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Constrictive pericarditis (CP) is an uncommon but reversible cause of diastolic heart failure if appropriately identified and treated. However, its diagnosis remains a challenge for clinicians. Artificial intelligence may enhance the identification of CP. The authors proposed a deep learning approach based on transthoracic echocardiography to differentiate CP from restrictive cardiomyopathy. Patients with a confirmed diagnosis of CP and cardiac amyloidosis (CA) (as the representative disease of restrictive cardiomyopathy) at Mayo Clinic Rochester from January 2003 to December 2021 were identified to extract baseline demographics. The apical 4-chamber view from transthoracic echocardiography studies was used as input data. The patients were split into a 60:20:20 ratio for training, validation, and held-out test sets of the ResNet50 deep learning model. The model performance (differentiating CP and CA) was evaluated in the test set with the area under the curve. GradCAM was used for model interpretation. A total of 381 patients were identified, including 184 (48.3%) CP, and 197 (51.7%) CA cases. The mean age was 68.7 ± 11.4 years, and 72.8% were male. ResNet50 had a performance with an area under the curve of 0.97 to differentiate the 2-class classification task (CP vs CA). The GradCAM heatmap showed activation around the ventricular septal area. With a standard apical 4-chamber view, our artificial intelligence model provides a platform to facilitate the detection of CP, allowing for improved workflow efficiency and prompt referral for more advanced evaluation and intervention of CP. [Display omitted] [ABSTRACT FROM AUTHOR]

: Galectin-1 is a glycan-binding protein with broad anti-inflammatory properties. Left ventricular diastolic dysfunction (DD) is associated with heart failure and mortality. The pathophysiology of DD is complex and our study aimed to investigate the associations between serum galectin-1 level, DD, and heart failure with preserved ejection fraction (HFpEF). : Patients with symptoms of angina pectoris were enrolled. Serum galectin-1 levels and echocardiography were assessed. The study endpoint was a composite of all-cause mortality or new-onset HFpEF. : In total, 258 patients were enrolled (63% male; mean age 68±12 years) and grouped into tertiles based on galectin-1 levels. Patients in the highest galectin-1 group had increased left ventricular mass indexes, left atrial diameters, and prevalence of DD compared to those in the lower tertiles (all p <0.05). Moreover, elevated galectin-1 levels were significantly associated with the composite endpoint (p =0.039). After adjusting for confounding factors, high galectin-1 levels remained significantly associated with DD (odds ratio 2.44, p =0.005). The Kaplan-Meier analysis revealed patients in the highest galectin-1 group had lowest cumulative survival of composite endpoint (log rank p =0.043). : Elevated serum galectin-1 levels were associated with DD and the composite endpoint of all-cause mortality and incident HFpEF. [Display omitted] [ABSTRACT FROM AUTHOR]

Elevated glycemic gap, as the differences between measured glucose and hemoglobin A1c (HbA1c)-derived average glucose (ADAG) levels, is a marker of stress-induced hyperglycemia and is a predictor of mortality in critically ill patients. Whether low glycemic gaps are associated with outcomes in critically ill patients remains unclear. We investigated the association of different glycemic gaps on mortality in critically ill patients. Totally 935 patients admitted to intensive care units (ICUs) were enrolled retrospectively after the exclusion of patients with absolute hypoglycemia, extreme hyperglycemia, and incomplete glycemic records. Patients were divided into 3 groups according to their glycemic gaps (<-29.7, −29.7–40, ≧40 mg/dL) at the time of ICU admission. The patients were followed for 1 year or until death. Patients with low glycemic gap (glycemic gap < -29.7 mg/dL), which implied relative hypoglycemia, had lower serum glucose levels, higher HbA1c levels, and greater disease severity. Compared with medium group (glycemic gap −29.7–40 mg/dL), both the low and the high glycemic gap (glycemic gap ≧40 mg/dL) groups had significantly greater 30-day (log-rank p = 0.0464) and 1-year mortality (log-rank p = 0.0016). However, only the low glycemic gap group was independently associated with greater in-hospital mortality after adjusting for comorbidities (adjusted OR 1.78, 95% CI 1.00–3.16, p = 0.048). This study revealed the presence of a U-shaped relationship between the glycemic gap and mortality in critically ill patients. Low glycemic gaps suggested relative hypoglycemia at the time of ICU admission, and were associated independently with greater in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: The transcatheter edge-to-edge mitral valve repair using MitraClip has been a safe and effective treatment for severe mitral regurgitation (MR). In patients with severe MR and cardiogenic shock under hemodynamic supporting devices, emergent surgical mitral valve interventions carry extremely high risk for peri-operative morbidities and mortalities. The feasibility and efficacy of emergent MitraClip to rescue patients in critical conditions remains elucidate.Methods: Patients with severe MR and high or prohibitive surgical risks were referred for MitraClip procedures. Emergent MitraClip were conducted in patients with unstable hemodynamics and under mechanical or inotropic support. The hemodynamic measures, transthoracic echocardiography, transesophageal echocardiography, and blood tests were performed before MitraClip procedures. Procedural success was defined as having mild mitral regurgitation immediately after MitraClip, and patients were free from in-hospital mortality. Clinical and echocardiographic outcomes were followed by telephones and clinics.Results: Among 50 consecutive patients (74.7 ± 11.2 years, 74% male), 8 emergent MitraClip procedures were conducted to rescue patients with cardiogenic shock. Extracorporeal membrane oxygenations were used in 2 patients and intra-aortic balloon pump were applied in 4 patients (50%). Compare to those who underwent elective procedures, patients underwent emergent MitraClip had higher surgical risk profile (EuroSCORE II 34.8% vs 5.1% and STS score 19.7% vs 5.1%), poorer renal function and higher right atrial pressure. There was no peri-procedural death, myocardial infarction, stroke or any adverse events requiring emergent cardiac surgery in both groups. Mild mitral regurgitation was achieved in 87.5% patients from the emergent group and 95.2% patients in the elective group (P = 0.514). The Kaplan-Meier analysis showed patients who underwent emergent procedures have poorer long-term survival rate as compare to those who received elective procedures. (P value = 0.008).Conclusion: When open-heart surgery is not feasible, trans-catheter mitral valve repair is an alternative way to rescue patients in cardiogenic shock status. [ABSTRACT FROM AUTHOR]

