Rapid infusion system for neurosurgical treatment of massive intraoperative hemorrhage

Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidural/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid losses associated with refractory diabetes insipidus were treated by the intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rates up to 1.5 L/min, thereby limiting the commonly associated hypotension, hypothermia, and coagulopathies. During the suboccipital craniectomy for evacuation of the EDH and repair of the sigmoid sinus, the patient required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased the operative fluid replacement to 39 L. Despite these massive blood and fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. When used in a neurosurgical setting associated with massive blood and/or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressure, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.     

How Cancer Cells Invade Bladder Epithelium and Form Tumors: The Mouse Bladder Tumor Model as a Model of Tumor Recurrence in Patients

Non-muscle-invasive bladder cancer is the most common form of bladder cancer. The main problem in managing bladder tumors is the high recurrence after the transurethral resection of bladder tumors (TURBT). Our study aimed to examine the fate of intravesically applied cancer cells as the implantation of cancer cells after TURBT is thought to be a cause of tumor recurrence. We established an orthotopic mouse bladder tumor model with MB49-GFP cancer cells and traced them during the first three days to define their location and contacts with normal urothelial cells. Data were obtained by Western blot, immunolabeling, and light and electron microscopy. We showed that within the first two hours, applied cancer cells adhered to the traumatized epithelium by cell projections containing α3β1 integrin on their tips. Cancer cells then migrated through the epithelium and on day 3, they reached the basal lamina or even penetrated it. In established bladder tumors, E-cadherin and desmoplakin 1/2 were shown as feasible immunohistochemical markers of tumor margins based on the immunolabeling of various junctional proteins. Altogether, these results for the first time illustrate cancer cell implantation in vivo mimicking cellular events of tumor recurrence in bladder cancer patients.     

Effect of steam environment on severe core damage behaviour for VVER-1000 with the ASTEC V1 code

Severe accident studies for very low frequency events for VVER-1000 (V320) are carried out to estimate in-vessel damage progression under steam-rich and starved conditions. The analyses with code ASTEC, jointly developed by IRSN (France) and GRS, Germany), have shown the influence of steam environment on core heat-up followed by material relocation, hydrogen production, vessel failure and aerosol generation along with release to containment. Hydro-accumulator injection for studied transients also gives rise to a steam-rich environment enhancing the material oxidation depending on the injection time and period. The generated information along with PSA-Level 2 is helpful to decide Plant Damage State (PDS) and fruitfully develop accident management strategies for the plant.     

Assessment of passive autocatalytic recombiners' capabilities in case of Zr oxidation during station blackout scenario for TVSA and TVSM fuel assemblies of WWER 1000

This paper presents the investigation of Passive Autocatalytic Recombiners' (PARs) capabilities for hydrogen recombination in case of Station blackout scenario. The assessment was performed for both types of WWER fuel assemblies – the old Modernistic type of fuel assemblies (TVSM) and recently installed new Alternative type of fuel assemblies (TVSA) in Kozloduy NPP. The main difference between both types of fuel assemblies is the different geometries, masses of internals materials as well as different burnable poisons. To investigate the PARs' capabilities it has been performed comparison of fuel behaviour of both types of fuel assemblies.To perform this analysis it has been used MELCOR “input model” for Kozloduy Nuclear Power Plant (KNPP) WWER-1000. The model was developed at the Institute for Nuclear Research and Nuclear Energy (INRNE) for investigation of severe accident scenarios. The model provides a significant analytical capability for the Bulgarian technical specialists, working in the field of the NPP safety, for analysis of core and containment damaged states and the estimation of radionuclides' release outside fuel cladding.To assess the PARs' capabilities it was used the acceptance criterion for containment integrity to be 8% hydrogen concentration. This criterion was based on the decision of RSK (Germany commission for reactor safety).Generally, based on the performed analyses it was made a conclusion that using both types of fuel assemblies it was not disturbance of PARs' capabilities and safety criterion of NPP.     

Attachment of Cancer Urothelial Cells to the Bladder Epithelium Occurs on Uroplakin-Negative Cells and Is Mediated by Desmosomal and Not by Classical Cadherins

