A numerical method based on septic B-spline function is presented for the solution of linear and nonlinear fifth-order boundary value problems. The method is fourth order convergent. We use the quesilinearization tech...A numerical method based on septic B-spline function is presented for the solution of linear and nonlinear fifth-order boundary value problems. The method is fourth order convergent. We use the quesilinearization technique to reduce the nonlinear problems to linear problems and use B-spline collocation method, which leads to a seven nonzero bands linear system. Illustrative example is included to demonstrate the validity and applicability of the proposed techniques.展开更多
Numerical solutions of the modified equal width wave equation are obtained by using collocation method with septic B-spline finite elements with three different linearization techniques. The motion of a single solitar...Numerical solutions of the modified equal width wave equation are obtained by using collocation method with septic B-spline finite elements with three different linearization techniques. The motion of a single solitary wave, interaction of two solitary waves and birth of solitons are studied using the proposed method. Accuracy of the method is discussed by computing the numerical conserved laws error norms L2 and L∞. The numerical results show that the present method is a remarkably successful numerical technique for solving the MEW equation. A linear stability analysis shows that this numerical scheme, based on a Crank Nicolson approximation in time, is unconditionally stable.展开更多
BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking Univers...BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.展开更多
Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the ost...Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the osteoarticular aspect representing a therapeutic problem, the infectious aspect was marked by sepsis, with a death in less than 48 hours. Based on this observation, a protocol for the initial management of large animal bites was submitted.展开更多
Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar dat...Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb...BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.展开更多
BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both pha...BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires supplementation.AIM To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with ESS.METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups.The analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with hemodynamics.RESULTS The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low T3T4.Hypoalbuminemia(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 group.Diastolic blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 group.CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic parameters.These findings suggest potentially maladaptive changes in the chronic phase of septic shock.展开更多
Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate...Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate the efficacy and safety of ulinastatin in the treatment of septic shock patients.Methods:Three English databases(Embase,Medline,and Cochrane Library)and four Chinese databases(China National Knowledge Infrastructure,Wanfang data,SinoMed,and VIP)were searched for published randomized controlled trials.Stata 16.0 software was used to conduct the meta-analysis.Results:A total of 48 articles were included(Chinese article 47,1 in English).The results show that the treatment of ulinastatin could reduce mortality(risk ratio=0.63,95%confidence interval(CI)(0.55,0.72)),multiple organ dysfunction syndrome(risk ratio=0.6,95%CI(0.53,0.68)),length of intensive care unit stay(mean difference(MD)=-3.92,95%CI(-4.65,-3.18)),length of hospital stay(MD=-4.39,95%CI(-6.63,-2.15))and decrease Acute Physiology and Chronic Health Evaluation II score(MD=-4.55,95%CI(-5.63,-3.47))and Sequential Organ Failure Assessment score(MD=-2.02,95%CI(-2.59,-1.44))with P<0.001.Moreover,it lowers TNF-α(standardized mean difference(SMD)=-1.78,95%CI(-2.24,-1.32)),Interleukin-6(SMD=-1.17,95%CI(-1.55,-0.8)),C reactive protein(SMD=-1.49,95%CI(-1.99,-0.99)),hypersensitive C-reactive protein(SMD=-1.9,95%CI(-2.87,-0.94))and procalcitonin(SMD=-0.89,95%CI(-1.12,-0.67))levels in the body.Conclusions:Available evidence shows that ulinastatin reduces case mortality rate,multiple organ dysfunction syndrome,length of intensive care unit stay,and length of hospital stay and decreases Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score.Moreover,it also lowers TNF-α,Interleukin-6,C reactive protein,hypersensitive C-reactive protein,and procalcitonin levels in the body.展开更多
