Machine learning-based prediction of acute mortality in emergency department patients using twelve-lead electrocardiogram.

Background: The risk of mortality is relatively high among patients who visit the emergency department (ED), and stratifying patients at high risk can help improve medical care. This study aimed to create a machine-learning model that utilizes the standard 12-lead ECG to forecast acute mortality risk in ED patients. Methods: The database included patients who visited the EDs and underwent standard 12-lead ECG between October 2007 and December 2017. A convolutional neural network (CNN) ECG model was developed to classify survival and mortality using 12-lead ECG tracings acquired from 345,593 ED patients. For machine learning model development, the patients were randomly divided into training, validation and testing datasets. The performance of the mortality risk prediction in this model was evaluated for various causes of death. Results: Patients who visited the ED and underwent one or more ECG examinations experienced a high incidence of 30-day mortality [18,734 (5.42%)]. The developed CNN model demonstrated high accuracy in predicting acute mortality (hazard ratio 8.50, 95% confidence interval 8.20-8.80) with areas under the receiver operating characteristic (ROC) curve of 0.84 for the 30-day mortality risk prediction models. This CNN model also demonstrated good performance in predicting one-year mortality (hazard ratio 3.34, 95% confidence interval 3.30-3.39). This model exhibited good predictive performance for 30-day mortality not only for cardiovascular diseases but also across various diseases. Conclusions: The machine learning-based ECG model utilizing CNN screens the risks for 30-day mortality. This model can complement traditional early warning scoring indexes as a useful screening tool for mortality prediction.

Co(II)-Chelated Polyimines as Oxygen Reduction Reaction Catalysts in Anion Exchange Membrane Fuel Cells.

In this paper, a cobalt (Co)-chelated polynaphthalene imine (Co-PNIM) was calcined to become an oxygen reduction reaction (ORR) electrocatalyst (Co-N-C) as the cathode catalyst (CC) of an anion exchange membrane fuel cell (AEMFC). The X-ray diffraction pattern of CoNC-1000A900 illustrated that the carbon matrix develops clear C(002) and Co(111) planes after calcination, which was confirmed using high-resolution TEM pictures. Co-N-Cs also demonstrated a significant ORR peak at 0.8 V in a C-V (current vs. voltage) curve and produced an extremely limited reduction current density (5.46 mA cm-2) comparable to commercial Pt/C catalysts (5.26 mA cm-2). The measured halfway potential of Co-N-C (0.82 V) was even higher than that of Pt/C (0.81 V). The maximum power density (Pmax) of the AEM single cell upon applying Co-N-C as the CC was 243 mW cm-2, only slightly lower than that of Pt/C (280 mW cm-2). The Tafel slope of CoNC-1000A900 (33.3 mV dec-1) was lower than that of Pt/C (43.3 mV dec-1). The limited reduction current density only decayed by 7.9% for CoNC-1000A900, compared to 22.7% for Pt/C, after 10,000 redox cycles.

Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention.

Background: The optimal revascularization strategy for elderly patients with acute coronary syndrome (ACS) remains uncertain. We evaluated the impact of complete revascularization (CR) vs. incomplete revascularization (IR) in elderly ACS patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI). Methods: Using registry data from 2011 to 2019, we conducted a propensity-score matched cohort study. Elderly patients (≥75 years) with ACS and MVD who underwent PCI were divided into CR and IR groups based on angiography during index hospitalization. Major adverse cardiovascular events (MACEs), including all-cause mortality, recurrent non-fatal myocardial infarction, and any revascularization, were assessed at 3-year follow-up. Results: Among 1,018 enrolled patients, 496 (48.7%) underwent CR and 522 (51.3%) received IR. After 1:1 propensity-score matching, we analyzed 395 pairs. At 3-year follow-up, CR was significantly associated with lower MACE risk compared to IR (16.7% vs. 25.6%, HR = 0.65, 95% CI: 0.47-0.88, p = 0.006), driven by reduced all-cause mortality. This benefit was consistent across all pre-specified subgroups, particularly in ST segment elevation (STE)-ACS patients. In non-STE (NSTE)-ACS subgroup analysis, CR was also associated with a lower risk of cardiac mortality compared to IR (HR = 0.30, 95% CI: 0.12-0.75, p = 0.01). Conclusion: In elderly ACS patients with MVD undergoing PCI, CR demonstrates superior long-term outcomes compared to IR, irrespective of STE- or NSTE-ACS presentation.

