The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia-Systematic Review of the Literature.

Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021. From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9-3.0) and intermittent (1.9 °C/h; 95% CI 1.5-2.3) methods (p > 0.9). Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines

Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases.

Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score. Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters. We identified 12 such survivors. The HOPE-estimated survival probability was ≥10% for all (n = 11) patients for whom we were able to calculate the HOPE score. Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors' group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis

Centralizacja danych w przemysłowej sieci Ethernet. 5 kroków doboru switcha

Warstwa komunikacji od zawsze miała szczególne znaczenie w systemach automatyki. Nawet najlepsze sterowniki PLC, układy I/O czy systemy nadrzędne, aby zapewnić ciągłe działanie procesów, wymagają nieprzerwanej pracy systemów transmisji danych. Element niezawodności jest więc kluczowym parametrem dla urządzeń odpowiedzialnych za przesył danych

The simulation of the interaction between a damaged wheelset and the railway track

W pracy przeprowadzono symulacyjne badania oddziaływań dynamicznych uszkodzonych powierzchni zestawów kołowych wagonu na tor kolejowy. W wagonie towarowym 4 –osiowym, na powierzchni tocznej zestawów kołowych jednego z wózków, umieszczono oddzielnie na jednym płaskie miejsca, a na drugim nalepy. Zbadano interakcyjne oddziaływanie sił generowanych przez te uszkodzenia na tor o rożnych wartościach sztywności, uwzględniając prędkość i masę wagonu. Zarejestrowano zarówno przebiegi czasowe podczas przejazdu wagonu jak i wyznaczono charakterystyki 3D, obrazujące wpływ tych parametrów. Dokonano analizy porównawczej. Symulacje dynamiki ruchu wagonu zaimplementowano w środowisku UM LOCO.The paper presents the simulation of the dynamic interaction between a damaged wheelset and the railway track. Two kind of defects have been used during the simulation, the first corresponding to the wheel with flatten and the second corresponding to the wheel with accretion. These defects were placed on the wheelset of the freight car. The dependence of forces generated by these defects on the track stiffness, the weight and speed of the freight car has been investigated. Both waveforms and 3D characteristics for forces generated by these defects have been presented. Comparative analysis has been carried out. The simulation has been performed in UMLOCO environment

A method for determining the decision variables of hazardous zone identification system for ship power plant operator

In this paper a method is presented of determining - on the basis of information available in the preliminary phase of ship power plant design - the set of hazardous and noxious factors for the operator, as well as of converting them into the set of input variables to a hazardous zone identification system. Basing on the choice of values of determined decision variables, the system's user is able to determine potential hazardous zones for the ship power plant operator. Conversions of the determined factors into the set of the system's input variables were performed by using the knowledge achieved from the side of experts in ship power plant designing and operating

Reakcja Ornithogalum saundersiae Bak. na stress solny

Most of the studies on the effects of salinity stress are conducted on ornamental bedding plants and perennials but little is known on flower bulbs response to this stress factor. Ornithogalum saundersiae is an attractive bulbous plant recommended for growing in pots, gardens and green areas. The study conducted in the years 2013–2014 investi-gated the effects of NaCl on the growth, flowering, photosynthetic activity, pigment content, and macro- and micronutrient content in the leaves of O. saundersiae. The plants were grown in pots in a plastic tunnel. NaCl was applied once a week for six weeks at concentration of 100 mM or 200 mM. The salt treatment did not cause chlorosis and did not affect flowering rate and number of inflorescences. The plants exposed to salinity stress had lower fresh weight of leaves, inflorescences and bulbs and their flowering be-gan later than in the control plants. Photosynthesis and transpiration intensity decreased as NaCl concentration increased. The content of chlorophyll and carotenoids in NaCl treated plants was significantly higher than in the control plants. Salinity stress increased the leaf content of nitrogen, potassium, sodium and chlorine and reduced the concentration of calcium, zinc and iron.Większość badań nad wpływem warunków stresowych wynikających z zasolenia prowadzi się na ozdobnych roślinach rabatowych i bylinach, natomiast wciąż niewiele jest informacji dotyczących reakcji geofitów na ten czynnik. Ornithogalum saun-dersiae to atrakcyjna roślina cebulowa polecana do uprawy w pojemnikach, w ogrodach i na terenach zieleni. Przeprowadzone w latach 2013–2014 badania dotyczyły oceny wpływu NaCl na wzrost, kwitnienie, funkcjonowanie aparatu fotosyntetycznego, zawartość barwników oraz makro- i mikroskładników w liściach O. saundersiae. Rośliny uprawiano w doniczkach w tunelu foliowym. Zasalanie prowadzono raz w tygodniu, przez okres 6 tygodni, stosując roztwór NaCl w stężeniu 100 i 200 mM. Stwierdzono, że traktowanie roślin NaCl nie spowodowało chloroz, nie miało wpływu na procent kwitnących roślin oraz na liczbę kwiatostanów. Pod wpływem stresu solnego rośliny miały zmniejszonąświeżą masę liści, kwiatostanów i cebul oraz rozpoczynały później kwitnienie. Intensywność fotosyntezy i natężenie transpiracji zmniejszyło się wraz ze wzrostem stężenia NaCl. Zawartość chlorofilu i karotenoidów w liściach roślin traktowanych NaCl była istotnie wyższa w porównaniu z roślinami kontrolnymi. W wyniku zasolenia wzrosła zawartość w liściach azotu, potasu, sodu i chloru, natomiast spadła zawartość wapnia, cynku i żelaza

Rhizopus cohnii as the cause of skin mucormycosis

The authors report the case of the mucormycosis of the skin. The diagnosis was made on the presence of Mucoraceae hyphe in the through examination, histology and the positive culture of the material taken from the ulcerations of patients skin. The isolated fungus was identified as Rhizopus cohnii