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Effect of stress-dependent microannulus aperture on well leakage

Journal of Rock Mechanics and Geotechnical Engineering 2024年第6期16卷 1967-1976页

作者： Meng Meng Luke P.Frash J.william carey Mohamed Mehana Wenfeng Li Bailian Chen Earth and Environmental Sciences Los Alamos National LaboratoryLos AlamosNMUSA

Debonding at the cement-casing interface is recognized as a principal failure mechanism leading to CO_(2) leakage in *** detachment gives rise to a microannulus,which notably possesses greater permeability than undamaged cement,undermining its sealing ***,the permeability of the microannulus is regarded as a uniform value throughout the ***,fundamentally,a microannulus is one type of fracture,and its gap or aperture size is affected by the effective *** this work,we developed a unique experimental *** equipment facilitates the curing of cement inside a steel casing,the formation of a microannulus between the casing and the cement,and the investigation of the fluid flow dynamics along the microannulus under laboratory-replicated in situ *** microannulus was formed by injecting fluid from one end of the setup,and receiving similar amount of fluid on the other end signified the development of the leakage ***,strain gauges affixed to the casing’s external surface yielded key information on the microannulus’s opening and *** observed a noticeable decline in microannulus hydraulic aperture(or permeability)in relation to effective stress and an exponential equation fits their *** findings also indicate a distinct behavior when comparing liquid CO_(2) with ***,it is easier for liquid CO_(2) to create the ***,the hydraulic aperture range for this microannulus(0.7-6 mm)is considerably smaller than that created by water flow(2-17 mm).Finally,we integrated the stressdependent microannulus aperture size into the combined analysis of well mechanical integrity and well *** outcomes consistently demonstrated that when factoring in the stress-dependent aperture sizes,the leakage rates are 3e5 times compared to a fixed aperture *** traditional assumption of a constant aperture significantly underestimates fluid leakage risks.

关键词： Microannulus Leakage assessment Aperture size Triaxial experiment Carbon sequestration

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Hydromechanical characterization of gas transport amidst uncertainty for underground nuclear explosion detection

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第6期16卷 2019-2032页

作者： Wenfeng Li Chelsea W.Neil J william carey Meng Meng Luke P.Frash Philip H.Stauffer Earth and Environmental Sciences Los Alamos National LaboratoryLos AlamosNM87544USA Department of Mineral Engineering New Mexico TechSocorroNM87801USA

Given the challenge of definitively discriminating between chemical and nuclear explosions using seismic methods alone,surface detection of signature noble gas radioisotopes is considered a positive identification of underground nuclear explosions(UNEs).However,the migration of signature radionuclide gases between the nuclear cavity and surface is not well understood because complex processes are involved,including the generation of complex fracture networks,reactivation of natural fractures and faults,and thermo-hydro-mechanical-chemical(THMC)coupling of radionuclide gas transport in the *** this study,we provide an experimental investigation of hydro-mechanical(HM)coupling among gas flow,stress states,rock deformation,and rock damage using a unique multi-physics triaxial direct shear rock testing *** testing system also features redundant gas pressure and flow rate measurements,well suited for parameter uncertainty *** porous tuff and tight granite samples that are relevant to historic UNE tests,we measured the Biot effective stress coefficient,rock matrix gas permeability,and fracture gas permeability at a range of pore pressure and stress *** Biot effective stress coefficient varies from 0.69 to 1 for the tuff,whose porosity averages 35.3%±0.7%,while this coefficient varies from 0.51 to 0.78 for the tight granite(porosity<1%,perhaps an underestimate).Matrix gas permeability is strongly correlated to effective stress for the granite,but not for the porous *** experiments reveal the following key engineering implications on transport of radionuclide gases post a UNE event:(1)The porous tuff shows apparent fracture dilation or compression upon stress changes,which does not necessarily change the gas permeability;(2)The granite fracture permeability shows strong stress sensitivity and is positively related to shear displacement;and(3)Hydromechanical coupling among stress states,rock damage,and gas flow appears to be

关键词： Underground nuclear explosion uncertainty quantification Radionuclide transport Biot effective stress coefficient Fracture permeability Matrix permeability

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Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

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Gastroenterology Report 2018年第4期6卷 284-290,I0002页

作者： John Guirguis Yilien Alonso Rocio Lopez william carey Department of Internal Medicine Blake Medical CenterBradentonFLUSA Department of Gastroenterology Ochsner Health SystemNew OrleansLAUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA Digestive Disease Institute Department of Gastroenterology and HepatologyCleveland ClinicClevelandOHUSA

