Refraction of an oblique shock wave on a tangential discontinuity dividing two gas flows with different properties is considered. It is shown that its partial reflection occurs excepting of geometrical diffraction of an oblique shock. Another oblique shock, expansion wave or weak discontinuity that coincides with Mach line, can act as a reflected disturbance. This study focuses on relationships which define the type of reflected discontinuity and its parameters. Domains of existence of various shock-wave structures with reflected disturbances of two types and boundaries between them are defined. The domains of parameters with one or two solutions exist for the characteristic refraction. Conditions of the regular refraction and the Mach refraction are formulated, and boundaries between those two refraction types are defined for various types of gases. Refraction phenomena in various engineering problems (hydrocarbon gaseous fuel and its combustion products, diatomic gas, fuel mixture of oxygen and hydrogen etc.) are discussed.

This article is a commentary on the publication Guo J, Hai H, Ma Y. Application of extracorporeal shock wave therapy in nervous system diseases: A review. Front Neurol. (2022) 13:963849. doi: 10.3389/fneur.2022.963849 (1). In the opinion of the authors of this commentary the information provided in the Section "Principles of ESWT" in (1) is partly incorrect and misleading. This is due to the fact that important, published knowledge regarding focused extracorporeal shock wave therapy (fESWT) and radial extracorporeal shock wave therapy (rESWT) was disregarded in (1).

The increasing demand for higher power in rocket launchers is driving the development of higher power nozzles, achieved essentially by increasing the expansion ratio. However, this can lead to flow separation and resulting unsteady, asymmetrical forces, called side loads, which can limit the life of both the nozzle itself and other engine components. If this problem can be overcome, engine performance can be significantly increased. Therefore, various separation control methods have been proposed, but none have been fully implemented to date due to the uncertainties associated with modeling and predicting the flow phenomena. A numerical study of high area ratio rocket engine is presented to analyze the aeroelastic performance of the structure under the condition of flow separation. The finite volume method, the 2nd order upwind scheme and the extended wall function are used to analyze the flow inside the rocket nozzle and the transition of the Free Shock Separation (FSS) to Restricted Shock Separation (RSS) separation pattern ) to be discussed in detail. Since the location of the flow separation point depends heavily on the flow.

The specifics of a shock wave propagation down a positive column of a dc discharge in molecular chemically inert gases has been investigated. It was shown that axial gradients caused by the imbalance in the charged particle momentum transfer to the gas molecules can be a reason for the shock velocity dependence on the electric field direction. In the pure nitrogen gas, the calculated shock velocity difference up to 13.5% is in good agreement with 12% value obtained in the experiment. A returning gas flow organizing in the discharge as a possible mechanism for an extended shock structure, and a number of kinetical factors capable of affecting the shock motion are discussed.

This paper presents a numerical study on the laser shock wave propagation in a 3D woven CFRP material by means of detailed and homogenized FE models. The aim of the study is to numerically characterize the shock wave response of the 3D woven CFRP in terms of back face velocity profiles and the induced damage and to investigate whether the detailed FE models could be replaced by homogenized FE models. The 3D woven geometry was designed using the TexGen software, while the numerical analyses were executed using the LS-Dyna explicit FE software. A high-strain rate behavior was considered for the matrix. The fiber bundles in the detailed models were modeled as a high fiber content unidirectional composite laminate, with its mechanical properties calculated by micromechanical equations. Both for the fiber bundles of the detailed model and the homogenized models a progressive damage material model was applied. The results of the detailed model reveal a considerable effect of material’s architecture on the shock wave propagation and the sensitivity of the back face velocity profile to the spot location. Consequently, the homogenized model is not capable of accurately simulating the shock wave response of the 3D woven composite. Moreover, the detailed predicts with high accuracy matrix cracking in the resin-rich areas and in the bundles as well as fiber failure. On the contrary, the homogenized model predicts matrix cracking at the same areas and no fiber failure.

The three-dimensional single fin configuration finds application in an intake geometry where the cowl-shock wave interacts with the side-wall boundary-layer. Accurate numerical simulation of such three-dimensional shock/turbulent boundary-layer interaction flows, which are characterized by the appearance of strong crossflow separation, is a challenging task. Reynolds-averaged Navier-Stokes computations using the shock-unsteadiness modified Spalart-Allmaras model is carried out at Mach of 5 at large fin angle of 23^◦. The computed results using the modified model are compared to the standard Spalart-Allmaras model and validated against the experimental data. The focus of work is to implement the modified model and to study the flow physics in detail in the complex region of swept-shock-wave turbulent boundary-layer interaction in terms of the shock structure, expansion fan, shear layer and the surface streamlines. The flow structure is correlated to the wall pressure and skin friction in detail. It is observed that the standard model predicts an initial pressure location downstream of the experiments. The modified model reduces the eddy viscosity at the shock and predicts close to the experiments. Overall, the surface pressure using modified model is predicted accurately at all the locations. The skin friction is under predicted by both the models in the reattachment region and is attributed to the poor performance of turbulence models due to flow laminarization.

A gas-hydrate method of CO₂ gas storage is one of the modern technology for reducing it emissions into the atmosphere. The breakup of gas bubbles by a shock wave is an actual area of scientific and technological research. However, it is little known that such research began in the late 1950s in the USSR. The article presents the main discoveries related to the destruction of gas bubbles in a liquid under the influence of a shock wave, made more than 60 years ago. Looking back: study the past to understand the present.

The process of shock wave focusing can make the strength of shock waves be continuously accumulated and turned into detonation wave in Pulse Detonation Engine (PDE). However, its effective application needs the inlet jets be in high temperature and velocity, which is difficult to be satisfied under certain conditions. Therefore, in this paper, metal magnesium assisted detonation initiation is proposed and the effect of magnesium particle addition on the shock wave focusing process in a kerosene-fueled PDE with cavity configuration is investigated through numerical simulation. The result showed that when the temperature of the premixed fuel/air jets injected in opposite direction was set as 650 K, the collision of leading shock waves on the central axis was the main source of energy deposition and the shock wave focusing could make the detonation be initiated in the cavity. When the temperature of jets is reduced to 550 K, fuel ignition and detonation could not be achieved through shock wave focusing. Then adding metal magnesium particles into the combustor made the energy deposition be enhanced and the detonation be induced. The diffusion of metal particles can significantly change the structure, motion, merging and dissipation of vortices in the flow field. Generally, the shock wave focusing process is basically not affected with metal particles injection. Therefore, this method can be successfully employed for detonation initiation in the cavity when the fuel/air premixed jet temperature is not high for PDE.

Background: Injury of the spinal cord causes motor and sensory dysfunction, and pathological reflexes, leading to paraplegia or tetraplegia. The sequelae of traumatic spinal cord injury (SCI) is a significant burden and impact on healthcare systems. Despite constant progress in medicine, traumatic SCI still remains irreversible. Till now, no satisfying treatment that can enable neuronal regeneration and recovery of function at the damaged level has been found. Hundreds of experiments have been conducted on various possibilities of influencing spinal regeneration, some of them have yielded promising results, but unfortunately, the successes obtained in experimental animals have not translated into humans. Methods: This narrative review article presents the application of Extracorporeal Shock Wave Therapy (eSWT) in Spinal Cord Injury. The article has been divided into parts: 1. Use of extracorporeal Shock Wave Therapy for regeneration of the spinal cord after traumatic Spinal Cord Injury. 2. Application of extracorporeal Shock Wave Therapy in spasticity after Spinal Cord Injury. In both cases, the hypotheses of possible mechanisms of action will be described. Results and conclusions: A small number of clinical trials have demonstrated the potential of eSWT to influence the regeneration of the spine, as an innovative, safe, and cost-effective treatment option for patients with SCI. Some reports have shown that eSWT can improve spasticity, walking ability, urological function, quality of life, and independence in daily life.

Wind energy is a kind of renewable energy with great potential for development. This study mainly investigated the application of shock waves generated by high-pressure gases (wind energy) for generating energy. In this study, we designed a new supersonic shock wave generator that can be reused without disassembling and assembling bolts and developed a supersonic shock wave monitoring system. This system monitored the velocity of the generated shock waves, which was Mach 3-5, and the output pressure was more than 100 times higher than the input pressure of the shock wave generator tank.Then, we developed a power generation system driven by supersonic shock waves based on the characteristics of the new shock wave generator, which can generate high-pressure and high-speed blast waves and can be reused. The shock wave generator can repeatedly generate high-pressure waves to drive the Tesla turbine and then the magnetic energy generator for power generation. We established a complete control process for power generation driven by shock waves by controlling the valve stem. The system can detect the tank pressure, output pressure, gas flow, rotation speed, voltage, and current during the control process for the performance analysis of power generation.

Objective: The main purpose of the study is to investigate the combined effects of polydeoxyribonucleotide (PDRN) and extracorporeal shock wave therapy (ESWT) sequences on the regenerative processes in atrophied animal muscles. Methods: Thirty male New Zealand rabbits, aged 12 weeks, were divided into five groups: normal saline, PDRN, ESWT, PDRN injection before ESWT, and PDRN injection after ESWT. Following 2 weeks of cast immobilization, the respective treatments were administered to the atrophied calf muscles. Radial ESWT was performed twice weekly. The evaluation included measurements of calf circumference, tibial nerve compound muscle action potential (CMAP), and gastrocnemius (GCM) muscle thickness after 2 weeks of treatment. Histological and immunohistochemical staining, as well as Western blot analysis, were conducted 2 weeks post-treatment. Staining intensity and extent were assessed using semi-quantitative scores. Results: Groups 4 and 5 demonstrated significantly greater calf muscle circumference, GCM muscle thickness, tibial nerve CMAP, and GCM muscle fiber cross-sectional area (types I, II, and total) than in the remaining three groups (p < 0.05), while they did not did not differ significantly in these parameters. Groups 2 and 3 showed the higher values for all the observations compared to group 1 (p < 0.05). Group 4 had the greatest ratio of vascular endothelial growth factor (VEGF) to platelet endothelial cell adhesion molecule-1 (PECAM-1) in the gastrocnemius muscle fibers than in the other four groups (p < 0.05). Western blot analysis revealed significantly higher expression of angiogenesis cytokines in groups 4 and 5 than in the remaining (p < 0.05). Conclusion: The combination of ESWT and PDRN injection demonstrated superior regenerative efficacy for atrophied calf muscle tissue in rabbit models than these techniques alone or saline. Particularly, administering ESWT after PDRN injection yielded the most favorable outcomes in specific parameters.

Extracorporeal shock wave therapy (ESWT) is a well investigated and widely used treatment modality for a number of musculoskeletal disorders. A limitation of ESWT is its potential painfulness at higher, clinically relevant energy flux density (EFD), which may limit its applicability and, thus, effectiveness. Various studies in the literature demonstrated that neither application of a higher number of extracorporeal shock waves with lower EFD nor use of local anesthesia may solve this problem. Based on the results of several other studies in the literature it is hypothesized here that in patients suffering from musculoskeletal disorders that can be treated with ESWT, pretreatment with a pulsed, high power laser with a wavelength of 904 or 905 nanometers (hereafter: "laser pretreatment") does not only allow to apply higher EFDs in subsequent ESWT but actually results in faster and/or better treatment outcome than ESWT without laser pretreatment. Accordingly, it is hypothesized here that combining ESWT with laser pretreatment leads to synergistic effects and, thus, is superior to either treatment modality alone. Confirming this hypothesis in preclinical and clinical research may raise significance and increase the use of ESWT in physical and rehabilitation medicine, with immediate benefit for patients.

In this paper, a two-phase model of air shock wave induced by rock-fall was described. The model was made up of the uniform motion phase (velocity was close to 0 m·s^-1) and the acceleration movement phase. The uniform motion phase was determined by experience, meanwhile the acceleration movement phase was derived by the theoretical analysis. A series of experiments were performed to verify the two-phase model and obtained the law of the uniform motion phase. The acceleration movement phase was taking a larger portion when height of rock-fall was higher with the observations. Experimental results of different falling heights showed good agreements with theoretical analysis values. Computational fluid dynamics (CFD) numerical simulation had been carried out to study the variation velocity with different falling height. As a result of this, the two-phase model could accurately and convenient estimating the velocity of air shock wave induced by rock-fall. The two-phase model could provide a reference and basis for estimating the air shock waves' velocity and designing the protective measures.

An investigation of compressible flow over two-dimensional obstacles is presented in this paper. When shock waves are formed on surfaces due to compressibility and these shocks interfere with the boundary layer, undesirable effects such as friction, separation, and flow instability occur. To weaken the shock and reduce its effects, various methods have been employed in the past, including surface suction, surface blowing, and vortex generators. Using numerical solutions, the present work attempts to reduce the negative effects of the shock generated by the obstacle by creating porosity on its surface. Numerical methods such as the finite volume method and the Navier-Stokes equations as well as the Spalart-Allmaras model are used. By creating suction and blowing and increasing the cross-sectional area of the flow, porous surfaces reduce the effects of shock. Achieving around 50% porosity on the obstacle weakened the shock and reduced the Mach number after it, according to this paper's results. Also, the area under the skin friction diagram has decreased by about 38% as a result of less interference between the shock and the boundary layer and blowing caused by the porous surface.