This work puts forward an explicit isogeometric topology optimization(ITO)method using moving morphable components(MMC),which takes the suitably graded truncated hierarchical B-Spline based isogeometric analysis as th...This work puts forward an explicit isogeometric topology optimization(ITO)method using moving morphable components(MMC),which takes the suitably graded truncated hierarchical B-Spline based isogeometric analysis as the solver of physical unknown(SGTHB-ITO-MMC).By applying properly basis graded constraints to the hierarchical mesh of truncated hierarchical B-splines(THB),the convergence and robustness of the SGTHB-ITOMMC are simultaneously improved and the tiny holes occurred in optimized structure are eliminated,due to the improved accuracy around the explicit structural boundaries.Moreover,an efficient computational method is developed for the topological description functions(TDF)ofMMC under the admissible hierarchicalmesh,which consists of reducing the dimensionality strategy for design space and the locally computing strategy for hierarchical mesh.We apply the above SGTHB-ITO-MMC with improved efficiency to a series of 2D and 3Dcompliance design problems.The numerical results show that the proposed SGTHB-ITO-MMC method outperforms the traditional THB-ITO-MMCmethod in terms of convergence rate and efficiency.Therefore,the proposed SGTHB-ITO-MMC is an effective way of solving topology optimization(TO)problems.展开更多
Directly applying the B-spline interpolation function to process plate cams in a computer numerical control(CNC)system may produce verbose tool-path codes and unsmooth trajectories.This paper is devoted to addressing ...Directly applying the B-spline interpolation function to process plate cams in a computer numerical control(CNC)system may produce verbose tool-path codes and unsmooth trajectories.This paper is devoted to addressing the problem of B-splinefitting for cam pitch curves.Considering that the B-spline curve needs to meet the motion law of the follower to approximate the pitch curve,we use the radial error to quantify the effects of thefitting B-spline curve and the pitch curve.The problem thus boils down to solving a difficult global optimization problem tofind the numbers and positions of the control points or data points of the B-spline curve such that the cumulative radial error between thefitting curve and the original curve is minimized,and this problem is attempted in this paper with a double deep Q-network(DDQN)reinforcement learning(RL)algorithm with data points traceability.Specifically,the RL envir-onment,actions set and current states set are designed to facilitate the search of the data points,along with the design of the reward function and the initialization of the neural network.The experimental results show that when the angle division value of the actions set isfixed,the proposed algorithm can maximize the number of data points of the B-spline curve,and accurately place these data points to the right positions,with the minimum average of radial errors.Our work establishes the theoretical foundation for studying splinefitting using the RL method.展开更多
As many think that respect for the environment, is not only a question intended for industrialists but has all the sectors of life, in particular sanitary also. In this regard, our article brings alternative managemen...As many think that respect for the environment, is not only a question intended for industrialists but has all the sectors of life, in particular sanitary also. In this regard, our article brings alternative management of human waste (excrement) to solve the problems that plague our dear beautiful capital, namely: 1) Lack of latrines that meet the standards;2) Emptying of septic tanks directly into the gutters and;3) Water pollution by sewage csompanies. In order to carry out the cartographic analysis of the study area, we used Shapefile data from the OpenStreetMap, Diva-Gis. These different data allowed us, analyzed, to categorize with the software ArArcGIS 0.8.1 to produce different zones according to the cases incurred in the city of Kinshasa. To do this, the analytical method uses the Buswell equation to determine the amount of gas contained in human excrement. Focusing on the analysis of the excrements produced by the population of age superior to 10 years, for 2023, we obtained: 138355.7283 m<sup>3</sup>/day of CH4 (885476.66 kWh/day or 885.476 MWh/day), which, energy can light: 138,355 lamps of 60 to 100 W for six hours or nearly 70,000 lamps of 60 to 100 W for 12 hours. Considering the last one which offers the lowest access rate, i.e. 3% of the district population to these latrines, we have: a) In Tshangu, we produce: 1618.762 <sup>3>/day (10360.07 kWh/day or 10.36 MWh/day) which can light nearly 1600 lamps from 60 to 100 W for six hours or nearly 800 lamps from 60 to 100 W for twelve hours. b) Mont-Amba, we produce 1402.927 <sup>3>/day (8978.73 kWh/day or 8.97 MWh/day) which can light nearly 1400 lamps from 60 to 100 W for six hours or nearly 700 lamps from 60 to 100 W for twelve hours;c) In Lukunga, we produce: 946.35 <sup>3>/day (6056.66 kWh/day or 6.056 MWh/day) which can light nearly 900 lamps from 60 to 100 W for six hours or nearly 450 lamps from 60 to 100 W for twelve hours. d) Funa, we produce: 182.629 <sup>3>/day (1168.83 kWh/day or 1.17 MWh/day) which can light almost 180 lamps from 60 to 100 W for six hours or almost 90 lamps from 60 to 100 W for twelve hours.展开更多
