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Abstract Purpose To evaluate outcomes and complications of prophylactic internal iliac balloon occlusion (PIIBO) in the management of patients with placenta accreta spectrum (PAS) at a large regional referral centre. Materials and methods A retrospective review of all PIIBO for PAS performed over a 12-year period (2010–2022). Information for analysis was gathered from the local RIS/PACS and clinical documentation. Collected data included patient demographics, indication for procedure, sheath insertion and removal time, total duration of balloon inflation and complications that occurred. Results 106 patients underwent temporary internal iliac artery balloon occlusion within the 12-year period. All procedures utilised bilateral common femoral artery punctures, 6Fr sheath and 5Fr Le Maitre occlusion balloons. Catheters were successfully positioned and balloons inflated in obstetric theatre following caesarean delivery in 100% of the cases. The uterus was conserved in every case. There was no maternal mortality or foetal morbidity. Twenty patients (18.9%) had some form of complication that required further intervention. Of these, 7(6.6%) had post-operative PPH, which was treated with uterine artery embolisation; and 13 (12.3%) had arterial thrombus which required aspiration thrombectomy. All procedures were technically successful with no long-term sequelae. Conclusion PIIBO plays an important part in reducing morbidity and mortality in patients with PAS. Clear pathways and multidisciplinary team working is critical in the management of these patients to ensure that any complications are dealt with promptly to avoid long-term sequelae.

Meta-stable β titanium alloys that feature excellent mechanical properties are of great interest for a range of engineering applications. In particular, Fe containing titanium alloy is one of the most promising alloy systems because Fe is the most economic β stabilizer. However, Fe solute is highly prone to segregation during casting, which leads to the formation of “β flecks” in the subsequent thermo-mechanical treatment and deteriorates the fatigue properties. This paper aims to eliminate β flecks in Ti-3.5 wt%Fe alloy fabricated by Laser Directed Energy Deposition (L-DED), that utilises the high cooling rate during solidification and multiple thermal cycles after solidification. SEM and EDS analysis established that a large β-fleck free zone can be achieved in as-fabricated Ti-3.5 wt%Fe thin-walled samples. Combining the finite element temperature field simulation results and the one-dimensional dynamic diffusion model, the elimination of β flecks is well rationalized. The current work provides a paradigm to evaluate the segregation elimination in the additively manufactured alloy components.

Abstract Although bioderived flame retardants are environmentally sustainable and less toxic, their impact on the thermal stability and flammability of polymers remains poorly understood. In this study, we assessed the influence of mycelium on the thermal stability and flame spread characteristics of epoxy through thermogravimetric analysis, Fourier transform infrared spectroscopy, the UL94 flammability test, and scanning electron microscopy. We observed a decrease in the maximum mass loss rate temperature when mycelium was incorporated into epoxy, indicating an earlier onset of thermal degradation. The inclusion of mycelium increased char yields above 418 °C due to mycelium’s inherent char-forming ability. However, mycelium did not alter the thermal degradation pathway of epoxy. Furthermore, according to the UL94 test results, the incorporation of mycelium reduced the flame spread rate compared to that of neat epoxy. These findings contribute to our understanding of the interaction between bioderived flame retardants and polymers paving the way for the development of more sustainable fireproofing materials.

Syntactic foams, containing up to 23 wt% of untreated waste tyre-derived rubber particles mixed with hollow glass microspheres (HGMs) and epoxy, were produced via compressed air-assisted injection moulding. This study investigated the effect of rubber particles on the through-the-thickness compression properties and the vibration-damping response of the ternary syntactic foams. The interaction between foam constituents was investigated using SEM, with the objective to establish a microstructure-compression property relationship for rubber-incorporated foam. The effect of rubber particles on the energy absorbed by the foam under compression deformation was also studied. The substitution of epoxy for rubber particles did not alter the compression properties (crush behaviour) of the foam. A laser Doppler vibrometer was used to measure the vibration-damping response and natural resonance frequency. The vibration-damping ratio of the rubber-incorporated foam increased by up to 75% upon the addition of 23 vol % rubber particles.

