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The development of a dry-tree semisubmersible (DTS), a new type offshore hydrocarbon production system, is facing unconventional challenges in the issues of dynamic stability, structural integrity, and parametric resonance. The Mathieu equation is used to assess the dynamic stability of a top-tensioned riser (TTR) in order to prevent the parametric resonance which leads to detrimental effects on structural integrity. The objectives of this paper are to (i) study a Mathieu stability diagram and its coefficients for an assessment of the stability of a TTR, (ii) identify the effects of the dynamic tension variations in the Mathieu stability assessment, and (iii) analyze the stability of the TTR on a DTS, which is equipped with a long-stroke tensioner, by using numerical simulation. The dynamic tension variation in the DTS was identified to induce instability in the TTR. Hence, the Mathieu stability assessment is recommended to be included in an analysis of TTR behaviors in a dry-tree interface of semisubmersibles. [ABSTRACT FROM AUTHOR]

Background: The optimal dosing of novel oral P2Y 12 receptor platelet inhibitors such as prasugrel or ticagrelor is unclear and especially challenging in East Asians. We hypothesize that half-dose prasugrel and ticagrelor may be sufficient for long-term maintenance management in Korean patients with the acute coronary syndrome (ACS) compared with conventional dosages. Design: HOPE-TAILOR (Half Dose of Prasugrel and Ticagrelor in Platelet Response after Acute Coronary Syndromes) is a prospective, randomized, open-label, blinded, endpoint (PROBE) single-center, clinical trial. A total of 100 patients with ACS undergoing drug-eluting stent implantation will be randomly assigned to prasugrel, ticagrelor, or clopidogrel, and the patients in each treatment group will receive 1-month therapy with 100 mg q.d. aspirin plus prasugrel 10 mg q.d., ticagrelor 90 mg b.i.d., or clopidogrel 75 mg q.d., followed by half-dose prasugrel 5 mg q.d. or ticagrelor 45 mg b.i.d. for maintenance treatment but without clopidogrel dose reduction. The primary endpoint will be optimal platelet reactivity 3 months after coronary intervention, defined by VerifyNow Analyzer (PRU: 85-208) and vasodilator-stimulated phosphoprotein P2Y 12 flow cytometry assay (platelet reactivity indices: 16-50%). Clinical outcomes will also be assessed, including major efficacy (composite of cardiac death, nonfatal myocardial infarction, repeat revascularization, or stroke) and safety (bleeding = 2 according to the Bleeding Academic Research Consortium). Conclusion: HOPE-TAILOR is a prospective, randomized, open-label, blinded, endpoint study to explore the efficacy and safety of novel P2Y 12 receptor inhibitors administered orally at half the dose in Korean patients with ACS. The results will be available late in 2017. [ABSTRACT FROM AUTHOR]

Background: Septic shock remains a leading cause of death, despite advances in critical care management. The Surviving Sepsis Campaign (SSC) has reduced morbidity and mortality. This study evaluated risk factors for mortality in patients with septic shock who received treatment following the SSC bundles. Materials and Methods: This retrospective cohort study included patients with septic shock who received treatments following SSC bundles in an urban emergency department between November 2007 and November 2011. Primary and secondary endpoints were all-cause 7- and 28-day mortality. Results: Among 436 patients, 7- and 28-day mortality rates were 7.11% (31/436) and 14% (61/436), respectively. In multivariate analysis, high lactate level (odds ratio [OR], 1.286; 95% confidence interval [CI], 1.016-1.627; P=0.036) and low estimated glomerular filtration rate (OR, 0.953; 95% CI, 0.913-0.996; P=0.032) were independent risk factors for 7-day mortality. Risk factors for 28-day mortality were high lactate level (OR, 1.346; 95% CI, 1.083-1.673; P=0.008) and high Acute Physiology and Chronic Health Evaluation II score (OR, 1.153; 95% CI, 1.029-1.293; P=0.014). Conclusion: The risk of mortality of septic shock patients remains high in patients with high lactate levels and acute kidney injury. [ABSTRACT FROM AUTHOR]

For oillgas productionlprocessing platforms, multiple liquid layers can exist and their respective sloshing motions can also affect operational effectiveness or platform performance. To numerically simulate those problems, a new multiliquid moving particle simulation (MPS) method is developed. In particular, to better simulate the relevant physics, robust self-buoyancy model, inteiface searching model, and swface-tension model are developed. The developed multiliquid MPS method is validated by comparisons against experiment in which three-liquid-sloshing experiment and the corresponding linear potential theory are given. The validated multiliquid MPS program is subsequently coupled with a vessel-motion program in time domain to investigate their dynamiccoupling effects. In case of multiple liquid layers, there exists a variety of sloshing natural frequencies for respective inteifaces, so the relevant physics can be much more complicated compared with the single-liquid-tank case. The simulation program can also reproduce the detailed small-scale inteiface phenomenon called Kelvin-Helmholtz instability. The numerical simulations also show that properly designed liquid cargo tank can alsofunction as a beneficial antirolling device. [ABSTRACT FROM AUTHOR]

