Gas-phase isopropanol degradation by nonthermal plasma combined with Mn-Cu/-Al2O3.

In this study, the dielectric barrier discharge (DBD) induced by nonthermal plasma (NTP) technology was used for isopropanol (IPA) degradation. IPA, intermediate, final product, and ozone concentrations were analyzed using GC-MS, carbon dioxide detector, and ozone detector. The experimental flow rate and concentration were fixed to 1 L/min and 1200 ppm ± 10%, respectively. Different reaction procedures were proposed for self-made metal catalyst combined with a plasma system (plasma alone and γ-Al2O3 combined with plasma, Cu (5 wt%)/γ-Al2O3 combined with plasma, Mn (3 wt%)-Cu (5 wt%)/γ-Al2O3 combined with plasma). In addition, the effect of the carrier gas oxygen content (0%, 20%, and 100%) on IPA conversion and intermediate and carbon dioxide selectivity was also investigated. The results revealed that the Mn (F)-Cu/γ-Al2O3 combined with plasma exhibited more efficient IPA conversion. In the 100% oxygen environment, the IPA conversion rate increased from 79.32 to 99.99%, and carbon dioxide selectivity increased from 3.82 to 50.23%. IPA was completely converted after 60 min of plasma treatment with the acetone selectivity, carbon dioxide selectivity, and tail ozone concentration of 26.71% ± 1.27%, 50.23% ± 0.56%, and 1761 ± 11 ppm, respectively. This study proved that the current single planar DBD configuration is an effective advanced treatment technology for the decomposition of VOCs.

Recycle of synthetic calcium fluoride and waste sulfuric acid to produce electronic grade hydrofluoric acid.

An innovative method for utilizing synthetic calcium fluoride (CaF2), recovered from fluoride-containing semiconductor wastewater, and waste sulfuric acid (H2SO4) to produce hydrofluoric acid (HF) was investigated. The research was set to study the low-temperature production of HF via reaction of synthetic CaF2 and waste H2SO4. The impact of four factors, including H2SO4 concentration, total volume (H2SO4 + H2O)/CaF2 ratio, drying temperature of synthetic CaF2, and reaction carried out under different temperature, on HF productivity was investigated in this study. HF yield increased with increasing H2SO4 concentration and total volume/CaF2 ratio under room temperature. Generally, reactions carried out under low-temperature (< 100 °C) had a positive impact on HF yield. The higher temperature led to an increase in absorbed-HF but a decrease in total-HF. The reaction of commercial CaF2 and 70% H2SO4 had a higher absorbed-HF yield of 61.7% than synthetic CaF2 and 70% waste H2SO4, which had a yield of 36%. This was due to the higher purity of the commercial CaF2 and fewer interference ions in H2SO4. HF productivity was lowered by CaSO4, which hindered the reaction of reactants and also the generation of fluorosulfuric acid.

Usefulness of Therapeutic Hypothermia to Improve Survival in Out-of-Hospital Cardiac Arrest.

BACKGROUND: In recent years, therapeutic hypothermia (TH) has been used to improve outcomes in patients with out-of-hospital cardiac arrest (OHCA). Despite these recommendations, many centers are still hesitant to implement such hypothermia protocols. In this study, we assessed the effects of TH for OHCA patients. METHODS: A total of 58 OHCA patients who had return of spontaneous circulation after OHCA presumed to be due to cardiac causes were enrolled. Twenty-three patients underwent TH, which was performed using a large volume of ice crystalloid fluid infusions in the emergency room and conventional cooling blankets in the ICU to maintain a body temperature of 32-34 °C for 24 hours using a tympanic thermometer. Patients in the control group received standard supportive care without TH. Hospital survival and neurologic outcomes were compared. RESULTS: There were no significant differences between the groups in patient characteristics, underlying etiologies and disease severity. In the 23 patients who received TH, 17 were alive at hospital discharge. In the 35 patients who received supportive care, only 11 were alive at hospital discharge (73.91% vs. 31.43%, p = 0.0015). Approximately 52% of the patients in the TH group had good neurologic outcomes (12 of 23) compared with the 20% (7 of 35) of the patients in the supportive group (p = 0.01). CONCLUSIONS: TH can improve the outcomes of OHCA patients. Further large-scale studies are needed to verify our results.

