Heat shock proteins (HSPs) serve to correct proteins’ conformation, send the damaged proteins for degradation (quality control function). Heat shock factors (HSFs) are their transcription factors. The protein complex...Heat shock proteins (HSPs) serve to correct proteins’ conformation, send the damaged proteins for degradation (quality control function). Heat shock factors (HSFs) are their transcription factors. The protein complexes mTOR1 and 2 (with the same core mTOR), the phosphoinositide-dependent protein kinase-1 (PDK1), the seine/threonine-specific protein kinase (Akt), HSF1, plus their associated proteins form a network participating in protein synthesis, bio-energy generation, signaling for apoptosis with the help of HSPs. A cancer cell synthesizes proteins at fast rate and needs more HSPs to work on quality control. Shutting down this network would lead to cell death. Thus inhibitors of mTOR (mTORI) and inhibitors of HSPs (HSPI) could drive cancer cell to apoptosis—a “passive approach”. On the other hand, HSPs form complexes with polypeptides characteristic of the cancer cells;on excretion from the cell, they becomes antigens for the immunity cells, eventually leading to maturation of the cytotoxic T cells, forming the basic principle of preparing cancer-specific, person-specific vaccine. Recent finding shows that HSP70 can penetrate cancer cell and expel its analog to extracellular region, giving the hope to prepare a non-person-specific vaccine covering a variety of cancers. Activation of anti-cancer immunity is the “active approach”. On the other hand, mild hyperthermia, with increase of intracellular HSPs, has been found to activate the immunity response, and demonstrate anti-cancer effects. There are certain “mysteries” behind the mechanisms of the active and passive approaches. We analyze the mechanisms involved and provide explanations to some mysteries. We also suggest future research to improve our understanding of these two approaches, in which HSPs play many roles.展开更多
AIM: To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats. METHODS: The rats were subject to hemorrhagic...AIM: To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats. METHODS: The rats were subject to hemorrhagic shock and followed by reperfusion, and were divided randomly into two groups. Group 1 received saline, and group 2 received EFRRS intravenously. The index of gastric mucosal lesions (IGML) was expressed as the percentage of lesional area in the corpus or antrum. The degree of gastric mucosal lesions (DGML) was catalogued grade 0,1,2 and 3. The concentrations of prostaglandins (PGs) were measured by radioimmunoassay. The concentration of MDA was measured according to the procedures of Asakawa. The activity of SOD was measured by the biochemical way. The growth rates or inhibitory rates of above-mentioned parameters were calculated. RESULTS: As compared with IGML (%), grade 3 damage (%) and MDA content (nmol/g tissue) of gastric antrum which were respectively 7.96 +/- 0.59, 34.86 +/- 4.96 and 156.98 +/- 16.12, those of gastric corpus which were respectively 23.18 +/- 6.82, 58.44 +/- 9.07 and 230.56 +/- 19.37 increased markedly (P 【0.01), whereas the grade 0 damage, grade 1 damage, the concentrations of PGE(2) and PGI(2)(pg/mg tissue), the ratio of PGI(2)/TXA(2) and the activity of SOD (U/g tissue) of corpus which were respectively 3.01 +/- 1.01, 8.35 +/- 1.95, 540.48 +/- 182.78, 714.38 +/- 123.74, 17.38 +/- 5.93 and 134.29 +/- 13.35 were markedly lower than those of antrum which were respectively 13.92 +/- 2.25, 26.78 +/- 6.06, 2218.56 +/- 433.12, 2531.76 +/- 492.35, 43.46 +/- 8.51 and 187.45 +/- 17.67 (P【0.01) after hemorrhagic shock and reperfusion.After intravenous EFRRS, the growth rates (%) of grade 0 damage, grade 1 damage, the concentrations of PGE(2) and PGI(2), the ratio of PGI(2)/TXA(2) and the activity of SOD of corpus which were respectively 632.56, 308.62, 40.75, 74.75, 92.29 and 122.25 were higher than those in antrum which were respectively 104.89, 58.40, 11.12, 56.58, 30.65 and 82.64, whereas the inhibitory rates (%) of IGML, grade 3 damage and MDA content of gastric corpus were 82.93, 65.32 and 59.09, being higher than those of gastric antrum which were 76.64, 53.18 and 42.37. CONCLUSION: After hemorrhagic shock reperfusion, the gastric mucosal lesions in the corpus were more severe than those in the antrum, which were related not only to the different distribution of endogenous PGs in the mucosa, but also to the different ability of anti-oxidation of the mucosa. The protective effect of EFRRS on the gastric mucosa in the corpus was more evident than that in the antrum, which was related to higher growth degree of PGs contents and anti-oxitative ability in gastric corpus after administration of EFRRS.展开更多
The mixed venous-to-arterial carbon dioxide(CO_2)tension difference[P(v-a) CO_2]is the difference between carbon dioxide tension(PCO_2) in mixed venous blood(sampled from a pulmonary artery catheter) and the PCO_2 in ...The mixed venous-to-arterial carbon dioxide(CO_2)tension difference[P(v-a) CO_2]is the difference between carbon dioxide tension(PCO_2) in mixed venous blood(sampled from a pulmonary artery catheter) and the PCO_2 in arterial blood.P(v-a) CO_2 depends on the cardiac output and the global CO_2 production,and on the complex relationship between PCO_2 and CO_2 content.Experimental and clinical studies support the evidence that P(v-a) CO_2 cannot serve as an indicator of tissue hypoxia,and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO_2generated by the peripheral tissues.P(v-a) CO_2 can be replaced by the central venous-to-arterial CO_2 difference(△PCO_2),which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and,therefore,more easy to obtain at the bedside.Determining the △PCO_2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation(SCVO_2) > 70%associated with elevated blood lactate levels.Because high blood lactate levels is not a discriminatory factor in determining the source of that stress,an increased △PCO_2(> 6 mmHg)could be used to identify patients who still remain inadequately resuscitated.Monitoring the △PCO_2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and,thus,guiding the therapy.In this respect,it can aid to titrate inotropes to adjust oxygen delivery to CO_2 production,or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO_2 related to metabolic demand.The combination of P(v-a) CO_2 or △PCO_2 with oxygen-derived parameters through the calculation of the P(v-a) CO_2 or △PCO_2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.展开更多
The manipulation of intense shock waves to either attenuate or enhance damage has long been a key goal in the domain of impact dynamics.Effective methods for such manipulation,however,remain elusive owing to the wide ...The manipulation of intense shock waves to either attenuate or enhance damage has long been a key goal in the domain of impact dynamics.Effective methods for such manipulation,however,remain elusive owing to the wide spectrum and irreversible destructive nature of intense shock waves.This work proposes a novel approach for actively controlling intense shock waves in solids,inspired by the principles of optical and explosive lenses.Specifically,by designing a shock wave convex lens composed of a low-shock-impedance material embedded in a high-shock-impedance matrix,we prove the feasibility of transforming a planar shock into a spherically converging shock.This is based on oblique shock theory,according to which shock waves pass through an oblique interface and then undergo deflection.Both experimental and simulation results demonstrate that,as expected,the obtained local spherical shock wave has a wavefront that is nearly perfectly spherical and uniform in pressure.Thus,this work proves the possibility of generating spherical shock waves using plate-impact experiments and highlights the potential of further exploration of the manipulation of shock waves in solids.It also contributes an innovative perspective for both armor penetration technologies and shock wave mitigation strategies.展开更多