Studies on the Application of Polyimidobenzimidazole Based Nanofiber Material as the Separation Membrane of Lithium-Ion Battery.

Aromatic polyimide has good mechanical properties and high-temperature resistance. Based on this, benzimidazole is introduced into the main chain, and its intermolecular (internal) hydrogen bond can increase mechanical and thermal properties and electrolyte wettability. Aromatic dianhydride 4,4'-oxydiphthalic anhydride (ODPA) and benzimidazole-containing diamine 6,6'-bis [2-(4-aminophenyl)benzimidazole] (BAPBI) were synthesized by means of a two-step method. Imidazole polyimide (BI-PI) was used to make a nanofiber membrane separator (NFMS) by electrospinning process, using its high porosity and continuous pore characteristics to reduce the ion diffusion resistance of the NFMS, enhancing the rapid charge and discharge performance. BI-PI has good thermal properties, with a Td5% of 527 °C and a dynamic mechanical analysis Tg of 395 °C. The tensile strength of the NFMS increased from 10.92MPa to 51.15MPa after being hot-pressed. BI-PI has good miscibility with LIB electrolyte, the porosity of the film is 73%, and the electrolyte absorption rate reaches 1454%. That explains the higher ion conductivity (2.02 mS cm-1) of NFMS than commercial one (0.105 mS cm-1). When applied to LIB, it is found that it has high cyclic stability and excellent rate performance at high current density (2 C). BI-PI (120 Ω) has a lower charge transfer resistance than the commercial separator Celgard H1612 (143 Ω).

Artificial intelligence-enabled electrocardiographic screening for left ventricular systolic dysfunction and mortality risk prediction.

Background: Left ventricular systolic dysfunction (LVSD) characterized by a reduced left ventricular ejection fraction (LVEF) is associated with adverse patient outcomes. We aimed to build a deep neural network (DNN)-based model using standard 12-lead electrocardiogram (ECG) to screen for LVSD and stratify patient prognosis. Methods: This retrospective chart review study was conducted using data from consecutive adults who underwent ECG examinations at Chang Gung Memorial Hospital in Taiwan between October 2007 and December 2019. DNN models were developed to recognize LVSD, defined as LVEF <40%, using original ECG signals or transformed images from 190,359 patients with paired ECG and echocardiogram within 14 days. The 190,359 patients were divided into a training set of 133,225 and a validation set of 57,134. The accuracy of recognizing LVSD and subsequent mortality predictions were tested using ECGs from 190,316 patients with paired data. Of these 190,316 patients, we further selected 49,564 patients with multiple echocardiographic data to predict LVSD incidence. We additionally used data from 1,194,982 patients who underwent ECG only to assess mortality prognostication. External validation was performed using data of 91,425 patients from Tri-Service General Hospital, Taiwan. Results: The mean age of patients in the testing dataset was 63.7 ± 16.3 years (46.3% women), and 8,216 patients (4.3%) had LVSD. The median follow-up period was 3.9 years (interquartile range 1.5-7.9 years). The area under the receiver-operating characteristic curve (AUROC), sensitivity, and specificity of the signal-based DNN (DNN-signal) to identify LVSD were 0.95, 0.91, and 0.86, respectively. DNN signal-predicted LVSD was associated with age- and sex-adjusted hazard ratios (HRs) of 2.57 (95% confidence interval [CI], 2.53-2.62) for all-cause mortality and 6.09 (5.83-6.37) for cardiovascular mortality. In patients with multiple echocardiograms, a positive DNN prediction in patients with preserved LVEF was associated with an adjusted HR (95% CI) of 8.33 (7.71 to 9.00) for incident LVSD. Signal- and image-based DNNs performed equally well in the primary and additional datasets. Conclusion: Using DNNs, ECG becomes a low-cost, clinically feasible tool to screen LVSD and facilitate accurate prognostication.