The need to understand the process by which particles, including solar wind and coronal ions as well as pickup ions, are accelerated to high energies (ultimately to become anomalous cosmic rays) motivate a multi-fluid shock wave model which includes kinetic effects (e.g. ion acceleration) in an electromagnetically self-consistent framework. Particle reflection at the cross-shock potential leads to ion acceleration in the motional electric field and thus anisotropic heating and pressure in the shock layer, with important consequences for the multi-fluid dynamics. This motivates development of a multi-fluid model of solar wind electrons and ions treated as fluid, coupled self-consistently with a small population of kinetically treated ions (e.g. pickup ions.) Consideration of both the time dependent and steady state regimes, indicate that such a multi-fluid approach is necessary for resolving the, Debye scale, particle reflecting cross-shock potential and subsequent dynamics. To study charge separation effects in narrow, supersonic wave layers we consider a reduction of the system to the steady state for cold ions and hot electrons and find two types of solitary waves inherent to the reduced two-fluid system in this limiting case.

Many patients with Coronavirus disease 2019 (COVID-19) suffer from shortness of breath and severe chest pain. Here we report successful therapy of a patient with diagnosis of COVID-19, severe chest pain and significant shortness of breath, using radial extracorporeal shock wave therapy (rESWT). The latter started seven days after beginning of symptoms and drug therapy without success, and involved daily application of 15.000 to 20.000 radial extracorporeal shock waves over the intercostal muscles as well as the paravertebral muscles of the thoracic and lumbar spine, diaphragm and flanks. Immediately after the first rESWT session the patient experienced significant pain relief and improvement of breathing. Four days later the pain had completely subsided and breathing was largely normalized. This type of noninvasive, non-pharmacologic treatment could help many COVID-19 patients or patients who still suffer from breathing problems weeks after having been infected with SARS-CoV-2, giving them back quality of life.

The possibility of a shock wave recovery at a discrete closed interface with a heated gas has been investigated. A two-dimensional model applied to conditions of optical discharges featuring spherical, elliptical, and drop-like configurations demonstrated that non-symmetry in the shock refraction contributes to the specific mechanism of recovery other than simply its compensation. Even though the full restoration of the hypersonic flow state doesn’t occur in a strict sense of it, clear reverse changes toward the initial shape of the shock front eventually take place, thus creating an appearance of a full recovery seen in experiments. From analysis for different interfaces symmetries, the factors determining the recovery dynamics are identified. The results are directly applicable to the problem of energy deposition into a hypersonic flow, however it can be useful anywhere else where the flow modifications following the interaction are important. The dimensionless form of the equations allows applications on any scale other than that demonstrated for the optical discharges.

Is HSP-27 an emerging marker of good prognosis in septic shock patients – a pilot study Objective To estimate the value of serum changes of C-reactive protein, procalcitonin, presepsin, heat shock protein 27 (HSP27) and neutrophil to lymphocyte ratio in assessing the prognosis in patients with septic shock (SS) treated in intensive care unit. Methods The SS was diagnosed and treated in accordance with the guidelines of the Surviving Sepsis Campaign. 37 selected adult patients with SS were included. Serum concentrations of biomarkers were measured at admission and daily for 4 consecutive days (time points T0,T1, T2, T3 and T4 respectively). The mortality rate was determined 28 days after admission. Patients were divided into survivor and non-survivor groups according to their mortality. The differences between the levels of biomarkers at the T0 and T4 time points were analyzed. Results The mean value of the SOFA score on admission was 11.7 ± 2.7, and the APACHE II scale 29.9 ± 6.85. Nine patients died. Univariate logistic analysis revealed that changes between T0 and T4 time points of presepsin, procalcytonin, and HSP27 were associated with prognosis. A multivariate Cox analysis showed that an increase in HSP27 on T4 was the only independent predictor of good prognosis in SS patients. The area under the receiver operating characteristics curve for HSP27 was 0.785. Kaplan–Meier analysis showed that the mortality was lower (p=0.014) in patients who had an increase in HSP27 on T4 compared to those whose serum HSP27 did not increase on T4. Conclusions The increase of HSP27 level on the 4th day predicts favorable outcome in SS patients.

Introduction: The viral respiratory disorder known as severe acute respiratory syndrome (SARS) is caused by the SARS-associated coronavirus. End of May 2021, there have been over 170 million reported cases and more than 3.53 million deaths worldwide. In the field of cardiovascular performance, the shock index (SI) is a simple and widely used formula that measures the physiological response prior to systemic hypotension. It is obtained by dividing the heart rate by the systolic blood pressure. Another parameter, the modified shock index (MSI), is defined as the ratio of heart rate to mean arterial pressure (MAP). Methods: In this retrospective study, we examined the data of COVID-19 patients who were admitted to the ICU between June 1st, 2020, and January 31st, 2021. The patient details were collected from the Medical Records Department (MRD) in a tertiary care center. A case-recorded proforma was used to record the patient information, which was then analyzed using SPSS software. Results: The mean age of the patients was 67 years, consisting of 64 males (68.9%) and 29 females (31.1%). The standard deviation was calculated as 13.557. Among the patients, the minimum age recorded was 28, while the maximum age was 97. Patients with known CAD (Coronary Artery Disease) had a higher mortality rate among comorbidities. The p-value for Shock Index and Mortality Status was 0.205 (with an alpha value greater than 0.05), indicating no significant association. However, the modified shock index (MSI) showed a significant association with mortality status. The Pearson chi-square value for MSI and Mortality Status was 4.19, with a p-value of 0.041 (with an alpha value less than 0.05). These results suggest that there is a higher risk of mortality for patients with a Modified Shock Index of less than 0.7 or greater than 1.3. The MSI Odds ratio was found to be 4.500, indicating that such patients have a 4.5 times higher risk of mortality compared to others. Conclusion: In conclusion, our study found that there is no significant association between the Shock Index (SI) and mortality, as the p-value was greater than 0.05. However, the Modified Shock Index (MSI) showed a significant association with mortality status, with a p-value less than 0.05. This suggests that patients with a Modified Shock Index less than 0.7 or greater than 1.3 are at a higher risk of mortality. It is important to consider these findings when assessing the prognosis and potential interventions for COVID-19 patients.

Grain supply is the lifeblood of a country, and the stability of the supply chain is a crucial prerequisite for ensuring national grain security. This paper draws on the definition of resilience in physics and economics. It takes supply chain fracture resilience, impact resilience, and synergy resilience as the secondary indicators. It constructs a comprehensive evaluation indicator system of the grain supply chain resilience, measures the resilience indicator of China's grain supply chain from 1996 to 2021, and analyzes the role of supply, cost, exchange rate, and other external shocks in influencing the resilience of China's grain supply chain on this basis. The study found that the overall level of China's total grain supply chain resilience has been growing year by year and can be divided into three stages: low-level stabilization stage, continuous growth stage, and high-level stabilization stage. Grain supply chain fracture resilience has been growing steadily, grain supply chain impact resilience fluctuation is more obvious, and grain supply chain synergy resilience has been changing more gently. In the inquiry of the impact of external shocks on the resilience of China's grain supply chain, it was found that world grain exports and the RMB exchange rate have a significant positive impact on China's grain supply chain resilience level, while the international oil price has a significant negative impact. Based on this, the paper puts forward suggestions for ensuring stable production and supply in the grain market, improving the structure of foreign trade in grain, and actively coping with international commodity price shocks.

To conduct a precise impact assessment of marine diesel engines, a 200t floating impact platform was utilized to simulate realistic testing conditions. The testing generated the acceleration time curve and the impact response spectrum for the diesel engine. According to the applicable standards, the spectral velocity was chosen as the evaluation index, and an evaluation of the longitudinal, transverse, and vertical impact environment of the diesel engine was conducted. The shock factor interpolation method was corrected using the confidence interval based on normal distribution, and the interpolated confidence interval of the shock factor was determined. The findings reveal that: The 200t-class floating shock platform is capable of providing a reliable shock environment for diesel engine tests. The shock wave serves as the primary external force during the experiment, and the impact of bubble pulsation can be disregarded when assessing using the floating shock platform. To more accurately describe the experimental shock intensity when presented with dispersed data, the confidence interval can be utilized, and the resulting prediction formula provides a higher level of impact safety. The obtained conclusions can serve as a reference for predicting the shock environment of large shipboard equipment using the shock platform.

The main objective of the present study is to demonstrate the possibility of actively influencing the position of the bow shock wave and the main parameters of supersonic flow over a blunt body by organizing a gas discharge near the front surface, in the region between the body and the bow shock wave. The research is carried out using both experimental and numerical methods. The working gas was xenon. It is shown that the steady bow shock wave stand-off distance along with the current and power of the discharge, is associated with the change in the adiabatic index of the plasma created by the discharge, which, in turn, is determined by the plasma parameters, such as the degrees of nonequilibrium and the degree of ionization. It is shown that the adiabatic index with the power supplied to the impact zone in the range of 30-120 kW can both increase and de-crease in the range of 1.25-1.288. The study of the discharge created plasma zone was conducted and the correspondence between the discharge current and power, and the average parameters in the plasma zone created by the discharge is presented. A good agreement between the numerical and experimental data was shown. The results may be useful in developing control systems for high-speed civil aircrafts.

This work is an addition to the previously developed two-dimensional model of the shock-plasma interaction extending it into the third dimension. The model allows tracing the evolution of the state of the hypersonic flow and the shock front refracted at a thermal discontinuity. The advantages of using the spherical coordinate system for this type of the problems include more transparency in interpreting the solution and a shortened calculation procedure, because all the changes to the front become reduced to one distortion component only. Although the vorticity generation triggered at the interface is the consequence of the refraction and tied to the steep changes of the front, it is shown here that it is not because of an instant parameter jump at the interface due to refraction itself.

This study demonstrates the orientation and the ‘shape factor’ have pronounced effects on the development of the localized pressure fields inside of the helmet. We used anatomically accurate headform to evaluate four modern combat helmets under blast loading conditions in the shock tube. The Advanced Combat Helmet (ACH) is used to capture the effect of the orientation on pressure under the helmet. The three modern combat helmets: ECH, Ops-Core, and Airframe, were tested in frontal orientation to determine the effect of helmet geometry. Using the unhelmeted headform data as a reference, we characterized pressure distribution inside each helmet and identified pressure focal points. The nature of these localized “hot spots” is different than the elevated pressure in the parietal region of the headform under the helmet widely recognized as the under-wash effect also observed in our tests. It is the first experimental study which indicates that the helmet presence increased the pressure experienced by the eyes (as evidenced by the pressure sensors in the H8 and H9 locations), and the forehead (denoted as H1 location). Pressure fingerprinting using an array of sensors combined with the application of principle component analysis (PCA) helped elucidate the subtle differences between helmets.

Background: Acute injuries of the hamstring muscle complex (HMC) Type 3b (interfascicle / bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries Type 3b is a progressive physiotherapeutic exercise program. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury Type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. Methods/Design: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Fourty patients with acute HMC injury Type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for eight weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of six months after inclusion into the study. Discussion: Because of the lack of adequate treatment options for acute HMC injury Type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. Trial registration: ClinicalTrials.gov ID NCT03473899. Registered March 22, 2018.

Image restoration plays a vital role in image processing and pattern recognition in producing better recognition accuracy. It was observed that, most of the traditional restoration algorithms were meant for removing a single type of noise and efforts have been made towards the use of partial differential equation model (PDE), to restore different types of images such as super-resolution, bleeding through and deblurring. This research work deployed hybridized shock filter, shock diffusion of higher order PDE to remove degraded images that have been affected by atmospheric turbulence and water smear images. Degraded images of different types were acquired from various sources. The degraded images were subjected to shock filter algorithm, shock diffusion of higher order PDE. The shock filter was combined with PDE, likewise the shock diffusion was also combined with PDE, and the three algorithms were also combined to test the efficiency of the hybridized method on different degraded images. The result was validated using Mean Square Error, Structural Similarity Index Measure (SSIM), Peak-to-Noise-Signal -Ratio (PNSR) and universal quality index (UQI). From the result, it was observed that the combination of many image restoration algorithms does not give better results whereas, the combination of two of the algorithms has really proved effective.

In this paper, we investigated the capacitive effect and the electromagnetic coupling on the measurement chain induced by the gas gun or the powder gun during impact experiments. Reduced bandwidth and noise have been noticed on experimental signals. Rogowski coil measurements have been added on the cables to characterize the electromagnetic coupling. The perturbation currents on the cables have been quantified depending on the configuration. The gauge, the transmission line and the conditioning system have been modeled. The calculations have reproduced the electrical wave arrival time, the transmission line transfer impedance, the conditioning system transfer impedance and it shows the bandwidth limitation. A capacitive effect with the piezoresistive manganin gauge embedded into the sample has been identified depending on the experimental setup.

Extracorporeal shock wave therapy (ESWT) is a safe and effective treatment option for various pathologies of the musculoskeletal system. Many studies addressed the molecular and cellular mechanisms of action of ESWT. However, no uniform concept could be established in this matter until now. We performed a systematic review of the effects of exposure of musculoskeletal tissue to extracorporeal shock waves (ESWs) reported in the literature. The key results were as follows: (i) compared to the effects of many other forms of therapy, the clinical benefit of ESWT does not appear to be based on a single mechanism; (ii) different tissues respond to the same mechanical stimulus in different ways; (iii) just because a mechanism of action of ESWT was described in a study does not automatically mean that this mechanism was relevant to the observed clinical effect; (iv) focused ESWs and radial ESWs seem to act in a similar way; and (v) even the most sophisticated research into the effects of exposure of musculoskeletal tissue to ESWs cannot substitute clinical research in order to determine the optimum intensity, treatment frequency and localization of ESWT.

