Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TOUCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

Experimental study on temperature stress calculation and temperature control optimization of concrete based on early age parameters

Temperature control curve is the key to achieving temperature control and crack prevention of high concrete dam during construction,and its rationality depends on the accurate measurement of temperature stress.With the simulation testing machine for the temperature stress,in the present study,we carried out the deformation process tests of concrete under three temperature curves:convex,straight and concave.Besides,we not only measured the early-age elastic modulus,creep parameters and stress process,but also proposed the preferred type.The results show that at early age,higher temperature always leads to greater elastic modulus and smaller creep.However,the traditional indoor experiments have underestimated the elastic modulus and creep development at early age,which makes the calculated value of temperature stress too small,thus increasing the cracking risk.In this study,the stress values of the three curves calculated based on the strain and early-age parameters are in good agreement with the temperature stress measured by the temperature stress testing machine,which verifies the method accuracy.When the temperature changes along the concave curve,the law of stress development is in consistent with that of strength.Under this condition,the stress fluctuation is small and the crack prevention safety of the concave type is higher,so the concave type is better.The test results provide a reliable basis and support for temperature control curve design and optimization of concrete dams.

Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model:A cohort study

BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.

Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

Nondestructive Testing and Characterization of Residual Stress Field Using an Ultrasonic Method

To address the difficulty in testing and calibrating the stress gradient in the depth direction of mechanical components, a new technology of nondestructive testing and characterization of the residual stress gradient field by ultrasonic method is proposed based on acoustoelasticity theory. By carrying out theoretical analysis, the sensitivity coefficients of different types of ultrasonic are obtained by taking the low carbon steel（12%C） as a research object. By fixing the interval distance between sending and receiving transducers, the mathematical expressions of the change of stress and the variation of time are established. To design one sending-one receiving and oblique incidence ultrasonic detection probes, according to Snell law, the critically refracted longitudinal wave（LCR wave） is excited at a certain depth of the fixed distance of the tested components. Then, the relationship between the depth of LCR wave detection and the center frequency of the probe in Q235 steel is obtained through experimental study. To detect the stress gradient in the depth direction, a stress gradient LCR wave detection model is established, through which the stress gradient formula is derived by the relationship between center frequency and detecting depth. A C-shaped stress specimen of Q235 steel is designed to conduct stress loading tests, and the stress is measured with the five group probes at different center frequencies. The accuracy of ultrasonic testing is verified by X-ray stress analyzer. The stress value of each specific depth is calculated using the stress gradient formula. Accordingly, the ultrasonic characterization of residual stress field is realized. Characterization results show that the stress gradient distribution is consistent with the simulation in ANSYS. The new technology can be widely applied in the detection of the residual stress gradient field caused by mechanical processing, such as welding and shot peening.

New artificial neural networks for true triaxial stress state analysis and demonstration of intermediate principal stress effects on intact rock strength

Simulations are conducted using five new artificial neural networks developed herein to demonstrate and investigate the behavior of rock material under polyaxial loading. The effects of the intermediate principal stress on the intact rock strength are investigated and compared with laboratory results from the literature. To normalize differences in laboratory testing conditions, the stress state is used as the objective parameter in the artificial neural network model predictions. The variations of major principal stress of rock material with intermediate principal stress, minor principal stress and stress state are investigated. The artificial neural network simulations show that for the rock types examined, none were independent of intermediate principal stress effects. In addition, the results of the artificial neural network models, in general agreement with observations made by others, show （a） a general trend of strength increasing and reaching a peak at some intermediate stress state factor, followed by a decline in strength for most rock types; （b） a post-peak strength behavior dependent on the minor principal stress, with respect to rock type; （c） sensitivity to the stress state, and to the interaction between the stress state and uniaxial compressive strength of the test data by the artificial neural networks models （two-way analysis of variance; 95% confidence interval）. Artificial neural network modeling, a self-learning approach to polyaxial stress simulation, can thus complement the commonly observed difficult task of conducting true triaxial laboratory tests, and/or other methods that attempt to improve two-dimensional （2D） failure criteria by incorporating intermediate principal stress effects.

Study on Swell Pressure Stress of Bentonite in Geosynthetic Clay Liners

The geosynthetic clay liner （GCL） is a kind of waterproofing material used widely in engineering. The waterproof mechanism is understood in terms of bentonite particles becoming water-obstruct colloid layers after they sorb water and swell. The swell pressure stress, however, has not been determined directly till now. In our experiment, swell pressure stress of the GCL under saturated water-sorbing condition was measured directly using a custom-made instrument. The results show that （1） the instrument designed by the authors performs satisfactorily and the test results are reproducible; and （2） the trend line of swell pressure stress variation with time can be divided into three segments. The first segment is characterized by a quick increase of the swell force in the first 0-50 hours. The swell pressure stress increases by 7.00×10^-4-1.00×10^-3 MPa/h. The second segment shows a slow increase of the swell pressure stress from the 50th to 1730th hour. The swell force increases by 7.54×10^-6-2.02×10^-5 MPa/h. The third segment is characterized by a little variation in swell pressure stress after 1730 hours. In this segment, the average value of the swell pressure stress measurements is 0.0719 MPa and the maximum value is 0.0729 MPa. It is suggested that the swell pressure stress is mainly raised by water entering pores among montmorillonite particles and interstitial layers in individual montmorillonite crystals, leading to an increase of volume.

