To flip or not: Case series of coronary angioplasty in patients with right-sided heart.

Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.

Metamemory and executive function mediate the age-related decline in memory.

OBJECTIVE: Although the effect of aging on episodic memory is relatively well studied, little is known about how aging influences metamemory. In addition, while executive function (EF) is known to mediate the age-related decline in episodic memory, the role of metamemory in aging-related memory differences beyond EF remains unknown. This study aimed to elucidate the effect of aging on metamemory and to clarify the role of metamemory in the age-related decline in memory. METHOD: One hundred and four adults aged 18-79 years (50 M, 54 F) performed several EF tasks, as well as a face-scene paired-associate learning task that required them to make judgments of learning, feeling-of-knowing judgments, and retrospective confidence judgments. RESULTS: Aging was significantly associated with poor metamemory accuracy and increased confidence across metamemory judgment types, even after controlling for EF and memory performance. A parallel mediation analysis indicated that both confidence of learning and EF performance had significant partial mediation effects on the relationship between aging and memory, albeit in different ways. Specifically, poor EF explained the age-related decline in memory, whereas increased confidence of learning served to compensate for this memory decline. CONCLUSIONS: Aging is associated with general changes (i.e., poor inferences from cues) rather than specific changes (i.e., declined activation or utilization of certain cues) in metamemory monitoring. Also, changes in confidence of learning and in EF ability contribute to the preservation and decline of memory during aging, respectively. Therefore, boosting confidence during encoding and enhancing EF skills might be complementary memory intervention strategies for older adults.

Cortical activity during online motor control in children with and without developmental coordination disorder: a cross-sectional functional near-infrared spectroscopy study.

BACKGROUND: Children with developmental coordination disorder (DCD) have impaired online motor control. Researchers posit that this impairment could be due to a deficit in utilizing the internal model control process. However, there is little neurological evidence to support this view because few neuroimaging studies have focused specifically on tasks involving online motor control. Therefore, the aim of this study was to investigate the differences in cortical hemodynamic activity during an online movement adjustment task between children with and without DCD. METHODS: Twenty children with DCD (mean age: 9.88 ± 1.67 years; gender: 14M/6F) and twenty age-and-gender matched children with typical development (TD) (mean age: 9.87 ± 1.59 years; gender: 14M/6F) were recruited via convenience sampling. Participants performed a double-step reaching task under two conditions (with and without online adjustment of reaching). Cortical hemodynamic activity during task in ten regions of interest, including bilateral primary somatosensory cortex, primary motor cortex, premotor cortex, superior parietal cortex, and inferior parietal cortex was recorded using functional near-infrared spectroscopy. In the analyses, change in oxyhemoglobin (ΔHbO) concentration was used to characterize hemodynamic response. Two-way analyses of variance were conducted for each region of interest to compare hemodynamic responses between groups and conditions. Additionally, Pearson's r correlations between hemodynamic response and task performance were performed. RESULTS: Outcome showed that children with DCD required significantly more time to correct their reaching movements compared to the control group (t = 3.948, P < 0.001). Furthermore, children with DCD have a significantly lower ΔHbO change in the left superior parietal cortex during movement correction, compared to children with TD (F = 4.482, P = 0.041). Additionally, a significant negative correlation (r = - 0.598, P < 0.001) was observed between the difference in movement time of reaching and the difference in ΔHbO between conditions in the left superior parietal cortex. CONCLUSIONS: The findings of this study suggest that deficiencies in processing real-time sensory feedback, considering the function of the superior parietal cortex, might be related to the impaired online motor control observed in children with DCD. Interventions could target this issue to enhance their performance in online motor control.

Effects of age on the interactions of attentional and emotional processes: a prefrontal fNIRS study.

