Remote ischaemic conditioning as a cardioprotective mechanism against anthracycline induced cardiac injury and multimodality monitoring of patients receiving anthracycline chemotherapy

Introduction: Remote ischaemic conditioning was investigated as a cardioprotective strategy against anthracycline cardiotoxicity in the clinical setting. Identifying ways to best monitor these was also assessed. Methodology: A randomised double-blind controlled trial of remote ischaemic conditioning vs sham was performed in patients receiving anthracyclines. Conditioning was delivered with 4 cycles of 5-minute inflations/deflations prior to each chemotherapy cycle. High sensitivity troponin T was analysed at baseline, during chemotherapy and at follow-up. Echocardiography was performed at baseline and at follow-up. Arrhythmia assessment was performed during chemotherapy. Clinical events were documented at each visit. A cohort of patients had rapid sequence cardiac MRI and cardiac myosin binding protein C. The main outcome was change in troponin T between the two groups. Secondary outcomes included LV function, clinical events and arrhythmia outcomes. The relationship between peak troponin and secondary outcomes was assessed in a prospective observational manner. Results: Thirty-seven patients were randomly allocated to the remote ischaemic conditioning (n=19) or sham group (n=18). After excluding withdrawals, 16 patients in each group were included in the intention to treat analysis. Troponin T significantly increases during chemotherapy and peaks 1 month after. Regression analysis shows no difference in troponins between the groups during chemotherapy (mean difference 1.59ng/L, p=0.245) or follow-up (mean difference 0.62ng/L, p=0.744). Clinical events were similar. There was a significant trend towards more admissions with sepsis/neutropenia in the RIC group. There is a moderate correlation between peak troponin and total cumulative dose received (r=0.422, p=0.016) but no correlation with other outcomes. cMyC has a 4-fold median peak increase compared to 2-fold for TnT (p<0.001). Rapid sequence CMR is feasible (mean scanning time 14 minutes) and acceptable (85% acceptance rate). Conclusions: Remote ischaemic conditioning does not reduce anthracycline cardiotoxicity as assessed with troponin T despite a significant rise in troponin from chemotherapy

Modelling of turbulent gas-solid flows from DNS to LES

The purpose of this thesis is to explain the underlying physics of turbulent particle­ laden flows in the context of Direct Numerical Simulations (DNS). Moreover , mod­ elling tools, that can be used in Large Eddy Simulations (LES), are developed and validated against experimental and DNS data. DNS of homogenous and isotropic turbulence are performed in order to explain the turbulence modulation caused by the particles. In order to carry out this analysis, a novel forcing method is developed that retains the statistics of the fluid. Contrary to other forcing schemes, it is shown that this scheme does not affect the statistics of both phases. The two-way coupling spectrum reveals that the particles transfer energy from the large to the small scales, whereby some of this energy is dissipated by the fluid. Additionally, a model two-way coupling spectrum is proposed that considers the observations of the DNS study. Filtering is performed on the DNS results in order to remove the high frequency velocity components. It is evident from the results that the absence of the subgrid velocity fluctuations have an impact on the particle pair dispersion. Moreover , a novel stochastic model is proposed which reconstructs the subgrid scale turbulence characteristics. The results of the model are very promising as there is good agree­ ment with the DNS data. LES of a turbulent horizontal particle-laden channel flow is performed in order to compare the soft-sphere and hard-sphere models and coupling strategies. A novel roughness model, used in conjunction with the soft-sphere model, is proposed. The results of the soft sphere and hard sphere models are in very good agreement with the available experimental data. Furthermore, the results, also, show that the wall roughness is an important mechanism in keeping the particles distributed across the channel despite the action of gravity.Open Acces

Reynolds number effects on particle agglomeration in turbulent channel flow

The work described in this paper employs large eddy simulation and a discrete element method to study particle-laden flows, including particle dispersion and agglomeration, in a horizontal channel. The particle-particle interaction model is based on the Hertz- Mindlin approach with Johnson-Kendall-Roberts cohesion to allow the simulation of Van der Waals forces in a dry air flow. The influence of different flow Reynolds numbers, and therefore the impact of turbulence, on particle agglomeration is investigated. The agglomeration rate is found to be strongly influenced by the flow Reynolds number, with most of the particle-particle interactions taking place at locations close to the channel walls, aided by the higher turbulence and concentration of particles in these regions

