脑血流动力学及脑氧饱和度变化与感染性休克患者预后的相关性:前瞻性队列研究

目的探讨大脑中动脉血流动力学相关指标及脑氧饱和度变化与感染性休克患者预后的相关性。方法前瞻性收集2018年5月至2019年3月在中南大学湘雅医院重症医学科住院治疗的感染性休克患者临床资料,根据28 d内是否死亡,将患者分为死亡组和存活组。比较两组患者一般资料,入重症监护室即刻和初始复苏治疗6 h后动脉和中心静脉血气指标,重症心脏超声指标,器官功能指标,Sepsis生物标志物指标,液体复苏治疗6 h后大脑中动脉血流速度、灌注指数、动态脑血管自动调节功能[瞬时脑充血反应率(transient hyperemic response ratio,THRR)]以及脑氧饱和度变化。采用多因素Logistic回归,分析影响感染性休克患者预后的危险因素。结果 51例符合纳入和排除标准的感染休克患者入选本研究,男性31例,女性20例,年龄(53±13)岁,28 d死亡率为43%。死亡组的序贯性器官衰竭评分(sequential organ failure assessment,SOFA)(P=0. 007)、入室急性生理和慢性健康状况评估(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分(P=0. 026)以及高峰APACHEⅡ评分(P<0. 001)均高于存活组。初始复苏治疗6 h后,死亡组的氧合指数低于存活组(P=0. 047),而中心静脉-动脉二氧化碳分压差(central venous-to-arterial carbon dioxide difference,Pcva CO_2)则高于存活组(P=0. 044)。死亡组动态脑血管自动调节功能受损者(THRR<1. 09)多于存活组(P=0. 025),脑氧饱和度(regional cerebral oxygen saturation,rSO_2)均值低于存活组(P=0. 031)且rSO_2均值<60%者多于存活组(P=0. 010)。多因素Logistic回归分析显示,高峰APACHEⅡ评分(OR=1. 099,95%CI:1. 009～1. 196,P=0. 030)、液体复苏治疗6 h后的Pcv-aCO_2(OR=1. 320,95%CI:1. 001～1. 742,P=0. 050)、THRR<1. 09 (OR=4. 952,95%CI:1. 130～21. 70,P=0. 034)和rSO_2均值<60%(OR=4. 817,95%CI:1. 392～16. 663,P=0. 013)是预测感染性休克患者28 d内死亡的独立危险因素。结论感染性休克患者死亡率高,脑血流动力学和rSO_2指标中动态脑血管自动调节功能障碍(THRR<1. 09)与rSO_2均值<60%是28 d死亡率增加的独立预测因素。     

术前2h饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响:前瞻性随机对照研究

目的应用床旁超声技术观察术前2 h饮用碳水化合物对老年胃肠道手术患者麻醉前胃容量的影响,并评估患者发生反流误吸的风险。方法前瞻性选取2017年12月至2018年10月,在四川省人民医院行胃肠道手术的老年患者(>65岁),随机分为试验组和对照组。试验组常规禁食8 h,术前2 h口服200 ml碳水化合物;对照组要求术前禁食8 h,禁饮4 h。麻醉前采用床旁超声技术测量45°半坐位及右侧卧位胃窦部头尾径及前后径,分别计算两种体位下的胃窦部横截面积(cross-sectional area,CSA)、胃容量(gastric volume,GV)及胃容量与体重比(GV/weight,GV/W)。采用GV超声半定量3分评估法及GV/W分级法评估患者发生反流误吸的风险。结果共纳入69例符合入选和排除标准的患者,其中试验组33例,对照组36例。两组基线资料、手术类别及美国麻醉医师学会分级无统计学差异(P均>0. 05)。半坐位下,试验组和对照组的GV/W分别为(0. 57±0. 23) ml/kg和(0. 44±0. 21) ml/kg;右侧卧位下,试验组和对照组的CSA分别为(578. 8±71. 5) mm2和(513. 3±53. 2) mm2,GV分别为(21. 2±11. 1) ml和(12. 9±6. 8) ml,GV/W分别为(0. 36±0. 17) ml/kg和(0. 20±0. 11) ml/kg,上述指标两组间均存在统计学差异(P均<0. 05)。GV超声半定量评分:试验组0分17例(51. 5%,17/33),1分15例(45. 5%,15/33),2分1例(3. 0%,1/33),对照组0分25例(69. 4%,25/36),1分11例(30. 6%,11/36),2分0例(0,0/33),两组评分构成比无统计学差异(P>0. 05)。反流误吸风险评估:试验组极低风险者占比81. 8%(27/33)、低风险18. 2%(6/33)、高风险0 (0/33),对照组极低风险者占比94. 4%(34/36)、低风险5. 6%(2/36)、高风险0 (0/33),两组间构成比亦无统计学差异(P>0. 05)。结论老年胃肠道手术患者术前2 h饮用200 ml碳水化合物虽可以增加麻醉前胃容量,但并不增加反流误吸的风险。     