The aging of attentional and emotional functions has been extensively studied but relatively independently. Therefore, the relationships between aging and the interactions of attentional and emotional processes remain elusive. This study aimed to determine how age affected the interactions between attentional and emotional processes during adulthood. One-hundred forty adults aged 18-79 performed the emotional variant of the Attention Network Test, which probed alerting, orienting, and executive control in the presence and absence of threatening faces. During this task, contexts with varying levels of task preparatory processes were created to modulate the effect of threatening faces on attention, and functional near-infrared spectroscopy (fNIRS) was used to examine the neural underpinnings of the behavioural effects. The behavioural results showed that aging was associated with a significant decline in alerting efficiency, and there was a statistical trend for age-related deficits in executive control. Despite these age differences, age did not significantly moderate the interactions among attentional networks or between attention and emotion. Additionally, the fNIRS results showed that decreased frontal cortex functioning might underlie the age-related decline in executive control. Therefore, while aging has varying effects on different attentional networks, the interactions of attentional and emotional processes remain relatively unaffected by age.

Calibrating the Dice Loss to Handle Neural Network Overconfidence for Biomedical Image Segmentation.

The Dice similarity coefficient (DSC) is both a widely used metric and loss function for biomedical image segmentation due to its robustness to class imbalance. However, it is well known that the DSC loss is poorly calibrated, resulting in overconfident predictions that cannot be usefully interpreted in biomedical and clinical practice. Performance is often the only metric used to evaluate segmentations produced by deep neural networks, and calibration is often neglected. However, calibration is important for translation into biomedical and clinical practice, providing crucial contextual information to model predictions for interpretation by scientists and clinicians. In this study, we provide a simple yet effective extension of the DSC loss, named the DSC++ loss, that selectively modulates the penalty associated with overconfident, incorrect predictions. As a standalone loss function, the DSC++ loss achieves significantly improved calibration over the conventional DSC loss across six well-validated open-source biomedical imaging datasets, including both 2D binary and 3D multi-class segmentation tasks. Similarly, we observe significantly improved calibration when integrating the DSC++ loss into four DSC-based loss functions. Finally, we use softmax thresholding to illustrate that well calibrated outputs enable tailoring of recall-precision bias, which is an important post-processing technique to adapt the model predictions to suit the biomedical or clinical task. The DSC++ loss overcomes the major limitation of the DSC loss, providing a suitable loss function for training deep learning segmentation models for use in biomedical and clinical practice. Source code is available at https://github.com/mlyg/DicePlusPlus .

Causal Prefrontal Contributions to Stop-Signal Task Performance in Humans.

The frontal lobes have long been implicated in inhibitory control, but a full understanding of the underlying mechanisms remains elusive. The stop-signal task has been widely used to probe instructed response inhibition in cognitive neuroscience. The processes involved have been modeled and related to putative brain substrates. However, there has been surprisingly little human lesion research using this task, with the few existing studies implicating different prefrontal regions. Here, we tested the effects of focal prefrontal damage on stop-signal task performance in a large sample of people with chronic focal damage affecting the frontal lobes (n = 42) and demographically matched healthy individuals (n = 60). Patients with damage to the left lateral, right lateral, dorsomedial, or ventromedial frontal lobe had slower stop-signal RT compared to healthy controls. There were systematic differences in the patterns of impairment across frontal subgroups: Those with damage to the left or right lateral and dorsomedial frontal lobes, but not those with ventromedial frontal damage, were slower than controls to "go" as well as to stop. These findings suggest that multiple prefrontal regions make necessary but distinct contributions to stop-signal task performance. As a consequence, stop-signal RT slowing is not strongly localizing within the frontal lobes.

An optical window into brain function in children and adolescents: A systematic review of functional near-infrared spectroscopy studies.

Despite decades of research, our understanding of functional brain development throughout childhood and adolescence remains limited due to the challenges posed by certain neuroimaging modalities. Recently, there has been a growing interest in using functional near-infrared spectroscopy (fNIRS) to elucidate the neural basis of cognitive and socioemotional development and identify the factors shaping these types of development. This article, focusing on the fNIRS methods, presents an up-to-date systematic review of fNIRS studies addressing the effects of age and other factors on brain functions in children and adolescents. Literature searches were conducted using PubMed and PsycINFO. A total of 79 fNIRS studies involving healthy individuals aged 3-17 years that were published in peer-reviewed journals in English before July 2020 were included. Six methodological aspects of these studies were evaluated, including the research design, experimental paradigm, fNIRS measurement, data preprocessing, statistical analysis, and result presentation. The risk of bias, such as selective outcome reporting, was assessed throughout the review. A qualitative synthesis of study findings in terms of the factor effects on changes in oxyhemoglobin concentration was also performed. This unregistered review highlights the strengths and limitations of the existing literature and suggests directions for future research to facilitate the improved use of fNIRS in developmental cognitive neuroscience research.

