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BACKGROUND: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide. METHODS: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries. FINDINGS: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE ± DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %). INTERPRETATION: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population. ispartof: THROMBOSIS RESEARCH vol:222 pages:31-39 ispartof: location:United States status: published

ObjectivesTo report the 10-year survival rate and prognostic factors of pulmonary arterial hypertension associated with CTD (CTD-PAH) patients, to compare treatment and survival between patients enrolled before and after 2015, and to validate the discrimination of the recommended four-strata model in predicting 10-year survival at follow-up in Chinese CTD-PAH patients.MethodsThis study was derived from a Chinese national multicentre prospective registry study from 2009 to 2019. Medical records were collected at baseline and follow-up, including PAH-targeted therapy and binary therapy (both CTD and PAH-targeted therapy).ResultsA total of 266 CTD-PAH patients were enrolled and the 10-year survival rate was 59.9% (median follow-up time: 4.85 years). Underlying CTD (SSc), baseline 6-min walking distance and SaO2 were independent risk factors for 10-year survival. The proportion of patients receiving PAH-targeted combination therapy increased from 10.1% (2009–2014) to 26.5% (2015–2019) and that of binary therapy increased from 14.8% to 35%. The 1-year survival rate increased from 89.8% (2009–2014) to 93.9%, and the 3-year survival rate increased from 80.1% (2009–2014) to 86.5% (both P > 0.05). The four-strata strategy performed well in predicting 10-year survival at follow-up (C-index = 0.742).ConclusionThe 10-year survival rate of CTD-PAH patients was reported for the first time. The 10-year prognosis was poor, but there was a tendency for more standardized treatment and better survival in patients enrolled after 2015. The recommended four-strata model at follow-up can effectively predict 10-year survival in CTD-PAH patients.

Reactive red 2 (RR2) azo dye wastewater poses a serious hazard to the water environment health, so using a novel and efficient Electro- Ce(III) (E- Ce(III)) process takes on a critical significance in treating RR2 dye wastewater. In this study, the effects of a variety of single-factor conditions on RR2 removal efficiency were evaluated in depth. The results indicated that the optimal experimental conditions are as reaction temperature of 25 °C, Na

A bulk (Hf0.2Ta0.2Zr0.2Nb0.2Ti0.2)C high-entropy ceramic (HEC) with a high density was prepared by hot pressing (HP), and through a robust joining technique, large-sized piece was fabricated. A hot-pressed carbide HEC with a single-phase and homogeneous composition was obtained at the sintering temperatures from 1800 to 1950 °C for 30 min under a pressure of 30 MPa. The influence of sintering temperature on the mechanical properties of the HEC was investigated, and the flexural and compressive strengths were reported. Additionally, the feasibility of active brazing of this HEC was studied and solid joints with high shear strength were obtained by atomic diffusion and chemical reaction at the interface, providing a key approach to fabricate complex components of HECs.

Background At present, there is no generally accepted comprehensive prognostic risk prediction model for medically treated chronic thromboembolic pulmonary hypertension (CTEPH) patients. Methods Consecutive medically treated CTEPH patients were enrolled in a national multicenter prospective registry study from August 2009 to July 2018. A multivariable Cox proportional hazards model was utilized to derive the prognostic model, and a simplified risk score was created thereafter. Model performance was evaluated in terms of discrimination and calibration, and compared to the Swedish/COMPERA risk stratification method. Internal and external validation were conducted to validate the model performance. Results A total of 432 patients were enrolled. During a median follow-up time of 38.73 months (IQR: 20.79, 66.10), 94 patients (21.8%) died. The 1-, 3-, and 5-year survival estimates were 95.5%, 83.7%, and 70.9%, respectively. The final model included the following variables: the Swedish/COMPERA risk stratum (low-, intermediate- or high-risk stratum), pulmonary vascular resistance (PVR, ≤ or > 1600 dyn·s/cm5), total bilirubin (TBIL, ≤ or > 38 µmol/L) and chronic kidney disease (CKD, no or yes). Compared with the Swedish/COMPERA risk stratification method alone, both the derived model [C-index: 0.715; net reclassification improvement (NRI): 0.300; integrated discriminatory index (IDI): 0.095] and the risk score (C-index: 0.713; NRI: 0.300; IDI: 0.093) showed improved discriminatory power. The performance was validated in a validation cohort of 84 patients (C-index = 0.707 for the model and 0.721 for the risk score). Conclusions A novel risk stratification strategy can serve as a useful tool for determining prognosis and guide management for medically treated CTEPH patients. Trial registration: ClinicalTrials.gov (Identifier: NCT01417338).

