Modelling the equilibrium partitioning of low concentrations of airborne volatile organic compounds in human IVF laboratories.

RESEARCH QUESTION: Can volatile organic compounds (VOC) be modelled in an IVF clinical setting? DESIGN: The study performed equilibrium modelling of low concentrations of airborne VOC partitioning from the air phase into the oil cover layer into the water-based culture media and into/onto the embryo (air-oil-water-embryo). The air-phase VOC were modelled based on reported VOC concentrations found in modern assisted reproductive technology (ART) suites, older IVF clinics, and hospitals, as well as at 10 parts per billion (ppb) and 100 ppb for all compounds. The modelling was performed with 23 documented healthcare-specific VOC. RESULTS: Based on the partitioning model, seven compounds (acrolein, formaldehyde, phenol, toluene, acetaldehyde, ethanol and isopropanol) should be of great concern to the embryologist and clinician. Acrolein, formaldehyde, phenol, toluene and acetaldehyde are the VOC with the most potent cytotoxic factor and the highest toxic VOC concentration in media. In addition, ethanol and isopropanol are routinely found in the greatest air-phase concentrations and modelled to have the highest water-based culture concentrations. CONCLUSIONS: The results of the equilibrium partitioning modelling of VOC provides a fundamental understanding of how airborne VOC partition from the air phase and negatively influence human IVF outcomes. The results presented here are based on the theoretical model and the values presented have not yet been measured in a laboratory or clinical setting. High air-phase concentrations and toxic concentrations of VOC in culture media are likely indicators of poor clinical outcomes. Based on this model, improved air quality in IVF laboratories reduces the chemical burden imparted on embryos, which supports findings of improved IVF outcomes with reduced air-phase VOC concentrations.

Rapid Characterization and Modeling of Natural and Undefined Charge-Regulated Surfaces in Aqueous Systems.

The surfaces of most materials in aqueous systems are charged due to the ionization of surface functional groups. When these surfaces interact, the surface charge, electrostatic potential, and pH will vary as a function of separation distance, and this process is termed the charge-regulation effect. Charge regulation is a controlling factor in the adhesion and transport of colloids and microorganisms in aqueous systems, and its modeling requires representation of the pH-charge response of the surfaces, typically provided as the equilibrium constants (K) and site densities (N) of the dominant surface functional groups. Existing methods for obtaining these parameters demonstrate shortcomings when applied to many natural and man-made materials, such as weathered materials, materials with undefined or complex surface structures, and permeable materials, and for materials that do not provide the requisite high surface area in suspension due to small sample sizes. This hinders inclusion of the charge-regulation effect in colloid and microbial transport studies, and most studies of colloidal and microbial surface interactions use simplifying assumptions; a key example is the routine use of the constant potential assumption in DLVO modeling. Here we present a robust method that overcomes these issues and provides a rapid means to characterize charge-regulated surfaces using zeta potential data, without requiring a priori knowledge of the material composition. Applying a combined charge-regulation and Gouy-Chapman model, K and N values are obtained that accurately represent the electrostatic response of a charge-regulated surface. This method is demonstrated using activated carbon, aluminum oxide, iron (hydr)oxide, feldspar, and silica sand. The resulting K and N values are then used to show the variations in surface charge, electrostatic potential, and pH that can occur as these charge-regulated surfaces interact. This method provides a readily applied experimental approach for characterizing charge-regulated surfaces, with the overall goal to promote the inclusion of charge-regulated interactions into adhesion and transport studies with natural and undefined materials.

We implore lawmakers to protect the essentials as they craft a replacement plan for ACA.

Delivering effective, efficient and extraordinary healthcare to all requires full access to care. Health insurance, either private or government, is essential to that access, which is why Beaumont Health is urging President Donald Trump and members of Congress to tread carefully as they consider changes in the Affordable Care Act.