Aggressive lipid reduction is recommended for patients with AMI, but reverse epidemiology, the lipid paradox, has been reported in several clinical studies. The cause of lipid paradox remains uncertain, and nutrition is one possible explanation. In this single-center retrospective study, we investigated the relationships between baseline LDL concentrations and clinical outcomes in patients with AMI, stratified by different nutritional status. Totally 409 patients were enrolled for analysis. The Nutritional Risk Index (NRI) was used to estimate the risk of malnutrition. Subjects were grouped into tertiles according to their NRIs. Clinical outcomes were compared among patients with varying NRIs and LDL levels. Patients in the lowest NRI tertile had increased incidences of in-hospital mortality, cardiogenic shock, decompensated heart failure, renal failure, and sepsis. This tertile was also associated with increased long-term mortality during the follow-up period of 832 ± 744 days. Mortality was increased among patients with baseline LDL concentrations ≤70 mg/dL in the lowest NRI tertile (log rank test, p = 0.0257), but not in the high or median tertiles. Moreover, baseline LDL level ≤70 mg/dL was an independent risk factor of all-cause mortality (adjusted hazard ratio = 1.73; 95% confidence interval, 1.01–2.94; p = 0.045) in the lowest NRI tertile. Lipid paradox was observed in the high-risk of malnutrition population among patients with AMI. Aggressive lipid-lowering therapy is still recommended for patients with AMI and fair nutritional status. However, when treating patients at high risk of malnutrition, the improvement of nutritional status may be more beneficial than strict LDL control. • Lower NRI is associated with increased mortality in patients with AMI. • Lipid paradox is only observed in patients with the lowest NRI tertile. • Benefit of strict LDL control is limited in patients with AMI & malnutrition. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) represents a clinical challenge for clinicians because of nonspecific presentations, including dyspnea, chest pain, and tachycardia. The immediate 12-lead electrocardiogram (ECG) is commonly used to facilitate differential diagnosis of acute chest pain. Although relative rare, massive pulmonary embolism could induce ST segment elevation and mimic acute myocardial infarction.Case Presentation: We present a challenging scenario that ECG showed ST segment elevation, nevertheless, urgent coronary angiogram revealed non-obstructive coronary artery disease. Unfortunately, the patient suffered from cardiac arrest and required extracorporeal membrane oxygenation devices. Finally, massive pulmonary embolism was diagnosed.Conclusion: This case illustrates acute PE could mimic ST segment elevation myocardial infarction. ST elevations on ECG should be interpreted after considering clinical presentations before making a decision. [ABSTRACT FROM AUTHOR]

