Monocyte HLA-DR level on admission predicting in-hospital mortality rate in exertional heatstroke: A 12-year retrospective study.

BACKGROUND: Exertional heatstroke (EHS), a fatal illness, pronounces multiple organ dysfunction syndrome (MODS) and high mortality rate. Currently, no ideal factor prognoses EHS. Decreased monocyte human leukocyte-DR antigen (mHLA-DR) has been observed in critically ill individuals, particularly in those with sepsis. While most research focus on the pro-inflammatory response exploration in EHS, there are few studies related to immunosuppression, and no report targeted on mHLA-DR in EHS. The present study tried to explore the prognostic value of mHLA-DR levels in EHS patients. METHODS: This was a single-center retrospective study. Clinical data of EHS patients admitted to the intensive care unit of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. RESULTS: Seventy patients with 54 survivors and 16 nonsurvivors were ultimately enrolled. Levels of mHLA-DR in the nonsurvivors (41.8% [38.1-68.1]%) were significantly lower than those in the survivors (83.1% [67.6-89.4]%, p < 0.001). Multivariate logistic regression indicated that mHLA-DR (odds ratio [OR] = 0.939; 95% confidence interval [CI]: 0.892-0.988; p = 0.016) and Glasgow coma scale (GCS) scores (OR = 0.726; 95% CI: 0.591-0.892; p = 0.002) were independent risk factors related with in-hospital mortality rate in EHS. A nomogram incorporated mHLA-DR with GCS demonstrated excellent discrimination and calibration abilities. Compared to the traditional scoring systems, the prediction model incorporated mHLA-DR with GCS had the highest area under the curve (0.947, 95% CI: [0.865-0.986]) and Youden index (0.8333), with sensitivity of 100% and specificity of 83.33%, and a greater clinical net benefit. CONCLUSION: Patients with EHS were at a risk of early experiencing decreased mHLA-DR early. A nomogram based on mHLA-DR with GCS was developed to facilitate early identification and timely treatment of individuals with potentially poor prognosis.

Innovative Solutions for Worn Fingerprints: A Comparative Analysis of Traditional Fingerprint Impression and 3D Printing.

Fingerprint recognition systems have achieved widespread integration into various technological devices, including cell phones, computers, door locks, and time attendance machines. Nevertheless, individuals with worn fingerprints encounter challenges when attempting to unlock original fingerprint systems, which results in disruptions to their daily activities. This study explores two distinct methods for fingerprint backup: traditional fingerprint impression and 3D printing technologies. Unlocking tests were conducted on commonly available optical fingerprint lock-equipped cell phones to assess the efficacy of these methods, particularly in unlocking with worn fingerprints. The research findings indicated that the traditional fingerprint impression method exhibited high fidelity in reproducing fingerprint patterns, achieving an impressive unlocking success rate of 97.8% for imprinting unworn fingerprints. However, when dealing with worn fingerprints, the traditional fingerprint impression technique showed a reduced unlocking success rate, progressively decreasing with increasing degrees of finger wear. In contrast, 3D-printed backup fingerprints, with image processing and optimization of ridge height, mitigated the impact of fingerprint wear on the unlocking capability, resulting in an unlocking success rate of 84.4% or higher. Thus, the utilization of 3D printing technology proves advantageous for individuals with severely worn or incomplete fingerprints, providing a viable solution for unforeseen circumstances.

Hepatic portal venous gas initially manifesting as severe shock: a case series.

Hepatic portal venous gas is often referred to as the "sign of death" because it signifies a very poor prognosis if appropriate treatments are not promptly administered. The etiologies of hepatic portal venous gas are diverse and include severe complex abdominal infections, mesenteric ischemia, diving, and complications of endoscopic surgery, and the clinical manifestations are inconsistent among individual patients. Thus, whether emergency surgery should be performed remains controversial. In this report, we present three cases of hepatic portal venous gas. The patients initially exhibited symptoms consistent with severe shock of unknown etiology and were treated in the intensive care unit upon admission. We rapidly identified the cause of each individual patient's condition and selected problem-directed intervention measures based on active organ support, antishock support, and anti-infection treatments. Two patients recovered and were discharged without sequelae, whereas one patient died of refractory infection and multiple organ failure. We hope that this report will serve as a valuable reference for decision-making when critical care physicians encounter similar patients.

