Extracorporeal rewarming from experimental hypothermia: Effects of hydroxyethyl starch versus saline priming on fluid balance and blood flow distribution

This is the peer reviewed version of the following article:Extracorporeal rewarming from experimental hypothermia: Effects of hydroxyethyl starch versus saline priming on fluid balance and blood flow distribution which has been published in final form at https://doi.org/10.1113/EP087786. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Rewarming by extracorporeal circulation (ECC) is the recommended treatment for accidental hypothermia patients with cardiac instability. Hypothermia, along with initiation of ECC, introduces major changes in fluid homeostasis and blood flow. Scientific data to recommend best practice use of ECC for rewarming these patients is lacking, and no current guidelines exist concerning the choice of priming fluid for the extracorporeal circuit. The primary aim of this study was to compare the effects of different fluid protocols on fluid balance and blood flow distribution during rewarming from deep hypothermic cardiac arrest. Sixteen anaesthetized rats were cooled to deep hypothermic cardiac arrest and rewarmed by ECC. During cooling, rats were equally randomized into two groups: an extracorporeal circuit primed with saline or primed with hydroxyethyl starch (HES). Calculations of plasma volume (PV), circulating blood volume (CBV), organ blood flow, total tissue water content, global O2 delivery and consumption were made. During and after rewarming, the pump flow rate, mean arterial pressure, PV and CBV were significantly higher in HES‐treated compared with saline‐treated rats. After rewarming, the HES group had significantly increased global O2 delivery and blood flow to the brain and kidneys compared with the saline group. Rats in the saline group demonstrated a significantly higher total tissue water content in the kidneys, skeletal muscle and lung. Compared with crystalloid priming, the use of an iso‐oncotic colloid prime generates less tissue oedema and increases PV, CBV and organ blood flow during ECC rewarming. The composition of fluid additions appears to be an important factor during ECC rewarming from hypothermia

Precision measurement of the electric quadrupole moment of 31Al and determination of the effective proton charge in the sd-shell

he electric quadrupole coupling constant of the 31Al ground state is measured to be nu_Q = |eQV_{zz}/h| = 2196(21)kHz using two different beta-NMR (Nuclear Magnetic Resonance) techniques. For the first time, a direct comparison is made between the continuous rf technique and the adiabatic fast passage method. The obtained coupling constants of both methods are in excellent agreement with each other and a precise value for the quadrupole moment of 31Al has been deduced: |Q(31Al)| = 134.0(16) mb. Comparison of this value with large-scale shell-model calculations in the sd and sdpf valence spaces suggests that the 31Al ground state is dominated by normal sd-shell configurations with a possible small contribution of intruder states. The obtained value for |Q(31Al)| and a compilation of measured quadrupole moments of odd-Z even-N isotopes in comparison with shell-model calculations shows that the proton effective charge e_p=1.1 e provides a much better description of the nuclear properties in the sd-shell than the adopted value e_p=1.3 e

Study of 19^{19} Na at SPIRAL

NESTERInternational audienceThe excitation function for the elastic-scattering reaction p18Ne, p18Ne was measured with the first radioactive beam from the SPIRAL facility at the GANIL laboratory and with a solid cryogenic hydrogen target. Several broad resonances have been observed, corresponding to new excited states in the unbound nucleus 19Na. In addition, two-proton emission events have been identified and are discussed

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy

peer reviewedBackground: The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. Objective: Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. Methods: Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non–oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. Results: For non–OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. Conclusions: These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction. © 202

A sensitivity-based approach for adaptive decomposition of anticipatory network traffic control

Anticipatory optimal network control is defined as the problem of determining the set of control actions that minimizes a network-wide objective function. This not only takes into account local consequences on the propagation of flows, but also the global network-wide routing behavior of the users. Such an objective function is, in general, defined in a centralized setting, as knowledge regarding the whole network is needed to correctly compute it. Reaching a level of centralization sufficient to attain network-wide control objectives is however rarely realistic in practice. Multiple authorities are influencing different portions the network, separated either hierarchically or geographically. The distributed nature of networks and traffic directly influences the complexity of the anticipatory control problem. This is our motivation for this work, in which we introduce a decomposition mechanism for the global anticipatory network traffic control problem, based on dynamic clustering of traffic controllers. Rather than solving the full centralized problem, or blindly performing a full controller-wise decomposition, this technique allows recognizing when and which controllers should be grouped in clusters, and when, instead, these can be optimized separately. The practical relevance with respect to our motivation is that our approach allows identification of those network traffic conditions in which multiple actors need to actively coordinate their actions, or when unilateral action suffices for still approximating global optimality. This clustering procedure is based on well-known algebraic and statistical tools that exploit the network's sensitivity to control and its structure to deduce coupling behavior. We devise several case studies in order to assess our newly introduced procedure's performances, in comparison with fully decomposed and fully centralized anticipatory optimal network control, and show that our approach is able to outperform both centralized and decomposed procedures. © 2016 Elsevier Ltd

Centralized and decomposed anticipatory Model Predictive Control for network-wide Ramp Metering

The problem of determining Ramp Metering control rates, taking into account routing response, is addressed in this paper. We develop Model Predictive Control based Anticipatory control schemes, featuring both centralized and decomposed optimization problems, with focus on real-life deployability. We then evaluate the aforementioned schemes' performances in comparison to simpler, non-anticipatory control techniques, by means of software simulation based on purpose-built experimental scenarios. © 2013 IEEE