Two-Dimensional Covalent Organic Framework Solid Solutions.

Covalent organic frameworks (COFs) generally leverage one or two monomers with specific sizes and shapes to access highly symmetric and periodic polymer networks. Almost all reported COFs employ the minimum sets of monomers needed for the polymerization (usually two, sometimes one) and crystallize in high-symmetry topologies. COFs synthesized from more than two monomers usually employ mixtures with different pendant functionalities to distribute these groups statistically throughout the structure, or monomers with different sizes in ratios targeting lower symmetry topologies. Here, we demonstrate that mixtures of monomers with different lengths generate single-phase, hexagonal two-dimensional covalent organic framework (2D COF) solid solutions at continuously variable feed ratios. X-ray diffraction measurements, Fourier-transform infrared spectroscopy, and Pawley refinement indicate that both monomers distribute randomly within the same lattice, and the lattice parameters continuously increase as more of the larger linker is incorporated. Furthermore, COF solid solutions are accessed directly by polymerizing a mixture of monomers but not via linker exchange from a preformed COF. As strain develops from the lattice accommodating monomers with different sizes, the nonlinear relationship between the monomer incorporation and the COF's lattice parameters suggests that bond-bending of the monomers plays a role in incorporating monomers of different lengths into the solid solutions. Solid solution formation represents a new strategy to design 2D COFs and increase their complexity. Specifically, varying the monomer composition of a given network enables many properties, such as the average pore size, to be continuously tuned between those of corresponding pure COFs.

A Systematic Review of the Application of Functional Near-Infrared Spectroscopy to the Study of Cerebral Hemodynamics in Healthy Aging.

Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies have shown that healthy aging is associated with functional brain deterioration that preferentially affects the prefrontal cortex. This article reviews the application of an alternative method, functional near-infrared spectroscopy (fNIRS), to the study of age-related changes in cerebral hemodynamics and factors that influence cerebral hemodynamics in the elderly population. We conducted literature searches in PudMed and PsycINFO, and selected only English original research articles that used fNIRS to study healthy individuals with a mean age of ≥ 55 years. All articles were published in peer-reviewed journals between 1977 and May 2019. We synthesized 114 fNIRS studies examining hemodynamic changes that occurred in the resting state and during the tasks of sensation and perception, motor control, semantic processing, word retrieval, attentional shifting, inhibitory control, memory, and emotion and motivation in healthy older adults. This review, which was not registered in a registry, reveals an age-related reduction in resting-state cerebral oxygenation and connectivity in the prefrontal cortex. It also shows that aging is associated with a reduction in functional hemispheric asymmetry and increased compensatory activity in the frontal lobe across multiple task domains. In addition, this article describes the beneficial effects of healthy lifestyles and the detrimental effects of cardiovascular disease risk factors on brain functioning among nondemented older adults. Limitations of this review include exclusion of gray and non-English literature and lack of meta-analysis. Altogether, the fNIRS literature provides some support for various neurocognitive aging theories derived from task-based PET and fMRI studies. Because fNIRS is relatively motion-tolerant and environmentally unconstrained, it is a promising tool for fostering the development of aging biomarkers and antiaging interventions.

Ability of a novel shock index that incorporates invasive hemodynamics to predict mortality in patients with ST-elevation myocardial infarction.