Cardio-oncology for the general physician: 'old' and 'new' cardiovascular toxicities and how to manage them

Cardio-oncology is the care of cancer patients with cardiovascular disease. The need for a dedicated subspecialty emerged to address heart failure caused by drugs such as anthracyclines and anti-human epidermal growth factor receptor 2 (HER2) therapies, but over time has expanded into an exciting subspecialty with widening horizons. While still dealing with a lot of commonly recognised toxicities, such as heart failure, hypertension and coronary disease, new and revolutionary cancer therapies have been associated with challenging cardiovascular complications, requiring specialist input to manage effectively. Echocardiography is a key investigation, with advanced techniques such as three-dimensional and strain assessment allowing more accurate diagnosis and earlier detection of subtle changes. Cardiac magnetic resonance and biomarkers are useful adjuncts to aid diagnosis and management. With increasing cancer incidence and improved cancer survival rates, it is important that general cardiologists and physicians are aware of cardiac complications associated with cancer and how to manage them

Anthracyclines and Biomarkers of Myocardial Injury: The Effect of Remote Ischemic Conditioning

Background: Remote ischemic conditioning (RIC) has been beneficial in laboratory studies of anthracycline cardiotoxicity, but its effects in patients is not established. Objectives: The authors studied the effect of RIC on cardiac biomarkers and function during and after anthracycline chemotherapy. Methods: The ERIC-Onc study (Effect of Remote Ischaemic Conditioning in Oncology Patients; NCT02471885) was a randomized, single-blind, sham-controlled study of RIC at each chemotherapy cycle. The primary endpoint was troponin T (TnT) during chemotherapy and up to 1 year. Secondary outcomes included cardiac function, major adverse cardiovascular events (MACE), and MACE or cancer death. Cardiac myosin-binding-protein C (cMyC) was investigated in parallel with TnT. Results: The study was prematurely halted after the evaluation of 55 patients (RIC n = 28, sham n = 27). Biomarkers increased from baseline to cycle 6 of chemotherapy for all patients (median TnT 6 [IQR: 4-9] ng/L to 33 [IQR: 16-36)] ng/L; P ≤ 0.001; cMyC 3 (IQR: 2-5) ng/L to 47 (IQR: 18-49) ng/L; P ≤ 0.001). Mixed-effects regression analysis for repeated measures showed no difference in TnT between the 2 groups (RIC vs sham, mean difference 3.15 ng/L; 95% CI: −0.04 to 6.33; P = 0.053), or cMyC (RIC vs sham, mean difference 4.17 ng/L; 95% CI: −0.12 to 8.45; P = 0.056). There were more MACE and cancer deaths in the RIC group (11 vs 3; HR: 0.25; 95% CI: 0.07-0.90; P = 0.034), with more cancer deaths (8 vs 1; HR: 0.21; 95% CI: 0.04-0.95; P = 0.043) at 1 year. Conclusions: TnT and cMyC significantly increased during anthracycline chemotherapy with 81% having a TnT ≥14 ng/L at cycle 6. RIC did not affect the rise in biomarkers, but there was a small increase in early cancer deaths, possibly related to the greater proportion of patients with metastatic disease randomized to the RIC group (54%vs 37%). (Effect of Remote Ischaemic Conditioning in Oncology Patients [ERIC-ONC]; NCT02471885

Particle Agglomeration and Dispersion in Fully-coupled Turbulent Channel Flow Using Large Eddy Simulation and Discrete Element Method

The work described in this paper employs large eddy simulation and the discrete element method to study particle-laden flows, including particle dispersion and agglomeration, in a horizontal channel. The particle-particle interaction model used is based on the Hertz-Mindlin approach with Johnson-Kendall-Roberts cohesion to allow the simulation of Van der Waals forces in the dry air flow considered. The influence of different particle surface energies, particle size, particle concentration and flow Reynolds numbers on particle agglomeration is investigated. The turbulent structure of the flow is found to dominate the motion of the particles, although the agglomeration rate is found to be strongly influenced by all of the variables noted above, with most of the particle-particle interactions taking place at locations close to the channel walls, aided by the higher turbulence levels and concentration of particles in these regions