The spectra and global distributions of the X-ray emissions generated by the solar wind charge-exchange (SWCX) process in the terrestrial magnetosheath are investigated based on a global hybrid model and a global geocoronal hydrogen model. The solar wind O6+ ions which are the primary charge state for oxygen ions in solar wind are considered. The line emissivity of the charge-exchange born O5+ ions are calculated by Spectral Analysis System for Astrophysical and Lab oratory (SASAL). It is found that the emission lines from the O5+ ranges from 105.607 to 118.291 eV with the strong line at 107.047 eV. We then simulated the magnetosheath X-ray emission intensity distributions with a virtual camera at two positions of north pole and dusk at six stages during the passing of a perpendicular interplanetary shock combined with a tangential discontinuity structure through the Earth’s magnetosphere. During this process, the X-ray emission intensity increases with time, and the maximum value is 27.11 keV cm-2 s-1 sr-1 on the dayside, which is 4.5 times that before the solar wind structure reaches the Earth. A clear shock structure can be seen in the magnetosheath and moves earthward. The maximum emission intensity seen at dusk is always higher than that seen at north pole.

The COVID-19 pandemic has impacted the healthcare system across the globe, leading to more than 6.9 million deaths in the past four years. Cardiac Arrest is a terminal event with associated significantly high morbidity and mortality across age groups. Multiple clinical parameters, organ dysfunction, and chronic co-morbid conditions impact mortality in COVID-19 patients with heart failure. In this retrospective, administrative dataset-based study on 148899 patients admitted to the hospital with COVID-19 and heart failure diagnosis, we reported 6703 cardiac arrests and 5783 mortality. We have used ICD 10 codes to identify the diagnosis. The primary objective of the study is to find the predictors of Cardiac Arrest among patients admitted to hospitals with COVID-19 and heart failure. Secondary objective is to calculate the percentage of cardiac Arrest and mortality across the various age groups and the correlation of hours on the mechanical ventilator and mortality. Study results have shown that the use of a mechanical ventilator has the strongest co-correlation with cardiac Arrest with an odd ratio of 14.4, followed by septic shock with an odd ratio of 5.6, tension pneumothorax with an odd ratio of 4.9 preceding the acute renal failure with an odd ratio of 2.4 and sepsis 2.3. Complete heart block had an odd ratio of 1.9, followed by ESRD with a ratio of 1.6, acute pulmonary embolism with an odd ratio of 1.5, and Type 2 MI with an odd ratio of 1.49. Chronic co-morbid condition of DM had an odd ratio of 1.3, followed by Atrial fibrillation with an odd ratio of 1.1. These results and findings emphasized that multi-organ failure has a huge impact on cardiac Arrest among COVID-19 patients with heart failure.

Both globally and in Hungary, agriculture is one of the industries that is most vulnerable to weather and climate extremes. Intense temperature rises, spatial and temporal variations in precipitation, and significant changes in extreme climatological and weather parameters have contributed to changes in the conditions of cropland, crop losses, and impacts on crop quality in recent years. This paper depicts the transformation of the domestic agricultural sector due to the extreme drought shock of 2022, as well exploring the adaptation strategies applied. The research is based on official agro-climate database and crop data, and the temperature, precipitation, and radiation during the growing season are all examined. The agro-meteorological properties in Hungary had to be investigated for the entire year and all four of its seasons, with indicator analysis projected onto the ever-increasing and dormant seasons. Long-term climate analysis is necessary to understand the historic drought of 2022 and the success of future adaptation and mitigation techniques. The results can help smallholders effectively reduce the adverse impacts of drought conditions, thereby increasing their adaptation to similar shocks.

Impressively increasing availability of the mechanical circulatory/cardiac support systems (MCS) worldwide, together with the deepening of the knowledge of critical care medical practitioners, have inevitably led to the discussion about further improvements of intensive care associated to MCS. An appealing topic of the left ventricle (LV) overload related to VA ECMO support endangering myocardial recovery is being widely discussed within the scientific community. Unloading of LV leads to the reduction of LV end-diastolic pressure, reduction of pressure in the left atrium and decrease of the LV thrombus formation risk. Consequently, better conditions for myocardial recovery, with comfortable filling pressures and better oxygen delivery/demand ratio are achieved. The combination of VA ECMO and Impella device, also called ECPELLA seems to be a promising strategy which may bring the improvement of CS mortality rates. The series of presented trials and meta-analyses clearly showed potential benefits of this strategy. However, the ongoing research has brought a series of new questions, as whether Impella itself is the only appropriate unloading modality, or any other approach to unload LV would be beneficial in the same way? Benefits and potential risks of LV unloading and its timing are being discussed in current review.

Anti-inflammatory agents are widely used for the treatment of inflammatory diseases. Nevertheless, the associated side effects of available drugs make necessary the search for new anti-inflammatory conditions. Here, we investigated the anti-inflammatory activity of solidagenone. Initially, we observed that a single dose of 30, 60 or 90 mg/Kg of solidagenone did not result in mortality or elicit any discernible signs of toxicity in the animals. At the same doses, solidagenone promoted a significative reduction in the migration of neutrophils in an acute peritonitis model and decreased mortality in a lipopolysaccharide-induced endotoxic shock model. Interestingly, treatment with solidagenone conferred a protective effect against leukopenia and thrombocytopenia, hematological disorders commonly observed in sepsis conditions. In addition, treatment with all the doses of solidagenone promoted a significative reduction in nitric oxide, TNF-α, and IL-1β relative to the LPS-stimulated vehicle-treated cultures. Furthermore, gene expression and in silico analyses also supported the modulation of NF-κB pathway by solidagenone. Finally, in silico pharmacokinetics prediction indicated a favorable drugability profile for solidagenone. Taken together, the findings of the present investigation show that solidagenone exhibits significant anti-inflammatory properties in acute experimental models, potentially through the modulation of NF-κB signaling pathway.

Abstract: Background: Vasoplegic shock syndrome(VSS) after an off-pump coronary artery bypass graft (OPCABG) is an extremely rare condition. Inotropic support is usually the first-line therapy though it can precipitate several complications or be ineffective. We report the first case of severe refractory VSS after OPCABG successfully treated with hydroxycobalamin. Methods: A 77-year-old gentleman underwent OPCABG for three vessels coronary artery disease. Preoperative LV ejection fraction was 28%, and the patient before surgery started sacubi-tril/valsartan titrated, then, to the highest dose. Surgery was uneventful and, by the end of the procedure, TEE showed improved biventricular contractility. Results: The patient was transferred to the ICU without inotropic support but he developed soon hypotension. TEE ruled out pericardial tamponade and confirmed fair contractility. Norepineph-rine was titrated to a medium-high dose, vasopressin was started and a Swan-Ganz catheter was placed. SVR was 480 dyn·s·cm−5. Despite aggressive pharmacologic treatment (including Methylprednisolone and Methylene blue), no improvements were noticed. 10 g of hydroxycobalamin were administered. One hour later hemodynamic status re-assessment showed SVR > 800 dyn·s·cm−5. Afterward, vasopressors were gradually reduced. Conclusions: Our case demonstrated the importance of adequate early treatment in VSS after OPCABG. For the first time, hydroxycobalamin was effectively used to restore homeostasis.

Fusion device and its structure may be designed by various means. Two of most popular are; weight basis (described in previous study by author) and energy basis. In present research, later method is explored and described. Energy basis is based on amount of energy released from device upon detonation followed by explosion. Its beneficial in a sense that device size can be kept as independent variable as compared to dependent in former case. Further, it shortens the design procedure. For example, heat transfer pattern in such approach directly helps in quantifying wall thickness which dictates material, fabrication, and manufacturing route. It may also eliminate anisotropy as wall thickness is direct function of amount of heat at which it will rupture and can be much thinner. Device geometry can also be flexibility controlled as it is no longer dependent on pay load bay capacity. This allows more freedom in designing subsystems (compartments, their locations, focusing, switches, and mixers). Such devices can be more compact and simpler. Few such design configurations are proposed.

Based on PVDF (piezoelectric sensing techniques), this paper attempts to study the propagation law of shock waves in brittle materials during the process of three-wavelength laser irradiation of polysilicon, and discusses the formation mechanism of thermal shock failure. The experimental results show that the vapor pressure effect and the plasma pressure effect in the process of pulsed laser irradiation lead to the splashing of high temperature and high density melt. With the decrease of the laser wavelength, the laser breakdown threshold decreases and the shock wave is weakened. Because of pressure effect of the laser shock, the brittle fracture zone is at the edge of the irradiated area. The surface tension gradient and surface shear wave caused by the surface wave are the result of coherent coupling between optical and thermodynamics. The average propagation velocity of laser shock wave in polysilicon is 8.47×103m/s, and the experiment has reached the conclusion that the laser shock wave pressure peak exponentially distributes attenuation in the polysilicon.

Relativistic shocks are one of the most plausible sites of the emission of strongly variable, polarized multi-wavelength emission from relativistic jet sources such as blazars, via diffusive shock acceleration (DSA) of relativistic particles. This paper summarizes recent results on a self-consistent coupling of diffusive shock acceleration and radiation transfer in blazar jets. We demonstrate that the observed spectral energy distributions (SEDs) of blazars strongly constrain the nature of hydromagnetic turbulence responsible for pitch-angle scattering by requiring a strongly energy-dependent pitch-angle mean free path. The prominent soft X-ray excess (``Big Blue Bump'') in the SED of the BL Lac object AO 0235+164 can be modelled as the signature of bulk Compton scattering of external radiation fields by the thermal electron population, which places additional constraints on the level of hydromagnetic turbulence. It has further been demonstrated that internal shocks propagating in a jet pervaded by a helical magnetic field naturally produce polarization-angle swings by 180$^o$, in tandem with multi-wavelength flaring activity, without requiring any helical motion paths or other asymmetric jet structures. The specific application of this model to 3C279 presents the first consistent, simultaneous modeling of snap-shot SEDs, multi-wavelength light curves and time-dependent polarization signatures of a blazar during a polarization-angle (PA) rotation. This model has recently been generalized to a lepto-hadronic model, in which the high-energy emission is dominated by proton synchrotron radiation. It is shown that in this case, the high-energy (X-ray and $\gamma$-ray) polarization signatures are expected to be significantly more stable (not showing PA rotations) than the low-energy (electron-synchrotron) signatures.

A dysregulated immune response is associated with the excessive release of cytokines that can lead to systemic vasoplegia and vasoplegic shock with the development of multiorgan failure that is associated with an increased risk of dying. Under physiological circumstances, the endothelium and the glycocalyx are responsible for maintaining vascular tone, capillary permeability, hemostasis, and controlling inflammation. In hyperinflammation, the endothelium and glycocalyx become damaged due to the excessive production of certain toxic proteins, along with an overwhelming release of cytokines. It has been shown in both in vitro animal experiments and also in humans that extracorporeal hemoadsorption can reduce circulating levels of cytokines and may also remove toxic proteins that directly take part in endothelium and glycocalyx damage. The current review aims to summarize current knowledge and to put recent findings into context, and introduce the hypothesis of “endothelial protection with hemoadsorption” in critically ill patients.

In this study, the asymmetric effect of oil and natural gas price shocks on the trade balance of 11 CESEE countries was estimated. These countries are net importers of oil and natural gas, and price shocks are often the cause of imbalances in trade. Quarterly data for the period 1994Q1 to 2023Q4 and nonlinear ARDL model were used. In the long run, a significant asymmetric effect due to the oil price shock on the trade balance of Bulgaria, Czechia, Latvia and Slovenia was found, as well as a significant asymmetric effect due to the natural gas price shock on the trade balance of Croatia. Also in the long run, a significant asymmetric effect due to wholesale prices on the trade balance of Romania, Bulgaria and Croatia was found as well as a significant asymmetric effect due to industrial production on the trade balance of Croatia, Czechia and Latvia was found, in addition to a significant asymmetric effect due to the exchange rate on the trade balance of Czechia, Poland and Romania.

This review discusses the pivotal role of microcirculation in maintaining tissue oxygenation and waste removal and highlights its significance in various pathological conditions. It delves into the cellular mechanisms underlying hemodynamic coherence elucidating the roles of endothelium, glycocalyx, and erythrocytes in sustaining microcirculatory integrity. Furthermore, the review gives comprehensive information about microcirculatory changes observed in cardiac surgery, sepsis, shock and COVID-19 disease. Through comprehensive exploration, the review underscores the intricate relationship between microcirculation, disease states, and clinical outcomes, emphasizing the importance of understanding and monitoring microvascular dynamics in critical care settings.

