Predictive Factors of No Reflow during Primary Angioplasty

Introduction: No reflow during primary angioplasty is associated with a poor prognosis despite the reopening of the culprit coronary. The aim of our work was to determine the predictive factors of no reflow. Methodology: Single-center retrospective analytical study from June 2000 to December 2016 that included patients presenting with STEMI took care of by primary angioplasty. No reflow was defined according to angiographic criteria: a TIMI flow Results: The prevalence of no reflow was 24%. In univariate analysis mean age, diabetes,hypertension, tachycardia, hypotension, killip stage 4 left ventricular failure, hyperglycemia > 11, renal failure, left ventricular dysfunction, tritruncal status, common trunk involvement, initial TIMI flow at 0, significant thrombotic load, delay to angioplasty > 6 hours, and predilation were all correlated with no reflow with a p 75 years [OR = 6.02, 95% CI 1.4 - 27, p = 0.014], tachycardia [OR = 4.3, 95% CI 1.6 - 7.4, p = 0.037], delay to angioplasty > 6 hours [OR = 1.3, 95% CI 1.1 - 2.1, p = 0.003] and high thrombotic load [OR = 1.5, 95% CI 1.3 - 3.2, p = 0.02] were independent predictors of no reflow. Conclusion: No reflow is associated with a poor short-term prognosis. Its care requires knowledge of predictive factors, prevention and treatment.

Related factors of coronary no-reflow phenomenon and progress of traditional Chinese medicine treatment

Coronary no-reflow phenomenon belongs to a type of coronary microcirculation disturbance,and its main pathogenic factors are vascular endothelial cell injury,microembolism and inflammatory reaction,which are corresponding to the pathogenesis of choroid injury,blood stasis and heat toxin in traditional Chinese medicine,such as NO,ET-1,chemokine,IL and other cytokines.The degree of improvement of patients'symptoms and laboratory examination data provide a basis for traditional Chinese medicine compound prescription,monomer and traditional Chinese medicine characteristic therapy for the treatment of no-reflow phenomena(NRP).Combined with related factors,the author summarizes the research progress of traditional Chinese medicine treatment of NRP in recent years,in order to provide clinical reference.

Effects of reflowing temperature and time on alloy layer of tinplate and its electrochemical behavior in 3.5%NaCl solution

Effects of reflowing temperature and time on the alloy layer of tinplate and its electrochemical behavior in 3.5%NaCl solution were investigated by electrochemical measurements and surface characterization.It is found that the amount of alloy layer increases with the increase of reflowing temperature and time.Then the corrosion potential of detinned tinplate shifts positively and the corrosion rate decreases.After being coupled with tin,the detinned tinplate acts as cathode and tin acts as anode initially.However,after being exposed for some time,the potential shifts of both detinned tinplate and tin reverse the polarity of the coupling system.The galvanic current density decreases with the increase of reflowing temperature and time.

FORMATION AND CHANGE OF AuSn_4 COMPOUNDS AT INTERFACE BETWEEN PBGA SOLDER BALL AND Au/Ni/Cu METALLIZATION DURING LASER AND INFRA-RED REFLOW SOLDERING

Interactions between 63Sn37Pb solder and PBGA metallization (Au/Ni/Cu) duringlaser and infrared reflow soldering were studied. During laser reflow soldering process,a thin layer of AuSn_4 was observed at the interface of the solder bumps, its morphologywas strongly dependent on the laser reflow power and heating time. The solder bumpsformed by the first laser reflow was reflowed again to form the solder joints. TheAuSn_4 compounds formed in the first laser reflow process dissolved into the bulk solderafter the secondary infrared reflow process. The needle-like AuSn_4 changed into rod-like, and distributed inside the solder near the solder/pad interface.

Effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction

Objective To evaluate effects of preinfarction angina(PA) on no reflow phenomenon after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods one hundred patients with first AMI were divided into no reflow group( n =15)and reflow group( n =85). All patients undervent PCI within 12h after onset of AMI.No reflow phenomenon,defined as TIMI grade 2 flow or less without apparent residual stenosis .Myocardial enzyme was continuously measured;Left ventricular function was assessed by radionuclideimaging; The incidence of ventricular aneurysm and in hospital mortality was observed. Results (1)Patients with no reflow had a significantly lower incidence of PA( 20% vs 61% , P <0.01 ), a higher incidence of anterior infarction (67%vs35%, P <0.05 ), and had significantly higher peak creatine MB fraction than those with reflow(403±132vs277±151, P <0.01 ).(2) Patients with no reflow had significantly larger myocardial infarction area (MIA) ( 27.6 ±9.1% vs 20.9 ±9.4% , P <0.01 ), significantly higer left ventricular ejection fraction (46±8% vs 53±9%, P <0.01 ),and had a higher incidence of ventricular aneurysm and mortality than those with reflow (20%vs4%,p<0.05;20% vs 2%, P <0.05 ). (3)Multivariate Logistic analysis showed that the absence of preinfarction angina was a major independent determinant of no reflow( OR = 6.12 , P =0.01 ).Conclusions The absence of preinfarction angina is a high dangerous factor of no reflow phenomenon; No reflow phenomenon is associated with a high incidence of heart failure and mortality.