2018 TSOC guideline focused update on diagnosis and treatment of pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is characterized as a progressive and sustained increase in pulmonary vascular resistance, which may induce right ventricular failure. In 2014, the Working Group on Pulmonary Hypertension of the Taiwan Society of Cardiology (TSOC) conducted a review of data and developed a guideline for the management of PAH.4 In recent years, several advancements in diagnosis and treatment of PAH has occurred. Therefore, the Working Group on Pulmonary Hypertension of TSOC decided to come up with a focused update that addresses clinically important advances in PAH diagnosis and treatment. This 2018 focused update deals with: (1) the role of echocardiography in PAH; (2) new diagnostic algorithm for the evaluation of PAH; (3) comprehensive prognostic evaluation and risk assessment; (4) treatment goals and follow-up strategy; (5) updated PAH targeted therapy; (6) combination therapy and goal-orientated therapy; (7) updated treatment for PAH associated with congenital heart disease; (8) updated treatment for PAH associated with connective tissue disease; and (9) updated treatment for chronic thromboembolic pulmonary hypertension.

Clinical Outcomes of Polytetrafluoroethylene-Covered Stents for Coronary Artery Perforation in Elderly Patients Undergoing Percutaneous Coronary Interventions.

BACKGROUND: Coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) is associated with increased mortality. Polytetrafluoroethylene covered stents (CS) are an effective approach to treat CAP, but data regarding elderly patients requiring CS implantation for CAP are limited. The aim of this study is to report clinical data for elderly CAP patients undergoing CS implantation during PCI. METHODS: Nineteen consecutive elderly patients (≥ 65 years) undergoing CS implantation due to PCI-induced CAP in a tertiary referral center from July 2003 to April 2016 were retrospectively examined. RESULTS: There were 13 men and six women, with a mean age of 75.3 ± 5.6 years (range: 65-86 years). Perforation grade was Ellis type II in five patients (26.3%), and Ellis type III in 14 patients (73.7%). Cardiac tamponade developed in six patients (31.6%), and intra-aortic balloon pumping was needed in four patients (21.1%). The overall success rate for CS implantation rate was 94.7%. The overall in-hospital mortality rate was 15.8%; the in-hospital myocardial infarction rate was 63.2%. Among 16 survival-to-discharge cases, dual antiplatelet therapy (DAPT) was prescribed in 14 cases (87.5%) for a mean duration of 14 months. Overall, there were five angiogram- proven CS failures among 18 patients receiving successful CS implantation. The 1, 2 and 4 years of actuarial freedom from the CS failure were 78%, 65%, and 43% in the angiogram follow-up patients. CONCLUSIONS: CS implantation for CAP is feasible and effective in elderly patients, while CS failure remains a major concern that encourages regular angiographic follow-up in these case.

The relationships of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease.

Hypertension, blood pressure variation, and resistant hypertension have close relations to sleep apnea, which lead to target organ damage, including the kidney. The complex relationships between sleep apnea and blood pressure cause their interactions with chronic kidney disease ambiguous. The aim of the study was to elucidate the separate and joint effects of sleep apnea, hypertension, and resistant hypertension on chronic kidney disease. A cross-sectional study was done to see the associations of sleep apnea, hypertension, and resistant hypertension with chronic kidney disease in 998 subjects underwent overnight polysomnography without device-therapy or surgery for their sleep-disordered breathing. Multivariate logistic regression was used to analyze the severity of SA, hypertension stage, resistant hypertension, and their joint effects on CKD. The multivariable relative odds (95% CI) of chronic kidney disease for the aged (age ≥65 years), severe sleep apnea, stage III hypertension, and resistant hypertension were 3.96 (2.57-6.09) (P < 0.001), 2.28 (1.13-4.58) (P < 0.05), 3.55 (1.70-7.42) (P < 0.001), and 9.42 (4.22-21.02) (P < 0.001), respectively. In subgroups analysis, the multivariable relative odds ratio of chronic kidney disease was highest in patients with both resistant hypertension and severe sleep apnea [13.42 (4.74-38.03)] (P < 0.001). Severe sleep apnea, stage III hypertension, and resistant hypertension are independent risk factors for chronic kidney disease. Patients with both severe sleep apnea and resistant hypertension have the highest risks.

Management of distal left main coronary artery aneurysm.

Aneurysms of the left main coronary artery are extremely rare. The cause of such aneurysms is uncertain. Although the treatment of distal left main aneurysms is very complicated, definitive treatment is necessary because the aneurysm may grow further and cause embolism or rupture. Herein, we report a case of acute myocardial infarction caused by aneurysm of the distal left main coronary artery, which was successfully treated by performing coronary artery bypass surgery, followed by implantation of a polytetrafluoroethylene-covered stent.

Late Intervention-Related Complication - A Huge Subepicardial Hematoma.