A TiB2–TiC–SiC composite was successfully joined to Ta by brazing with a Ti/Ni/Ti interlayer. The microstructure and properties of the Ta/TiB2–TiC–SiC joint were analyzed at various joining temperatures, and the reaction mechanism of the joint was studied. The results showed that α-Ti+(βTi, Ta) formed contiguous with the Ta substrate; the reaction layers of TiC, TiB, and (Ti, Ta)B formed adjacent to the TiB2–TiC–SiC composite, and Ti2Ni and (Ti, Ta)B formed in the central brazing seam. The reactions between the Ti and TiB2–TiC–SiC composite intensified as the joining temperature increased, and the reaction layer contiguous with the TiB2–TiC–SiC composite became thicker. The joint brazed at 1293 K for 20 min exhibited a maximum room temperature shear strength of 158 MPa, and the shear strengths at the high temperature of 873 K and 1073 K were 97 MPa and 74 MPa, respectively. The crack of the joint tested at room temperature was primarily propagated along the Ti2Ni phase of the brazing seam at 1253 K. When the joining temperature was relatively high, the fracture location changed to the TiB2–TiC–SiC composite. However, the fracture path of the joint that was tested at the high temperature of 1073 K occurred at the α-Ti+(βTi, Ta) phases.

This study aimed to compare the cardiac function among different sub-types of pulmonary hypertension (PH) and to explore the independent predictors of major adverse cardiovascular events (MACE). Eighty-seven PH patients diagnosed by right heart catheterization (RHC) were recruited. Patients underwent cardiac magnetic resonance (CMR) and RHC examination within 2 weeks. The CMR images were analyzed to calculate the cardiac functional parameters including right ventricle (RV) and left ventricle (LV) end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and myocardial mass (MM). The median follow-up time was 46.5 months (interquartile range: 26–65.5 months), and the endpoints were the occurrence of MACE. RVEDVI, LVEDVI, and LVESVI were higher in congenital heart disease–related PH (CHD-PH) than in other sub-types (p 0.05). Comparing with the non-MACE group, RVEF, TAPSE, and LVSVI significantly decreased in the MACE group, while the RVESVI significantly increased (p < 0.05). TAPSE ≤ 15.65 mm and LVSVI ≤ 30.27 mL/m2 were significant independent predictors of prognosis in PH patients. CHD-PH had a higher RV function reserve but lowest LVEF comparing to other subgroups. TAPSE and LVSVI could contribute to the prediction of MACE in PH patients. • CMR imaging is a noninvasive and accurate tool to assess ventricular function. • CHD-PH had higher RV function reserve but lowest LVEF. • TAPSE and LVSVI could contribute to the prediction of MACE in PH patients.

Black zirconia contains both VO and IZr defects, both of which can enhance its light absorption performance.

Relapsing polychondritis (RPC) is a systemic immune-mediated disease characterized by recurrent and progressive inflammation of cartilaginous tissues. 64% of RPC patients concurrent with other autoimmune disorders, there are very few reports about the concomitant RPC patients with systemic sclerosis (SSc). Herein we report a case of RPC in a 50-year-old female following SSc with pulmonary arterial hypertension (PAH) 2 years ago. She was treated with corticosteroids, immunosuppressive drugs, oral endothelin-A receptor antagonist and phosphodiesterase type 5 inhibitors. Her ocular and auricular symptoms disappeared quickly. The hemodynamic parameters were also significantly improved after treatment. To our knowledge, this is the first RPC complicated with SSc-PAH reported.

A novel surface treatment method by electrophoretic depositing SiC nanowires on the C/C composite was introduced to reinforce the C/C–Nb brazed joints. Results showed that the electrophoretic deposition (EPD) process of SiC nanowires could improve the wettability of the liquid AgCuTi alloy on the C/C substrate because of the reaction between SiC nanowires and active element Ti in the AgCuTi alloy. With the introduction of SiC nanowires, the formation of continuous brittle Ti3Cu4 layer was inhibited and the Ti3Cu4 changed into lumps. The thickness of the TiC reaction layer was 500 nm when the EPD time was 5s which was larger than that of the original brazed joint. As the EPD time continued to increase, the thickness of the TiC reaction layer decreased gradually and the size of brittle Ti3Cu4 phase in the joint became smaller and smaller. With the combined effects of the change in the Ti3Cu4 morphology and the TiC reaction layer thickness, the average shear strength of joints achieved a peak of 48 MPa when the EPD time was 30s, which was 60% higher than that of the original brazed joints.