Atomically Dispersed NiNx Site with High Oxygen Electrocatalysis Performance Facilely Produced via a Surface Immobilization Strategy.

Nonprecious-metal heterogeneous catalysts with atomically dispersed active sites demonstrated high activity and selectivity in different reactions, and the rational design and large-scale preparation of such catalysts are of great interest but remain a huge challenge. Current approaches usually involve extremely high-temperature and tedious procedures. Here, we demonstrated a straightforward and scalable preparation strategy. In two simple steps, the atomically dispersed Ni electrocatalyst can be synthesized in a tens grams scale with quantitative yield under mild conditions, and the active Ni sites were produced by immobilizing preorganized NiNx complex on the substrate surface via organic thermal reactions. This catalyst exhibits excellent catalysis performances in both oxygen evolution and reduction reactions. It also exhibited tunable catalysis activity, high catalysis reproducibility, and high stability. The atomically dispersed NiNx sites are tolerant at high Ni concentration, as the random reactions and metal nanoparticle formation that generally occurred at high temperatures were avoided. This strategy illustrated a practical and green method for the industrial manufacture of nonprecious-metal single-site catalysts with a predictable structure.

Cardiovascular outcomes in patients with atrial fibrillation concomitantly treated with antiarrhythmic drugs and non-vitamin k antagonist oral anticoagulants.

AIMS: Limited data compared antiarrhythmic drugs (AADs) with concomitant non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients, hence the aim of the study. METHODS AND RESULTS: National health insurance database were retrieved during 2012-17 for study. We excluded patients not taking AADs, bradycardia, heart block, heart failure admission, mitral stenosis, prosthetic valve, incomplete demographic data, and follow-up <3 months. Outcomes were compared in Protocol 1, dronedarone vs. non-dronedarone; Protocol 2, dronedarone vs. amiodarone; and Protocol 3, dronedarone vs. propafenone. Outcomes were acute myocardial infarction (AMI), ischaemic stroke/systemic embolism, intracranial haemorrhage (ICH), major bleeding, cardiovascular death, all-cause mortality, and major adverse cardiovascular event (MACE) (including AMI, ischaemic stroke, and cardiovascular death). In Protocol 1, 2298 dronedarone users and 6984 non-dronedarone users (amiodarone = 4844; propafenone = 1914; flecainide = 75; sotalol = 61) were analysed. Dronedarone was associated with lower ICH (HR = 0.61, 95% CI = 0.38-0.99, P = 0.0436), cardiovascular death (HR = 0.24, 95% CI = 0.16-0.37, P < 0.0001), all-cause mortality (HR = 0.33, 95% CI = 0.27-0.42, P < 0.0001), and MACE (HR = 0.56, 95% CI = 0.45-0.70, P < 0.0001). In Protocol 2, 2231 dronedarone users and 6693 amiodarone users were analysed. Dronedarone was associated with significantly lower ICH (HR = 0.53, 95%=CI 0.33-0.84, P = 0.0078), cardiovascular death (HR = 0.20, 95% CI = 0.13-0.31, P < 0.0001), all-cause mortality (HR 0.27, 95% CI 0.22-0.34, P < 0.0001), and MACE (HR = 0.53, 95% CI = 0.43-0.66, P < 0.0001), compared with amiodarone. In Protocol 3, 812 dronedarone users and 2436 propafenone users were analysed. There were no differences between two drugs for primary and secondary outcomes. CONCLUSION: The use of dronedarone with NOACs was associated with cardiovascular benefits in an Asian population, compared with non-dronedarone AADs and amiodarone.

2,6-Diaminopyridine-Based Polyurea as an ORR Electrocatalyst of an Anion Exchange Membrane Fuel Cell.