Aim Inducible nitric oxide synthase （iNOS） makes a great contribution to host defense and inflamma-tion. In many settings, lipopolysaccharide （LPS） induces iNOS expression through activation of the inhibitor of K...Aim Inducible nitric oxide synthase （iNOS） makes a great contribution to host defense and inflamma-tion. In many settings, lipopolysaccharide （LPS） induces iNOS expression through activation of the inhibitor of KB- α （IKB-α） -nuclear factor-KB （NF-KB） cascade, whereas interferon-γ （IFN-γ） acts through Janus kinase （ JAK）- signal transducer and activator of transcription 1 （ STAT1 ） signals. Heat shock factor 1 （ HSF1 ）, a major regulator of heat shock protein transcription, has been shown to regulate the production of pro-inflammatory cytokines such as tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6）. But it remains obscure whether and how HSF1 affects iNOS induction. Methods Western blot was used to measure the protein expression. The mRNA level was meas- ured by real time-PCR. Silence of HSF1 was achieved by small interfering RNA. Nitric oxide （NO） content and NF-KB binding activity were assayed by commercial kits. Chromatin immunoprecipitation （CHIP） was used to measure the binding activity of NF-KB and STAT1 to iNOS promoters. Results HSF1 inhibition or knockdown pre- vented the LPS- and/or IFN-γ-stimulated iNOS protein expression in cultured microglia. HSF1 inhibition blocked iNOS mRNA transcription. These inhibitory effects of HSF1 inhibition on iNOS expression were confirmed in brain tissues from endotoxemic mice. Further analysis showed that HSF1 inhibition had no effect on IKB-α degradation and NF-KB or STAT1 phosphorylation in LPS/IFN-γ-stimulated cells. The nuclear transport of active NF-KB or STAT1 was also not affected by HSF1 inhibition. But HSF1 inhibition reduced the binding of NF-KB and STAT1 to their DNA elements. In addition, HSF1 inhibition reduced NF-KB and STAT1 bindings to iNOS promoter inside the LPS/IFN-γ-stimulated cells. Conclusions This preventing effect of HSF1 inhibition on iNOS mRNA transcription presents the necessary role of HSF1 in iNOS induction.展开更多
AIM: To study the effect of cholecystokinin-octapeptide (CCK-8) on systemic hypotension and cytokine production in lipopolysaccharide (LPS)-induced endotoxic shock (ES) rats. METHODS: The changes of blood pressure wer...AIM: To study the effect of cholecystokinin-octapeptide (CCK-8) on systemic hypotension and cytokine production in lipopolysaccharide (LPS)-induced endotoxic shock (ES) rats. METHODS: The changes of blood pressure were observed using physiological record instrument in four groups of rats: LPS (8mg.kg(-1),iv) induced ES; CCK-8 (40 microg.kg(-1), iv) pretreatment 10 min before LPS (8mg.kg(-1)); CCK-8 (40 micro.kg(-1), iv) or normal saline (control) groups. Differences in tissue and circulating specificity of the proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) were assayed with ELISA kits. RESULTS: CCK-8 reversed LPS-induced decrease of mean artery blood pressure (MABP) in rats. Compared with control, LPS elevated the serum level of IL-6 significantly (3567 +/- 687 ng.L(-1) vs 128 +/- 22 ng.L(-1), P【0.01), while contents of TNF-alpha and IL-1beta elevated significantly (277 +/- 86 ng.L(-1) vs not detectable and 43 +/- 9 ng.L(-1) vsnot detectable, P【0.01) but less extent than IL-6. CCK-8 significantly inhibited the LPS-induced increase in serum TNF-alpha IL-1beta and IL-6. LPS elevated spleen and lung content of IL-1beta significantly (5184 +/- 85 ng.L(-1) vs 1047 +/- 21 ng.L(-1) and 4050 +/- 614 ng.L(-1) vs not detectable, P【0.01), while levels of TNF-alpha and IL-6 also rose significantly but in less extent than IL-1beta. CCK-8 inhibited the LPS-induced increase of the cytokines in spleen and lung. In the heart, CCK-8 significantly inhibited LPS-induced increase of TNF-alpha (864 +/- 123 ng.L(-1) in CCK-8+LPS group vs 1599 +/- 227 ng.L(-1) in LPS group, P 【 0.01), and IL-1beta (282 +/- 93 ng.L(-1) in CCK-8+LPS group vs 621 +/- 145ng.L(-1) in LPS group, P 【 0.01). CONCLUSION: CCK-8 reverses ES, which may be related to its inhibitory effect on the overproduction of cytokines.展开更多
Tellurene,a chiral chain semiconductor with a narrow bandgap and exceptional strain sensitivity,emerges as a pivotal material for tailoring electronic and optoelectronic properties via strain engineering.This study el...Tellurene,a chiral chain semiconductor with a narrow bandgap and exceptional strain sensitivity,emerges as a pivotal material for tailoring electronic and optoelectronic properties via strain engineering.This study elucidates the fundamental mechanisms of ultrafast laser shock imprinting(LSI)in two-dimensional tellurium(Te),establishing a direct relationship between strain field orientation,mold topology,and anisotropic structural evolution.This is the first demonstration of ultrafast LSI on chiral chain Te unveiling orientation-sensitive dislocation networks.By applying controlled strain fields parallel or transverse to Te’s helical chains,we uncover two distinct deformation regimes.Strain aligned parallel to the chain’s direction induces gliding and rotation governed by weak interchain interactions,preserving covalent intrachain bonds and vibrational modes.In contrast,transverse strain drives shear-mediated multimodal deformations—tensile stretching,compression,and bending—resulting in significant lattice distortions and electronic property modulation.We discovered the critical role of mold topology on deformation:sharp-edged gratings generate localized shear forces surpassing those from homogeneous strain fields via smooth CD molds,triggering dislocation tangle formation,lattice reorientation,and inhomogeneous plastic deformation.Asymmetrical strain configurations enable localized structural transformations while retaining single-crystal integrity in adjacent regions—a balance essential for functional device integration.These insights position LSI as a precision tool for nanoscale strain engineering,capable of sculpting 2D material morphologies without compromising crystallinity.By bridging ultrafast mechanics with chiral chain material science,this work advances the design of strain-tunable devices for next-generation electronics and optoelectronics,while establishing a universal framework for manipulating anisotropic 2D systems under extreme strain rates.This work discovered crystallographic orientation-dependent deformation mechanisms in 2D Te,linking parallel strain to chain gliding and transverse strain to shear-driven multimodal distortion.It demonstrates mold geometry as a critical lever for strain localization and dislocation dynamics,with sharp-edged gratings enabling unprecedented control over lattice reorientation.Crucially,the identification of strain field conditions that reconcile severe plastic deformation with single-crystal retention offers a pathway to functional nanostructure fabrication,redefining LSI’s potential in ultrafast strain engineering of chiral chain materials.展开更多
BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadl...BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.展开更多
