Browsing by Subject "SHOCK"

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  • SICS Study Grp; Hiemstra, Bart; Eck, Ruben J.; Wiersema, Renske; Pettilä, Ville; van der Horst, Iwan C. C. (2019)
    Objectives: Caregivers use clinical examination to timely recognize deterioration of a patient, yet data on the prognostic value of clinical examination are inconsistent. In the Simple Intensive Care Studies-I, we evaluated the association of clinical examination findings with 90-day mortality in critically ill patients. Design: Prospective single-center cohort study. Setting: ICU of a single tertiary care level hospital between March 27, 2015, and July 22, 2017. Patients: All consecutive adults acutely admitted to the ICU and expected to stay for at least 24 hours. Interventions: A protocolized clinical examination of 19 clinical signs conducted within 24 hours of admission. Measurements Main Results: Independent predictors of 90-day mortality were identified using multivariable logistic regression analyses. Model performance was compared with established prognostic risk scores using area under the receiver operating characteristic curves. Robustness of our findings was tested by internal bootstrap validation and adjustment of the threshold for statistical significance. A total of 1,075 patients were included, of whom 298 patients (28%) had died at 90-day follow-up. Multivariable analyses adjusted for age and norepinephrine infusion rate demonstrated that the combination of higher respiratory rate, higher systolic blood pressure, lower central temperature, altered consciousness, and decreased urine output was independently associated with 90-day mortality (area under the receiver operating characteristic curves = 0.74; 95% CI, 0.71-0.78). Clinical examination had a similar discriminative value as compared with the Simplified Acute Physiology Score-II (area under the receiver operating characteristic curves = 0.76; 95% CI, 0.73-0.79; p = 0.29) and Acute Physiology and Chronic Health Evaluation-IV (using area under the receiver operating characteristic curves = 0.77; 95% CI, 0.74-0.80; p = 0.16) and was significantly better than the Sequential Organ Failure Assessment (using area under the receiver operating characteristic curves = 0.67; 95% CI, 0.64-0.71; p <0.001). Conclusions: Clinical examination has reasonable discriminative value for assessing 90-day mortality in acutely admitted ICU patients. In our study population, a single, protocolized clinical examination had similar prognostic abilities compared with the Simplified Acute Physiology Score-II and Acute Physiology and Chronic Health Evaluation-IV and outperformed the Sequential Organ Failure Assessment score.
  • Good, S. W.; Kilpua, E. K. J.; Ala-Lahti, M.; Osmane, A.; Bale, S. D.; Zhao, L. -L. (2020)
    Magnetic clouds are large-scale transient structures in the solar wind with low plasma-beta, low-amplitude magnetic field fluctuations, and twisted field lines with both ends often connected to the Sun. Their inertial-range turbulent properties have not been examined in detail. In this Letter, we analyze the normalized cross helicity, sigma(c), and residual energy, sigma(r), of plasma fluctuations in the 2018 November magnetic cloud observed at by the Parker Solar Probe. A low value of |sigma(c)| was present in the cloud core, indicating that wave power parallel and antiparallel to the mean field was approximately balanced, while the cloud's outer layers displayed larger amplitude Alfvenic fluctuations with high |sigma(c)| values and sigma(r) similar to 0. These properties are discussed in terms of the cloud's solar connectivity and local interaction with the solar wind. We suggest that low |sigma(c)| is likely a common feature of magnetic clouds given their typically closed field structure. Antisunward fluctuations propagating immediately upstream of the cloud had strongly negative sigma(r) values.
