Septic B-Spline Solution of Fifth-Order Boundary Value Problems

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.

Septic B-Spline Collocation Method for the Numerical Solution of the Modified Equal Width Wave Equation

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.

B-Spline曲线聚风装置直线翼垂直轴风力机启动性能数值模拟

为了提升直线翼垂直轴风力机的启动性能,基于B-Spline曲线生成方法,提出一种具有流线型轮廓的聚风装置,将其分别安装在风轮顶端和底端,用以提升风轮附近的来流风速,使风轮汲取更多风能,达到更易启动的特点.选取聚风装置的5个结构参数进行设计:聚风装置与风轮间隙距离ΔL、底圆半径R_(1)、顶圆半径R_(2)、入口角度α_(1)和出口角度α_(2).设计方法采用二次旋转正交组合筛选最优模型,通过三维数值模拟研究聚风装置参数对直线翼垂直轴风力机启动性能的影响,获得了最佳外形参数组合.此外,对有无加装聚风装置的直线翼垂直轴风力机进行了静态三维数值模拟.结果表明,通过添加具有外凸流线型轮廓的聚风装置,直线翼垂直轴风力机的启动性能有显著提升.在风速较低的情况下,性能改善更加明显.聚风装置可使直线翼垂直轴风力机的平均启动力矩系数最大增加38.8%,峰值平均启动力矩系数最大可增加31.2%.

Osteoarticular Lesions of the Shoulder Girdle by Hippopotamus Bite: Highly Septic Lesion

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.

Knowledge,management,and complications of sepsis and septic shock:A significant therapeutic challenge in the intensive care unit

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.

Native and prosthetic septic arthritis in a university hospital in Saudi Arabia:A retrospective study

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.

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock:An Indian perspective

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.

Efficacy and safety of ulinastatin in the treatment of septic shock:a systematic review and meta-analysis

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.

基于B-spline的路径规划与轨迹跟踪研究

为满足局部路径规划换道路径下的特性和提高智能驾驶车辆在多种变曲率条件下的路径跟踪精度和稳定性,采用贝塞尔曲线、B-spline等路径规划换道条件下的方法,分别在圆形轨迹、8字形轨迹、S形轨迹、正弦曲线形轨迹路径下,基于MATLAB对4类路径跟踪算法进行分析,得出最合理的B-spline路径规划和跟踪算法。结果表明,B-spline算法在换道点和并道点曲率为0,满足换道条件的要求;MPC算法在正弦轨迹下比其他算法平均误差小约48.6%,在圆形轨迹下比其他算法平均误差小约84%,说明该算法在多种轨迹下都具有很好的跟踪性,能在一定程度上保证智能驾驶汽车的安全性和稳定性,为今后智能车辆路径规划和轨迹跟踪控制研究提供参考。

基于二维B-splines方法研究强磁场中类氢离子He+的低能能级

采用改进的二维B-spline方法在柱坐标系下研究了强磁场下类氢离子He^(+)的结构和电子空间几率密度,计算包含三种对称性0^(+)、0^(-)和(^(-)1)^(+)共10个本征态1 0^(+)、2 0^(+)、ν 0^(-)(ν=1~4)和ν(-1)^(+)(ν=1~4)的能级,选定磁感应强度分别为0、0.001、0.003、0.005、0.007、0.010、0.030、0.050、0.070、0.100、0.200、0.300、0.500、0.700和1.000 a.u.。计算结果表明,类氢离子He^(+)的能级在强磁场中发生劈裂,简并度消除,得到了各个能级随磁感应强度变化规律,并且发现随着磁感应强度的增加能级高低会改变,甚至会发生能级翻转现象;定量地研究了类氢离子He^(+)的基态1 0^(+)和激发态3 0^(-)几率密度分布随磁感应强度的变化规律,并与氢原子进行比较。本研究部分计算结果与他人研究结果十分吻合,有助于进一步理解其他复杂原子的电子运动行为。

B-Spline-Based Curve Fitting to Cam Pitch Curve Using Reinforcement Learning

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.

Explicit Isogeometric Topology Optimization Method with Suitably Graded Truncated Hierarchical B-Spline

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.