A B-spline Interpolation Transport Solver(BITS) based on a collocation method is developed. It solves transport equations as a generalized interpolation problem, taking the first-order accuracy in time and the second-...A B-spline Interpolation Transport Solver(BITS) based on a collocation method is developed. It solves transport equations as a generalized interpolation problem, taking the first-order accuracy in time and the second-order accuracy in space along with a predictor–corrector or under-relaxation iteration method. Numerical tests show that BITS can solve one-dimensional transport equations for tokamak plasma more accurately without additional computation cost, compared to the finite difference method transport solver which is widely used in existing tokamak transport codes.展开更多
Introduction: Septic hip arthritis involves the functional prognosis of the hip in case of joint destruction. The aim of this work was to evaluate the hospital frequency, to determine the therapeutic and evolutionary ...Introduction: Septic hip arthritis involves the functional prognosis of the hip in case of joint destruction. The aim of this work was to evaluate the hospital frequency, to determine the therapeutic and evolutionary aspects of septic arthritis of the hip at the trauma orthopedic department of CHU Gabriel TOURE Bamako. Methods: This was a descriptive, monocentric, cross-sectional study of patients with septic hip arthritis, managed from January 2010 to December 2019. Results: We collected 48 patients. Gender male was represented 58.3% with a sex ratio of 1.4. The average age of our patients was 17.02, with extremes of 7 and 80. Septic hip arthritis was observed in a chronic mode in 87.5% (more than 3 weeks). Diagnosis was based on clinical, bacteriological and imaging. Trauma was incriminated in 5 cases (10.4%). The radiographic assessment at the time of the consultation was normal in 66.7% of cases. Staphylococcus aureus was the most common germ with 47.9%, and the culture was sterile in 10.4%. Septic hip arthritis was complicated in 18.75% of cases. Antibiotic therapy was probabilistic with the combination of ciprofloxacin and metronidazole in 24 cases (50%). Watson Jones antero-lateral arthrotomy was performed in 35.71%. We observed 66.6% complications. After an average decrease of 41.6 months, functional results were good in 58.3%. Conclusion: Septic hip arthritis is a serious condition of the child and adolescent. Diagnosis must be early;management must also be early, multidisciplinary and adapted to minimize sequelae.展开更多
Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremen...Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review,we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.展开更多
The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This...The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This includes the destruction of articular cartilage and bone tissue with the development of osteomyelitis, the involvement of paraarticular soft tissues in the purulent process, and the destruction of the flexor/extensor tendons of the fingers. The currently missing specialized classification of septic arthritis could help in systematizing the diseases, determining treatment tactics, and predicting the results of treatment.The classification of septic arthritis of the hand proposed for discussion is based on the following principle: Joint-Wound-Tendon(Jx Wx Tx);Jx characterizes damage to the osteochondral structures of the joint, Wx is the presence of paraarticular purulent wounds or fistulas, and Tx is destruction of the flexor/extensor tendons of the finger. The classification of the diagnosis makes it possible to assess the nature and severity of damage to the structures of the joint and may also be useful when comparing the results of treatment of septic arthritis of the hand.展开更多
文摘A numerical method based on septic B-spline function is presented for the solution of linear and nonlinear fifth-order boundary value problems. The method is fourth order convergent. We use the quesilinearization technique to reduce the nonlinear problems to linear problems and use B-spline collocation method, which leads to a seven nonzero bands linear system. Illustrative example is included to demonstrate the validity and applicability of the proposed techniques.
