Design parameters of the proposed GALHP.
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"604",leadTitle:null,fullTitle:"Earth Observation",title:"Earth Observation",subtitle:null,reviewType:"peer-reviewed",abstract:"Today, space technology is used as an excellent instrument for Earth observation applications. 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It discusses the industrial uses of some minerals as raw materials and in electrical firms and gemology. The book also introduces several works on synthesis of some compounds and applications of mineralogy in biomedicine, including iron oxide nanoparticles and nannocomposites, and their biomedical applications as diagnostic and drug delivery tools for treatment of cancer and many other diseases.",isbn:"978-1-78985-826-6",printIsbn:"978-1-78985-825-9",pdfIsbn:"978-1-83880-738-2",doi:"10.5772/intechopen.83247",price:119,priceEur:129,priceUsd:155,slug:"mineralogy-significance-and-applications",numberOfPages:174,isOpenForSubmission:!1,hash:"5149699e666cbb61c220646173769f18",bookSignature:"Ali Ismail Al-Juboury",publishedDate:"May 27th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/9247.jpg",keywords:null,numberOfDownloads:3050,numberOfWosCitations:2,numberOfCrossrefCitations:7,numberOfDimensionsCitations:8,numberOfTotalCitations:17,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 13th 2019",dateEndSecondStepPublish:"September 17th 2019",dateEndThirdStepPublish:"November 16th 2019",dateEndFourthStepPublish:"February 4th 2020",dateEndFifthStepPublish:"April 4th 2020",remainingDaysToSecondStep:"a year",secondStepPassed:!0,currentStepOfPublishingProcess:5,editedByType:"Edited by",kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"58570",title:"Prof.",name:"Ali",middleName:"Ismail",surname:"Al-Juboury",slug:"ali-al-juboury",fullName:"Ali Al-Juboury",profilePictureURL:"https://mts.intechopen.com/storage/users/58570/images/system/58570.png",biography:"Ali Ismail Al-Juboury is a professor in the Geology Department, University of Mosul, Iraq. He obtained his BSc in Geology and MSc in Sedimentology in 1980 and 1983, respectively, and his PhD from Comenius University, Slovakia, in 1992. He has published more thah 100 papers in local and peer-reviewed journals in the fields of mineralogy, petroleum geology, sedimentology, and geochemistry. He is a member of numerous international societies and serves on the editorial board of the Iraqi Geological Journal and International Sedimentology and Stratigraphy Journal of Oil and Gas Basins, Azerbaijan, and International Journal of Geophysics and Geochemistry (American Association of Science and Technology). He has received several awards, such as the Distinguished Scholars Award from the Arab Fund for Economic and Social Development, Kuwait, in 2009, and the Science and Technology (Geology) Award from the Islamic States in 2014.",institutionString:"University of Mosul",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"4",institution:{name:"University of Mosul",institutionURL:null,country:{name:"Iraq"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"651",title:"Mineralogy",slug:"geology-and-geophysics-mineralogy"}],chapters:[{id:"64824",title:"Hematite Spherules on Mars",slug:"hematite-spherules-on-mars",totalDownloads:546,totalCrossrefCites:0,authors:[{id:"257657",title:"Dr.",name:"Anupam",surname:"Misra",slug:"anupam-misra",fullName:"Anupam Misra"},{id:"272258",title:"Dr.",name:"Tayro",surname:"Acosta-Maeda",slug:"tayro-acosta-maeda",fullName:"Tayro Acosta-Maeda"}]},{id:"69780",title:"Mineral Chemistry of Chalki Basalts in Northern Iraq and Their Petrological Significance",slug:"mineral-chemistry-of-chalki-basalts-in-northern-iraq-and-their-petrological-significance",totalDownloads:265,totalCrossrefCites:0,authors:[{id:"58570",title:"Prof.",name:"Ali",surname:"Al-Juboury",slug:"ali-al-juboury",fullName:"Ali Al-Juboury"},{id:"219752",title:"Dr.",name:"Mohsin",surname:"Ghazal",slug:"mohsin-ghazal",fullName:"Mohsin Ghazal"},{id:"300008",title:"MSc.",name:"Sabhan",surname:"Jalal",slug:"sabhan-jalal",fullName:"Sabhan Jalal"}]},{id:"68291",title:"Titanite from Titanite-Spots Granodiorites of the Moldanubian Batholith (Central European Variscan Belt)",slug:"titanite-from-titanite-spots-granodiorites-of-the-moldanubian-batholith-central-european-variscan-be",totalDownloads:367,totalCrossrefCites:0,authors:[{id:"142108",title:"Dr.",name:"Miloš",surname:"René",slug:"milos-rene",fullName:"Miloš René"}]},{id:"69711",title:"Investigation of the Usability of Pseudoleucites in Central Anatolia Alkali Syenites as Industrial Raw Materials",slug:"investigation-of-the-usability-of-pseudoleucites-in-central-anatolia-alkali-syenites-as-industrial-r",totalDownloads:195,totalCrossrefCites:0,authors:[{id:"299081",title:"Dr.",name:"Zeynel",surname:"Başıbüyük",slug:"zeynel-basibuyuk",fullName:"Zeynel Başıbüyük"},{id:"299082",title:"Dr.",name:"Gökhan",surname:"Ekincioğlu",slug:"gokhan-ekincioglu",fullName:"Gökhan Ekincioğlu"}]},{id:"71848",title:"Mineralogical-Petrographical Investigation and Usability as the Gemstone of the North Anatolian Kammererite, Tokat, Turkey",slug:"mineralogical-petrographical-investigation-and-usability-as-the-gemstone-of-the-north-anatolian-kamm",totalDownloads:207,totalCrossrefCites:0,authors:[{id:"299081",title:"Dr.",name:"Zeynel",surname:"Başıbüyük",slug:"zeynel-basibuyuk",fullName:"Zeynel Başıbüyük"},{id:"299082",title:"Dr.",name:"Gökhan",surname:"Ekincioğlu",slug:"gokhan-ekincioglu",fullName:"Gökhan Ekincioğlu"},{id:"317737",title:"Dr.",name:"İlkay",surname:"Kaydu Akbudak",slug:"ilkay-kaydu-akbudak",fullName:"İlkay Kaydu Akbudak"}]},{id:"71052",title:"Enhanced Humidity Sensing Response in Eu3+-Doped Iron-Rich CuFe2O4: A Detailed Study of Structural, Microstructural, Sensing, and Dielectric Properties",slug:"enhanced-humidity-sensing-response-in-eu-sup-3-sup-doped-iron-rich-cufe-sub-2-sub-o-sub-4-sub-a-deta",totalDownloads:221,totalCrossrefCites:7,authors:[{id:"266255",title:"Dr.",name:"Jagadeesh",surname:"Angadi V",slug:"jagadeesh-angadi-v",fullName:"Jagadeesh Angadi V"},{id:"321561",title:"Dr.",name:"I.C.",surname:"Sathisha",slug:"i.c.-sathisha",fullName:"I.C. Sathisha"},{id:"321562",title:"Dr.",name:"K.",surname:"Manjunatha",slug:"k.-manjunatha",fullName:"K. Manjunatha"},{id:"321564",title:"Dr.",name:"B.",surname:"Chethan",slug:"b.-chethan",fullName:"B. Chethan"},{id:"321565",title:"Dr.",name:"Y.T.",surname:"Ravikiran",slug:"y.t.-ravikiran",fullName:"Y.T. Ravikiran"},{id:"321566",title:"Dr.",name:"Vinayaka K.",surname:"Pattar",slug:"vinayaka-k.-pattar",fullName:"Vinayaka K. Pattar"},{id:"321567",title:"Dr.",name:"S.O.",surname:"Manjunatha",slug:"s.o.-manjunatha",fullName:"S.O. Manjunatha"},{id:"321568",title:"Dr.",name:"Shidaling",surname:"Matteppanavar",slug:"shidaling-matteppanavar",fullName:"Shidaling Matteppanavar"}]},{id:"68949",title:"Iron Oxides Synthesized in Hypersaline Solutions",slug:"iron-oxides-synthesized-in-hypersaline-solutions",totalDownloads:311,totalCrossrefCites:0,authors:[{id:"161472",title:"Dr.",name:"Nurit",surname:"Taitel-Goldman",slug:"nurit-taitel-goldman",fullName:"Nurit Taitel-Goldman"}]},{id:"67459",title:"Preparation and Characterization of Fe2O3-SiO2 Nanocomposite for Biomedical Application",slug:"preparation-and-characterization-of-fe-sub-2-sub-o-sub-3-sub-sio-sub-2-sub-nanocomposite-for-biomedi",totalDownloads:596,totalCrossrefCites:0,authors:[{id:"256415",title:"Dr.",name:"Violeta",surname:"Nikolic",slug:"violeta-nikolic",fullName:"Violeta Nikolic"}]},{id:"71054",title:"Future of Nanoparticles in the Field of Medicine",slug:"future-of-nanoparticles-in-the-field-of-medicine",totalDownloads:181,totalCrossrefCites:0,authors:[{id:"301389",title:"Dr.",name:"Neha",surname:"Sharma",slug:"neha-sharma",fullName:"Neha Sharma"}]},{id:"69811",title:"Chemical Synthesis and Characterization of Luminescent Iron Oxide Nanoparticles and Their Biomedical Applications",slug:"chemical-synthesis-and-characterization-of-luminescent-iron-oxide-nanoparticles-and-their-biomedical",totalDownloads:163,totalCrossrefCites:0,authors:[{id:"258023",title:"Dr.",name:"Martin",surname:"Onani",slug:"martin-onani",fullName:"Martin Onani"},{id:"302723",title:"Dr.",name:"Leandré Bianca",surname:"Brandt",slug:"leandre-bianca-brandt",fullName:"Leandré Bianca Brandt"},{id:"302725",title:"MSc.",name:"Zuraan",surname:"Paulsen",slug:"zuraan-paulsen",fullName:"Zuraan Paulsen"}]}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"297737",firstName:"Mateo",lastName:"Pulko",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/297737/images/8492_n.png",email:"mateo.