A nomogram based on lymphocyte percentage for predicting hospital mortality in exertional heatstroke patients: a 13-year retrospective study.

BACKGROUND: Exertional heatstroke (EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality. METHODS: This is a single-center retrospective study. Clinical data from EHS patients admitted to the Intensive Care Unit (ICU) of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. Univariate and multivariate logistic regression were used to identify the factors for mortality. The prediction model was developed with the prognostic markers, and a nomogram was established. RESULTS: The study ultimately enrolled 156 patients, and 15 (9.6%) of patients died before discharge. The lymphocyte count (Lym) and percentage (Lym%) were significantly lower in non-survivors (P<0.05). The univariate and multivariate logistic regression analyses indicated that Lym% at the third day of admission (Lym% D3) (OR=0.609, 95%CI: 0.454-0.816) and hematocrit (HCT) (OR=0.908, 95%CI: 0.834-0.988) were independent protective factors for hospital mortality. A nomogram incorporating Lym% D3 with HCT was developed and demonstrated good discrimination and calibration ability. The comparison between the prediction model and scoring systems revealed that the prediction model had the largest area under the curve (AUC) (0.948, 95%CI: 0.900-0.977), with 100.00% sensitivity and 83.69% specificity, and a greater clinical net benefit. CONCLUSION: Severe EHS patients had a higher risk of experiencing prolonged lymphopenia. A nomogram based on Lym% D3 and HCT was developed to facilitate early identification and timely treatment of patients with potentially unfavorable prognoses.

Prediction of in-hospital mortality in patients with exertional heatstroke: a 13-year retrospective study.

Hyperactivity of coagulation is common in exertional heatstroke (EHS). Disseminated intravascular coagulation (DIC) is the most severe form of coagulation dysfunction and associated with poor outcome. DIC, temperature and Glasgow coma scale score were identified as independent risk factors for in-hospital mortality by multivariate logistic regression analysis, and we developed a nomogram for predicting in-hospital mortality in a 13-year EHS patient cohort. The nomogram was assessed by calibration curves and bootstrap with 1,000 resamples. The receiver operating characteristic curve was constructed, and the area under the curve (AUC) was compared. Two hundred and ten patients were included. The in-hospital mortality was 9.0%, and the incidence of DIC was 17.6%. The AUC of the nomogram was 0.897 (95% CI 0.848-0.935, p < .0001) and was non-inferior to SOFA and APACHE II scores but superior to SIRS score, which were widely-used score systems of disease severity. The nomogram contributed to the adverse outcome prediction of EHS.

Glasgow Coma Scale as an Indicator of Patient Prognosis: A Retrospective Study of 257 Patients with Heatstroke from 3 Medical Centers in Guangdong, China.

BACKGROUND Coma has been considered as a valuable symptom of heatstroke. This study aimed to evaluate the role of the Glasgow Coma Scale (GCS) as an indicator of prognosis of patients with heatstroke. MATERIAL AND METHODS From Jan 1st, 2013 to Dec 31st, 2020, the clinical courses of 257 heatstroke patients from 3 medical centers in Guangdong, China, were observed. Diagnosis of heatstroke was made according to Expert Consensus in China. GCSs were calculated on the 1st, 3rd, and 5th days after admission to intensive care units (ICUs). GCS £8, as a coma criterion, was employed to predict the outcomes. RESULTS Seventy-five patients (29.18%) were comatose at admission. Twenty-seven (10.50%) patients, including 24 (24/75, 32.00%) coma patients and 3 (3/182,1.65%) non-coma patients died during ICU stay (P<0.0001). Patients with GCS ≤8 had a 2-fold higher risk of death as compared with those with GCS >8. The area under curves (AUCs) of GCSs on the 1st, 3rd, and 5th days to predict mortality were 0.81 (0.70-0.91), 0.91 (0.84-0.98), and 0.91 (0.82-0.99), respectively. Each additional 1 year of age, 1/min of respiratory rate (RR), and 1% of hematocrit (HCT) increased the risk of death of coma patients by 3%, 6%, and 4%, respectively (all P≤0.05). Patients with improving GCSs had lower mortality rates than non-improving patients (5.71% vs 55.00%, P<0.0001) within 5 days after admission. CONCLUSIONS GCS ≤8 at admission predicted worse outcomes in heatstroke patients, which possibly enhanced the risks of death for other factors, including age, RR, and HCT.

