Postoperative serum squamous cell carcinoma antigen and carcinoembryonic antigen predict overall survival in surgical patients with esophageal squamous cell carcinoma

BackgroundTumor markers are routinely used in clinical practice. However, for resectable patients with esophageal squamous cell carcinoma (ESCC), they are applied infrequently as their prognostic significance is incompletely understood.MethodsThis historical cohort study included 2769 patients with resected ESCC from 2011 to 2018 in a high-risk area in northern China. Their clinical data were extracted from the Electronic Medical Record. Survival analysis of eight common tumor markers was performed with multivariable Cox proportional hazards regressions.ResultsWith a median follow-up of 39.5 months, 901 deaths occurred. Among the eight target markers, elevated postoperative serum SCC (Squamous cell carcinoma antigen) and CEA (Carcinoembryonic antigen) predicted poor overall survival (SCC HRadjusted: 2.67, 95% CI: 1.70-4.17; CEA HRadjusted: 2.36, 95% CI: 1.14-4.86). In contrast, preoperative levels were not significantly associated with survival. Stratified analysis also demonstrated poorer survival in seropositive groups of postoperative SCC and CEA within each TNM stage. The above associations were generally robust using different quantiles of concentrations above the upper limit of the clinical normal range as alternative cutoffs. Regarding temporal trends of serum levels, SCC and CEA were similar. Their concentrations fell rapidly after surgery and thereafter remained relatively stable.ConclusionPostoperative serum SCC and CEA levels predict the overall survival of ESCC surgical patients. More importance should be attached to the use of these markers in clinical applications

A numerical study of the hemodynamic behavior and gas transport in cardiovascular systems with severe cardiac or cardiopulmonary failure supported by venoarterial extracorporeal membrane oxygenation

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been extensively demonstrated as an effective means of bridge-to-destination in the treatment of patients with severe ventricular failure or cardiopulmonary failure. However, appropriate selection of candidates and management of patients during Extracorporeal membrane oxygenation (ECMO) support remain challenging in clinical practice, due partly to insufficient understanding of the complex influences of extracorporeal membrane oxygenation support on the native cardiovascular system. In addition, questions remain as to how central and peripheral venoarterial extracorporeal membrane oxygenation modalities differ with respect to their hemodynamic impact and effectiveness of compensatory oxygen supply to end-organs. In this work, we developed a computational model to quantitatively address the hemodynamic interaction between the extracorporeal membrane oxygenation and cardiovascular systems and associated gas transport. Model-based numerical simulations were performed for cardiovascular systems with severe cardiac or cardiopulmonary failure and supported by central or peripheral venoarterial extracorporeal membrane oxygenation. Obtained results revealed that: 1) central and peripheral venoarterial extracorporeal membrane oxygenation modalities had a comparable capacity for elevating arterial blood pressure and delivering oxygenated blood to important organs/tissues, but induced differential changes of blood flow waveforms in some arteries; 2) increasing the rotation speed of extracorporeal membrane oxygenation pump (ω) could effectively improve arterial blood oxygenation, with the efficiency being especially high when ω was low and cardiopulmonary failure was severe; 3) blood oxygen indices (i.e., oxygen saturation and partial pressure) monitored at the right radial artery could be taken as surrogates for diagnosing potential hypoxemia in other arteries irrespective of the modality of extracorporeal membrane oxygenation; and 4) Left ventricular (LV) overloading could occur when ω was high, but the threshold of ω for inducing clinically significant left ventricular overloading depended strongly on the residual cardiac function. In summary, the study demonstrated the differential hemodynamic influences while comparable oxygen delivery performance of the central and peripheral venoarterial extracorporeal membrane oxygenation modalities in the management of patients with severe cardiac or cardiopulmonary failure and elucidated how the status of arterial blood oxygenation and severity of left ventricular overloading change in response to variations in ω. These model-based findings may serve as theoretical references for guiding the application of venoarterial extracorporeal membrane oxygenation or interpreting in vivo measurements in clinical practice

Aerodynamic Divergence of a Super-long Span Cable-stayed Bridge under Very Strong Wind

ABSTRACT: Wind tunnel test of aeroelastic full model of Sutong Bridge is introduced, and special aerodynamic instability style was observed. The aeroelastic full model is regarded as a non-normal vibration system, and the vibration characteristics are investigated and analyzed. Complex modal analysis is carried out using SSA (Stochastic Search Algorithm) and SSI (Stochastic Subspace Identification). The results of both methods are agreed well. The torsional mode participates largely in vertical and lateral vibration, while the vertical and lateral modes have a little participation in the other two modes respectively