AIM: To investigate if sleep deprivation is able to increase the expression of inducible heat shock protein 70 in gastric mucosa and its possible role in mucosal defense. METHODS: Rats for sleep disruption were placed...AIM: To investigate if sleep deprivation is able to increase the expression of inducible heat shock protein 70 in gastric mucosa and its possible role in mucosal defense. METHODS: Rats for sleep disruption were placed inside a computerized rotating drum, gastric mucosa was taken from rats with 1, 3 and 7d sleep deprivation. RT-PCR, immunohistochemistry and Western blotting were used to determine the expression of heat shock protein 70. Ethanol (500mL.L(-1), i.g.) was used to induce gastric mucosa damage. RESULTS: RT-PCR, Western blotting and immunostaining confirmed that the sleep deprivation as a stress resulted in significantly greater expression of inducible heat shock protein 70 in gastric mucosa of rats. After the 500mL.L(-1) ethanol challenge, the ulcer area found in the rats with 7d sleep deprivation (19.15 +/- 4.2)mm(2) was significantly lower (P【0.01) than the corresponding control (53.7 +/- 8.1) mm(2). CONCLUSION: Sleep deprivation as a stress, in addition to lowering the gastric mucosal barrier, is able to stimulate the expression of inducible heat shock protein 70 in gastric mucosa of rats, the heat shock protein 70 may play an important role in gastric mucosal protection.展开更多
Two-dimensional critical nozzle flows at low Reynolds numbers are visualized by the rainbow schlieren deflectometry. Experiments have been performed in a region of overexpanded nozzle flow. The variation of the shock ...Two-dimensional critical nozzle flows at low Reynolds numbers are visualized by the rainbow schlieren deflectometry. Experiments have been performed in a region of overexpanded nozzle flow. The variation of the shock structure against the back pressure ratio can be clearly visible with color gradation. Static pressure rises due to the shock-induced flow separation are compared with the previous theories. The unsteady characteristics of overexpanded critical nozzle flows at low Reynolds numbers are quantitatively and qualitatively visualized using laser schlieren and Mach-Zehnder interferometer systems combined with a high-speed digital camera. It was found that an oscillating normal shock wave appears inside the nozzle, and that the shock wave has a specified dominant frequency. Also the time-history of the oscillating shock wave is obtained from both the systems and compared with each other.展开更多
The nonlinear propagation of the DIA (dust ion-acoustic) waves in multi-ion dense plasma system containing degener- ate electrons, both positive and negative ions, arbitrary charged dust grains has been investigated b...The nonlinear propagation of the DIA (dust ion-acoustic) waves in multi-ion dense plasma system containing degener- ate electrons, both positive and negative ions, arbitrary charged dust grains has been investigated by employing the reductive perturbation method. The nonlinear waves (solitary and shock waves) have been observed to be formed in case of both positive and negative charged dust grains from the stationary solution of the Korteweg de-Vries (K-dV) equation and Burger’s equation. The fundamental properties of such nonlinear waves have been theoretically analyzed by comparing system potential for both positive and negative dust grains. It has been shown that the basic features of these waves are significantly modified by the positive and negative ions drift speed and polarities of dust grains. The implications of our results in space and laboratory plasmas are briefly discussed.展开更多
Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling sc...Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.展开更多
INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping ...INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping of the hepatoduodnal ligament ,has often been used for this purpose[1],This is the simplest and userul technique to reduce intraoperative blood loss .展开更多
BACKGROUND Severe dengue children with critical complications have been attributed to high mortality rates,varying from approximately 1%to over 20%.To date,there is a lack of data on machine-learning-based algorithms ...BACKGROUND Severe dengue children with critical complications have been attributed to high mortality rates,varying from approximately 1%to over 20%.To date,there is a lack of data on machine-learning-based algorithms for predicting the risk of inhospital mortality in children with dengue shock syndrome(DSS).AIM To develop machine-learning models to estimate the risk of death in hospitalized children with DSS.METHODS This single-center retrospective study was conducted at tertiary Children’s Hospital No.2 in Viet Nam,between 2013 and 2022.The primary outcome was the in-hospital mortality rate in children with DSS admitted to the pediatric intensive care unit(PICU).Nine significant features were predetermined for further analysis using machine learning models.An oversampling method was used to enhance the model performance.Supervised models,including logistic regression,Naïve Bayes,Random Forest(RF),K-nearest neighbors,Decision Tree and Extreme Gradient Boosting(XGBoost),were employed to develop predictive models.The Shapley Additive Explanation was used to determine the degree of contribution of the features.RESULTS In total,1278 PICU-admitted children with complete data were included in the analysis.The median patient age was 8.1 years(interquartile range:5.4-10.7).Thirty-nine patients(3%)died.The RF and XGboost models demonstrated the highest performance.The Shapley Addictive Explanations model revealed that the most important predictive features included younger age,female patients,presence of underlying diseases,severe transaminitis,severe bleeding,low platelet counts requiring platelet transfusion,elevated levels of international normalized ratio,blood lactate and serum creatinine,large volume of resuscitation fluid and a high vasoactive inotropic score(>30).CONCLUSION We developed robust machine learning-based models to estimate the risk of death in hospitalized children with DSS.The study findings are applicable to the design of management schemes to enhance survival outcomes of patients with DSS.展开更多
The present experimental study investigates shock wave mitigation capability of potentially new personal protective equipment(PPE) suspension pads made from polyurea and shear thickening fluid(STF).The shock tube test...The present experimental study investigates shock wave mitigation capability of potentially new personal protective equipment(PPE) suspension pads made from polyurea and shear thickening fluid(STF).The shock tube test results show that when placed behind Twaron fabric systems with thickness ranging from 2 mm to 18 mm, the replacement of conventional flexible foam pad with STF and STF-infused foam pads with the same thickness of 20 mm greatly reduces the normalized peak pressure(by about 72% for each pad). However, this benefit is partially offset by a large increase in the normalized impulse(by about78% for the STF pad and 131% for the STF-infused foam pad) which may cause the shock wave mitigation performance of these two pads to become less effective. Interestingly, the use of 4 mm thick polyurea pad can greatly reduce the normalized peak pressure and impulse as well(by about 74% and 49%, respectively). These results reveal that among the potentially new suspension pads tested, the polyurea pad displays the best shock wave mitigation performance. Therefore, polyurea has potential for use as a suspension pad in personal protective equipment requiring shock wave mitigation capability such as fabric ballistic vests, bomb suits and combat helmets.展开更多