Construction and Validation of the Nomogram Based on von Willebrand Factor Predicting Mortality in Patients with Heatstroke.

Heatstroke (HS), a severe condition, can develop multiple organ dysfunction syndrome and death. However, at present, no early reliable index exists for risk stratification and prognosis. von Willebrand factor (vWF), a marker of vascular endothelial injury, is a key regulatory target of inflammation and coagulation, which is closely associated with the pathogenesis of HS. vWF was reported as a prognostic marker in several infectious and noninfectious severe illness such as COVID-19, sepsis, and trauma. Although early increased level of vWF is seen in HS, the relationship between vWF and mortality is to be elucidated. Clinical data of patients with HS in a tertiary hospital were recorded and analyzed. It was shown that plasma vWF concentrations at admission were significantly increased in the nonsurvivors (351% ± 105%) compared with survivors (278% ± 104%, p = 0.021). After multivariate logistic regression analysis it was shown that vWF (odds ratio [OR] = 1.010; 95% confidence interval [CI], 1.002-1.18; p = 0.017), hemoglobin (Hb) (OR = 0.954; 95% CI, 0.931-0.979; p < 0.001), and hematocrit (HCT) in blood (OR = 0.859; 95% CI, 0.790-0.934; p < 0.001) were independent factors of in-hospital mortality in HS. The nomogram based on vWF and Hb was constructed in patients with HS. The area under curve under the receiver operating characteristic of this prediction model was 0.860 (95% CI, 0.773-0.923) and cutoff was 0.15, with Youden index 0.5840, which were not significantly different to sequential organ failure assessment (p = 0.0644), Acute Physiology and Chronic Health Evaluation II (APACHE II) (p = 0.7976), and systemic inflammatory response syndrome (SIRS) scores (p = 0.3274). The prediction model that integrated vWF and Hb showed a better predicting efficiency than single variable, and a higher specificity (81.48%) than APACHE II (72.84%) and SIRS (72.84%) scores. In summary, vWF, as an independent risk factor for in-hospital mortality, combined with Hb, could effectively prognosis the mortality in HS patients at early stage.

Prognostic value of plasma exosomal levels of histone H3 protein in patients with heat stroke.

Heat stroke (HS) is a condition that can lead to multiple organ dysfunction syndrome and death; however, there is no reliable method for stratifying mortality risk in HS. The abundance of exosomes in the circulation and their contents may be used as potential biomarkers of HS. The present study aimed to examine whether histone H3 levels in plasma exosomes could be used to determine HS prognosis. Blood samples were collected from patients with HS (36 survivors and 8 non-survivors) at admission to the intensive care unit and 4 days after admission. Blood samples were additionally collected from 15 healthy volunteers. Plasma exosomes were isolated using high-speed differential centrifugation. Correlation between histone H3 level and organ function and disease severity was examined. The results suggested differential expression and enrichment of histone H3 in the plasma exosomes of patients with HS (survivors, 249.3±04.6; non-survivors, 500.4±216.8; healthy controls, 161.1±52.49 pg/100 µg; P<0.05). The increased expression of histone H3 was associated with increased disease severity and duration. Plasma exosomal levels of histone H3 were significantly correlated with both organ dysfunction and disease severity (P<0.0001) and were significantly different between non-survivors and survivors (area under the receiver operating characteristic curve, 0.9668). A cutoff value of 307 pg/100 µg demonstrated optimized sensitivity (95%) and specificity (91.67%) for predicting mortality risk, suggesting that histone H3 levels in plasma exosomes may be a reliable biomarker for HS prognosis.

Sequential intraventricular injection of tigecycline and polymyxin B in the treatment of intracranial Acinetobacter baumannii infection after trauma: a case report and review of the literature.