Laminar flow-induced vibration of a three-degree-of-freedom circular cylinder with an attached splitter plate

Splitter plates are widely used for drag reduction and vibration control or enhancement of circular cylinders. The effects of a splitter plate on the vertical flow-induced vibrations of a circular cylinder have been well studied. However, its effects on the vertical-torsional coupled vibrations require further investigation. In this paper, the three-degree-of-freedom (TDoF) flow-induced vibrations of a circular cylinder with an attached splitter plate are numerically investigated at a Reynolds number of 100. The ratio between the torsional and vertical natural frequencies is varied within ,0/ℎ,0 = 6, 4, 3, 2, and 1. Numerical results show that the flow-induced vibrations of a TDoF cylinder-plate assembly, depending on the frequency ratio, may differ significantly from those of a single-degree-of-freedom (SDoF) vertical or torsional assembly. For cylinder-plate assemblies with ,0/ℎ,0 = 6–2, the vibrations can be divided into a vertical vibration-dominated branch (V branch), a torsional vibration-dominated branch (T branch), and a coupled vibration-dominated branch (C branch). The V branch vibration of a TDoF assembly is similar to that of an SDoF vertical assembly at the same reduced flow velocity, while the difference increases with decreasing the frequency ratio. The T branch vibration of a TDoF assembly is almost identical to the vibration of an SDoF torsional assembly at the same reduced flow velocity. The ratio between the torsional and vertical vibration amplitudes increases with decreasing the frequency ratio in the C branch. For the assembly with ,0/ℎ,0 = 1, vertical-torsional coupled vortex-induced vibrations are observed with the largest torsional amplitude as high as 46.3°. The vibrations of TDoF assemblies with all considered frequency ratios may be more severe than those of SDoF vertical and torsional assemblies within specific ranges of reduced flow velocities. The mean drag coefficients for the ,0/ℎ,0 = 6–2 assemblies are lower than a stationary circular cylinder but often higher than a stationary cylinder-plate assembly. The mean drag coefficients for the ,0/ℎ,0 = 1 assembly in the lock-in range are considerably larger than that of a stationary circular cylinder. For TDoF assemblies with ,0/ℎ,0 = 6–2, the V branch and C branch vibrations are mainly driven by the interaction between the assembly and the shear layers, while the T branch vibrations are excited by the typical 2S mode of vortex shedding. The 2S vortex shedding mode is also observed in the lock-in range of the ,0/ℎ,0 = 1 assembly

Experimental Investigation on Glaze Ice Accretion and Its Influence on Aerodynamic Characteristics of Pipeline Suspension Bridges

Pipeline suspension bridges may experience ice accretion under special atmospheric conditions, and the aerodynamic characteristics of the bridges may be modified by the ice accretion. Under some specific climatic conditions of freezing rain, the dependencies of the ice size and shape on the icing duration and some structural properties (including pipeline diameter, inclination angle of wind hanger, inclination angle and size of section steel, and girder geometry) were experimentally investigated in a refrigerated precipitation icing laboratory. Typical ice accretions on pipelines, wind hangers, section steels, and girders of pipeline suspension bridges are summarized. Then the effects of some selected ice accretions on aerodynamic force coefficients of a bridge girder were further investigated through wind tunnel tests. The ice size and shape on the pipeline were closely related to the pipeline diameter and icing duration. The engineering geometric models of ice accretion on pipelines were extracted. The ice shape and size on wind hangers and section steels changed with their inclination angles. The aerodynamic force coefficients of a girder with ice accretion were much higher than those of an ice-free one. The results can provide references for simulating the ice accretion and further evaluating the effect of ice accretion on the aerodynamics of pipeline suspension bridges

Research on the aerostatic characteristics of bridge deck based on OpenFOAM

Taking an Italian cable-stayed bridge as an engineering example, the aerostatic characteristics of closed-box deck section are investigated using both wind tunnel test and CFD numerical simulation. Based on the open source code OpenFOAM, the aerostatic coefficients and pressure coefficients distribution of square section and bridge deck section under different attack angles are numerically simulated. The simulation results are compared with the experimental data from the wind tunnel test. The effects of bottom surface chamfers on the aerostatic characteristics are also studied. Furthermore, the simulated wind flow around the box deck section is carried out to explore the mechanisms of the experimental results. The results show that the aerostatic coefficients of square section and bridge deck section under different angles of attack obtained from the test and the simulation match well. The aerostatic performance of closed-box deck section can be improved by using a rounded chamfer on the bottom surface