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3. The impact of positive end-expiratory pressure on right ventricular function in patients with moderate-to-severe ARDS: a prospective paired-design study

Author

Luo Xingzheng, Gu Weiguang, Ye Quanqiu, Zhou Huifen, Zheng Zijun, Zou Qiming, Yuan Suhua, Zhang Fu, and Jian Zhigang

Subjects
positive end-expiratory pressure, right ventricular function, acute cor pulmonale, ARDS, hemodynamics, Medicine (General), R5-920
Abstract

ObjectiveTo determine the effects of varying positive end-expiratory pressures (PEEPs) on right ventricular function, hemodynamics, oxygenation, and the incidence of acute cor pulmonale (ACP) in patients with moderate-to-severe acute respiratory distress syndrome (ARDS).MethodsThis prospective paired-design study involved patients with moderate-to-severe ARDS in the ICU. Participants received lung-protective ventilation and hemodynamic monitoring. During the study, mechanical ventilation was administered with PEEPs of 5 cmH2O, 10 cmH2O, and 15 cmH2O, while maintaining an end-inspiratory plateau pressure ≤ 30 cmH2O. Various assessments, including transthoracic echocardiography, cardiac output measurement, and blood gas analysis, were conducted at baseline and after 1 h of ventilation at each PEEP. Subsequently, variations in ventilation oxygenation, echocardiographic parameters, and hemodynamic indicators under different PEEPs were analyzed to explore the potential effects of PEEP on right ventricular function and hemodynamics, as well as the incidence of ACP.ResultsA total of 317 ARDS patients were screened. Among them, 104 met the diagnostic criteria for moderate-to-severe ARDS, and 52 completed the study. The baseline PEEP of these 52 participants, acquired before commencement, was 11.5 ± 1.7 cmH2O, and the incidence of ACP was 25.0% (13/52). Intensive care unit mortality, overall hospital mortality, and 28-day mortality rates were 19.2% (10/52), 21.2% (11/52), and 32.7% (17/52), respectively. During the study, ACP incidences at PEEPs of 5 cmH2O, 10 cmH2O, and 15 cmH2O were 17.3% (9/52), 21.2% (11/52), and 38.5% (20/52), respectively. Meanwhile, the PaO2/FiO2 ratio improved with increasing PEEP, reaching 162.0 (140.9, 174.0), 171.0 (144.0, 182.0), and 176.5 (151.0, 196) mmHg at PEEPs of 5 cmH2O, 10 cmH2O, and 15 cmH2O, respectively. In addition, higher PEEPs were associated with a slight increase in PaCO2, showing statistically significant differences compared to moderate and low PEEPs. Compared to a PEEP of 5 cmH2O or 10 cmH2O, right ventricular function exhibited substantial changes at 15 cmH2O PEEP, manifested as increased pulmonary artery systolic pressure, enlarged right ventricular end-diastolic area, and decreased tricuspid annular plane systolic excursion, all with significant differences. Conversely, variations in left ventricular end-diastolic area and ejection fraction were not statistically significant. In terms of hemodynamics, increasing PEEP resulted in a decline in cardiac index (CI), with statistically significant differences between different PEEPs. Specifically, compared to the value at a PEEP of 5 cmH2O, the CI at a PEEP of 15 cmH2O decreased by 14.3% (2.63 [2.20, 2.95] vs. 3.07 [2.69, 3.67], p

Published
2024
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4. Predicting Peak Day and Peak Hour of Electricity Demand with Ensemble Machine Learning

Author

Fu, Tao, Zhou, Huifen, Ma, Xu, Hou, Z. Jason, and Wu, Di

Subjects
Computer Science - Machine Learning
Abstract

Battery energy storage systems can be used for peak demand reduction in power systems, leading to significant economic benefits. Two practical challenges are 1) accurately determining the peak load days and hours and 2) quantifying and reducing uncertainties associated with the forecast in probabilistic risk measures for dispatch decision-making. In this study, we develop a supervised machine learning approach to generate 1) the probability of the next operation day containing the peak hour of the month and 2) the probability of an hour to be the peak hour of the day. Guidance is provided on the preparation and augmentation of data as well as the selection of machine learning models and decision-making thresholds. The proposed approach is applied to the Duke Energy Progress system and successfully captures 69 peak days out of 72 testing months with a 3% exceedance probability threshold. On 90% of the peak days, the actual peak hour is among the 2 hours with the highest probabilities.