Preoperative nuclear stress testing in the very old patient population

BACKGROUND Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing(NST)in order to evaluate their cardiovascular risk.The prognostic utility of such testing in the very elderly(≥85 years)has yet to be fully evaluated.Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease,and therefore the prognostic value of NST for their preoperative risk assessment has been questioned.Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient population.AIM To investigate the ability of NST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk surgery.METHODS Patients≥85 years undergoing pre-operative NST were retrospectively evaluated.Patients undergoing low-risk surgery were excluded.Major adverse cardiac events(MACE)were considered any adverse event that occurred prior to discharge and included acute heart failure,arrhythmia,acute myocardial infarction,unstable angina,or death.Associations between patient risk factors,MACE,and the obtained results of the pre-operative stress testing,ejection fraction(<40%or≥40%),summed stress score(≤8,≥9),and the summed difference score(≤0,>0)were analyzed.RESULTS A total of 69 patients(mean age 88±2.6 years,31 males)underwent nuclear stress testing prior to surgery.There were 41(60%)patients found to have an abnormal NST.Sixteen(23%)patients were noted to experience post-operative MACE.No significant associations between risk factors and MACE were noted.Patients with an abnormal NST and/or a summed stress score≥9 weresignificantly(P<0.01)more likely to develop peri-operative MACE.CONCLUSION Indicated preoperative NST is useful to assess pre-operative risk in elderly patients≥85 years undergoing moderate to high-risk surgery.

Stress corrosion cracking of EV31A in 0.1 M Na_(2)SO_(4) saturated with Mg(OH)_(2)

This paper studied the stress corrosion cracking(SCC)of EV31A in 0.1 M Na 2 SO 4 saturated with Mg(OH)2 using linearly increasing stress tests,compared with pure Mg and WE43B.All three materials were susceptible to SCC.SCC susceptibility increased with decreasing applied stress rate.The threshold stress was 0.3×(yield stress)for pure Mg,0.6×(yield stress)for EV31A,and 0.8×(yield stress)for WE43B.The SCC velocities at an applied stress rate of 7.3×10^(-4)MPa s^(-1)were 7.2×10^(-8)m s^(−1)for pure Mg,5.6×10^(-9)m s^(-1)for WE43B,and 1.5×10^(-9)m s^(-1)for EV31A.

SYNTHETIC STRESSLIFE TESTING OF MECHATRONIC PRODUCTS UNDER VARIABLE STRESS SPECTRUM

Mechatronic products usually endure the variable stress spectrum when they operate in certain operational condition and environmental condition, which obey the Weibull distribution. In accordance with the features of mechatronic product, this paper analyzes the failure mode, its corresponding sensitive stress and the design principles of life testing profiles. Based on the above analyses, this paper presents a synthetic stress life testing method based on the hybrid Weibull distribution and its statistical method under variable stress spectrum to evaluate the reliability and life indices of mechatronic products. Because the mechatronic products have many characteristics such as high price, long life and small testing samples, the synthetic stress life testing method under variable load spectrum can simulate the real various spectra, decrease the life testing time and reduce the testing samples. So it is effective to carry out the life testing to mechatronic products. The application results of hydraulic pumps indicate that this method can easily handle the experimental data under variable amplitude spectrum, obtain the high precision parameters point estimation and confidence interval estimation and reduce the testing cost greatly.

The Extension Rate of the Medial Collateral Ligament of the Knee Joint during the Valgus Stress Test: Two Case Reports

This study aimed to evaluate the influence of measuring the length of the medial collateral ligament (MCL) to compare the MCL burden when the knee joint is placed under valgus stress in the open and closed and closed kinetic chain. Two examiners conducted the examination. The MCL length was measured using ultrasonography. Two subjects were measured in unload bearing and load-bearing positions, with and without valgus stress test at the knee joint extension and 30° flexion, under eight different measurement conditions. The MCL of the subject was delineated in the longitudinal direction using an ultrasound system. The attachment points of the medial femoral and tibial condyle of the MCL were identified, and the ligament length was measured. The MCL rate before and after the valgus stress test in the loading and unloading positions was calculated. The MCL length increased by an average of 8.9% when the external stress test was performed in the non-weight bearing and knee extension positions and by an average of 17.0% when external stress was applied in the non-weight bearing and knee flexion positions. The MCL length increased by an average of 12.2% when the external stress test was performed in the load-bearing and knee extension positions and an average of 8.9% when the valgus stress test was applied in load-bearing and knee flexion positions. In conclusion, the effect of valgus stress on the MCL differs between load-bearing and non-load-bearing positions. It is considered that the dynamic stabilization mechanism works in the knee joint flexion position in the load position and works simultaneously as the static stabilization mechanism, which limits the knee joint valgus and reduces the extension rate of MCL. Therefore, this study reconsiders the shifting of traditional therapy from open kinetic chain to close kinetic chain.