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review, to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. 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To date, various types of heat pipes have been investigated for various applications, for example, electronics cooling, solar devices, heat exchangers, aerospace, medical applications and transportation system [3]. Of these, the most commonly used one is a gravitational straight type, which possesses the problems of increased flow resistances within the vapour and liquid flows and reduced overall heat transport capacity of the heat pipe.
\nLoop heat pipe (LHP) [3, 4, 5] is a two-phase (liquid/vapour) heat transfer device allowing a high thermal flux to be transported over a distance of up to several tens of metres in a horizontal or vertical position owing to its capillary or gravitational structure. LHP has a separate evaporator and condenser, thus eliminating an entrainment effect occurring in between. LHP can operate under different gravitational regimes, regardless of whether the evaporator is above or below the condenser.
\nA conventional LHP is usually composed of the complex capillary pumps (evaporators), compensation chambers (storage), condensers and vapour and liquid transfer lines [6, 7, 8]. The working principle of the LHP device could be described as follows [1]: the heat transfer fluid in the wick absorbs the heat added to the evaporator and vaporises via the vapour line to the condenser. Within the condenser, the vapour will be condensed to the liquid of the same temperature and return to the compensation chamber through the liquid line. The liquid will then be accumulated and stored in the compensation chamber and further saturate the wick.
\nNumerous works in relation to LHP have been developed, for example, loop component designs, mathematical models, working fluid and wick structures. The first LHP was developed and tested in 1972 by Russian scientists Gerasimov and Maydanik [9]. A book written by Peterson [10] illustrated the performance limit approach for the heat pipe in the steady-state condition. Peterson [11] also analysed the heat pipe’s heat transfer processes in the steady-state condition by using thermal resistances calculating method. In order to simplify the existing engineering models and reduce the required computing resources, Zuo and Faghri [12] developed a thermal network model to analyse the circulation of the working fluid in the heat pipe by using the thermodynamic cycle approach. Kaya and Hoang [13] modelled the performance of a LHP based on steady-state energy balance equations at each component of the loop. The loop operating temperature was found to be a function of the applied power at the given loop condition. Bai et al. [14] established a mathematical model for the start-up process of a LHP based on the node network method. Pauken and Rodriguez [15] modelled and tested a LHP with two different working fluids, that is, ammonia and propylene. Hoang et al. [16] mentioned that the heat transfer characteristic of a LHP was difficult to predict, owing to the complicated nature of the thermal interaction between the LHP and environment. Riehl [17] tested a LHP system operating with acetone as the working fluid. Zan et al. [18] established an experimental formula for a sintered nickel powder wick. Riehl and Dutra [19] presented the development of an experimental LHP. Vlassov and Riehl [20] explored LHP modelling by developing a relatively precise condenser sub-model from the solutions of the conjugate equations of energy, momentum and mass balances, and only describing a few transient nodes within the evaporator and compensation chamber. A more comprehensive dynamic model was published by Launay et al. [21], who proposed a transient model to predict the thermal and hydrodynamic behaviour of a standard LHP.
\nIn recent years, the application of the LHP in solar thermal field has become more and more attractive owing to the significant technical advance in renewable energy [22, 23, 24]. LHP is suitable for use in building solar hot water system, owing to its unique features, that is, highly effective thermal conductance and flexible design embodiment and installation [1]. For such an application, the LHP was mostly operated under gravity-assisted conditions, and termed gravitation-assisted loop heat pipe ‘GALHP’. The GALHPs have been identified with two shortfalls that need to be tackled with, that is, complicated wick structure and liquid film ‘dry-out’ problem [3, 4].
\nIn order to overcome the problems exhibited by the conventional GALHP, a novel liquid-vapour separator-incorporated GALHP was proposed, which is dedicated to simplify the wick structure, eliminate the ‘dry-out’ potential and, thus, create a high-efficient and cost-effective heat transport solution. Through the theoretical and experimental analysis, the analysis results will be compared with the conventional GALHP and conventional straight heat pipe. The research results could be directly used for design, optimisation and analyses of the new GALHP configuration, thus promoting its wide applications in various situations to enable the enhanced performance of the GALHP heat transport to be achieved.
\nSchematic of the proposed GALHP is shown in Figure 1, and the novel liquid-vapour separator-incorporated GALHP is shown in Figure 2. This separator is configured as a three-way structure, internally containing a tubular pipe with a downward expanding opening, which is fitted into the top of the evaporator while the edge of the expanding opening is tightly attached to the wicked inner surface of the heat pipe. In this way, the return liquid will be reserved in the liquid reservoir above the evaporator, thus formulating a certain liquid head. Under the action of the liquid head, the liquid will penetrate through the peripheral gap between the pipe and the expanding opening, and flow evenly downward along the wicked surface of the heat pipe. Meanwhile, the evaporated fluid, in the form of vapour, will flow upward through the central tubular pipe and enter into the vapour transport line. If the liquid level is further controlled by a valve mounted on the liquid transfer line, the downward liquid flow rate can be controlled to match the rate of evaporation on the inner surface of the heat pipe. So the wicked inner heat pipe surface will be constantly in ‘wet’ state, thus preventing the potential ‘dry-out’ problem with the conventional GALHP. Meanwhile, the vapour and liquid flows will be regulated in the same direction and separated clearly during the operation, thus preventing the potential entrainment problem with the conventional straight heat pipe.
\nSchematic of the proposed GALHP.
Top-positioned vapour-liquid separator of new GALHP.
Based on the above innovative concept, a dedicated mathematical model and the associated computer program will be developed to analyse the characteristics of the new GALHP.
\nThe mathematical model for the evaporation-condensation processes in the proposed GALHP is based on the following assumptions:
Heat transfer and fluid flow occur under the quasi-steady-state condition.
Heat conduction and fluid flow across the wick are one-dimensional in the radial direction.