Published
2022

18. Optimal Future Sub-Transmission Volt-Var Planning Tool to Enable High PV Penetration

Author

Nguyen, Quan, Ke, Xinda, Samaan, Nader, Holzer, Jesse, Elizondo, Marcelo, Zhou, Huifen, Hou, Zhangshuan, Huang, Renke, Vallem, Mallikarjuna, Vyakaranam, Bharat, Ghosal, Malini, and Makarov, Yuri V.

Subjects
Electrical Engineering and Systems Science - Systems and Control
Abstract

This paper proposes a reactive power planning tool for sub-transmission systems to mitigate voltage violations and fluctuations caused by high photovoltaic (PV) penetration and intermittency with a minimum investment cost. The tool considers all existing volt-ampere reactive (var) assets in both sub-transmission and distribution systems to reduce the need of new equipment. The planning tool coordinates with an operational volt-var optimization tool to determine all scenarios with voltage violations and verify the planning results. The planning result of each scenario is the solution of a proposed optimal power-flow framework with efficient techniques to handle a high number of discrete variables. The final planning decision is obtained from the planning results of all selected violated scenarios by using two different approaches - direct combination of all single-step solutions and final investment decision based only on the scenarios that are representative for the power-flow voltage violations at most time steps. The final planning decision is verified using a realistic large-scale sub-transmission system and 5-minute PV and load data. The results show a significant voltage violation reduction with a less investment cost for additional var equipment compared to conventional approaches.

Published
2019

26. The combination of a tyrosine kinase inhibitor and blinatumomab in patients with Philadelphia chromosome–positive acute lymphoblastic leukemia or Philadelphia chromosome‐like acute lymphoblastic leukemia.

Author

Wu, Xiaoxia, Lu, Shenqi, Zhang, Xinhui, Yang, Zhen, Sun, Aining, Wu, Depei, Zhou, Huifen, and Miao, Miao

Subjects
LYMPHOBLASTIC leukemia, PROTEIN-tyrosine kinase inhibitors, ACUTE leukemia, RETROSPECTIVE studies
Abstract

Tyrosine kinase inhibitors (TKIs) have revolutionized Philadelphia chromosome‐positive (Ph+) acute lymphoblastic leukemia (ALL) treatment. The combination of blinatumomab and a TKI in the frontline setting has shown the safety and efficacy of the chemotherapy‐free treatment approach in patients with Ph + ALL. This retrospective analysis included 19 patients with Ph + ALL and Ph‐like ALL treated with the combination of blinatumomab and a TKI. Of the 14 newly diagnosed patients, the overall response, complete remission (CR), and molecular response (CMR) rates after one cycle of blinatumomab were 100% (10/10), 90% (9/10), and 57% (8/14), respectively. Of the five relapsed patients, the CR and CMR rates were 50% (2/4) and 40% (2/5). Blinatumomab in combination with TKIs is safe and effective and hence this combination therapy could be a viable therapeutic option in front‐line treatment of patients with Ph + ALL. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Successful treatment with bortezomib, thalidomide and dexamethasone in plasma cell myeloma post-bone marrow transplant.

Author

Cao, Yaqing, Shang, Jingjing, Zhai, Yingying, Wang, Qingyuan, Yan, Lingzhi, Shi, Xiaolan, Wang, Jing, Yao, Ying, Zhou, Huifen, Sun, Aining, Miao, Miao, Fu, Chengcheng, and Jin, Song

Subjects
MULTIPLE myeloma, PLASMACYTOMA, BONE marrow, MONOCLONAL gammopathies, TREATMENT effectiveness, EPSTEIN-Barr virus diseases, THALIDOMIDE
Abstract

This article discusses a rare case of plasma cell myeloma, a type of cancer, occurring after a bone marrow transplant. The patient, a 48-year-old male, developed the condition after receiving a stem cell transplant for acute myeloid leukemia. The cancer was found to be positive for the Epstein-Barr virus (EBV), and the patient was successfully treated with a combination of bortezomib, thalidomide, and dexamethasone. The treatment resulted in a very good partial response, and the patient has remained disease-free for over three years. The article highlights the rarity of this condition and the need for further research and treatment protocols. [Extracted from the article]

Published
2024
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