Optic nerve transection increased the expression of heat shock protein 72 （HSP72） in the lateral geniculate body, indicating that this protein is involved in the prevention of neuronal injury. Zinc sulfate and querc...Optic nerve transection increased the expression of heat shock protein 72 （HSP72） in the lateral geniculate body, indicating that this protein is involved in the prevention of neuronal injury. Zinc sulfate and quercetin induced and inhibited the expression of HSP72, respectively. Intraperitoneal injections of zinc sulfate, SP600125 （c-Jun N-terminal kinase inhibitor）, or quercetin were performed on retinal ganglion cells in a Wistar rat model of chronic ocular hypertension. Our results showed that compared with the control group, the expression of HSP72 in retinal ganglion cells and the lateral geniculate body was increased after the injection of zinc sulfate, but was decreased after the injection of quercetin. The expression of phosphorylated c-Jun N-terminal kinases and phosphorylated c-Jun were visible 3 days after injection in the control group, and reached apeak at 7 days. Zinc sulfate and SP600125 significantly decreased the expression of p-c-Jun, whereas quercetin significantly enhanced the expression of this protein. These results suggest that HSP72 protects retinal ganglion cells and lateral geniculate body in a rat model of chronic ocular hypertension from injury by blocking the activation of the stress-activated kinase/c-Jun N-terminal kinase apoptotic pathway.展开更多
BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the ma...BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration. CASE SUMMARY Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen;she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-threeyear- old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death. CONCLUSION Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.展开更多
When the spacecraft flies much faster than the sound speed (~1200 km/h), the airflow disturbances deflected forward from the spacecraft cannot get away from the spacecraft and form a shock wave in front of it. Shock w...When the spacecraft flies much faster than the sound speed (~1200 km/h), the airflow disturbances deflected forward from the spacecraft cannot get away from the spacecraft and form a shock wave in front of it. Shock waves have been a detriment for the development of supersonic aircrafts, which have to overcome high wave drag and surface heating from additional friction. Shock wave also produces sonic booms. The noise issue raises environmental concerns, which have precluded routine supersonic flight over land. Therefore, mitigation of shock wave is essential to advance the development of supersonic aircrafts. A plasma mitigation technique is studied. A theory is presented to show that shock wave structure can be modified via flow deflection. Symmetrical deflection evades the need of exchanging the transverse momentum between the flow and the deflector. The analysis shows that the plasma generated in front of the model can effectively deflect the incoming flow. A non-thermal air plasma, generated by on-board 60 Hz periodic electric arc discharge in front of a wind tunnel model, was applied as a plasma deflector for shock wave mitigation technique. The experiment was conducted in a Mach 2.5 wind tunnel. The results show that the air plasma was generated symmetrically in front of the wind tunnel model. With increasing discharge intensity, the plasma deflector transforms the shock from a welldefined attached shock into a highly curved shock structure with increasing standoff distance from the model;this curved shock has increased shock angle and also appears in increasingly diffused form. In the decay of the discharge intensity, the shock front is first transformed back to a well-defined curve shock, which moves downstream to become a perturbed oblique shock;the baseline shock front then reappears as the discharge is reduced to low level again. The experimental observations confirm the theory. The steady of the incoming flow during the discharge cycle is manifested by the repeat of the baseline shock front.展开更多
Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure...Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.展开更多
BACKGROUND Calcific tendinopathy denotes calcific deposits in a specific tendon.It is also known as calcifying tendinitis,calcifying periarticulitis,or periarticular apatite deposition disease.Recently,extracorporeal ...BACKGROUND Calcific tendinopathy denotes calcific deposits in a specific tendon.It is also known as calcifying tendinitis,calcifying periarticulitis,or periarticular apatite deposition disease.Recently,extracorporeal shock wave therapy(ESWT)has been reported to be effective in relieving and treating pain in calcific tendinopathy.CASE SUMMARY A 36-year-old female patient suffered from left hip joint pain for six months.The pain was increased during abduction of the hip,waking,and jumping.B-mode ultrasonography was performed by a physiatrist with an L12-5 linear transducer.A single session of ESWT was given in the marking area under ultrasound guidance at 4 Hz,2500 shots with intensity of stimulation using energy of 0.1 mJ/mm2.The hip pain of the patient slowly decreased within 4 wk after starting the ESWT.After six weeks of ESWT,her hip pain was completely resolved.However,the size of calcification showed almost no reduction in simple radiography at the final follow-up.CONCLUSION Ultrasonography is a very good modality not only for diagnosing calcified tendinitis by classical appearance,but also for evaluating the effect of ESWT during the follow-up period.展开更多
文摘Heat shock proteins (HSPs) serve to correct proteins’ conformation, send the damaged proteins for degradation (quality control function). Heat shock factors (HSFs) are their transcription factors. The protein complexes mTOR1 and 2 (with the same core mTOR), the phosphoinositide-dependent protein kinase-1 (PDK1), the seine/threonine-specific protein kinase (Akt), HSF1, plus their associated proteins form a network participating in protein synthesis, bio-energy generation, signaling for apoptosis with the help of HSPs. A cancer cell synthesizes proteins at fast rate and needs more HSPs to work on quality control. Shutting down this network would lead to cell death. Thus inhibitors of mTOR (mTORI) and inhibitors of HSPs (HSPI) could drive cancer cell to apoptosis—a “passive approach”. On the other hand, HSPs form complexes with polypeptides characteristic of the cancer cells;on excretion from the cell, they becomes antigens for the immunity cells, eventually leading to maturation of the cytotoxic T cells, forming the basic principle of preparing cancer-specific, person-specific vaccine. Recent finding shows that HSP70 can penetrate cancer cell and expel its analog to extracellular region, giving the hope to prepare a non-person-specific vaccine covering a variety of cancers. Activation of anti-cancer immunity is the “active approach”. On the other hand, mild hyperthermia, with increase of intracellular HSPs, has been found to activate the immunity response, and demonstrate anti-cancer effects. There are certain “mysteries” behind the mechanisms of the active and passive approaches. We analyze the mechanisms involved and provide explanations to some mysteries. We also suggest future research to improve our understanding of these two approaches, in which HSPs play many roles.
