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Splenic artery aneurysm (SAA) is a rare condition; however, it is one of the most common intra-abdominal aneurysm. In the emergency department (ED), due to an uncommon cause of shock and syncope in SAA, it poses great diagnostic challenge for emergency physicians. Here we reported a case of spontaneous rupturing of SAA. A 47-year-old man presented to the ED for syncope and shock. As he had unstable hemodynamic, we gave him fluid resuscitation and point-of-care ultrasound (POCUS), free intraperitoneal fluid was identified on ultrasound, then hemorrhagic ascites was identified by a diagnostic abdominal paracentesis. The rare but life-threatening diagnosis of spontaneous rupturing of SAA was confirmed by contrast-enhanced Computed Tomography and surgery. Spontaneous SAA rupturing is a rare fatal condition which needs immediate diagnosis and management to achieve a favorable outcome. Though there are no risk factors, emergency physicians should consider SAA in the differential diagnosis of sudden collapse. Also, as an emergency physician, it is very important to be a master of first aid skills such as POCUS and treat patients according to the process.

This study aimed to explore the impact of different pH values of resuscitation fluid on traumatic hemorrhagic shock (THS), focusing on their effects on glycocalyx and inflammation. A rat model of THS was induced by hemorrhage from a left femur fracture, while an oxygen‐glucose deprivation/reoxygenation (OGD/R)‐induced HULEC‐5a cell model was considered as an in vitro THS model. The lung tissue pathology and glycocalyx structure were assessed through hematoxylin–eosin (H&E) staining and transmission electron microscope examination. The levels of glycocalyx‐related factors and inflammation‐related factors were determined by enzyme‐linked immunosorbent assay (ELISA). The expression of glycocalyx‐related proteins, cell junction‐related proteins, and proteins involved in the PI3K/Akt/NF‐κB signaling pathway was analyzed by western blot. The results showed that both sodium bicarbonate Ringer's solution (BRS) and lactate Ringer's solution (LRS) were effective in restoring mean arterial pressure and heart rate in THS rats. However, LRS has a stronger impact on promoting inflammation and damaging the glycocalyx compared with BRS. In OGD/R‐induced HULEC‐5a cells, a pH of 7.4 and 6.5 increased inflammation and disrupted the glycocalyx, while a pH of 8.1 had no significant effect on inflammation or glycocalyx. Furthermore, the PI3K/Akt/NF‐κB signaling pathway was activated by fluid resuscitation and different pH values. However, the activating effect of BRS and pH 8.1 on the PI3K/Akt/NF‐κB signaling pathway was milder compared with LRS and pH6.5. In conclusion, an alkaline recovery environment was more beneficial for the treatment of THS. [ABSTRACT FROM AUTHOR]

The creep failure for a lattice truss sandwich panel structure has been predicted by finite element method (FEM). The creep damage is calculated by three kinds of stresses: as-brazed residual stress, operating thermal stress and mechanical load. The creep damage at tensile and compressive loads have been calculated and compared. The creep rate calculated by FEM, Gibson–Ashby and Hodge–Dunand models have been compared. The results show that the creep failure is located at the fillet at both tensile and creep loads. The damage rate at the fillet at tensile load is 50 times as much as that at compressive load. The lattice truss panel structure has a better creep resistance to compressive load than tensile load, because the creep and stress triaxiality at the fillet has been decreased at compressive load. The maximum creep strain at the fillet and the equivalent creep strain of the panel structure increase with the increase of applied load. Compared with Gibson–Ashby model and Hodge–Dunand models, the modified Gibson–Ashby model has a good prediction result compared with FEM. However, a more accurate model considering the size effect of the structure still needs to be developed.