Nationally representative reports on the characteristics and long-term survival of pulmonary arterial hypertension (PAH) from developing countries are scarce. The applicability of the current main risk stratifications and the longitudinal changes in goal-oriented treatments have yet to be elucidated in real-world settings. Therefore, we aimed to provide insights into the characteristics, goal-oriented treatments and survival of PAH in China and to explore the applicability of the main risk stratifications in our independent cohort.PAH patients were consecutively enrolled from a national prospective multicentre registry. Data on baseline, follow-up re-evaluation and therapeutic changes were collected.A total of 2031 patients were enrolled, with congenital heart disease (CHD)-PAH (45.2%) being the most common aetiology. The mean age was 35 ± 12 years, and 76.2% were females. At baseline, approximately 20% of the patients with intermediate or high risk received combination treatment. At follow-up, approximately half of the re-evaluated patients did not achieve low-risk profiles, and even among patients who received combination therapy at baseline, 4% of them still worsened. The rate of combination therapy increased significantly from 6.7% before 2015 to 35.5% thereafter. The main risk assessment tools demonstrated good performance for predicting survival both at baseline and at follow-up.Chinese PAH patients show both similar and distinct features compared to other countries. Current main risk stratifications can significantly discriminate patients at different risk levels. There were still many patients not achieving low-risk profiles at follow-up, indicating more aggressive treatment should be implemented to optimize the goal-oriented treatment strategy.

Purpose This paper aims to use nano-silver paste to design a new bonding method for super-large-area direct-bonded-aluminum (DBA) plates. It compared several frequently used bonding methods and proved the feasibility of an optimized low-pressure-assisted double-layer-printed silver sintering technology for large-area bonding to increase the thermal conductivity of power electronic modules with high junction temperature, higher power density and higher reliability. Design/methodology/approach The bonding profile was optimized by using transparent glasses as substrates. Thus, the bonding qualities could be directly characterized by optical observation. After sintering, the bonded DBA samples were characterized by nondestructive X-ray computed tomography system, scanning electron microscopy equipped with an energy dispersive spectrometer. Finally, bonding stress evolution was characterized by shear tests. Findings Low-pressure-assisted large-area double-layer-printed bonding process consisting of six-step was successfully developed to bond DBA substrates with the size of 50.8 × 25.4 mm. The thickness of the sintered-silver bond-line was between 33 and 74 µm with the average porosity of 12.5 per cent. The distribution of shear strength along the length of DBA/DBA bonded sample was from 9.7 to 18.8 MPa, with average shear strength of 15.5 MPa. The typical fracture primarily propagated in the sintered-silver layer and partially along the Ni layer. Research limitations/implications The bonding stress needs to be further improved. Meanwhile, the thermal and electrical properties are encouraged to test further. Practical implications If nano-silver paste can be used as thermal interfacial material for super-large-area bonding, the thermal performance will be improved. Social implications The paper accelerated the use of nano-silver paste for super-large-area DBA bonding. Originality/value The proposed bonding method greatly decreased the bonding pressure.

The development of welding technology for zirconium alloy has great significance on the safety, stability, and reliability of the operation of the nuclear reactor. In this work, vacuum diffusion bonding of Zr-4 alloy was studied at the diffusion temperature ranging from 760 to 820 °C with holding times of 30–90 min. The effects of diffusion bonding temperature and holding time on the interfacial microstructure and mechanical properties of the diffusion bonded Zr-4 alloy joints were investigated in detail, and the relationship between the interfacial microstructure and shear strength of the diffusion bonded joints was discussed. The results show that the interface bonding ratio of the diffusion bonded Zr-4 joint gradually increased from 74% to 95% with the increasing of bonding temperature. In addition, the grain size of the base material became a larger and brittle second phase composed of Zr(Cr, Fe)2 and eutectic α-Zr + Zr(Fe, Cr)2 formed in the joint with the increase of the temperature as well as the extension of the bonding time. The highest shear strength of 349 MPa was obtained at 800 °C for 30 min under 7 MPa, and the crack of the joint was primarily propagated along with the base material rather than the bonded interface.

To derive the higher mechanical properties of diffusion-bonded joints at a low bonding temperature, ultrasonic impact treatment (UIT) was used to increase the dislocations and refine the microstructure of faying surfaces prior to diffusion bonding. The results show that a deformation layer with a thickness of 30 μm formed near the impacted TC11 alloy surface, with many dislocation tangles, substructures, and dislocation cells in this layer. Diffusion bonding experiments were performed for both original samples and UIT samples. For the original TC11 alloy, the average shear strength of the diffusion-bonded joints increased with an increase in the bonding temperature, and the joint strength was 550 MPa for joints bonded at 820 °C for 30 min under a pressure of 10 MPa. However, the average shear strength of the TC11 alloy joints with UIT reached 560 MPa for the joint that was diffusion-bonded at 780 °C, whereas it was only 370 MPa for the joint without UIT. Therefore, UIT of the alloy surface resulted in a joint with a high strength at a relatively low bonding temperature, which may be beneficial to inhibit the grain growth caused by the high temperature bonding process.

