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- Brannstrom, A, et al.
(författare)
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Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine
- 2022
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Ingår i: European journal of trauma and emergency surgery : official publication of the European Trauma Society. - : Springer Science and Business Media LLC. - 1863-9941. ; 48:1, s. 335-344
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Tidskriftsartikel (refereegranskat)abstract
- PurposePelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg.Methods60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion.ResultsCumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support.ConclusionZone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.
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- Kockum, Ingrid, et al.
(författare)
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Genetic and immunological findings in patients with newly diagnosed insulin-dependent diabetes mellitus
- 1996
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Ingår i: Hormone and Metabolic Research. - : Georg Thieme Verlag KG. - 0018-5043 .- 1439-4286. ; 28:7, s. 344-347
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Tidskriftsartikel (refereegranskat)abstract
- Two large population-based case-control studies are reviewed. The aim is to determine the effects of HLA, other genetic factors and immune markers (ICA, IAA and GAD65Ab) on the age at onset of insulin-dependent diabetes mellitus (IDDM) in 0-34 year olds. The primary HLA risk gene sequence for IDDM was difficult to identify because of the low recombination frequency within the HLA region. The frequency of the DR3-DQA1 * 0501-DQB1 * 0201 haplotype and the DR3-DQA1 * 0501 DQB1 * 0201 (DQ2)/DR4-DQA1 * 0301-DQB1 * 0302 (DQ8) genotype were higher among patients diagnosed before the age of 10 compared with those diagnosed after the age of 30. The negatively associated haplotype, DR15-DQA1 * 0102-DQB1 * 0602 was absent before the age of 10, but the frequency increased with increasing age at onset. The IDDM2 gene representing the variable number of tandem repeat (VNTR) sequences and 5' of the insulin gene on chromosome 11 were associated with IDDM since homozygous short VNTR was positive but not homozygous, and heterozygous long VNTR was negatively associated with the disease. The diagnostic sensitivity and specificity of GAD65 (GA65Ab) and insulin (IAA) autoantibodies varied with the age at onset and gender. GAD65Ab had the highest sensitivity (> 80%) in patients older than 20 years of age with no difference in gender. The lowest sensitivity (54%) was in 0-10 year old boys, while age did not affect the sensitivity in girls. In contrast, the sensitivity of IAA was highest (46%) before the age of 15 but decreased thereafter as did the sensitivity for ICA. Classification of patients who develop IDDM above 20-25 years of age was inadequate since many patients classified with NIDDM either had GAD65Ab or ICA or developed these antibodies after 1-2 years of NIDDM. We conclude that not only age but also gender affects the risk for IDDM associated with HLA, other IDDM genes as well as commonly used immunological markers for IDDM.
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- Naqvi, Muhammad, et al.
(författare)
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Polygeneration system integrated with small non-wood pulp mills for substitute natural gas production
- 2018
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Ingår i: Applied Energy. - : Elsevier. - 0306-2619 .- 1872-9118. ; 224, s. 636-646
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to examine the potential substitute natural gas (SNG) production by integrating black liquor gasification (BLG) island with a small wheat straw-based non-wood pulp mills (NPM), which do not employ the black liquor recovery cycle. For such integration, it is important to first build knowledge on expected improvements in an overall integrated non-wood pulp mill energy system using the key performance indicators. O2-blown circulating fluidized bed (CFB) gasification with direct causticization is integrated with a reference small NPM to evaluate the overall performance. A detailed economic analysis is performed together with a sensitivity analysis based on variations in the rate of return due to varying biomass price, total capital investment, and natural gas prices. The quantitive results showed considerable SNG production but significantly reduced electricity production. There is a substantial CO2 abatement potential combining CO2 capture and CO2 mitigation from SNG use replacing compressed natural gas (CNG) or gasoline. The economic performance through sensitivity analysis reflects significant dependency on both substitute natural gas production and natural gas market price. Furthermore, the solutions to address the challenges and barriers for the successful commercial implementation of BLG based polygeneration system at small NPMs are discussed. The system performance and discussion on the real application of integrated system presented in this article form a vital literature source for future use by large number of small non-wood pulp industries.
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