Stopping Aspirin Within 1 Month After Stenting for Ticagrelor Monotherapy in Acute Coronary Syndrome: The T-PASS Randomized Noninferiority Trial.

BACKGROUND: Stopping aspirin within 1 month after implantation of a drug-eluting stent for ticagrelor monotherapy has not been exclusively evaluated for patients with acute coronary syndrome. The aim of this study was to investigate whether ticagrelor monotherapy after <1 month of dual antiplatelet therapy (DAPT) is noninferior to 12 months of ticagrelor-based DAPT for adverse cardiovascular and bleeding events in patients with acute coronary syndrome. METHODS: In this randomized, open-label, noninferiority trial, 2850 patients with acute coronary syndrome who underwent drug-eluting stent implantation at 24 centers in South Korea were randomly assigned (1:1) to receive either ticagrelor monotherapy (90 mg twice daily) after <1 month of DAPT (n=1426) or 12 months of ticagrelor-based DAPT (n=1424) between April 24, 2019, and May 31, 2022. The primary end point was the net clinical benefit as a composite of all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding at 1 year after the index procedure in the intention-to-treat population. Key secondary end points were the individual components of the primary end point. RESULTS: Among 2850 patients who were randomized (mean age, 61 years; 40% ST-segment-elevation myocardial infarction), 2823 (99.0%) completed the trial. Aspirin was discontinued at a median of 16 days (interquartile range, 12-25 days) in the group receiving ticagrelor monotherapy after <1 month of DAPT. The primary end point occurred in 40 patients (2.8%) in the group receiving ticagrelor monotherapy after <1-month DAPT, and in 73 patients (5.2%) in the ticagrelor-based 12-month DAPT group (hazard ratio, 0.54 [95% CI, 0.37-0.80]; P<0.001 for noninferiority; P=0.002 for superiority). This finding was consistent in the per-protocol population as a sensitivity analysis. The occurrence of major bleeding was significantly lower in the ticagrelor monotherapy after <1-month DAPT group compared with the 12-month DAPT group (1.2% versus 3.4%; hazard ratio, 0.35 [95% CI, 0.20-0.61]; P<0.001). CONCLUSIONS: This study provides evidence that stopping aspirin within 1 month for ticagrelor monotherapy is both noninferior and superior to 12-month DAPT for the 1-year composite outcome of death, myocardial infarction, stent thrombosis, stroke, and major bleeding, primarily because of a significant reduction in major bleeding, among patients with acute coronary syndrome receiving drug-eluting stent implantation. Low event rates, which may suggest enrollment of relatively non-high-risk patients, should be considered in interpreting the trial. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03797651.

Ticagrelor monotherapy for acute coronary syndrome: an individual patient data meta-analysis of TICO and T-PASS trials.

BACKGROUND AND AIMS: In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS. METHODS: Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year. RESULTS: Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56-1.13; P = .194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40-0.72; P < .001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome. CONCLUSIONS: In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT. STUDY REGISTRATION: PROSPERO (ID: CRD42023476470).

Safety and usefulness of a novel short track sliding balloon catheter.

OBJECTIVES: To evaluate the safety and technical utility of the short track sliding (STS) balloon catheter. BACKGROUND: An STS balloon catheter is designed to ensure a low profile at the shaft and perform distal anchoring using a single guidewire. However, its clinical practice with the STS balloon catheter has not been reported. METHODS: This prospective multi-center registry enrolled 100 patients with significant coronary artery disease who had undergone percutaneous coronary intervention using an STS balloon catheter at three hospitals in Korea from March 2019 to July 2020. Overall safety was assessed as any occurrences of device-related malfunction during the pre-dilation of the lesions. Its technical success rates of the kissing balloon technique or the distal anchoring technique using a single guidewire were also evaluated. RESULTS: Of the 118 lesions pre-dilated using the STS balloon, no significant complication was observed except for three significant coronary dissections, which were completely covered with stents. There was no incidence of balloon catheter malfunction, such as fracture, entrapment, or perforation. With 13 attempts of kissing ballooning techniques with the STS balloon with a 6F guiding catheter, all cases were successful. The distal anchoring techniques were attempted in 10 cases, the stent was successfully crossed to the target lesion in all 10 cases. CONCLUSIONS: The novel STS balloon catheter can be safely applied in routine coronary intervention with minimal complications. In addition, this catheter could be useful for performing the kissing balloon technique with a small-caliber guiding catheter and distal anchoring technique with a single guidewire.