Background: The predictive value of changes in C-reactive protein (CRP), procalcitonin and leukocyte levels, which are commonly used in the diagnosis of infection in sepsis and septic shock, remains a topic of debate. This study aims to evaluate the effectiveness of changes in CRP, procalcitonin, and leukocyte counts on the prognosis of patients admitted to the intensive care unit (ICU) with a diagnosis of pneumosepsis and pneumonia-related septic shock, and to investigate whether any of these markers have a superior predictive value over the others in forecasting prognosis. Methods: The study analyzed the demographic data, Charlson Comorbidity Index score (CCIS), CURB-65 score (confusion, uremia, respiratory rate, BP, age ≥ 65 years), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores of 230 patients admitted to the ICU with a diagnosis of pneumosepsis and pneumonia-related septic shock between April 1, 2022, and December 31, 2023. The levels of CRP, procalcitonin, and leukocytes were also recorded and analyzed to assess their impact on 1-month and 3-month mortality outcomes. Results: According to multivariate logistic regression analysis, low BMI, male gender, high CCIS, CURB-65, and APACHE-II scores were found to be significantly associated with both 1-month and 3-month mortality (p<0.05). An elevated SOFA score was associated with 1-month mortality, while advanced age was related to 3-month mortality (p<0.05). Although there was no significant relationship between the first-day levels of leukocytes, CRP, and PCT and mortality, their levels on the third day were observed to be at their highest in both 1-month and 3-month mortality cases (p<0.05). Additionally, a concurrent increase in any two or all three of CRP, PCT, and leukocyte values was found to be higher in patients with 3-month mortality compared to those who survived (p=0.004). Discussion: Although PCT, CRP, and leukocyte values measured at the time of admission were not significantly associated with 1-month mortality in patients with pneumosepsis or pneumonia-related septic shock, the persistent elevation and concurrent increase of these values, along with male gender, advanced age, low BMI, and high CCIS, CURB-65, and APACHE-II scores, were found to be significantly associated with 3-month mortality.

The Characteristics of the cardiac muscle cell are described as a rod-shaped structure, single nu-cleus, and intercalated discs which make the heart’s action practical for enhancing contraction ef-ficiency. Mitochondria within these cells are vital for ATP synthesis, redox balance, calcium ho-meostasis, and lipid synthesis. The crucial role of Hsp60 is in protein folding and immune re-sponses; Hsp60 is a mitochondrial chaperonin, and its expression rises when the heart is under a stress condition like myocardial infarction and heart failure. This review has tried to deeply un-derstand the structural resemblance between cardiac and skeletal muscle cells, the amplitude number of mitochondria, its roles in cardiomyocytes, and the polyhedral functions of Hsp60. In this review, by investigating various articles, we brighten up Hsp60's distribution within cells, its association with apoptosis, and its action as a Damage Associated Molecular Pattern (DAMP), interacting with Toll-like receptors to modulate immune responses. Cardiac remodeling and failure are linked to cardiac-specific micro-RNAs whose expression may be affected by dysregu-lation of Hsp60. In conclusion, targeting mitochondrial function and Hsp60 expression may be of therapeutic potential for heart diseases.

Background: Restorative materials might significantly affect load transmission at peri-implant bone. The aim of the present study is to evaluate the shock absorption capacity of two different polymeric materials to be used as frameworks for implant-supported prostheses. Methods: A masticatory robot was used to compare the shock absorption capacity of polyether-ketoneketone (PEKK) Pekkton®ivory (Cendres+Mètaux) and glass fiber-reinforced composite (GFRC) TRINIATM (Bicon). Five identical sample crowns for each of the materials was tested un-der the same conditions described in previously published papers (Menini et al. 2013). Forces transmitted at the simulated periimplant bone were recorded and statistically analysed. Results: The statistical analysis of forces transmitted at the simulated dental implant revealed significant differences between all the materials tested and significant differences with the mate-rials tested in a previously published paper (Menini et al. 2013: zirconia, glass ceramic, composite resin, acrylic resin). Only differences between PEKK and veneered PEKK and between PEKK and one of the previously tested composite resins were not statistically significant. PEKK samples demonstrated significantly greater shock absorption capacity compared to GFRC. Conclusions: PEKK revealed optimal shock absorption capacity. Further studies are needed to evaluate its efficacy in case of long span prostheses with reduced prosthetic volume.

Sepsis is a life-threatening condition with high hospital mortality. Elevated mortality has also been observed in patients after hospital discharge due to post-sepsis syndrome (PSS). The etiology of PSS is still not entirely known, but it involves inflammation. Plasma extracellular vesicles (EVs) are recognized as a unique mechanism of intercellular communication in inflammatory processes. It has been reported that EV microRNA (miRNA) production during the acute sepsis phase may persist until after disease resolution and is associated with PSS. We employed mass spectrometry and qPCR analysis to determine the protein and miRNA composition of plasma-derived EVs of 36 patients during sepsis-related hospitalization, immediately after ICU discharge (post-sepsis), and three, six, twelve, and up to 36 months post-sepsis. We determined that patients’ immune system cells were the primary EV source. Fifteen differentially expressed EV miRNAs (DEmiRs) were identified in samples from septic patients compared to the control group. Predictive analyses revealed that these DEmiRs could influence inflammation by modulating pathways mediated by NF-κB, STAT3, and TLR4 signaling activation. Thirteen miRNAs (-15b-5p,-16-5p,-20a-5p,-25-3p,-27a-3p,-29a-3p,-30d-5p,-93-5p,-146a-5p,-148a-3p,-191-5p,-195-5p,-223-3p) were downregulated in the death group compared to the survivor group, making them candidate prognostic markers of ICU survival. One year after ICU discharge, the expression of miR-21-5p and miR-195-5p were decreased in the survivor group. The miRNAs identified in the present study represent potential biomarkers for the survival prognosis of post-sepsis patients.

Recycling and waste management have garnered immense popularity in recent years, but few studies have been carried out regarding these systems. Therefore, an in-depth literature review was done in order to highlight the different sectors of the recycling system that need to be reformed. Hence this study examined recycling and waste management systems within three categories–medical, municipal, and plastic–that were carried out pre and post COVID by reviewing previous studies, technical reports, and annual reports. This was done by visiting numerous academic search engines alongside online resources that were utilized to assemble literature related to waste and recycling systems. Continuing a recurring idea was that no matter the type of waste, further research regarding all waste should be carried out. Additionally, since recycling and waste management are a vital part of our society, and seeing how unpredictable events such as the pandemic may be, it is paramount that that research is done not only on how the pandemic has affected systems now, but also how we can learn from current issues to utilize them for future “waste shocks”.

The temperature-assisted laser shock process has shown promising prospects in the fields of forming manufacturing and surface strengthening. However, large-scale application of this process is limited by the instability and failure of confinement medium at high temperatures (≥300 ℃). Aiming at this problem, we propose a novel laser shock strategy based on Leidenfrost effect, where the suspended droplets are utilized as the confinement medium. According to the sequence of images acquired by time delay system and high-speed camera, the droplet dynamics behavior is studied. The focusing enhancement effect of the droplet is comprehensively explored. And the correlations between droplet size, ambient temperature, vapor layer thickness and focusing effect are investigated. Combining the dynamics and focusing enhancement effect of droplets, a theoretical model of laser shock pressure under droplet confinement is established. Finally, the effectiveness and feasibility of the droplet-based laser shock strategy in high temperature processing environments are verified by typical applications in laser shock forming and laser shock peening fields. The results show that the droplet-based laser shock process presents better forming effect. And the mechanical property tests demonstrate that this process can obtain the simultaneous improvement of the strength (~51%) and ductility (~6.4%) of annealed Cu. The multiscale plasticity mechanisms of the strengthened material are comprehensively investigated. We believe that this low-energy, low-cost and high-quality process can provide a new solution for the industrial application of laser shock at high temperatures.

Several preclinical and clinical reports have demonstrated that levels of circulating high mobility group box 1 protein (HMGB1) are increased early after trauma and are associated with systemic inflammation and clinical outcomes. However, the mechanisms of the interaction between HMGB1 and inflammatory mediators that lead to the development of remote organ damage after trauma remain obscure. HMGB1 and inflammatory mediators were analyzed in plasma from 54 combat casualties, collected on admission to a military hospital in Iraq, and at 8 and 24 hours after admission. Forty-five (83%) of these patients had traumatic brain injury (TBI). Nine healthy volunteers were enrolled as controls. HMGB1 plasma levels were significantly increased in the first 8 hours after admission, and were found to be associated with systemic inflammatory responses, injury severity score, and presence of TBI. These data provided the rationale for designing experiments in rats subjected to blast injury and hemorrhage, to explore the effect of HMGB1 inhibition by CX-01. Animals were cannulated, then recovered for 5-7 days before blast injury in a shock tube and volume-controlled hemorrhage. Blast injury and hemorrhage induced an early increase in HMGB1 plasma levels that coincided with severity of tissue damage and mortality. CX-01 inhibited systemic HMGB1 release, decreased local and systemic inflammatory responses, significantly reduced tissue and organ damage, and tended to increase survival. These data suggest that CX-01 has potential as an adjuvant treatment for traumatic hemorrhage.

Objectives: To investigate the value of early lactate dynamic monitoring index in predicting prognosis of patients with sepsis and septic shock. Methods: We performed our test on 50 patients. Out of 50 patients, 28 are male, and 22 are female. Prospectively studied pediatric patients with septic shock were performed. Vital signs, Lactate clearance, were obtained at presentation 6 h, 12 h, 24 h over the first 48 h of hospitalization. The therapy received, outcome parameters of mortality and duration of hospitalization were recorded. Results: The statistical data and comparative analysis showed that an average of 16.88 days after admission, 5 patients have died, 17 patients are poorly prognosis leaves the hospital, and the remaining 28 are recovered and discharged. The primary outcome variable of mean 16 days hospitalization mortality rate was 10%. Poor prognosis 34% and fully recovery 56 % were observed. In this retrospective cohort study, a lactate level of more than 2.5mmol/L was the best threshold to predict 28-day mortality among severe sepsis and septic shock patients. In our research, we found mean LC 6 h 3.08mmol/L, and after 48 h mean it is 1.79mmol/L. Significant LC 6 h found, which is 8.08mmol/L in the death group patient where 48 h mmol/L shows significant high. Poor prognosis also presents a clinical increase of lactate level high in the LC 6 h analysis, which is 3.32mmol/L. Recovered patients showed a significant improvement after administering treatment depending on the patient organ involvement and good decrease of lactate reports achieved, which is 1.20mmol/L, where admission reports show it was 1.91mmol/L in LC 6 h. Mean Heart rate 94/51mmhg, pulse 119, temperature 39℃, respiratory rate 32.26, and urine output 456 ml recorded during our study. Death patient shows a remarkable detonation of those reports but has a significant clinical report with the recovered patients. Conclusion: The early lactate dynamic monitoring index has a high value in predicting sepsis and septic shock patients' prognosis, thus worth popularizing.

The inhibition of heat shock protein 90 (Hsp90) a molecular chaperone for multiple oncogenic client proteins is considered as a promising approach to overcome radioresistance. Since most Hsp90 inhibitors activate HSF-1 that induces the transcription of cytoprotective and tumor-promoting stress proteins such as Hsp70 and Hsp27, a combined approach consisting of HSF-1 knockdown (k.d.) and Hsp90 inhibition was investigated. A specific HSF-1 k.d. was achieved in H1339 lung cancer cells using RNAi-Ready pSIRENRetroQ vectors with puromycin resistance. The Hsp90 inhibitor NVP-AUY922 was evaluated at low concentrations - ranging from 1-10nM - in control and HSF-1 k.d. cells. Protein expression (i.e., Hsp27/Hsp70, HSF-1, pHSF-1) and transcriptional activity was assessed by Western blot analysis and luciferase assays and radiosensitivity was measured by proliferation, apoptosis (Annexin V, active caspase 3), clonogenic cell survival, alkaline comet, γH2AX, 53BP1 and Rad51 foci assays. The k.d. of HSF-1 resulted in a significant reduction of basal and NVP-AUY922-induced Hsp70/Hsp27 expression levels. A combined approach consisting of HSF-1 k.d. and low concentrations of the Hsp90 inhibitor NVP-AUY922 potentiates radiosensitization which involves an impaired homologous recombination mediated by Rad51. Our findings are key for clinical applications of Hsp90 inhibitors with respect to adverse hepatotoxic effects.

Background: The goal of this study was to evaluate the effect of Extracorporeal Membrane Oxygenator (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over age of 18 on mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO, and cardiogenic shock for available years 2016-2020 were utilized. A total of 796,585 (age 66.5±14.4) patients had a diagnosis of cardiogenic shock excluding Impella. 13,160 (age 53.7±15.4) were treated with ECMO without IABP. Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. Using multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6-1.9, p<0.001). Evaluating teaching hospitals only revealed similar findings. Major complications were also high in ECMO cohort. Conclusion: In patients with cardiogenic shock, the use of ECMO was associated with the high in hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital.

The pressure exerted on the heart and blood vessels because of blood flow is considered as an important parameter for the cardiovascular function. It determines sufficient blood perfusion as well as transportation of nutrition, oxygen and other essential factors to every organ. Pressure in the primary arteries located near the heart and the brain, known as central blood pressure (CBP), while in peripheral arteries, known as peripheral blood pressure (PBP). Normally, CBP and PBP are correlated; however, cardiovascular disorders interfere their regulation and affect the blood flow in vital organs and accessory organs, differently. Therefore, understanding each of them in normal and disease conditions is essential for managing various cardiovascular disorders and increasing their treatment outcomes. In this review, we have described the control systems (neural, hormonal, osmotic and cellular) of the blood pressure and its regulation in hypovolemic shock using centhaquine (Lyfaquin®) as a resuscitative agent.

