Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Incidence,predictors and prognosis of acute kidney injury in acute ST-segment elevation myocardial infarction patients undergoing emergent coronary angiography/primary percutaneous coronary intervention

BACKGROUND Acute kidney injury(AKI) after coronary angiography(CAG) and primary percutaneous coronary intervention(PPCI) is frequently observed, and often interpreted as contrast induced-AKI. This study aimed to investigate the incidence, predictors and outcomes of AKI in acute ST-segment elevation myocardial infarction(STEMI) patients undergoing emergent CAG/PPCI using the control group of STEMI patients who were not exposed to contrast agents within the first 72 h.METHODS We performed a retrospective analysis of 1670 STEMI patients. Of them, 673 patients underwent emergent CAG/PPCI, and 997 patients treated with thrombolysis or no reperfusion therapy who were not exposed to contrast material during the first 72 h. AKI was defined as an increase of serum creatinine ≥ 44.2 mmol/L or ≥ 25% from baseline within 72 h. Patents were then followed up for the occurrence of all-cause mortality for 40 months(interquartile range: 24–55 months).RESULTS After propensity score matching, 505 pairs of patients were matched. Overall, the incidence of AKI was 27.4%, and AKI rates were not significantly different in patients with and without emergent CAG/PPCI procedure(27.5% vs. 27.3%, P = 0.944). Multivariate logistic regression analysis identified that the independent predictors of AKI were female, elevated interleukin-6 level,decreased lymphocyte count, left ventricular ejection fraction < 50% and use of diuretics in patients with emergent CAG/PPCI. Patients with AKI than those without AKI experienced higher incidence of acute heart failure with Killip class Ⅲ(9.4% vs. 3.3%, P =0.005;15.2% vs. 6.8%, P = 0.003, respectively) and mortality(5.8% vs. 1.4%, P = 0.014;12.3% vs. 4.6%, P = 0.002, respectively) in patients with and without emergent CAG/PPCI. Multivariate Cox regression analysis confirmed that AKI was independently associated with long-term mortality rate at 40 months follow-up in patients with and without emergent CAG/PPCI(HR = 1.867, 95% CI:1.086–3.210, P = 0.024;HR = 1.700, 95% CI: 1.219–2.370, P = 0.002, respectively).CONCLUSIONS Approximately 27.0% of STEMI patients experience AKI, which is strongly associated with an increased shortand long-term mortality regardless of emergent CAG/PPCI procedure. The development of AKI is mainly related to female gender, inflammation reaction, heart failure and use of diuretics in STEMI patients undergoing emergent CAG/PPCI.

Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis

Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009,we identified 167 patients in whom FFR was measured in at least one 70%–89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80),and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively,an additional 1176 patients undergoing PCI in at least one lesion with 70%–89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82,95% CI: 0.37–1.82,P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8,P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.

Photoelectrocatalytic oxidation of methane into methanol and formic acid over ZnO/graphene/polyaniline catalyst

ZnO/graphene/polyaniline(PANI) composite is synthesized and used for photoelectrocatalytic oxidation of methane under simulated sun light illumination with ambient conditions. The photoelectrochemical(PEC) performance of pure ZnO, ZnO/graphene, ZnO/PANI, and ZnO/graphene/PANI photoanodes is investigated by cyclic voltammetry(CV),chronoamerometry(J–t) and electrochemical impedance spectroscopy(EIS). The yields of methane oxidation products,mainly methanol(CH_3OH) and formic acid(HCOOH), catalysed by the synthesized ZnO/graphene/PANI composite are 2.76 and 3.20 times those of pure ZnO, respectively. The mechanism of the photoelectrocatalytic process converting methane into methanol and formic acid is proposed on the basis of the experimental results. The enhanced photoelectrocatalytic activity of the ZnO/graphene/PANI composite can be attributed to the fact that graphene can efficiently transfer photo-generated electrons from the inner region to the surface reaction to form free radicals due to its superior electrical conductivity as an inter-media layer. Meanwhile, the introduction of PANI promotes solar energy harvesting by extending the visible light absorption and enhances charge separation efficiency due to its conducting polymer characteristics.In addition, the PANI can create a favorable π-conjunction structure together with graphene layers, which can achieve a more effective charge separation. This research demonstrates that the fabricated ZnO/graphene/PANI composite promises to implement the visible-light photoelectrocatalytic methane oxidation.