Heat pipe evaporator is heated axial-symmetrically and the difference of the temperature along the axial direction is negligible.
The hydrostatic pressure drop across the radial direction owing to the gravity effect is considered to be zero.
The axial pressure drop is negligible due to less magnitude against the gravitational head.
The working fluid is incompressible and has a constant property value in each phase.
The wick is liquid saturated and wick material is assumed homogenous and isotropic.
A local thermal equilibrium exists between the porous structure and the working fluid.
Heat loss to the surroundings is ignored due to the well-insulated pipes.
The mass flow rate within the wick structure is considered to be constant owing to the mass conservation law, given by [4, 16]
\nThe energy conservation equations of the single wick structure are given by [4, 25]
\nThe effective thermal conductivity of liquid-saturated wick in a cylindrical geometry is [3, 4]
\nin which, the porosity of screen wick is expressed as [3, 4]
\nDefine the variable\n
Then, rewrite Eq. (2) as
\nThe boundary conditions are
\nBy solving the second-order ordinary differential Eq. (6) with twice integrals, temperature distribution in the wick is
\nFor a single saturated wick layer, the radial thermal conductance is then
\nIn this case, the temperature distributions are
\nThermal conductance of the inner and outer wick layers are respectively
\nand
\nAs a result, the overall thermal conductance of the composite wick structure can be given by
\nAccording to energy conservation, heat flux at the internal surface of the outer wick layer should be equal to the heat flux at the external surface of the inner wick layer
\nPutting Eq. (10) into the above expression results in
\nPut Eq. (11) into Eq. (16) and it becomes
\nRewrite Eq. (17) as
\nPut Eq. (18) into Eq. (14) for obtaining the expression of the composite wick structure,
\nThe thermal resistance in this region is therefore
\nThe interface temperature conditions can be assumed local thermal equilibrium
\nIn a heat pipe, the maximum capillary pumping head (\n
Based on the results derived from the theoretical and computer simulation studies [26], the proposed GALHP was designed, fabricated and presented in Figure 3 respectively. For the evaporator, the length remained 550 mm and diameter fixed to 22 mm. Within the inner surfaces of the evaporator, the compound screen mesh wick structure was applied with the size of 160 × 60 mm. For the condenser, they were all fixed with a steel cooling jacket of the same size, with a length of 150 mm and a diameter of 105 mm. The detailed design parameters are illustrated in Table 1.
\nFabrication schematics of the proposed GALHP.
Parameters | \nNomenclature | \nValue | \n
---|---|---|
External diameter of evaporator (mm) | \nDhp,o | \n22 | \n
Internal diameter of evaporator (mm) | \nDhp,in | \n19.6 | \n
T1: internal diameter of vapour channel in three-way fitting (mm) | \nDtw,in | \n14 | \n
Operating pressure in heat pipe (Pa) | \nPhp | \n1.3 × 10–4 | \n
Evaporator length (mm) | \nLhp,ev | \n550 | \n
Liquid filling volume (ml) | \nVfl | \n85 | \n
Transportation line’s outer diameter (mm) | \nDll,o/Dvl,o | \n22 | \n
Transportation line’s inner diameter (mm) | \nDll,in/Dvl,in | \n19.6 | \n
Lengths of vapour/liquid /line (mm) | \nLvl,T1/Lll,T1 | \n595/445 | \n
Lvl,T2/Lll,T2 | \n595/1145 | \n|
Mesh screen wire diameter (layer I) (mm) | \nDowi,ms | \n7.175 × 10–2 | \n
Mesh screen layer thickness (layer I) (mm) | \ndowi,ms | \n3.75 × 10–1 | \n
Mesh number (layer I) (/m) | \nNowi,ms | \n6299 | \n
Mesh screen wire diameter (layer II) (mm) | \nDiwi,ms | \n12.23 × 10–2 | \n
Mesh screen layer thickness (layer II) (mm) | \ndiwi,ms | \n3.75 × 10–1 | \n
Mesh number (layer II) (/m) | \nNiwi,ms | \n2362 | \n
Mesh screen conductivity (W/m °C) | \nkms | \n394 | \n
Design parameters of the proposed GALHP.
Figure 4 shows the test rig of the proposed GALHP. In the rig, an electrical heating tap with the percentage controller, which acts as the heat source, was evenly attached to the external surfaces of the evaporators. The condenser is covered by a steel cooling jacket that allows cooling water to pass through, removing heat from the condenser. A magnetic regeneration water pump was installed in the cooling water loop to power the cooling water cross. A clamp-supported retort stand was used to adjust the inclination angle of the piping installation. The foamy polyurethane was attached to the pipes to provide a satisfactory insulation. During operation, in order to keep a relatively constant condensation temperature, the water tap would remain open to enable adequate amount of cold water to be fed into the loop. When the water tank was fully charged, the drainage valve would be turned open to allow the extra amount of water to be discharged.
\nOn-site testing rig.
A list of the piping elements and test instruments are provided in Table 2. A number of T-type thermocouples were attached to the external surface of heat pipe walls, and installed in the inlet/outlet and inside of cooling jacket and water tank: there were totally four thermocouples (No. 1–4) equidistantly attached along each heat pipe evaporator wall from top to bottom, which were used to measure the temperature distribution along the evaporator wall and their corresponding average temperature at the evaporation sections; another four thermocouples were respectively placed in the mid of heat pipe condenser wall (No. 7), the inlet/outlet (No. 5/6) of cooling jacket and the mid of water tank (No. 8) to measure their related average temperature; there were still four more thermal couples applied to measure the temperatures at the vapour (No. 9, 11) and liquid (No. 10, 12) transportation lines; all these thermocouples were further connected to a data logger to record the temperature signals at each testing interval. A control box is provided to adjust the power output of the heating belt, which is considered a thermal load.
\nNo. | \nName | \nModel no. | \nDescription | \n
---|---|---|---|
1 | \nPVC-U ball valve | \nRS: 282-5148 | \nCompression fitting size: 20mm | \n
2 | \nPVC-U hose connector | \nRS: 212-3638 | \n1/2in BSPT MX20 mm | \n
3 | \nGeorge fischer 90° PVC-U elbow | \nRS: 279-0575 | \n25 × 25 mm, L. 33 mm | \n
4 | \nArmorvin HNA hose | \nRS: 339-9921 | \nClear 5 m × 20 mm ID | \n
5 | \nMagnetically coupled regenerative pump | \nTotton: HPR6/8 | \nMax capacity: 5.5 l/min Max head: 7.4 m | \n
6 | \nHeating tapes with percentage controller | \nOmega: HTWC102-004 | \nLength: 1220 mm 14.4–288 w; 240 V; ±0.5 W | \n
7 | \nBlack nitrile rubber pipe insulation | \nRS: 486-053 | \n\n\n | \n
k = 0.035 W/m °C at 0°C | \n|||
0.037 W/m °C at 20°C | \n|||
0.040 W/m °C at 40°C Min/max temperature sensed | \n|||
8 | \nT-type thermocouple | \nRS: 621–2164 | \nMin/max temperature sensed: ±0.1°C, 200–350°C Probe diameter: 0.3 mm | \n
9 | \n1/2” LCD Water fluid flow sensor meter digital display rate turbine flow meter | \n\n | Flow rate range: 1.5–25.0 l/m, fitting for 1/200, BSP: ±0.1 l/m, water temperature range: 0–80°C | \n
10 | \nData logger and data recording equipment | \nTD500 series 3 | \n10 channels DataTaker; ±0.16% 5-s interval recording | \n
List of piping connectors and experimental instruments.
A series of laboratory steady-state tests were carried out and the results of the tests were used to evaluate the thermal performance of the proposed GALHP. The testing conditions are displayed in Table 3. During all the sets of tests, the surrounding air temperature and speed were maintained at 20 ± 2°C and 0.01 m/s, respectively. Under initial test conditions, one parameter is changed and the other parameter remains fixed, enabling the development of a correlation between the heat pipe’s heat output and associated operating parameters. Once the steady-state conditions have been achieved, the test period is successive 10 h period. The measurement data will be recorded at 5-s interval and logged into the computer system using the DT500 data logger to enable the follow-up analyses to be undertaken.