C/C composite was successfully joined to Ti 2 AlNb alloy with inactive filler metal, Ag–Cu–Zn filler. In addition, a designed composite interlayer, Ag–Cu–Zn/Cu/Ag–Cu–Ti, was used to improve the properties of brazed joints. AlCu 2 Ti compound blocks were formed in brazing seam and the double reaction layers adjacent to C/C composite were AlCu 2 Ti and TiC when Ag–Cu–Zn filler was used to join C/C composite and Ti 2 AlNb. With the increase of brazing temperature and time, the amount of AlCu 2 Ti compound blocks increased and tended to accumulate together nearby the C/C composite, the double reaction layers thickened as well. In order to avoid the serious accumulation of brittle AlCu 2 Ti compound nearby C/C composite, Cu foil was added between the Ag–Cu–Zn filler and Ti 2 AlNb. Soft Cu but not brittle AlCu 2 Ti existed nearby the C/C composite with the addition of Cu foil, which is beneficial for the relief of residual stress near the C/C composite, and the shear strength of joint improved obviously. With the barrier of Cu foil, the thickness of reaction layers adjacent to C/C composite could be controlled easily by the addition of Ag–Cu–Ti foil. Correspondingly, the shear strength of this joint reached at 28 MPa, which was close to that of C/C itself.

A surface modification method of C/C composites involving a combination of pre-oxidation treatment and in situ growth of CNTs was developed to form a reinforced interfacial structure in Nb-C/C brazed joints. The interfacial structure under different surface conditions of the C/C composites and its effects on the mechanical properties of brazed joints at both room temperature (RT) and elevated temperatures were studied. Through pre-oxidation, annular gaps with an adjustable size were uniformly formed around the carbon fibers, and these gaps acted as artificial channels for the liquid brazing alloy to infiltrate into. The RT shear strength of the Nb-C/C joints increased from 29 MPa to 57 MPa after oxidation of the C/C composites at 800 °C for 5min. The growth of CNTs was able to improve the wettability, since it was beneficial for liquid brazing alloy filling in the annular gaps. Further, a reinforced joint with fine TiC particles was formed by the reaction between Ti and the CNTs. The shear strength of the brazed joints reached 62 MPa after pre-oxidation and CNT growth and remained at 48 MPa at 500 °C. The improvement in the joint shear strength after surface modification of the C/C composites was attributed to the reduced residual stress, increased bonding area, and enhanced pinning effect.

Low-temperature silver sintering technology, which has been proven to be a promising die-attach solution, was extended to bonding large substrates. Strong bonding strengths for substrates with a dimension of greater than 25 mm × 50 mm were achieved by sintering a nanosilver paste at temperatures below 270 °C under a pressure of less than 5 MPa. To characterize the thermal performance of the substrate-attach interface, we applied a transient thermal technique with cumulative structure function analysis. Using self-heating and the temperature-sensitive threshold voltage of a power device, we measured the transient thermal responses of the device placed at various locations on the bonded structures. Each transient thermal response was used to determine the cumulative structure function, which represents the relationship between cumulative thermal capacitance and cumulative thermal resistance from the device junction to the ambient environment. Two-dimensional maps corresponding to interface thermal resistance were obtained from structure function plots. We found that for well-bonded substrates, the average specific thermal resistance contributed by the sintered silver interface was between 5.20 and 5.78 mm2K/W with a variation of 4.7%–6.0%.

Ag-Cu-Ti/Cu/Ag-Cu-Ti composite interlayer was successfully designed to braze Al2O3 ceramic and Nb. The effect of the addition of Cu interlayer with various thicknesses on the microstructure, residual stress and mechanical properties of the brazed joints was investigated by finite element modeling (FEM) computation combined with experimental verification. The results showed that the layered Ag-Cu-Ag solid solution structure formed in the Al2O3/Nb brazed joints when the composite interlayer was used. Moreover, the thickness of TiO + Ti3Cu3O reaction layers adjacent to the Al2O3 ceramic substrate did not change obviously regardless of the Cu foil thickness. The maximum residual stress in the whole brazed joint always appeared in the Al2O3 ceramic substrate nearby the interlayer, but it was reduced from 384 MPa to 119 MPa when a 150 μm thick Cu foil was added. The variation of calculated residual stresses as a function of Cu foil thickness, which was verified by X-ray measurement, exhibited a consistent with Al2O3 ceramic strain energy. Thus, the calculation of Al2O3 ceramic strain energy could be a good criterion to evaluate the joint shear strength because the fracture occurred in the Al2O3 ceramic. The reduction of detrimental residual stress was primarily attributed to the increased plastic strain energy of Cu interlayer. The FEM and experiment results indicated that the ability of plastic deformation of the interlayer played a key role in determining the residual stress in the brazed joint, providing a method for improving the bonding properties of ceramic and metal.