OBJECTIVE: To determine whether the use of invasively measured hemodynamics improves the prognostic ability of a shock index (SI). BACKGROUND: SI such as Admission-SI, Age-SI, Modified SI (MSI), and Age-MSI predict short-term mortality in ST-elevation myocardial infarction (STEMI). METHODS: Single-center study of 510 patients who underwent primary percutaneous coronary intervention. STEMI SI was defined as age × heart rate (HR) divided by coronary perfusion pressure (CPP). RESULTS: The mean age was 62 ± 14 years, 66% were males with hypertension (69%), tobacco use (38%), diabetes (28%) and chronic kidney disease (6%). The mean HR, systolic blood pressure (SBP), and CPP were 81 ± 18 bpm, 124 ± 28 mmHg, and 52.8 ± 16.3 mmHg, respectively. Patients with STEMI SI ≥182 (n = 51) were more likely to experience a cardiac arrest in the catheterization laboratory (9.8% vs. 2.0%; p = .001), require mechanical circulatory support (47.1% vs. 8.5%; p < .0001) and be treated with vasopressors (56.9% vs. 10.7%; p < .0001) compared to STEMI SI < 182 (n = 459). After multivariate adjustment, patients with STEMI SI ≥182 were 10, 10.1 and 4.8 times more likely to die during hospitalization, at 30 days and at 5 years, respectively. The C statistic of STEMI SI was 0.870, similar to GRACE score (AUC = 0.902; p = .29) and TIMI STEMI score (AUC = 0.895; p = .36). CONCLUSION: STEMI SI is an easy to calculate risk score that identifies STEMI patients at high risk of in-hospital death.

Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.

BACKGROUND: On the basis of encouraging preliminary results, we conducted a randomized, controlled trial to determine whether minocycline reduces the risk of conversion from a first demyelinating event (also known as a clinically isolated syndrome) to multiple sclerosis. METHODS: During the period from January 2009 through July 2013, we randomly assigned participants who had had their first demyelinating symptoms within the previous 180 days to receive either 100 mg of minocycline, administered orally twice daily, or placebo. Administration of minocycline or placebo was continued until a diagnosis of multiple sclerosis was established or until 24 months after randomization, whichever came first. The primary outcome was conversion to multiple sclerosis (diagnosed on the basis of the 2005 McDonald criteria) within 6 months after randomization. Secondary outcomes included conversion to multiple sclerosis within 24 months after randomization and changes on magnetic resonance imaging (MRI) at 6 months and 24 months (change in lesion volume on T2-weighted MRI, cumulative number of new lesions enhanced on T1-weighted MRI ["enhancing lesions"], and cumulative combined number of unique lesions [new enhancing lesions on T1-weighted MRI plus new and newly enlarged lesions on T2-weighted MRI]). RESULTS: A total of 142 eligible participants underwent randomization at 12 Canadian multiple sclerosis clinics; 72 participants were assigned to the minocycline group and 70 to the placebo group. The mean age of the participants was 35.8 years, and 68.3% were women. The unadjusted risk of conversion to multiple sclerosis within 6 months after randomization was 61.0% in the placebo group and 33.4% in the minocycline group, a difference of 27.6 percentage points (95% confidence interval [CI], 11.4 to 43.9; P=0.001). After adjustment for the number of enhancing lesions at baseline, the difference in the risk of conversion to multiple sclerosis within 6 months after randomization was 18.5 percentage points (95% CI, 3.7 to 33.3; P=0.01); the unadjusted risk difference was not significant at the 24-month secondary outcome time point (P=0.06). All secondary MRI outcomes favored minocycline over placebo at 6 months but not at 24 months. Trial withdrawals and adverse events of rash, dizziness, and dental discoloration were more frequent among participants who received minocycline than among those who received placebo. CONCLUSIONS: The risk of conversion from a clinically isolated syndrome to multiple sclerosis was significantly lower with minocycline than with placebo over 6 months but not over 24 months. (Funded by the Multiple Sclerosis Society of Canada; ClinicalTrials.gov number, NCT00666887 .).

Impact of age and comorbidities on the effect of transcatheter versus surgical mitral valve repair on inpatient outcomes.