The mixed oil and gas including water and sand are extracted from well to offshore structure. This mixed fluid must be separated for subsequent processes by using wash tanks or separators. To design such a system, a proper numerical-prediction tool for multiphase fluids is required. In this regard, a new moving particle simulation (MPS) method is developed to simulate multiliquid-layer sloshing problems. The new MPS method for multifluid system includes extra search methods for interface particles, boundary conditions for interfaces, buoyancy-correction model, and surface-tension model for interface particles. The new particle interaction models are verified through comparisons with published numerical and experimental data. In particular, the multiliquid MPS method is verified against Molin et al's (2012) experiment with three liquid layers. In case of excitation frequency close to one of the internallayer resonances, the internal interface motions can be much greater than top free-surface motions. The verified multiliquid MPS program is subsequently used for more nonlinear cases including multi chromatic multi modal motions with larger amplitudes, from which various nonlinear features, such as internal breaking and more particle detachment, can be observed. For the nonlinear case, the differences between with and without buoyancy-correction and surface-tension models are also demonstrated. [ABSTRACT FROM AUTHOR]

Air embolism is a rare, potentially critical complication that can induce death. Central venous catheterization, which is commonly used for critically ill patients, is a possible cause of air embolism. We experienced a severe air embolism with abnormal air in left ventricle after CVC removal in a patient who was treated for eosinophilic pneumonia. Although the neurologic symptoms were severe, the patient was successfully treated with immediate hyperbaric oxygen therapy and the neurologic deficit was minimal. [ABSTRACT FROM AUTHOR]

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate. [ABSTRACT FROM AUTHOR]

Background: With the introduction of drug-eluting stents (DES), the angiographic rates of restenosis have reduced dramatically but less prominently in diabetic patients. We compared the effects of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) on 6-month angiographic and clinical outcomes in Korean diabetic patients. Method: Diabetic patients with de novo coronary lesions (169 patients with 190 lesions) were randomly assigned to either SES or PES in six different cardiovascular centers from April 2005 to January 2006. Patients with vessel size >2.0 mm and ≤2 vessel diseases requiring ≤2 DES implantation were included in the study. Results: Baseline clinical and angiographic characteristics were similar between the two groups. At 6-month follow-up, the late lumen loss (0.26 ± 0.76 in the SES group vs. 0.39 ± 0.92 mm in the PES group, P = 0.356) and the rate of binary restenosis (2.8%[n = 2] in the SES group vs. 6.9%[n = 5] in the PES group, P = 0.441) showed no significant differences. Rates of death (1.2%[n = 1] in the SES group vs. 1.2%[n = 1] in the PES group, P = 1.000), myocardial infarction (1.2%[n = 1] in the SES group vs. 1.2%[n = 1] in the PES group, P = 1.000), and target lesion revascularization (2.4%[n = 2] in the SES group vs. 4.8%[n = 4] in the PES group, P = 0.443) were similar in both groups during 6 months of follow-up. Conclusion: The use of either SES or PES demonstrated similar 6-month angiographic and clinical outcomes in Korean diabetic patients with coronary artery disease. [ABSTRACT FROM AUTHOR]

Nonlinear wave-current interactions with fixed or freely floating bodies are investigated by a two-dimensional (2D) fully-nonlinear numerical wave tank (NWT). The NWT is developed based on the potential theory and boundary element method (BEM) with constant panels. Mixed Eulerian-Lagrangian (MEL) time marching scheme (material-node approach) is used with fourth-order Runge-Kutta fully updated time integration, regriding, and smoothing techniques, and acceleration-potential formulation and direct mode-decomposition method. Specially devised [lowercase_phi_synonym]n-η type artificial damping zones (i.e., numerical beach) are implemented to prevent wave reflection from the end wall and wave maker. Using the developed NWT, nonlinear wave-current interactions (1) without bodies; (2) with a stationary body; and (3) with a floating body for various wave and current conditions have been investigated and some of the NWT simulations are compared with the results of Boussinesq’s equation and perturbation theory. It is seen that the NWT results reproduce the general trend of linear or perturbation theory in free-surface profiles, runup, forces, and motions but their magnitudes can be appreciably different from the perturbation-based solutions as wave steepness and current velocity grow. [ABSTRACT FROM AUTHOR]