In order to yield more Co(II), 2,6-diaminopyridine (DAP) was polymerized with 4,4-methylene diphenyl diisocyanates (MDI) in the presence of Co(II) to obtain a Co-complexed polyurea (Co-PUr). The obtained Co-PUr was calcined to become Co, N-doped carbon (Co-N-C) as the cathode catalyst of an anion exchange membrane fuel cell (AEMFC). High-resolution transmission electron microscopy (HR-TEM) of Co-N-C indicated many Co-Nx (Co covalent bonding with several nitrogen) units in the Co-N-C matrix. X-ray diffraction patterns showed that carbon and cobalt crystallized in the Co-N-C catalysts. The Raman spectra showed that the carbon matrix of Co-N-C became ordered with increased calcination temperature. The surface area (dominated by micropores) of Co-N-Cs also increased with the calcination temperature. The non-precious Co-N-C demonstrated comparable electrochemical properties (oxygen reduction reaction: ORR) to commercial precious Pt/C, such as high on-set and half-wave voltages, high limited reduction current density, and lower Tafel slope. The number of electrons transferred in the cathode was close to four, indicating complete ORR. The max. power density (Pmax) of the single cell with the Co-N-C cathode catalyst demonstrated a high value of 227.7 mWcm-2.

Inorganic Flame-Retardant Coatings Based on Magnesium Potassium Phosphate Hydrate.

A magnesium potassium phosphate hydrate-based flame-retardant coating (MKPC) is formulated by dead-burnt magnesium oxide (magnesia) and potassium dihydrogen phosphate (KH2PO4), behaving as a matrix. Constituents of the MKPC include wollastonite, vermiculite, aluminum fluoride, aluminum trihydroxide, and calcium carbonate. Some of the ingredients inter-react to produce mullite whiskers at high temperatures, despite an acid-base hydration induced reaction between magnesia and KH2PO4. The MKPC's thermal, corrosion-resistant, mechanical, and flame-resistant properties were analyzed using scanning electron microscopy, electrochemical corrosion testing, compression testing, thermogravimetric analysis, and freeze/thaw tests. The results show that with the molar ratio = 4 of magnesia to KH2PO4, MKPC demonstrates lower thermal conductivity (0.19 W/m K), along with better corrosion resistance, stronger compressive strength (10.5 MPa), and higher bonding strength (6.62 kgf/cm2) to the steel substrate. Furthermore, acceptable additives to the formulation could enhance its flame-retardancy and increase its mechanical strength as well. Mullite whisker formed from the interaction of wollastonite, aluminum trihydroxide, and aluminum fluoride acts as an outer ceramic shield that enhances mechanical strength and compactness. In addition, Mg-containing minerals with calcium carbonate treated at high temperatures, transform into magnesium calcium carbonate after releasing CO2. At the optimum composition of MKPC (magnesia/KH2PO4 molar ratio = 4; wollastonite:vermiculite = 20:10 wt.%; aluminum trihydroxide = 10 wt.%; and calcium carbonate = 5 wt.%), coated on a steel substrate, the flame-resistance limit results exhibit below 200 °C on the back surface of the steel substrate after one hour of flaming (ca. 1000 °C) on the other surface, and the flame-resistance rating results demonstrate only 420 °C on the back surface of the steel substrate after three hours of flaming (>1000 °C) on the other surface. Both requirements for the flame-resistance limit and three-hour flame-resistance rating are met with the optimum compositions, indicating that MKPC plays an effective role in establishing flame-retardancy.

Calcined Co(II)-Chelated Polyazomethine as Cathode Catalyst of Anion Exchange Membrane Fuel Cells.

Polyazomethine (PAM) prepared from the polycondensation between p-phenylene diamine (PDA) and p-terephthalaldehyde (PTAl) via Schiff reaction can physically crosslink (complex) with Co ions. Co-complexed PAM (Co-PAM) in the form of gel is calcined to become a Co, N-co-doped carbonaceous matrix (Co-N-C), acting as cathode catalyst of an anion exchange membrane fuel cell (AEMFC). The obtained Co-N-C catalyst demonstrates a single-atom structure with active Co centers seen under the high-resolution transmission electron microscopy (HRTEM). The Co-N-C catalysts are also characterized by XRD, SEM, TEM, XPS, BET, and Raman spectroscopy. The Co-N-C catalysts demonstrate oxygen reduction reaction (ORR) activity in the KOH(aq) by expressing an onset potential of 1.19-1.37 V vs. RHE, a half wave potential of 0.70-0.92 V, a Tafel slope of 61-89 mV/dec., and number of exchange electrons of 2.48-3.79. Significant ORR peaks appear in the current-voltage (CV) polarization curves for the Co-N-C catalysts that experience two-stage calcination higher than 900 °C, followed by double acid leaching (CoNC-1000A-900A). The reduction current of CoNC-1000A-900A is comparable to that of commercial Pt-implanted carbon (Pt/C), and the max power density of the single cell using CoNC-1000A-900A as cathode catalyst reaches 275 mW cm-2.

