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Clinical outcomes of patients suffering periprocedural myocardial injury and undergoing incomplete revascularization (IR) following percutaneous coronary intervention (PCI) has never been investigated.To investigate the relationship between different thresholds of post-PCI cardiac troponin (cTn) elevation and revascularization completeness in determining long-term clinical outcomes.Patients were stratified in tertiles according to preprocedural SYNTAX score (SS) (low: 0-6; medium:6-11; high:11) and residual SS (low: 0-4; medium:4-8; high:8). IR was defined by a rSS value4. Three thresholds of myocardial injury were pre-specified: 5×, 35× and 70× 99th percentile upper reference limit (URL) increase of baseline cTn. Primary outcome was a composite of major adverse cardiac events (MACE) at two years of follow-up.1061 patients undergoing PCI for stable coronary artery disease were enrolled. IR occurred in 249 (23.4 %) and major myocardial injury in 540 (50.9 %). Patients belonging to the highest tertile of SS showed an increased risk of experiencing IR and periprocedural myocardial injury. Two-year follow-up was available in 869. At multi-variate Cox's regression analysis, patients undergoing IR + cTn35 × URL and IR + cTn70 × URL showed an increased risk of MACE [HR 2.30 (1.19-4.41) and HR 3.20 (1.38-7.41); respectively].Periprocedural myocardial injury is critically associated with MACE at two-year follow-up in patient treated with PCI who achieve IR. Despite conflicting evidence exists regarding the influence of periprocedural myocardial injury on clinical outcomes, patients undergoing IR seem to represent a high-risk subgroup.

The interest of engineering industries in sandwich structures is growing quickly in the last year’s cause of their intriguing properties coupled with the development of new materials and the need for high performance and low-weight systems. A sandwich construction consists of high performant outer skins that reinforce a lightweight inner core material; the formers provide the main load-carrying capabilities, while the core serves to transfer the load between the facings. Different results were proposed in the literature for the core material and structure. Among these, aluminium foams appear to be a potential solution to ensure lightness as well as relatively high mechanical performances. As for the skins, the commonly used reinforcement systems such as metals sheets and composite material plates, disagree with some of the requirements imposed by engineering companies. In particular, the formers are in contrast with the lightweight condition, while the latter tend to deteriorate slightly above room temperature, making it impossible to use them in some extreme environmental conditions, where high temperatures may be involved. Therefore, in this research activity, an innovative solution was proposed for the manufacturing of aluminium foam based sandwich panels, with stainless steel wire mesh-grid used as reinforced skin, by using the powder compact melting technique. The so manufactured samples were tested under three-point bending conditions. The collapse modes were analysed and compared with those reported in the literature in order to verify the effectiveness of the manufacturing method developed as well as the validity of the theoretical prediction models.

Cold spray (CS) is an emerging coating technology that makes use of a converging/diverging nozzle, a high pressure and a heated gas source to create a high‐velocity gas flow. Coating deposition occurs at relatively low temperatures compared to other spray technologies, therefore the sprayed particles remaining in the solid-state. The process can produce dense coatings when the process parameters are optimized. Despite the incredible advantages of CS and the established knowledge of CS considering metal substrates, some questions like the bonding mechanism and the adhesion/cohesion strength of the coating with polymeric substrates remain an open research topic. In this paper, a metal coating (AlSi10Mg) was deposited on a plate in polypropylene by cold spray in order to increase the properties of the surface. Metallic particles, in the range of 20-40 µm, were injected into gas flow and propelled to supersonic velocities. Polymers require a deposition technique in which the substrate remains at relatively low temperatures during the whole process in order to avoid plastic deformation or degradation. Determination of the mechanical properties of thin films on substrates by indentation has always been difficult because of the influence of the substrate on the measured properties. In order to evaluate the local properties of the deposited coating, microindentation tests and DMA were carried out. In particular hardness values by microindentation tests and values of elastic modulus by DMA were calculated.

Background Coronavirus disease 2019 (COVID-19) has changed the way we practice medicine. Standards of care are evolving in an effort to diagnose, manage, and treat the cause of this global pandemic, as well as to protect the health care workforce. These practices can have unexpected and potentially dangerous consequences, particularly for patient populations with confounding factors that put them at increased risk for complications and poor outcomes. Case Report A 52-year-old previously healthy woman presented with 4 days of nasal pain and discharge after using a home collection kit in an attempt to obtain a nasopharyngeal viral sample for COVID-19 testing. Why Should an Emergency Physician Be Aware of This? With treatments, policies, and procedures that are rapidly evolving and often deviating from established, evidence-based, usual care in response to the COVID-19 pandemic, emergency physicians must be cognizant of and monitor for poor outcomes and potential downstream complications, especially in underserved patient populations.