The stress-inducible heat shock protein 70 (Hsp70), which functions as a molecular chaperone and is frequently overexpressed in different cancer cell types, is presented on the cell surface of tumor cells and is actively released into the circulation in free and extracellular lipid vesicle-associated forms. Since the exact pathomechanism of endometriosis has not yet been elucidated but has been associated with the development of endometrial and ovarian cancer, we asked whether extracellular Hsp70 and circulating endometriotic cells (CECs) reflects the presence and development of endometriosis. Therefore, circulating levels of free and lipid microvesicle-associated Hsp70 were measured using the Hsp70-exo ELISA, and the presence of circulating CECs in the peripheral blood of patients with endometriosis was determined using membrane Hsp70 (mHsp70) and EpCAM monoclonal antibody (mAb)-based bead isolation approaches. Isolated CECs were further characterized by immunofluorescence using reagents directed against cytokeratin (epithelial), CD45 (leukocyte), CD105/CD44 (mesenchymal-stemness) and by comparative RNA analysis. Similar to the situation in patients with cancer, levels of circulating Hsp70 were elevated in the blood of patients with histologically proven endometriosis compared to a healthy control cohort, with the highest Hsp70 level in a patient with lymph node endometriosis. Moreover, CECs could be isolated using the cmHsp70.1 mAb- and to a lesser extent EpCAM mAb-based bead approaches in all patients with endometriosis. The longevity in cell culture and the expression of cytokeratin, CD105 and CD44, together with differentially expressed genes related to EMT reveals similarities of mHsp70 expressing CECs with circulating tumor cells (CTCs) and suggest a mesenchymal-stemness origin. These findings may support the involvement of mHsp70 positive, stem cell-like cells in the development of endometriotic lesions. In summary, elevated levels of Hsp70 in the blood and CECs could serve as liquid biopsy markers for endometriosis and help to elucidate the underlying pathomechanism of the disease.

The present study investigates the impact of electrode surface roughness on the electrofreezing of water. This research focuses on how the electrode roughness induced by a laser treatment affects the nucleation and growth of ice crystals under controlled electric fields. To achieve this, a series of experiments were conducted using deionized water samples placed between electrodes with varying surface roughness. The electrodes, fabricated with the Al6061 T6 alloy were structured via the Laser Shock Processing (LSP) method. For this purpose, the pulsed densities during the LSP process were varied from 900 to 2500 pulses/cm2. The increase of the pulse density was correlated to the surface structuring and to the microstructural features and average roughness of the LSP-treated Al6061 alloy. A wavy-like microstructure was induced upon the LSP treatment with average roughnesses between ~ 3.5 and 6 µm at the selected pulse densities. The results indicate that electrode roughness significantly influences the electrofreezing process. Rougher electrodes were found to lower the nucleation temperature compared to smoother ones, suggesting enhanced ice nucleation activity. The findings are attributed to the increased electric field concentration at the asperities of the rough surfaces, which may facilitate the alignment of water molecules and the formation of critical ice nuclei.

Background: The clinical impact of vasopressin in hemorrhagic shock remains largely unknown. Objective: This systematic review and meta-analysis was designed to investigate the effects of vasopressin receptor agonists during the resuscitation of hemorrhagic shock. Methods: A systematic search of PubMed (MEDLINE), Scopus, and PubMed Central was conducted for relevant articles. Preclinical (animal) and clinical studies were included. The primary objective was to investigate the correlation of vasopressin receptor agonist use with mortality and various hemodynamic parameters. Results: Data extraction was possible in 13 animal studies and two clinical studies. Differences in risk of mortality between patients who received a vasopressin receptor agonist were not statistically significant when compared to those who were not treated with such agents [RR (95%CI): 1.17 (0.67, 2.08); p=0.562; I2 = 50%]. The available data were insufficient to conduct a meta-analysis assessing the effect of vasopressin receptor agonists on hemodynamics. Drawing safe conclusions from animal studies was challenging, due to significant heterogeneity in terms of species and dosage of vasopressin receptor agonists across studies. Conclusions: Differences in risk of mortality between patients who received a vasopressin receptor agonist were not statistically significant when compared to those who were not treated with such agents after hemorrhagic shock.

Mesoscale imperfections, such as pores and voids, can strongly modify the properties and the mechanical response of materials under extreme conditions. Tracking the material response and microstructure evolution during void collapse is crucial for understanding its performance. In particular, imperfections in ablator materials, such as voids, can limit the efficiency of the fusion reaction and ultimately hinder ignition. To characterize how voids influence the response of materials during dynamic loading and seed hydrodynamic instabilities, we have developed a tailored fabrication procedure for designer targets with voids at specific locations. Our procedure uses SU-8 as a proxy for ablators materials and hollow silica microspheres as proxy for voids and pores. By using photolithography to design the targets’ geometry, we demonstrate precise and highly reproducible placement of a single void within the sample, which is key for a detailed understanding of its behavior under shock compression. This fabrication technique will benefit high-repetition rate experiments at x-ray and laser facilities. Insight from shock compression experiments will provide benchmarks for the next generation of microphysics modelling.

The non-symmetrical collapse of an empty cylindrical cavity is modelled using Smoothed Particle Hydrodynamics. The presence of a nearby surface produces an anisotropic pressure field generating a high velocity jet that hits the surface. The collapse follows a different dynamic based to the initial distance between the centre of the cavity and the surface. When the distance is greater than the cavity radius (detached cavity) the surface is hit by travelling shock waves. When the distance is less than the cavity radius (attached cavity) the surface is directly hit by the jet and later by other shock waves generated in the last stages of the of the collapse. The results show that the surface is hit by a stronger shock when distance between the centre of the cavity and the surface is zero while showing more complex double peaks behaviour for other distances.

As symbionts of fungi and algae, lichens produce a variety of secondary products which pharmacological activities. This study aimed to investigate the anti-inflammatory activities of Heterodermia hypoleuca and its main compound, atraric acid. The results confirmed that atraric acid could regulating induced pro-inflammatory cytokine, nitric oxide, induced nitric oxide synthase and cyclooxygenase-2 expression by lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Means while, atraric acid down-regulated expression of phosphorylated IκB, ERK and nuclear factor kappa B (NFκB) signaling pathway to exhibit anti-inflammatory effects in LPS-stimulated RAW264.7 cells. Based on these results, the anti-inflammatory effect of atraric acid during LPS-induced endotoxin shock in a mouse model was confirmed. In the atraric acid treated-group, cytokine production was decreased in the peritoneum and serum, and each organ damaged by LPS-stimulation was recovered. These results show that atraric acid has an anti-inflammatory effect and its molecular mechanism may be involved in the inactivation of the ERK/NFκB signaling pathway, demonstrating its value as a potential therapeutic for inflammatory diseases.

The paper argues that universal approaches to infiltration and drainage in permeable media that pivot around capillarity and that led to dual porosity, non-equilibrium, or preferential flow need to be replaced by a dual process approach. One process has to account for relatively fast infiltration and drainage based on Newton's shear flow, while the other one is responsible for storage and relatively slow redistribution of soil water by focusing on capillarity. Already Schumacher (1864) postulated two separate processes. However, Buckingham's (1907) and Richards' (1931) apparent universal capillary-based approach to flow and storage of water in soils dominated. The paper introduces the basics of Newton's shear flow in permeable media. It presents experimental support for the four presumptions of (i) sharp wetting shock fronts; (ii) that move with constant velocities; (iii) atmospheric pressure prevails behind the wetting shock front; (iv) laminar flow. It further discusses the scale tolerance of the approach, its relationship to Darcy's (1856) law, and its extension to solute transport.

Sepsis is a devastating disease that carries an enormous toll in terms of human suffering and lives lost. Over 100 novel pharmacologic agents which targeted specific molecules or pathways have failed to improve the outcome of sepsis. Preliminary data suggests that the combination of Hydrocortisone, Ascorbic Acid and Thiamine (HAT therapy) may reduce organ failure and mortality in patients with sepsis and septic shock. HAT therapy is based on the concept that a combination of readily available, safe and cheap agents which target multiple components of the host’s response to an infectious agent will synergistically restore the dysregulated immune response and thereby prevent organ failure and death. This paper reviews the rationale for HAT therapy with a focus on vitamin C.

In this paper, modification of dual-Halbach permanent magnet (PM) array is investigated to improve performance of tubular linear machine, in terms of flux density and output power. Instead of a classical Halbach array with only radial and axial PMs, proposed model involves insertion of mig-magnets, which have magnetized angle shifted from the reference magnetized angles of axial and radial PMs. This structure leads to elimination of flux leakage and concentration of flux linkage in middle of the coil; therefore, the performance of machine is increased.

Background: Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. Recent studies support the possibility of providing Extracorporeal Shock Wave Treatment in patients suffering from osteoarthritis. Shock wave biostimulation may be able to modulate joint inflammation and stimulate chondorocytes in a reparative sense. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. Methods: A prospective clinical study was designed, in which seventy-two patients suffering from rhizoarthrosis were randomized to treatment with shock waves or exercises; in both groups an immobilization brace of the first finger was used. At recruitment and at 1, 3 and 6 months, patients received assessments of pain (VAS), functionality (FIHOA), disability (DASH); furthermore, the perception of improvement was monitored during follow-ups (Roles and Maudsley Score). Results: In both groups there was a significant improvement in all scores in the comparison between recruitment and 6 months; this improvement was confirmed for VAS, FIHOA and DASH in the comparison between individual time points in both groups, except for the comparison between 3 and 6 months for all scales in the exercise group and for FIHOA in both groups. The perception of improvement was statistically better in the shock wave group than in the exercise group at 1, 3 and 6 months. The regression analysis showed that the reduction of VAS and DASH are statistically influenced by shock wave treatment (p<0.001). Conclusions: Both shock waves and exercises, together with the use of the brace, are effective in managing pain, functionality and disability in patients suffering from arthritis of the first finger. The shock wave treatment ensured further improvement at 6 months

Background/Objectives: The 28-day mortality rate for septic shock is high, necessitating rapid and effective empiric antimicrobial therapy. This study investigates whether the rate of catecholamine dose reduction in septic shock can indicate bacterial susceptibility to initial antimicrobial therapy. Methods: This retrospective observational study involved 108 adult patients with bacteraemia and septic shock admitted at the intensive care unit of Nihon University Itabashi Hospital between January 2017 and December 2023. They were classified into the Susceptible or Resistant group based on the bacteria’s susceptibility to the initial empiric antimicrobial therapy. Catecholamine dosages were converted to norepinephrine equivalent (NEE) scores, with the time course from peak to end of administration measured at NEE reductions. Results: Of the 108 patients, 94 were in the Susceptible group and 14 in the Resistant group. The Susceptible group showed faster reductions in catecholamine doses: time to reduce the dose from the maximum NEE to 25% was 19 vs. 49.5 hours (p = 0.0057); and 0%, 29 vs. 54 hours (p = 0.0475). Conclusions: In septic shock with bacteraemia, faster catecholamine dose reduction indicates bacterial susceptibility to initial empiric antibiotics. This reduction rate can serve as an early clinical indicator of appropriate initial empiric therapy.

[Introduction]: In the contemporary international financial environment, marked by intricate complexities and increasing uncertainties, the impact of exchange rate fluctuations on national economies has become increasingly significant. In this context, this study uses the Chinese economy as a case study to delve deeply into the interaction effects between macroprudential and monetary policies, analyzing how these policies jointly address economic instability. The aim is to offer new perspectives and strategies for stabilizing the global economic and financial landscape. [Methods]: This paper constructs an open-economy Dynamic Stochastic General Equilibrium (DSGE) model specifically tailored for China, incorporating Bayesian estimation and numerical simulation techniques. The study meticulously examines how macroprudential and monetary policies can be coordinated to achieve economic stability in response to exchange rate shocks. [Results]: The research finds that (1) targeted coordination of macroprudential and monetary policies towards asset prices and price levels can maintain stability under exchange rate shocks; (2) the effective implementation of such coordinated policies not only mitigates the fluctuations in asset prices due to exchange rate shocks but also enhances the level of societal welfare; (3) in terms of choosing an exchange rate regime, a managed floating rate system can prevent policy overlaps and conflicts that might occur in a floating rate system during the coordination of macroprudential and monetary policies, thus offering comparative advantages. [Discussion]: The findings underscore the importance of policy integration in a dynamic and complex global economic environment. They provide policy recommendations for China and other emerging market countries on how to effectively maintain economic stability through the synergistic interplay of macroprudential and monetary policies amid fluctuations in exchange rates and asset prices.

