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

It was reported on the elimination of interfering absorption of BTX. the absorption of O2 includes different absorption bands, which change differently when the partial pressure of oxygen is varied. These cause the nonlinear absorption of O2 and the observed band shape to vary with the column density of O2. The absorption ratios of molecular absorption in each of the Herzberg bands and dimer absorptions, as well as the contribution to the correction error of molecular absorption, are studied based on the characteristic of these absorption bands. The optimized way to eliminate the interfering absorption is obtained in the end and the effectiveness of using interpolation proposed by Volkamer et al. to remove O2 absorption is proved again. As to O2 and SO2, the effect of the thermal effect of characteristic spectra on the elimination error of their absorption is studied. Solutions to these problems are discussed and demonstrated together with methods to optimize the interpolation of spectra. As a sample application, differential optical absorption spectroscopy （DOAS） measurements of BTX are carried out. Results show a low detection limit and the good correlation with point instruments are achieved. All these prove the feasibility of using spectral interpolation to improve the accuracy of DOAS measurements of aromatic hydrocarbons for practical purposes.

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.

Influence of particle size on the breaking of aluminum particle shells

Rupturing the alumina shell(shell-breaking)is a prerequisite for releasing energy from aluminum powder.Thermal stress overload in a high-temperature environment is an important factor in the rupture of the alumina shell.COMSOL Multiphysics was used to simulate and analyze the shell-breaking response of micron-scale aluminum particles with different particle sizes at 650℃in vacuum.The simulation results show that the thermal stability time and shell-breaking response time of 10μm–100μm aluminum particles are 0.15μs–11.44μs and 0.08μs–3.94μs,respectively.They also reveal the direct causes of shell breaking for aluminum particles with different particle sizes.When the particle size is less than 80μm,the shell-breaking response is a direct result of compressive stress overload.When the particle size is between80μm and 100μm,the shell-breaking response is a direct result of tensile stress overload.This article provides useful guidance for research into the energy release of aluminum powder.

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.