Arctic Primary Aerosol Production Strongly Influenced by Riverine Organic Matter.

The sources of primary and secondary aerosols in the Arctic are still poorly known. A number of surface seawater samples-with varying degrees of Arctic riverine and sea ice influences-were used in a sea spray generation chamber to test them for their potential to produce sea spray aerosols (SSA) and cloud condensation nuclei (CCN). Our interdisciplinary data showed that both sea salt and organic matter (OM) significantly influenced the SSA production. The number concentration of SSA in the coastal samples was negatively correlated with salinity and positively correlated with a number of OM tracers, including dissolved and chromophoric organic carbon (DOC, CDOM), marine microgels and chlorophyll a (Chl-a) but not for viral and bacterial abundances; indicating that OM of riverine origin enhances primary aerosol production. When all samples were considered, transparent exopolymer particles (TEP) were found to be the best indicator correlating positively with the ratio number concentration of SSA/salinity. CCN efficiency was not observed to differ between the SSA from the various samples, despite differences in organic characteristics. It is suggested that the large amount of freshwater from river runoff have a substantial impact on primary aerosols production mechanisms, possibly affecting the cloud radiative forcing.

Humification of effluent organic matters through a surface-flow constructed wetland.

Dominant fractions of wastewater effluent organic matter (EfOM) were changed from polysaccharides (PS) to polyhydroxyaromatics (PHA), throughout the constructed treatment wetland connected to a wastewater treatment plant, as measured using pyrolysis gas chromatography-mass spectrometry (Py-GC/MS). The changes in the fractions were also identified, with respect to molecular weight (MW) distributions of the effluent organic matters, as measured using high performance size exclusion chromatography equipped with both UV and fluorescence detectors, for aromatic/hydrophobic and protein-like organic substances, respectively; organic matter, with MWs of approximately 2,500 and 20,000 Da, and approximately 38,000 Da, as measured by the UV and fluorescence detectors, respectively, were newly formed after the wetlands, especially for the samples of the Typha wetland in June and August against in December. Thus, with the above two different analyses, the humification type of transformation of EfOM through the treatment wetland, was believed to occur, probably due to biological transformation (from the comparison of results in June and August with those in December). It was anticipated that the humification of EfOM could reduce biodegradable organic portions of wastewater effluents even though total organic carbon levels were not reduced that much after the treatment wetland.

Artificial neural network implementation for dissolved organic carbon quantification using fluorescence intensity as a predictor in wastewater treatment plants.

Although spectroscopic methods provide a fast and cost-effective means of monitoring dissolved organic carbon (DOC) in natural and engineered water systems, the prediction accuracy of these methods is limited by the complex relationship between optical properties and DOC concentration. In this study, we developed DOC prediction models using multiple linear/log-linear regression and feedforward artificial neural network (ANN) and investigated the effectiveness of spectroscopic properties, such as fluorescence intensity and UV absorption at 254 nm (UV254), as predictors. Optimum predictors were identified based on correlation analysis to construct models using single and multiple predictors. We compared the peak-picking and parallel factor analysis (PARAFAC) methods for selecting appropriate fluorescence wavelengths. Both methods had similar prediction capability (p-values >0.05), suggesting PARAFAC was not necessary for choosing fluorescence predictors. Fluorescence peak T was identified as a more accurate predictor than UV254. Combining UV254 and multiple fluorescence peak intensities as predictors further improved the prediction capability of the models. The ANN models outperformed the linear/log-linear regression models with multiple predictors, achieving higher prediction accuracy (peak-picking: R2 = 0.8978, RMSE = 0.3105 mg/L; PARAFAC: R2 = 0.9079, RMSE = 0.2989 mg/L). These findings suggest the potential to develop a real-time DOC concentration sensor based on optical properties using an ANN for signal processing.

The characteristic large-scale annual analysis by gender and age in heart failure patients: cohort for 10 years in Korea.

