Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study

BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.

City-Bus-Route Demand-based Efficient Coupling Driving Control for Parallel Plug-in Hybrid Electric Bus

Recently,plug?in hybrid electric bus has been one of the energy?e cient solutions for urban transportation. However,the current vehicle e ciency is far from optimum,because the unpredicted external driving conditions are di cult to be obtained in advance. How to further explore its fuel?saving potential under the complicated city bus driving cycles through an e cient control strategy is still a hot research issue in both academic and engineering area. To realize an e cient coupling driving operation of the hybrid powertrain,a novel coupling driving control strategy for plug?in hybrid electric bus is presented. Combined with the typical feature of a city?bus?route,the fuzzy logic inference is employed to quantify the driving intention,and then to determine the coupling driving mode and the gear?shifting strategy. Considering the response deviation problem in the execution layer,an adaptive robust controller for electric machine is designed to respond to the transient torque demand,and instantaneously compensate the response delay and the engine torque fluctuation. The simulations and hard?in?loop tests with the actual data of two typical driving conditions from the real?world city?bus?route are carried out,and the results demonstrate that the pro?posed method could guarantee the hybrid powertrain to track the actual torque demand with 10.4% fuel economy improvement. The optimal fuel economy can be obtained through the optimal combination of working modes. The fuel economy of plug?in hybrid electric bus can be significantly improved by the proposed control scheme without loss of drivability.

Improving properties of fluxed iron ore pellets with high-silica by regulating liquid phase

With rapid development of the pellet production under the background of green development,high-quality iron concentrates were gradually exhausted;thus,using high-silica iron concentrates was expected to be a promising way to relieve resource pressure for pellet production.However,increasing the proportion of high-silica acid pellets into the furnace led to worse blast furnace slag,and the metallurgical properties of high-silica pellets were imperfect.To understand the reciprocal effects of basicity(CaO/SiO_(2))and MgO content on the properties of the high-silica pellets,the phase compositions and microstructure were investigated using X-ray diffraction and scanning electron microscope,equipped with energy dispersive X-ray spectrometry.The results indicated that simply increasing MgO content from O to 2.50 wt.%could decrease the reduction swelling index,but the compressive strength rapidly declined due to the formation of magnesioferrite.However,adding CaO to 2.50 wt.%MgO pellets greatly improved the pellet qualities,which could be attributed to a substantial increase in the amount of high-melting-point silicate liquid phase.

Preparation of blast furnace burdens by composite agglomeration process: effect of distribution of magnetite and hematite concentrates in pelletized and matrix feed

Effect of distribution of iron concentrates between pelletized and matrix feed on the preparation of blast furnace burdens from two different kinds of fine iron concentrates (magnetite and hematite) by composite agglomeration process (CAP) was explored. It was found that when the mass ratio of iron concentrate A (magnetite) to iron concentrate B (hematite) in the mixed feed was constant, the proportion of iron concentrate A in the pelletized and matrix feed significantly affected the quality of CAP products. Particularly, as the proportion of iron concentrate A in the pelletized feed increased from 0 to 100%, the yield decreased from 82.11% to 79.19% and the tumbler index decreased from 71.33% to 68.27%. The mineralization characterization results indicated that when 100% iron concentrate A was used as the pelletized feed, the crystallization styles of the outer layer and the inner layer of the pellet were different, and a lot of pores exist around hematite and magnetite phases in the pelletized part, with the weak connection of pelletized and matrix part, resulting in poor strength of agglomeration product.