\nTest mode | \nApplied heat load (W) | \nInclination angle (°) | \nCooling-fluid temperature (°C) | \nFlow rates of cooling fluid (l/min) | \n
---|---|---|---|---|
Standard | \n100.8 | \n90 | \n10 ± 0.5 | \n1 ± 0.2 | \n
1 | \n14.4 | \n90 | \n10 ± 0.5 | \n1 ± 0.2 | \n
43.2 | \n||||
100.8 | \n||||
129.6 | \n||||
2 | \n100.8 | \n90 | \n10 ± 0.5 | \n1 ± 0.2 | \n
60 | \n||||
30 | \n||||
3 | \n100.8 | \n90 | \n10 ± 0.5 | \n1 ± 0.2 | \n
15 ± 0.5 | \n||||
20 ± 0.5 | \n||||
4 | \n100.8 | \n90 | \n10 ± 0.5 | \n1 ± 0.2 | \n
2 ± 0.2 | \n||||
3 ± 0.2 | \n
List of operational modes (parameters) for simulation of the three heat pipes.
Table 4 provides the comparison between the testing and the simulation results under all selected testing conditions. The mean correlation coefficient (CR) was found no less than 0.8346 and the root mean square percentage deviation (E) was below 18.18%. This indicated that the developed simulation model could predict the thermal performance at a reasonable accuracy. The differences resolved above may be caused by theoretical and/or inaccurate measurements. From the theoretical side, some simplified assumptions and empirical equations were involved; from the experimental side, a few of the uncertainties addressed above may be the potential reasons for the deviation. Based on these considerations, the errors may be attributed to the theoretical inaccuracies and it would be better for the simulation model to be refined to further improve its accuracy in making predictions based on the experimental results.
\nQ (W) | \nu (°) | \nTcf (°C) | \nmcf (l/m) | \nTeva (exp) (°C) | \nTeva (sim) | \nCR (−) | \nE (%) | \nU (%) | \nR (exp) (°C/W) | \nR (sim) | \nCR (−) | \nE (%) | \nU (%) | \nStart-up (s) | \n
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
14.4 | \n90 | \n10 | \n1 | \n31.31 | \n34.12 | \n0.8346 | \n6.61 | \n8.05 | \n0.32 | \n0.32 | \n0.9533 | \n18.18 | \n10.63 | \n840 | \n
43.2 | \n\n | \n | \n | 40.04 | \n36.41 | \n\n | \n | 7.34 | \n0.27 | \n0.21 | \n\n | \n | 8.26 | \n780 | \n
129.6 | \n\n | \n | \n | 42.11 | \n43.28 | \n\n | \n | 8.00 | \n0.08 | \n0.09 | \n\n | \n | 10.26 | \n280 | \n
100.8 | \n\n | \n | \n | 41.14 | \n40.99 | \n\n | \n | 6.80 | \n0.11 | \n0.10 | \n\n | \n | 9.46 | \n410 | \n
\n | 60 | \n\n | \n | 46.72 | \n45.65 | \n0.9825 | \n1.30 | \n5.65 | \n0.13 | \n0.15 | \n0.9995 | \n11.88 | \n6.19 | \n960 | \n
\n | 30 | \n\n | \n | 48.90 | \n49.43 | \n\n | \n | 5.97 | \n0.16 | \n0.20 | \n\n | \n | 11.47 | \n1210 | \n
\n | 90 | \n15 | \n\n | 56.53 | \n48.65 | \n0.8827 | \n8.14 | \n9.98 | \n0.15 | \n0.18 | \n0.9855 | \n13.76 | \n12.36 | \n370 | \n
\n | \n | 20 | \n\n | 56.92 | \n55.99 | \n\n | \n | 7.94 | \n0.14 | \n0.17 | \n\n | \n | 9.42 | \n320 | \n
\n | \n | 10 | \n2 | \n40.96 | \n38.65 | \n0.9413 | \n6.26 | \n8.89 | \n0.11 | \n0.09 | \n0.9556 | \n13.71 | \n10.65 | \n380 | \n
\n | \n | \n | 3 | \n39.95 | \n35.99 | \n\n | \n | 10.81 | \n0.10 | \n0.08 | \n\n | \n | 11.76 | \n360 | \n
Comparison of testing and simulation results of the three heat pipes under different modes.
This chapter reported the study of a novel liquid-vapour separator-incorporated gravity-assisted loop heat pipe (GALHP), which was designed, constructed, and tested. A parallel comparison between simulation and experimental results was made.
\nUnder the specified operational conditions, the start-up timing of the proposed GALHP was 410 s. The overall thermal resistance was 0.11°C/W, indicating that it has small heat transfer resistance owing to its unique structure that led to the even liquid film distribution and thus reduced flow resistance. The actual effective thermal conductivity was 29,968 W/°C m, indicating that it achieved significant improvement in terms of heat transfer. All of these data provide evidence that the proposed GALHP is a super-performance heat transfer device that can be widely used in gravity-assisted heat transfer operations to achieve significant thermal management in a variety of practical applications.
\nThis chapter focuses on the treatment of acute cerebral ischemia and intracranial hemorrhage, which are two types of stroke. Stroke is characterized by a sudden loss of brain function with no established cause other than vascular origin. This applies to both ischemic stroke and intracranial hemorrhage.
\nAcute stroke suggests the following signs:
Sudden onset of symptoms and development of the clinical picture in a few seconds or minutes with further stabilization or improvement.
Focal neurological symptoms associated with damage to certain parts of the brain: motor deficits (weakness or immobility of the limbs on one side of the body (hemiplegia or hemiparesis) or an isolated limb), loss of sensitivity (decreased sensitivity in various parts of the body), aphasia, agnosia, and vision disorders.
Symptoms suggesting a loss of function: limb tremors, convulsions, paresthesias, visual hallucinations, and flashes before the eyes.
Headache, nausea and vomiting, dysphagia, dysarthria, dysphonia, diplopia, ataxia, hiccups, one-sided acute hearing loss, respiratory disorder, convulsive syndrome, and transient loss of consciousness may be clinical manifestations of a stroke localized in the brain stem.
Symptoms such as loss of consciousness, dizziness, general weakness, confusion, urinary incontinence, syncopal condition, and tinnitus do not indicate the development of a stroke if they are not associated with focal neurological symptoms.
For the differential diagnosis of ischemic and hemorrhagic strokes, it is necessary to conduct a neuroimaging study [1]. This is the most important stage of diagnosis, because patients with ischemic and hemorrhagic strokes require different therapies in the acute period and various measures of secondary prevention [2].
\nMagnetic resonance imaging (MRI) is the most appropriate diagnostic method for patients with acute cerebral circulation disorders due to the following reasons [3]:
T1- and T2-weighted images and fluid-attenuated inversion recovery (FLAIR) sequences allow the differentiation of old foci and foci of nonvascular origin.
Diffusion-weighted images allow the identification of new ischemic foci. Low brain blood flow causes the development of cytotoxic cell edema and, as a result, a decrease in the movement of extracellular fluid, which is displayed as a hyperintensive signal on diffusion-weighted images, and a decrease in the water diffusion coefficient. These changes appear earlier than changes in T1 and T2 and FLAIR.
T* sequences are used to detect hemorrhages.
Time-of-flight (TOF) MR angiography can be used to visualize the occlusion of extra- and intracranial arteries.
