Inodilators May Improve the In-Hospital Mortality of Patients with Cardiogenic Shock Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

Although inodilators (dobutamine and milrinone) are widely used empirically for cardiogenic shock (CS), the efficacy of inodilators for patients with CS undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is controversial. We evaluated the effects of inodilators on clinical outcomes using the RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock; NCT02985008) registry. We selected and analyzed the clinical outcomes of 496 patients who underwent VA-ECMO and did or did not receive inodilators. Of the 496 patients, 257 (51.8%) died during hospitalization. We selected 191 matched pairs to adjust for baseline clinical characteristics after 1:1 propensity score matching (PSM). The univariate and multivariate analyses showed that the inodilator group had significantly lower in-hospital mortality than the no-inodilator group (unadjusted hazard ratio [HR], 0.768; 95% confidence interval [CI], 0.579-1.018; p = 0.066, adjusted HR, 0.702; 95% CI, 0.552-0.944; p = 0.019). For patients with CS undergoing VA-ECMO, inodilators may improve clinical outcomes.

Mechanically robust textile-based strain and pressure multimodal sensors using metal nanowire/polymer conducting fibers.

Recently, multifunctional textile-based sensory systems have attracted a lot of attention because of the growing demand for wearable electronics performing real-time monitoring of various body signals and movements. In particular, textile-based physical sensors often require multimodal sensing capabilities to accurately detect and identify multiple mixed stimuli simultaneously. Here, we demonstrate a textile-based strain/pressure multimodal sensor using high-k poly(vinylidene fluoride)-co-hexafluoropropylene ion-gel film and silver nanowire/poly(3,4-ethylenedioxythiophene):polystyrene sulfonate-coated conducting fibers. The multimodal sensors exhibited reliable strain and pressure-sensing characteristics for strain ranges up to 25% and pressures up to 50 kPa, respectively, with a relatively high strain gauge factor (up to 2.74) and pressure sensitivity (0.32 kPa-1). More importantly, the textile-based multimodal sensor was able to detect the strain and pressure independently, allowing facile discrimination of strain and pressure. Using this approach, we demonstrated a textile-based multimodal sensor that incorporates one strain sensor and two pressure sensors detecting multiple weights simultaneously.

Large-Area Pixelized Optoelectronic Neuromorphic Devices with Multispectral Light-Modulated Bidirectional Synaptic Circuits.

The complete hardware implementation of an optoelectronic neuromorphic computing system is considered as one of the most promising solutions to realize energy-efficient artificial intelligence. Here, a fully light-driven and scalable optoelectronic neuromorphic circuit with metal-chalcogenide/metal-oxide heterostructure phototransistor and photovoltaic divider is proposed. To achieve wavelength-selective neural operation and hardware-based pattern recognition, multispectral light modulated bidirectional synaptic circuits are utilized as an individual pixel for highly accurate and large-area neuromorphic computing system. The wavelength selective control of photo-generated charges at the heterostructure interface enables the bidirectional synaptic modulation behaviors including the excitatory and inhibitory modulations. More importantly, a 7 × 7 neuromorphic pixel circuit array is demonstrated to show the viability of implementing highly accurate hardware-based pattern training. In both the pixel training and pattern recognition simulation, the neuromorphic circuit array with the bidirectional synaptic modulation exhibits lower training errors and higher recognition rates, respectively.

Comparison of in-hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno-arterial-extracorporeal membrane oxygenation.

AIMS: This study aimed to investigate differences in baseline and treatment characteristics, and in-hospital mortality according to the aetiologies of cardiogenic shock in patients undergoing veno-arterial-extracorporeal membrane oxygenation (VA-ECMO). METHODS AND RESULTS: The RESCUE registry is a multicentre, observational cohort that includes 1247 patients with cardiogenic shock from 12 centres. A total of 496 patients requiring VA-ECMO were finally selected, and the study population was stratified by cardiogenic shock aetiology [ischaemic cardiomyopathy (ICM, n = 342) and non-ICM (NICM, n = 154)]. The primary outcome of interest was in-hospital mortality. Sensitivity analyses including propensity-score matching adjustments were performed. Mean age of the entire population was 61.8 ± 14.2, and 30.8% were women. There were significant differences in baseline characteristics; notable differences included the older age of patients with ICM (65.1 ± 13.7 vs. 58.2 ± 13.8, P < 0.001), preponderance of males [258 (75.4%) vs. 85 (55.2%), P < 0.001], and higher prevalence of diabetes mellitus [140 (40.9%) vs. 39 (25.3%), P = 0.001] compared with patients in the NICM aetiology group. Patients with ischaemic cardiogenic shock were more likely to have longer shock duration before VA-ECMO implantation (518.7 ± 941.4 min vs. 292.4 ± 707.8 min, P = 0.003) and were less likely to undergo distal limb perfusion than those with NICM [108 (31.6%) vs. 79 (51.3%), P < 0.001]. In-hospital mortality in the overall cohort was 52.2%; patients with ICM had a higher unadjusted risk of in-hospital mortality [203 (59.4%) vs. 56 (36.4%); unadjusted hazard ratio, 2.295; 95% confidence interval, 1.698-3.100; P < 0.001]. There were no significant differences in the primary outcome between the two aetiologies following propensity-score matching multiple adjustments (adjusted hazard ratio, 1.265; 95% confidence interval, 0.840-1.906; P = 0.260). CONCLUSIONS: Results of the current study indicated among patients with cardiogenic shock undergoing VA-ECMO, ischaemic aetiology does not seem to impact in-hospital mortality. These findings underline that early initiation and appropriate treatment strategies of VA-ECMO for patients with ICM shock are required.

