 v 2.8 ± 1.5, p = 0.03), and sequential organ failure assessment (SOFA) score at 24 and 48 hours. CONCLUSION: In patients undergoing cardiac surgery, there was a significant decrease in postoperative microcirculatory convective blood flow and diffusive capacity during early postoperative resuscitation. Severely impaired perfused vessel density, represented by the lowest quartile of distribution, is significantly related to hyperlactatemia and early organ injury.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ácido Láctico , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemodinâmica , Humanos , Microcirculação , Soalho Bucal , Estudos Prospectivos
18.
ACS Omega ; 5(44): 28587-28596, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33195910

RESUMO

The aim of this study was to determine the operating parameters of bioethanol burners used in the so-called bioethanol fireplaces, mainly in terms of their actual heat output. The method used to determine the actual heat output was designed considering procedures from the standard EN 16647 fireplaces for liquid fuel. Experiments were carried out on eight different types of burners with two different types of fuels. The measurements demonstrated a difference of up to 19% in the maximal heat output among individual fuels and a difference of up to 16% in the average heat output when comparing identical burners over approximately 60 min of operation. The average heat outputs of the burners during the measurements reached approximately 41-62% of the heat output declared by the manufacturers. The measured values were used to create graphs of the dependency of the burner opening size on its average heat output based on the fuel type. Two-chambered burners reached a higher average heat output than single-chambered burners with the same burner opening area of above ∼6000 mm2. The positions of the regulation damper (75 and 50%) increased the burning time by 21 and 86%, respectively.

20.
J Environ Manage ; 248: 109269, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31352275

RESUMO

In this study, 73 ash samples (comprising 49 ash samples from combustion tests performed in 2017, and 24 ash samples from combustion tests performed during 2014-2016 at the Energy Research Center, Ostrava, Czech Republic) were analysed. Ash samples were obtained via the combustion of various solid fuels, their mixtures with municipal waste (floor coverings, paper, polyethylene terephthalate (PET) briquettes, plastics, and textiles), and municipal wood waste (furniture chipboard, window frames) in household combustion units, such as an overfire boiler, boiler with downdraft combustion, gasification boiler, automatic boiler, and stove. The aim of this study was to determine the composition of representative ash samples from solid fuels and municipal waste and to determine which parameters (metals and halides) were present in the ash analysis after waste incineration. Statistical evaluation of box plots with the determination of the boundaries for outliers and extreme values was performed. Finally, six metals (Sb, Cu, Pb, Sn, Ti, and Zn), together with chlorides, were taken as the indicators of municipal waste incineration in households. The highest value of Sb was 344 mg/kg in plastics + dry beech; the highest value of Cu was 30,500 mg/kg in textiles + black coal (B1); the highest concentration of Pb was 1,360 mg/kg in floor coverings + dry beech; the highest value of Sn was 108 mg/kg in textiles + dry beech; the highest concentration of Ti was 38,200 mg/kg in window frames; the highest value of Zn was 215,000 mg/kg in window frames; and the highest concentration of chlorides was 191,000 mg/kg in floor coverings + dry beech.


Assuntos
Cinza de Carvão , Metais Pesados , República Tcheca , Incineração , Resíduos Sólidos , Madeira
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