When MRI is not available in an emergency or cannot be performed due to contraindications (established rhythm driver, claustrophobia, psychomotor agitation), an emergency computed tomography (CT) scan of the brain is performed without contrast. CT scan reveals an intracranial hemorrhage in the form of a hyperintensive zone in the brain parenchyma. Figure 1 shows a non-contrast CT scan with a spontaneous hyperdensity of the right cerebral hemisphere, due to a deep intracerebral hemorrhage (ICH). In the early stages of acute cerebral ischemia, CT signs of ischemia may be absent. But within 3 hours, you can see signs of ischemia, for example, the disappearance of a clear border of gray and white matter. With the occlusion of the middle cerebral artery, CT signs will appear in the form of a hyperintensive zone. CT with contrast allows you to visualize the anatomy of the arteries and perfusion.
\nNon-contrast CT scan shows a spontaneous hyperdensity of the right cerebral hemisphere.
The most common causes of ischemic stroke are common atherosclerosis, atrial fibrillation (AF), occlusion of small perforating arteries of the brain, pathology of heart valves, and infectious diseases, in young patients—cerebral artery dissection.
\nIntracerebral hemorrhages in most cases are the result of the damage to small cerebral vessels due to chronic arterial hypertension or amyloid angiopathy.
\nFor all patients in the acute stage, the following examinations should be carried out, which will determine the treatment plan: a thorough collection of anamnesis to determine the presence of hypertension, medications used, alcohol abuse, and substance abuse and a family history of stroke, oncology, and trauma; a clinical examination; blood test to detect polycythemia and plateletemia, erythrocyte sedimentation rate (ESR) to detect vasculitis, and the level of glycemia to detect diabetes or hypoglycemia, and coagulation tests. Cardiac assessment including electrocardiogram (ECG) and echocardiography (EchoCG) is quite important in all cases and Holter in selected cases. ECG recording to detect heart attacks, atrial fibrillation, continuous ECG monitoring to detect arrhythmias; monitoring of systolic, diastolic, and mean blood pressure (BP) by noninvasive method; dopplerography to detect stenoses and dissections of cervical and intracranial vessels; transthoracic EchoCG to detect blood clots, tumors, valve pathology, vegetations on the valves, reduction of ejection fraction, and the presence of an open oval window. Neuroimaging methods include MRI and CT of the brain to detect caverns, intracranial venous thromboses, cerebral microhemorrhages, arteriovenous malformations (AVM), tumors, and indirect signs of unknown injuries. Additional examinations are prescribed depending on the initial results obtained, the patient’s age, and the presumed etiology of the stroke: angiography (usually MR, CT angiography) and specific biological tests when it comes to specific causes, such as antinuclear antibodies, etc.
\nThere are neurological complications that occur in the acute phase of stroke in any type in the form of convulsive syndrome; hyper- and hypoactive delirium, especially with a pre-existing decrease of cognitive functions and the development of metabolic or infectious complications; as well as intracranial hypertension.
\nNonspecific complications include bedsores, pneumonia, urinary tract infection, hyponatremia due to inadequate secretion of antidiuretic hormone (ADH), deep vein thrombosis, and pulmonary thromboembolism. They are more likely to develop in patients with severe neurological deficits. Hyponatremia is a common accompaniment during the acute stage of stroke. Its relevance to the clinical presentation, treatment and prognosis should be mentioned.
\n\n
Hypernatremia: Na >145 mmol/l (the main reason—central DI)
Criteria: polyuria: rate of diuresis >3 ml/kg/hour
Hypernatremia: >145 mmol/l
Urine specific gravity: <1005
\nInfusion therapy:
Base 75–100 ml/hour monitoring of sodium concentration every 6 hours.
Fluid deficit replenishment: in case of polyuria—compensation of fluid loss.
\nIf ineffective, symptoms of diabetes insipidus (DI) persist—ADH\n
Desmopressin: 2–4 mcg per 24 hours
Vasomirin (nasal spray): 10 mcg
\n
Total body fluid = 0.6 × body weight
Free water deficit = (0.6 × body weight) − (0.6 × body weight) × (140/Na act)
Example: body weight = 75 kg, Na = 154 mmol/l
Free water deficit = 0.6 × 75 − [0.6 × 75 × (140/154)] = 45 − 40.9 = 4.1 l
\n
Hyponatremia: Na < 135 mmol/l
If Na <125 mmol/l, there is a high risk of neurological disorders.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
No neurological deterioration
Acute neurological deterioration
Hyponatremia: no longer than 24 hours acute not prolonged reducing the level of sodium
Negative fluid balance: IV 3% NaCl—4 ml/kg during 15–30 min
2/3 of physiological need for fluid + furosemide 1 mg/kg
Intravenous (IV): only sodium solutions
Monitoring: fluid balance, diuresis, sodium in plasma/urine, and urine specific gravity
Central salt wasting syndrome
Restoring of fluid deficit
Positive sodium balance
Rehydration
HyperHAES: 0.25 ml/kg/hour or 0.9%NaCl
Fludrocortisone: 0.4 mg per 24 hours
Acute hyponatremia correction rate (<48 h): ≤24 mmol/l/24 hours
Chronic hyponatremia correction rate (>48 h): ≤0.5 mmol/l/hour, but ≤10 mmol/l/24 hours
In the presence of an accompanying potassium deficit: ≤4 mmol/l/25 hours
Stroke patients should be treated in specialized departments. For every 24 patients treated in a specialized rather than general ward, one death and one disability are prevented [4]. This does not depend on the age, type, and severity of stroke [4, 5]. Therefore, specialized departments are very important for the treatment of stroke patients [1, 4]. For all strokes with persistent neurological deficits, the treatment aimed at stabilizing the patient’s condition, controlling vital functions, and actively curating problems that may worsen recovery is indicated. This is the main component of the stroke treatment program [6, 7].
\nIn the detection and treatment of emergency life-threatening conditions (risk of aspiration, epileptic status, respiratory failure, etc.), the patency of the upper respiratory tract should be ensured in the case of deprivation of consciousness to the level of coma, respiratory failure of central origin, or local causes leading to respiratory disorders.
\nThe stabilization of most physiological parameters, blood pressure, saturation (more than 93%), glycemic level (less than 180 mg), body temperature (below 37.50°C), and hydration, is necessary in the first few days to prevent negative dynamics in the penumbra zone.
\nA normal respiratory function with adequate blood oxygenation is necessary in the acute period of stroke to maintain an adequate oxygen delivery to brain cells, but there is no conclusive evidence that all patients with stroke receive oxygen therapy with a positive result [4]. In cases of hypoxemia, improved blood oxygenation is achieved by oxygen therapy via a nasal catheter and noninvasive or invasive ventilation.
\nComplications of acute stroke include neurogenic stressful cardiomyopathy, paroxysmal sympathetic hyperactivity, atrial fibrillation, acute heart failure, myocardial infarction, and sudden death [1, 2]. The frequency of these complications explains the need for a constant monitoring for 2–3 days.
\nMany stroke patients are in a state of dehydration, which leads to a worse outcome of the disease [1, 2]. Despite limited clinical data, the administration of infusion therapy (0.9% sodium chloride solution) is considered part of the overall treatment of stroke, especially in patients with an increased risk of dehydration due to depression of consciousness or respiratory disorders. Experience in the treatment of hyperglycemia recommends avoiding the introduction of glucose solutions in the early period of stroke and strict control of the level of glycemia [4].
\nAccording to the literature, there are no mechanisms for autoregulation of cerebral blood flow in the penumbra zone. Therefore, a decrease in blood pressure in the first hours after a stroke before the penumbra zone appears can cause significant hypoperfusion, which worsens the development of the ischemia zone. Therefore, in the acute period, it is not necessary to aggressively treat arterial hypertension if there are no concomitant life-threatening conditions, such as aortic dissection or intracranial hematoma [2, 4].
\nIn practice, blood pressure correction is usually started when the systolic blood pressure exceeds 220 mm Hg and diastolic blood pressure exceeds 120 mm Hg. However, in many clinics, antihypertensive therapy is performed only in cases of heart failure, acute renal failure, aortic arch dissection, or malignant hypertension. When conducting a thrombolytic therapy (TLT), it is common practice to maintain blood pressure below 185 mm Hg. The intravenous administration of labetalol (10 mg bolus, followed by an infusion of 0.1–0.3 mg/kg/hour) or urapidil (12.5 mg bolus for 20 seconds, followed by an infusion of 6–30 mg/hour) is often used.