BACKGROUND: Intracranial infection after craniotomy is one of the most serious postoperative complications, especially multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacterial meningitis, and strongly affects the prognosis of patients. Current treatment experience regarding these infections is scarce. CASE PRESENTATION: We report a case of severe intracranial infection of XDR Acinetobacter baumannii (A. baumannii) that was treated by intravenous (IV) injection, sequential intraventricular (IVT) injection of tigecycline and polymyxin B, and other anti-infective drugs. Good results were obtained, and the patient was eventually discharged from the hospital. This case is characterized by intracranial infection. CONCLUSIONS: The polymyxin B IV + IVT pathway is an ideal treatment strategy for XDR A. baumannii. The tigecycline IVT pathway is also a safe treatment option.

Role of LPSO Phase in Crack Propagation Behavior of an As-Cast Mg-Y-Zn Alloy Subjected to Dynamic Loadings.

In this work, the role of long period stacking ordered (LPSO) phase in the crack propagation behavior of an as-cast Mg95.5Y3Zn1.5 alloy was investigated by dynamic four-point bent tests. The as-cast Mg95.5Y3Zn1.5 alloy is mainly composed of Mg matrix, 18R LPSO phase located at the grain boundaries and 14H LPSO phase located within the Mg matrix. The alloy exhibits excellent dynamic mechanical properties; the yield stress, maximum stress and strain to failure are 190.51 ± 3.52 MPa, 378.32 ± 4.26 MPa and 0.168 ± 0.006, respectively, at the strain rate of ~3000 s-1. The LPSO phase effectively hinders dynamic crack propagation in four typical ways, including crack tip blunting, crack opening inhibition, crack deflection and crack bridging, which are beneficial to the mechanical properties of the alloy under dynamic loadings.

Beam Diameter Dependence of Performance in Thick-Layer and High-Power Selective Laser Melting of Ti-6Al-4V.

A 400 W high-power laser was used to fabricate 200-µm-thick Ti-6Al-4V samples to evaluate the effects of small (50 µm) and large (200 µm) beam diameter on density, microstructure and mechanical properties. A series of single-track experiments demonstrated that it was challenging for the small-beam laser to fabricate smooth and defect-free scan tracks. A larger beam diameter efficiently avoided process instability and provided a more stable and uniform melt pool. By increasing the beam diameter, the density of multilayer samples reached 99.95% of the theoretical value, which is much higher than that achieved with the small beam diameter. However, it was difficult to completely eliminate defects due to serious spatter and evaporation. Moreover, all of the generated samples had relatively coarse surfaces. For the large beam diameter of 200 µm, the optimal yield strength, ultimate tensile strength and elongation were 1150 MPa, 1200 MPa and 8.02%, respectively. In comparison, the small beam diameter of 50 µm resulted in values of 1035 MPa, 1100 MPa and 5.91%, respectively. Overall, the large-diameter laser is more suitable for high-power selective laser melting (SLM) technology, especially for thick layers.

Effect of Molten Pool Size on Microstructure and Tensile Properties of Wire Arc Additive Manufacturing of Ti-6Al-4V Alloy.

Wire arc additive manufacturing (WAAM) technique is a cost-competitive and efficient technology to produce large structure components in industry domains. Mechanical properties are mainly dominated by the microstructure of the components, which is deeply affected by the molten pool size. In this work, to investigate the effect of the molten pool size on microstructure and mechanical properties of the components, a series of Ti-6Al-4V alloy blocks with different width of molten pool (WMP) ranging from 7 mm to 22 mm were deposited by adjusting the wire feed speed (WFS) from 100 cm/min to 500 cm/min. It is interesting to find that the macrostructure changes from columnar grains to equiaxial grains, and then returns to large columnar grains with the increase of WMP, which is mainly caused by the different cooling rates and thermal gradients. Nonetheless, the tensile properties of the components have a tendency to decline with the increase of WMP.

Mesenteric Lymph Duct Ligation Alleviating Lung Injury in Heatstroke.

