The interplay of inflammation and coagulation in COVID-19 Patients receiving extracorporeal membrane oxygenation support.

OBJECTIVE: Bleeding and thrombosis are common complications during Extracorporeal Membrane Oxygenation (ECMO) support for COVID-19 patients. We sought to examine the relationship between inflammatory status, coagulation effects, and observed bleeding and thrombosis in patients receiving venovenous (VV) ECMO for COVID-19 respiratory failure. STUDY DESIGN: Cross-sectional cohort study. SETTINGS: Quaternary care institution. PATIENTS: The study period from April 1, 2020, to January 1, 2021, we included all patients with confirmed COVID-19 who received VV ECMO support. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Thirty-two patients were supported with VV ECMO during the study period, and 17 patients (53%) survived to hospital discharge. The ECMO nonsurvivors mean lactate dehydrogenase (LDH) levels were markedly elevated in comparison to survivors (1046 u/L [IQR = 509, 1305] vs 489 u/L [385 658], p = 0.003). Platelet/fibrinogen dysfunction, as reflected by the low Maximum Amplitude (MA) on viscoelastic testing, was worse in nonsurvivors (65.25 mm [60.68, 67.67] vs 74.80 mm [73.10, 78.40], p = 0.01). Time-group interaction for the first seven days of ECMO support, showed significantly lower platelet count in the nonsurvivors (140 k/ul [103, 170] vs 189.5 k/ul [ 146, 315], p < 0.001) and higher D-dimer in (21 µg/mL [13, 21] vs 14 µg/mL [3, 21], p < 0.001) in comparison to the survivors. Finally, we found profound statistically significant correlations between the clinical markers of inflammation and markers of coagulation in the nonsurvivors group. The ECMO nonsurvivors experienced higher rate of bleeding (73.3% vs 35.3%, p = 0.03), digital ischemia (46.7% vs 11.8%, p = 0.02), acute renal failure (60% vs 11.8%, p = 0.01) and bloodstream infection (60% vs 23.5%, p = 0.03). CONCLUSION: The correlation between inflammation and coagulation in the nonsurvivors supported with VV ECMO could indicate dysregulated inflammatory response and worse clinical outcomes.

Dielectric, thermal and mechanical properties of zirconium silicate reinforced high density polyethylene composites for antenna applications.

A low cost and low dielectric loss zirconium silicate (ZrSiO4) reinforced HDPE (high-density polyethylene) composite has been developed for antenna applications. The 0-3 type composite is prepared by dispersing ZrSiO4 fillers for various volume fractions (0.1 to 0.5) in the HDPE matrix by the melt mixing process. The composite shows good microwave dielectric properties with a relative permittivity of 5.6 and a dielectric loss of 0.003 at 5 GHz at the maximum filler loading of 0.5 volume fraction. The composite exhibits low water absorption, excellent thermal and mechanical properties. It shows a water absorption of 0.03 wt%, a coefficient of thermal expansion of 70 ppm per °C and a room temperature thermal conductivity of 2.4 W mK(-1). The composite shows a tensile strength of 22 MPa and a microhardness of 13.9 kg mm(-2) for the filler loading of 0.5 volume fraction. The HDPE-ZrSiO4 composites show good dielectric, thermal and mechanical properties suitable for microwave soft substrate applications. A microstrip patch antenna is designed and fabricated using the HDPE-0.5 volume fraction ZrSiO4 substrate and the antenna parameters are investigated.

Impact of age on the outcomes of Takotsubo syndrome.

