Comparison of the prognosis among in-hospital survivors of cardiogenic shock based on etiology: AMI and Non-AMI.

BACKGROUND: Current data on post-discharge mortality and rehospitalization is still insufficient among in-hospital survivors of cardiogenic shock (CS), including acute myocardial infarction (AMI) and non-AMI survivors. METHODS: Patients with CS who survived after hospital discharge were selected from the Taiwan National Health Insurance Research Database. Each patient was followed up at 3-year intervals. Mortality and rehospitalization were analyzed using Kaplan-Meier curves and Cox regression models. RESULTS: There were 16,582 eligible patients. Of these, 42.4% and 57.6% were AMI-CS and non-AMI-CS survivors, respectively. The overall mortality and rehospitalization rates were considerably high, with reports of 7.0% and 22.1% at 30 days, 24.5% and 58.2% at 1 year, and 38.9% and 73.0% at 3 years, respectively, among in-hospital CS survivors. Cardiovascular (CV) problems caused approximately 40% mortality and 60% rehospitalization. Overall, the non-AMI-CS group had a higher mortality burden than the AMI-CS group owing to older age and a higher prevalence of comorbidities. In multivariable models, the non-AMI-CS group exhibited a lower risk of all-cause mortality (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.60 to 0.78) and CV mortality (aHR 0.65, 95% CI 0.54 to 0.78) compared to the AMI-CS group. However, these risks diminished and even reversed after one year (aHR 1.13, 95% CI 1.03 to 1.25 for all-cause mortality; aHR 1.27, 95% CI 1.09 to 1.49 for CV mortality).This reversal was not observed in all-cause and CV rehospitalization. For rehospitalization, AMI-CS was associated with the risk of CV rehospitalization in the entire observation period (aHR:0.80, 95% CI:0.76-0.84). CONCLUSIONS: In-hospital AMI-CS survivors had an increased risk of CV rehospitalization and 30-day mortality, whereas those with non-AMI-CS had a greater mortality risk after 1-year follow-up.

A Discrete-Finite Element Analysis Model Based on Almen Intensity Test for Evaluation of Real Shot Peening Residual Stress.

In this study, a combined discrete-finite element model based on the Almen intensity measurement test was proposed to evaluate the real shot peening residual stress. The discrete element analysis was utilized to simulate the random behavior of numerous shot balls, while the finite element analysis was employed to quantitatively predict the residual stress induced by shot peening. Moreover, the Almen intensity, an essential factor in the actual shot peening process, was taken into account. Initially, an Almen strip analysis model was established, and the multi-random impact analysis was performed to validate the good agreement between the analytical Almen curve and experimental Almen curve. Subsequently, the unit cell discrete-finite element analysis model was expanded for predicting the peening residual stress, incorporating the Almen intensity. The analysis results showed a significant correlation between the predicted peening residual stress and the XRD (X-ray diffraction) experimental residual stress. Therefore, it was confirmed that the proposed discrete-finite element random impact analysis model in this study could serve as an effective analytical technique capable of substituting for the actual shot peening process.

Multiband directional reflectance properties of oil-in-water emulsion: application for identification of oil spill types.

Reflection characteristics play a critical role in identifying, assessing, and responding to different types of oil spills. In this paper, we prepared three concentrations of oil-in-water (OW) emulsions and measured their directional reflection properties in the visible and near-IR range. The spectral differences in reflectance between OW emulsions and oil films were analyzed. Furthermore, the AVIRIS and Landsat 7 images collected over the oil spill accident in the Gulf of Mexico were used to demonstrate the feasibility to apply the experimental results in the identification of oil spill types. The results show that OW emulsions and oil films can be well discriminated in remote sensing images based on their reflectance spectral differences. The OW emulsion is mainly distributed in strips along the edge of the oil film, which is useful to delineate the spill outline and calculate the polluted area.

Comparison between ticagrelor versus clopidogrel in long term outcomes of Taiwanese diabetic subjects with acute coronary syndrome undergoing successful revascularization: From TSOC ACS-DM registry.