This paper presents research findings on the influence of tyre-derived rubber particle size on the mechanical properties of rubberised syntactic foam manufactured through stir casting. The study examined how the rubber particle size affected the shear, in-plane compression, and through-thickness compression properties, as well as the flexural properties of sandwich composites with rubberised syntactic foam core. Rubber particles of various sizes (425 µm) were integrated into the syntactic foam at both low (9 wt%) and high (23 wt%) concentrations. Rubber particles measuring less than 150 µm, promoted agglomeration and increased void volume due to elevated viscosity, leading to a reduction in the mechanical properties of the rubberised foam. Conversely, larger rubber particles exceeding 425 µm reduced the mechanical properties of the syntactic foam due to debonding at the matrix/rubber interface. This study identified the optimal rubber particle size for achieving the highest mechanical properties in rubberised foam, which falls within the range of 150–425 µm. This research demonstrates the sustainable development of multifunctional composites from recovered waste tyres.

The aim of this research work is to investigate the effect of strain rates and temperatures on the mechanical properties of an equiatomic copper-nickel (Cu–Ni) alloy with a pre-existing faceted Σ3 [111] 60° {11 8 5} grain boundary. Molecular dynamics simulations conducted in this scrutiny focuses on understanding the tensile behaviour of bicrystalline equiatomic Cu–Ni alloys (denoted by Cu50Ni50) under various thermodynamic conditions. The uniaxial tensile deformation simulation was carried out at various strain rates (108, 109 and 1010 1/s) in conjunction with different conditions of cryogenic temperature (100 K), room temperature (300 K) and high temperature (500 K). The authors found that the yield stress and Young's modulus of the bicrystalline Cu50Ni50 alloy were highest at the cryogenic temperature, and decreased as the temperature increased. To add on, the yield stress of the bicrystalline Cu50Ni50 alloy increased with an increase in the strain rate value. From the microstructural and dislocation analysis point of view, it was observed that the formation of dislocations was lowest at the cryogenic temperature. Interestingly, at the yield point, the coherent twin boundary tip act as the nucleation site for the dislocations for cryogenic temperature condition. These findings shed light on the relationship between the temperatures, strain rates, and the mechanical properties of Cu–Ni alloys, which will aid in reporting the optimized conditions for their desired engineering applications. It is also proposed that tailoring of the tensile properties is achievable by exposing Cu–Ni alloys to various environmental conditions (cryogenic, ambient, and elevated temperatures with different applied strain rates).

Abstract Background Uterine artery embolisation is well established as a treatment for symptomatic fibroids, however, there remain some uncertainties. We have carried out a focused literature review on three particularly challenging aspects – post-procedure fertility, symptomatic adenomyosis and large volume fibroids and uteri, to enable operators to utilise evidence-based guidance in patient selection, consent, and management. Review Literature searches were performed of the PubMed/Medline, Google scholar, EMBASE and Cochrane databases. The outcomes of our analysis of studies which recorded fertility rates in women desiring pregnancy following UAE for symptomatic fibroids found an overall mean pregnancy rate of 39.4%, live birth rate of 69.2% and miscarriage rate of 22%. The major confounding factor was patient age with many studies including women over 40 years who already have lower fertility compared to younger cohorts. Miscarriage rates and pregnancy rates in the studies analysed were comparable to the age matched population. Treatment of pure adenomyosis and adenomyosis with co-existing uterine fibroids with UAE has been shown to produce symptomatic improvement with better outcomes in those with combined disease. Although the effectiveness is not as high as it is in pure fibroid disease, UAE provides a viable and safe alternative for patients seeking symptom relief and uterine preservation. Our analysis of studies assessing the outcomes of UAE in patients with large volume uteri and giant fibroids (> 10 cm) demonstrate no significant difference in major complication rates demonstrating that fibroid size should not be a contraindication to UAE. Conclusion Our findings suggest uterine artery embolisation can be offered to women desiring pregnancy with fertility and miscarriage rates comparable to that of the age-matched general population. It is also an effective therapeutic option for symptomatic adenomyosis as well as for the treatment of large fibroids > 10 cm in diameter. Caution is advised in those with uterine volumes greater than 1000cm3. It is however clear that the quality of evidence needs to be improved on with an emphasis on well-designed randomised controlled trials addressing all three areas and the consistent use of validated quality of life questionnaires for outcome assessment to enable effective comparison of outcomes in different studies.