  • Morosan, D. E.; Palmerio, E.; Lynch, B. J.; Kilpua, E. K. J. (2020)
    Context. Coronal mass ejections (CMEs) on the Sun are the largest explosions in the Solar System that can drive powerful plasma shocks. The eruptions, shocks, and other processes associated to CMEs are efficient particle accelerators and the accelerated electrons in particular can produce radio bursts through the plasma emission mechanism. Aims. Coronal mass ejections and associated radio bursts have been well studied in cases where the CME originates close to the solar limb or within the frontside disc. Here, we study the radio emission associated with a CME eruption on the back side of the Sun on 22 July 2012. Methods. Using radio imaging from the Nancay Radioheliograph, spectroscopic data from the Nancay Decametric Array, and extreme-ultraviolet observations from the Solar Dynamics Observatory and Solar Terrestrial Relations Observatory spacecraft, we determine the nature of the observed radio emission as well as the location and propagation of the CME. Results. We show that the observed low-intensity radio emission corresponds to a type II radio burst or a short-duration type IV radio burst associated with a CME eruption due to breakout reconnection on the back side of the Sun, as suggested by the pre-eruptive magnetic field configuration. The radio emission consists of a large, extended structure, initially located ahead of the CME, that corresponds to various electron acceleration locations. Conclusions. The observations presented here are consistent with the breakout model of CME eruptions. The extended radio emission coincides with the location of the current sheet and quasi-separatrix boundary of the CME flux and the overlying helmet streamer and also with that of a large shock expected to form ahead of the CME in this configuration.
  • Janvier, Miho; Winslow, Reka; Good, Simon; Bonhomme, Elise; Démoulin, Pascal; Dasso, Sergio; Möstl, Christian; Lugaz, Noé; Amerstorfer, Tanja; Soubrié, Elie; Boakes, Peter D. (2019)
    We study interplanetary coronal mass ejections (ICMEs) measured by probes at different heliocentric distances (0.3-1 AU) to investigate the propagation of ICMEs in the inner heliosphere and determine how the generic features of ICMEs change with heliospheric distance. Using data from the MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER), Venus Express and ACE spacecraft, we analyze with the superposed epoch technique the profiles of ICME substructures, namely, the sheath and the magnetic ejecta. We determine that the median magnetic field magnitude in the sheath correlates well with ICME speeds at 1 AU, and we use this proxy to order the ICMEs at all spacecraft. We then investigate the typical ICME profiles for three categories equivalent to slow, intermediate, and fast ICMEs. Contrary to fast ICMEs, slow ICMEs have a weaker solar wind field at the front and a more symmetric magnetic field profile. We find the asymmetry to be less pronounced at Earth than at Mercury, indicating a relaxation taking place as ICMEs propagate. We also find that the magnetic field intensities in the wake region of the ICMEs do not go back to the pre-ICME solar wind intensities, suggesting that the effects of ICMEs on the ambient solar wind last longer than the duration of the transient event. Such results provide an indication of physical processes that need to be reproduced by numerical simulations of ICME propagation. The samples studied here will be greatly improved by future missions dedicated to the exploration of the inner heliosphere, such as Parker Solar Probe and Solar Orbiter.