Protective effect of Danhong injection in patients with acute myocardial infarction at a high risk of no-reflow during primary percutaneous coronary intervention

Objective To observe the effect of Danhong injection(DI)in patients with acute ST-segment elevation myocardial infarction(STEMI)at a high risk of no-reflow(NR)during primary percutaneous coronary intervention(PCI).Methods Patients were placed in a DI group and control group.The DI group was given DI and the control group was given physiologic saline.The administration lasted 4 to 6 days in both groups after PCI.Cardiac magnetic resonance(CMR)was carried out during the perioperative period(7±2 days).The primary endpoint of the study was myocardial infarct size(IS)imaged on delayed-enhancement CMR.The secondary endpoint was major adverse cardiac events observed 6 months after PCI.Results In total,160 high-risk NR patients were enrolled,and 110 patients completed the CMR examination.According to postoperative CMR,the Myocardial Salvage Index and left ventricular ejection fraction were higher in the DI group(0.57±0.13 vs.0.48±0.17,P<0.01;49.3%±6.9%vs.46.2%±7.7%,P=0.03,respectively),whereas the IS was lower(19.7%±5.6%vs.22.2%±6.5%,P=0.04),compared with that in the control group.These differences were observed to be significant.After 6 months,the prevalence of major adverse cardiac events in the DI group decreased compared with that in the control group,but the differences were not observed to be significant(P>0.05).Conclusion The application of DI can reduce the myocardial infarct size in STEMI patients at a high risk of NR during primary PCI.

Removal of the main inflorescence to induce reflowering of loquat

Loquat(Eriobotrya japonica Lindl.)is an evergreen fruit tree species of the Rosaceae,and its unique flowering time greatly hinders its production.To explore the artificial regulation of loquat flowering time,we removed the main inflorescence(by cutting it)to induce reflowering.For different loquat tree cultivars with different stages,the inflorescence was removed by cutting the main floral axis at two alternative positions:the upper or the lower position beneath the inflorescence,and it was found that the proportion of reflowering resulting from removing the upper position of the main floral axis of yellow-flesh loquat cultivars during the full-bloom stage was the highest.In addition,compared with those of the normal-growing panicles,the number of flower buds and branch axes of the reflowering panicles decreased significantly after cutting.Importantly,these newly produced inflorescences flowered 2–4 months later than normal-growing inflorescences did,effectively prolonging both the flowering and fruiting time.In addition,qRT-PCR results showed that EjFT1,EjFT2,EjAP1–1 and EjAP1–2 were highly expressed in the floral axis.These findings highlighted a new method for extending the production cycle of loquat and provided a reference for the flowering regulation of loquat and other economically important fruit tree species.

Evolution of AuSnx intermetallic compounds in laser reflowed micro-solder joints

To investigate the effect of Au thickness on evolution of AuSnx IMCs, pads with 0. 1, 0. 5 and 4. 0 μm thickness of Au surface finish were utilized. Laser reflowed solder joints were aged in 125℃ isothermal ovens. Results indicated that little IMC formed at the interface of solder and pad with 0. 1 μm thickness of Au. Even in condition of 744 hours aging, thickness of lMCs did not increase obviously. As for the joints with 0. 5 μm thickness of Au, most of AuSn4 IMCs stayed at the inteornce and were in needle-like or dendritic morphology. With the increase of aging time, AuSn4 IMCs beeame flat and changed to a continuous layer. In the joints with 4. 0 μm thickness of Au on pads, AuSn, AuSn2, AuSn4 IMCs and Au2Sn phase formed at the interface. As aging time was increased, more Sn rich IMCs formed at the interface, and evolved to AuSn4 IMCs in condition of long time aging. Thickness of AuSn4 IMCs reached about 30μm.