Urinary bladder cancer is often multifocal; however, the intraluminal dissemination of the urothelial cancer cells is poorly understood. The involvement of N-cadherin in the adhesion of the cancer urothelial cells to the urothelium had not previously been studied. Therefore, we herein explore the possibility of the intraluminal dissemination of the urothelial cancer cells by evaluating the role of classical cadherins in the adhesion of urothelial cancer cells to the urothelium. We used E-cadherin negative T24 cells and established a T24 Ncad^low cell line with an additionally decreased expression of N-cadherin in the plasma membrane and a decreased secretion of proform of metalloproteinase 2. The labelled T24 and T24 Ncad^low cells were seeded onto urothelial in vitro models. After 24 h in co-culture, unattached cancer cells were rinsed and urothelia with attached cancer urothelial cells were processed for fluorescence and electron microscopy. Both the T24 and T24 Ncad^low cells attached to the urothelium, yet only to the uroplakin-negative urothelial cells. The ultrastructural analysis showed that T24 and T24 Ncad^low cells adhere to poorly differentiated urothelial cells by desmosomes. To achieve this, they first disrupt tight junctions of superficial urothelial cells. This study indicates that the lack of E-cadherin expression and decreased expression of N-cadherin in the plasma membrane of T24 cells does not interfere with their adhesion to the urothelium; therefore, our results suggest that intraluminal dissemination of cancer urothelial cells along the urothelium occurs on uroplakin-negative cells and is desmosome-mediated.     

PSB-VVER simulation of Kozloduy NPP “loss of feed water transient”

This paper provides a comparison between the PSB test facility experimental results obtained during the simulation of loss of feed water transient (LOFW) and the calculation results received by INRNE computer model of the same test facility. Integral thermal-hydraulic PSB-VVER test facility located at Electrogorsk Research and Engineering Center on NPPs Safety (EREC) was put in operation in 1998. The structure of the test facility allows experimental studies under steady state, transient and accident conditions.RELAP5/MOD3.2 computer code has been used to simulate the loss of feed water transient in a PSB-VVER model. This model was developed at the Institute for Nuclear Research and Nuclear Energy for simulation of loss of feed water transient.The objective of the experiment “loss of feed water”, which has been performed at PSB-VVER test facility is simulation of Kozloduy NPP LOFW transient. One of the main requirements to the experiment scenario has been to reproduce all main events and phenomena that occurred in Kozloduy NPP during the LOFW transient. Analyzing the PSB-VVER test with a RELAP5/MOD3.2 computer code as a standard problem allows investigating the phenomena included in the VVER code validation matrix as “integral system effects” and ”natural circulation“. For assessment of the RELAP5 capability to predict the “Integral system effect” phenomenon the following RELAP5 quantities are compared with external trends: the primary pressure and the hot and cold leg temperatures. In order to assess the RELAP5 capability to predict the “Natural circulation” phenomenon the hot and cold leg temperatures behavior have been investigated.This report was possible through the participation of leading specialists from Kozloduy NPP and with the support of Argonne National Laboratory (ANL), under the International Nuclear Safety Program (INSP) of the United States Department of Energy.     

RELAP5/MOD3.2 sensitivity calculations of loss-of-feed water (LOFW) transient at Unit 6 of Kozloduy NPP

This paper provides a comparison between the real plant data obtained by Unit 6 of Kozloduy nuclear power plant (NPP) during the loss-of-feed water (LOFW) transient and the calculation results received by RELAP5/MOD3.2 computer model of the same NPP unit.RELAP5/MOD3.2 computer model of the VVER-1000 has been developed at the Institute for Nuclear Research and Nuclear Energy-Bulgarian Academy of Sciences (INRNE-BAS) based on Unit 6 of Kozloduy NPP. This model has been used for simulation the behavior of the real VVER-1000 NPP during the LOFW transient. Several calculations have been provided to describe how the different boundary conditions reflect on the prediction of real plant parameters.This paper discusses the results of the thermal–hydraulic sensitivity calculations of loss-of-feed water transient for VVER-1000 reactor design. The report also contains a brief summary of the main NPP systems included in the RELAP5 VVER model and the LOFW transient sequences.This report was possible through the participation of leading specialists from Kozloduy NPP and with the assistance of Argonne National Laboratory (ANL) for the United States Department of Energy (US DOE), International Nuclear Safety Program (INSP).     

Overview of plant specific severe accident management strategies for Kozloduy nuclear power plant,WWER-1000/320

This paper focuses on the fourth level of the defence in depth concept in nuclear safety, including the transitions from the third level and into the fifth level. The use of the severe accident management guideline (SAMG) is required when an accident situation is not handled adequately through the use of emergency operating procedures (EOP), thus leading to a partial or a total core melt. In the EOPs, the priority is to save the fuel, whereas, in the SAMG, the priority is to save the containment. Actions recommended in the SAMG aim at limiting the risk of radiologically significant radioactive releases in the short- and mid-term (a few hours to a few days). The paper describes basic severe accident management requirements related to nuclear power plant (NPP), specified by the IAEA and in Republic of Bulgaria Nuclear Legislation. It also surveys plant specific severe accident management (SAM) strategies for the Kozloduy NPP, equipped with WWER-1000 type reactors.