基于B-Spline的位移监测数据动态优化拟合

为更好地进行工程位移的监测,对基坑施工过程钢支撑水平位移激光监测数据特征、误差类型及其成因进行了分析,研究了B-Spline在海量监测数据去噪中的适用性,并通过引入待估参数的B样条基函数修正,建立最小二乘控制下位移-时间关系的高精度拟合优化。结果表明:待估参数ζ_(i)的修正重构,把监测数据序列转化为参数估计问题,使位移时变关系的最优化拟合成为可能;移动时间坐标方法,可实现等时距监测数据的动态处理,优化计算时间;B-Spline融合最小二乘法,在最小方差控制下实现监测数据-时间关系最优拟合,形成光滑、连续的高精度拟合曲线,有利于提高监测反馈控制的精度和可靠性。实例应用验证了成果的可靠性和适用性。

Theoretical Analysis of Biogas Production from Septic Tanks: The Case of the City of Kinshasa

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 m3/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 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 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 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 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.

BITS: an efficient transport solver based on a collocation method with B-spline basis

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.

Septic Hip Arthritis at CHU Gabriel TOURE: Therapeutic and Evolutionary Aspects

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.

New classification for septic arthritis of the hand

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.

Emerging concepts in the care of patients with cirrhosis and septic shock

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.

Continuous renal replacement therapy with oXiris®in patients with hematologically malignant septic shock:A retrospective study

BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.

Hypoperfusion context as a predictor of 28-d all-cause mortality in septic shock patients:A comparative observational study

BACKGROUND As per the latest Surviving Sepsis Campaign guidelines,fluid resuscitation should be guided by repeated measurements of blood lactate levels until normalization.Nevertheless,raised lactate levels should be interpreted in the clinical context,as there may be other causes of elevated lactate levels.Thus,it may not be the best tool for real-time assessment of the effect of hemodynamic resuscitation,and exploring alternative resuscitation targets should be an essential research priority in sepsis.AIM To compare the 28-d mortality in two clinical patterns of septic shock:hyperlactatemic patients with hypoperfusion context and hyperlactatemic patients without hypoperfusion context.METHODS This prospective comparative observational study carried out on 135 adult patients with septic shock that met Sepsis-3 definitions compared patients with hyperlactatemia in a hypoperfusion context(Group 1,n=95)and patients with hyperlactatemia in a non-hypoperfusion context(Group 2,n=40).Hypoperfusion context was defined by a central venous saturation less than 70%,central venousarterial PCO_(2)gradient[P(cv-a)CO_(2)]≥6 mmHg,and capillary refilling time(CRT)≥4 s.The patients were observed for various macro and micro hemodynamic parameters at regular intervals of 0 h,3 h,and 6 h.All-cause 28-d mortality and all other secondary objective parameters were observed at specified intervals.Nominal categorical data were compared using theχ^(2)or Fisher’s exact test.Nonnormally distributed continuous variables were compared using the Mann-Whitney U test.Receiver operating characteristic curve analysis with the Youden index determined the cutoff values of lactate,CRT,and metabolic perfusion parameters to predict the 28-d all-cause mortality.A P value of<0.05 was considered significant.RESULTS Patient demographics,comorbidities,baseline laboratory,vital parameters,source of infection,baseline lactate levels,and lactate clearance at 3 h and 6 h,Sequential Organ Failure scores,need for invasive mechanical ventilation,days on mechanical ventilation,and renal replacement therapy-free days within 28 d,duration of intensive care unit stay,and hospital stay were comparable between the two groups.The stratification of patients into hypoperfusion and nonhypoperfusion context did not result in a significantly different 28-d mortality(24%vs 15%,respectively;P=0.234).However,the patients within the hypoperfusion context with high P(cva)CO_(2)and CRT(P=0.022)at baseline had significantly higher mortality than Group 2.The norepinephrine dose was higher in Group 1 but did not achieve statistical significance with a P>0.05 at all measured intervals.Group 1 had a higher proportion of patients requiring vasopressin and the mean vasopressor-free days out of the total 28 d were lower in patients with hypoperfusion(18.88±9.04 vs 21.08±8.76;P=0.011).The mean lactate levels and lactate clearance at 3 h and 6 h,CRT,P(cv-a)CO_(2)at 0 h,3 h,and 6 h were found to be associated with 28-d mortality in patients with septic shock,with lactate levels at 6 h having the best predictive value(area under the curve lactate at 6 h:0.845).CONCLUSION Septic shock patients fulfilling the hypoperfusion and non-hypoperfusion context exhibited similar 28-d all-cause hospital mortality,although patients with hypoperfusion displayed a more severe circulatory dysfunction.Lactate levels at 6 h had a better predictive value in predicting 28-d mortality than other parameters.Persistently high P(cv-a)CO_(2)(>6 mmHg)or increased CRT(>4 s)at 3 h and 6 h during early resuscitation can be a valuable additional aid for prognostication of septic shock patients.