Predictive Value of ST-Segment Elevation in Lead aVR for Left Main and/or Three-Vessel Disease in Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: ST-segment elevation in lead aVR predicts left main and/or three-vessel disease (LM/3VD) in patients with acute coronary syndromes. ST-segment elevation in lead aVR is generally reciprocal to and accompanied by ST-segment depression in precordial leads. Previous studies have assessed the independent predictive value of ST-segment elevation in lead aVR for LM/3VD in non-ST-segment elevation acute coronary syndrome and have reported conflicting results. METHODS: We performed a retrospective analysis of 379 patients with non-ST-segment elevation myocardial infarction (NSTEMI). Electrocardiograms on presentation were reviewed especially for ST-segment elevation ≥0.05 mV in lead aVR and ST-segment depression ≥0.05 mV in more than two contiguous leads in any other leads. RESULTS: Among 379 patients, 97 (26%) patients had ST-segment elevation in lead aVR and 88 (23%) patients had LM/3VD. Patients with ST-segment elevation in lead aVR had a higher rate of LM/3VD (39% vs. 18%; P < 0.001) and in-hospital revascularization (73% vs. 60%; P = 0.02) driven by a higher rate of in-hospital coronary artery bypass grafting (19% vs. 7%; P < 0.001) than those without ST-segment elevation in lead aVR. On multivariate analysis, ST-segment elevation in lead aVR (odds ratio [OR] 2.05; 95% confidence interval [CI] 1.10-3.77; P = 0.02) and ST-segment depression in leads V1 -V4 (OR 2.99; 95% CI 1.46-6.15; P = 0.003) were independent predictors of LM/3VD. CONCLUSION: This study demonstrates that ST-segment elevation in lead aVR is an independent predictor of LM/3VD in patients with NSTEMI.

STEMI notification by EMS predicts shorter door-to-balloon time and smaller infarct size.

BACKGROUND: Emergency medical services (EMS) transportation is associated with shorter door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI). In addition to EMS transportation, prehospital notification of STEMI by EMS to receiving hospital might be able to further shorten DTB time. We evaluated the impact of STEMI notification on DTB time as well as infarct size. METHODS: We performed a retrospective analysis of consecutive patients with anterior wall STEMI who underwent emergent coronary angiography. We excluded patients who presented with cardiac arrest and those who were transferred from non-percutaneous coronary intervention-capable hospitals. Mode of transportation were categorized into the 3 groups: (1) EMS transport with STEMI notification, (2) EMS transport without STEMI notification, and (3) self-transport. Baseline characteristics, laboratory data, left ventricular ejection fraction (LVEF), and DTB time were compared among the 3 groups. RESULTS: A total of 148 patients were included in the final analysis. Of the 148 patients, 56 patients arrived by EMS transport with STEMI notification, 56 patients arrived by EMS transport without STEMI notification, and 36 patients arrived by self-transport. Patients who arrived by EMS transport with STEMI notification had the shortest DTB time among the 3 groups. Patients who arrived by EMS transport with STEMI notification had smaller infarct size, as indicated by lower peak creatine kinase value and higher LVEF, compared with those who arrived by EMS transport without STEMI notification. CONCLUSION: Emergency medical services transport with STEMI notification was associated with shorter DTB time and smaller infarct size in patients with anterior wall STEMI.

Ebola Virus Disease: Experience and Decision Making for the First Patients outside of Africa.

David Stephens and colleagues describe their experience of treating patients with Ebola virus disease at Emory University in the United States.

Absence of ST-segment elevation in lead V1 predicts worse long-term outcomes in patients with first anterior ST-segment elevation myocardial infarction.

BACKGROUND: The prognostic value of ST-segment elevation in lead V1 (STE in V1) in anterior ST-segment elevation myocardial infarction (STEMI) has not been elucidated. METHODS: We performed a retrospective analysis of 190 consecutive first anterior STEMI patients. STE in V1 ≥0.1mV was recorded. Major adverse cardiac events (MACE) were defined as a composite of all-cause death, recurrent myocardial infarction, or target vessel revascularization. RESULTS: Among 190 patients, 42 patients did not have STE in V1. The patient without STE in V1 had a higher peak creatine kinase value and a higher incidence of 1-year MACE (36% vs. 13%, p<0.001), driven by a higher mortality (24% vs. 5%, p<0.001). The absence of STE in V1 was an independent predictor for 1-year MACE (odds ratio 3.16; 95% confidence interval 1.28-7.83; p=0.01). CONCLUSION: The absence of STE in V1 was an independent predictor for worse long-term outcomes in patients with first anterior STEMI.

Transradial cardiac catheterization: a review of access site complications.