基金Supported by the National Natural Science Foundation of China.No.3870890
文摘AIM: To compare the effects of extract F of red-rooted Salvia (EFRRS) on mucosal lesions of gastric corpus and antrum induced by hemorrhagic shock and reperfusion in rats. METHODS: The rats were subject to hemorrhagic shock and followed by reperfusion, and were divided randomly into two groups. Group 1 received saline, and group 2 received EFRRS intravenously. The index of gastric mucosal lesions (IGML) was expressed as the percentage of lesional area in the corpus or antrum. The degree of gastric mucosal lesions (DGML) was catalogued grade 0,1,2 and 3. The concentrations of prostaglandins (PGs) were measured by radioimmunoassay. The concentration of MDA was measured according to the procedures of Asakawa. The activity of SOD was measured by the biochemical way. The growth rates or inhibitory rates of above-mentioned parameters were calculated. RESULTS: As compared with IGML (%), grade 3 damage (%) and MDA content (nmol/g tissue) of gastric antrum which were respectively 7.96 +/- 0.59, 34.86 +/- 4.96 and 156.98 +/- 16.12, those of gastric corpus which were respectively 23.18 +/- 6.82, 58.44 +/- 9.07 and 230.56 +/- 19.37 increased markedly (P 【0.01), whereas the grade 0 damage, grade 1 damage, the concentrations of PGE(2) and PGI(2)(pg/mg tissue), the ratio of PGI(2)/TXA(2) and the activity of SOD (U/g tissue) of corpus which were respectively 3.01 +/- 1.01, 8.35 +/- 1.95, 540.48 +/- 182.78, 714.38 +/- 123.74, 17.38 +/- 5.93 and 134.29 +/- 13.35 were markedly lower than those of antrum which were respectively 13.92 +/- 2.25, 26.78 +/- 6.06, 2218.56 +/- 433.12, 2531.76 +/- 492.35, 43.46 +/- 8.51 and 187.45 +/- 17.67 (P【0.01) after hemorrhagic shock and reperfusion.After intravenous EFRRS, the growth rates (%) of grade 0 damage, grade 1 damage, the concentrations of PGE(2) and PGI(2), the ratio of PGI(2)/TXA(2) and the activity of SOD of corpus which were respectively 632.56, 308.62, 40.75, 74.75, 92.29 and 122.25 were higher than those in antrum which were respectively 104.89, 58.40, 11.12, 56.58, 30.65 and 82.64, whereas the inhibitory rates (%) of IGML, grade 3 damage and MDA content of gastric corpus were 82.93, 65.32 and 59.09, being higher than those of gastric antrum which were 76.64, 53.18 and 42.37. CONCLUSION: After hemorrhagic shock reperfusion, the gastric mucosal lesions in the corpus were more severe than those in the antrum, which were related not only to the different distribution of endogenous PGs in the mucosa, but also to the different ability of anti-oxidation of the mucosa. The protective effect of EFRRS on the gastric mucosa in the corpus was more evident than that in the antrum, which was related to higher growth degree of PGs contents and anti-oxitative ability in gastric corpus after administration of EFRRS.
文摘The mixed venous-to-arterial carbon dioxide(CO_2)tension difference[P(v-a) CO_2]is the difference between carbon dioxide tension(PCO_2) in mixed venous blood(sampled from a pulmonary artery catheter) and the PCO_2 in arterial blood.P(v-a) CO_2 depends on the cardiac output and the global CO_2 production,and on the complex relationship between PCO_2 and CO_2 content.Experimental and clinical studies support the evidence that P(v-a) CO_2 cannot serve as an indicator of tissue hypoxia,and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO_2generated by the peripheral tissues.P(v-a) CO_2 can be replaced by the central venous-to-arterial CO_2 difference(△PCO_2),which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and,therefore,more easy to obtain at the bedside.Determining the △PCO_2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation(SCVO_2) > 70%associated with elevated blood lactate levels.Because high blood lactate levels is not a discriminatory factor in determining the source of that stress,an increased △PCO_2(> 6 mmHg)could be used to identify patients who still remain inadequately resuscitated.Monitoring the △PCO_2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and,thus,guiding the therapy.In this respect,it can aid to titrate inotropes to adjust oxygen delivery to CO_2 production,or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO_2 related to metabolic demand.The combination of P(v-a) CO_2 or △PCO_2 with oxygen-derived parameters through the calculation of the P(v-a) CO_2 or △PCO_2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.
基金supported by the National Key R&D Program of China(Grant No.2021YFB3802303)the National Natural Science Foundation of China(Grant Nos.12302493 and 12525211).