Considering tumors from an evolucionary perspective, successive tumor cells undergo turnover in response to stressful conditions which pressures tumor cells to adapt to a new environment. Tumor cells uses parts of themselves to communicate and share biological information, known as extracellular vesicles (EV) secretion to promote their survival and “survive to each and every metabolic cost”. Tumor microenvironment (TME) is a miscellaneous of cells, factors, extracellular matrix proteins and EVs. EVs include smalls (<160nm, exosomes) and larger (100-1,000nm, microvesicles) lipid bilayer enclosed packages of biomolecules that are shed by tumors to TME. Tumor-derived extracellular vesicles transfer adaptative stress signaling to recipient cells, reprograming these cells. Heat Shock Proteins (HSP) are more prominent stress response regulators found in exosomes. HSP-loaded exosomes actively reprogram tumor and TME cells to acquire mechanisms that contribute to tumor progression and therapy resistance. The intercellular communication mediated by HSP-loaded EVs favors the escape of tumor cells from, endoplasmic reticulum (ER) stress, hypoxia, apoptosis and anti-cancer therapies. Extracellular HSPs activate and deactivate immune response, induce cell differentiation, changes vascular homeostasis, and help to augment the pre-metastatic niche formation. Here we will explore the EV mechanism of HSP transmission among TME cells and the relevance of these intercellular communications for resistance to therapies in cancer.

The spectra of the plasma emitted from the studied samples consist of several dozens of narrow bands superimposed on each other. Tables of spectral lines were used to interpret the spectra. It turned out that the largest number of bands corresponds to the radiation of positively charged ions and atoms of elements that make up the crystal lattices of minerals that make up the studied rocks. Thus, the spectra of the plasma emitted from quartz corresponded to the radiation of atoms and positively charged silicon ions, the charge of which varied from 1 to 4, as well as atoms and positively charged oxygen ions, the charge of which varied from 1 to 3. Positively charged ions and atoms of Si, O, K, Ca, Al and Na, which are part of the crystal lattices of quartz and feldspar, flew out of granites. Positively charged ions and Ca, C and O atoms flew out of the calcite.

HspA1A, a molecular chaperone, translocates to the plasma membrane (PM) of stressed and cancer cells. This translocation results in HspA1A’s cell-surface presentation, which renders tumors radiation insensitive. To specifically inhibit the lipid-driven HspA1A’s PM translocation and devise new therapeutics it is imperative to characterize the unknown HspA1A’s lipid-binding regions and determine the relationship between the chaperone and lipid-binding functions. To elucidate this relationship, we determined the effect of phosphatidylserine (PS)-binding on the secondary structure and chaperone functions of HspA1A. Circular dichroism revealed that binding to PS resulted in minimal modification on HspA1A’s secondary structure. Measuring the release of inorganic phosphate revealed that PS-binding had no effect on HspA1A’s ATPase activity. In contrast, PS-binding showed subtle but consistent increases in HspA1A’s refolding activities. Furthermore, using a Lysine-71-Arginine mutation (K71A; a null-ATPase mutant) of HspA1A we show that although K71A binds to PS with affinities similar to the WT, the kinetics of the binding are significantly different, probably because of the mutant’s inability to achieve specific conformations. These observations suggest a two-step binding model that includes conformational changes and strongly support the notion that the chaperone and lipid-binding activities of HspA1A are dependent but the regions mediating these functions do not overlap. These findings provide the basis for future interventions to inhibit HspA1A’s PM-translocation in tumor cells, making them sensitive to radiation therapy.

In the end of April nearly 100 cases of children aged between 6 month and 9 years with Kawasaki like disease were reported (mostly in Europe) probably linked to COVID-19. With the increasing awareness of this condition the number of cases reported is increasing worldwide. We aim to sum up the known data about this new entity based on published data (in a case report, a series of 8 cases and in newspapers and society statement) and using our knowledge of classical Kawasaki disease. It seems to be a post infectious disease with an onset between 2-4 weeks after the infection, probably in genetically predisposed children aged between 6 month to 17 years. A very rough estimation of incidence based on current data from Bergamo, Italy, and New York State and a lot assumption is between 0.016% (95% CI:0.013-0.02%) - 0.31% (95% CI: 0.2-0.47%) of infected children. Clinical signs overlaps with Kawasaki disease in some children, but another feature is prominent gastrointestinal manifestations. For the 9 detailed patients most had incomplete presentation for Kawasaki disease (with a mean 1.7 (+/-1.2) criteria per patient for the 5 non fever criterion) and only one had a classical form. In some cases, presentation is closer to toxic shock syndrome or isolated myocarditis. Persistent fever seems to be constant and biological exploration are consistent with inflammation (elevated CRP, ferritin and D-Dimers). Management is described as supportive and children seem to improve rapidly, but can require cardiac or respiratory support. In date of 11 may 2020 there is 4 deaths confirmed linked to these new entities (1 in UK and 3 in New York). Paediatricians and general practitioners need to be aware of these possible evolution following COVID-19 infection. However it seems to be rare and children are probably still spared from most morbidities and mortality linked to COVID-19 infection .There are need of published detailed cohorts to better delineate these entities.

Heat shock protein 27 (HSP27), induced by heat shock, environmental, and pathophysiological stressors, is a multi-dimensional protein that acts as a protein chaperone and an antioxidant. HSP27 plays a major role in the inhibition of apoptosis and actin cytoskeletal remodeling. HSP27 is upregulated in many cancers and is associated with poor prognosis, as well as treatment resistance whereby cells are protected from therapeutic agents that normally induce apoptosis. This review highlights the most recent findings and role of HSP27 in cancer, as well as strategies for using HSP27 inhibitors for therapeutic purposes.

The objective of this study was to evaluate the effect of in ovo injection of L-arginine (L-Arg) into Ross broiler eggs at different embryonic developmental stages on their survival, hatchability, and body weight (BW). Additionally, we have analyzed the levels of serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT), protein expression of heat shock proteins (HSPs), also we have the determined micronuclei (MN) and nuclear abnormality (NA). Results showed that survival and hatching rates as well as body weight were increased on the 14th day incubation compared to 8th and 18th day incubation at lower concentration of L-Arg. Moreover, the levels of SGOT and SGPT were also significantly (P < 0.05) increased at 14th day incubation at the same concentration (100μg/μl/egg) of injection. In addition, IgM levels were increased on the 14th day incubation compared to other days. The protein expressions of HSP-47, HSP-60, and HSP-70 in the liver were significantly down-regulated whereas the expression of myogenin and MyoD were significantly up-regulated on the 14th day after incubation in treated with all different doses such as 100μg, 1000μg and 2500μg/μl/egg namely 3T1, 3T2 and 3T3 respectively. However, the treatment with low dose of L-Arg down-regulated expression levels of those proteins on the 14th day incubation. Histopathology of liver by hematoxylin and eosin (H&E) straining showed that the majority of liver damage, specifically intracytoplasmic vacuoles, were observed in 3T1, 3T2, and 3T3. The minimum dose of 100 μg/ml/egg on the 14th day of incubation significantly prevented intracytoplasmic vacuole damages. These results demonstrate that in ovo administration of L-Arg at (100μg/μl/egg) may be an effective method to increase chick BW, hatch rate, increasing muscle growth related proteins and promote the immune response through increasing IgM on the 14th day of incubation period.

In this study, a parameter of volume stability was proposed for the first time to design polymorph zirconia ceramics used for special components. A series of heterogeneous polymorph zirconia ceramics with various amounts of monoclinic (M) phase were fabricated by two-step sintering. Samples with about 27%, 31%, and 51% M phase content were selected to study the properties. The thermal shock durability was found to be associated with thermal expansion behavior and noncritical micro cracks, which both based on M phase initial content. In good agreement with experimental results, the correlation of normalized K versus M phase initial content was established. It could provide a repeatable reference to prepare special zirconia components without loss of density.

Outer particles collision with certain dynamic object is not a pure impact wear behavior; it is typically accompanied by sliding wear phenomena. This study aimed investigating the impact-sliding wear performance of three different TC17 titanium alloys. One was untreated, and the other two were subjected to laser shock peening (LSP) by 5 and 7 J pulse energy, respectively. Wear test was performed on a novel impact-sliding wear testing rig, which can realize multiple impact-sliding motions by changing motion parameters in x and z directions. Present results showed that wear resistance of both treated samples improved compared with the untreated alloy. Given the increase in wear cycles, increment in wear rate of the untreated sample was constantly higher than those of treated samples. All results can be attributed to the increase in surface hardness of the material and residual compressive stress, which was also introduced after LSP.

The study proposes laser shock peening without a coating of high strength ultrafine bainitic steel to mitigating the fatigue failures for automotive and structural engineering applications. Laser pulse density of 2500 pulses/cm2 (75% overlapping) was optimised based on the induced residual stresses for employing the wide range of characterisations. The roughness and topographic results showed that surface roughening was controlled by tuning the laser pulse density. The High-Resolution X-ray Diffraction analysis confirmed the lattice misorientation resulting peak shift and the trend towards martensite phase transformations. The electron microscopic micro/nanostructure analyses revealed the grain refinement features such as nano-twins, micro shear bands and shear cells. The work hardening depth and nanomechanical properties were significantly enhanced. A fully reversed (R= -1) high-cycle fatigue tests extended the lifespan by an average of fifteen times than the untreated. Also, it has potential to repair the structural components effectively.

In this paper, the current technologies of the regenerative shock absorber systems have been categorized and evaluated. Three drive modes of the regenerative shock absorber systems, namely the direct drive mode, the indirect drive mode and hybrid drive mode are reviewed for their readiness to be implemented. The damping performances of the three different modes are listed and compared. Electrical circuit and control algorithms have also been evaluated to maximize the power output and to deliver the premium ride comfort and handling performance. Different types of parameterized road excitations have been applied to vehicle suspension systems to investigate the performance of the regenerative shock absorbers including that of the nonlinear regenerative shock absorber. The research gaps for comparison of the different drive modes and the nonlinearity analysis of the regenerative shock absorbers are identified and, the corresponding research questions have been proposed for future work.

Despite medical advances, sepsis and septic shock remain one of the leading causes of mortality worldwide, with a high inter-individual variability in prognosis, clinical manifestations and response to treatment. Given the heterogeneity of sepsis and recent technological progress amongst machine learning analysis technique, a new, personalized approach in sepsis is being intensively studied. Despite the difficulties when tailoring a targeted approach, with the use of artificial intelligence-based pattern recognition, more and more publications are becoming available, highlighting novel factors that may intervene in the high heterogenicity of sepsis. This has led to the devise of a phenotypical approach in sepsis, further dividing patients based on host and trigger-related factors, clinical manifestations and progression towards organ deficiencies, dynamic prognosis algorithms and patient trajectory in the Intensive Care Unit (ICU). Host and trigger-related factors refer to patients’ comorbidities, body-mass index, age, temperature, immune response, type of bacteria and infection site. The progression to organ deficiencies refers to individual particularities of sepsis-related multiorgan failure. Finally, the patient’s trajectory in the ICU points out the need of a better understanding of interindividual response to various supportive therapies. This review aims to identify the main sources of variability in clustering septic patients in various clinical phenotypes, as a useful clinical tool for precision-based approach in sepsis and septic shock.

Applying cold to a bone injury can aid healing, though its mechanisms are complex. This study investigates how cold therapy impacts bone repair to optimize healing. Cold was applied to a rodent bone model, with physiological responses analyzed. Vasoconstriction was mediated by an increase in TRP channels, TRPA1 (p=0.012) and TRPM8 (p&lt;0.001), within cortical defects enhancing sensory response and blood flow regulation. Cold exposure also elevated hypoxia (p &lt; 0.01) and VEGF expression (p &lt; 0.001), promoting angiogenesis vital for bone regeneration. Increased expression of osteogenic proteins PGC-1α (p = 0.039) and RBM3 (p&lt;0.008) suggests stimulated reparative processes. Enhanced osteoblast differentiation and ALP presence at days 5 (three-fold, p=0.014) and 10 (two-fold, p=0.010) were observed, along with increased osteocalcin (OCN) at day 10 (two-fold, p = 0.010) indicating presence of mature osteoblasts capable of mineralization. These findings highlight cold therapy's multifaceted effects on bone repair, offering insights for therapeutic strategies.

Background: Uncontrolled hemorrhage is a major preventable cause of death in patients with trauma. However, the majority of large animal models of hemorrhage have utilized controlled hemorrhage rather than uncontrolled hemorrhage to investigate the impact of immunopathy and coagulopathy on multi-organ failure (MOF) and mortality. This study evaluates these alterations in a severe porcine-controlled and uncontrolled hemorrhagic shock (HS) model. Methods: Anesthetized female swine underwent controlled hemorrhage (22 ml/kg) and uncontrolled hemorrhage by partial splenic resection followed with or without lactated Ringer solution (LR) or Voluven® resuscitation. Blood chemistry, physiologic variables, systemic and tissue levels of complement proteins and cytokines, coagulation parameters, organ function, and damage were recorded and assessed. Results: HS resulted in systemic and local complement activation, cytokine release, metabolic acidosis, hyperkalemia, MOF, and no animal survival. Resuscitation with LR and Voluven® after HS improved hemodynamic parameters (MAP and SI), metabolic acidosis, hyperkalemia, and survival but resulted in increased complement activation and worse coagulopathy. Compared with the LR group, the HS animal treated with Voluven® had worse dilutional anemia, coagulopathy, renal and hepatic dysfunction, increased myocardial complement activation and renal damage, and decreased survival rate. Conclusions: Hemorrhagic shock triggers early immunopathy and coagulopathy that appear associated with MOF and death. This study indicates that immunopathy and coagulopathy are therapeutic targets that may be addressed with a high-impact adjunctive treatment to conventional resuscitation.