Transradial catheterization (TRC) has been associated with a lower incidence of major access site related complications as compared to the transfemoral approach. With the increased adoption of transradial access, it is essential to understand the potential major and minor complications of TRC. The most common complication is asymptomatic radial artery occlusion, which rarely leads to clinical events, owing to the dual collateral perfusion of the hand. Adequate anticoagulation, appropriate compression techniques, and smaller sheath size can minimize the risk of radial artery occlusion. Hand ischemia with necrosis has never been reported during TRC with thorough pre-examination of intact collateral circulation. Radial artery spasm is relatively common, and can result in access and procedural failure. It can be prevented by the use of vasodilator cocktails and hydrophilic sheaths. Radial artery perforation can lead to severe forearm hematoma and compartment syndrome if not managed promptly. Careful observation, prompt detection of the hematoma, and management with a pressure bandage dressing are critical to avoid serious complications. Pseudoaneurym and arteriovenous fistula are rare complications, which can likely be managed conservatively without surgical intervention. Nerve injury occurring during access has been reported. Close observation for improvement is necessary, although symptoms usually improve over time. In summary, to prevent access site complications, avoidance of multiple punctures, gentle catheter manipulation, use of guided compression, coupled with careful observation for adverse warning signs such as hematoma, loss of pulse, pain, are critical for safe and effective TRC.

Binding waste anthracite fines with Si-containing materials as an alternative fuel for foundry cupola furnaces.

An alternative fuel to replace foundry coke in cupolas was developed from waste anthracite fines. Waste anthracite fines were briquetted with Si-containing materials and treated in carbothermal (combination of heat and carbon) conditions that simulated the cupola preheat zone to form silicon carbide nanowires (SCNWs). SCNWs can provide hot crushing strengths, which are important in cupola operations. Lab-scale experiments confirmed that the redox level of the Si-source significantly affected the formation of SiC. With zerovalent silicon, SCNWs were formed within the anthracite pellets. Although amorphous Si (+4) plus anthracite formed SiC, these conditions did not transform the SiC into nanowires. Moreover, under the test conditions, SiC was not formed between crystallized Si (+4) and anthracite. In a full-scale demonstration, bricks made from anthracite fines and zerovalent silicon successfully replaced a part of the foundry coke in a full-scale cupola. In addition to saving in fuel cost, replacing coke by waste anthracite fines can reduce energy consumption and CO2 and other pollution associated with conventional coking.

Patients with adenosine-induced ST-segment depressions and normal myocardial perfusion imaging: cardiac outcomes at 24 months.

BACKGROUND: The significance of ischemic ECG changes during adenosine infusion in patients with normal myocardial perfusion imaging (MPI) is controversial. We evaluated the prevalence of, and defined the predictors for, severe coronary artery disease (CAD) in patients with such discordant findings. METHODS: The findings of 3700 adenosine MPI studies performed at our institution between June 2005 and March 2009 were reviewed. RESULTS: Data for 76 patients who had not previously undergone coronary revascularization and who had sufficient follow-up were analyzed; 22 (29%) were referred for coronary angiography and 10 (13%) underwent revascularization. None had left main disease and only three (14%) had multivessel disease. Diabetes mellitus was more prevalent (70% vs. 23%; P = .010) and ischemic ST-segment depressions more often lasted >5 minutes (50% vs. 15%; P = 0.021) in patients undergoing revascularization. During a 24 ± 13 month follow-up period, there were no deaths or myocardial infarctions, while an eleventh patient underwent revascularization 19 months after MPI. CONCLUSIONS: In the presence of normal MPI, the specificity of ischemic ECG changes during adenosine infusion for the detection of severe obstructive CAD is poor, although patients with multiple coronary risk factors, particularly diabetes mellitus, should undergo further investigation.

ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction.

BACKGROUND: ST-segment depression in lead aVR in acute inferior wall ST-segment elevation myocardial infarction (STEMI) has recently been suggested as a predictor of left circumflex (LCx) artery involvement. The purpose of this study is to evaluate the clinical significance of aVR depression during inferior wall STEMI. METHODS: This study included 106 consecutive patients who presented with inferior wall STEMI and underwent urgent coronary angiogram. Clinical and angiographic findings were compared between patients with and without aVR depression > or = 0.1 mV. RESULTS: The sensitivity and specificity of aVR depression as a predictor of LCx infarction were 53% and 86%, respectively. In patients with right coronary artery infarction, aVR depression was associated with increased cardiac enzymes and the involvement of a large posterolateral branch, which may explain the larger infarction. CONCLUSIONS: ST-segment depression in lead aVR in inferior wall STEMI predicts LCx infarction or larger RCA infarction involving a large posterolateral branch.

Synthesis and appraisal of a hydroxyapatite/pectin hybrid material for zinc removal from water.