  • Lorey, Martina B.; Rossi, Katriina; Eklund, Kari; Nyman, Tuula A.; Matikainen, Sampsa (2017)
    Gram-negative bacteria are associated with a wide spectrum of infectious diseases in humans. Inflammasomes are cytosolic protein complexes that are assembled when the cell encounters pathogens or other harmful agents. The non-canonical caspase-4/5 inflammasome is activated by Gram-negative bacteria-derived lipopolysaccharide (LPS) and by endogenous oxidized phospholipids. Protein secretion is a critical component of the innate immune response. Here, we have used label-free quantitative proteomics to characterize global protein secretion in response to non-canonical inflammasome activation upon intracellular LPS recognition in human primary macrophages. Before proteomics, the total secretome was separated into two fractions, enriched extracellular vesicle (EV) fraction and rest-secretome (RS) fraction using size-exclusion centrifugation. We identified 1048 proteins from the EV fraction and 1223 proteins from the RS fraction. From these, 640 were identified from both fractions suggesting that the non-canonical inflammasome activates multiple, partly overlapping protein secretion pathways. We identified several secreted proteins that have a critical role in host response against severe Gram-negative bacterial infection. The soluble secretome (RS fraction) was highly enriched with inflammation-associated proteins upon intracellular LPS recognition. Several ribosomal proteins were highly abundant in the EV fraction upon infection, and our data strongly suggest that secretion of translational machinery and concomitant inhibition of translation are important parts of host response against Gram-negative bacteria sensing caspase-4/5 inflammasome. Intracellular recognition of LPS resulted in the secretion of two metalloproteinases, a disintegrin and metalloproteinase domain-containing protein 10 (ADAM10) and MMP14, in the enriched EV fraction. ADAM10 release was associated with the secretion of TNF, a key inflammatory cytokine, and M-CSF, an important growth factor for myeloid cells probably through ADAM10-dependent membrane shedding of these cytokines. Caspase-4/5 inflammasome activation also resulted in secretion of danger-associated molecules S100A8 and prothymosin- in the enriched EV fraction. Both S100A8 and prothymosin- are ligands for toll-like receptor 4 recognizing extracellular LPS, and they may contribute to endotoxic shock during non-canonical inflammasome activation.
  • Passov, Arie; Schramko, Alexey; Mäkisalo, Heikki; Nordin, Arno; Andersson, Sture; Pesonen, Eero; Ilmakunnas, Minna (2019)
    Objective Ischaemia/reperfusion-injury degrades endothelial glycocalyx. Graft glycocalyx degradation was studied in human liver transplantation. Methods To assess changes within the graft, blood was drawn from portal and hepatic veins in addition to systemic samples in 10 patients. Plasma syndecan-1, heparan sulfate and chondroitin sulfate, were measured with enzyme-linked immunosorbent assay. Results During reperfusion, syndecan-1 levels were higher in graft caval effluent [3118 (934–6141) ng/ml, P = 0.005] than in portal venous blood [101 (75–121) ng/ml], indicating syndecan-1 release from the graft. Concomitantly, heparan sulfate levels were lower in graft caval effluent [96 (32–129) ng/ml, P = 0.037] than in portal venous blood [112 (98–128) ng/ml], indicating heparan sulfate uptake within the graft. Chondroitin sulfate levels were equal in portal and hepatic venous blood. After reperfusion arterial syndecan-1 levels increased 17-fold (P <0.001) and heparan sulfate decreased to a third (P <0.001) towards the end of surgery. Conclusion Syndecan-1 washout from the liver indicates extensive glycocalyx degradation within the graft during reperfusion. Surprisingly, heparan sulfate was taken up by the graft during reperfusion. Corroborating previous experimental reports, this suggests that endogenous heparan sulfate might be utilized within the graft in the repair of damaged glycocalyx.
  • Lakka, Antti; Pulkkinen, Tuija I.; Dimmock, Andrew P.; Kilpua, Emilia; Ala-Lahti, Matti; Honkonen, Ilja; Palmroth, Minna; Raukunen, Osku (2019)
    We study the response of the Earth's magnetosphere to fluctuating solar wind conditions during interplanetary coronal mass ejections (ICMEs) using the Grand Unified Magnetosphere-Ionosphere Coupling Simulation (GUMICS-4). The two ICME events occurred on 15-16 July 2012 and 29-30 April 2014. During the strong 2012 event, the solar wind upstream values reached up to 35 particles cm(-3), speeds of up to 694 km s(-1), and an interplanetary magnetic field of up to 22 nT, giving a Mach number of 2.3. The 2014 event was a moderate one, with the corresponding upstream values of 30 particles cm(-3), 320 km s(-1) and 10 nT, indicating a Mach number of 5.8. We examine how the Earth's space environment dynamics evolves during both ICME events from both global and local perspectives, using well-established empirical models and in situ measurements as references. We show that on the large scale, and during moderate driving, the GUMICS-4 results are in good agreement with the reference values. However, the local values, especially during high driving, show more variation: such extreme conditions do not reproduce local measurements made deep inside the magnetosphere. The same appeared to be true when the event was run with another global simulation. The cross-polar cap potential (CPCP) saturation is shown to depend on the Alfven-Mach number of the upstream solar wind. However, care must be taken in interpreting these results, as the CPCP is also sensitive to the simulation resolution.