\nHyperglycemia occurs in 60% of stroke patients who have not previously suffered from diabetes [2, 7]. Hyperglycemia after a stroke is usually associated with a large volume of infarction and cortical damage and is associated with an adverse outcome of the disease [4]. Currently, the routine use of insulin infusions in patients with moderate hyperglycemia is not recommended. The European Stroke Association recommends maintaining glycemia below 180 mg/dl (10 mmol/l) [4].
\n\nBody temperature control: hyperthermia is associated with an increase in the size of the infarction zone and a worsening of the outcome of the disease [8]. Fever is associated with a worse clinical outcome [9]. When the body temperature increases, it is necessary to quickly exclude concomitant infections and, if necessary, treat them.
\nThe prevention of trophic disorders in the form of bedsores is carried out by establishing an early enteral nutrition through a nasogastric probe with an adequate calorie of nutritional mixtures: early mobilization, anti-bedsore mattresses, suitable beds, and nursing care.
\n\nAspiration pneumonia: diagnosis of dysphagia (special examination of the function of swallowing by doctors, nurses, or speech therapists) [10, 11] or use of a nasogastric probe if necessary.
\nDeep vein thrombosis and pulmonary embolism: low-molecular-weight heparins (LMWH) in prophylactic doses reduce the risk of thromboembolic complications without affecting mortality [2]. Their use slightly increases the risk of intracranial hemorrhages. The use of LMWH is recommended only if the patient has risk factors for deep vein thrombosis and pulmonary embolism, such as lower limb immobilization, in the first few hours after a stroke [2], and not earlier than 24 hours in patients with intracranial hemorrhage [9]. A recent study of Clots in Legs Or sTockings after Stroke (CLOTS) [12] has shown that an intermittent pneumatic compression reduces the risk of deep vein thrombosis and can improve stroke survival in patients who cannot go to the toilet with an assistant.
\n\nRehabilitation: it is an important issue both in acute phase and in chronic phase. Points to be covered are position turning to avoid pressure sores, chest physiotherapy to minimize lung complication, swallowing assessment and training, limb movements to prevent deep vein thrombosis, speech therapy, early mobilization, etc. All should be started as early as possible. Rehabilitation should begin as soon as the patient’s condition stabilizes: passive measures to minimize contractures, bedsores, and pneumonia. A coordinated multidisciplinary approach to patient management with the help of constantly trained staff is important, which leads to a reduction in mortality and disability.
\nThe intravenous administration of a recombinant tissue plasminogen activator (tPA) increases the chances of a favorable outcome approximately 8 times within 3 months if performed in the first 90 minutes, 2 times when performed within 91–180 minutes after a stroke, and 1.4 times when performed in 181–270 minutes [6, 13]. The mortality does not change when administered up to 270 min after stroke onset, but increases with later administration of tPA [6]. Indications and contraindications for thrombolytic therapy are noted in Tables 1 and 2, respectively.
\nNo. of wording | \n
---|
\n
| \n
Indications for thrombolytic therapy.
No. of wording | \n
Cerebral \n
| \n
Contraindications for thrombolytic therapy.
Hemorrhagic transformation is more often observed in patients with large strokes and of old age [7]. The earlier the tPA is introduced, the more likely the beneficial effect is, and despite the fact that the probability of a favorable effect is also present when used later than 3 hours from a stroke, it is significantly reduced. The dose is 0.9 mg/kg (10% intravenous bolus, 90%—within an hour microjet). In Japan, the recommended dose is lower—0.6 mg/kg. Thus, thrombolytic therapy is recommended as early as possible after the onset of a stroke, no later than 4.5 hours. Restrictions apply both to contraindications [increased risk of hemorrhage, delay of more than 4.5 hours, blood pressure (BP) above 185 mm Hg, blood glucose above 4 G/l] and strict rules of use (only by a doctor trained in the management of stroke patients and only in the stroke department) [6].
\nOther ways to achieve rapid recanalization are currently being investigated and do not change the existing recommendations: other thrombolytic drugs, MRI patient selection criteria, intra-arterial thrombolytic therapy, and ultrasound-assisted intravenous thrombolysis. Mechanical thrombextraction is considered a promising technique in addition to intravenous thrombolysis in patients with proximal occlusions. In patients receiving oral anticoagulants, mechanical thrombectomy is often the only recommended recanalization strategy.
\nAspirin at a starting dose of 300 mg and then 75–150 mg daily prevents 9 cases of disability and death per 1000 patients. Aspirin should be prescribed 24 hours after any thrombolytic therapy. Recently, a Clopidogrel in High-Risk Patients with Acute Nondisabling of Cerebrovascular Events (CHANCE) study showed that patients with small strokes and transient ischemic attack (TIA) who received a loading dose of clopidogrel for 24 hours, against the background of aspirin, and then for 90 days on 75 mg of aspirin and 75 mg of clopidogrel had better outcomes without the risk of bleeding.
\nLow-molecular-weight heparins do not have advantages, because a decrease in the frequency of early recurrent strokes is balanced by an increase in the frequency of hemorrhagic transformations. There is no reason to recommend heparin in the acute stage of ischemic stroke, even in patients with atrial fibrillation.
\nExperimental studies have shown that potential neuroprotectors are effective, but this is not confirmed in the human population. Many neuroprotective agents have been developed based on a cascade of biochemical events leading to cell death. We report below the current clinical status of drugs that have been developed as neuroprotective agents (Table 3) [14].
\nCategory, mechanism | \nDrug name, name of multicenter study, and its results | \nCategory, mechanism | \nDrug name, name of multicenter study, and its results | \n
---|---|---|---|
Ca2+ channel blocker | \nNimodipine: no benefit (VENUS) | \nNoncompetitive NMDA antagonist | \nDizocilpine, discontinued Dextrorphan, no benefit | \n
Na+ channel blocker | \nLifarizine, no benefit; lubeluzole, no benefit; fosphenytoin, discontinued | \nCompetitive NMDA antagonist | \nSelfotel: discontinued | \n
GABA agonist | \nClomethiazole: no effect | \nAMPA/KA receptor antagonist | \nNBQX, discontinued YM872, RCT | \n
Free radical scavenger | \nEdaravone, clinical use; ebselen, phase III; NXY059: phase III; tirilazad, discontinued | \nMetabotropic receptor antagonist | \nGroups I, II, and III: RCT being planned | \n
Growth factor | \nbFGF: abandoned AX200 (filgrastim, G-CSF analogue), phase II | \nLMWH-CoA reductase inhibitor | \nLovastatin, phase II; simvastatin, phase III | \n
Growth factors, oxygen delivery | \nHuman chorionic gonadotropin (hCG)/erythropoietin (Ntx-265): phase II | \nHemodiluting agent | \nAlbumin: phase III (ALIAS) | \n
Ganglioside | \nNo benefit | \nMembrane stabilizer | \nCiticoline (CDP choline): phase III | \n
MgSO4\n | \nFAST-MAG: ongoing (IMAGE) | \nIron chelator | \nDeferoxamine mesylate: phase II | \n
Opioid receptor antagonist | \nNalmefene: no benefit | \nMetal ion chelator | \nDP-b99: phase III | \n
Polyamine receptor antagonist | \nEliprodil: discontinued | \nAntibiotic, pleiotropic protective effects | \nMinocycline: phase III | \n
Glycine antagonist | \nACEA-1021, no benefit; gavestinel, no benefit | \nOthers | \nPiracetam: phase III | \n
Neuroprotective drugs developed so far and results of clinical trials.