文摘The manipulation of intense shock waves to either attenuate or enhance damage has long been a key goal in the domain of impact dynamics.Effective methods for such manipulation,however,remain elusive owing to the wide spectrum and irreversible destructive nature of intense shock waves.This work proposes a novel approach for actively controlling intense shock waves in solids,inspired by the principles of optical and explosive lenses.Specifically,by designing a shock wave convex lens composed of a low-shock-impedance material embedded in a high-shock-impedance matrix,we prove the feasibility of transforming a planar shock into a spherically converging shock.This is based on oblique shock theory,according to which shock waves pass through an oblique interface and then undergo deflection.Both experimental and simulation results demonstrate that,as expected,the obtained local spherical shock wave has a wavefront that is nearly perfectly spherical and uniform in pressure.Thus,this work proves the possibility of generating spherical shock waves using plate-impact experiments and highlights the potential of further exploration of the manipulation of shock waves in solids.It also contributes an innovative perspective for both armor penetration technologies and shock wave mitigation strategies.
文摘Aim Inducible nitric oxide synthase （iNOS） makes a great contribution to host defense and inflamma-tion. In many settings, lipopolysaccharide （LPS） induces iNOS expression through activation of the inhibitor of KB- α （IKB-α） -nuclear factor-KB （NF-KB） cascade, whereas interferon-γ （IFN-γ） acts through Janus kinase （ JAK）- signal transducer and activator of transcription 1 （ STAT1 ） signals. Heat shock factor 1 （ HSF1 ）, a major regulator of heat shock protein transcription, has been shown to regulate the production of pro-inflammatory cytokines such as tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6）. But it remains obscure whether and how HSF1 affects iNOS induction. Methods Western blot was used to measure the protein expression. The mRNA level was meas- ured by real time-PCR. Silence of HSF1 was achieved by small interfering RNA. Nitric oxide （NO） content and NF-KB binding activity were assayed by commercial kits. Chromatin immunoprecipitation （CHIP） was used to measure the binding activity of NF-KB and STAT1 to iNOS promoters. Results HSF1 inhibition or knockdown pre- vented the LPS- and/or IFN-γ-stimulated iNOS protein expression in cultured microglia. HSF1 inhibition blocked iNOS mRNA transcription. These inhibitory effects of HSF1 inhibition on iNOS expression were confirmed in brain tissues from endotoxemic mice. Further analysis showed that HSF1 inhibition had no effect on IKB-α degradation and NF-KB or STAT1 phosphorylation in LPS/IFN-γ-stimulated cells. The nuclear transport of active NF-KB or STAT1 was also not affected by HSF1 inhibition. But HSF1 inhibition reduced the binding of NF-KB and STAT1 to their DNA elements. In addition, HSF1 inhibition reduced NF-KB and STAT1 bindings to iNOS promoter inside the LPS/IFN-γ-stimulated cells. Conclusions This preventing effect of HSF1 inhibition on iNOS mRNA transcription presents the necessary role of HSF1 in iNOS induction.
文摘AIM: To study the effect of cholecystokinin-octapeptide (CCK-8) on systemic hypotension and cytokine production in lipopolysaccharide (LPS)-induced endotoxic shock (ES) rats. METHODS: The changes of blood pressure were observed using physiological record instrument in four groups of rats: LPS (8mg.kg(-1),iv) induced ES; CCK-8 (40 microg.kg(-1), iv) pretreatment 10 min before LPS (8mg.kg(-1)); CCK-8 (40 micro.kg(-1), iv) or normal saline (control) groups. Differences in tissue and circulating specificity of the proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) were assayed with ELISA kits. RESULTS: CCK-8 reversed LPS-induced decrease of mean artery blood pressure (MABP) in rats. Compared with control, LPS elevated the serum level of IL-6 significantly (3567 +/- 687 ng.L(-1) vs 128 +/- 22 ng.L(-1), P【0.01), while contents of TNF-alpha and IL-1beta elevated significantly (277 +/- 86 ng.L(-1) vs not detectable and 43 +/- 9 ng.L(-1) vsnot detectable, P【0.01) but less extent than IL-6. CCK-8 significantly inhibited the LPS-induced increase in serum TNF-alpha IL-1beta and IL-6. LPS elevated spleen and lung content of IL-1beta significantly (5184 +/- 85 ng.L(-1) vs 1047 +/- 21 ng.L(-1) and 4050 +/- 614 ng.L(-1) vs not detectable, P【0.01), while levels of TNF-alpha and IL-6 also rose significantly but in less extent than IL-1beta. CCK-8 inhibited the LPS-induced increase of the cytokines in spleen and lung. In the heart, CCK-8 significantly inhibited LPS-induced increase of TNF-alpha (864 +/- 123 ng.L(-1) in CCK-8+LPS group vs 1599 +/- 227 ng.L(-1) in LPS group, P 【 0.01), and IL-1beta (282 +/- 93 ng.L(-1) in CCK-8+LPS group vs 621 +/- 145ng.L(-1) in LPS group, P 【 0.01). CONCLUSION: CCK-8 reverses ES, which may be related to its inhibitory effect on the overproduction of cytokines.
基金financial support from NSF ExpandQISE program.The synthesis of tellurene was supported by NSF under grant no.CMMI-2046936supports from Purdue Research Foundation.
文摘Tellurene,a chiral chain semiconductor with a narrow bandgap and exceptional strain sensitivity,emerges as a pivotal material for tailoring electronic and optoelectronic properties via strain engineering.This study elucidates the fundamental mechanisms of ultrafast laser shock imprinting(LSI)in two-dimensional tellurium(Te),establishing a direct relationship between strain field orientation,mold topology,and anisotropic structural evolution.This is the first demonstration of ultrafast LSI on chiral chain Te unveiling orientation-sensitive dislocation networks.By applying controlled strain fields parallel or transverse to Te’s helical chains,we uncover two distinct deformation regimes.Strain aligned parallel to the chain’s direction induces gliding and rotation governed by weak interchain interactions,preserving covalent intrachain bonds and vibrational modes.In contrast,transverse strain drives shear-mediated multimodal deformations—tensile stretching,compression,and bending—resulting in significant lattice distortions and electronic property modulation.We discovered the critical role of mold topology on deformation:sharp-edged gratings generate localized shear forces surpassing those from homogeneous strain fields via smooth CD molds,triggering dislocation tangle formation,lattice reorientation,and inhomogeneous plastic deformation.Asymmetrical strain configurations enable localized structural transformations while retaining single-crystal integrity in adjacent regions—a balance essential for functional device integration.These insights position LSI as a precision tool for nanoscale strain engineering,capable of sculpting 2D material morphologies without compromising crystallinity.By bridging ultrafast mechanics with chiral chain material science,this work advances the design of strain-tunable devices for next-generation electronics and optoelectronics,while establishing a universal framework for manipulating anisotropic 2D systems under extreme strain rates.This work discovered crystallographic orientation-dependent deformation mechanisms in 2D Te,linking parallel strain to chain gliding and transverse strain to shear-driven multimodal distortion.It demonstrates mold geometry as a critical lever for strain localization and dislocation dynamics,with sharp-edged gratings enabling unprecedented control over lattice reorientation.Crucially,the identification of strain field conditions that reconcile severe plastic deformation with single-crystal retention offers a pathway to functional nanostructure fabrication,redefining LSI’s potential in ultrafast strain engineering of chiral chain materials.