  • Moller, Morten Hylander; Skrifvars, Markus B.; Azoulay, Elie (2017)
  • Jousi, Milla; Saikko, Simo; Nurmi, Jouni (2017)
    Background: Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making. Methods: Two samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples. The samples were analysed for sodium, potassium, ionized calcium, glucose, haemoglobin, haematocrit, pH, blood gases, base excess, bicarbonate, and lactate using the i-STAT (R) POC device. Agreement and reliability were estimated by using the Bland-Altman method and intraclass correlation coefficient calculations. Results: Good agreement was evident between the IO and arterial samples for pH, glucose, and lactate. Potassium levels were clearly higher in the IO samples than those from arterial blood. Base excess and bicarbonate were slightly higher, and sodium and ionised calcium values were slightly lower, in the IO samples compared with the arterial values. The blood gases in the IO samples were between arterial and venous values. Haemoglobin and haematocrit showed remarkable variation in agreement. Discussion: POC diagnostics of IO blood can be a useful tool to guide treatment in critical emergency care. Seeking out the reversible causes of cardiac arrest or assessing the severity of shock are examples of situations in which obtaining vascular access and blood samples can be difficult, though information about the electrolytes, acid-base balance, and lactate could guide clinical decision making. The analysis of IO samples should though be limited to situations in which no other option is available, and the results should be interpreted with caution, because there is not yet enough scientific evidence regarding the agreement of IO and arterial results among unstable patients. Conclusions: IO blood samples are suitable for analysis with the i-STAT (R) point-of-care device in emergency care. The aspirate used to confirm the correct placement of the IO needle can also be used for analysis. The results must be interpreted within a clinical context while taking the magnitude and direction of bias into account.
  • Järvinen, R.; Vainio, R.; Palmroth, M.; Juusola, L.; Hoilijoki, S.; Pfau-Kempf, Y.; Ganse, U.; Turc, L.; von Alfthan, S. (2018)
    We report ion acceleration by flux transfer events in the terrestrial magnetosheath in a global two-dimensional hybrid-Vlasov polar plane simulation of Earth's solar wind interaction. In the model we find that propagating flux transfer events created in magnetic reconnection at the dayside magnetopause drive fast-mode bow waves in the magnetosheath, which accelerate ions in the shocked solar wind flow. The acceleration at the bow waves is caused by a shock drift-like acceleration process under stationary solar wind and interplanetary magnetic field upstream conditions. Thus, the energization is not externally driven but results from plasma dynamics within the magnetosheath. Energetic proton populations reach the energy of 30 keV, and their velocity distributions resemble time-energy dispersive ion injections observed by the Cluster spacecraft in the magnetosheath.