UNLABELLED: A 75-year-old man had a history of triple vessel coronary artery disease. In August 2009, he had undergone successful percutaneous coronary intervention to the left circumflex coronary artery (LCX) for management of an in-stent restenosis (ISR) lesion. However, in September 2010, he began experiencing recurrent episodes of exertional chest pain. Chest radiography showed the left cardiac border bulging upwards. Transthoracic echocardiography and chest computed tomography revealed a huge oval mass of about 10.4 cm × 7.9 cm × 8.6 cm, which showed calcification and was obliterating the LCX. Subsequent coronary angiography revealed significant instent restenosis, with extravasation of a small amount of contrast material at the stent location, suggesting that the coronary artery had ruptured. We implanted a polytetrafluoroethylene-covered stent to seal the coronary perforation and to release the occlusion. The patient was symptom-free and had an uneventful outcome until the 1-year follow up. KEY WORDS: Coronary artery perforation; Covered stent; Hematoma.

Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention.

PURPOSES: Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. BASIC PROCEDURE: We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65). MAIN FINDINGS: Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I (P = .046). PRINCIPAL CONCLUSIONS: The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.

A novel method for in-situ monitoring of local voltage, temperature and humidity distributions in fuel cells using flexible multi-functional micro sensors.

In this investigation, micro voltage, temperature and humidity sensors were fabricated and integrated for the first time on a stainless steel foil using micro-electro-mechanical systems (MEMS). These flexible multi-functional micro sensors have the advantages of high temperature resistance, flexibility, smallness, high sensitivity and precision of location. They were embedded in a proton exchange membrane fuel cell (PEMFC) and used to simultaneously measure variations in the inner voltage, temperature and humidity. The accuracy and reproducibility of the calibrated results obtained using the proposed micro sensors is excellent. The experimental results indicate that, at high current density and 100%RH or 75%RH, the relative humidity midstream and downstream saturates due to severe flooding. The performance of the PEM fuel cell can be stabilized using home-made flexible multi-functional micro sensors by the in-situ monitoring of local voltage, temperature and humidity distributions within it.

Retrieval of dislodged coronary intravascular ultrasound catheter with embolic protection device.

A retained fractured segment of an intravascular ultrasound catheter in the coronary artery during percutaneous coronary intervention is a rare occurrence. We describe our experience with successful retrieval of a fractured IVUS catheter fragment in a previously stented left anterior descending artery using a distal embolic protection device.

The role of false lumen size in prediction of in-hospital complications after acute type B aortic dissection.

OBJECTIVES: The aim of this study was to determine whether false lumen size predicts in-hospital complications for acute type B aortic dissection. BACKGROUND: The incidence of complications developing in patients with acute type B aortic dissection has been high. However, methods for recognizing high-risk patients have not been well-studied. We used quantitative analysis by computed tomography (CT) to predict the occurrence of in-hospital complications. METHODS: Fifty-five consecutive patients with acute type B aortic dissection documented by CT imaging were analyzed. They were divided into groups, with and without in-hospital complications, and compared regarding maximal aortic diameter (MAD), maximal false lumen area (MFLA), minimal true lumen area (MTLA), branch-vessel involvement (BVI), and longitudinal length (LL) of aortic dissection. RESULTS: There were 31 patients with a stable course (group 1) and 24 patients who developed complications (group 2). The MFLA of group 2 was significantly larger than that of group 1 (group 1 vs. group 2=577.7+/-273.2 mm2 vs. 1,899.3+/-1,642.4 mm2, p<0.001). The BVI number was also higher in group 2 (group 1 vs. group 2=1.0+/-1.1 vs. 3.3+/-2.0, p<0.001). On multivariate analysis, only MFLA and BVI number were independent predictors of in-hospital complications. Patients with initial MFLA>or=922 mm2 or BVI number>or=2 showed a significantly higher incidence of in-hospital complications than the other patients (p<0.001). CONCLUSIONS: A large MFLA and a higher BVI number are powerful predictors of in-hospital complications after acute type B aortic dissection.

Total detachment of cardiac myxoma causing saddle embolization and mimicking aortic dissection.

A 51-year-old male presented with sudden onset lower abdominal pain followed by weakness of both legs. Examination revealed blood pressure of 220/130 mmHg, with a grade 2/6 systolic murmur audible at the apex of the heart, and absence of both femoral arterial pulses. Two-dimensional and transesophageal echocardiography showed no evidence of intracardiac tumor or dissection of the ascending and thoracic aorta. Moreover, an aortogram demonstrated total occlusion of the abdominal aorta just below the renal arteries. A myxomatous-like material occupying the abdominal aorta just above the bifurcation of the common iliac arteries was discovered during surgery. Histologic examination of the embolic material confirmed the diagnosis of myxomatous embolus. One year after the embolic episode, the patient was well and two-dimensional and transesophageal echocardiography revealed no evidence of residual intracardiac tumor.

Comparison of peripheral monocyte counts in patients with and without coronary spasm and without fixed coronary narrowing.

The relation between peripheral monocyte count and coronary vasospasm was examined in 180 patients with chest pain. It is suggested that coronary vasospasm should be investigated in patients with angina, hemodynamically insignificant coronary artery disease, and increased monocyte count (> or =547/mm(3)).