Value of Platelet to Lymphocytes Ratio in Predicting Angiographic Reflow after Primary Percutaneous Coronary Intervention in STEMI Patient

Background: Acute myocardial infarction is a leading cause of death worldwide nowadays and treatment of choice is primary percutaneous coronary intervention (PCI). No reflow is a complication that increases mortality and morbidity post intervention and one of its predictors is platelet lymphocyte ratio. Aim of Study: To assess relation between admission platelet to lymphocyte ratio (PLR) and angiographic reflow after primary PCI in acute ST elevation myocardial infarction (STEMI). Patients and Methods: This is a prospective study that was conducted from May 2017 to May 2018 at Cardiology Department, Menoufia University Hospital. Sixty patients presented with ST-elevation myocardial infarction who were eligible for primary PCI were enrolled in the study. According to TIMI flow post intervention, patients were arranged into 2 groups: Group 1 (Normal Reflow) included thirty patients with post intervention TIMI flow III and Group 2 (NO Reflow) included thirty patients with post intervention TIMI flow (0, I, II). Comparison between both groups was done regarding platelet lymphocyte ratio (PLR). Result: PLR was significantly higher in patients with coronary no reflow than in patients with normal reflow with a P-value of , timing interval between onset of chest pain to time of intervention and thrombus grading was significantly higher in patients with no reflow than in patients with normal reflow. Conclusion: Pre-intervention PLR is an independent predictor of slow flow/no reflow following PPCI in patient with acute STEMI.

Study on detinning process of a reflow conductor roll

Adhering tin is the main reason of a reflow conductor roll which works in an electroplating tin line （ETL）. A det- inning agent whose main composition is NaOH and KOH and assistant composition is Na2PbO2 or K2PbO2 and NaNO3 or NaNO2 has excellent detinning effects when the temperature of detinning solution is 40-80℃ and the temperature of the reflow conductor roll reaches 40-70℃. After the adhering tin layer of the reflow conductor roll is removed, the roughness of the reflow conductor roll can resume to 4.0 μm, its service life increases by 80%, and the repairing cost decreases by 90%.

Failure Mechanism of Reflow Conductor Roll of Electroplating Tinning Line

The surface roughness of reflow conductor roll was checked on membrane sample. The surface morphology of conductor roll was observed by microscope, and the composition of adhered layer on conductor roll surface was analyzed by X-ray spectroscope. The results show that tin adhesion is the main reason for failure of conductor roll, and the failure of conductor roll is accelerated by wear. The measures to decrease tin adhesion and improve wear resistance were put forward.

Failure Modes of Lead Free Solder Bumps Formed by Induction Spontaneous Heating Reflow

The shear failure modes and respective failure mechanism of Sn3.5Ag and Sn3.0Ag0.5Cu lead-free solder bumping on Au/Ni/Cu metallization formed by induction spontaneous heating reflow process have been investigated through the shear test after aging at 120℃ for 0, 1, 4, 9 and 16 d. Different typical shear failure behaviors have been found in the loading curves （shear force vs displacement）. From the results of interracial morphology analysis of the fracture surfaces and cross-sections, two main typical failure modes have been identified. The probabilities of the failure modes occurrence are inconsistent when the joints were aged for different times. The evolution of the brittle NiaSn4 and Cu-Ni-Au-Sn layers and the grains coarsening of the solder bulk are the basic reasons for the change of shear failure modes.

Characteristics of Laser Reflow Bumping of Sn3.5Ag and Sn3.5Ag0.5Cu Lead-Free Solder Balls

ead-free Sn3.5Ag and Sn3.5Ag0.5Cu solder balls were reflowed by laser to form solder bumps. Shear test was performed on the solder bumps, and SEM/EDX （scanning electron microscopy/energy dispersive X-ray spectrometer） was used to analyze the formation of intermetallic compounds （IMCs） at interface region. A finite element modeling on the temperature gradient and distribution at the interface of solder bump during laser reflow process was conducted to elucidate the mechanism of the IMCs growth direction. The results show that the parameters window for laser reflow bumping of Sn3.5Ag0.5Cu was wider than that of Sn3.5Ag. The shear strength of Sn3.5Ag0.5Cu solder bump was comparable to that of Sn3.5Ag solder bump, and was not affected obviously by laser power and irradiation time when appropriate parameters were used. Both laser power and heating time had a significant effect on the formation of IMCs. A continuous AuSn4 intermetallic compound layer and some needle-like AuSn4 were observed at the interface of solder and Au/Ni/Cu metallization layer when the laser power is small. The formation of needle-like AuSn4 was due to temperature gradient at the interface, and the direction of temperature gradient was the preferred growth direction of AuSn4. With increasing the laser power and heating time, the needle-like AuSn4 IMCs dissolved into the bulk solder, and precipitated out once again during solidification along the grain boundary of the solder bump.