  • Wallgren, Ulrika Margareta; Antonsson, Viktor Erik; Castren, Maaret; Kurland, Lisa (2016)
    Background: The presentation of sepsis is varied and our hypotheses were that septic patients with non-specific presentations such as decreased general condition (DGC) have a less favourable outcome, and that a screening tool could increase identification of these patients. We aimed to: 1) assess time to antibiotics and in-hospital mortality among septic patients with ED chief complaint DGC, as compared with septic patients with other ED chief complaints, and 2) determine whether a screening tool could improve identification of septic patients with non-specific presentations such as DGC. Methods: Cross sectional study comparing time to antibiotics (Mann Whitney and Kaplan-Meier tests), and in-hospital mortality (logistic regression), between 61 septic patients with ED chief complaint DGC and 516 septic patients with other ED chief complaints. The sensitivity and specificity of the modified Robson screening tool was compared with that of ED doctor clinical judgment (McNemar's two related samples test) among 122 patients presenting to the ED with chief complaint DGC, of which 61 were discharged with ICD code sepsis. Results: Septic patients presenting to the ED with the chief complaint DGC had a longer median time to antibiotics (05: 26 h: minutes; IQR 4: 00-10: 40, vs. 03: 56 h: minutes; IQR 2: 21-7: 32) and an increased in-hospital mortality (crude OR = 4.01; 95 % CI, 2.19-7.32), compared to septic patients with other ED chief complaints. This association remained significant when adjusting for sex, age, priority, comorbidity and fulfilment of the Robson score (OR 4.31; 95 % CI, 2.12-8.77). The modified Robson screening tool had a higher sensitivity (63.0 vs. 24.6 %, p <0.001), but a lower specificity (68.3 vs. 100.0 %, p <0.001), as compared to clinical judgment. Discussion: This is, to the best of our knowledge, the first study comparing outcome of septic patients according to ED chief complaint. Septic patients presenting with a non-specific ED presentation, here exemplified as the chief complaint DGC, have a less favourable outcome. Our results indicate that implementation of a screening tool may increase the identification of septic patients.
  • Palmerio, Erika; Scolini, Camilla; Barnes, David; Magdalenic, Jasmina; West, Matthew J.; Zhukov, Andrei N.; Rodriguez, Luciano; Mierla, Marilena; Good, Simon W.; Morosan, Diana E.; Kilpua, Emilia K. J.; Pomoell, Jens; Poedts, Stefaan (2019)
    We analyze in this work the propagation and geoeffectiveness of four successive coronal mass ejections (CMEs) that erupted from the Sun during 2013 May 21-23 and were detected in interplanetary space by the Wind and/or STEREO-A spacecraft. All these CMEs featured critical aspects for understanding so-called "problem space weather storms" at Earth. In the first three events a limb CMEs resulted in moderately geoeffective in situ structures at their target location in terms of the disturbance storm time (Dst) index (either measured or estimated). The fourth CME, which also caused a moderate geomagnetic response, erupted from close to the disk center as seen from Earth, but it was not visible in coronagraph images from the spacecraft along the Sun-Earth line and appeared narrow and faint from off-angle viewpoints. Making the correct connection between CMEs at the Sun and their in situ counterparts is often difficult for problem storms. We investigate these four CMEs using multiwavelength and multipoint remote-sensing observations (extreme ultraviolet, white light, and radio), aided by 3D heliospheric modeling, in order to follow their propagation in the corona and in interplanetary space and to assess their impact at 1 au. Finally, we emphasize the difficulties in forecasting moderate space weather effects that are provoked by problematic and ambiguous events and the importance of multispacecraft data for observing and modeling problem storms.
  • Inkinen, Nina; Selander, Tuomas; Pettila, Ville; Valkonen, Miia; Bäcklund, Minna; Wennervirta, Johanna; Pulkkinen, Anni; Hästbacka, Johanna; Vaara, Suvi T. (2020)
    Background Oliguria is a frequent trigger for administering a fluid bolus, but the effect of fluid bolus in improving urine output is inadequately demonstrated. Here, we summarize the protocol and detailed statistical analysis plan of the randomized, controlled RESPONSE trial comparing follow-up as the experimental group and a 500 mL crystalloid fluid bolus as the control group for oliguria in critically ill oliguric patients. Methods Our trial is an investigator-initiated, randomized, controlled, pilot trial conducted in three ICUs in two centers. We aim to randomize 1:1 altogether 130 hemodynamically stable oliguric patients either to a 2-hour follow-up without interventions or to receive a crystalloid bolus of 500 mL over 30 minutes. The primary outcome is the change in individual urine output during the 2-hour period compared to 2 hours preceding randomization. Doubling of the urine output is considered clinically significant. Additionally, we record the duration of oliguria, physiological and biochemical variables, adverse events, and the incidences of acute kidney injury and renal replacement therapy. Conclusions Oliguria is a frequent trigger for potentially harmful fluid loading. Therefore, the RESPONSE trial will give information of the potential effect of fluid bolus on oliguria in critically ill patients. Trial registration, NCT02860572.