BACKGROUND: The impact on age on the short-term and long-term prognosis in patients with Takotsubo syndrome (TTS) is unclear. We aimed to evaluate whether age has prognostic implications during hospital stay and long-term follow-up of TTS patients. METHODS: 688 consecutive patients were admitted for TTS in 7 tertiary centers from January-2008 to June-2021. We divided our cohort into two groups (patients <75 years and ≥75 years). Clinical, analytical, and hemodynamic variables as well as in-hospital management were registered and compared between groups. Mortality rates during hospital stay and follow-up were assessed. Adverse cardiovascular events (ACE) were defined as the composite of cardiovascular death, heart failure event, acute myocardial infarction, stroke and symptomatic arrhythmia. RESULTS: Median age was 74.7 years and 49.4 % were ≥75 years. 86.9 % were women and 22.3 % were secondary forms of TTS. In-hospital mortality was 3.6 % (1.5 % cardiovascular). Median clinical follow-up was 4.3 years. Mortality during the follow-up period was 23 % (5.0 % cardiovascular) while ACE were 22.5 %, mainly due to heart failure events. Kaplan-Meier curves showed both higher rates of mortality and ACE in ≥75 years group (30.2 % vs 15.8 %; p < 0.001 and 28.3 % vs 16.7 %; p < 0.001). Age was independently associated with higher rates of overall mortality and ACE in patients with TTS. Hypertension, absence of sinus rhythm, Killip class > I and a more impaired coronary microvascular resistance were also associated to ACE in TTS patients. CONCLUSIONS: Advanced age was associated with higher rate of overall mortality and ACE during long-term follow-up in TTS patients.

Comparison of Body Mass Index (Four Categories) to In-Hospital Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation.

Although obesity is often associated with adverse outcomes in cardiovascular diseases, studies have demonstrated a beneficial effect on patients who underwent transcatheter aortic valve implantation (TAVI), coining the term "obesity paradox." We sought to determine if the obesity paradox is valid when patients are studied in body mass index (BMI) groups versus simplified classification of obese and nonobese. We examined the National Inpatient Sample database from 2016 to 2019 for all patients who underwent TAVI >18 years of age using the International Classification of Diseases, 10th edition procedure codes. Patients were grouped by BMI categories of underweight, overweight, obese, and morbidly obese. They were compared with normal-weight patients to assess the relative risk of in-hospital mortality, cardiogenic shock, ST-elevation myocardial infarction, bleeding complications requiring transfusions, and complete heart blocks requiring permanent pacemaker. A logistic regression model was constructed to account for potential confounders. Of the 221,000 patients who underwent TAVI, 42,315 patients with appropriate BMI designation were stratified into BMI groups. Compared to the normal-weight group, overweight, obese, and morbid-obese TAVI patients were associated with a lower risk of in-hospital mortality (relative risk [RR] 0.48, confidence interval [CI] 0.29 to 0.77, p <0.001), (RR 0.42, CI 0.28 to 0.63, p <0.001), (RR 0.49, CI 0.33 to 0.71, p <0.001 respectively), cardiogenic shock (RR 0.27, CI 0.20 to 0.38, p <0.001), (RR 0.21, CI 0.16 to 0.27, p <0.001), (RR 0.21, CI 0.16 to 0.26, p <0.001), and blood transfusions (RR 0.63, CI 0.50 to 0.79, p <0.001), (RR 0.47, CI 0.39 to 0.58, p <0.001), (RR 0.61, CI 0.51 to 0.74, p <0.001). This study indicated that obese patients were at a significantly lower risk of in-hospital mortality, cardiogenic shock, and bleeding complications requiring transfusions. In conclusion, our study supported the existence of the obesity paradox in TAVI patients.

Impact of Migraine Headaches on Stress-Induced 'Takotsubo' Cardiomyopathy.

INTRODUCTION: Takotsubo cardiomyopathy (TCM) is an acute left ventricular dysfunction, typically due to a neuro-cardiogenic mechanism. Although many stressors can precipitate TCM, the role of migraines in hospitalized TCM patients has not been studied. Our objective is to describe the in-hospital outcomes of TCM in patients with a concurrent diagnosis of migraines. METHODS: We conducted a US-wide analysis of TCM hospitalizations from 2013 to 2017 by querying the National Inpatient Sample database for the International Classification of Diseases, Ninth and 10th Revisions (ICD-9 and ICD-10). Patients admitted with a principal diagnosis of TCM with a history of migraines were identified using the ICD-10 codes. TCM patients with migraines were then compared to TCM patients without migraines regarding mortality and acute inpatient complications (intubation, cardiac arrest, heart failure exacerbation, acute kidney injury). A logistic regression model was constructed to account for potential confounders. RESULTS: A total of 172,025 TCM patients were identified. Of those patients, 3610 suffered from migraines. TCM patients with a diagnosis of migraine were associated with a lower odds for mortality (OR: 0.388; [0.311-0.485]; p < 0.001) and acute complications (OR: 0.511 [0.471-0.554]; p < 0.001) compared to those without migraines. After adjusting for confounders, the adjusted odds ratio for mortality was 0.622; [0.495-0.782]; p < 0.001, and acute complications were 0.563 [0.519-0.611]; p < 0.001. CONCLUSIONS: TCM patients with migraines were found to have a better outcome and mortality. They had significantly fewer complications (cardiac arrest, heart failure exacerbation, intubation, acute kidney injury).