The thermal performance of the airflow window systems was studied numerically using the finite-volume method. Effort was directed towards the reduction in space cooling load for the exhausting and the semi-exhausting triple-glazed airflow windows. The effects of various parameters such as exhausting airflow rate, solar insolation, and aspect ratio were presented. Some qualitative and quantitative comparisons between two systems were made. It was disclosed that the space-heat gain was considerably reduced by increasing the exhausting airflow rate, and the decrease in the space-heat gain of the semi-exhausting airflow window was larger than that of the exhausting airflow window by about 10W throughout most of the Re range (except the range of near Re = 0) of this numerical work. [ABSTRACT FROM AUTHOR]

The flow and heat transfer characteristics of a triple-glazed exhaust airflow window system were studied numerically by using the finite-volume method. Exhaust airflow rate, solar insolation and aspect ratio were considered important parameters. It was shown that space-heat gain was reduced considerably by increasing the exhaust airflow rate. The optimum exhaust airflow rate and aspect ratio were suggested to be Re=600 and W/H=0.05, respectively. Some comparisons between the airflow window system and the enclosed window system were made qualitatively and quantitatively. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Investigates the feasibility and safety of nonselective left internal mammary artery (LIMA) angiography via right transradial approach. Limitation of the right transradial approach; Procedure for LIMA angiography; Possibility of complication by mammary artery dissection.

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 27-year-old male patient who was treated for sepsis on his nose caused by augmentation rhinoplasty with fat grafting and septal extension graft.

Background: The US Food and Drug Administration Adverse Event Reporting System (FAERS) is a global passive surveillance database that relies on voluntary reporting by health care professionals and consumers as well as required mandatory reporting by pharmaceutical manufacturers. However, the initial filers and comparative patterns for oral P2 Y12 platelet inhibitor reporting are unknown. We assessed who generated original FAERS reports for clopidogrel, prasugrel, and ticagrelor in 2015. Methods: From the FAERS database we extracted and examined adverse event cases coreported with oral P2 Y12 platelet inhibitors. All adverse event filing originating sources were dichotomized into consumers, lawyers, pharmacists, physicians, other health care professionals, and unknown. Results: Overall, 2015 annual adverse events were more commonly coreported with clopidogrel (n = 13,234) with known source filers (n = 12,818, or 96.9%) than with prasugrel (2,896; 98.9% out of 2,927 cases) or ticagrelor (2,163, or 82.3%, out of 2,627 cases, respectively). Overall, most adverse events were filed by consumers (8,336, or 44.4%), followed by physicians (5,290, or 28.2%), other health care professionals (2,997, or 16.0%), pharmacists (1,125, or 6.0%), and finally by lawyers (129, or 0.7%). The origin of 811 (4.7%) initial reports remains unknown. The adverse event filing sources differ among drugs. While adverse events coreported with clopidogrel and prasugrel were commonly originated by patients (40.4 and 84.3%, respectively), most frequently ticagrelor reports (42.5%) were filed by physicians. Conclusion: The reporting quality and initial sources differ among oral P2 Y12 platelet inhibitors in FAERS. The ticagrelor surveillance in 2015 was inadequate when compared to clopidogrel and prasugrel. Patients filed most adverse events for clopidogrel and prasugrel, while physicians originated most ticagrelor complaints. These differences justify stricter compliance control for ticagrelor manufacturers and may be attributed to the confusion of treating physicians with unexpected fatal, cardiac, and thrombotic adverse events linked to ticagrelor. [ABSTRACT FROM AUTHOR]

Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. Methods: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. Results: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). Conclusion: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended. [ABSTRACT FROM AUTHOR]

The impact of antithrombotics on cancer is currently under intense investigation because of the excess of solid cancers in trials after thienopyridines such as TRITON (prasugrel), DAPT (prasugrel and clopidogrel), PAR-1 thrombin antagonist in TRACER (vorapaxar), pyrimidines in PEGASUS (ticagrelor), and in APPRAISE-2 after apixaban. However, whether patient survival after solid cancer (SASC) in antithrombotic trials may be affected is unknown. We matched the 1-year SASC rate in antithrombotic trials reported by Food and Drug Administration with the census averages in Surveillance, Epidemiology, and End Results (SEER) Program by the US National Cancer Institute and World Health Organization (WHO) surveys. The Food and Drug Administration provided the SASC data for 3 trials with similar cancer survival of about 70% for the first year of follow-up in TRITON, APPRAISE-2, and ARISTOTEL. Adjusted cancers in TRITON with SEER (odds ratio 0.92; 95% confidence interval 0.53 to 1.59, p = 0.4351) and WHO (odds ratio 0.99; 95% confidence interval 0.57 to 1.7, p = 1.00) revealed very close if not identical SASC rates in antithrombotic trials compared to epidemiologic census estimates. In conclusion, SASC rates in patients enrolled in antithrombotic trials do not differ from SEER or World Health Organization averages. [ABSTRACT FROM AUTHOR]