  • Jiang, Xiaojie; Keto-Timonen, Riikka; Skurnik, Mikael; Korkeala, Hannu (2019)
    Yersinia pseudotuberculosis is an important foodborne pathogen threatening modern food safety due to its ability to survive and grow at low temperatures. DEAD-box RNA helicase CsdA has been shown to play an important role in the low-temperature growth of psychrotrophic Y. pseudotuberculosis. A total of five DEAD-box RNA helicase genes (rhlB, csdA, rhlE, dbpA, srmB) have been identified in Y. pseudotuberculosis IP32953. However, their role in various stress conditions used in food production is unclear. We studied the involvement of the DEAD-box RNA helicase-encoding genes in the cold tolerance of Y. pseudotuberculosis IP32953 using quantitative real-time reverse transcription (RT-qPCR) and mutational analysis. Quantitative RT-PCR revealed that mRNA transcriptional levels of csdA, rhlE, dbpA and srmB were significantly higher after cold shock at 3 degrees C compared to non-shocked culture at 28 degrees C, suggesting the involvement of these four genes in cold shock response at the transcriptional level. The deletion of csdA ceased growth, while the deletion of dbpA or srmB significantly impaired growth at 3 degrees C, suggesting the requirement of these three genes in Y. pseudotuberculosis at low temperatures. Growth of each DEAD-box RNA helicase mutant was also investigated under pH, osmotic, ethanol and oxidative stress conditions. The five helicase-encoding genes did not play major roles in the growth of Y. pseudotuberculosis IP32953 under pH, osmotic, ethanol or oxidative stress.
  • Ottesen, Anett H.; Carlson, Cathrine R.; Eken, Olav Sovik; Sadredini, Mani; Myhre, Peder L.; Shen, Xin; Dalhus, Bjorn; Laver, Derek R.; Lunde, Per Kristian; Kurola, Jouni; Lunde, Marianne; Hoff, Jon Erik; Godang, Kristin; Sjaastad, Ivar; Pettila, Ville; Stridsberg, Mats; Lehnart, Stephan E.; Edwards, Andrew G.; Lunde, Ida G.; Omland, Torbjorn; Stokke, Mathis K.; Christensen, Geir; Rosjo, Helge; Louch, William E. (2019)
    BACKGROUND: Circulating SN (secretoneurin) concentrations are increased in patients with myocardial dysfunction and predict poor outcome. Because SN inhibits CaMKII delta (Ca2+/calmodulin-dependent protein kinase II delta) activity, we hypothesized that upregulation of SN in patients protects against cardiomyocyte mechanisms of arrhythmia. METHODS: Circulating levels of SN and other biomarkers were assessed in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT; n=8) and in resuscitated patients after ventricular arrhythmia-induced cardiac arrest (n=155). In vivo effects of SN were investigated in CPVT mice (RyR2 [ryanodine receptor 2]-R2474S) using adeno-associated virus-9-induced overexpression. Interactions between SN and CaMKII delta were mapped using pull-down experiments, mutagenesis, ELISA, and structural homology modeling. Ex vivo actions were tested in Langendorff hearts and effects on Ca2+ homeostasis examined by fluorescence (fluo-4) and patchclamp recordings in isolated cardiomyocytes. RESULTS: SN levels were elevated in patients with CPVT and following ventricular arrhythmia-induced cardiac arrest. In contrast to NT-proBNP (N-terminal proB- type natriuretic peptide) and hs-TnT (high-sensitivity troponin T), circulating SN levels declined after resuscitation, as the risk of a new arrhythmia waned. Myocardial pro-SN expression was also increased in CPVT mice, and further adeno-associated virus-9-induced overexpression of SN attenuated arrhythmic induction during stress testing with isoproterenol. Mechanistic studies mapped SN binding to the substrate binding site in the catalytic region of CaMKII delta. Accordingly, SN attenuated isoproterenol induced autophosphorylation of Thr287-CaMKII delta in Langendorff hearts and inhibited CaMKII delta-dependent RyR phosphorylation. In line with CaMKII delta and RyR inhibition, SN treatment decreased Ca2+ spark frequency and dimensions in cardiomyocytes during isoproterenol challenge, and reduced the incidence of Ca2+ waves, delayed afterdepolarizations, and spontaneous action potentials. SN treatment also lowered the incidence of early afterdepolarizations during isoproterenol; an effect paralleled by reduced magnitude of L-type Ca2+ current. CONCLUSIONS: SN production is upregulated in conditions with cardiomyocyte Ca2+ dysregulation and offers compensatory protection against cardiomyocyte mechanisms of arrhythmia, which may underlie its putative use as a biomarker in at-risk patients.
