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.

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.

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.

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

shear 失败模式和 Sn3.5Ag andSn3.0Ag0.5Cu 的各自的失败机制无铅焊接在正式就职 spontaneousheating 形成的 Au/Ni/Cu metallization 上颠簸回流过程在 120 °C for0,1,4,9 和 16 d.Different 在老化以后通过shear 测试被调查了典型砍失败行为在 loadingcurves 被发现了(砍力量对排水量) .From thefracture 表面和剖面图的界面的形态学分析的结果。

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.

STEMI患者外周血单个核细胞中MAPK通路与炎症反应及PCI后无复流的关系

目的 研究ST段抬高型心肌梗死(STEMI)患者外周血单个核细胞(PBMCs)中丝裂原活化蛋白激酶(MAPK)通路与炎症反应及经皮冠状动脉介入术(PCI)后无复流的关系。方法 选取郑州市第七人民医院2021年2月至2022年10月进行PCI治疗的STEMI患者和同期进行体检的健康志愿者,分别作为STEMI组(n=92)和对照组(n=100)。采用荧光定量PCR法检测PBMCs中p38MAPK、JNK的表达水平,根据中位数将STEMI组患者分为p38MAPK、JNK高表达和低表达。检测STEMI患者血清ICAM-1、TNF-α、IL-6含量,评估STEMI患者心肌损伤程度及无复流情况。结果 STEMI组患者PBMCs中p38MAPK、JNK的表达水平高于对照组,差异有统计学意义(t=5.386、5.126,P<0.05);STEMI组中p38MAPK、JNK高表达患者的CK-MB峰值、cTnT峰值及ICAM-1、TNF-α、IL-6含量均高于p38MAPK、JNK低表达患者,差异有统计学意义(t=7.143、4.999、9.528、6.805、6.890、6.226、8.132、7.807、7.162、7.588,P<0.05);STEMI组中无复流患者PBMCs中p38MAPK、JNK的表达水平高于血流正常患者,差异有统计学意义(t=5.208、4.240,P<0.05);经ROC曲线分析,PBMCs中p38MAPK、JNK的表达水平对STEMI患者PCI后无复流具有预测价值(P<0.05)。结论 STEMI患者MAPK通路中p38MAPK、JNK的高表达与炎症反应激活、PCI后无复流有关。

回流焊工艺对SMT器件热翘曲的影响

集成电路正在向小型化、高集成度的方向发展,回流焊工艺已成为其组装过程中的关键技术。在回流焊过程中集成电路容易发生热翘曲现象。采用阴影云纹法对PBGA1296、PBGA1024器件在不同回流焊温度、升降温速率的回流焊工艺下的热翘曲进行测量,在此基础上通过建模仿真对实验结果进行分析。结果表明,采用表面贴装技术(SMT)的BGA器件的热翘曲会随着回流焊温度的升高而增大,回流焊升降温速率较快同样会导致严重的热翘曲。实验结果与仿真结果高度一致,进而验证了仿真模型的准确性和有效性。采用实验结合有限元分析的方法为改善集成电路热翘曲提供了参考。

三项指标与老年急性STEMI患者介入术后无复流的相关性研究

目的 探讨入院休克指数(shock index, SI)、入院血糖(admission plasma glucose, APG)和同型半胱氨酸(homocysteine, HCY)与老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后无复流的相关性。方法 分析行急诊PCI术379例老年急性STEMI患者的临床资料,根据PCI术后TIMI血流分为无复流组(n=71)和正常血流组(n=308)。比较两组患者的临床资料、造影及介入情况。采用单因素及多因素Logistic回归模型分析老年急性STEMI患者行急诊PCI术后出现无复流的独立危险因素,利用受试者工作特征(receiver operator characteristic,ROC)曲线评估老年急性STEMI患者行急诊PCI术后发生无复流的预测效能。结果 与正常血流组比较,无复流组患者入院心率、SI高于正常血流组,收缩压、舒张压低于正常血流组,均P<0.01。白细胞计数(white blood cell,WBC)升高(P<0.05),中性粒细胞绝对值(neutrophil absolute count, NEUT)升高(P<0.05),红细胞计数(red bloodcell,RBC)降低(P<0.01),红细胞平均体积(meanredcellvolume,MCV)降低(P<0.01),血红蛋白(hemoglobin, HGB)降低(P<0.05),C反应蛋白(C-reactive protein, CRP)升高(P<0.05),APG升高(P<0.05),尿素(serum urea nitrogen, UREA)升高(P<0.05),HCY升高(P<0.01),D-二聚体(D-Dimer,D-D)升高(P<0.01)多因素Logistic回归分析表示SI、APG、HCY是老年急性STEMI患者急诊PCI术后发生无复流的独立危险因素。ROC曲线分析显示SI+APG+HCY对老年STEMI患者行PCI术后发生无复流的预测价值优于SI、APG、HCY、SI+APG、SI+HCY、APG+HCY,差异有统计学意义(P<0.01)。结论 SI、APG和HCY是老年急性STEMI患者行急诊PCI术后发生无复流的独立危险因素,且SI+APG+HCY对其有较好的预测价值。