To explore the roles of mesenteric lymph on lung injury in heatstroke (HS), HS rat model was prepared in a prewarmed incubator. Vascular endothelium injury biomarkers (circulating endothelial cell [CEC] as well as von Willebrand factor [vWF] and thrombomodulin [TM]), proinflammatory factors (tumor necrosis factor-α [TNF-α], interleukin-1ß [IL-1ß], IL-6, and high mobility group box 1), and coagulant markers (activated partial thromboplastin time, prothrombin time, D-Dimer, and platelet count) were tested in HS and HS with mesenteric lymph duct ligation (LDL) rats. In addition, lung histopathology; arterial blood gas; Evans Blue dye (EBD) and protein lung permeability; intralung inflammatory parameters including bronchoalveolar lavage fluid (BALF) TNF-α, IL-1ß, and IL-6 levels; myeloperoxidase (MPO) activity; and vWF immune staining were analyzed. LDL prolonged HS onset time but not HS survival time. LDL significantly attenuated endothelial cell injury for decreased CEC counts as well as plasma vWF and TM concentrations; downregulated systemic inflammation for decreased plasma TNF-α, IL-1ß, IL-6, and high mobility group box 1 levels; and ameliorated coagulant disorders for decreased activated partial thromboplastin time, prothrombin time, and D-Dimer levels as well as increased platelet counts. LDL also significantly reduced acute lung pathological injury; improved lung function indexes including arterial blood PaO2, pH, PaCO2, and lactic acid; decreased BALF TNF-α, IL-1ß, and IL-6 levels and lung MPO activity; improved EBD and protein lung permeability; and inhibited lung vascular endothelium vWF expression. However, all of these parameters were not recovered to the normal states. In summary, LDL developed protection roles systemically and alleviated lung injury in HS rats which indicated that modulating mesenteric lymph flow may have some potential benefits in HS.

Performance of High Layer Thickness in Selective Laser Melting of Ti6Al4V.

To increase building rate and save cost, the selective laser melting (SLM) of Ti6Al4V with a high layer thickness (200 µm) and low cost coarse powders (53 µm-106 µm) at a laser power of 400 W is investigated in this preliminary study. A relatively large laser beam with a diameter of 200 µm is utilized to produce a stable melt pool at high layer thickness, and the appropriate scanning track, which has a smooth surface with a shallow contact angle, can be obtained at the scanning speeds from 40 mm/s to 80 mm/s. By adjusting the hatch spacings, the density of multi-layer samples can be up to 99.99%, which is much higher than that achieved in previous studies about high layer thickness selective laser melting. Meanwhile, the building rate can be up to 7.2 mm³/s, which is about 2 times-9 times that of the commercial equipment. Besides, two kinds of defects are observed: the large un-melted defects and the small spherical micropores. The formation of the un-melted defects is mainly attributed to the inappropriate overlap rates and the unstable scanning tracks, which can be eliminated by adjusting the processing parameters. Nevertheless, the micropores cannot be completely eliminated. It is worth noting that the high layer thickness plays a key role on surface roughness rather than tensile properties during the SLM process. Although a sample with a relatively coarse surface is generated, the average values of yield strength, ultimate tensile strength, and elongation are 1050 MPa, 1140 MPa, and 7.03%, respectively, which are not obviously different than those with the thin layer thickness used in previous research; this is due to the similar metallurgical bonding and microstructure.

Prognostic value of blood zinc, iron, and copper levels in critically ill children with pediatric risk of mortality score III.

We aimed to explore the association of blood Zn, Fe, and Cu concentrations and changes in the pediatric risk of mortality (PRISM) score in critically ill children, to predict prognosis. We included 31 children (22 boys and 9 girls, 1 month to 5 years old), who had been admitted to the intensive care unit of our hospital and who were critically ill according to PRISM score of III. Another 20 children (12 boys, 8 girls, 3 months to 5 years old) who were brought to the hospital for a health checkup were included as controls. We recorded clinical data, time in the intensive care unit, prognosis, and PRISM III score for critically ill children. Blood Cu, Zn, and Fe values were measured by inductively coupled plasma atomic emission spectrophotometry. Zn and Fe levels were significantly lower in patients than in controls (all p < 0.05). Cu levels differed between patients and controls, but not significantly (p > 0.05). In ill children, blood Zn and Fe concentrations were inversely correlated with PRISM III score (Zn: r = -0.36; Fe: r = -0.50, both p < 0.05), with no significant correlation of blood Cu level and PRISM III score (r = -0.13, p > 0.05). Serious illness in children may lead to decreased Zn and Fe blood concentrations. Zn and Fe supplements may be beneficial for critically ill children.