The interface between layered conjugated polymer and electrode is a most important factor to improve the performance and lifetime of polymeric light-emitting devices (PLEDs). In this work, a blue PLED with improved stability was achieved by the combination of optimized cathode structure as well as thermal treatment of light-emitting polymer (LEP). Experimental evidence of the initial luminance “settling in” stage was found to be dependent upon the cathode structure, while the long-term slope of luminance as a function of elapsed time is governed by the annealing conditions. Our study revealed the importance of extrinsic design of device for the improvement of PLED stability. Experimental data shows that a blue PLED annealed at 170 °C and 6 nm LiF at LiF/Ca/Al cathode retained the best lifetime, which can be explained by the improved polymer–metal interface and LEP’s charge mobility. [ABSTRACT FROM AUTHOR]

배경 Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of COVID-19. This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. 방법 A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The study hospital consists of three main categories: ward, outpatient clinic(OPD), and emergency room(ER).The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. We assumed exposed and infectious people from the patient and caregiver group came into the ER and OPD. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients,early testing of suspected infected people, and personal protective equipment(PPE) for both medical staff and visitors were evaluated. We set worse and best cases based on different parameters and performed sensitivity analysis for the vulnerability of results for each intervention. 결과 The model suggested that the early testing (within eight hours) of infected cases and operating the quarantine ward for newly hospitalized patients are effective measures for decreasing incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. Reinforcement of PPE for medical staff does not show an expected improvement of effectiveness. The effectiveness of front door screening and use of a quarantine unit are higher in the best case while the probability of control by testing and protection devices is higher in worst cases. 결론 This model suggests under the assumed conditions, some measures have a great influence on the incidence of COVID-19 within a hospital. Detecting the patients with COVID-19 from the ER and in wards before inflow to a hospital is effective in low transmission settings, and control by PPE is important in high transmission settings. Above all, the implementation of the preventive measures could reduce the size of a hospital outbreak. [ABSTRACT FROM AUTHOR]

배경 Identifying the extent of environmental contamination of SARS-CoV-2 is essential for infection control and prevention. In patients with severe COVID-19 requiring mechanical ventilation or high-flow oxygen, the extent of environmental contamination has not been fully investigated. 방법 We investigated virus contamination by collecting environmental swab samples and air sampling from negative pressure isolation rooms of three COVID-19 patients with severe pneumonia or acute respiratory distress syndrome. Among the study subjects, Patient 1 and Patient 2 received mechanical ventilation with a closed suction system while Patient 3 received high flow oxygen therapy and noninvasive ventilation. SARS-CoV-2 was detected by real-time reverse transcription polymerase chain reaction (rRT-PCR), and viral cultures were done for samples not negative on rRT-PCR. 결과 Of the 48 swab samples collected in the rooms of Patient 1 and Patient 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in Patient 3’s room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of Patient 1 and seven sites in Patient 3’s room. 결론 Environmental contamination of SARS-CoV-2 can be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic infection that is usually transmitted from cattle to humans through ingestion of animal milk, direct contact with animal parts, or inhalation of aerosolized particles. In Korea, brucellosis seem to be transmitted through close contact with blood, fetus, urine, and placenta of domestic cow that has been infected by Brucella abortus, or inhalation of B. arbortus while examining or slaughtering cow. Brucella melitensis infection is rare in Korea and there have been no reported cases of B. meliten- SIS or g nating from other countries until now. This report details a case of complicated brucellosis with infective spondylitis in a 48-year-old male construction worker recently returned from Iraq. Infection with B. melitensis was confirmed using 16s rRNA sequencing and 〇mp31 gene analysis. The patient was successfully treated using a combination of rifampin, doxycycline, and streptomycin, in accordance with WHO guidelines. This is the first reported case of complicated brucellosis with infective spondylitis in Korea caused by B. melitensis originating from Iraq. [ABSTRACT FROM AUTHOR]