Consumers receive risk information about prescription drugs from many sources, including from largely unregulated attorney advertisements. This experiment measures subjective risk beliefs about prescription drugs and subjects’ drug-taking behavior in an incentivized setting. Results of the experiment are used to estimate a Bayesian learning model to ascertain the risk levels implied by different information sources and the informational weights subjects place on these sources. Even after people have received scientifically based drug risk information from a doctor and product label, attorney litigation advertising boosts risk beliefs about side effects by an average of 16 out of 100 cases, which is roughly a 50% increase over baseline risk beliefs. Risk beliefs have a significant effect on drug-taking behavior in an incentivized environment. Experience with taking the drug also feeds back into the learning process about risk beliefs. Our experimental results help formalize how consumers update risk beliefs and suggest ways to encourage a learning environment that avoids alarmist updating based on information sources like attorney advertising.

The paper reports a sustainable, fast and efficient methodology to treat natural hemp fibers (HF) using a mechanochemical approach. Mechanical milling was used to carry out an alkaline attack on HFs for 30 minutes at ambient temperature. Composites HF/pectins were prepared by varying the fiber weight fraction (3%; 7.5%; 10%; 20% w/w by weight). The improvement in thermal degradation, mechanical and barrier properties to water vapor was correlated with the fiber volume fraction and mainly due to the improved fiber-matrix adhesion. The fibers-matrix interaction was then evaluated by analyzing and modeling the mechanical properties using several mathematical models: a modified Nielsen and Pukanszky and Smith models. Sorption isotherms to water vapor were analyzed through a modified Guggenheim, Anderson, de Boer (GAB) model where a new parameter, α, was introduced to consider the heterogeneity of the system. Finally, a modified Burgemman model was used to fit the experimental data and support the improvement in water diffusion with fiber loading.

Endothelial function, as assessed with flow-mediated dilatation (FMD), and carotid intima-media thickness (IMT) correlate with the presence and extent of coronary artery disease (CAD). We investigated the incremental value of a combined evaluation of FMD and IMT in predicting the presence of CAD over traditional cardiovascular risk factors.A total of 497 consecutive patients undergoing elective coronary angiography were enrolled in this study. Brachial artery FMD and ultrasound-based carotid IMT were evaluated prior to angiography. CAD was defined as the presence of a ≥ 50% stenosis in at least one coronary artery. SYNTAX score was also calculated. Patients were categorized based on the presence of FMD and IMT values below or above gender-specific median.Patients with both low FMD and high IMT presented the highest prevalence of CAD, number of diseased vessels, and SYNTAX score. At multivariate analysis, the combination of low FMD and high IMT was the strongest predictor of CAD (OR 3.63, 95% CI 2.19-6.02; p .001). At ROC curve analysis, the addition of FMD and IMT to a model of traditional risk factors improved the predictive power for the presence of CAD (area under the curve [AUC] of risk factors model 0.715; AUC of risk factors + FMD + IMT 0.780; p .001). The addition of FMD and IMT to the model of risk factors correctly reclassified 24.9% of patients.A combined evaluation of endothelial function and subclinical atherosclerosis at the carotid artery level improves the ability of traditional risk factors to identify patients with CAD.

Impaired cardiorespiratory fitness (CRF) in heart failure (HF) is influenced by a complex array of cardiac and extracardiac factors. The study aimed to identify clinical determinants of CRF measured as peak oxygen consumption (peak VO2) in HF patients, and to determine a peak VO2 prediction model using regression equations. Retrospective analysis of 200 HF patients who completed treadmill cardiopulmonary exercise testing and underwent Doppler echocardiography and/or biomarker analysis on the same day was performed. After univariate linear regression analysis, a multivariate peak VO2 prediction model was developed using significant variables in a stepwise linear regression analysis. In subjects with repeated testing, Pearson's correlation was used to assess correlations between measured and predicted change in peak VO2 (Δpeak VO2) over time. Mean age was 57 years, with 55% being male. Stepwise linear regression was used to generate a weighted model for peak VO2: 30.895 + (−0.112•age[years]) + (0.296•hemoglobin [g/dl]) + (−0.101•E/e'[unit change]) + (−0.202• body mass index [kg/m2]) + (−0.593• N-terminal pro-brain natriuretic peptide [logN pg/ml])) + (−1.349•CRP [log mg/L]). Predicted peak VO2 correlated strongly with measured peak VO2 in HF with reduced ejection fraction and HF with preserved ejection fraction patients (r = +0.63, p 2 correlated with measured Δpeak VO2 (r = +0.23, p 2 in HF patients and may be used to estimate peak VO2 changes over time.