Recurrent lower gastrointestinal bleeding secondary to cytomegalovirus-associated colonic ulcer in a non human immunodeficiency virus infected patient:Timely diagnosis and treatment averted surgery

Mr C, a 68-year-old Chinese male with diabetes mellitus, previous stroke and ischaemic cardiomyopathy on clopidogrel, presented with haematochezia. Colonoscopy showed a sigmoid ulcer, which was treated endoscopically. Histology of the biopsy from the ulcer revealed non-specific changes. However, he presented with recurrent bleeding from this non-healing sigmoid ulcer. A review of the histologic specimen revealed CMV intranuclear inclusion bodies. He was treated with intravenous ganciclovir, with no further hematochezia.

Keywords Hematochezia, cytomegalovirus, ulcer

Statistical modelling of cement slurries for self compacting SIFCON containing silica fume

This paper reports a study carried out to develop a self-compacting fibre reinforced concrete containing a high fibre content with slurry infiltrated fibre concrete (SIFCON). The SIFCON was developed with 10% of steel fibres which are infiltrated by self-compacting cement slurry without any vibration. Traditionally, the infiltration of the slurry into the layer of fibres is carried out under intensive vibration. A two-level fractional factorial design was used to optimise the properties of cement-based slurries with four independent variables, such as dosage of silica fume, dosage of superplasticiser, sand content, and water/cement ratio (W/C). Rheometer, mini-slump test, Lombardi plate cohesion meter, J-fibre penetration test, and induced bleeding were used to assess the behaviour of fresh cement slurries. The compressive strengths at 7 and 28 days were also measured. The statistical models are valid for slurries made with W/C of 0.40 to 0.50, 50 to 100% of sand by mass of cement, 5 to 10% of silica fume by mass of cement, and SP dosage of 0.6 to 1.2% by mass of cement. This model makes it possible to evaluate the effect of individual variables on measured parameters of fresh cement slurries. The proposed models offered useful information to understand trade-offs between mix variables and compare the responses obtained from various test methods in order to optimise self-compacting SIFCON.

Factorial Design of Cement Slurries Containing Limestone Powder for Self-Consolidating Slurry-Infiltrated Fiber Concrete

Slurries with high penetrability for production of Self-consolidating Slurry Infiltrated Fiber Concrete (SIFCON) were investigated in this study. Factorial experimental design was adopted in this investigation to assess the combined effects of five independent variables on mini-slump test, plate cohesion meter, induced bleeding test, J-fiber penetration test and compressive strength at 7 and 28 days. The independent variables investigated were the proportions of limestone powder (LSP) and sand, the dosages of superplasticiser (SP) and viscosity agent (VA), and water-to-binder ratio (w/b). A two-level fractional factorial statistical method was used to model the influence of key parameters on properties affecting the behaviour of fresh cement slurry and compressive strength. The models are valid for mixes with 10 to 50% LSP as replacement of cement, 0.02 to 0.06% VA by mass of cement, 0.6 to 1.2% SP and 50 to 150% sand (% mass of binder) and 0.42 to 0.48 w/b. The influences of LSP, SP, VA, sand and W/B were characterised and analysed using polynomial regression which identifies the primary factors and their interactions on the measured properties. Mathematical polynomials were developed for mini-slump, plate cohesion meter, J-fiber penetration test, induced bleeding and compressive strength as functions of LSP, SP, VA, sand and w/b. The estimated results of mini-slump, induced bleeding test and compressive strength from the derived models are compared with results obtained from previously proposed models that were developed for cement paste. The proposed response models of the self-consolidating SIFCON offer useful information regarding the mix optimization to secure a highly penetration of slurry with low compressive strength

Influence of mix proprtions on rheolgy of cement grouts containing limestone powder

In this paper the parameters of cement grout affecting rheological behaviour and compressive strength are investigated. Factorial experimental design was adopted in this investigation to assess the combined effects of the following factors on fluidity, rheological properties, induced bleeding and compressive strength: water/binder ratio (W/B), dosage of superplasticiser (SP), dosage of viscosity agent (VA), and proportion of limestone powder as replacement of cement (LSP). Mini-slump test, Marsh cone, Lombardi plate cohesion meter, induced bleeding test, coaxial rotating cylinder viscometer were used to evaluate the rheology of the cement grout and the compressive strengths at 7 and 28 days were measured. A two-level fractional factorial statistical model was used to model the influence of key parameters on properties affecting the fluidity, the rheology and compressive strength. The models are valid for mixes with 0.35-0.42 W/B, 0.3-1.2% SP, 0.02-0.7% VA (percentage of binder) and 12-45% LSP as replacement of cement. The influences of W/B, SP, VA and LSP were characterised and analysed using polynomial regression which can identify the primary factors and their interactions on the measured properties. Mathematical polynomials were developed for mini-slump, plate cohesion meter, inducing bleeding, yield value, plastic viscosity and compressive strength as function of W/B, SP, VA and proportion of LSP. The statistical approach used highlighted the limestone powder effect and the dosage of SP and VA on the various rheological characteristics of cement grout