This study focuses on examining antecedents of hotel pipeline speed using the setting of chain-branded pipelines in the top 25 markets in the U.S. Based on competitive dynamics, we propose factors influencing chain-branded hotels' pipeline speed in two domains: awareness-motivation-capability (AMC) and competitive inertia (CI). A total of 1447 hotel pipeline projects are analyzed in this study. We find that (1) a hotel's pipeline speed is negatively associated with the number of total pipeline rooms in the same market and in the same brand segment; (2) pipeline speed is negatively associated with the percentage of pipeline rooms under construction in the same market and in the same brand segment; (3) pipeline speed is positively associated with the number of rooms of the property. Our study contributes to the literature by providing theoretical underpinnings of pipeline speed and exams the explanatory factors with field data. The findings can be translated to practical insights that could benefit hoteliers when planning pipeline projects. • A total of 1447 hotel pipeline projects from 25 markets in the U.S. is analyzed. • Factors influencing chain-branded hotels' pipeline speed are proposed based on competitive dynamics. • Number of total pipeline rooms in the same market and the same brand segment is associated with slower pipeline speed. • Percentage of pipeline rooms in the status of construction in the same market and the same brand segment is associated with slower pipeline speed. • Number of rooms of a case pipeline property is associated with quicker pipeline speed. [ABSTRACT FROM AUTHOR]

The increasing frequency and severity of wildfire events in the last few decades has created an urgent need for new technologies that allow rapid surveying and assessment of post-wildfire building damage. However, existing technologies lack in accuracy and ability to scale to effectively aid disaster relief and recovery. Even today, most wildfire event inspectors need to physically visit the areas impacted by wildfires and manually classify building damage, which requires considerable time and resources. Here, we present DamageMap, an artificial intelligence-powered post-wildfire building damage classifier. DamageMap is a binary classifier (outputs are "damaged" or "undamaged"). Unlike existing solutions that require both pre- and post-wildfire imagery to classify building damage, DamageMap relies on post-wildfire images alone by separating the segmentation and classification tasks. Our model has an overall accuracy of 98% on the validation set (five wildfire events all around the world) and 92% and 98% on two independent test sets from the Camp Fire and the Carr Fire, respectively. Excellent model performance across a variety of datasets provides evidence of DamageMap's robustness to unseen data. Thus, DamageMap may help governmental and non-governmental agencies rapidly survey building damage using post-wildfire aerial or satellite imagery in wildfire-impacted areas. [ABSTRACT FROM AUTHOR]

NORYL™ SA9000 resin is a commercialized telechelic PPO oligomer with phenyl methacrylate end groups. However, neat SA9000 thermoset is brittle after thermally curing. To find a method to enhance the toughness of neat SA9000 thermoset, three model reactions are designed. The first one is the 4-dimethylaminopyridine (DMAP)-catalyzed homopolymerization of glycidyl phenyl ether. The second one is the reaction of glycidyl phenyl ether and phenyl acetate in the presence of DMAP. The third one is the reaction of glycidyl phenyl ether and phenyl methacrylate in the presence DMAP. Through 1 H NMR analysis, the product is 1,3-diphenoxy-2-acetoxypropane and 1,3-diphenoxy-2-methacryalatepropane, respectively, for model reactions 2 and 3. According to the structure of products, we identify the reaction mechanisms between the phenyl acetate and epoxy, and between the phenyl methacrylate and epoxy. Based on the knowledge, we used two commercialized epoxy resin (DGEBA and HP7200) to copolymerize with SA9000 in the presence of DMAP and tert -butyl cumyl peroxide (TBCP). The toughness of the thermosets are significantly improved, which means the brittle drawback of neat SA9000 thermoset has been solved. Homogeneous, flexible thermosetting films with high glass transition temperatures, low dielectric constants, and extremely low dissipation factors are obtained. [ABSTRACT FROM AUTHOR]

Abstract: Biochars have received increasing attention in recent years because of their properties pertaining to soil fertility and contaminant immobilization as well as serving as carbon sinks. In this work, a series of biochars were produced from dried swine manure waste by slow pyrolysis at different temperatures (i.e., 673–1073K). The characterization of the resulting biochars was examined for its relevance to its potential use as soil amendment. It was found that the pore properties, ash contents and pH values of all swine-manure-derived biochars basically increased as temperature increased, while the yield and nitrogen/oxygen contents decreased with increasing temperature as a result of pyrolytic volatilization during pyrolysis. From the organic and inorganic elements analyses, the manure-derived biochar was rich in soil nutrients such as N, P, Ca, Mg, and K. Furthermore, the pore, surface and chemical properties were also consistent with the observations of the SEM-EDS, XRD and FTIR. This result suggested that the mesoporous manure-derived biochar could be used as an excellent medium to soil environment. [Copyright &y& Elsevier]