AIMS: The prevalence and incidence rate of heart failure (HF) continues to increase along with the aging of the population and the increase of ischaemic heart disease. The morbidity and mortality of HF are also on the rise in the industrialized countries; it can be a great public health problem. A detailed and accurate analysis of the demographical incidence and prevalence of HF is an important first step in predicting the occurrence of the disease in the future and proper preparing for prevention. Here, we aimed to analyse the annual prevalence and incidence of HF by gender and age using long-term national health insurance service data in the Republic of Korea. METHODS AND RESULTS: A total of 47 243 patients newly diagnosed with HF between 2006 and 2015 among nationally representative random subjects of 1 000 000 were included. The data of age and gender were analysed by year, and the total population information of the Ministry of Land, Infrastructure, and Transport of Korea was referred to compare the data of HF patients with the total population (2008-15). Over the decade from 2006 to 2015, the prevalence of HF patients showed tendency of increase (P < 0.001). The overall incidence rate was also gradually increasing (P < 0.001), but in women, it tended to decrease gradually. Women significantly accounted higher than the male group in incidence of HF over the period (54.6% vs. 45.4%, P < 0.001). The mean age at the time of diagnosis gradually increased (P = 0.002 for total, P = 0.001 for each gender). Total incidence was highest in 70s (27.22%), but males were the most in their 60s and females were in their 70s. Analysis of annual trend by age and gender distribution of HF incidence in men presented highest in the 50s-70s with a similar pattern annually, and the incidence is increasing more recently. Different from that of men, in the case of women, the incidence gradually increased with age in a similar annual pattern, peaking in their 70s and gradually decreasing in recent years. CONCLUSIONS: The prevalence and incidence of HF are gradually increasing. It increased rapidly in their 50s and older. It showed an increased incidence of HF especially in men between their 50s and 70s, and more observation and caution for the management of the risk factors may be needed to prevent HF in the male group.

Delayed blood pressure recovery after exercise stress test is associated with autonomic dysfunction and pulse pressure in a middle-aged healthy group.

BACKGROUND: Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial changes in various indicators during exercise test and correlations with recovery of HR and blood pressure in a normotensive healthy middle-aged group. METHODS: A total of 122 patients without hypertension or diabetes was enrolled (mean age, 55.6 ± 11.0; male, 56.6%; mean blood pressure, 124.8 ± 16.6 / 81.5 ± 9.6 mmHg). Treadmill test was performed for evaluation of chest pain. Patients with coronary artery disease, positive treadmill test result, left ventricular dysfunction or renal failure were excluded. Heart rate recovery was calculated by subtracting the HR in the first or second minute of recovery period from the HR of peak exercise (HRR1 or HRR2). Systolic blood pressure in the 4th minute of recovery stage (SBPR4) was used to show delayed blood pressure recovery. RESULTS: Metabolic equivalents (METs) and HR in stage 2 to 4 were significantly correlated with both HRR1 and HRR2. Multiple regression analysis of HRR revealed significant correlation of METs and SBPR4. SBPR4 was significantly correlated with both HRR1 and HRR2 (HRR1, r = -0.376, p<0.001; HRR2, r = -0.244, p = 0.008) as well as SBP in the baseline to stage 3 and pulse pressure (r = 0.406, p<0.001). CONCLUSIONS: Delayed BP recovery after peak exercise test revealed significant association with autonomic dysfunction and increased pulse pressure in normotensive middle-aged healthy group. It can be a simple and useful marker of autonomic dysfunction and arterial stiffness.

Ocean-atmosphere interactions: Different organic components across Pacific and Southern Oceans.

Sea spray aerosol (SSA) particles strongly influence clouds and climate but the potential impact of ocean microbiota on SSA fluxes is still a matter of active research. Here-by means of in situ ship-borne measurements-we explore simultaneously molecular-level chemical properties of organic matter (OM) in oceans, sea ice, and the ambient PM2.5 aerosols along a transect of 15,000 km from the western Pacific Ocean (36°13'N) to the Southern Ocean (75°15'S). By means of orbitrap mass spectrometry and optical characteristics, lignin-like material (24 ± 5 %) and humic material (57 ± 8 %) were found to dominate the pelagic Pacific Ocean surface, while intermediate conditions were observed in the Pacific-Southern Ocean waters. In the marine atmosphere, we found a gradient of features in the aerosol: lignin-like material (31 ± 9 %) dominating coastal areas and the pelagic Pacific Ocean, whereas lipid-like (23 ± 16 %) and protein-like (11 ± 10 %) OM controlled the sympagic Southern Ocean (sea ice-influence). The results of this study showed that the OM composition in the ocean, which changes with latitude, affects the OM in aerosol compositions in the atmosphere. This study highlights the importance of the global-scale OM monitoring of the close interaction between the ocean, sea ice, and the atmosphere. Sympagic primary marine aerosols in polar regions must be treated differently from other pelagic-type oceans.