In this paper, the modified formulae have been provided. They can be used to calculate the stress in layers with gaps of a layered cylinder In order to obtain the modified formulae, a detailed derivation process has also been presented in this paper. Meanwhile, we have clarified the derivation process and application range of Pimshtein's formulae and corrected the errors. We have also indicated the shortcomings of the formulae given by Huang, Chen and Lai, and the ASME code. Finally, a practical example is presented to show how the modified formulae are applied. Calculation results obtained from the modified formulae have been compared with those obtained by finite element method and above mentioned formulae; it shows that the results from the modified formulae are in accordance with finite element results. [DOI: 10.1115/1.4001658] Keywords: layered vessel interlayer gaps, modified formulae, stress calculation

A failure analysis was performed on a fractured twin‐screw pump shaft. Through the analysis of the macromorphology and microstructure of the fracture, the analysis of the chemical compositions of shaft material, the metallographic test of the specimens cut from the fracture, the investigation of the operating condition of the pump, the main reason for the fracture can be described as the increased rotating and bending load caused by low viscosity medium. Corresponding preventive measures were put forward. © 2017 American Institute of Chemical Engineers Process Process Saf Prog 37:95–103, 2018 [ABSTRACT FROM AUTHOR]

Objective: To explore the cause of early death (death within 3-12 months after hemodialysis) and the related influencing factors patients undergoing maintenance hemodialysis (MHD) as to provide a scientific basis for the prevention of early death., Methods: A retrospective matched controlled study was conducted. Fifty-one patients who underwent MHD from January 2004 to April 2014 and died within 3-12 months after hemodialysis in hemodialysis center of the 174th Chinese People's Liberation Army Hospital were included in the case group by retrospective analysis method. According to 1:2 matched controls, 102 patients underwent hemodialysis in the same period (±2 months) and survived over 12 months were selected as control group. All patients received regular hemodialysis (dialysis 2-3 times per week), with conventional limitation of water and sodium intake, routine treatments such as control of blood pressure, treatment of anemia and disorders of calcium and phosphorus contents. Causes of short-term death were analyzed. Clinical and biochemical parameters of two groups were collected when dialysis was started, and the single factor and multiple factors logistic regression was used to analyze the related risk factors when dialysis was started. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of above parameters in predicting the early death in patents with MHD., Results: The main causes of early death of 51 patients with MHD were mainly cardiovascular and cerebrovascular diseases (27 cases, 52.9%), and infections (15 cases, 29.4%). It was shown by single factor analysis that the age [odds ratio (OR) = 6.625, 95% confidence interval (95%CI) = 3.232-13.580, P = 0.000 ], diabetes (OR = 3.875, 95%CI = 0.654 - 10.622, P = 0.031), specialist intervention time before dialysis (OR = 0.349, 95%CI = 0.287 - 0.572, P = 0.004), the emergence of cardiovascular and cerebrovascular events before dialysis (OR = 9.667, 95%CI = 4.632 - 20.174, P = 0.000), the first dialysis for emergency dialysis (OR = 3.875, 95%CI = 1.713 - 8.765, P = 0.005), blood albumin level (OR = 0.294, 95%CI = 0.068 - 0.550, P = 0.008), leukocyte count (OR = 6.286, 95%CI = 1.648 - 23.982, P = 0.026), neutrophil count (OR = 2.833, 95%CI = 1.630 - 4.923, P = 0.001) might be the factors correlating with early death. Eight independent factors were statistically significant, and their effect on the MHD patients was analyzed by logistic regression analysis in α = 0.05 level. The results showed that patients with old age (OR = 1.054, 95%CI = 1.019-1.090, P = 0.002), and the emergence of cardio-cerebrovascular events (OR = 7.469, 95%CI = 2.474 - 22.545, P = 0.000) were early death risk factors of MHD patients, and early specialist intervention before dialysis was a protective factor (OR = 0.286, 95%CI = 0.113-0.722, P = 0.008). ROC curve showed that age had moderate diagnostic value for early death of MHD [area under ROC curve (AUC) = 0.756], the cut-off value was 59.0 years old, the sensitivity was 66.7%, and the specificity was 77.5%. The diagnostic value of early specialist intervention before dialysis was relatively low (AUC = 0.36), the cut-off value was 0.875 years, the sensitivity was 39.2%, and the specificity was 33.3%., Conclusions: Old age, the emergency of cardiovascular and cerebrovascular events before dialysis is associated with early death, and specialist intervention ahead of dialysis can reduce the risk of early death.