Abstract Purpose To evaluate the technical feasibility and clinical outcomes of endovascular treatment for internal iliac artery (IIA) aneurysms. Material and methods This was a retrospective analysis of 25 patients with 32 IIA aneurysms (mean diameter: 39.1 ± 12.6 mm) who underwent endovascular treatment over a 10-year period, and were available for follow-up. Univariate analysis was used to determine the association between variables (including aortoiliac involvement and technique) and outcome. Results The IIA inflow was covered with an iliac stent graft (N = 29) or embolized with a plug (N = 3). The IIA outflow was embolized in all but one case in which there was thrombotic occlusion of outflow branches. Outflow embolization using plugs or coils was performed in the distal IIA or anterior/posterior trunks in 9 cases and distal IIA branches in 22 cases. During a mean follow-up period of 39.9 months, 31.2% of aneurysms demonstrated endoleak and 12.5% demonstrated enlargement. Univariate analysis revealed that endoleak was associated with technical failure (p = 0.01) and that endoleak rate was higher in patients who underwent distal IIA branch embolization (p = 0.03). No variable was associated with sac expansion. Major complication occurred in one patient who died from aneurysm rupture. Minor complications were reported in six patients who developed femoral pseudoaneurysm (N = 2, 8%), buttock claudication (N = 3, 12%), and limb graft occlusion (N = 1, 4%). Conclusion Endovascular treatment of IIA aneurysms effectively prevents sac expansion. Endoleak was more frequently observed in cases of technical failure and those in which distal IIA branches were embolized. Level of Evidence Level 3b, retrospective cohort study.

In this study, we employed a straightforward flame synthesis process to produce carbon soot containing carbon nano onions (CNOs) using easily accessible ghee oil as a precursor. The ghee oil, with a molecular composition rich in more than 50 carbon atoms, served as an effective source for generating CNOs. The synthesized CNO particles underwent comprehensive characterization through high-resolution transmission electron microscopy (HRTEM), energy dispersive X-ray spectroscopy (EDX), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD) analyses, providing a detailed account of their physicochemical properties. In addition, we explored the direct deposition of CNOs on carbon fiber (CF) surfaces for 5 and 10 min via a soot deposition process. The resulting freeze–fracture images obtained from scanning electron microscope (SEM) offered insights into the morphology of the CNO-deposited CF. Our study aims to shed light on the potential applications of CNOs, focusing on their characterization and the possible benefits they may offer in diverse fields, including but not limited to enhancing interfacial bonding in thermoplastic composites.

Aero-engines, the core of air travel, rely on advanced high strength-toughness alloys (THSAs) such as titanium alloys, nickel-based superalloys, intermetallics, and ultra-high strength steel. The precision of cutting techniques is crucial for the manufacture of key components, including blades, discs, shafts, and gears. However, machining THSAs pose significant challenges, including high cutting forces and temperatures, which lead to rapid tool wear, reduced efficiency, and compromised surface integrity. This review thoroughly explores the current landscape and future directions of cutting techniques for THSAs in aero-engines. It examines the principles, mechanisms, and benefits of energy-assisted cutting technologies like laser-assisted machining and cryogenic cooling. The review assesses various tool preparation methods, their effects on tool performance, and strategies for precise shape and surface integrity control. It also outlines intelligent monitoring technologies for machining process status, covering aspects such as tool wear, surface roughness, and chatter, contributing to intelligent manufacturing. Additionally, it highlights emerging trends and potential future developments, including multi-energy assisted cutting mechanisms, advanced cutting tools, and collaborative control of structure shape and surface integrity, alongside intelligent monitoring software and hardware. This review serves as a reference for achieving efficient and high-quality manufacturing of THSAs in aero-engines.