  • Hästbacka, Johanna; Kirkegaard, Hans; Soreide, Eldar; Taccone, Fabio Silvio; Rasmussen, Bodil Steen; Storm, Christian; Kjaergaard, Jesper; Laitio, Timo; Duez, Christophe Henri Valdemar; Jeppesen, Anni N.; Grejs, Anders M.; Skrifvars, Markus B. (2021)
    Purpose: We explored whether severe or critical hypotension can be predicted, based on patient and resuscitation characteristics in out-of-hospital cardiac arrest (OHCA) patients. We also explored the association of hypotension with mortality and neurological outcome. Materials and methods: We conducted a post hoc analysis of the TTH48 study (NCT01689077), where 355 out-of-hospital cardiac arrest (OHCA) patients were randomized to targeted temperature management (TTM) treatment at 33 degrees C for either 24 or 48 h. We recorded hypotension, according to four severity categories, within four days from admission. We used multivariable logistic regression analysis to test association of admission data with severe or critical hypotension. Results: Diabetes mellitus (OR 3.715, 95% CI 1.180-11.692), longer ROSC delay (OR 1.064, 95% CI 1.022-1.108), admission MAP (OR 0.960, 95% CI 0.929-0.991) and non-shockable rhythm (OR 5.307, 95% CI 1.604-17.557) were associated with severe or critical hypotension. Severe or critical hypotension was associated with increased mortality and poor neurological outcome at 6 months. Conclusions: Diabetes, non-shockable rhythm, longer delay to ROSC and lower admission MAP were predictors of severe or critical hypotension. Severe or critical hypotension was associated with poor outcome. (C) 2020 Published by Elsevier Inc.
  • Moreau, J.; Kohout, T.; Wüennemann, K. (2017)
    We determined the shock-darkening pressure range in ordinary chondrites using the iSALE shock physics code. We simulated planar shock waves on a mesoscale in a sample layer at different nominal pressures. Iron and troilite grains were resolved in a porous olivine matrix in the sample layer. We used equations of state (Tillotson EoS and ANEOS) and basic strength and thermal properties to describe the material phases. We used Lagrangian tracers to record the peak shock pressures in each material unit. The post-shock temperatures (and the fractions of the tracers experiencing temperatures above the melting point) for each material were estimated after the passage of the shock wave and after the reflections of the shock at grain boundaries in the heterogeneous materials. The results showed that shock-darkening, associated with troilite melt and the onset of olivine melt, happened between 40 and 50GPa with 52GPa being the pressure at which all tracers in the troilite material reach the melting point. We demonstrate the difficulties of shock heating in iron and also the importance of porosity. Material impedances, grain shapes, and the porosity models available in the iSALE code are discussed. We also discuss possible not-shock-related triggers for iron melt.