A simple method to modify hydroxyapatite and pectin into an efficient zinc sorbent was investigated. Process and formulation modifications enabled the formation of a flower-like hydroxyapatite/pectin hybrid material. The hybrid material was characterized with scanning electron microscopy, elemental analysis, and zeta potential tests. Sorption data were analyzed with different kinetic and isotherm models. The results showed that the pseudo-second order kinetic model and two-staged isotherm curves with Langmuir at the first stage and a Freundlich model the at second stage could best describe the zinc sorption on the hybrid. The maximum experimental sorption capacity was 330.4 mg Zn2+ per gram of sorbent, which was obtained with an initial concentration of 260 mg L-1 Zn2+ at pH 5.0. pH monitoring and Zeta potential tests suggested surface complexation and electrostatic attraction were fundamental in the zinc sorption process.

Electrocardiographic Left Ventricular Hypertrophy as a Predictor for Nonsignificant Coronary Artery Disease in Patients With Non-ST-Segment Elevation Myocardial Infarction.

Left ventricular hypertrophy (LVH) can lead to subendocardial ischemia by altering the coronary blood flow and its transmural myocardial distribution in the setting of increased oxygen demand. We hypothesized that electrocardiographic LVH predicts nonsignificant coronary artery disease (CAD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We performed a retrospective analysis of 406 consecutive patients with NSTEMI who underwent coronary angiography. The LVH was diagnosed using Sokolow-Lyon and Cornell voltage criteria. Nonsignificant CAD was defined as stenosis less than 50% in the left main and 70% in any other coronary arteries. Of the 406 patients, 100 (25%) patients had electrocardiographic LVH and 99 (24%) patients had nonsignificant CAD. Patients with electrocardiographic LVH had a higher prevalence of nonsignificant CAD (32% vs 22%, P = .04) and a lower rate of in-hospital revascularization (45% vs 69%, P < .001) than those without LVH. On multivariate analysis, electrocardiographic LVH was an independent predictor of nonsignificant CAD (odds ratio 1.94; 95% confidence interval 1.12-3.35; P = .02). In conclusion, electrocardiographic LVH is an independent predictor of nonsignificant CAD and associated with a lower rate of in-hospital revascularization in patients with NSTEMI.

Association Between Preinfarction Angina and Angiographic Findings in Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: The association between preinfarction angina and angiographic findings has not been elucidated in patients with non-ST-segment elevation myocardial infarction (NSTEMI). HYPOTHESIS: Patients with preinfarction angina have favorable angiographic findings. METHODS: This retrospective study analyzed 481 patients who underwent coronary angiography within 5 days of presenting NSTEMI. Preinfarction angina was defined as experiencing ≥1 chest-pain episode within 7 days prior to admission. Infarct size was measured as the peak cardiac troponin I (cTnI) level, and large myocardial infarction (MI) was defined as a peak cTnI level >85th percentile value in the study population. Infarct-related artery (IRA) patency was defined as Thrombolysis In Myocardial Infarction grade 2 or 3 flow. Clinical and angiographic characteristics and in-hospital mortality were compared between patients with and without preinfarction angina. RESULTS: Among 481 patients, 200 (42%) had preinfarction angina. Preinfarction angina was associated with smaller infarct size, indicated by lower peak cTnI levels (P = 0.006) and lower incidence of large MI (P = 0.02), and IRA patency (P = 0.03). There was no significant difference in in-hospital mortality. On multivariate analysis, both preinfarction angina (odds ratio: 0.53, 95% confidence interval: 0.29-0.94, P = 0.03) and IRA patency (odds ratio: 0.30, 95% confidence interval: 0.17-0.52, P < 0.001) were independent negative predictors of large MI. CONCLUSION: Our study demonstrates that preinfarction angina is a predictor of smaller infarct size and infarct-related artery patency in NSTEMI patients, suggesting that NSTEMI patients presenting without preinfarction angina are at increased risk of developing a large MI.