Beneficiation and recovery of indium from liquid-crystal-display glass by hydrometallurgy.

Considering indium scarcity, the end-of-life (EOL) LCD, which accounts for up to 90% of market share can be a feasible secondary resource upon successful recycling. In the preferred hydrometallurgical process of such critical metals, leaching is the essential primary and essential phase has been investigated. In this process, LCD was mechanically separated along with other parts from EOL TVs through a smartly engineered process developed at our institute, Institute for Advanced Engineering (IAE), the Republic of Korea. After removing plastics and metals from the LCD, it was mechanically shredded for size reduction. The mechanically shredded LCD waste was leached with HCl for recovery of indium. Possible leaching parameters such as; effect of acid concentration, pulp density, temperature and effect of oxidant H2O2 concentration were investigated to identify the best conditions for indium extraction. Indium (76.16×10-3g/L) and tin (10.24×10-3g/L) leaching was achieved at their optimum condition, i.e. lixiviant of 5M HCl, a pulp density of 500g/L, temperature 75°C, agitation speed of 400rpm and time for 120min. At optimum condition the glass, plastic and the valuable metal indium have completely been separated. From indium enriched leach liquor, indium can be purified and recovered through hydrometallurgy.

Selective recovery of pure copper nanopowder from indium-tin-oxide etching wastewater by various wet chemical reduction process: Understanding their chemistry and comparisons of sustainable valorization processes.

Sustainable valorization processes for selective recovery of pure copper nanopowder from Indium-Tin-Oxide (ITO) etching wastewater by various wet chemical reduction processes, their chemistry has been investigated and compared. After the indium recovery by solvent extraction from ITO etching wastewater, the same is also an environmental challenge, needs to be treated before disposal. After the indium recovery, ITO etching wastewater contains 6.11kg/m(3) of copper and 1.35kg/m(3) of aluminum, pH of the solution is very low converging to 0 and contain a significant amount of chlorine in the media. In this study, pure copper nanopowder was recovered using various reducing reagents by wet chemical reduction and characterized. Different reducing agents like a metallic, an inorganic acid and an organic acid were used to understand reduction behavior of copper in the presence of aluminum in a strong chloride medium of the ITO etching wastewater. The effect of a polymer surfactant Polyvinylpyrrolidone (PVP), which was included to prevent aggregation, to provide dispersion stability and control the size of copper nanopowder was investigated and compared. The developed copper nanopowder recovery techniques are techno-economical feasible processes for commercial production of copper nanopowder in the range of 100-500nm size from the reported facilities through a one-pot synthesis. By all the process reported pure copper nanopowder can be recovered with>99% efficiency. After the copper recovery, copper concentration in the wastewater reduced to acceptable limit recommended by WHO for wastewater disposal. The process is not only beneficial for recycling of copper, but also helps to address environment challenged posed by ITO etching wastewater. From a complex wastewater, synthesis of pure copper nanopowder using various wet chemical reduction route and their comparison is the novelty of this recovery process.

Percutaneous cardiopulmonary support-supported percutaneous coronary intervention: a single center experience.

BACKGROUND AND OBJECTIVES: Percutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI. SUBJECTS AND METHODS: We retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI. RESULTS: Among the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality. CONCLUSION: Our experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.

Gender-based differences in the management and prognosis of acute coronary syndrome in Korea.

PURPOSE: Gender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans. MATERIALS AND METHODS: We examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months. RESULTS: Women were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina. CONCLUSION: Female ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.

Constrictive Pericarditis Accompanied by Swine-Origin Influenza A (H1N1) Infection.

Swine-origin influenza A (H1N1) is caused by a new strain of the influenza virus. The disease has spread rapidly and was declared a pandemic in April, 2009. So far, however, there is a scarcity of information regarding the complications of swine influenza. A report of the disease in the winter of 2009 in the Southern Hemisphere found that the most common manifestations of influenza A virus infection are upper respiratory tract infection and pneumonia. Although there may be an association between fulminant myocarditis and Swine influenza, cardiovascular complications resulting from swine Influenza A infection are exceedingly rare. We report a case of acute constrictive pericarditis in a healthy subject infected by the swine-origin influenza A (H1N1) virus.

Pulmonary hypertension associated with use of phentermine.

Weight-control drugs (known as anorexigens) such as fenfluramine have been linked with pulmonary hypertension in previous reports. In our case, a 29 year old woman was admitted for shortness of breath and was diagnosed with pulmonary hypertension. Three months ago, she had been taking phentermine for five weeks. Other factors that might have contributed to the development of pulmonary hypertension were excluded. With treatment, her symptoms improved. This is the first case that can suggest a possible connection between phenermine single medication with pulmonary hypertension. Phentermine has been considered a relatively safe drug to treat obesity, and further investigation is needed to decide the safety and dosage of phentermine.