肾脏叶间动脉阻力指数对Ⅰ型心肾综合征的诊断价值

目的探讨彩色多普勒超声测量肾脏叶间动脉阻力指数(resistance index,RI)对Ⅰ型心肾综合征(cardiorenal syndrome,CRS)的诊断价值。方法选取2017年6月1日至2018年3月1日收住民航总医院急诊综合病房并诊断为Ⅰ型CRS的20例患者作为试验组(CRS组),选取同期诊断为单纯急性心力衰竭的患者20例作为对照组,分析两组患者的临床特征、实验室检查及用药情况,并根据受试者工作特征(receiver operating characteristic,ROC)曲线评价肾动脉RI对Ⅰ型CRS的诊断价值。结果两组患者年龄、左心室射血分数、心功能分级、心率及脉压差差异无统计学意义(P均>0. 05),CRS组患者的氨基末端脑钠尿肽、肌酐水平、呋塞米剂量以及肾动脉RI均高于对照组,而肾小球滤过率低于对照组,差异具有统计学意义(P均<0. 05)。ROC曲线下面积为0. 78,取最佳截点值0. 70时预测Ⅰ型CRS的敏感度为80%,特异度为80%。结论作为一种新的手段,肾动脉RI可与传统方法相互补充,对诊断Ⅰ型心肾综合征患者具有潜在应用价值。     

镍基MOF电极材料物理超声改性及电化学性能

采用水热法合成了以4,4′-联苯二甲酸(BPDC)为配体的Ni-金属有机框架(MOF),利用低成本、无污染的物理超声法在不改变Ni-MOF晶体结构的前提下对其进行改性,使块状Ni-MOF表面产生孔隙,改善Ni-MOF表面微/纳米结构,提高其电化学性能。通过扫描电子显微镜(SEM)图、X射线衍射(XRD)谱、循环伏安(CV)曲线和恒电流充放电(GCD)曲线分析了改性前后Ni-MOF的微结构形貌和电化学性能。结果表明,经过超声处理后,Ni-MOF的比表面积从40.6 m^2·g^-1增加到65.8 m^2·g^-1,平均孔径从12 nm增加到22 nm。在0.5 A·g^-1电流密度下,超声处理后Ni-MOF电极比电容从420 F·g^-1增加到515 F·g^-1,提高了22.6%,电荷转移电阻明显降低,从25.11Ω降低到15.51Ω。因此,物理超声法可有效改善Ni-MOF表面微/纳米结构,提高其电化学性能。     

Innovative focused ultrasound-based sealing method of flexible packaging films—Principles and characteristics

A key process to package goods is the closure procedure. It ensures the good protection against the environment and vice versa. Ultrasonic sealing presents the advantage of converting locally ultrasound into heat, which is optimal for temperature sensitive goods. The disadvantages remain, however, the equipment cost, the noise generation, and the process sensitivity to materials. It is necessary to develop a sealing process to decrease the acquisition cost of the sealing equipment and cover a wide range of polymer films. This paper focuses on a new sealing method based on high-intensity focused ultrasound. The principles and characteristics of this process are discussed and underpinned with experimental results. Both the acoustic and thermal effects of the sealing process are summarized. A study of the process parameter impact on the seam strength in static and dynamic operating is proposed. Low-density polyethylene films with a carrier layer of bi-oriented polypropylene and polyethylene terephthalate are used. A first test bench generates point-shaped seam. The heat generation is recorded with an infrared thermography system. A second test bench, a horizontal form fill and seal machine, produces longitudinal seams. The seam quality is controlled by tensile test and tightness test. A quick heating of the polymer films is found. Point seams and longitudinal seams are successfully generated. The seams behave similarly to the ones generated with ultrasonic sealing process. However, the sealing velocity is limited to 3 m/min. This work provides a summary of the characteristics and principles of the new sealing method in packaging applications.     