文摘Numerical solutions of the modified equal width wave equation are obtained by using collocation method with septic B-spline finite elements with three different linearization techniques. The motion of a single solitary wave, interaction of two solitary waves and birth of solitons are studied using the proposed method. Accuracy of the method is discussed by computing the numerical conserved laws error norms L2 and L∞. The numerical results show that the present method is a remarkably successful numerical technique for solving the MEW equation. A linear stability analysis shows that this numerical scheme, based on a Crank Nicolson approximation in time, is unconditionally stable.
基金supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region(2020D01C236)
文摘BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.
文摘Hippopotamus bites are rare in medical consultations, despite several studies exposing their aggressive character. A case of a hippopotamus bite on the shoulder of a fisherman has been reported. In addition to the osteoarticular aspect representing a therapeutic problem, the infectious aspect was marked by sepsis, with a death in less than 48 hours. Based on this observation, a protocol for the initial management of large animal bites was submitted.
文摘Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
文摘BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.
基金approved by the Institutional Review Board(IRB)of Cantonal Hospital Zenica,and the protocols used in the study were approved by the Ethical Committee of Cantonal Hospital Zenica(00-03-35-38-14/22).
文摘BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires supplementation.AIM To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with ESS.METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups.The analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with hemodynamics.RESULTS The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low T3T4.Hypoalbuminemia(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 group.Diastolic blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 group.CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic parameters.These findings suggest potentially maladaptive changes in the chronic phase of septic shock.
基金funded Secondary Classroom Project fund of Capital Medical University (Project Number:D2KT 2021092).
文摘Background:Septic shock is a common systemic inflammatory response syndrome for critical patients in the intensive care unit.Ulinastatin is currently used for the treatment of septic shock.Our study sought to evaluate the efficacy and safety of ulinastatin in the treatment of septic shock patients.Methods:Three English databases(Embase,Medline,and Cochrane Library)and four Chinese databases(China National Knowledge Infrastructure,Wanfang data,SinoMed,and VIP)were searched for published randomized controlled trials.Stata 16.0 software was used to conduct the meta-analysis.Results:A total of 48 articles were included(Chinese article 47,1 in English).The results show that the treatment of ulinastatin could reduce mortality(risk ratio=0.63,95%confidence interval(CI)(0.55,0.72)),multiple organ dysfunction syndrome(risk ratio=0.6,95%CI(0.53,0.68)),length of intensive care unit stay(mean difference(MD)=-3.92,95%CI(-4.65,-3.18)),length of hospital stay(MD=-4.39,95%CI(-6.63,-2.15))and decrease Acute Physiology and Chronic Health Evaluation II score(MD=-4.55,95%CI(-5.63,-3.47))and Sequential Organ Failure Assessment score(MD=-2.02,95%CI(-2.59,-1.44))with P<0.001.Moreover,it lowers TNF-α(standardized mean difference(SMD)=-1.78,95%CI(-2.24,-1.32)),Interleukin-6(SMD=-1.17,95%CI(-1.55,-0.8)),C reactive protein(SMD=-1.49,95%CI(-1.99,-0.99)),hypersensitive C-reactive protein(SMD=-1.9,95%CI(-2.87,-0.94))and procalcitonin(SMD=-0.89,95%CI(-1.12,-0.67))levels in the body.Conclusions:Available evidence shows that ulinastatin reduces case mortality rate,multiple organ dysfunction syndrome,length of intensive care unit stay,and length of hospital stay and decreases Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score.Moreover,it also lowers TNF-α,Interleukin-6,C reactive protein,hypersensitive C-reactive protein,and procalcitonin levels in the body.