The Screw Driving Sounding (SDS) is a recently developed in-situ testing method for soil/site characterisation. To better understand the mechanism of testing, it is essential to create a simulation model for the SDS test to assist in better understanding the response and in improving the testing process, not to mention the development of empirical correlations to estimate geotechnical parameters for use in design. Complex problems involving large deformations are usually difficult to solve with the classical finite element (FE) method because large deformations can lead to large mesh distortions and contact problems. In this paper, a computational model using the finite element method is developed to simulate the drilling process involved in SDS tests; the Coupled Eulerian-Lagrangian (CEL) approach is used to deal with large deformation problems. The SDS drilling process in a sandy deposit with defined stress states (i.e., relative density and effective confining pressure) is simulated, and the SDS-derived parameters are monitored. Based on the simulation results, a chart was established to correlate the measured SDS parameter with the internal friction angle for different vertical effective overburden stresses. The derived chart is validated with the results of laboratory tests performed on samples taken from several sites in Christchurch, NZ, adjacent to the locations of the SDS tests. The results show that the CEL FE framework can model complex physical processes encountered during the SDS drilling. Moreover, the developed chart can be used to estimate the friction angle of the sandy soil based on the SDS-measured torque at a given depth.

The dynamic response of an anisotropic multilayer magneto-electro-elastic (MEE) plate due to an external excitation is investigated in this work, using the stiffness matrix approach. A parametric study is performed by varying the stacking sequence, polarization direction, boundary conditions, and interlayer thickness. The proposed method yields the numerical estimation of the dispersion curve and the free vibration of the Lamb waves for different crystallographic orientations and magneto-electric boundary conditions. It is demonstrated that the anisotropy highly affects the dispersion curve and the non-dimensional frequency, and also decreases the interlayer thickness of the magneto-electro-elastic multilayer and raises the phase velocity of the fundamental symmetric Lamb mode vibration. The key outcomes of this research can serve as a reference in the design and analysis of new smart magneto-electro-elastic structures.

Renewed efforts towards greater use of environmentally sustainable materials have created new opportunities for balsa wood (Ochroma pyramidale) to replace non-renewable, petroleum-based cores such as polymer foams in a broad range of sandwich structures. This paper reviews published research into the applications, manufacturing, microstructure, mechanical properties and in-service performance of sandwich structures with balsa wood cores. The benefits of balsa wood in sandwich structure construction are reviewed, including environmental sustainability, low raw material cost, excellent specific mechanical properties, and thermal insulation properties. The potential challenges of balsa cores in sandwich structures are also evaluated, including potential global supply chain issues, limited applicability of part processing techniques, impact, blast and fire performance, as well as water durability. Published research into the underlying properties and mechanisms responsible for the benefits and limitations of balsa core sandwich structures are reviewed. Topics for further research to advance the characterisation and applications of balsa structural sandwich materials are also discussed.

Advanced composites have a brittle nature making them highly susceptible to failure and propagation under impact loading conditions. Appropriate modeling techniques to accurately simulate these conditions are required. This study presents and examines a coupled thermo-mechanical modeling technique and its associated numerical simulations for analyzing carbon fiber-reinforced composite panels subjected to high-velocity impact. The essential numerical parameters necessary to accurately simulate the selected configuration are determined through a physical-based approach, which has not been previously reported. By following the proposed framework, the conventional trial-and-error calibration process that relies on an extensive testing campaign is minimized. A stacked shell-cohesive methodology has been applied to T800/F3900 unidirectional carbon fiber/epoxy composite panel with 16 plies in a quasi-isotropic layup configuration [(0/90/45/-45)2]s. The flat composite panel was manufactured according to ASTM D8010 standards. Both failure condition and progressive damage analysis have been explored and discussed in comparison with numerical and experimental test cases available in the open literature. Thermal effects on the mechanical performance of composite targets are also discussed based on the application of the constitutive transient thermal coupling method available in LS-DYNA®. The contact heat generated by the conversion of impact-induced damage and the kinetic energy of the projectile is also evaluated and analyzed. New observations regarding modeling techniques, energy transfer, and damage mechanisms in target plates are offered. Additionally, findings related to changes in material characteristics resulting from heat transfer are discussed.