Risk Stratification by Coronary Perfusion Pressure in Left Ventricular Systolic Dysfunction Patients Undergoing Revascularization: A Propensity Score Matching Analysis.

Background: Coronary perfusion pressure (CPP) and coronary artery stenosis are responsible for myocardial perfusion. However, how CPP-related survival outcome affects revascularization is unclear. Objective: The aim of this study is to investigate the prognostic role of CPP in patients with left ventricular systolic dysfunction (LVSD) undergoing percutaneous coronary intervention (PCI) with complete revascularization (CR) or reasonable incomplete revascularization (RIR). Methods: We retrospectively screened 6,076 consecutive patients in a registry. The residual synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (rSS) was used to define CR (rSS = 0) and RIR (0 42 mmHg. Moreover, 101 pairs of RIR and CR were present in patients with CPP ≤ 42 mmHg. In patients with CPP > 42 mmHg, RIR was not significantly different from CR in long-term mortality [hazard ratio (HR) 1.20; 95% confidence interval (CI):0.70-2.07; p = 0.513]; However, in patients with CPP≤42 mmHg, RIR had a significantly higher mortality risk than CR (HR 2.39; 95% CI: 1.27-4.50; p = 0.007). Conclusions: The CPP had a risk stratification role in selecting different revascularization strategies in patients with LVSD. When patients with LVSD had CPP > 42 mmHg, RIR was equivalent to CR in survival. However, when patients with LVSD had CPP ≤ 42 mmHg, RIR had a significantly higher mortality risk than CR.

Angiographic Complete versus Clinical Selective Incomplete Percutaneous Revascularization in Heart Failure Patients with Multivessel Coronary Disease.

BACKGROUND: Patients with multivessel disease (MVD) often pursue complete revascularization (CR) during percutaneous coronary intervention (PCI) to improve prognosis. However, angiographic CR is not always feasible and is associated with some procedure-related complications in heart failure (HF) patients with MVD. Clinical selective incomplete revascularization (IR) may be reasonable for these high-risk patients, but its role in long-term outcomes remains uncertain. METHODS: Six hundred patients with HF and MVD submitted to PCI were enrolled. Major adverse cardiac events (MACEs) were defined as a composite of recurrent myocardial infarction, any revascularization, and all-cause mortality at 5 years. RESULTS: During a mean follow-up period of 3.7 ± 1.9 years, there was no significant difference in 5-year MACEs between selective IR and successful angiographic CR in HF patients with MVD. However, patients who failed CR had a significantly greater incidence of 5-year MACEs than those in the other two groups (failed CR: 46.4% vs. selective IR: 27.7% vs. successful CR: 27.8%, p < 0.001). CONCLUSIONS: Long-term outcomes of selective IR were comparable with those of successful angiographic CR in HF patients with MVD. However, patients that failed CR showed 2.53-fold increased risk of MACEs compared to patients undergoing either selective IR or successful angiographic CR. A more comprehensive planning strategy should be devised before PCI in HF patients with MVD.

Polyaniline Based Pt-Electrocatalyst for a Proton Exchanged Membrane Fuel Cell.