Background: The US Food and Drug Administration Adverse Event Reporting System (FAERS) is a global passive surveillance database that relies on voluntary reporting by health care professionals and consumers as well as required mandatory reporting by pharmaceutical manufacturers. However, the initial filers and comparative patterns for oral P2 Y12 platelet inhibitor reporting are unknown. We assessed who generated original FAERS reports for clopidogrel, prasugrel, and ticagrelor in 2015. Methods: From the FAERS database we extracted and examined adverse event cases coreported with oral P 2 Y12 platelet inhibitors. All adverse event filing originating sources were dichotomized into consumers, lawyers, pharmacists, physicians, other health care professionals, and unknown. Results: Overall, 2015 annual adverse events were more commonly coreported with clopidogrel (n = 13,234) with known source filers (n = 12,818, or 96.9%) than with prasugrel (2,896; 98.9% out of 2,927 cases) or ticagrelor (2,163, or 82.3%, out of 2,627 cases, respectively). Overall, most adverse events were filed by consumers (8,336, or 44.4%), followed by physicians (5,290, or 28.2%), other health care professionals (2,997, or 16.0%), pharmacists (1,125, or 6.0%), and finally by lawyers (129, or 0.7%). The origin of 811 (4.7%) initial reports remains unknown. The adverse event filing sources differ among drugs. While adverse events coreported with clopidogrel and prasugrel were commonly originated by patients (40.4 and 84.3%, respectively), most frequently ticagrelor reports (42.5%) were filed by physicians. Conclusion: The reporting quality and initial sources differ among oral P2 Y12 platelet inhibitors in FAERS. The ticagrelor surveillance in 2015 was inadequate when compared to clopidogrel and prasugrel. Patients filed most adverse events for clopidogrel and prasugrel, while physicians originated most ticagrelor complaints. These differences justify stricter compliance control for ticagrelor manufacturers and may be attributed to the confusion of treating physicians with unexpected fatal, cardiac, and thrombotic adverse events linked to ticagrelor. [ABSTRACT FROM AUTHOR]

Background: The incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased. We investigated the impact of ESBL production on the mortality of patients with P. mirabilis bacteremia in Korea.Methods: Patients diagnosed with P. mirabilis bacteremia between November 2005 and December 2013 at a 2000-bed tertiary care center in South Korea were included in this study. Phenotypic and molecular analyses were performed to assess ESBL expression. Characteristics and treatment outcomes were investigated among ESBL-producing and non-ESBL-producing P. mirabilis bacteremia groups. A multivariate analysis of 28-day mortality rates was performed to evaluate the independent impact of ESBLs.Results: Among 62 P. mirabilis isolates from 62 patients, 14 expressed ESBLs (CTX-M, 2; TEM, 5; both, 6; other, 1), and the 28-day mortality rate of the 62 patients was 17.74%. No clinical factor was significantly associated with ESBL production. The 28-day mortality rate in the ESBL-producing group was significantly higher than that in the non-ESBL-producing group (50% vs. 8.3%, p = 0.001). A multivariate analysis showed that ESBL production (odds ratio [OR], 11.53, 95% confidence interval [CI], 2.11-63.05, p = 0.005) was independently associated with the 28-day mortality rate in patients with P. mirabilis bacteremia.Conclusions: ESBL production is significantly associated with mortality in patients with bacteremia caused by P. mirabilis. Rapid detection of ESBL expression and prompt appropriate antimicrobial therapy are required to reduce mortality caused by P. mirabilis bacteremia. [ABSTRACT FROM AUTHOR]

Background: In areas where Mycobacterium tuberculosis is endemic, tuberculosis is known to be the most common cause of pericarditis. However, the difficulty in diagnosis may lead to late complications such as constrictive pericarditis and increased mortality. Therefore, identification of patients at a high risk for poor prognosis, and prompt initiation of treatment are important in the outcome of TB pericarditis. The aim of this study is to identify the predictive factors for unfavorable outcomes of TB pericarditis in HIV-uninfected persons in an intermediate tuberculosis burden country. Methods: A retrospective review of 87 cases of TB pericarditis diagnosed at a tertiary referral hospital in South Korea was performed. Clinical characteristics, treatment outcomes, complications during treatment, duration of treatment, and medication history were reviewed. Unfavorable outcome was defined as constrictive pericarditis identified on echocardiography performed 3 to 6 months after initial diagnosis of TB pericarditis, cardiac tamponade requiring emergency pericardiocentesis, or death. Predictive factors for unfavorable outcomes were identified. Results: Of the 87 patients, 44 (50.6%) had unfavorable outcomes; cardiac tamponade (n = 36), constrictive pericarditis (n = 18), and mortality (n = 4). 14 patients experienced both cardiac tamponade and constrictive pericarditis. During a 1 year out-patient clinic follow up, 4 patients required repeat pericardiocentesis and pericardiectomy was performed in 0 patients. In the multivariate analysis, patients with large amounts of pericardial effusion (P = .003), those with hypoalbuminemia (P = .011), and those without cardiovascular disease (P = .011) were found to have a higher risk of unfavorable outcomes. Conclusion: HIV-uninfected patients with TB pericarditis are at a higher risk for unfavorable outcomes when presenting with low serum albumin, with large pericardial effusions, and without cardiovascular disease. [ABSTRACT FROM AUTHOR]