Modelling the performance of self-compacting SIFCON of cement slurries containing limestone powder using genetic programming technique

The paper explores the potential of applicability of Genetic programming approach (GP), adopted in this investigation, to model the combined effects of five independent variables to predict the mini-slump, the plate cohesion meter, the induced bleeding test, the J-fiber penetration value, and the compressive strength at 7 and 28 days of self-compacting slurry infiltrated fiber concrete (SIFCON). The variables investigated were the proportions of limestone powder (LSP) and sand, the dosage rates of superplasticiser (SP) and viscosity modifying agent (VMA), and water-to-binder ratio (W/B). Twenty eight mixtures were made with 10-50% LSP as replacement of cement, 0.02-0.06% VMA by mass of cement, 0.6-1.2% SP and 50-150% sand (% mass of binder) and 0.42-0.48 W/B. The proposed genetic models of the self-compacting SIFCON offer useful modelling approach regarding the mix optimisation in predicting the fluidity, the cohesion, the bleeding, the penetration, and the compressive strength.

Filling Ability and Plastic Settlement of Self-Compacting Concrete

The use of self-compacting concrete (SCC) facilitates the placing of concrete by eliminating the need for compaction by vibration. Given the highly flowable nature of such concrete, care is required to ensure excellent filling ability and adequate stability. This is especially important in deep structural members and wall elements where concrete can block the flow, segregate and exhibit bleeding and settlement which can result in local defects that can reduce mechanical properties, durability and quality of surface finish. This paper shows results of an investigation of fresh properties of self-compacting concrete, such as filling ability measured by slump flow and flow time (measured by Orimet) and plastic fresh settlement measured in a column. The SCC mixes incorporated various combinations of fine inorganic powders and admixtures. The slump flow of all SCCs was greater than 580 mm and the time in which the slumping concrete reached 500 rnm was less than 3 s. The flow time was less than 5 s. The results on SCCs were compared to a control mix. The compressive strength and splitting tensile strength of SCCs were also measured. The effects of water/powder ratio, slump and nature of the sand on the fresh settlement were also evaluated. The volume of coarse aggregate and the dosage of superphsticizer were kept constant. It can be concluded that the settlement of fresh self-compacting concrete increased with the increase in water/powder ratio and slump. The nature of sand influenced the maximum settlement.

Novel interactions between UFH and TFPI in children

The impact of age upon therapeutic response to unfractionated heparin (UFH) in children is proposed to reflect quantitative and potentially qualitative differences in coagulation proteins across childhood. This study explores the UFH-dependent tissue factor pathway inhibitor (TFPI) release in children compared to previously published data in adults. Children <16 years of age undergoing cardiac angiography formed the population for this prospective cohort study. TFPI release was measured prior to (baseline) and at 15, 30, 45 and 120 min post-UFH dose. This study demonstrated that, whilst the immediate release of TFPI post-UFH was similar in children compared to adults, TFPI release in children remained increased and consistent for a significantly longer period post-UFH administration compared to adults. Plasma TFPI levels in children did not demonstrate an UFH concentration –dependent reduction, as has been previously reported in adults. The prolonged TFPI-mediated anticoagulant levels observed in children administered UFH may contribute to the increased rate of major bleeding reported in children compared to adults. Furthermore, we postulate that this sustained UFH-dependent increase in TFPI levels in children may influence the binding of UFH to competitive plasma proteins, such as those involved in the immunological response to UFH associated with heparin-induced thrombocytopenia.

A national clinical scenario-based survey of clinicians' attitudes towards fresh frozen plasma transfusion for critically ill patients

Background: It is known that 20-30% of fresh frozen plasma (FFP) is used in intensive care units (ICUs), but little is known about variations in decision making between clinicians in relation to coagulopathy management. Our aim was to describe ICU clinicians' beliefs and practice in relation to FFP treatment of non-bleeding coagulopathic critically ill patients.