Calcination reduction reaction is used to prepare Pt/EB (emeraldine base)-XC72 (Vulcan carbon black) composites as the cathode material of a proton exchange membrane fuel cell (PEMFC). The EB-XC72 core-shell composite obtained from directly polymerizing aniline on XC72 particles is able to chelate and capture the Pt-ions before calcination. X-ray diffraction spectra demonstrate Pt particles are successfully obtained on the EB-XC72 when the calcined temperature is higher than 600 °C. Micrographs of TEM and SEM illustrate the affluent, Pt nanoparticles are uniformly distributed on EB-XC72 at 800 °C (Pt/EB-XC72/800). More Pt is deposited on Pt/EB-XC72 composite as temperatures are higher than 600 °C. The Pt/EB-XC72/800 catalyst demonstrates typical type of a cyclic voltammograms (C-V) curve of a Pt-catalyst with clear Pt-H oxidation and Pt-O reduction peaks. The highest number of transferred electrons during ORR approaches 3.88 for Pt/EB-XC72/800. The maximum power density of the single cell based on Pt/EB-XC72/800 reaches 550 mW cm-2.

Single Bolus Rosuvastatin Accelerates Calcium Uptake and Attenuates Conduction Inhomogeneity in Failing Rabbit Hearts With Regional Ischemia-Reperfusion Injury.

Acute statin therapy reduces myocardial ischemia/reperfusion (IR) injury-induced ventricular fibrillation (VF), but the underlying electrophysiological mechanisms remain unclear. This study sought to investigate the antiarrhythmic effects of a single bolus rosuvastatin injection in failing rabbit hearts with IR injury and to unveil the underlying molecular mechanisms. Rabbits were divided into rosuvastatin, rosuvastatin + L-NAME, control, and L-NAME groups. Intravenous bolus rosuvastatin (0.5 mg/kg) and/or L-NAME (10 mg/kg) injections were administered 1 hour and 15 minutes before surgery, respectively. Heart failure was induced using rapid ventricular pacing. Under general anesthesia with isoflurane, an IR model was created by coronary artery ligation for 30 minutes, followed by reperfusion for 15 minutes. Plasma NO end product levels were measured during IR. Then, hearts were excised and Langendorff-perfused for optical mapping studies. Cardiac tissues were sampled for Western blot analysis. Rosuvastatin increased plasma NO levels during IR, which was abrogated by L-NAME. Spontaneous VF during IR was suppressed by rosuvastatin (P < 0.001). Intracellular calcium (Cai) decay and conduction velocity were significantly slower in the IR zone. Rosuvastatin accelerated Cai decay, ameliorated conduction inhomogeneity, and reduced the inducibility of spatially discordant alternans and VF significantly. Western blots revealed significantly higher expression of enhancing endothelial NO-synthase and phosphorylated enhancing endothelial NO-synthase proteins in the Rosuvastatin group. Furthermore, SERCA2a, phosphorylated connexin43, and phosphorylated phospholamban were downregulated in the IR zone, which was attenuated or reversed by rosuvastatin. Acute rosuvastatin therapy before ischemia reduced IR-induced VF by improving SERCA2a function and ameliorating conduction disturbance in the IR zone.

LCZ696 Therapy Reduces Ventricular Tachyarrhythmia Inducibility in a Myocardial Infarction-Induced Heart Failure Rat Model.

BACKGROUND: LCZ696 (valsartan/sacubitril) therapy significantly reduced mortality in patients with heart failure (HF). Although a clinical trial (PARADISE-MI Trial) has been ongoing to examine the effects of LCZ696 in myocardial infarction (MI) patients, the effects of LCZ696 on remodeling of cardiac electrophysiology in animal models remain largely unclear. METHODS: We performed coronary artery ligation to create MI in Sprague-Dawley rats. Echocardiography was performed one week after MI to confirm the development of HF with left ventricular ejection fraction ≤ 40%. MI rats were randomly assigned to receive medical therapy for 4 weeks: LCZ696, enalapril, or vehicle. The sham-operation rats received sham operation without MI creation. In vivo electrophysiological exams were performed under general anesthesia. Western blot analyses were conducted to quantify ion channel proteins. RESULTS: The HF-vehicle group did not show significant changes in LVEF. Both enalapril and LCZ696 therapy significantly improved LVEF. The HF-vehicle group had higher ventricular arrhythmia (VA) inducibility than the sham group. As compared with the HF-vehicle group, LCZ696 therapy significantly reduced VA inducibility, but enalapril therapy did not. Western blot analyses showed significant downregulation of NaV1.5, ERG, KCNE1, and KCNE2 channel proteins in the HF vehicle group compared with the sham group. LCZ696 therapy upregulated protein expression of ERG, KCNE1, and KCNE2. CONCLUSION: As compared with enalapril therapy, LCZ696 therapy led to improvement of LVEF, reduced VA inducibility, and upregulated expression of K+ channel proteins.