Abstract Background Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. Results Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5–10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45–90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. Conclusions This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arteries and further experience will demonstrate the utility of the shape memory polymer devices.

Numerical simulations have the potential to be used for designing damage-tolerance composite structures. However, numerical models are currently computationally intensive, and their post-failure evolution and fracture morphology predictions are still limited. In the present work, a numerical methodology to simulate advanced composite joints is presented. The results of a numerical campaign aimed to evaluate the progressive damage and failure analysis (PDFA) of an advanced pin-hole connection under tensile and compressive load are evaluated. A high-fidelity stacked shell-cohesive methodology is employed to simulate the ultimate load, fracture initiation, and propagation of the proposed composite joint. Post-failure erosion methodology is proposed to control the initiation and evolution of composite fractures. The location and extension of the numerically predicted damages are compared with experimental observations. The proposed methodology demonstrates its preliminary ability to be used for designing composite joints up to failure. Specific outcomes are also pointed out.

The present study proposes a novel silicone-based composite skin simulant to develop equivalent tensile properties and structures similar to the human scalp. The study utilised randomly distributed short polyethylene fibres and bioactive glass particles as reinforcements. The tensile properties of the composites reinforced with 1% and 3% filler weight concentrations were characterised. Experimental results highlighted that the short polyethylene fibres could maintain the tensile strength and enhance the elastic modulus of the silicone matrix up to 14% when integrating a 3% fibre weight fraction. Bioglass particles could also increase the stiffness of a silicone-based composite up to 5% when integrating a 3% particle concentration. The study has established that the proposed composite skin simulants are more suitable as a human scalp simulant than silicone elastomer.

The use of the combination of ultrafine rice husk ash (RHA) and nano silica (NS) enhances the compactness of hardened concrete, but there is still a lack of studies that address the effects of NS and RHA on the workability, mechanical properties and pore microstructure of concrete. This study mainly aims to investigate the influence of the pore size distribution in multiphysics concrete model modified by NS and RHA and to determine the workability and mechanical properties of concrete with NS and RHA. In this work, NS and RHA were used as 0, 5, 10, 15 and 20% replacements of ordinary Portland cement (OPC) in concrete grade M20. Concrete mixed with NS and RHA showed improved performance for up to 10% addition of NS and RHA. Further addition of NS and RHA showed a decrease in performance at 7, 14 and 28 days. The decrease in concrete porosity was also found to be up to 10% when adding NS and RHA to cement. Image processing was performed on the cement-based materials to describe the microstructure of the targeted material without damage. The results from the experimental and tomography images were utilized to investigate the concrete microstructure and predict its inner properties.

Piezoelectric materials are used to harvest ambient mechanical energy from the environment and supply electrical energy via their electromechanical coupling property. Amongst many intensive activities of energy harvesting research, little attention has been paid to study the effect of the environmental factors on the performance of energy harvesting from laminated piezoelectric materials, especially when the temperature in the operating condition is different from the room temperature. In this work, thermomechanical effects on the electrical energy harvested from a type of laminated piezoelectric devices, known as thin layer unimorph ferroelectric driver (called THUNDER) were investigated. Three configurations of THUNDER devices were tested in a controlled temperature range of 30–80 °C. The THUNDER devices were pushed by using a cam mechanism in order to generate required displacements and frequencies. The experimental results exhibited a detrimental effect of the elevated temperature on the generated voltage and the harvested electrical power. It is due to changes in residual stress and geometry. These results are advantageous for many applications of the THUNDER devices and for future design of a new laminated piezoelectric sensor and energy harvester in an elevated temperature environment.