Efficacy of Percutaneous Coronary Intervention With Synergy Stents in Patients Aged ≥75 Years: 1-Year Clinical Outcomes from the Synergy Elderly Registry.

Data regarding the clinical outcomes of older patients after Synergy everolimus-eluting stent (S-EES) implantation are limited. This study investigated the 12-month clinical outcomes of older patients who underwent percutaneous coronary intervention with new-generation drug-eluting stents according to ischemic risks. This prospective multicenter study targeted patients aged ≥75 years who underwent S-EES implantation. The primary and secondary end points included 12-month device-oriented composite end point (DOCE) (cardiovascular death, target vessel myocardial infarction, or target lesion revascularization) and major adverse cardiac and cerebrovascular events (MACCEs; all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, or stroke), respectively. A stratified analysis was conducted according to high-ischemic risk (HIR), defined as complex coronary intervention (number of stents implanted ≥3, total stented length >60 mm, chronic total occlusion, left main, or bifurcation), diabetes, or chronic kidney disease. In total, 650 enrolled patients aged ≥75 years were categorized into HIR (n = 425) and non-HIR groups (n = 225). In the total population, the 1-year incidence of DOCEs was 2.5%. The rates of DOCEs were not significantly different between the HIR and the non-HIR groups, whereas the MACCE rate was higher in the HIR (9.4%) than the non-HIR group (4.9%, p = 0.035), and the DOCE and MACCE components did not differ significantly in the occurrence between the groups. The independent predictors for the DOCEs or MACCEs included age, anemia, or left ventricular ejection fraction <40%. In conclusion, in older patients, S-EES implantation demonstrated favorable device-related outcomes, regardless of procedural complexity or co-morbidities. However, it requires careful attention because older patients with HIR are associated with worse clinical outcomes.

Perioperative Antiplatelet Strategy in Patients Undergoing Noncardiac Surgery Within One Year After Percutaneous Coronary Intervention.

BACKGROUND: The optimal antiplatelet therapy (APT) for patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention (PCI) is not yet established. METHODS: Patients who underwent non-cardiac surgery within 1 year after second-generation drug-eluting stent implantation were included from a multicenter prospective registry in Korea. The primary endpoint was 30-day net adverse clinical event (NACE), including all-cause death, major adverse cardiovascular event (MACE), and major bleeding events. Covariate adjustment using propensity score was performed. RESULTS: Among 1130 eligible patients, 708 (62.7%) continued APT during non-cardiac surgery. After propensity score adjustment, APT continuation was associated with a lower incidence of NACE (3.7% vs 5.5%; adjusted odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = .019) and MACE (1.1% vs 1.9%; adjusted OR, 0.35; 95% CI, 0.12-0.99; P = .046), whereas the incidence of major bleeding events was not different between the 2 APT strategies (1.7% vs 2.6%; adjusted OR, 0.61; 95% CI, 0.25-1.50; P = .273). CONCLUSIONS: The APT continuation strategy was chosen in a substantial proportion of patients and was associated with the benefit of potentially reducing 30-day NACE and MACE with similar incidence of major bleeding events, compared with APT discontinuation. This study suggests a possible benefit of APT continuation in non-cardiac surgery within 1 year of second-generation drug-eluting stent implantation.

Desalination Technology in South Korea: A Comprehensive Review of Technology Trends and Future Outlook.

Due to advances in desalination technology, desalination has been considered as a practical method to meet the increasing global fresh water demand. This paper explores the status of the desalination industry and research work in South Korea. Desalination plant designs, statistics, and the roadmap for desalination research were analyzed. To reduce energy consumption in desalination, seawater reverse osmosis (SWRO) has been intensively investigated. Recently, alternative desalination technologies, including forward osmosis, pressure-retarded osmosis, membrane distillation, capacitive deionization, renewable-energy-powered desalination, and desalination batteries have also been actively studied. Related major consortium-based desalination research projects and their pilot plants suggest insights into lowering the energy consumption of desalination and mitigation of the environmental impact of SWRO brine as well. Finally, considerations concerning further development are suggested based on the current status of desalination technology in South Korea.