Retrograde aortic approach for atrial fibrillation ablation with a conventional 3-D mapping catheter: A case report.

The presence of a Gore-Tex patch can create difficulty in performing transeptal puncture for atrial septal defect patients underwent atrial fibrillation ablation. The maneuverability and stability of using manually operated catheters via retrograde aortic approach could be overcome by a large-curved catheter to form a loop facilitating approachability to all parts of left atrium.

Safety of Qigong: Protocol for an overview of systematic reviews.

BACKGROUND: Qigong, as one of the essential elements of Traditional Chinese exercises, has been used to improve physical and psychological health and combat diseases in China for thousands of years. In recent years, the beneficial effects of Qigong on different medical conditions are becoming more accepted by both patients and health care providers. Although it is a common impression that Qigong and related therapies are generally safe procedures, but the current understanding of its adverse events is fragmented. Thus, we conducted this overview to synthesize comprehensively existing systematic reviews on adverse events associated with Qigong and related therapies, and our findings can be used to informing clinicians, Qigong practitioner, and patients alike on applying such treatments or interventions in clinical treatment and daily life training mindful manner, and provide a guideline for researchers in future. METHODS: A systematic review of reviews will be performed. A literature search strategy designed by a number of specialists in the fields of Traditional Chinese Medicine (TCM), sports medicine, health information, and Qigong training will be carried out in relevant English and Chinese electronic database. The date range of search will start from inception to the search date. Two reviewers will identify relevant studies, extract data information, and then assess the methodical quality by Assessment of Multiple Systematic Reviews (AMSTAR) tool. Any types of systematic review that summarized adverse effects related to Qigong and related therapies in human will be included. Any safety-related outcomes will be considered as the primary outcomes of this overview. Where objectives from 2 or more reviews overlap, we will assess the causes of any noted discrepancies between reviews. An overall summary of results will be performed using tabular and graphical approaches and will be supplemented by narrative description. RESULTS: This overview will identify any adverse events associated with nonstandardized Qigong and related therapies procedures based on current relevant literature evidence of safety for Qigong. CONCLUSION: Our overview will provide evidence to help synthesize the broad degree of information available on furthering the knowledge, safety, and application of Qigong. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as this study is an overview based on the published systematic reviews. The result of this overview of systematic reviews will be published in a peer-reviewed journal or disseminated at national and international conferences. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42018109409.

Applications of Electrochromic Copolymers Based on Tris(4-carbazoyl-9-ylphenyl)amine and Bithiophene Derivatives in Electrochromic Devices.

Four copolymers (P(tCz (tris(4-carbazoyl-9-ylphenyl)amine)-co-bTP (2,2'-bithiophene)), P(tCz-co-CPDT (4H-cyclopenta[2,1-b:3,4-b']dithiophene)), P(tCz-co-DTC (3,6-di(2-thienyl)carbazole)), and P(tCz-co-CPDTK (cyclopentadithiophene ketone))) are deposited on indium tin oxide (ITO) surfaces using electrochemical polymerization. Spectroelectrochemical properties of copolymer electrodes reveal that the colors of P(tCz-co-bTP) film are pinkish-orange, light olive green, light grayish blue, and dark blue at 0.0, 0.8, 1.2, and 1.6 V, respectively, whereas the color variations of P(tCz-co-CPDTK) film are light yellow, yellow, and blue at 0.0 V, 0.8 V, and 1.5 V, respectively. The ΔT of P(tCz-co-bTP), P(tCz-co-CPDT), P(tCz-co-DTC), and P(tCz-co-CPDTK) films are estimated to be 43.0% at 967 nm, 28.7% at 864 nm, 43.6% at 870 nm, and 24.5% at 984 nm, respectively. Five electrochromic devices (ECDs) are assembled using the tCz-based homopolymer and copolymers as coloring electrodes, and poly(2,2-dimethyl-3,4-propylenedioxythiophene) (PProDOT-Me2) as the complementary electrode. P(tCz-co-DTC)/PProDOT-Me2 ECD reveals high transmittance change (45.9% at 624 nm), P(tCz-co-CPDTK)/PProDOT-Me2 ECD shows high η (513.0 cm² C-1 at 582 nm), and P(tCz-co-bTP)/PProDOT-Me2 ECD presents short switching time (less than 0.4 s) at 628 nm. Moreover, these ECDs show satisfactory redox stability and open circuit stability.