基金supported by the National Key R&D Program of China (2020YFB1708300)the Project funded by the China Postdoctoral Science Foundation (2021M701310).
文摘This work puts forward an explicit isogeometric topology optimization(ITO)method using moving morphable components(MMC),which takes the suitably graded truncated hierarchical B-Spline based isogeometric analysis as the solver of physical unknown(SGTHB-ITO-MMC).By applying properly basis graded constraints to the hierarchical mesh of truncated hierarchical B-splines(THB),the convergence and robustness of the SGTHB-ITOMMC are simultaneously improved and the tiny holes occurred in optimized structure are eliminated,due to the improved accuracy around the explicit structural boundaries.Moreover,an efficient computational method is developed for the topological description functions(TDF)ofMMC under the admissible hierarchicalmesh,which consists of reducing the dimensionality strategy for design space and the locally computing strategy for hierarchical mesh.We apply the above SGTHB-ITO-MMC with improved efficiency to a series of 2D and 3Dcompliance design problems.The numerical results show that the proposed SGTHB-ITO-MMC method outperforms the traditional THB-ITO-MMCmethod in terms of convergence rate and efficiency.Therefore,the proposed SGTHB-ITO-MMC is an effective way of solving topology optimization(TO)problems.
基金supported by Fujian Province Nature Science Foundation under Grant No.2018J01553.
文摘Directly applying the B-spline interpolation function to process plate cams in a computer numerical control(CNC)system may produce verbose tool-path codes and unsmooth trajectories.This paper is devoted to addressing the problem of B-splinefitting for cam pitch curves.Considering that the B-spline curve needs to meet the motion law of the follower to approximate the pitch curve,we use the radial error to quantify the effects of thefitting B-spline curve and the pitch curve.The problem thus boils down to solving a difficult global optimization problem tofind the numbers and positions of the control points or data points of the B-spline curve such that the cumulative radial error between thefitting curve and the original curve is minimized,and this problem is attempted in this paper with a double deep Q-network(DDQN)reinforcement learning(RL)algorithm with data points traceability.Specifically,the RL envir-onment,actions set and current states set are designed to facilitate the search of the data points,along with the design of the reward function and the initialization of the neural network.The experimental results show that when the angle division value of the actions set isfixed,the proposed algorithm can maximize the number of data points of the B-spline curve,and accurately place these data points to the right positions,with the minimum average of radial errors.Our work establishes the theoretical foundation for studying splinefitting using the RL method.
文摘As many think that respect for the environment, is not only a question intended for industrialists but has all the sectors of life, in particular sanitary also. In this regard, our article brings alternative management of human waste (excrement) to solve the problems that plague our dear beautiful capital, namely: 1) Lack of latrines that meet the standards;2) Emptying of septic tanks directly into the gutters and;3) Water pollution by sewage csompanies. In order to carry out the cartographic analysis of the study area, we used Shapefile data from the OpenStreetMap, Diva-Gis. These different data allowed us, analyzed, to categorize with the software ArArcGIS 0.8.1 to produce different zones according to the cases incurred in the city of Kinshasa. To do this, the analytical method uses the Buswell equation to determine the amount of gas contained in human excrement. Focusing on the analysis of the excrements produced by the population of age superior to 10 years, for 2023, we obtained: 138355.7283 m<sup>3</sup>/day of CH4 (885476.66 kWh/day or 885.476 MWh/day), which, energy can light: 138,355 lamps of 60 to 100 W for six hours or nearly 70,000 lamps of 60 to 100 W for 12 hours. Considering the last one which offers the lowest access rate, i.e. 3% of the district population to these latrines, we have: a) In Tshangu, we produce: 1618.762 <sup>3>/day (10360.07 kWh/day or 10.36 MWh/day) which can light nearly 1600 lamps from 60 to 100 W for six hours or nearly 800 lamps from 60 to 100 W for twelve hours. b) Mont-Amba, we produce 1402.927 <sup>3>/day (8978.73 kWh/day or 8.97 MWh/day) which can light nearly 1400 lamps from 60 to 100 W for six hours or nearly 700 lamps from 60 to 100 W for twelve hours;c) In Lukunga, we produce: 946.35 <sup>3>/day (6056.66 kWh/day or 6.056 MWh/day) which can light nearly 900 lamps from 60 to 100 W for six hours or nearly 450 lamps from 60 to 100 W for twelve hours. d) Funa, we produce: 182.629 <sup>3>/day (1168.83 kWh/day or 1.17 MWh/day) which can light almost 180 lamps from 60 to 100 W for six hours or almost 90 lamps from 60 to 100 W for twelve hours.