BACKGROUND: Transcatheter mitral valve repair (TMVR) has shown to be a safe and effective treatment option for symptomatic severe mitral regurgitation (MR) in patients who are at prohibitive surgical risk. Whether age and comorbidities impact the inpatient safety outcomes of TMVR versus surgical mitral valve repair (SMVR) is unknown. METHODS: Using the national inpatient sample, patients undergoing either elective TMVR or SMVR between 2012 and 2015 were analyzed. Logistic, generalized logistic, and linear regression were used to compare inpatient complications, discharge disposition, and length of stay (LOS). Heterogeneity in the effect of TMVR versus SMVR across Charlson comorbidity index (CCI, categorized as <2 and ≥2) and age (categorized as <75 years old and ≥75 years old) were assessed for effect modification. RESULTS: Overall, 8,716 hospitalizations were included, 7,950 (91%) SMVR and 766 (9%) TMVR. Compared with SMVR, patients undergoing TMVR were older (median age 79 vs. 62 years) and more likely to be female (45% vs. 40%) with a higher CCI score (median CCI 2 vs. 1). Despite being older with a higher comorbidity burden, patients undergoing TMVR had a lower incidence of permanent pacemaker implantation (OR 0.23, 95% CI: 0.11, 0.50), cerebrovascular accidents (OR 0.37, 95% CI: 0.15, 0.92), and major bleeding (OR 0.39, 95% CI: 0.32, 0.47). TMVR patients were also discharged 3 days earlier (CIE -3.26; 95% CI: -3.72, -2.80) and were less likely to be discharged to a skilled nursing facility (OR 0.72, 95% CI 0.55, 0.93). Additionally, the relative reduction in complications after TMVR versus SMVR was significantly higher in older (age ≥75 years) and more comorbid (CCI ≥2) patients (p for interaction <.05 for both). CONCLUSION: Patients treated with TMVR, as compared with SMVR, were older and had more comorbidities, but had a lower incidence of inpatient complications, shorter LOS, and better discharge disposition. Therefore, TMVR may be a safer option than SMVR in older patients and those with a higher burden of comorbidities.

Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results.

BACKGROUND: Acutely ill and frail older adults have complex social and health care needs. It is important to understand how this complexity affects acute outcomes for admission to hospital. We validated a frailty index using routine admission laboratory tests with outcomes after patients were admitted to hospital. METHODS: In a prospective cohort of older adults admitted to a large tertiary hospital in the United Kingdom, we created a frailty index from routine admission laboratory investigations (FI-Laboratory) linked to data comprising hospital outcomes. We evaluated the association between the FI-Laboratory and total days spent in hospital, discharge to a higher level of care, readmission and mortality. RESULTS: Of 2552 admissions among 1750 older adults, we were able to generate FI-Laboratory values for 2254 admissions (88.3% of the cohort). More than half of admitted patients were women (55.3%) and the mean age was 84.6 (SD 14.0) years. We found that the FI-Laboratory correlated weakly with the Clinical Frailty Scale (CFS; r 2 = 0.09). An increase in the CFS and the equivalent of 3 additional abnormal laboratory test results in the FI-Laboratory, respectively, were associated with an increased proportion of inpatient days (rate ratios [RRs] 1.43, 95% confidence interval [CI] 1.35-1.52; and 1.47, 95% CI 1.41-1.54), discharge to a higher level of care (odd ratios [ORs] 1.39, 95% CI 1.27-1.52; and 1.30, 95% CI 1.16-1.47) and increased readmission rate (hazard ratios [HRs] 1.26, 95% CI 1.17-1.37; and 1.18, 95% CI 1.11-1.26). Increases in the CFS and FI-Laboratory were associated with increased mortality HRs of 1.39 (95% CI 1.28-1.51) and 1.45 (95% CI 1.37-1.54), respectively. INTERPRETATION: We determined that FI-Laboratory, distinct from baseline frailty, could be used to predict risk of many adverse outcomes. The score is therefore a useful way to quantify the degree of acute illness in frail older adults.

Neurocognitive development of flanker and Stroop interference control: A near-infrared spectroscopy study.

The abilities to resolve flanker and Stroop interference, which are primarily mediated by the prefrontal cortex (PFC), have been shown to be dissociable at the individual difference level. However, the relationship between the neurocognitive development of these two aspects of interference control remains unclear. This study examined developmental changes in inhibition performance and PFC activation during flanker and Stroop interference control using functional near-infrared spectroscopy (fNIRS). Twenty-eight healthy children and adolescents aged 7-16 years (16 males) underwent the arrow flanker and color-word matching Stroop paradigms while changes in oxyhemoglobin concentration in the PFC were monitored by fNIRS. We found developmental improvements in inhibition performance in terms of the interference scores on both the flanker and Stroop tasks. There were also developmental increases in PFC activation, particularly in the medial region, while resolving flanker and Stroop interference. Despite developmental changes in inhibition performance and medial PFC activation during both tasks, the developmental changes that we observed for these two aspects of interference control were found to be relatively independent of each other. Our findings support the heterogeneous view of interference control and suggest that the neurocognitive development of flanker and Stroop interference control is only weakly associated, if not dissociable.