In this meeting report, particularly addressing the topic of protection of the cardiovascular system from ischemia/reperfusion injury, highlights are presented that relate to conditioning strategies of the heart with respect to molecular mechanisms and outcome in patients’ cohorts, the influence of co-morbidities and medications, as well as the contribution of innate immune reactions in cardioprotection. Moreover, developmental or systems biology approaches bear great potential in systematically uncovering unexpected components involved in ischemia–reperfusion injury or heart regeneration. Based on the characterization of particular platelet integrins, mitochondrial redox-linked proteins, or lipid-diol compounds in cardiovascular diseases, their targeting by newly developed theranostics and technologies opens new avenues for diagnosis and therapy of myocardial infarction to improve the patients’ outcome. [ABSTRACT FROM AUTHOR]

Background ST-elevated myocardial infarction (STEMI) holds the highest early mortality among patients with acute coronary syndromes. Despite numerous claims of clinical benefits and superiority over clopidogrel, there are no head-to-head outcome randomized clinical trials (RCTs) directly comparing novel antithrombotic agents in STEMI. Moreover, since most regulatory approvals are based on a single RCT's results, their meta-analyses are rare to compare death rates. We analyzed the 30-day mortality in STEMI patients who underwent percutaneous coronary intervention (PCI) and were treated with antithrombotic agents compared to clopidogrel as a reference. Methods and results Altogether, 10 RCT's and 1 retrospective study with a total number of 26,658 STEMI patients were included. Random-effects model with Mantel-Heanszel weighting was used to pool outcomes into a meta-analysis. Therapy with clopidogrel was associated with 2.76% 30-day STEMI mortality which was similar to that of ticagrelor (2.6%; OR = 0.9395 [CI = 0.76 to 1.17; p = 0.58]), and for bivalirudin (2.8%; OR = 1.02 [CI = 0.82 to 1.27; p = 0.86]), but was slightly higher for heparin (3.0%; OR = 1.08 [CI = 0.86 to 1.35; p = 0.52]). There was a trend towards lower mortality after tirofiban (2.1%; OR = 0.77 [CI = 0.52 to 1.13; p = 0.20]), and cangrelor (1.7%; OR = 0.59 [CI = 0.29 to 1.20; p = 0.19]), although the sample size for both agents was woefully small. The only agent which offers a significant 30-day mortality benefit in STEMI was prasugrel with significant lowest 1.75% death rate (OR = 0.63 [CI = 0.46 to 0.86; p = 0.03]). Conclusions Among antithrombotic agents, prasugrel, but not ticagrelor, offers significant 30-day mortality benefit over clopidogrel in PCI-treated STEMI patients justifying short-term use in such a high-risk population. [ABSTRACT FROM AUTHOR]

An 87-year-old woman with continuous chest discomfort was referred to our hospital. ST-segment elevation in lead V1-4 was detected on electrocardiography and ventricular septal rupture (VSR) was observed on echocardiography. Post-acute myocardial infarction (AMI) VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography showed normal coronary artery. On the fourth day after admission, the patient died. We suspect that VSR was developed by stress induced cardiomyopathy, not by AML. [ABSTRACT FROM AUTHOR]

Objectives We conducted a randomised, double blind, placebo controlled trial to assess the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase 3, in patients with vasospastic angina (VSA). Background Cilostazol has been shown to induce vascular dilatation, but its efficacy in patients with VSA is unknown. Methods Between October 2011 and July 2012, 50 patients with confirmed VSA who had =1 angina episodes/week despite amlodipine therapy (5 mg/day) were randomly assigned to receive either cilostazol (up to 200 mg/day) or placebo for 4 weeks. All patients were given diaries to record the frequency and severity of chest pain (0-10 grading). The primary endpoint was the relative reduction of the weekly incidence of chest pain. Results Baseline characteristics were similar between the two groups. Among 49 evaluable patients (25 in the cilostazol group, 24 in the placebo group), the primary endpoint was significantly greater in the cilostazol group compared with the placebo group (-66.5±88.6% vs -17.6±140.1%, respectively, p=0.009). The secondary endpoints, including a change in the frequency of chest pain (-3.7±0.5 vs -1.9±0.6, respectively, p=0.029), a change in the chest pain severity scale (-2.8±0.4 vs -1.1±0.4, respectively, p=0.003), and the proportion of chest pain-free patients (76.0% vs 33.3%, respectively, p=0.003) also significantly favoured cilostazol. Headache was the most common adverse event in both groups (40.0% vs 20.8%, respectively, p=0.217). Conclusions Cilostazol is an effective therapy for patients with VSA uncontrolled by conventional amlodipine therapy, and has no serious side effects. Trial registration number NCT01444885. [ABSTRACT FROM AUTHOR]