基金the National MCF Energy R&D Program of China(No.2019YFE03040004)the Comprehensive Research Facility for Fusion Technology Program of China(No.2018-000052-73-01-001228)the National MCF Energy R&D Program of China(No.2019YFE03060000)。
文摘A B-spline Interpolation Transport Solver(BITS) based on a collocation method is developed. It solves transport equations as a generalized interpolation problem, taking the first-order accuracy in time and the second-order accuracy in space along with a predictor–corrector or under-relaxation iteration method. Numerical tests show that BITS can solve one-dimensional transport equations for tokamak plasma more accurately without additional computation cost, compared to the finite difference method transport solver which is widely used in existing tokamak transport codes.
文摘Introduction: Septic hip arthritis involves the functional prognosis of the hip in case of joint destruction. The aim of this work was to evaluate the hospital frequency, to determine the therapeutic and evolutionary aspects of septic arthritis of the hip at the trauma orthopedic department of CHU Gabriel TOURE Bamako. Methods: This was a descriptive, monocentric, cross-sectional study of patients with septic hip arthritis, managed from January 2010 to December 2019. Results: We collected 48 patients. Gender male was represented 58.3% with a sex ratio of 1.4. The average age of our patients was 17.02, with extremes of 7 and 80. Septic hip arthritis was observed in a chronic mode in 87.5% (more than 3 weeks). Diagnosis was based on clinical, bacteriological and imaging. Trauma was incriminated in 5 cases (10.4%). The radiographic assessment at the time of the consultation was normal in 66.7% of cases. Staphylococcus aureus was the most common germ with 47.9%, and the culture was sterile in 10.4%. Septic hip arthritis was complicated in 18.75% of cases. Antibiotic therapy was probabilistic with the combination of ciprofloxacin and metronidazole in 24 cases (50%). Watson Jones antero-lateral arthrotomy was performed in 35.71%. We observed 66.6% complications. After an average decrease of 41.6 months, functional results were good in 58.3%. Conclusion: Septic hip arthritis is a serious condition of the child and adolescent. Diagnosis must be early;management must also be early, multidisciplinary and adapted to minimize sequelae.
文摘Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review,we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.
文摘The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This includes the destruction of articular cartilage and bone tissue with the development of osteomyelitis, the involvement of paraarticular soft tissues in the purulent process, and the destruction of the flexor/extensor tendons of the fingers. The currently missing specialized classification of septic arthritis could help in systematizing the diseases, determining treatment tactics, and predicting the results of treatment.The classification of septic arthritis of the hand proposed for discussion is based on the following principle: Joint-Wound-Tendon(Jx Wx Tx);Jx characterizes damage to the osteochondral structures of the joint, Wx is the presence of paraarticular purulent wounds or fistulas, and Tx is destruction of the flexor/extensor tendons of the finger. The classification of the diagnosis makes it possible to assess the nature and severity of damage to the structures of the joint and may also be useful when comparing the results of treatment of septic arthritis of the hand.