Study on laser and hot air reflow soldering of PBGA solder ball

Laser and hot air reflow soldering of PBGA solder ball was investigated. Experimental results showed that surface quality and shear strength of solder bump reflowed by laser was superior than the solder bump by hot air, and the microstructure within the solder bump reflowed by laser was much finer. Analysis on interfacial reaction showed that eutectic solder reacted with Au/Ni/Cu pad shortly after the solder was melted. Interface of solder bump reflowed by laser consists of a continuous AuSn 4 layer and remnant Au element. Needle like AuSn 4 grew sidewise from interface, and then spread out to the entire interface region. A thin layer of Ni 3Sn 4 intermetallic compound was found at the interface of solder bump reflowed by hot air, and AuSn 4 particles distributed within the whole solder bump randomly. The combination effect of the continuous AuSn 4 layer and finer eutectic microstructure contributes to the higher shear strength of solder bump reflowed by laser.

Effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI

Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and had no reflow in Gong'an County People's Hospital in Hubei Province between August 2014 and July 2017 were selected as the research subjects and randomly divided into two groups, combined group accepted intracoronary sodium nitroprusside and tirofiban injection during PCI, and control group accepted intracoronary tirofiban injection during PCI. The serum levels of myocardial injury indexes, oxidative stress indexes and inflammatory mediators of the two groups were measured before treatment and 1 d after treatment. Results: 1 d after treatment, serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of both groups were significantly lower than those before treatment whereas SOD and NQO-1 levels were higher than those before treatment, and serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of combined group were significantly lower than those of control group whereas SOD and NQO-1 levels were higher than those control group. Conclusion: Intracoronary sodium nitroprusside and tirofiban injection can reduce the myocardial injury in patients with no reflow in PCI.

Preparation and atmospheric wet-reflow of indium microbump for low-temperature flip-chip applications

An urgent demand for lowering bonding temperature has been put forward by advanced flip-chip integration such as micro-LED packaging and heterogeneous integration of semiconductor devices.Indium microbump with low-melting point has attracted attention for its potential use as the interconnection intermediate,and the development of its fabrication process is therefore of great attraction.To reveal the critical process factors for successfully fabricating a high-density In microbump array,this paper investigated a simple process flow of In patterning and reflow and detailed the flux-assisted wet reflow process.Critical process conditions,including the patterned In volume,alignment accuracy,reflow reagent liquidity,and temperature profile,were described,with a particular emphasis on the role of surface tension of molten indium film during the formation of spherical microbumps.A high-density indium ball array with an overall yield greater than 99.7%can be obtained,which suggests that the In patterning and wet-reflow processes are robust and that a high-quality microbump array could be readily formed with low equipment requirements.Furthermore,the interfacial reaction characteristics between In microbump and Au adhesion layer were investigated under thermal aging conditions,which revealed lateral intermetallic growth of AuIn2 compound and well-retained interfacial strength even after prolonged aging.

基于冠状动脉造影术中即刻新型评分系统对STEMI患者急诊PCI术中慢血流/无复流的预测价值和短期预后研究

目的基于临床指标和造影术中即刻影像学指标构建新型评分系统评估急性ST段抬高型心肌梗死(STEMI)接受急诊PCI(PPCI)术中慢血流/无复流的风险。方法本研究连续入选325例接受PPCI的STEMI患者作为建模组;另外连续入选412例患者作为验证组,用于验证该评分系统对慢血流/无复流(SF/NRF)的预测价值,并评估住院期间该评分系统高风险组与低风险组主要不良心血管事件的相关性。结果本研究使用5个变量建立SF/NRF预测模型。SF/NRF的独立预测因素为Killip≥2级、症状发作到球囊扩张时间≥4 h、初始TIMI血流0级、造影血栓负荷分级≥4和IRA管径≥3.5 mm。依据OR值对SF/NRF的独立预测因素进行赋分,进而建立SF/NRF的独立预测因素预测模型,使用受试者工作特征曲线(ROC)分析显示该模型评分≥7分对SF/NRF预测的敏感度为81.2%,特异度为72.3%(AUC=0.845,95%CI:0.788~0.902,P=0.012)。在验证队中使用该模型评分≥7分对SF/NRF预测的敏感度为78.2%,特异度为69.5%(AUC=0.752,95%CI:0.687~0.827,P=0.021)。在建模组、验证组和总人群中高危组(≥7分)住院期间主要不良心血管事件(MACE)显著高于对照组。结论基于冠状动脉造(冠脉)影术中即刻新型评分系统对STEMI患者PPCI术中SF/NRF具有良好的预测价值,且高风险组患者住院期间MACE显著高于低风险组。