Effect of Atmospheric Interfering Absorption on Measurement of BTX by DOAS

它在 BTX 的介入的吸收的消除上被报导。当氧的部分压力被改变时， O2 的吸收包括不同吸收乐队，它不同地变化。这些引起 O2 和观察乐队形状的非线性的吸收与 O2 的列密度变化。在每 Herzberg 乐队的分子的吸收和更暗淡的吸收的吸收比率，以及对分子的吸收的修正错误的贡献，基于这些吸收乐队的特征被学习。消除介入的吸收的优化方法最后被获得，使用插值的有效性由 Volkamer 等求婚了。为了移开 O2，吸收再被证明。至于 O3 和 SO2，他们的吸收的消除错误上的典型系列的热效果的效果被学习。这些问题的答案被讨论并且和方法示威了优化系列的插值。作为样品应用， BTX 的微分光吸收光谱学(DOAS ) 大小被执行。结果证明有点仪器的低察觉限制和好关联被完成。都，这些证明使用的可行性光谱为实际目的改进芳香的烃的 DOAS 大小的精确性的插值。

Performance optimization of self-powered visible photodetectors based on Cu2O/electrolyte heterojunctions

The performance of the self-powered photodetectors based on the Cu2O/electrolyte heterojunctions is optimized by adjusting morphology and structure of the Cu2O film.The Cu2O film with a deposition time of 2000 s possesses a largest current density of 559.6μA/cm2 under visible light illumination at zero bias,with a rising time of 5.2 ms and a recovering time of 9.0 ms.This optimized Cu2O film has a highest responsivity of about 25.8 mA/W for visible light,and a negligible responsivity for UV light.The high crystallinity and excellent charge transfer property are responsible for the improved photodetection performance.

A fiber bundle structure with uniform transmission characteristics for high-density astronomical optical cables

Transmission efficiency(TE) and focal ratio degradation(FRD) are two important parameters for evaluating the quality of an optical fiber system used for astronomy. Compared to TE, the focal ratio is more easily influenced by external factors, such as bending or stress. Optical cables are widely implemented for multi-object telescopes and integral field units(IFUs). The design and fabrication process of traditional optical cables seldom considers the requirements of astronomical applications. In this paper, we describe a fiber bundle structure as the basic unit for miniaturized high-density FASOT-IFU optical cables,instead of the micro-tube structure in stranded cables. Seven fibers with hexagonal arrangement were accurately positioned by ultraviolet(UV)-curing acrylate to form the bundle. The coating diameter of a fiber is0.125 mm, and the outer diameter of the bundle is 0.58 mm. Compared with the 0.8 mm micro-tube structure of a traditional stranded cable, the outer diameter of the fiber bundle was reduced by 27.5%. Fiber paste was filled into the bundle to reduce stress between the fibers. We tested the output focal ratio(OFR) in95% of the encircled energy(EE95) of the fibers in the bundle under different conditions. With the incident focal ratio F/8, the maximum difference of OFR is 0.6. In particular, when the incident focal ratio is F/5,the maximum difference of OFR is only 0.1. The jacket formed by the UV-curing acrylate can withstand a certain stress of less than 1.38 N mm-1. The fiber bundle can maintain uniform emitting characteristics with a bending radius of 7.5 cm and with tension less than 6 N. The test results show that the structure of the fiber bundle can be used as a basic unit for miniaturized high-density astronomical optical cables.

Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).Methods:The 419 consecutive patients with STEMI,treated at one medical center,from March 2010 to December 2015 were retrospectively investigated.Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay.The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups.Short- and long-term outcomes were compared,as were age-based subgroups (patients aged 60 years and younger vs.those older than 60 years).Statistical analyses were mainly conducted by Student t-test,Chi-squared test,logistic regression,and Cox proportional-hazards regression.Results:The H-HCY group had more males (84.6% vs.75.4%,P=0.018),and a lower prevalence of diabetes (20.2% vs.35.5%,P<0.001),compared with the L-HCY group.During hospitalization,there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs.4.8%,P= 0.440).During the median follow-up period of 35.8 (26.9–46.1) months,33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE)(P=0.120).History of hypertension (hazard ratio [HR]:1.881,95% confidence interval [CI]:1.178–3.005,P=0.008) and higher Killip class (HR:1.923,95% CI:1.419–2.607,P<0.001),but not HCY levels (HR:1.007,95% CI:0.987–1.027,P=0.507),were significantly associated with long-term outcomes.However,the subgroup analysis indicated that in older patients,HCY levels were significantly associated with long-term outcomes (HR:1.036,95% CI:1.011–1.062,P=0.005).Conclusion:Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI;however,among elderly patients with STEMI,this study revealed a risk profile for late outcomes that incorporated HCY level.

Finite Time Convergent Wavelet Neural Network Sliding Mode Control Guidance Law with Impact Angle Constraint

This paper presents a novel guidance law to intercept non-maneuvering targets with impact angle and lateral acceleration command constraints. Firstly, we formulate the impact angle control to track the desired line-of-sight(LOS) angle, which is achieved by selecting the missile s lateral acceleration to enforce the sliding mode on a sliding surface at impact time. Secondly, we use the Lyapunov stability theory to prove the stability and finite time convergence of the proposed nonlinear sliding surface. Thirdly, we introduce the wavelet neural network(WNN) to adaptively update the additional control command and reduce the high-frequency chattering of sliding mode control(SMC). The proposed guidance law, denoted WNNSMC guidance law with impact angle constraint,combines the SMC methodology with WNN to improve the robustness and reduce the chattering of the system. Finally, numerical simulations are performed to demonstrate the validity and effectiveness of the WNNSMC guidance law.