Synthesis and Characterization of Single-Phase Metal Dodecaboride Solid Solutions: Zr1- xY xB12 and Zr1- xU xB12.

Single-phase metal dodecaboride solid solutions, Zr0.5Y0.5B12 and Zr0.5U0.5B12, were prepared by arc melting from pure elements. The phase purity and composition were established by powder X-ray diffraction (PXRD), energy-dispersive X-ray spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), and 10B and 11B solid-state nuclear magnetic resonance (NMR) spectroscopy. The effects of carbon addition to Zr1- xY xB12 were studied and it was found that carbon causes fast cooling and as a result rapid nucleation of grains, as well as "templating" and patterning effects of the surface morphology. The hardness of the Zr0.5Y0.5B12 phase is 47.6 ± 1.7 GPa at 0.49 N load, which is ∼17% higher than that of its parent compounds, ZrB12 and YB12, with hardness values of 41.6 ± 2.6 and 37.5 ± 4.3 GPa, respectively. The hardness of Zr0.5U0.5B12 is ∼54% higher than that of its UB12 parent. The dodecaborides were confirmed to be metallic by band structure calculations, diffuse reflectance UV-vis, and solid-state NMR spectroscopies. The nature of the dodecaboride colors-violet for ZrB12 and blue for YB12-can be attributed to charge-transfer. XPS indicates that the metals are in the following oxidation states: Y3+, Zr4+, and U5+/6+. The superconducting transition temperatures ( Tc) of the dodecaborides were determined to be 4.5 and 6.0 K for YB12 and ZrB12, respectively, as shown by resistivity and superconducting quantum interference device (SQUID) measurements. The Tc of the Zr0.5Y0.5B12 solid solution was suppressed to 2.5 K.

Photobiomodulation improves the frontal cognitive function of older adults.

OBJECTIVES: The frontal lobe hypothesis of age-related cognitive decline suggests that the deterioration of the prefrontal cortical regions that occurs with aging leads to executive function deficits. Photobiomodulation (PBM) is a newly developed, noninvasive technique for enhancing brain function, which has shown promising effects on cognitive function in both animals and humans. This randomized, sham-controlled study sought to examine the effects of PBM on the frontal brain function of older adults. METHODS/DESIGNS: Thirty older adults without a neuropsychiatric history performed cognitive tests of frontal function (ie, the Eriksen flanker and category fluency tests) before and after a single 7.5-minute session of real or sham PBM. The PBM device consisted of three separate light-emitting diode cluster heads (633 and 870 nm), which were applied to both sides of the forehead and posterior midline, and delivered a total energy of 1349 J. RESULTS: Significant group (experimental, control) × time (pre-PBM, post-PBM) interactions were found for the flanker and category fluency test scores. Specifically, only the older adults who received real PBM exhibited significant improvements in their action selection, inhibition ability, and mental flexibility after vs before PBM. CONCLUSIONS: Our findings support that PBM may enhance the frontal brain functions of older adults in a safe and cost-effective manner.

Correlation of infarct size with invasive hemodynamics in patients with ST-elevation myocardial infarction.

OBJECTIVES: To identify invasive hemodynamic parameters that correlate with infarction size in patients with ST-elevation myocardial infarction (STEMI). BACKGROUND: Invasive hemodynamics obtained during primary percutaneous coronary intervention (PPCI) are predictive of mortality in STEMI, but which parameters correlate best with the size of the infarction are unknown. METHODS: This is a single-center study of 405 adult patients with STEMI who had left ventricular end-diastolic pressure (LVEDP) measured during PPCI. Size of infarction was estimated by peak troponin I level and ejection fraction (LVEF) determined by echocardiography. RESULTS: The average (±SD) age was 61 ± 14 years, TIMI STEMI risk score was 3.5 ± 2.7 and Grace score was 157 ± 42. Hemodynamic parameters that correlated best with EF were LVEDP (r = -0.40), PP (r = 0.24), and SBP/LVEDP ratio (r = 0.22) and with peak troponin were SBP/LVEDP ratio (r = -0.41), LVEDP (r = 0.31), and PP (r = -0.29). SBP/LVEDP (AUC = 0.76) and SBP (AUC = 0.77) had a stronger association with in-hospital mortality than did LVEDP (AUC = 0.66) or PP (AUC = 0.64). Door-to-balloon time did not affect the correlations between hemodynamic parameters and infarct size. CONCLUSIONS: In this sample of 405 patients undergoing PPCI, SBP/LVEDP ratio had the strongest correlation with peak troponin levels and LVEDP with EF, whereas SBP/LVEDP and SBP had a strong association with in-hospital mortality. These results suggest that measurement of LVEDP as well as SBP may help risk stratify patients during PPCI.