血清SFRP5、CTRP3水平对急性心肌梗死患者术后无复流现象的预测价值

目的探讨血清分泌型卷曲相关蛋白5(SFRP5)、C1q/TNF相关蛋白3(CTRP3)水平对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后无复流现象的预测价值。方法收集2022年1月至2023年6月期间于新乡医学院第一附属医院接受PCI的AMI患者151例作为AMI组,并收集同期我院150例健康体检者作为对照组。其中AMI患者根据术后有无复流现象分为无复流组(n=31)和复流组(n=120)两组。采用ELISA法检测AMI患者与对照组血清SFRP5、CTRP3水平;采用Pearson法分析血清SFRP5、CTRP3水平与常见心肌梗死标志物的相关性;对比PCI术后的无复流组与复流组患者血清SFRP5、CTRP3水平。Logistic多因素回归分析AMI患者PCI术后无复流现象发生的影响因素。受试者工作特征(ROC)曲线评估血清SFRP5、CTRP3指标对AMI患者PCI术后无复流现象的预测价值。结果与对照组相比,AMI患者肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)水平均显著升高(P<0.05),而SFRP5、CTRP3水平显著降低(P<0.05)。Pearson相关分析提示AMI患者血清SFRP5、CTRP3水平与心肌梗死标志物cTnI、CK-MB、Mb水平均呈负相关系(P<0.05)。AMI患者PCI术后发生无复流31例(20.52%),与复流组相比,无复流组患者受Mb、cTnI、CK-MB等因素的影响(P<0.05),与患者的年龄、性别、既往史、吸烟史、血压、心率、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等因素无关(P>0.05)。Logistic多因素回归分析结果显示cTnI、Mb、CK-MB等水平升高是AMI患者PCI术后无复流现象的独立危险因素(P<0.05),SFRP5、CTRP3水平升高是AMI患者PCI术后无复流现象的独立保护因素(P<0.05)。血清SFRP5、CTRP3水平单独及联合预测AMI患者PCI术后无复流现象的曲线下面积(AUC)分别为0.881、0.876、0.950,两者联合预测价值高于单独预测(Z二者联合-SFRP5=3.082,P=0.021;Z二者联合-CTRP3=2.901,P=0.037)。结论AMI患者血清SFRP5、CTRP3水平升高,两者联合对PCI术后无复流现象的发生具有较好的预测价值。

急性冠脉综合征患者血清sST2及NLRP3水平与介入术后无复流-慢血流的相关性分析

目的探讨急性冠脉综合征(acute coronary syndrome,Acs)患者血清可溶性生长刺激表达基因蛋白2(soluble growth stimulation expression gene 2 protein,sST2),核苷酸寡聚化结构域样受体热蛋白结构域相关蛋白3(nucleotide oligomerization domain like receptor heat protein domain associated protein 3,NLRP3)水平与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后无复流-慢血流的关系。方法选择2020年1月~2022年12月佳木斯市中心医院收治的97例急性冠脉综合征患者,所有患者均接受PCI治疗,根据术后无复流-慢血流发生情况分为无复流-慢血流组(n=20)和对照组(n=77)。术前检测血清sST2及NLRP3水平,分析影响急性冠脉综合征患者PCI术后无复流-慢血流的因素以及sST2,NLRP3预测急性冠脉综合征患者PCI术后无复流-慢血流的价值。结果无复流-慢血流组血清sST2(14.32±2.65 ng/ml vs 11.02±2.13 ng/ml),NLRP3(68.23±10.17 pg/ml vs 42.05±8.23 pg/ml)水平高于对照组,差异具有统计学意义(t=5.860,12.055,均P<0.05)。多因素Logistic回归分析显示高血栓负荷(OR:7.791,95%CI:2.834~21.421)、高水平sST2(OR=2.071,95%CI:1.146~3.743)、高水平NLRP3(OR=2.008,95%CI:1.228~3.284)是急性冠脉综合征患者PCI术后无复流-慢血流的危险因素(均P<0.05)。sST2,NLRP3诊断急性冠脉综合征患者PCI术后无复流-慢血流的临界值分别为12.91ng/ml,55.39 pg/ml,曲线下面积分别为0.737,0.686,联合sST2,NLRP3诊断急性冠脉综合征患者PCI术后无复流-慢血流的曲线下面积为0.907,高于单独诊断(Z=2.662,2.856,均P<0.05)。结论急性冠脉综合征患者血清sST2,NLRP3水平增高与PCI术后无复流-慢血流的发生有关,联合检测sST2和NLRP3可提高对术后无复流-慢血流的诊断效能。