Despite the usefulness of intravascular ultrasound (IVUS) in percutaneous coronary intervention (PCI), the impact of IVUS guidance on clinical outcomes, particularly for chronic total occlusion (CTO) intervention, has rarely been studied. We sought to investigate the clinical usefulness of IVUS-guided CTO intervention with second-generation drug-eluting stent implantation. From 2007 to 2009, a total of 2,568 patients were enrolled in the Korean-CTO registry and 534 patients with successful implantation of second-generation drug-eluting stents were analyzed. IVUS-guided PCI was performed on 206 patients (39%). Clinical outcomes at 2 years were compared between the IVUS-guidance group and the angiographyguidance group in 201 propensity scoreematched pairs. The primary end point was the occurrence of definite or probable stent thrombosis. Clinical characteristics were similar between both groups after matching. At 2 years, the IVUS-guidance group showed significantly less stent thrombosis than the angiography-guidance group (0% vs 3.0%, p = 0.014) and a lesser trend toward myocardial infarction (1.0% vs 4.0%, p = 0.058). Target lesion revascularization (TLR) and major adverse cardiovascular event rates were similar. However, a significant interaction was observed between the use of IVUS and lesion length for predicting the TLR (p = 0.037), suggesting usefulness of IVUS in long-lesion (≥3 cm) relative to short-lesion CTO. In conclusion, although IVUS-guided CTO PCI was not associated with a reduction in overall major adverse cardiovascular events, IVUS guidance appears to be associated with a reduction of stent thrombosis and myocardial infarction compared with angiography-guided CTO PCI. Additionally, TLR occurred less frequently in the IVUS-guidance group, especially for long lesions. [ABSTRACT FROM AUTHOR]

Potential (inviscid-irrotational) and Navier-Stokes equation-based (viscous) flows were numerically simulated around a 2D floating rectangular body with a moonpool; particular emphasis was placed on the piston mode through the use of finite volume method (FVM) and boundary element method (BEM) solvers. The resultant wave height and phase shift inside and outside the moonpool were compared with experimental results by Faltinsen et al. (2007) for various heaving frequencies. Hydrodynamic coefficients were compared for the viscous and potential solvers and sway and heave forces were discussed. The effects of the viscosity and vortex shedding were investigated by changing the gap size, corner shape, and viscosity. The viscous flow fields were thoroughly discussed to better understand the relevant physics and shed light on the detail flow structure at resonant frequency. Vortex shedding was found to account for the most of the damping. The viscous flow simulations agreed well with the experimental results, showing the actual role and contribution of viscosity compared to potential flow simulations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the performance and feasibility of the rotational thromboelastometry (ROTEM) profile by comparing prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) results with ROTEM parameters. Methods: We tested external TEM (EXTEM)- and internal TEM (INTEM)-activated determinations, mainly focusing on 5 basic parameters: Clotting time (CT), clot formation time (CFT),α angle, clot formation rate (CFR), and maximum clot firmness (MCF). We then compared PT and APTT results with ROTEM parameters. Results: We observed no significant correlations between any of the ROTEM EXTEM or INTEM parameters and PT results. Similarly, only 1 parameter, the INTEM CT value, was significantly correlated with APTT results (r 2 = 0.165, P <.05). Conclusion: Much work is still needed to further evaluate ROTEM assay results stemming from clinical scenarios and standard laboratory testing. [ABSTRACT FROM AUTHOR]

Although human amniotic mesenchymal stem cells (AMMs) have been recognised as a promising stem cell resource, their therapeutic potential for wound healing has not been widely investigated. In this study, we evaluated the therapeutic potential of AMMs using a diabetic mouse wound model. Quantitative real-time PCR and ELISA results revealed that the angiogenic factors, IGF-1, EGF and IL-8 were markedly upregulated in AMMs when compared with adipose-derived mesenchymal stem cells (ADMs) and dermal fibroblasts. In vitro scratch wound assays also showed that AMM-derived conditioned media (CM) significantly accelerated wound closure. Diabetic mice were generated using streptozotocin and wounds were created by skin excision, followed by AMM transplantation. AMM transplantation significantly promoted wound healing and increased re-epithelialization and cellularity. Notably, transplanted AMMs exhibited high engraftment rates and expressed keratinocyte-specific proteins and cytokeratin in the wound area, indicating a direct contribution to cutaneous closure. Taken together, these data suggest that AMMs possess considerable therapeutic potential for chronic wounds through the secretion of angiogenic factors and enhanced engraftment/differentiation capabilities. [ABSTRACT FROM AUTHOR]