Rubus occidentalis and Ellagic Acid Affect the Contractility of Penile Corpus Cavernosum Smooth Muscle through the Nitric Oxide-Cyclic Guanosine Monophosphate and Cyclic Adenosine 3',5'-Monophosphate Signaling Pathway.

The present study was designed to evaluate the relaxation effect of Rubus occidentalis (RO) and ellagic acid (EA) on rabbit penile corpus cavernosum smooth muscle (PCCSM). Rabbit PCCSM was treated with ROE or EA after preincubation with nitric oxide synthase (NOS), guanylate cyclase (GC), adenylyl cyclase (AC) or protein kinase A (PKA) blocker. Cyclic nucleotides in the perfusate were analyzed using radioimmunoassay (RIA). Subsequently, perfused PCCSMs were subjected to analysis to evaluate the expression level of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS). The interaction of ROE or EA with phosphodiesterase (PDE) 5 and PDE4 inhibitors, such as udenafil (UDE) and rolipram (ROL), were also evaluated. Both ROE and EA relaxed the PCCSM in a concentration-dependent manner. Coincubation of ROE or EA with NOS, GC, AC, or PKA blocker significantly decreased the ROE- and EA-induced relaxation. Pretreatment of ROE and EA significantly upregulated the cyclic guanosine monophosphate (cGMP), cyclic adenosine 3',5'-monophosphate (cAMP), and eNOS levels in the perfused PCCSM. Furthermore, the treatment of ROE and EA markedly increased the UDE- and ROL-induced relaxation of the PCCSM. In conclusion, ROE and EA induced PCCSM relaxation by activating the nitric oxide (NO)-cGMp and cAMp signaling pathways and may have a synergistic action to improve erectile function.

Long coverage with drug-eluting stents is superior to spot coverage for long femoropopliteal artery disease: PARADE II study.

Background: The efficacy of spot stenting using drug-eluting stents (DES) for the treatment of long femoropopliteal (FP) lesion is unknown. This study aimed to compare clinical outcomes of long full coverage vs. spot coverage with DES for long FP artery disease. Methods: This multicenter randomized trial compared long DES vs. spot DES for FP lesions longer than 150 mm. All lesions were treated with paclitaxel-eluting stents (Zilver PTX). The primary endpoint was primary patency at 12 months. Results: The study was terminated early after an interim analysis. A total of 103 patients (55 in the long DES group; 48 in the spot DES group) were eligible for analysis. There were no significant differences in baseline and lesion characteristics between groups. Total stent length was longer in the long DES group than in the spot DES group (225.6 ± 67.2 vs. 131.3 ± 48.7 mm, p < 0.001). Technical success was achieved in all patients. There was a trend toward a higher primary patency rate at 12 months in the long DES group than in the spot DES group (87.5% vs. 67.5%, p = 0.120). The rate of survival free from target lesion revascularization was significantly higher in the long DES group than in the spot DES group (91.7% vs. 72.0%, p = 0.044). In multivariate Cox regression analysis, spot DES [hazard ratio (HR) 2.42, 95% confidence interval (CI) 1.14-5.12, p = 0.021] and postdilation (HR 0.27, 95% CI 0.09-0.79, p = 0.018) were identified as independent predictors for loss of patency at 12 months post-procedure. Conclusions: Long DES were more effective than spot DES for treating long FP lesions. Clinical trial registration: Clinicaltrials.gov, identifier: NCT02701881.

A warm footbath improves coronary flow reserve in patients with mild-to-moderate coronary artery disease.