Fabrication of modern lithium ion batteries by 3D inkjet printing: opportunities and challenges.

Inkjet printing (IJP) is a prospective additive manufacturing technology that enables the rapid and precise deposition of thin films or patterns. It offers numerous advantages over other thin-film manufacturing processes, including cost-effectiveness, ease of use, reduced waste material, and scalability. The key advantage of this technique is the ability of the fabrication of complex patterns with very high precision. The IJP gives the possibility of building three-dimensional (3D) structures on the microscale, which is beneficial for modern Li-Ion batteries (LIBs) and All-Solid-State Li-Ion Batteries (ASSLIBs). In contrast to typical laminated composite electrodes manufactured by tape casting and calendaring, 3D electrode design allows the electrolyte to penetrate through the electrode volume, increasing the surface-to-volume ratio and reducing ion diffusion paths. Thus, 3D electrodes/electrolyte structures are one of the most promising strategies for producing next-generation lithium-ion batteries with enhanced electrochemical performance. Although in the literature review, the IJP is frequently reported as a future perspective for the fabrication of 3D electrodes/electrolytes structures for LIBs, only a few works focus on this subject. In this review, we summarize the previous studies devoted to the topic and discuss different bottlenecks and challenges limiting further development.

A Temperature-Responsive Copper Molybdate Polymorph Mixture near to Water Boiling Point by a Simple Cryogenic Quenching Route.

Smart temperature-responsive inorganic materials in accessible temperature ranges open up new positions in the technology. Herein, we present for the first time a CuMoO4 polymorph mixture prepared by a simple cryogenic quenching approach, which offers a fast temperature response close to water boiling temperature for use as a permanent temperature recorder. The new cryogenic quenching technique initiates the formation of a unique polymorph mixture of a deep brown color with a nonuniform combination of γ- and α-CuMoO4, with the γ phase being confined to the outer region of α-CuMoO4, which has been prepared by conventional solid-state synthesis. In situ structural analysis and refinement results confirm the presence of CuMoO4 α and γ polymorphs in which the amount of γ polymorph decreases and that of the α phase increases with temperature, accounting for the irreversible thermochromic behavior. The thermal analysis reveals that the polymorph mixture exhibits a fast response with the color changing from deep brown to bright green with intermediate colors of light brown, yellowish green, and light green depending on the exposure temperature as observed from reflectance measurements.

ULTCC Glass Composites Based on Rutile and Anatase with Cofiring at 400 °C for High Frequency Applications.

The article presents the very first materials to the ultralow temperature cofired ceramic (ULTCC) technology with the sintering temperature of 400 °C. The dielectric composites are based on a rutile and anatase with commercial GO17 sealing glass. In addition to the bulk samples, the tape casting procedure is also introduced to show its feasibility to cofiring with commercial Ag electrodes at 400 °C. The structural, microstructural, thermal, and microwave dielectric properties in the green and sintered samples were investigated. The optimum amount of glass to fabricate substrates was found to be 30 vol %. The ULTCC substrates with the anatase TiO2A-30GO17 and rutile TiO2R-30GO17 that were sintered at 400 °C showed a relative permittivity of 9.9 and 15 and a dielectric loss of 0.006 and 0.003, respectively, at the measurement frequency of 9.9 GHz. The temperature dependences of the relative permittivity were +70 and -400 ppm/°C, respectively. Moreover, the coefficients of the thermal expansion of the substrates were 7.4 and 8.3 ppm/°C in the measured temperature range of 50-300 °C. A preliminary test to study the feasibility of the anatase TiO2A-30GO17 for a dual band antenna was performed due its relatively stable temperature behavior.

Ultra-Low-Temperature Cofired Ceramic Substrates with Low Residual Carbon for Next-Generation Microwave Applications.