Prognostic Value of Left Ventricular End-Diastolic Pressure in Patients With Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Elevated left ventricular end-diastolic pressure (LVEDP) has been reported to predict an increased mortality in patients with ST-segment elevation myocardial infarction. However, its prognostic value in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. METHODS: We performed a retrospective analysis of NSTEMI patients who underwent coronary angiography between January 2013 and June 2014. We excluded patients who did not undergo LVEDP measurements. Baseline and angiographic characteristics, in-hospital heart failure as well as in-hospital mortality were recorded. RESULTS: After exclusion, 367 patients were included in the final analysis. The median (interquartile range) LVEDP was 19 mm Hg (14 - 24 mm Hg). By receiver operating characteristic curve analysis, the optimal cutoff value for predicting in-hospital mortality was 22 mm Hg (area under the curve 0.80, sensitivity 80%, and specificity 71%). Of 367 patients, 109 patients (29.7%) had LVEDP > 22 mm Hg. Patients with LVEDP > 22 mm Hg had a greater number of comorbidities. There was no statistically significant difference in the rate of multi-vessel disease. Patients with LVEDP > 22 mm Hg had a significantly higher rate of in-hospital heart failure (22.0% vs. 13.2%, P = 0.03) and in-hospital mortality (3.7% vs. 0.4%, P = 0.03) than those with LVEDP ≤ 22 mm Hg. CONCLUSION: Elevated LVEDP was significantly associated with a higher in-hospital mortality in patients with NSTEMI.

Neutrophil-to-lymphocyte ratio as an independent predictor of left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction.

BACKGROUND/PURPOSE: Patients with acute coronary syndrome due to left main and/or three-vessel disease (LM/3VD) are at the highest risk of short- and long-term adverse cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict the severity of coronary artery disease in various clinical settings, but its independent predictive value for LM/3VD has not been investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to evaluate the independent predictive value of NLR for LM/3VD in NSTEMI patients. METHODS/MATERIALS: We performed a retrospective analysis of consecutive NSTEMI patients who underwent coronary angiography. NLR was calculated as the ratio of neutrophil to lymphocyte based on the laboratory data on admission. The primary outcome was the presence of LM/3VD. RESULTS: In all, 396 patients were included in the final analysis. Median NLR in the entire study population was 3.43 (interquartile range, 2.12-5.51). By receiver operating characteristics curve analysis, the optimal cutoff value of NLR in predicting LM/3VD was 2.80 (area under the curve 0.60, sensitivity 73%, specificity 43%). Of the 396 patients, 244 patients (62%) had NLR ≥2.8. Patients with NLR ≥2.8 were older and had a higher prevalence of LM/3VD (30 % vs. 18%, p=0.005). According to multivariate logistic regression analysis, NLR ≥2.8 was an independent predictor of LM/3VD after adjusting for other clinical variables including ST depression and ST elevation in lead aVR (odds ratio 1.83, 95% confidence interval 1.07-3.21, p=0.03). CONCLUSION: Our study demonstrates that NLR ≥2.8 is an independent predictor of LM/3VD in patients with NSTEMI.

Prevalence and outcomes of non-ST-segment elevation myocardial infarction resulting from stent thrombosis.

BACKGROUND/PURPOSE: Stent thrombosis is an infrequent yet one of the most feared complications after stent implantation. Stent thrombosis most commonly manifests as ST-segment elevation myocardial infarction, thus the data regarding non-ST-segment elevation myocardial infarction (NSTEMI) resulting from stent thrombosis are still sparse. The aim of the study is to evaluate the prevalence and outcomes of NSTEMI resulting from stent thrombosis. METHODS/MATERIALS: We performed a retrospective analysis of 378 consecutive NSTEMI patients who underwent coronary angiography. Patients were divided into those with and without stent thrombosis. The primary outcome was in-hospital mortality. Secondary outcome was the incidence of large myocardial infarction defined as a peak troponin I value greater than 90th percentile of the entire study population (26.5 µg/L). RESULTS: Among 378 patients with NSTEMI, 12 (3.2%) patients had angiographically confirmed definite stent thrombosis. With respect to the timing of stent thrombosis, 2 patients had early, 3 had late and 7 had very-late stent thrombosis. Patients with stent thrombosis had a higher incidence of large myocardial infarction (33% vs. 9%, p = 0.02) and a higher albeit statistically insignificant peak troponin value (interquartile, 4.62 [0.19-64.0] µg/L vs. 1.21 [0.14-7.12] µg/L, p = 0.25) compared to those without stent thrombosis. There was no significant difference in in-hospital mortality between the two groups (8% vs. 2%, p = 0.2). CONCLUSIONS: Stent thrombosis accounted for 3.2% cases of NSTEMI in our cohort of patients and patients with NSTEMI resulting from stent thrombosis had a higher incidence of large myocardial infarction.