BACKGROUNDS: Recent studies have shown that thermal therapy by means of warm waterbaths and sauna has beneficial effects in chronic heart failure. However, a comprehensive investigation of the hemodynamic effects of thermal vasodilation on coronary arteries has not been previously undertaken. In this study, we studied the effect of a warm footbath (WFB) on coronary arteries in patients with coronary artery disease (CAD), as well as any adverse effect. METHODS: We studied 21 patients (33.3% men, mean age 60.8 ± 13.5 years) with CAD. Coronary flow Doppler examination of the left anterior descending coronary artery and coronary flow reserve (CFR) were performed and measured using adenosine before and after a WFB. RESULTS: Systolic and diastolic blood pressure and heart rate did not change with the WFB. Mean velocity of diastolic coronary flow significantly increased (diastolic mean flow velocity: 18.3 ± 7.1 cm/sec initial, 21.5 ± 8.0 cm/sec follow-up, P = 0.002) and CFR significantly improved (1.6 ± 0.4 vs. 2.2 ± 0.5, P < 0.001) after WFB. The WFB was well accepted and no relevant adverse effects were observed. The change of CFR after WFB correlated well with diastolic function (E', r = 0.51, P = 0.031; E/E', r =-0.675, P = 0.002). CONCLUSIONS: A WFB significantly improved CFR without any adverse effects in patients with mild-to-moderate CAD and can be applied with little risk of a coronary artery event if appropriately performed.

Replacing the internal standard to estimate micropollutants using deep and machine learning.

Similar to the worldwide proliferation of urbanization, micropollutants have been involved in aquatic and ecological environmental systems. These pollutants have the propensity to wreak havoc on human health and the ecological system; hence, it is important to persistently monitor micropollutants in the environment. Micropollutants are commonly quantified via target analysis using high resolution mass spectrometry and the stable isotope labeled (SIL) standard. However, the cost-intensiveness of this standard presents a major obstacle in measuring micropollutants. This study resolved this problem by developing data-driven models, including deep learning (DL) and machine learning (ML), to estimate the concentration of micropollutants without resorting to the SIL standard. Our study hypothesized that natural organic matter (NOM) could replace internal standards if there was a specific mass spectrum (MS) subset, including NOM information, which correlated with an SIL standard peak. Therefore, we analyzed the MS to find the specific MS subsets for replacing the SIL standard peak. Thirty-five alternative MS subsets were determined for applying DL and ML as input data. Thereafter, we trained four different DL models, namely, ResNet101, GoogLeNet, VGG16, and Inception v3, as well as three different ML models, i.e., random forest (RF), support vector machine (SVM), and artificial neural network (ANN). A total of 680 MS data were used for the model training to estimate five different micropollutants, namely Sulpiride, Metformin, and Benzotriazole. Among the DL models, ResNet 101 exhibited the highest model performance, showing that the average validation R2 and MSE were 0.84 and 0.26 ng/L, respectively, while RF was the best in the ML models, manifesting R2 and MSE values of 0.69 and 0.58 ng/L. The trained models showed accurate training and validation results for the estimation of the five micropollutant concentrations. Therefore, this study demonstrates that the suggested analysis has a potential for alternative micropollutant measurement that has rapid and economic vantages.

Pharmaceutical removal at low energy consumption using membrane capacitive deionization.

The performance of the membrane capacitive deionization (MCDI) system was evaluated during the removal of three selected pharmaceuticals, neutral acetaminophen (APAP), cationic atenolol (ATN), and anionic sulfamethoxazole (SMX), in batch experiments (feed solution: 2 mM NaCl and 0.01 mM of each pharmaceutical). Upon charging, the cationic ATN showed the highest removal rate of 97.65 ± 1.71%, followed by anionic SMX (93.22 ± 1.66%) and neutral APAP (68.08 ± 5.24%) due to the difference in electrostatic charge and hydrophobicity. The performance parameters (salt adsorption capacity, specific capacity, and cycling efficiency) and energy factors (specific energy consumption and recoverable energy) were further evaluated over ten consecutive cycles depending on the pharmaceutical addition. A significant decrease in the specific adsorption capacity (from 24.6 to ∼3 mg-NaCl g-1) and specific capacity (from 17.6 to ∼2.5 mAh g-1) were observed mainly due to the shortened charging and discharging time by pharmaceutical adsorption onto the electrode. This shortened charging time also led to an immediate drop in specific energy consumption from 0.41 to 0.04 Wh L-1. Collectively, these findings suggest that MCDI can efficiently remove pharmaceuticals at a low energy demand; however, its performance changes dramatically as the pharmaceuticals are present in the target water.

Influence of natural organic matter on membrane capacitive deionization performance.