Background:Autoimmune hepatitis may flare up after treatment withdrawal,especially in those who had not achieved histological remission but had normal liver *** European Association for the Study of the Liver(EASL)and the American Association for the Study of Liver Disease(AASLD)Guidelines recommend performing liver biopsy before treatment *** aim of the study is to define the outcome of treatment withdrawal in adults with wellcontrolled disease for 2 years with and without liver-biopsy ***:A retrospective observational study was conducted on biopsy-proven autoimmune hepatitis patients who were treated for 2 years and with persistently normal aspartate aminotransferase(AST)and alanine aminotransferase(ALT)or nearly so for 6 months prior to treatment *** were:juvenile onset autoimmune hepatitis and prior treatment or use of agents other than corticosteroids and *** primary endpoint was to define freedomfrom flare-ups for 1 year after treatment ***:Thirty-four consecutive subjectsmeeting study criteria were *** withdrawal was accomplished in 24 subjects without liver-biopsy guidance and 10 had pre-treatment withdrawal liver ***,immunosuppressive usage,pre-treatment cirrhosis and pre-treatment liver enzymes were similar between the two groups,and 25%had an enzyme flare-up within 12months after treatment withdrawal,which was similar in the two groups(20.8 vs 30.0%,P=0.57).Conclusions:Adults with autoimmune hepatitis and excellent response to therapy for 2 years are candidates for treatment withdrawal without the need for liver biopsy.

关键词： Autoimmune hepatitis liver biopsy treatment withdrawal liver enzyme

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Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

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World Journal of Gastroenterology 2008年第41期14卷 6370-6375页

作者： Jamilé Wakim-Fleming Nizar N Zein Ana Bennett Rocio Lopez Janice Santisi william D carey Department of Gastroenterology and Hepatology Cleveland Clinic Foundation Cleveland Department of Pathology/Immunology Cleveland Clinic Foundation Cleveland Department of Quantitative Health Sciences Cleveland Clinic Foundation Cleveland

AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade fi ndings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty f ive patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded fi ndings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

关键词： Cirrhosis Portal hypertension Coeliac disease Marsh criteria Small bowel mucosa

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Outpatient telephonic transitional care after hospital discharge improves survival in cirrhotic patients

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World Journal of Hepatology 2019年第8期11卷 646-655页

作者： Bhavana Bhagya Rao Anastasia Sobotka Rocio Lopez Carlos Romero-Marrero william carey Department of Gastroenterology Hepatology and Nutrition Cleveland Clinic

BACKGROUND Intervention to improve outcomes in cirrhotic patients (CP) after hospital discharge often focus on 30 d readmission rate (RR). However, recent studies suggest dissociation between RR and survival. At our center, CP are now offered outpatient telephonic transitional care (OTTC) by a care coordinator for 30 d after hospital discharge. AIM To determine the effect of OTTC on survival in CP. METHODS In this cohort study from a tertiary center, CP who received OTTC formed the intervention group. They were compared with a control group discharged during the same period. Mortality and RR were compared between the groups. RESULTS After OTTC introduction, 194 CP were discharged. After applying exclusion criteria, 169 CP (51% male, mean age 58 years ± 12 years) were included. OTTC group comprised 76 patients and was compared with 93 controls. Baseline disease and index admission related characteristics were not significantly different between the groups. The intervention group showed significantly higher 6 mo survival compared to controls (84.2% vs 68.8%;P = 0.03), while RR at 1, 3, and 6 mo were comparable. On multivariable analysis, the intervention group showed lower odds for mortality compared to the controls (hazard ratio: 0.4;95% confidence interval: 0.2-0.82;P = 0.012), while higher model for endstage liver disease scores were associated with higher mortality (hazard ratio: 1.05;95% confidence interval: 1.01-1.1;P = 0.024).CONCLUSION CP provided OTTC had higher 6 mo survival compared to controls without a difference in RR. Use of RR to gauge quality of care provided during hospitalization or subsequent transitional care programs should be revisited.

关键词： Quality improvement Transitional care Outpatient monitoring Outcomes assessment

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注意缺陷多动障碍是一个有效的诊断吗?

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中国实用儿科杂志 2005年第9期20卷 569-572页

作者： william B.carey 邹小兵美国宾夕法尼亚大学附属儿童医院中山大学附属三院发育儿科广州510630

***是美国著名的儿童气质专家,carey系列儿童气质量表的作者。本文是作者在NIH儿童发育全体会议的大会发言稿,他代表了一种与当前主流学派的不同声音。carey教授对本文能译成中文在本刊发表感到格外高兴,并希望他的观点对中国同行起借... 详细信息

***是美国著名的儿童气质专家,carey系列儿童气质量表的作者。本文是作者在NIH儿童发育全体会议的大会发言稿,他代表了一种与当前主流学派的不同声音。carey教授对本文能译成中文在本刊发表感到格外高兴,并希望他的观点对中国同行起借鉴作用。本刊在此发表这篇译文,希望广大临床儿科医生了解这些不同的学术观点,以利于学术争鸣。

关键词：注意缺陷多动障碍儿童气质量表诊断全体会议儿童发育借鉴作用学术观点儿科医生学术争鸣

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Successful liver transplantation for acute sickle cell intrahepatic cholestasis: A case report and review of the literature

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World Journal of Hepatology 2020年第3期12卷 108-115页