Background: Despite recommendations for more intensive treatment and the availability of several effective treatments, hypertension remains uncontrolled in many patients. Objective: The aim of this study was to determine the dose-response relationship and assess the efficacy and safety of amlodipine or losartan monotherapy and amlodipine camsylate/losartan combination therapy in patients with essential hypertension. Methods: This was an 8-week, randomized, double-blind, factorial design, phase II, multicenter study conducted in outpatient hospital clinics among adult patients aged 18--75 years with essential hypertension. At screening, patients received placebo for 2--4 weeks. Eligible patients (n = 320) were randomized to one of eight treatment groups: amlodipine 5mg or 10 mg, losartan 50mg or 100 mg, amlodipine camsylate/losartan 5mg/50 mg, 5mg/100 mg, 10 mg/50 mg, or 10 mg/100 mg. Main Outcome Measures: The assumption of strict superiority was estimated using the mean change in sitting diastolic blood pressure (DBP) at 8 weeks. Safety was monitored through physical examinations, vital signs, laboratory test results, ECG, and adverse events. Results: The reduction in DBP at 8 weeks was significantly greater in patients treated with the combination therapies compared with the respective monotherapies for all specified comparisons except amlodipine camsylate/losartan 10 mg/100mg versus amlodipine 10 mg. The incidence of adverse events in the group of patients treated with the amlodipine camsylate/losartan 10 mg/50 mg combination tended to be higher than for any other group (27.9%, 12/43); however, the effect was not statistically significant. Conclusion: Combination amlodipine camsylate/losartan (5 mg/50 mg, 5mg/100mg and 10 mg/50 mg) resulted in significantly greater BP lowering compared with amlodipine or losartan monotherapy, and was determined to be generally safe and tolerable in patients with essential hypertension. Clinical Trial Registration: Registered at clinicaltrials.gov: NCT00942344. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether the adoption of new performance processes reduced the door-to-balloon time for primary percutaneous coronary intervention (PCI). To reduce the door-to-balloon time, we adopted 3 new performance processes: concurrent activation at the emergency department rather than stepwise activation; direct phone call rather than using a pager or message; patient transferred to catheterization laboratory before the PCI team arrive. A total of 139 consecutive patients were compared before and after the new performance processes. After the adoption of the new processes, median door-to-balloon time reduced significantly from 133 to 76 minutes (P < .0001) and patients undergoing primary PCI within 90 minutes increased significantly from 16% to 72% (P < .0001). Among the subdivisions of the door-to-balloon time, door-to-consent time and door-to-laboratory arrival time decreased significantly (50.0 vs 20.5 minutes, P < .0001; 95.0 vs 40.0 minutes, P < .0001, respectively). [ABSTRACT FROM AUTHOR]

This study was designed to test whether vena contracta width (VCW) measured by color Doppler flow could be used to assess the severity of mitral stenosis (MS). A secondary objective was to determine the cut-off value of VCW for the prediction of severe MS. We studied 47 consecutive patients with MS (mean age, 50 ± 11 years; 34 females) who did not have more than mild mitral regurgitation. We compared VCW with conventional methods for determining mitral valve area (MVA). Mitral valve area was assessed by one observer using continuity equation (CE), pressure half-time (PHT), and planimetry in the parasternal short axis view. Vena contracta width was measured in the same patients by two observers (blinded to the MVA data) using the apical four-chamber view by color Doppler flow. Vena contracta width measurements were compared with MVA by CE, PHT, and planimetry. The MVA determined by CE, PHT, and planimetry was 1.19 ± 0.42, 1.31 ± 0.53, and 1.27 ± 0.43 cm2, respectively. The VCW in patients with MVA <1 cm2, 1–1.5 cm2, and >1.5 cm2 (calculated by the CE method) was 0.77 ± 0.19, 1.13 ± 0.16, and 1.36 ± 0.24 cm, respectively. Vena contracta width was significantly correlated to MVA by planimetry ( r = 0.756, P < 0.001), PHT ( r = 0.673, P < 0.001), and CE ( r = 0.813, P < 0.001). The VCW of patients with MVA ≤1 cm2 was significantly smaller than that of patients with MVA >1 cm2 determined by the CE method (0.77 ± 0.19 vs 1.26 ± 0.26, P < 0.001). Vena contracta width measurement of 1 cm or less had a sensitivity of 88% and a specificity of 77% for the prediction of severe MS. These results demonstrate that the correlations between VCW and MVA measured by conventional methods were highly significant. In addition, these results suggest that VCW ≤1 cm may indicate the presence of severe mitral stenosis. [ABSTRACT FROM AUTHOR]

There have been few case reports on giant sinus of Valsalva aneurysm (SVA). We report a case of a giant unruptured right coronary SVA that was confused with a pericardial cyst by transthoracic echocardiography. [ABSTRACT FROM AUTHOR]