Membrane capacitive deionization (MCDI) is a prospective desalination technology that removes ions using an electric potential difference across charged porous carbon electrodes. Natural organic matter (NOM) in feed water could influence the electrochemical process by leading to pore-blockages or forming a cake layer on the ion-exchange membrane-coated porous carbon electrode, thereby hindering ion removal. In this study, we explored the influence of different types of NOM, namely, humic acid (HA) and tannic acid (TA), on the MCDI desalination process for feed waters with inorganic salts (NaCl and CaCl2). HA significantly interfered with the adsorption process and reduced the salt removal rate by up to 68% in the case of NaCl-based feed water. However, the influence of HA on salt removal in the case of CaCl2-based feed water was marginal owing to the formation of a charge-neutralized complex, which was caused by the egg-box effect between Ca2+ and HA. TA reduced removal rates of salts (NaCl and CaCl2) by 37% and 60%, respectively. This is because of the lower molecular weight and smaller hydrodynamic diameter of TA relative to that of HA, owing to which TA exhibits a stronger adhesion to the electrode pore structure. Furthermore, as TA substantially reduces MCDI performance with regard to the adsorption of inorganic salts, its presence in feed water results in higher electrical resistance and energy consumption.

Evaluating an on-line cleaning agent for mitigating organic fouling in a reverse osmosis membrane.

Cleaning-in-place (CIP) is a representative fouling management process from which the filtration performances of fouled membranes can be recovered. However, CIP can cause significant inefficiency in water production because frequent system restabilization is necessary for cleaning processes. This study applied a newly developed on-line cleaning agent (OCA, a feed water additive for fouling mitigation), to reduce the number of CIP by enhancing water productivity. Reverse osmosis filtration was performed to evaluate the effect of on-line cleaning on the mitigation of organic fouling originating from humic acid (HA) and bovine serum albumin. OCA increased the permeate flux in proportion to OCA concentration. In particular, OCA effectively reduced the fouling layer thickness by 22% when fouling was influenced by HA-Ca2+ complexation, increasing water production by 5%. It also had a minor influence on bovine serum albumin fouling, producing a 1.4% increase in permeate flux. Furthermore, the pore blockage-cake filtration model was used to evaluate OCA cleaning performance through the reduction in fouling layer resistance and the growth parameter. The results demonstrated the advantages of OCA utilization for mitigating cake layer development. These findings imply that OCA can be an effective cleaning additive, especially in seawater and groundwater treatment processes with a high proportion of HA and calcium ions.

1-Month Dual-Antiplatelet Therapy Followed by Aspirin Monotherapy After Polymer-Free Drug-Coated Stent Implantation: One-Month DAPT Trial.

OBJECTIVES: The aim of this study was to determine whether 1 month of dual-antiplatelet therapy (DAPT) followed by aspirin monotherapy after polymer-free drug-coated stent (PF-DCS) implantation is noninferior to 6 to 12 months of DAPT after biodegradable-polymer drug-eluting stent (BP-DES) implantation. BACKGROUND: It is necessary to determine the optimal minimal duration of DAPT followed by aspirin monotherapy after percutaneous coronary intervention (PCI). METHODS: In this trial, 3,020 patients with coronary artery disease considered for PCI for noncomplex lesions were randomized to 1-month DAPT after PF-DCS (n = 1,507) or 6- to 12-month DAPT after BP-DES (n = 1,513). The primary endpoint was the 1-year composite of cardiac death, nonfatal myocardial infarction, target vessel revascularization, stroke, or major bleeding (noninferiority hypothesis margin of 3%). RESULTS: The primary endpoint occurred in 88 patients (5.9%) in the 1-month DAPT after PF-DCS group and 98 patients (6.5%) in the 6- to 12-month DAPT after BP-DES group (absolute difference -0.7%; upper limit of 1-sided 97.5% confidence interval: 1.33%; P < 0.001 for noninferiority). The occurrence of major bleeding was not different (1.7% vs 2.5%; P = 0.136). There was no difference in the occurrence of stent thrombosis (0.7% vs 0.8%; P = 0.842). CONCLUSIONS: Among patients who underwent PCI for noncomplex lesions, 1-month DAPT followed by aspirin monotherapy after PF-DCS implantation was noninferior to 6- to 12-month DAPT after BP-DES implantation for the 1-year composite of cardiovascular events or major bleeding. The present findings need to be interpreted in the setting of different types of stents according to antiplatelet strategy. (A Randomized Controlled Comparison Between One Versus More Than Six Months of Dual Antiplatelet Therapy After Biolimus A9-Eluting Stent Implantation; NCT02513810).