作者： Motasem Alkhayyat Mohannad Abou Saleh Mohammad Zmaili Vedha Sanghi Tavankit Singh Carol Rouphael C Roberto Simons-Linares Carlos Romero-Marrero william D carey Christina C Lindenmeyer Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Digestive Disease&Surgery Institute Department of GastroenterologyHepatology&NutritionCleveland ClinicClevelandOH 44195United States

BACKGROUND Sickle cell hepatopathy(SCH)is an inclusive term referring to any liver dysfunction among patients with sickle cell *** sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of *** present the 23rd reported case of liver transplantation(LT)for SCH;a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus(HCV)nucleic acid amplification test positive *** SUMMARY A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain *** examination,he had jaundice and a soft,nontender *** he was alert and fully oriented;within 24 h he developed new-onset *** evaluation was notable for hyperbilirubinemia,leukocytosis,anemia,thrombocytopenia,acute kidney injury and elevated international normalized ratio(INR).Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal *** patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver *** underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial *** liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and *** postoperative day 3,HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day *** subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo *** This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis.

关键词： Case report Sickle cell hepatopathy Acute intrahepatic cholestasis Liver transplant Hepatitis C virus Post-operative surveillance

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LIV-4:A novel model for predicting transplant-free survival in critically ill cirrhotics

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World Journal of Hepatology 2020年第6期12卷 298-311页

作者： Christina C Lindenmeyer Gianina Flocco Vedha Sanghi Rocio Lopez Ahyoung J Kim Fadi Niyazi Neal A Mehta Aanchal Kapoor william D carey Eduardo Mireles-Cabodevila Carlos Romero-Marrero Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences Cleveland ClinicClevelandOH 44106United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Critically ill patients with cirrhosis,particularly those with acute decompensation,have higher mortality rates in the intensive care unit(ICU)than patients without chronic liver *** of short-term mortality is important in order to identify patients at highest risk of *** of the currently available prognostic models have been widely accepted for use in cirrhotic patients in the ICU,perhaps due to complexity of calculation,or lack of universal variables readily available for these *** believe a survival model meeting these requirements can be developed,to guide therapeutic decision-making and contribute to cost-effective healthcare resource *** To identify markers that best identify likelihood of survival and to determine the performance of existing survival *** Consecutive cirrhotic patients admitted to a United States quaternary care center ICU between 2008-2014 were included and comprised the training *** data and clinical laboratory test collected on admission to ICU were *** under the curve receiver operator characteristics(AUROC)analysis was performed to assess the value of various scores in predicting inhospital mortality.A new predictive model,the LIV-4 score,was developed using logistic regression analysis and validated in a cohort of patients admitted to the same institution between *** Of 436 patients,119(27.3%)died in the *** multivariate analysis,a combination of the natural logarithm of the bilirubin,prothrombin time,white blood cell count,and mean arterial pressure was found to most accurately predict in-hospital *** from the regression coefficients of the independent variables,a novel model to predict inpatient mortality was developed(the LIV-4 score)and performed with an AUROC of 0.86,compared to the Model for End-Stage Liver Disease,Chronic Liver Failure-Sequential Organ Failure Assessment,and Royal Free Hospital Score,wh

关键词： Risk stratification Resource allocation Intensive care unit Acute-on-chronic liver failure Modeling Mortality

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门静脉高压静脉曲张破裂出血的诊断和处理

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胃肠病学 2011年第3期16卷 143-147页

作者： william carey 袁春英冯怡燕巫协宁 Cleveland Clinic Lerner College of Medicine ClevelandOhioUSA

门静脉高压是导致肠腔内出血的主要原因,其主要源自食管静脉曲张。确定静脉曲张患者并采取相关治疗措施以降低初次出血率,可改善患者的预后。β受体阻滞剂或静脉曲张结扎是最常用的措施。急性静脉曲张出血处理(包括常规应用抗生素)后,... 详细信息

门静脉高压是导致肠腔内出血的主要原因,其主要源自食管静脉曲张。确定静脉曲张患者并采取相关治疗措施以降低初次出血率,可改善患者的预后。β受体阻滞剂或静脉曲张结扎是最常用的措施。急性静脉曲张出血处理(包括常规应用抗生素)后,需采取策略以降低出血的复发率。上述措施可降低门静脉高压出血患者的死亡率。

关键词：圈套结扎 β受体阻滞剂食管静脉曲张门静脉高压 TIPS

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肝硬化胃食管静脉曲张与曲张破裂出血的治疗和预防

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影像诊断与介入放射学 2010年第5期19卷 299-307页

作者： Guadalupe Garcia-Tsao Arun J.Sanyal Norman D.Grace william carey 范文哲陈斌向贤宏黄勇慧杨建勇 the Practice Guidelines Committee of the American Association for the Study of Liver Diseases the Practice Parameters Committee of the American College of Gastroenterology 中山大学附属第一医院介入放射科广州510080

这份指南已经被美围肝病学会和美国胃食管医师协会所认可，体现了两个协会对胃底食管静脉曲张与曲张破裂出血的治疗和预防的观点：

关键词：胃食管静脉曲张破裂出血预防治疗肝硬化胃底食管静脉曲张医师协会肝病学会

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