VENUS, very early nimodipine use in stroke; NMDA, N-methyl-D-aspartic acid; GABA gamma-aminobutyric acid; AMPA, amino-hydroxy-methyl-isoxalone propionic acid; KA, kainate; NBQX, 2,3dihydroxy-6-nitro-7-sulfamoyl-benzo [f]quinoxaline-2,3-dione; RCT, randomized controlled trial; bFGF basic fibroblast growth factor; ALIAS, albumin in acute stroke; FAST-MAG, Field Administration of Stroke Therapy—Magnesium; ACEA-1021, 5-nitro-6,7-dichloro-1,4dihydro-2,3-quinoxalinedione.
Hypothermia is a potential opportunity to provide neuroprotection, but due to side effects and the need for intensive therapy, it can only be used in severe cases, especially in patients with malignant heart attacks, and currently requires randomized trials [8, 15].
\nDecompressive neurosurgery (hemispherectomy) reduces mortality and disability in patients younger than 60 years old who recently suffered a massive stroke in the middle cerebral artery basin [16]. In order to be effective, the operation must be performed before the development of a malignant brain attack. The best selection criterion is the volume of damage on a diffusion-weighted MRI within 24 hours; a volume greater than 145 cm3 is a good predictor of malignant infarction. Therefore, the best candidates for surgical treatment are patients younger than 60 years with a lesion volume of more than 145 cm3 on diffusion-weighted MRI (6.50). The effectiveness of hemispherectomy is great—every second death is prevented. Results of the Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery II (DESTINY II) study also showed effectiveness in patients over 60 years of age [3].
\nIt is necessary to control blood pressure (BP). Lowering blood pressure in the first hours can prevent or slow down the growth of hematoma, as well as reduce the risk of repeated hemorrhage.
\nAn early decrease in blood pressure can cause cerebral ischemia in low-perfused and hypometabolic regions of the brain adjacent to the hematoma.
\nEuropean recommendations are based on the evidence of a low level of significance (class 4) [9]:
No specific drug is recommended.
In patients with a history of primary arterial hypertension or signs (ECG, changes in the fundus vessels) of chronic hypertension, systolic pressure above 180 mm Hg or diastolic pressure above 105 mm Hg and in patients without a history of hypertension, the target blood pressure is 170/100 or average 125 mm Hg.
In patients without a history of arterial hypertension (systolic blood pressure above 160 mm Hg and/or diastolic blood pressure above 95 mm Hg), the target blood pressure is 150/90 mm Hg or BP mean 110 mm Hg.
Avoid lowering blood pressure by more than 20%. These targets should be revised for patients who are being monitored for intracranial pressure (ICP) and are experiencing intracranial hypertension in order to maintain adequate cerebral perfusion pressure (greater than 70 mm Hg).
The INTERACT 2 study recently showed that in patients with intracerebral hematoma, an intensive reduction in blood pressure with targets below 140 mm Hg within an hour slightly improves the outcome and is well tolerated by the patient.
\nIn patients with intracerebral hematoma, complications such as deep vein thrombosis and pulmonary embolism are feared. A small study conducted on patients with intracerebral hematoma showed that the use of intermittent pneumatic compression is more effective than the use of compression knitwear alone [17]. The CLOTS study [12] showed that the use of compression knitwear is ineffective, but only 232 patients with intracerebral hematoma were included out of 2518 stroke patients. The expediency of using heparin and low-molecular-weight heparins is justified only in cases where the probability of bleeding risk is less than the possible benefit of prescribing drugs. In clinical practice, low doses of fractionated or low-molecular-weight heparin can be prescribed after 24 hours [16]. According to the results of the CLOTS 3 study [12], intermittent pneumatic compression is effective.
\nICP negatively affects the functional outcome. The superiority of invasive ICP monitoring over clinical observation and neuroimaging has not been proven. Ways to reduce ICP by medication help to buy time to prepare for surgical decompression, if it is planned. In the acute phase of intracranial hemorrhage, it is recommended to avoid corticosteroids. These recommendations are based on low confidence data. For the medical treatment of ICH, glycerol, mannitol, HAES, and short-term hyperventilation (confidence class 4) are used. For example, mannitol (20%) at a dose of 0.75–1.0 g/kg can be administered as an intravenous bolus followed by 0.25–0.5 g/kg every 3–6 hours, depending on the neurological status and fluid balance.
\nIn the acute stage, every patient with intracranial hemorrhage and an INR greater than 1.4 should receive intravenous vitamin K and drugs that replace the deficiency of clotting factors, despite the reason for taking oral anticoagulants (including patients with artificial valves). The goal is to prevent the growth of hematoma volume. In European protocols, it is recommended to use a concentrated prothrombin complex or SPP together with the intravenous administration of vitamin K [18]. Doses of concentrated prothrombin complex: 10–20 U/kg, if the INR is less than 3.5; or 20–30 units/kg, if the INR exceeds 3.5; together with 10 mg of vitamin K in/B.
\nRecombinant factor VIIa is not recommended for routine use outside of clinical trials.
\nThere is currently no antidote for patients with intracranial hematoma receiving new oral anticoagulants. This limits the use of these drugs.
\nThere are no specific recommendations for the treatment of hemorrhage on the background of antiplatelet drugs. Studies of the use of thrombosis have not proved its effectiveness [6, 13].
\nIn patients with intracranial hemorrhage with increased ventricles and obstruction of the third and fourth ventricles, according to some data, it is recommended to use a recombinant tissue plasminogen activator inserted directly into the ventricular system, which can improve the functional outcome [9].
\nThe removal of a blood clot should be considered in cases where there is neurological dysfunction or neuroimaging data about occlusion of cerebrospinal fluid spaces subtentorially. According to European recommendations, ventricular drainage and hematoma removal should be performed when the size of the hematoma is more than 2–3 cm in diameter or in the presence of hydrocephalus, even if the favorable outcome is doubtful due to old age or coma.
\nDynamic monitoring and conservative medical treatment are the first stage in the treatment of patients with intracranial hematoma. A special analysis of subgroups from the STICH study and a recent meta-analysis showed that craniotomy should be considered as a treatment option in cases of depression of consciousness (from 12 to 9 points on the Glasgow scale) [19] or in cases of superficial intracranial hemorrhage (less than 1 cm from the surface and does not reach the basal ganglia) [20, 21, 22]. With deep-seated hematomas, craniotomy does not bring a positive result. The STICH II study showed that early surgical treatment did not increase mortality and disability within 6 months, but slightly improved survival in patients with spontaneous intracranial hemorrhage in the absence of intraventricular hemorrhage.
\nSinus thrombosis is the cause of approximately 1% of strokes. It occurs due to the occlusion of the venous sinuses and/or cortical veins. This can lead to a venous infarction with petechial hemorrhages or a perivascular venous infarction. Usually, the cause of sinus thrombosis is congenital and acquired prothrombotic disorders, such as pregnancy and infections, including infections of the central nervous system as well as ear, sinuses, mouth, face, or neck. Also the predisposing factors are various diagnostic and therapeutic procedures, such as surgery, lumbar puncture, jugular vein catheterization, and administration of certain medications, especially oral contraceptives, hormone replacement therapy, steroids, and antitumor drugs [23].
\nThe clinical picture may be different, but sinus thrombosis should be excluded in young patients with recent headache and stroke-like symptoms, transient neurological deficits, convulsions, or lobar intracranial hemorrhages. This is especially true for patients with intracranial hypertension and patients with signs of hemorrhagic infarctions, especially if they are numerous and correspond to certain vascular pools.
\nThe gold standard for diagnosing sinus thrombosis is MRI, which provides direct visualization of occluded veins, sinuses, and blood clots [23]. Sometimes CT is used for diagnostics, but if MRI is available, this is not the method of choice for diagnostics. On CT, you can see a hyperintensive shadow of a blood clot in the occluded sinus, the so-called cord symptom.
\nThe available research data on the treatment of venous thrombosis recommend the use of heparin, as it reduces the risk of death and severe disability without the risk of intracranial hematoma. It has been shown that anticoagulant therapy leads to an absolute reduction in the risk of death and disability by 13% and a relative reduction in the risk by 54%, as well as a positive effect of using heparin without increasing the risk of intracranial hemorrhage.