Detrimental physical and mechanical properties are common problems for composites when their flame retardancy is improved through filler additions. An increased interest of the synergistic nanoparticle addition to improve the flame retardancy of natural fiber composites is the aim of this work. The paper investigates the synergistic effect of two different nanoparticles (halloysite nanotubes (HNTs) and montmorillonite (MMT) nanoclay) on the flame and mechanical properties in an intumescent ammonium polyphosphate (APP)-based polypropylene (PP)/kenaf composite system. First, the nature of nanoparticle dispersion in PP through X-ray diffraction (XRD) and transmission electron microscopy (TEM) reveals that under twin screw compounding process, the partial exfoliation and intercalation have taken place within the nanocomposites. An increase in the decomposition temperature was observed under thermogravimetric analysis (TGA), with the presence of HNT. However, MMT tends to lower the maximum decomposition temperature under inert atmosphere. The flammability analysis in an intumescent flame retardant (IFR) system shows that the suitable amount of high aspect ratio nanoparticles with their exfoliation characteristics effectively helps to reduce the sustained combustion. Even though, improved stiffness properties can be observed with the presence of increased filler content, particle agglomeration tends to reduce the mechanical strengths of these composites due to low compatibilization and crack propagation.

This paper investigates a modified acoustic metamaterial system with local resonators coupled through linear springs. The proposed acoustic metamaterial system can provide three band gaps for broadband vibration suppression. First, the band structure of the modified acoustic metamaterial is calculated by using Bloch’s theorem under the assumption of infinite lattice. The existence of three band gaps is confirmed in the band structure. Effects of mass and spring parameters on the band gap behaviour of the modified metamaterial are investigated through a dimensionless parametric study. Based on the parametric study, optimal dimensionless parameters are proposed to achieve maximal total band gap width in the low frequency range. Subsequently, a more realistic finite lattice model is established. The transmittances of the conventional and modified metamaterial systems are compared. The three band gaps predicted from transmittances and broadband vibration suppression behaviour are consistent with the predictions from infinite lattice model using Bloch’s theorem. Finally, the time-domain responses are simulated and the superiority of the modified acoustic metamaterial over the conventional one is demonstrated.

Purpose. This in vitro study investigates how unilateral and bilateral occlusal loads are transferred to an implant assisted removable partial denture (IARPD). Materials and Methods. A duplicate model of a Kennedy class I edentulous mandibular arch was made and then a conventional removable partial denture (RPD) fabricated. Two Straumann implants were placed in the second molar region, and the prosthesis was modified to accommodate implant retained ball attachments. Strain gages were incorporated into the fitting surface of both the framework and acrylic to measure microstrain (μStrain). The IARPD was loaded to 120Ns unilaterally and bilaterally in three different loading positions. Statistical analysis was carried out using SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) with an alpha level of 0.05 to compare the maximum μStrain values of the different loading conditions. Results. During unilateral and bilateral loading the maximum μStrain was predominantly observed in a buccal direction. As the load was moved anteriorly the μStrain increased in the mesial area. Unilateral loading resulted in a twisting of the structure and generated a strain mismatch between the metal and acrylic surfaces. Conclusions. Unilateral loading created lateral and vertical displacement of the IARPD. The curvature of the dental arch resulted in a twisting action which intensified as the unilateral load was moved anteriorly.

Diabetes Mellitus (DM) is associated with adverse cardiovascular prognosis. However, the risk associated with DM may vary between individuals according to their overall cardiovascular risk burden. Therefore, we aimed to determine whether DM is associated with poor outcome in patients presenting with Acute Coronary Syndrome (ACS) according to the index episode being a first or recurrent cardiovascular event.We conducted a retrospective analysis of a prospective cohort study involving 2499 consecutively admitted patients with confirmed ACS in 11 UK hospitals during 2003. Usual care was provided for all participants. Demographic factors, co-morbidity and treatment (during admission and at discharge) factors were recorded. The primary outcome was all cause mortality (median 2 year follow up), compared for cohorts with and without DM according to their prior cardiovascular disease (CVD) disease status. Adjusted analyses were performed with Cox proportional hazards regression analysis. Within the entire cohort, DM was associated with an unadjusted 45% increase in mortality. However, in patients free of a history of CVD, mortality of those with and without DM was similar (18.8% and 19.7% respectively; p = 0.74). In the group with CVD, mortality of patients with DM was significantly higher than those without DM (46.7% and 33.2% respectively; p