Heat shock factor 1 (HSF1) is a transcription factor crucial for regulating heat shock response (HSR), one of the significant cellular protective mechanisms. When cells are exposed to proteotoxic stress, HSF1 induces the expression of heat shock proteins (HSPs) to act as chaperones, correcting the protein-folding process and maintaining proteostasis. In addition to its role in HSR, HSF1 is overexpressed in multiple cancer cells, where its activation promotes malignancy and leads to poor prognosis. The mechanisms of HSF1-induced tumorigenesis are complex and involve diverse signaling pathways, dependent on cancer type. With its important roles in tumorigenesis and tumor progression, targeting HSF1 offers a novel cancer treatment strategy. In this article, we examine the basic function of HSF1 and its regulatory mechanisms, focus on the mechanisms involved in HSF1’s roles in different cancer types, and examine current HSF1 inhibitors as novel therapeutics to treat cancers.

The purpose of the study is to analyze the trade performance of Bangladesh during the COVID-19 pandemic. The study identifies the effects of private consumption demand shock and trade disruptions due to higher trade costs caused by the pandemic on the export and import of Bangladesh in different sectors and compares the analysis results with actual data. Based on the previous literature, this study assumes the shocks in different levels such as low, medium, and high level and identifies their effects on the trade in Bangladesh. The study applies the CGE model using GTAP to measure the effects of the shocks on trade and output and compares the actual trade with the CGE simulated results. The results of the study suggest that both demand shock and trade disruptions substantially affect the export, import, and domestic output of Bangladesh during the Covid-19 pandemic. It is also evident that the higher the level of shock, the higher the impact on trade and output. The actual export and import data cross-validate the CGE analysis results and provide mixed findings on the trade performance of various sectors of Bangladesh during the pandemic.

Objective: To evaluate the effect of care bundles on treatment compliance and intestinal barrier function in patients with refractory septic shock in the intensive care units (ICUs). Methods: In this retrospective study, the clinical data of 94 patients with refractory septic shock admitted to our hospital between June 2020 and April 2022 were collected. Patients with routine nursing were included in the routine group, and those with care bundles were assigned to the care bundles group, with 47 cases in each group. Outcome measures included nursing efficiency, treatment compliance, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE II) score, intestinal barrier function, inflammation factor level, treatment outcome and complications. Results: Care bundles resulted in significantly higher nursing efficiency and treatment compliance versus routine care (P<0.05). Patients receiving care bundles showed significantly higher SOFA scores and APACHE II scores than those receiving routine care (P<0.05). Intestinal fatty-acid binding protein (I-FABP), diamine oxidase (DAO), lactate, endotoxin, and intestinal dysfunction scores in the care bundles group were significantly lower than those in the conventional group after treatment (P<0.05). Care bundles were associated with significantly lower levels of procalcitonin (PCT) and hypersensitive C-reactive protein (hsCRP), shorter time to symptom relief, ICU treatment time, and duration of mechanical ventilation, and lower 28-d morbidity and mortality versus routine care (P<0.05). Patients in the care bundles group had a significantly lower incidence of complications than those in the routine group (P<0.05). Conclusion: Care bundles effectively enhance treatment compliance, improve intestinal barrier function and treatment outcomes, reduce the inflammatory response, and decrease the risk of SOFA score, APACHE II score, and complications in patients with refractory septic shock.

Objective: To evaluate the effect of care bundles on treatment compliance and intestinal barrier function in patients with refractory septic shock in the intensive care units (ICUs). Methods: In this retrospective study, the clinical data of 94 patients with refractory septic shock admitted to our hospital between June 2020 and April 2022 were collected. Patients with routine nursing were included in the routine group, and those with care bundles were assigned to the care bundles group, with 47 cases in each group. Outcome measures included nursing efficiency, treatment compliance, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE II) score, intestinal barrier function, inflammation factor level, treatment outcome and complications. Results: Care bundles resulted in significantly higher nursing efficiency and treatment compliance versus routine care (P<0.05). Patients receiving care bundles showed significantly higher SOFA scores and APACHE II scores than those receiving routine care (P<0.05). Intestinal fatty-acid binding protein (I-FABP), diamine oxidase (DAO), lactate, endotoxin, and intestinal dysfunction scores in the care bundles group were significantly lower than those in the conventional group after treatment (P<0.05). Care bundles were associated with significantly lower levels of procalcitonin (PCT) and hypersensitive C-reactive protein (hsCRP), shorter time to symptom relief, ICU treatment time, and duration of mechanical ventilation, and lower 28-d morbidity and mortality versus routine care (P<0.05). Patients in the care bundles group had a significantly lower incidence of complications than those in the routine group (P<0.05). Conclusion: Care bundles effectively enhance treatment compliance, improve intestinal barrier function and treatment outcomes, reduce the inflammatory response, and decrease the risk of SOFA score, APACHE II score, and complications in patients with refractory septic shock.

The evolution in the post shock nonequilibrium relaxation in a hypersonic plasma flow was investigated during a shock’s reflection off a thermal discontinuity. Within a transitional period, the relaxation zone parameters past both, the reflected and transmitted waves, evolve differently compared to that in the incident wave. In a numerical example for the non-dissociating N₂ gas heated to 5000 K/10,000 K across the interface and M = 3.5, the relaxation time for the transmitted wave is up to 50% shorter and the relaxation depth for both waves is significantly reduced, thus resulting in a weakened wave structure. The results of extension into larger values of heating strength and the shock Mach numbers are discussed. The findings can be useful in the areas of research involving strong shocks interacting with optical discharges or other heated media on the scale where the shock structure becomes important.

Injury to the central nervous system (CNS), in most vertebrate animals, results in permanent damage and lack of function, due to their limited regenerative capacities. In contrast, echinoderms can fully regenerate their radial nerve cord (RNC) following transection, with little or no scarring. Investigators have associated the regenerative capacity of some organisms with the stress response and inflammation produced by the injury. Here we explore the gene activation profile of the stressed holothurian CNS. To do this, we performed RNA sequencing on isolated RNC explants submitted to the stress of transection and enzyme dissection and compared them to explants kept in culture for 3 days following dissection. We describe stress-associated genes, including members of heat-shock families, ubiquitin-related pathways, transposons, and apoptosis that were differentially expressed. Surprisingly, the stress response does not induce apoptosis in this system. Other genes associated with stress in other animal models, such as hero proteins and those associated with the integrated stress response, were not found to be differentially expressed either. Our results provide a new viewpoint on the stress response in the nervous system of an organism with an amazing regenerative capacity. This is the first step to deciphering the molecular processes that allow echinoderms to undergo fully functional CNS regeneration while also providing a comparative view for students of the stress response in other organisms.

Worldwide, one of the main causes of death among young adults is multiple trauma. In these pa-tients hemorrhagic shock represents the leading cause for worsening of the clinical status and for increased morbidity and mortality. This is due to a multifactorial complex involving cellular, bi-ological, and biophysical mechanisms. The most important mechanisms affecting clinical out-come are oxidative stress, the augmentation of pro-inflammatory status, immune deficiency, dis-ruptions in the coagulation cascade, imbalances in electrolyte and acid-base homeostasis. Poly-trauma patients in hemorrhagic shock need adequate fluid management to ensure hemodynamic stability that must consider not only the maintenance of adequate blood pressure, but also the ad-equate oxygenation of tissues for optimal cellular function. In the current clinical practice, fluid resuscitation in polytrauma patients uses a variety of widely studied pharmacological products, such as crystalloids, colloids, blood transfusions, and the infusion of other blood products. Alt-hough these products exist, an agreement was not reached on a standard administration protocol that could be generally applied for all patients. Moreover, numerous studies have reported a se-ries of adverse events related to fluid resuscitation and to the inadequate use of these products. This review aims at describing the impact the administration of all the solutions used in fluid re-suscitation might have on the cellular and pathophysiological mechanisms in the case of poly-trauma patients suffering from hemorrhagic shock.

The mechanical properties and stability of hydrophobic surface structures prepared by traditional methods are still the main technical bottlenecks restricting the broad application of hydrophobic systems on workpiece surfaces. In this contribution, we propose a technique called selective laser shock peening (SLSP) to enable large-scale high efficient, low-cost manufacturing of hydrophobic metal surfaces with enhanced mechanical properties for durable applications. Using the method of experimental investigation combined with numerical calculation, the hydrophobic properties, mechanical properties, and tribological properties of the samples prepared under SLSP, all-laser shock peening (ALSP), and non-laser shock peening (NLSP) are studied. The SLSP process could prepare a 3D gradient structure material with surface structures, a two-phase (strong phase, soft phase) distribution on the surface, and a multi-level gradient distribution in the thickness direction. Compared with the 2D gradient structure prepared by the traditional process, 3D gradient structures by SLSP have more significant advantages in improving the wetting behavior and the mechanical properties of the material, which proves SLSP to be a novel method to fabricate functional metal surface structures, with highly high engineering application value.

Septic shock substantially alters the pharmacokinetic properties of ß-lactams with a subsequently high risk of insufficiently low serum concentrations and treatment failure. Considering their pharmacokinetic (PK)/pharmacodynamic (PD) index, prolonged infusions (PI) of ß-lactams extend the time that the unbound fraction of the drug remains above the minimal inhibitory concentration MIC (ft >MIC) and may improve patient survival. The present study is a monocentric, retrospective before-and-after analysis of septic shock patients treated with ß-lactams. Patients of the years 2015-2017 received intermittent bolus application whereas patients of 2017-2020 received PI of ß-lactams. The primary outcome was mortality at day 30 and 90 after diagnosis of septic shock. Mortality rates in the PI group were significantly lower on day 30 (PI: 41%, n=119/290 vs. IB: 54.8%, n=68/114; p=0.0097) and day 90 (PI: 47.9%, n=139/290 vs. IB: 62.9%, n=78/124; p=0.005). After propensity-score matching, 30- and 90-day mortality remained lower for the PI group (-10%). PI further reduced duration of invasive ventilation. PI of β-lactam antibiotics led to a stronger decrease in SOFA scores within a 14d-observation period. PI of ß-lactams significantly reduces mortality in patients with septic shock and may have beneficial effects on invasive ventilation and recovery from sepsis-related organ failure.

Lack of shock absorption capability of conventional steel bollards causes significant vehicle damage and consequently high repair costs. This research studies a solution to reduce vehicle damage by inserting PLA honeycomb structures. A honeycomb-inserted bollard was designed based on numerical simulations using LS-DYNA, which yielded the bollard designed for actual vehicle-bollard collision experiments. Simulation efforts were focused on calculating the acceleration characteristics when a vehicle collides with steel and honeycomb-inserted bollards. Compared to the simulated steel bollards, 20 MPa yield-strength honeycomb-inserted bollard showed 0.017s delay in the maximum acceleration occurrence time, reduction of the maximum acceleration to 37.4% of that of steel bollards, and 13.1% reduction in the B-pillar maximum acceleration. Actual vehicle-bollard collision experiments, with a gyro-sensor installed at the test vehicle front bumper frame, also proved improved shock absorption characteristics of the honeycomb-inserted bollards. An experiment with honeycomb-inserted bollard showed 0.783s delay in the maximum acceleration occurrence time, a significant delay when compared to steel bollards. The maximum acceleration measured by the gyro-sensor was 0.35m/s2 when the simulation predicted it to be 0.388 m/s2, proving the similarity in the simulations and experiments. Thus, this study of shock absorption characteristics promised reduced damage to vehicles and lower repair cost.

Urban tree planting initiatives can experience high levels of mortality during establishment years. Mortality tied to the stresses of transplanting can be partially negated or exacerbated depending on the species selected, nursery materials used, site conditions present, and management practices employed. Past research has quantified post-planting survival, health, and growth. However, varying climates, species, land use types, and management practices warrant additional region-specific research. The purpose of this study is to assess the success of plantings along Florida highways and identify species, site, and management factors related to tree and palm health and establishment. Results show high annual establishment survival (98.5%) across 21 planting projects ranging from 9 to 58 months after installation, (n = 2711). For transplanted palms, the presence of on-site irrigation significantly improved establishment from 96.2% to 99.4%. No establishment differences were detected with regard to irrigation treatment for small-stature trees, shade trees, and conifers. Additionally, there were significant differences in tree health response among tree groups given species, management, and site factors.

We attempted to apply the optoelectronic sensor entitled 'OPT101' in intensive care unit clinics, based on its optoelectronic response characteristics in near-infrared wavelength range and near-infrared spectroscopy principle. The successful novel applications in our lab include early-diagnosis and therapeutic effect tracking of thrombus, noninvasive monitoring of patients' shock severity, and fatigue evaluation. This study also expects further improvements of the detector in noninvasive clinical applications.