Röda Korsets hantering av den egna krisen : mediedrevet mot Röda Korset och Bengt Westerberg

I denna uppsats analyseras åtta artiklar publicerade av fyra stora, svenska dagstidningar. Syftet med analysen är att analysera välgörenhetsorganisationen Röda Korsets kriskommunikationsstrategier under organisationskrisen där styrelseordförande Bengt Westerbergs arvode är i nyhetsmediernas fokus. De frågor som uppsatsen besvarar är: Hur framställs Röda Korset i dagspressens rapportering om Bengt Westerbergs arvode? Hur tycks Röda Korsets inställning, i artiklarna, till krisen vara? Använder organisationen sig av någon kriskommunikationsstrategi? I analysen av artiklarna används van Djiks kritiska diskursanalys som analysmetod. De teorier som resultatet sen kopplas till är teorier om organisationskriser och kriskommunikationsstrategier, det vill säga apologia, mediedrevet och dess egenskaper samt diskursteori. I analysen av artiklarna framträder två kriskommunikationsstrategier där Röda Korset först försöker överföra ansvaret för arvodet på någon annan och sedan argumenterar varför Westerberg bör erhålla det arvode han får. Röda Korset beslutar även om en åtgärd, vilken innebär att organisationens medlemmar får möjligheten att påverka beslutet om arvodet i ett nationellt rådslag. Bengt Westerberg tycks dock inte vara posivit inställd till debatten, då han beskrivs vara irriterad under Röda Korsets presskonferens. Röda Korset meddelar däremot att de tar krisen på ”stort allvar”. Utöver den negativa framställningen av Westerberg i artiklarna, ger artiklarna även en bild av att Röda Korsets verksamhet är problemfylld då de drabbats av många krisen under den senaste tiden. Trots två kriskommunikationsstrategier och en åtgärd tycks organisationens ansträngningar för att lindra en förtroendekris hos medlemmarna vara otillräckliga. Medlemsantalet sjönk med 40 000 medlemmar under året då krisen inträffade

A Review of the Latest Trends in the Use of Green Ammonia as an Energy Carrier in Maritime Industry

This review paper examines the key barriers to using green ammonia as an alternative fuel in maritime industry. A literature survey is performed based on research articles and grey literature, with the aim of discussing the technoeconomic problems with and benefits of ammonia and the relevant technologies. The limitations of ammonia as a maritime fuel and its supply chain, the expected percentage demand by 2030 and 2050, its economic performance compared to other shipping fuels such as hydrogen, and the current regulations that may impact ammonia as a maritime fuel are discussed. There are several key barriers to ammonia&rsquo;s wide adoption: (1) High production costs, due to the high capital costs associated with ammonia&rsquo;s supply chain; (2) availability, specifically the limited geographical locations available for ammonia bunkering; (3) the challenge of ramping up current ammonia production; and (4) the development of ammonia-specific regulations addressing issues such as toxicity, safety, and storage. The general challenges involved with blue ammonia are the large energy penalty and associated operational costs, and a lack of technical expertise on its use. Regardless of the origin, for ammonia to be truly zero-carbon its whole lifecycle must be considered&mdash;a key challenge that will aid in the debate about whether ammonia holds promise as a zero-carbon maritime fuel

Modelling of Combustion, NOx Emissions and Radiation of a Natural Gas Fired Glass Furnace

Paper presented at AFRC 2014 Industrial Combustion SymposiumThis work performs numerical simulations of a natural gas fired glass furnace. The purpose of this work is to provide useful insights in the design of glass furnaces and the appropriate modelling strategy for such types of simulations. The results are compared to the available experimental data and the importance of the recirculating region for the effective heat transfer at the glass wall is highlighted. The formation of NOx is a crucial parameter in the design of glass furnaces. Therefore, additional calculations for NOx are performed. The simulations, which are in agreement with the available experimental data, indicate the approximate intensity and location of NOx formation. Finally, the importance of radiation effects is highlighted by performing a simulation without radiation. The results indicating that radiation is an important physical phenomenon in glass furnaces and certainly cannot be ignored