文摘BACKGROUND Bradycardia,renal failure,atrioventricular nodal blockade,shock,and hyper-kalemia(BRASH)syndrome is an acronym used to describe a constellation of BRASH.It is an underrecognized phenomenon that can be deadly if not appro-priately managed in a timely manner.This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.CASE SUMMARY We present a case of a 54-year-old male on a beta-blocker and angiotensin-con-verting enzyme inhibitor who presented with one day history of nausea,vomi-ting,and shortness of breath.Upon presentation,he was bradycardic and hypotensive,requiring transcutaneous pacing.Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30’s.He was found to have acute kidney injury,hyperkalemia,and metabolic acidosis.He was successfully treated with multiple potassium lowering agents,continuous renal replacement therapy,four pressors,mechanical ventilation,and transvenous pacing with complete recovery prior to discharge.CONCLUSION Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.
文摘AIM: To investigate if sleep deprivation is able to increase the expression of inducible heat shock protein 70 in gastric mucosa and its possible role in mucosal defense. METHODS: Rats for sleep disruption were placed inside a computerized rotating drum, gastric mucosa was taken from rats with 1, 3 and 7d sleep deprivation. RT-PCR, immunohistochemistry and Western blotting were used to determine the expression of heat shock protein 70. Ethanol (500mL.L(-1), i.g.) was used to induce gastric mucosa damage. RESULTS: RT-PCR, Western blotting and immunostaining confirmed that the sleep deprivation as a stress resulted in significantly greater expression of inducible heat shock protein 70 in gastric mucosa of rats. After the 500mL.L(-1) ethanol challenge, the ulcer area found in the rats with 7d sleep deprivation (19.15 +/- 4.2)mm(2) was significantly lower (P【0.01) than the corresponding control (53.7 +/- 8.1) mm(2). CONCLUSION: Sleep deprivation as a stress, in addition to lowering the gastric mucosal barrier, is able to stimulate the expression of inducible heat shock protein 70 in gastric mucosa of rats, the heat shock protein 70 may play an important role in gastric mucosal protection.
文摘Two-dimensional critical nozzle flows at low Reynolds numbers are visualized by the rainbow schlieren deflectometry. Experiments have been performed in a region of overexpanded nozzle flow. The variation of the shock structure against the back pressure ratio can be clearly visible with color gradation. Static pressure rises due to the shock-induced flow separation are compared with the previous theories. The unsteady characteristics of overexpanded critical nozzle flows at low Reynolds numbers are quantitatively and qualitatively visualized using laser schlieren and Mach-Zehnder interferometer systems combined with a high-speed digital camera. It was found that an oscillating normal shock wave appears inside the nozzle, and that the shock wave has a specified dominant frequency. Also the time-history of the oscillating shock wave is obtained from both the systems and compared with each other.
文摘The nonlinear propagation of the DIA (dust ion-acoustic) waves in multi-ion dense plasma system containing degener- ate electrons, both positive and negative ions, arbitrary charged dust grains has been investigated by employing the reductive perturbation method. The nonlinear waves (solitary and shock waves) have been observed to be formed in case of both positive and negative charged dust grains from the stationary solution of the Korteweg de-Vries (K-dV) equation and Burger’s equation. The fundamental properties of such nonlinear waves have been theoretically analyzed by comparing system potential for both positive and negative dust grains. It has been shown that the basic features of these waves are significantly modified by the positive and negative ions drift speed and polarities of dust grains. The implications of our results in space and laboratory plasmas are briefly discussed.
文摘Recent studies have revealed that patients with septic shock and acute skin failure(ASF)exhibit significantly higher levels of inflammatory cytokines,lactate,and C-reactive protein,along with elevated skin mottling score;modified early warning score(MEWS);and anxiety,depression,and Pittsburgh sleep quality index scores compared to those without ASF.Notably,these indicators are significantly correlated.Patients with septic shock accompanied by ASF tend to have a mean MEWS greater than 9,indicating severe disease progression.Therefore,it is ess-ential to not only manage septic shock but also mitigate anxiety,depression,sleep disorders,and disturbances of consciousness.This article explores the impact of severe anxiety,depression,and sleep disorders on the prognosis of septic shock and discusses intervention strategies.
基金This work was supported partly by Grant 90089102 from the Scientific Research Fund of the Ministry of Education,Japan
文摘INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping of the hepatoduodnal ligament ,has often been used for this purpose[1],This is the simplest and userul technique to reduce intraoperative blood loss .
文摘BACKGROUND Severe dengue children with critical complications have been attributed to high mortality rates,varying from approximately 1%to over 20%.To date,there is a lack of data on machine-learning-based algorithms for predicting the risk of inhospital mortality in children with dengue shock syndrome(DSS).AIM To develop machine-learning models to estimate the risk of death in hospitalized children with DSS.METHODS This single-center retrospective study was conducted at tertiary Children’s Hospital No.2 in Viet Nam,between 2013 and 2022.The primary outcome was the in-hospital mortality rate in children with DSS admitted to the pediatric intensive care unit(PICU).Nine significant features were predetermined for further analysis using machine learning models.An oversampling method was used to enhance the model performance.Supervised models,including logistic regression,Naïve Bayes,Random Forest(RF),K-nearest neighbors,Decision Tree and Extreme Gradient Boosting(XGBoost),were employed to develop predictive models.The Shapley Additive Explanation was used to determine the degree of contribution of the features.RESULTS In total,1278 PICU-admitted children with complete data were included in the analysis.The median patient age was 8.1 years(interquartile range:5.4-10.7).Thirty-nine patients(3%)died.The RF and XGboost models demonstrated the highest performance.The Shapley Addictive Explanations model revealed that the most important predictive features included younger age,female patients,presence of underlying diseases,severe transaminitis,severe bleeding,low platelet counts requiring platelet transfusion,elevated levels of international normalized ratio,blood lactate and serum creatinine,large volume of resuscitation fluid and a high vasoactive inotropic score(>30).CONCLUSION We developed robust machine learning-based models to estimate the risk of death in hospitalized children with DSS.The study findings are applicable to the design of management schemes to enhance survival outcomes of patients with DSS.