Inhomogeneous downregulation of INa underlies piceatannol proarrhythmic mechanism in regional ischemia-reperfusion.

BACKGROUND: Piceatannol, a grape-derived polyphenol, has been linked to proarrhythmic properties by aggravating inhomogeneous conduction delay in the ischemia-reperfusion (IR) zone to enhance arrhythmogenic alternans in heart failure (HF) rabbits. The underlying molecular mechanisms of piceatannol-induced conduction disturbance were unclear in this model. METHODS: HF was induced by 4 weeks' rapid ventricular pacing. IR injury was induced in vivo using a protocol of left coronary artery ligation and release. Left ventricular cardiomyocytes were isolated enzymatically for whole-cell patch-clamp studies. Piceatannol (10 µM) was administrated to test its inhibitory effect on sodium current (INa ). Immunoblots studies and immunoenzymological staining were conducted in tissues sampled from the IR and remote zones. RESULTS: Peak INa density was less in failing cardiomyocytes than control cardiomyocytes. IR injury further reduces peak INa density in both groups. Piceatannol showed a greater INa inhibitory effect in HF than control cardiomyocytes. Western blots showed reduced NaV 1.5 protein expression in the HF group compared to the control group but no significant difference between remote and IR zones. Immunostaining showed that IR led to cytosolic redistribution of NaV 1.5, especially in failing hearts. CONCLUSIONS: Downregulation of NaV 1.5 protein expression and reduced peak INa density are found in the failing hearts. Piceatannol exerts a greater inhibitory effect on peak INa in the failing cardiomyocytes than in the controls. IR injury further decreases peak INa density, which is more prominent in the failing hearts than in the control hearts.

Predictors of Long-Term Outcomes After Drug-Eluting Balloon Angioplasty for Bare-Metal Stent Restenosis.

BACKGROUND: Clinical trials have investigated efficacy of drug-eluting balloon (DEB) angioplasty for bare-metal stent (BMS) in-stent restenosis (ISR). Few studies have investigated predictors of long-term outcomes following BMS-ISR treatment with DEB. METHODS: From June 2011 to April 2015, 105 patients with 125 BMS-ISR lesions were enrolled from the Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN) registry. All these lesions were treated with DEB angioplasty as final therapy. The major adverse cardiac events (MACEs) were recurrent clinically driven target lesion revascularisation (TLR), myocardial infarction, and cardiac death after DEB angioplasty. RESULTS: After DEB angioplasty, the angiographic stenosis decreased from 84.8%±12.4% to 22.6%±10.4%. Over a mean follow-up duration of 21.7±13.4months, the rates of TLR at 1-12 months and 12-48 months were 4.8% and 4.2%, respectively. The rates of MACEs at 1-12 months and 12-48 months were 6.7% and 6.1%, respectively. Chronic haemodialysis, calcified lesion, chronic total occlusion lesion before stenting, stent with metal-to-artery ratio >16.5%, and residual stenosis >25% after DEB angioplasty were potential risk factors for MACEs in univariate analysis. After adjustment in multivariate analysis, independent predictors of long-term MACEs were identified as chronic haemodialysis, chronic total occlusion lesion before stenting, and residual stenosis >25% after DEB angioplasty. CONCLUSIONS: The long-term results of DEB angioplasty for BMS-ISR are acceptable in this real-world registry. Patient (chronic haemodialysis), lesion (chronic total occlusion) and angioplasty (residual stenosis percentage) related factors predicted long-term outcomes following BMS-ISR treatment with DEB angioplasty.