High-temperature cofired ceramics and low-temperature cofired ceramics are important technologies in the fabrication of multilayer ceramic substrates for discrete devices, electronics packages, and telecommunications. However, there is a place and need for materials with lower fabrication temperatures to decrease the associated energy consumption. The present paper studies the feasibility of two ultra-low sintering temperature cofired ceramic materials, copper molybdate and copper molybdate-Ag2O, sinterable at 650 and 500 °C, respectively, for multilayer substrates using tape casting. The slurry composition developed uses environmentally friendly organics and a nontoxic binder and solvent. Additionally, the green cast tapes exhibit very low residual carbon (less than 5%) after sintering on analysis by X-ray photoelectron spectroscopy. The multilayer substrates show a permittivity value of about 8 with a low dielectric loss in the range of 10-5 to 10-4 in the frequency range of 2-10 GHz along with a low coefficient of thermal expansion in the range of 4-5 ppm/°C and good compatibility with an Al electrode. Thus, these proposed substrates have much promise, with good thermal, mechanical, and dielectric properties comparable to commercial substrates while also providing an energy and environment-friendly solution.

Investigation of gait cycle deviation over surface irregularities utilizing muscle activities.

BACKGROUND: Human beings regularly walk over even and uneven surfaces during their daily activities. A human being with lower limb disability needs an exoskeleton to walk independently. However, walking surface irregularities increase the risk of falling of exoskeleton users. This falling tendency can be minimized by balancing the exoskeleton on irregular surface profiles against the gait cycle variation. Gait variation is studied using quality EMG signals obtained from the gastrocnemius and hamstring muscle activity during uneven surface walking. OBJECTIVE: The present study compares the activity of hamstring and gastrocnemius muscles during walking on a treadmill, utilizing both even and uneven planes. METHODS: Integrated electromyography signals from eight healthy male subjects are collected while walking on a treadmill, even and uneven planes. Muscle activity variation on these planes is studied using two-way ANOVA with replications. RESULTS: The results show that hamstring muscle activity registers a sound variation in swing phase but has no variation in stance phase over all three planes, whereas gastrocnemius muscle activity changes between swing and stance phases over even and uneven planes during forward walking. CONCLUSIONS: The results illustrate that the gait cycle variation depends on surface irregularities which indicates the importance of surface consideration.

Multilayer Functional Tapes Cofired at 450 °C: Beyond HTCC and LTCC Technologies.

This paper reports the first ultralow sintering temperature (450 °C) cofired multifunctional ceramic substrate based on a commercial lead zirconium titanate (PZ29)-glass composite, which is fabricated by tape casting, isostatic lamination, and sintering. This substrate was prepared from a novel tape casting slurry composition suitable for cofiring at low temperatures with commercial Ag electrodes at 450 °C. The green cast tape and sintered substrate showed a surface roughness of 146 and 355 nm, respectively, suitable for device-level fabrication by postprocessing. Additionally, the ferroelectric and piezoelectric studies disclosed low remnant polarization due to the dielectric glass matrix with average values of piezoelectric coefficient (+ d33) and voltage coefficient (+ g33) of 17 pC/N and 30 mV/N, respectively. The dielectric permittivity and loss value of the sintered substrates were 57.8 and 0.05 respectively, at 2.4 GHz. The variation of relative permittivity on temperature dependence in the range of -40 to 80 °C was about 23%, while the average linear coefficient of thermal expansion was 6.9 ppm/°C in the measured temperature range of 100-300 °C. Moreover, the shelf life of the tape over 28 months was studied through measurement of the stability of the dielectric properties over time. The obtained results open up a new strategy for the fabrication of next-generation low-cost functional ceramic devices prepared at an ultralow temperature in comparison to the high-temperature cofired ceramic and low-temperature cofired ceramic technologies.

Hafnium silicate: a new microwave dielectric ceramic with low thermal expansivity.

A HfSiO4 ceramic was prepared by a conventional solid state synthesis method by sintering at 1600 °C. The morphology of the sintered surface was characterized using scanning electron microscopy and atomic force microscopy and the average surface roughness was about 118 nm. The sintered HfSiO4 ceramic has εr = 7.0, Qu × f = 25 000 and τf = -44 ppm °C(-1) at 10 GHz. It exhibits promising thermal properties such as a low linear thermal expansivity (CTE) of -1.8 ppm °C(-1) (dilatometer) in the temperature range of 30-800 °C and a room temperature thermal conductivity of 11 W m(-1) K(-1).