基金supported by the Ministry of Education,Singapore(R265000533112)
文摘The present experimental study investigates shock wave mitigation capability of potentially new personal protective equipment(PPE) suspension pads made from polyurea and shear thickening fluid(STF).The shock tube test results show that when placed behind Twaron fabric systems with thickness ranging from 2 mm to 18 mm, the replacement of conventional flexible foam pad with STF and STF-infused foam pads with the same thickness of 20 mm greatly reduces the normalized peak pressure(by about 72% for each pad). However, this benefit is partially offset by a large increase in the normalized impulse(by about78% for the STF pad and 131% for the STF-infused foam pad) which may cause the shock wave mitigation performance of these two pads to become less effective. Interestingly, the use of 4 mm thick polyurea pad can greatly reduce the normalized peak pressure and impulse as well(by about 74% and 49%, respectively). These results reveal that among the potentially new suspension pads tested, the polyurea pad displays the best shock wave mitigation performance. Therefore, polyurea has potential for use as a suspension pad in personal protective equipment requiring shock wave mitigation capability such as fabric ballistic vests, bomb suits and combat helmets.
基金financially supported by the National Natural Science Foundation of China,No.81170843,81370913the Natural Science Foundation of Hunan Province,China,No.5JJ30051+2 种基金New Century Excellent Talents in University from the Ministry of Education of China,No.NCET-06-0677the Natural Science Foundation of Anhui Province,China,No.1408085QH158the First Affiliated Hospital of Anhui Medical University,Incubation Program of the National Natural Science Foundation for Young Scholars of China,No.2012KJ19
文摘Optic nerve transection increased the expression of heat shock protein 72 （HSP72） in the lateral geniculate body, indicating that this protein is involved in the prevention of neuronal injury. Zinc sulfate and quercetin induced and inhibited the expression of HSP72, respectively. Intraperitoneal injections of zinc sulfate, SP600125 （c-Jun N-terminal kinase inhibitor）, or quercetin were performed on retinal ganglion cells in a Wistar rat model of chronic ocular hypertension. Our results showed that compared with the control group, the expression of HSP72 in retinal ganglion cells and the lateral geniculate body was increased after the injection of zinc sulfate, but was decreased after the injection of quercetin. The expression of phosphorylated c-Jun N-terminal kinases and phosphorylated c-Jun were visible 3 days after injection in the control group, and reached apeak at 7 days. Zinc sulfate and SP600125 significantly decreased the expression of p-c-Jun, whereas quercetin significantly enhanced the expression of this protein. These results suggest that HSP72 protects retinal ganglion cells and lateral geniculate body in a rat model of chronic ocular hypertension from injury by blocking the activation of the stress-activated kinase/c-Jun N-terminal kinase apoptotic pathway.
文摘BACKGROUND Tuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration. CASE SUMMARY Sixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen;she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-threeyear- old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death. CONCLUSION Worse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.
文摘When the spacecraft flies much faster than the sound speed (~1200 km/h), the airflow disturbances deflected forward from the spacecraft cannot get away from the spacecraft and form a shock wave in front of it. Shock waves have been a detriment for the development of supersonic aircrafts, which have to overcome high wave drag and surface heating from additional friction. Shock wave also produces sonic booms. The noise issue raises environmental concerns, which have precluded routine supersonic flight over land. Therefore, mitigation of shock wave is essential to advance the development of supersonic aircrafts. A plasma mitigation technique is studied. A theory is presented to show that shock wave structure can be modified via flow deflection. Symmetrical deflection evades the need of exchanging the transverse momentum between the flow and the deflector. The analysis shows that the plasma generated in front of the model can effectively deflect the incoming flow. A non-thermal air plasma, generated by on-board 60 Hz periodic electric arc discharge in front of a wind tunnel model, was applied as a plasma deflector for shock wave mitigation technique. The experiment was conducted in a Mach 2.5 wind tunnel. The results show that the air plasma was generated symmetrically in front of the wind tunnel model. With increasing discharge intensity, the plasma deflector transforms the shock from a welldefined attached shock into a highly curved shock structure with increasing standoff distance from the model;this curved shock has increased shock angle and also appears in increasingly diffused form. In the decay of the discharge intensity, the shock front is first transformed back to a well-defined curve shock, which moves downstream to become a perturbed oblique shock;the baseline shock front then reappears as the discharge is reduced to low level again. The experimental observations confirm the theory. The steady of the incoming flow during the discharge cycle is manifested by the repeat of the baseline shock front.
文摘Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.
文摘BACKGROUND Calcific tendinopathy denotes calcific deposits in a specific tendon.It is also known as calcifying tendinitis,calcifying periarticulitis,or periarticular apatite deposition disease.Recently,extracorporeal shock wave therapy(ESWT)has been reported to be effective in relieving and treating pain in calcific tendinopathy.CASE SUMMARY A 36-year-old female patient suffered from left hip joint pain for six months.The pain was increased during abduction of the hip,waking,and jumping.B-mode ultrasonography was performed by a physiatrist with an L12-5 linear transducer.A single session of ESWT was given in the marking area under ultrasound guidance at 4 Hz,2500 shots with intensity of stimulation using energy of 0.1 mJ/mm2.The hip pain of the patient slowly decreased within 4 wk after starting the ESWT.After six weeks of ESWT,her hip pain was completely resolved.However,the size of calcification showed almost no reduction in simple radiography at the final follow-up.CONCLUSION Ultrasonography is a very good modality not only for diagnosing calcified tendinitis by classical appearance,but also for evaluating the effect of ESWT during the follow-up period.