Although previous clinical trials demonstrated that ticagrelor could reduce cardiovascular events and mortality versus clopidogrel in patients with acute coronary syndrome (ACS), the real-world evidence of its clinical impacts on East Asian Diabetic population has rarely been investigated.Between November 2013 and June 2015, 1534 patients were recruited into the Acute Coronary Syndrome-Diabetes Mellitus Registry of the Taiwan Society of Cardiology (TSOC ACS-DM registry). After propensity score matching, a total of 730 patients undergoing successful revascularization and discharged on ticagrelor (N = 365) or clopidogrel (N = 365) were analyzed. The primary and secondary endpoints were all-cause mortality and re-hospitalization, respectively. The all-cause death associated with ticagrelor vs clopidogrel was 3.6% vs 7.4% (adjusted hazard ratio (HR) 0.34 [0.15-0.80]; P = .0138) at 24 months. The re-hospitalization rate at 24 months was 38.9% vs 39.2% (P = .3258).For diabetic patients with ACS, ticagrelor provided better survival benefit than clopidogrel without an increase of re-hospitalization in 24 months after successful percutaneous coronary intervention. This study in real-world circumstance provided valuable complementary data to externally validate platelet inhibition and patient outcomes (PLATO) finding especially in Asian diabetic population.

Monte Carlo simulation of spectral reflectance and BRDF of the bubble layer in the upper ocean.

The presence of bubbles can significantly change the radiative properties of seawater and these changes will affect remote sensing and underwater target detection. In this work, the spectral reflectance and bidirectional reflectance characteristics of the bubble layer in the upper ocean are investigated using the Monte Carlo method. The Hall-Novarini (HN) bubble population model, which considers the effect of wind speed and depth on the bubble size distribution, is used. The scattering coefficients and the scattering phase functions of bubbles in seawater are calculated using Mie theory, and the inherent optical properties of seawater for wavelengths between 300 nm and 800 nm are related to chlorophyll concentration (Chl). The effects of bubble coating, Chl, and bubble number density on the spectral reflectance of the bubble layer are studied. The bidirectional reflectance distribution function (BRDF) of the bubble layer for both normal and oblique incidence is also investigated. The results show that bubble populations in clear waters under high wind speed conditions significantly influence the reflection characteristics of the bubble layer. Furthermore, the contribution of bubble populations to the reflection characteristics is mainly due to the strong backscattering of bubbles that are coated with an organic film.

Thyroid Storm and Incidental Anterior Mediastinal Teratoma: Coincidence or Correlation?

UNLABELLED: Teratoma is a rare cause of thyrotoxicosis. Among the different types of teratoma, struma ovarii is the main type which contains thyroid tissue. There is no evidence in the literature that would indicate mediasternal teratoma would also lead to thyrotoxicosis or thyroid storm. Herein we report a 37-year-old woman who suffered from palpitation. Her chest X-ray showed a mass lesion at the left hilum, and chest computed tomography scan yielded a suspicion of pericardial cyst. Thereafter, video-assisted thoracoscopic surgery was performed, and thymic cyst was diagnosed during the operation. However, subsequent pathological studies confirmed a diagnosis of mature cystic teratoma. A thyroid function test demonstrating hyperthyroidism was completed prior to the patient's operation, and thyroid storm was diagnosed by clinical presentation. The patient's symptoms did not improve after the operation until we added beta blocker and anti-thyroid agents. Therefore, was the presence of thyroid storm and anterior mediastinal teratoma coincident or correlative in this case? The special stain of teratoma tissues did not reveal any thyroid tissues. In conclusion, thyroid storm and anterior mediastinal teratoma in our case occurred coincidentally. However, a survey of possible hyperthyroidism in patients with anterior mediastinal tumor before operation is critical to avoid perioperative complications. KEY WORDS: Anterior mediastinal tumor; Hyperthyroidism; Teratoma.