The cell stress response is an essential system present in every cell for responding and adapting to extracellular environmental stimulations. A major program for stress response is the heat shock factor (HSF)–heat shock protein (HSP) system that maintains proteostasis in cells and promotes cancer progression. However, less is known about how the cell stress response is regulated by alternative transcription factors. Here, we show that the SCAN domain-containing transcription factors (SCAN-TFs) are involved in repressing the stress response in cancer. SCAND1 and SCAND2 are SCAN-TFs that can hetero-oligomerize with SCAN-zinc finger transcription factors, such as MZF1(ZSCAN6), for accessing DNA and transcriptionally co-repressing target genes. We found that heat stress induced the expression of both SCAND1 and MZF1(ZSCAN6) bound to HSP90 gene promoter regions in prostate cancer cells. SCAND1 and MZF1 blocked the heat shock responsiveness of HSP90 in prostate cancer cells. Gene expression of SCAND2, SCAND1 and MZF1 was negatively correlated with HSP90 expression in patients-derived prostate adenocarcinoma. MZF1 and SCAND2 were more highly expressed in paired normal tissues than in tumor tissues in several cancer types. High expression of SCAND2, SCAND1 and MZF1 correlated with enhanced prognoses of pancreatic cancer and head and neck cancers. Additionally, high expression of SCAND2 was correlated with better prognoses of lung adenocarcinoma and sarcoma. In contrast, high expression of HSP90AA1 correlated with poorer prognoses in several cancer types. These data suggest that the stress-inducible SCAN-TFs can function as a feedback system, suppressing excessive stress response and inhibiting cancers.

Acute cardiovascular disorders are incriminated in up to 33% of maternal death and the presence of sickle cell anaemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year Caribbean old woman with known SCA who developed vaso-occlusive crisis at 36-week gestation that justified emergency caesarean section in Pointe à Pitre (Guadeloupe). In the early postpartum period, she experienced acute res-piratory distress in the context of COVID-19 infection that required tracheal intubation with mechanical ventilation. Cardiogenic shock with severe biventricular dysfunction developed that was initially treated with inotropes and vasopressors. As the hemody-namic condition worsened, the cardiac surgical and intensive care team at the Universi-ty Hospital of Martinique (UHM) was requested to apply veno-arterial extracorporeal membrane oxygenation (ECMO) support and, a few hours later, the patient was trans-ferred by helicopter to the UHM. Administration of cardiovascular drugs was rapidly tapered off, there were no signs of ongoing hemolysis and progressive recovery of ven-tricular function allowed weaning of ECMO support, three days after implantation. The patient was extubated one day later, chest-X-Rays showing partial resolution of lung edema and she was transported back to Guadeloupe under medical treatment.

Background: Despite tremendous advances in medicine, infective endocarditis (IE) continues to be a challenge for physicians due to increasing morbidity and unchanged high mortality. Objectives: Our aim was to evaluate clinical outcomes in patients with IE and to identify predictors of in-hospital mortality. Material and methods: The study was retrospective, single-centered, and included 270 patients diagnosed with IE, for the period 2005-2021 (median age 65 (51–74), man 177 (65.6%). Results: Native IE (NVIE) was found in 180 (66.7%), prosthetic IE (PVIE) in 88 (33.6%) and cardiac device-related IE (CDRIE) in 2 (0.7%), significantly more in the non-survivors group. Healthcare associated IE (HAIE) was 72 (26.7%), the most common pathogen were Staphylococci and the proportion of Gram-negative bacteria (GNB) non-HACEK were significantly higher in non-survivor’s vs survivors (11 (15%) vs 9 (4.5%), p=0.004). Overall, early surgery was performed in 54 (20%) patients, with a significant difference between deceased/alive (3 (4.5%) vs 51 (25.1%, p=0.000). The all-cause in-hospital mortality rate was 24.8% (67). The risk factors identified that increased the risk of death were septic shock (OR – 83 1; 95% CI (17.0-405.2), p=0.000) and acute heart failure (OR –24.6; 95% CI (9.2-65.0), p=0.000). Early surgery (OR – 0.03, 95% CI (0.01-0.16), p=0.000) and low Charlson comorbidity index (OR – 0.85, 95% CI (0.74-0.98, p=0.026) in turn reduce this risk. Conclusion: We found that acute heart failure and septic shock are independent predictors of in-hospital mortality. Low Charlson comorbidity index and early surgery increased survival. Knowing the predictors of death would change the therapeutic approach to a more aggressive one and improve the near and long-term prognosis of patients with IE.

Background and Objectives Transpulmonary thermodilution has gained interest in recent years. It measures cardiac output (CO), stroke volume (SV), but also calculates global end diastolic indexed volume (GEDVI), and global ejection fraction (GEF). GEDVI is a static variable of cardiac preload. GEF provides information regarding cardiac function. GEF algorithm depends on SV and GEDVI. Therefore, in hypovolemic patients with decreased preload, SV or GEDVI could be decreased, and lead to altered GEF. The aim of our work was to evaluate whether impairment in GEDVI and SV may constitute a limitation for the interpretation of GEF in hypovolemic patients. A secondary objective was to determine factors independently associated with impaired GEF. Materials and Methods A retrospective study was conducted. Statistical analysis was performed by means of Mann Whitney and student t test. To determine correlation between GEF with SV, or GEF with GEDVI Pearson's coefficient was used. To determine factors independently associated with the presence of impaired GEF, binary logistic regression was performed. Results We included 113 patients with shock. Differences in mortality were detected in GEF (21[16-28] survivors versus 18 in non survivors[11-26]; p= 0.01). 38(34%) patients had hypovolemia. 44(39%) of them had depressed GEF values. Hypovolemic patients had lower GEF values than non-hypovolemic patients (16 [12-22] vs 20 [15-27]; p=0.01). Both SV and GEDVI had a statistically significant correlation with GEF (SV (Pearson's r 0.74; (p=0.00)) and GEDVI (Pearson's r -0.25; (p=0.00)). The only factors independently associated with low GEF were low SV and low GEDVI. Conclusion Hypovolemic patients frequently show low GEF values. We found correlation between SV and GEDVI with GEF. Low SV and low GEDVI were associated with low GEF. This could constitute a limitation in the interpretation of GEF and cardiac pump function. Hypovolemic patients could have low GEF without implying disorders in cardiac contractility.

Steady-state one-dimensional flows of five-component air behind a normal shock wave are considered with one-temperature model. A mathematical model is formulated to describe the relaxation of a five-component air mixture with a one-temperature non-equilibrium approximation. A numerical study of non-equilibrium flows of a reacting five-component air mixture behind shock waves at different heights and velocities of free flow is performed. The contribution of different types of reactions to the overall relaxation of the mixture is discussed, and the distributions of macro-parameters of the flow behind the shock wave front are calculated. The lengths of the relaxation zones behind the shock wave front are compared at different initial conditions.

Shock waves, as used in medicine, can induce cell permeabilization, genetically transforming filamentous fungi; however, little is known on the interaction of shock waves with the cell wall. Because of this, the selection of parameters has been empirical. We studied the influence of shock waves on the germination of Aspergillus niger, to understand their effect on the modulation of four genes related to the growth of conidia. Parameters were varied in the range reported in protocols for genetic transformation. Vials containing conidia in suspension were exposed to either 50, 100 or 200 single-pulse or tandem shock waves, with different peak pressures (approximately 42, 66 and 83 MPa). In the tandem mode, three delays were tested. To equalize the total energy, the number of tandem “events” was halved compared to the number of single-pulse shock waves. Our results demonstrate that shock waves do not generate severe cellular effects on the viability and germination of A. niger conidia. Nevertheless, increase in the aggressiveness of the treatment induced a modification in the four genes tested. Scanning electron microscopy revealed significant changes to the cell wall of the conidia. Under optimized conditions, shock waves could be used for several biotechnological applications, surpassing conventional techniques.

Laser shock peening is a process which can reduce stress corrosion cracking and improve fatigue life by forming compressive residual stress on the surface of the material. In a computational FE simulation of laser shock peening, during applying the pressure load generated by the laser pulse to the surface of simulation geometry, the peening is simulated by explicit analysis and then convert to implicit analysis to dissipate the dynamic energy remaining in the geometry. In this study, static damping is applied to dissipate residual dynamic energy without converting it into an implicit analysis. The compressive residual stress distribution is compared between the simulation results for the stainless steel 304 material and the same material subjected to actual laser shock peening. The laser shock peening parameters were 4.2J laser pulse energy, 50% overlap of 3mm diameter of the laser beam and water as a confinement layer. As a result, the compressive residual stress from the surface to the depth direction is similar to both the simulation and the experimental result measured by the hole drilling method.

A newly identified novel coronavirus named as severe acute respiratory syndrome-related coronavirus2 (SARS‐CoV 2) has given rise to the global pandemic. SARS-CoV2 which causes coronavirus disease 2019 (COVID-19), is a positive-stranded RNA virus with nucleocapsid. It binds to host angiotensin-converting enzyme2 (ACE2) receptor through surface glycoprotein (S protein). These ACE 2 receptors are attached to the cell membranes of many organs. Thus, COVID-19 does not only result in acute respiratory distress syndrome but also affects multiple organ systems, requiring a multidisciplinary approach to manage this disease. COVID-19 can damage the myocardial cells and result in fulminant myocarditis, acute cardiac injury, cardiomyopathy, heart failure, cardiogenic shock, or arrhythmia. COVID-19 seeds harmful immune response through cytokine storm leading to indirect organ damage. In this literature review, the available data is comprehended regarding cardiovascular complications in COVID-19, and the correlation of biomarkers with the disease activity is discussed. This literature review also highlights the important treatment options and outcomes of the individual study.

Background: Cutaneous squamous skin cell carcinoma (SCC) is the second most frequent type of non- melanoma skin cancer and the second cause of death by skin cancer in caucasian population. However, at present it is difficult to predict patients with worst SCC prognosis. Objective: To identify proteins whose expression level could predict SCC infiltration in SCC arising from actinic keratosis (AC). Methods: A total of 20 biopsies of 20 different patients were studied, 10 were from SCC-AK samples and 10 from normal skin. Early infiltrated SCC-AK were selected on histological examination and to determine the expression of proteins fresh skin samples were processed by 2DE-electrophoresis Results: The expression levels of three proteins namely alpha-hemoglobin, heat shock protein (Hsp)-27 and 70 were significantly increased in SCC-AK samples with respect to normal control skin. However, only the expression level of Hsp70 protein positively correlated with the level of SCC-AK dermis infiltration. Immnunohistological examination suggested that the increased expression of Hsp70 proteins seems to mainly occur in the keratinocytes cytoplasm. The increased cytoplasmic Hsp70 expression in SCC-AK was confirmed by Western-blot experiments. Conclusion: Cytoplasmic expression of Hsp70 could be potential biomarker of early infiltration of SCC arising from an AK. Keywords: actinic keratosis, cutaneous squamous cell carcinoma; cytoplasm, skin cancer; heat shock protein.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection. Recent in-vitro studies have investigated the effects of CytoSorb hemoadsorption on endothelial function in sepsis showing a reduction in markers of endothelial dysfunction, but to this day there is a lack of clinical studies showing whether this approach could actually positively influence the disturbed vascular barrier function in septic conditions. We analyzed the data on administered fluid volumes and catecholamines to determine the potential benefit of CytoSorb hemoadsorption therapy on endothelial function in a clinical scenario. We performed a retrospective analysis of 124 septic shock patients who had undergone adjunctive treatment with CytoSorb hemadsorption therapy. We collected volume requirements, and calculated the volume balance within different time periods to obtain an assumption on the stability of the vascular barrier. We also calculated catecholamine requirements. With regard to the entire study cohort our findings revealed a significant reduction in fluid balance at 72 hours (T72) compared to both baseline (T0) and the 24-hour mark (T24). Fluid balances from T72 – T0 were significantly lower in hospital survivors compared to non-survivors. Patients who received a second catecholamine had a significantly lower in-hospital mortality. Our findings showed that use of hemoadsorption therapy results in a reduced positive fluid balance paralleled by reductions in vasopressor needs suggesting a positive effect on endothelial integrity. These results, derived from a large cohort of patients, provide valuable insights that may greatly improve our understanding of the multiple effects of hemoadsorption treatment in septic shock patients.

In order to balance the conflicts among mass flow rate, total pressure ratio, adiabatic efficiency and stall margin in a low-bypass transonic fan, the optimization of the rotor blade is implemented in this study. An advanced 3D optimization design system is adopted, and flow diagnostic methods based on vorticity dynamics are employed to discuss the flow field. Results indicate that by controlling the blade camber line curvature, significant improvements in the aerodynamic performance for the fan stage are achieved, the total pressure ratio is increased by 1.90%, while the adiabatic efficiency and mass flow rate are increased by 4.45% and 5.82%, respectively. Vorticity diagnosis suggest that there exists a close link between performance parameters and vorticity parameters in the axial fan/compressor, both azimuthal vorticity and boundary vortex flux have significant influences on the stage performance. Moreover, the boundary layer separation is accompanied by the spike of entropy and static pressure, while the derivation/gradient of these flow parameters would also suffer drastic changes under the effect of shock wave. The vorticity parameters could provide detailed flow information about the on-wall flow with high accuracy, which provides the researchers with a novel method for the turbomachinery aerodynamic design and analysis.

Mechanical circulatory support has proven effective in managing postcardiotomy cardiogenic shock by stabilizing patients' hemodynamics and ensuring adequate organ perfusion. Among the available device modalities, the combination of extracorporeal life support and a microaxial flow pump for left ventricular unloading has emerged as a valuable tool in the surgical arma-mentarium. In this publication, we provide recommendations for the application and weaning of temporary mechanical circulatory support in cardiogenic shock patients, derived from a con-sensus among leading cardiac centers in German-speaking countrie