\nAccording to European recommendations [18], venous thrombosis should be treated with low-molecular-weight heparins subcutaneously or intravenous heparin; doses are selected by body weight. The presence of intracranial hemorrhage accompanying venous thrombosis is not a contraindication to a heparin therapy [18].
\nThere is no data from randomized controlled trials on the efficacy and safety of systemic or local thrombolytic therapy in patients with cerebral vein thrombosis and sinus thrombosis. A recently published systematic review of thrombolytic therapy in patients with cerebral vein thrombosis and sinus thrombosis suggests a favorable effect in comatose patients [24].
\nAccording to European protocols [18], there is insufficient data to recommend the use of systemic or local thrombolytic therapy in patients with cerebral vein thrombosis and sinus thrombosis. Thrombolytic therapy may be an option if the patient’s condition worsens despite an adequate anticoagulant therapy.
\nAfter the acute phase, they switch to oral anticoagulant therapy. The Target INR is 2.0–3.0. In cases of cerebral vein thrombosis and sinus thrombosis during pregnancy, oral anticoagulants are not prescribed due to their possible teratogenic effects and the ability to penetrate the placenta. In these cases, anticoagulant therapy is continued with heparin. There is no available data from controlled studies concerning the optimal duration of anticoagulant therapy in patients with cerebral vein thrombosis and sinus thrombosis. MRI data from 33 patients showed that recanalization occurs within 4 months after cerebral vein thrombosis and sinus thrombosis, regardless of further anticoagulation therapy [25].
\nAccording to European protocols [18], anticoagulants can be prescribed for 3 months if cerebral vein thrombosis occurred due to transient factors and for 6–12 months in patients with idiopathic thrombosis and congenital “moderate” thrombophilia.
\nThe preventive use of anticonvulsants is controversial. Some studies have shown that sensory and motor deficits, parenchymal lesions on MRI/CT, and cortical vein thrombosis can be independent predictors of early symptomatic epileptic seizures [26]. According to European recommendations [18], prophylactic administration of anticonvulsants is possible for patients with local neurological deficits and foci of parenchymal lesions. Treatment can be continued for a year. Despite the fact that 50% of patients with venous thrombosis experience brain edema, mild edema can be relieved by isolated administration of heparin to restore venous outflow. Steroids are not recommended for the treatment of intracranial hypertension due to their unproven effectiveness. In severe cases, with the threat of transtentorial dislocation, surgical decompression is considered the only lifesaving method of treatment.
\nThe incidence of strokes in the postoperative period in patients with coronary artery bypass grafting (CABG) is about 2%, and a higher incidence of strokes is observed in patients after valve replacement operations and other cardiac surgeries [3]. The causes of stroke after cardiac surgery include perioperative embolism from the aortic arch or heart chambers, systemic hypoperfusion, ischemia associated with occlusion of large vessels, or a combination of these factors [3]. Risk factors for stroke after cardiac surgery are old age; a history of strokes, hypertension, and diabetes mellitus; the presence of noise in the projection of the carotid arteries; the use of bronchodilators and diuretics; high serum creatinine levels; recovery of large vessels; the use of inotropes after artificial circulation; and the duration of artificial blood circulation.
\nCurrently, there are no special recommendations for the treatment of patients with stroke after CABG [3]. Moreover, patients with stroke after CABG are treated as patients with acute stroke with loading doses of aspirin (160–320 mg) [3].
\nCarotid endarterectomy is the standard method for treating carotid artery stenosis [3]. It is recommended for 70–99% of patients with symptomatic stenosis. It is confirmed that surgical treatment of asymptomatic stenosis reduces the risk of ipsilateral stroke; however, the absolute advantage of this method has not been proven. Currently, stenting is not recommended for revascularization of the carotid arteries.
\nThe pathophysiological mechanism of stroke in carotid revascularization may be associated with hemodynamic cerebral ischemia or arterio-arterial embolism. The latter mechanism may be more frequent during stenting due to endovascular access.
\nIntracranial hemorrhage can be a severe side effect of thrombolytic therapy in ACS. The risk of intracranial hemorrhage depends on the previous episodes in the history, age, and mode of thrombolytic therapy. Usually, the risk of intracranial hemorrhage during thrombolytic therapy of acute myocardial infarction is 0.5–1%.
\nThere are no special recommendations for the treatment of ischemic stroke in ACS in European protocols. In the presence of ACS, the protocols of the European Stroke Organization recommend lowering blood pressure [4, 6]. An anticoagulant therapy is not recommended, while a combination of clopidogrel and aspirin is recommended in terms of cardiac causes [4, 7].
\nCardio-cerebral embolism is considered to be the cause of at least 20% of ischemic strokes, and non-valvular AF is the most common cause, associated with a fivefold increase in the risk of stroke, and accounts for 25% of all strokes in patients older than 80 years [3]. Long-term thromboprophylaxis is necessary to prevent strokes in patients with AF. Recently, for patients who cannot be treated with warfarin and clopidogrel, it has been shown that clopidogrel and aspirin therapy reduces the risk of vascular accidents [7]. Oral direct thrombin inhibitors such as dabigatran have been shown to be effective in preventing stroke and systemic embolism with a risk of intracranial hemorrhage comparable to that of warfarin. Stroke in patients with AF can be divided into three groups:
Ischemic stroke in patients with insufficient therapy, i.e., not receiving anticoagulants, despite scores on the CHADS2 scale greater than 2 [3]
Ischemic stroke that developed despite warfarin therapy
Intracranial hemorrhage that occurred in a patient receiving anticoagulants
The incidence of intracranial hemorrhage increases 7–10 times compared to patients who do not receive oral anticoagulants and is 1.8% per year in patients at risk of stroke [7].
\nIn the acute phase of stroke, heparin is not recommended; its use leads to a slight decrease in repeated strokes, an indefinite decrease in mortality, and a disability with an increase in the frequency of intracranial hemorrhages [7].
\nThe connection between the brain and the heart reflects a complex multidirectional complex regulation of systemic hemodynamics and organ autoregulation of local perfusion, which is especially pronounced in a cerebral catastrophe. Arrhythmias, in particular AF, often accompany the development of stroke, while myocardial infarction, Takotsubo syndrome, and sudden death are rare, although they are also described in strokes [27, 28, 29]. Sometimes stroke patients are found to have high levels of troponin, indicating myocardial damage.
\nTo ensure adequate treatment, a rapid diagnosis of stroke and its nature and cause is necessary. Specialized stroke departments allow for effective treatment and specific therapy.
\nThe authors declare no conflict of interest.
\nWe would like to thank our teachers—neurologists, anesthesiologists, and neurosurgeons—of Russian Polenov’s Neurosurgical Institute, the first institute of neurological surgery in the world founded in 1926 in St. Petersburg (Petrograd) in Russia.
\nACS | acute coronary syndrome |
AF | atrial fibrillation |
ADH | antidiuretic hormone |
aPTT | activated partial thromboplastin time |
AVM | arteriovenous malformation |
BP | blood pressure |
CT | computed tomography |
CABG | coronary artery bypass grafting |
DI | diabetes insipidus |
DWI | diffusion-weighted imaging |
ECG | electrocardiogram |
EchoCG | echocardiography |
ESR | erythrocyte sedimentation rate |
LMWH | low-molecular-weight heparins |
ICH | intracranial hemorrhage |
ICP | intracranial pressure |
INR | international normalized ratio |
MCA | medium cerebral artery |
MRI | magnetic resonance imaging |
NIHSS | National Institutes of Health Stroke Scale |
SAH | subarachnoid hemorrhage |
SIADH | syndrome of inappropriate antidiuretic hormone secretion |
tPA | tissue plasminogen activator |
TLT | thrombolytic therapy |
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'Copyright is the term used to describe the rights related to the publication and distribution of original Works. Most importantly from a publisher's perspective, copyright governs how Authors, publishers and the general public can use, publish, and distribute publications.
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