Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line.

BACKGROUND: Routine assessment of dry weight in chronic hemodialysis patients relies primarily on clinical evaluation of patient fluid status. We evaluated whether measurement of postdialytic vascular refill could assist in the assessment of dry weight. METHODS: Twenty-eight chronic, stable hemodialysis patients were studied during routine treatment sessions using constant dialysate temperature and dialysate sodium concentration, and relative changes in blood volume were monitored using Crit-Line III monitors throughout this study. The study was divided into three phases. Phase 1 studies evaluated the time-dependence of vascular compartment refill after completion of hemodialysis. Phase 2 studies evaluated the relationships in patient subgroups between intradialytic changes in blood volume and the presence of postdialytic vascular compartment refill during that last 10 minutes of hemodialysis after stopping ultrafiltration. Phase 3 studies evaluated the extent of dry weight changes following the application of a protocol for blood volume reduction, postdialytic vascular compartment refill, and correlation with clinical evidence of intradialytic hypovolemia and/or postdialytic fatigue. Phase 3 included anywhere from three to five treatments. RESULTS: Phase 1 studies demonstrated that despite interpatient variability in the magnitude of postdialytic vascular compartment refill, when significant refill was evident, it always continued for at least 30 minutes. However, the majority of refill took place within 10 minutes postdialysis. Phase 2 studies identified 3 groups of patients: those who exhibited intradialytic reductions in blood volume but not postdialytic vascular compartment refill (group 1), those who exhibited intradialytic reductions in blood volume and postdialytic vascular compartment refill (group 2), and those whose blood volume did not change substantially during hemodialysis treatment (group 3). In phase 3 studies, use of an ultrafiltration protocol for blood volume reduction and monitoring of postdialytic vascular compartment refill combined with clinical assessment of hypovolemia and postdialytic fatigue demonstrated that patients often had a clinical dry weight assessment which was too low or too high. In all 28 patients studied, dry weight was either increased or decreased following use of this protocol. CONCLUSION: Determination of the extent of both intradialytic decreases in blood volume and postdialytic vascular compartment refill, combined with clinical assessment of intradialytic hypovolemia and postdialytic fatigue, can help assess patient dry weight and optimize volume status while reducing dialysis associated morbidity. The number of hospital admissions due to fluid overload may be reduced.

Twin plane re-entrant mechanism for catalytic nanowire growth.

A twin-plane based nanowire growth mechanism is established using Au catalyzed Ge nanowire growth as a model system. Video-rate lattice-resolved environmental transmission electron microscopy shows a convex, V-shaped liquid catalyst-nanowire growth interface for a ⟨112⟩ growth direction that is composed of two Ge {111} planes that meet at a twin boundary. Unlike bulk crystals, the nanowire geometry allows steady-state growth with a single twin boundary at the nanowire center. We suggest that the nucleation barrier at the twin-plane re-entrant groove is effectively reduced by the line energy, and hence the twin acts as a preferential nucleation site that dictates the lateral step flow cycle which constitutes nanowire growth.

Theoretical study of line narrowing in a sub-terahertz monolithic dual laser source with an integrated reflector

A monolithic design is proposed for low-noise sub-THz signal generation by integrating a reflector onto a dual laser source. The reflectivity and the position of such a reflector can be adjusted to obtain constructive feedback from the reflector to both lasers, thus causing a Vernier feedback effect. As a result, 10-fold line narrowing, the narrowing being limited by the resolution of the simulation, is predicted using a transmission line model. Finally, a simple control scheme using an electrical feedback loop to adjust laser biases is proposed to maintain the line narrowing performance. This line narrowing technique, comprising a passive integrated reflector, could allow the development of a low-cost, compact and energy-efficient solution for high-purity sub-THz signal generation. © The Institution of Engineering and Technology 2014.