Effects of Variable Boron Concentration on the Properties of Superhard Tungsten Tetraboride.

Tungsten tetraboride is an inexpensive, superhard material easily prepared at ambient pressure. Unfortunately, there are relatively few compounds in existence that crystallize in the same structure as tungsten tetraboride. Furthermore, the lack of data in the tetraboride phase space limits the discovery of any new superhard compounds that also possess high incompressibility and a three-dimensional boron network that withstands shear. Thus, the focus of the work here is to chemically probe the range of thermodynamically stable tetraboride compounds with respect to both the transition metal and the boron content. Tungsten tetraboride alloys with a variable concentration of boron were prepared by arc-melting and investigated for their mechanical properties and thermal stability. The purity and phase composition were confirmed by energy dispersive X-ray spectroscopy and powder X-ray diffraction. For variable boron WBx, it was found that samples prepared with a metal to boron ratio of 1:11.6 to 1:9 have similar hardness values (∼40 GPa at 0.49 N loading) as well as having a similar thermal oxidation temperature of ∼455 °C. A nearly single phase compound was successfully stabilized with tantalum and prepared with a nearly stoichiometric amount of boron (4.5) as W0.668Ta0.332B4.5. Therefore, the cost of production of WB4 can be decreased while maintaining its remarkable properties. Insights from this work will help design future compounds stable in the adaptable tungsten tetraboride structure.

Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.

OBJECTIVE: To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). BACKGROUND: Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. METHODS: This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. RESULTS: Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P < 0.0001), intra-aortic balloon pump (IABP) usage (51.6% vs. 9.6%, P < 0.0001) and combined endpoint of death or IABP usage (58.1% vs. 13.3%, P < 0.0001) compared to patients with SBP/LVEDP > 4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). CONCLUSION: An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc.

Extrinsic Hardening of Superhard Tungsten Tetraboride Alloys with Group 4 Transition Metals.

Alloys of tungsten tetraboride (WB4) with the group 4 transition metals, titanium (Ti), zirconium (Zr), and hafnium (Hf), of different concentrations (0-50 at. % on a metals basis) were synthesized by arc-melting in order to study their mechanical properties. The phase composition and purity of the as-synthesized samples were confirmed using powder X-ray diffraction (PXRD) and energy dispersive X-ray spectroscopy (EDS). The solubility limit as determined by PXRD is 20 at. % for Ti, 10 at. % for Zr, and 8 at. % for Hf. Vickers indentation measurements of WB4 alloys with 8 at. % Ti, 8 at. % Zr, and 6 at. % Hf gave hardness values, Hv, of 50.9 ± 2.2, 55.9 ± 2.7 and 51.6 ± 2.8 GPa, respectively, compared to 43.3 GPa for pure WB4 under an applied load of 0.49 N. Each of the aforementioned compositions are considered superhard (Hv > 40 GPa), likely due to extrinsic hardening that plays a key role in these superhard metal borides. Furthermore, these materials exhibit a significantly reduced indentation size effect, which can be seen in the plateauing hardness values for the W1-xZrxB4 alloy. In addition, W0.92Zr0.08B4, a product of spinoidal decomposition, possesses nanostructured grains and enhanced grain hardening. The hardness of W0.92Zr0.08B4 is 34.7 ± 0.65 GPa under an applied load of 4.9 N, the highest value obtained for any superhard metal at this relatively high loading. In addition, the WB4 alloys with Ti, Zr, and Hf showed a substantially increased oxidation resistance up to ∼460 °C, ∼510 °C, and ∼490 °C, respectively, compared to ∼400 °C for pure WB4.