Effect of ultrasound on the true flotation of lignite and its entrainment behavior

In this study, the ultrasound was fixed in the pulp zone of flotation cell and its effect on the true flotation of lignite was analyzed. Flotation results indicated that the simultaneous ultrasound treatment increased the concentrate yield and decreased the concentrate ash content. Screening analysis of flotation products revealed that the ultrasound could crush coarse coal to fine coal and scanning electron microscopy (SEM) tests indicated that the ultrasound could reduce the coverage of high-ash coal fines on the coarse particle surface. Thus, the flotation recovery of coarse lignite particle was increased. In addition, the true flotation and entrainment of ?0.074 mm fine particles were studied by the sink-float test and the method of Trahar. It was found the ultrasound significantly enhanced the true flotation of fine particles and improved the overall water recovery in lignite flotation.     

SnO2纳米颗粒对Sn0.6Cu钎料微观组织及界面金属间化合物的影响

本文利用超声波辅助法制备了SnO2纳米颗粒增强Sn0.6Cu钎料。研究了SnO2对钎料的微观组织、熔化性能的影响，以及Cu/Sn0.6Cu-XSnO2/Cu钎焊接头界面反应产物的变化，测量了金属间化合物层的厚度和晶粒尺寸。结果表明：1.0wt.% SnO2很好的抑制了钎料中β-Sn的长大，细化了晶粒尺寸；含SnO2钎料的熔点与不含SnO2钎料熔点基本相同，但熔程明显减小；钎料熔炼过程中施加超声波可以细化晶粒，制得的钎料熔点和液相线温度也低于普通熔炼钎料。用含SnO2钎料钎焊接头界面处的IMC层更薄且晶粒尺寸更小，主要是因为SnO2纳米颗粒吸附在界面金属间化合物的晶面处阻碍铜板与钎料基体之间的相互扩散，导致IMC的形成驱动力较低，从而抑制了界面化合物的生长。     

High-intensity ultrasound processed acerola juice containing oligosaccharides and dextran promotes Lacticaseibacillus casei NRRL B-442 growth

In the present study, a prebiotic acerola juice containing gluco-oligosaccharides and dextran was produced and processed by high-intensity ultrasound (HIUS). After a simulated in vitro digestion, the gluco-oligosaccharides and dextran maintained 90% and 80% of their initial concentration in all prebiotic’s juices. At the same time, Vitamin C and phenolic compounds concentration increased significantly by 19% and 7% (P < 0.05). After the in vitro digestion, the prebiotic juice HIUS processed by 10 min showed the highest increase in gluco-oligosaccharides and bioactive compound concentrations. The HIUS processing imparted some dextran hydrolysis and improved its fermentability by Lacticaseibacillus casei. Gluco-oligosaccharides were extensively consumed as substrate in simulated intestinal conditions, promoting the L. casei NRRL B-442 growth and production of organic acids and short-chain organic acids. The prebiotic juice HIUS processed for 6 min showed the best responses regarding the metabolism of L. casei NRRL B-442. The results showed high-intensity ultrasound processed acerola juices containing gluco-oligosaccharides and dextran as a prebiotic food.     

The production of volatile compounds in model casein systems with varying fat levels as affected by low-frequency ultrasound

The effects of low-frequency ultrasound on the production of volatile compounds in model casein protein systems containing various fat concentrations of 2%, 4% and 6% (w/w) were investigated. Ultrasound application was performed at 20 kHz for up to 10 min which corresponded to energy densities ranging from 9.54 to 190.8 J mL⁻¹. Similar volatile compounds were detected both in pure fat and mixtures of casein and fat (CF) systems. These volatiles belonged to the groups of aldehydes, ketones, esters, alcohols and hydrocarbons, which were the products of oxidation of lipids or protein degradation due to acoustic cavitation. The amount of fat in the casein systems had minor effects on the production of volatiles, whereas the production of volatile compounds was significantly affected by the ultrasound treatment. Short sonication times <5 min generated similar volatile profiles to the untreated samples. In contrast, prolonged sonication for 5 and 10 min considerably increased the production of volatile compounds and the amounts of fatty acids. Thus, the application of low–frequency ultrasound for short periods should be considered to minimise the production of volatile compounds which can ultimately affect the taste.