Autonomic Function in Individuals with Slow Heart Rate Response following an Exercise Stress Test

Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.

Effects of Strain Rate on Stress Corrosion of S355 Steel in 3.5% NaCl Solutions

The stress corrosion of S355 steel in 3.5% NaCl solution under the different strain rates was analyzed with the slow strain rate test（SSRT）, the stress corrosion cracking（SCC） behaviors of S355 steel under the different strain rates in the solution were investigated, and the fracture morphologies and compositions of corrosion products under the different strain rates were analyzed with scanning electron microscopy（SEM） and energy dispersive spectrometerry（EDS）, respectively. The experimental results show that the SCC sensitivity index is the highest when the strain rate is 2×10-6, and the medium corrosion is the main reason resulting in the highest SCC sensitivity index. The SCC sensitivity index is the least when the strain rate is 5×10-6, and the stress is the main reason resulting in the stress corrosion. The SCC sensitivity index is the middle when the strain rate is 9×10-6, the interaction of stress and medium is the stress corrosion fracture mechanism.

Ministries Design Exchange Rate Stress Test for Labor-Intensive Industries

China’s Ministry of Commerce(MOFCOM)and the Ministry of Industry and Information Technology(MIIT)have designed a stress-test for China’s labor-intensive industries,

基于动态Vine Copula模型的金融市场风险溢出效应研究

随着金融全球化进程的加速,国际金融市场间的联系日益紧密,深入分析国际金融市场对中国金融市场的风险溢出效应具有重要意义。本文首先基于高维动态Vine Copula模型构建高维金融市场的联合分布函数,然后运用条件在险价值方法测度国际原油市场、国际黄金市场以及国际外汇市场对中国股票市场的风险溢出效应,最后采用压力测试方法从多市场情景压力的视角进行稳健性检验。研究显示:国际金融市场对中国金融市场具有显著的风险溢出效应,但不同国际金融市场的风险溢出强度存在显著差异;国际金融市场对中国金融市场的上行风险溢出效应显著大于下行风险溢出效应,风险溢出强度呈现出非对称性特征;基于高维动态Vine Copula模型的压力测试方法可以有效度量多个金融市场对单一金融市场的风险溢出效应。本文针对投资者、风险管理者以及监管者提出了相应的政策建议。

An Experimental Study on Constant Current Load Test of Reinforced Concrete based on 3D Paraffin Isolation

Aiming at the complex corrosion degradation factors of reinforced concrete and clearing the deterioration mechanism in the constant stress state,a new type of constant current accelerated corrosion method in the saline soil environment was developed.The three-dimensional paraffin isolation specimens and the three-dimensional penetration specimens were taken as the research objects,and the Cl−content and AC impedance Bode diagram were measured.The macro morphology and micro analysis were also used to evaluate the corrosion degradation laws of the two groups of specimens.A constant current three-factor system accelerated model was established for the current acceleration factor,chloride ion,and sulfate ion acceleration factor.The experimental results show that,in the constant stress test of the saline soil environmental conditions,the paraffin isolation layer can effectively isolate corrosive chloride ions,which is a brand-new research method of single factor variable control in the constant stress test.According to the basic corrosion data,the law of constant current acceleration test is summarized and divided into five corrosion degradation stages,and each stage has significant changes in the accelerated corrosion efficiency.The corrosion degradation of a constant stress test is the combined effect of constant current,positive and negative penetration of chloride ions and sulfate ions.

Heart rate response and recovery during exercise predict future delirium risk——A prospective cohort study in middle-to older-aged adults

Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.

Development of forced degradation and stability indicating studies of drugs——A review

Forced degradation is a degradation of new drug substance and drug product at conditions more severe than accelerated conditions. It is required to demonstrate specificity of stability indicating methods and also provides an insight into degradation pathways and degradation products of the drug substance and helps in elucidation of the structure of the degradation products. Forced degradation studies show the chemical behavior of the molecule which in turn helps in the development of formulation and package. In addition, the regulatory guidance is very general and does not explain about the performance of forced degradation studies. Thus, this review discusses the current trends in performance of forced degradation studies by providing a strategy for conducting studies on degradation mechanisms and also describes the analytical methods helpful for development of stability indicating method.

High-field-induced electron detrapping in an AlGaN/GaN high electron mobility transistor

A step stress test is carried out to study the reliability characteristics of an AlGaN/GaN high electron mobility transistor（HEMT）.An anomalous critical drain-to-gate voltage with a negative temperature coefficient is observed in the stress sequence,beyond which the HEMT device starts to recover from degradation induced by early lower voltage stress.While the performance degradation featuring the drain current slump stems from electron trapping in the surface or bulk states during low-to-medium bias stress,the recovery is attributed to high field induced electron detrapping.The carrier detrapping mechanism could be helpful for lessening the trapping-related performance degradation of a GaN-based HEMT.

Maisonneuve injury with no fibula fracture:A case report

BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.