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.

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.

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.

Stress test and analysis based on SMS fiber structure with high sensitivity

Single mode-multimode-single mode （SMS） sensor is widely used for parameters measurement, such as bending, dis-placement, temperature, strain, refractive index, etc. Generally, SMS sensor has advantages of simple structure, low cost and easy layout, therefore it has become a research hotspot in recent years. In this paper, the multimode fiber with large core is used for manufacturing SMS structure with high sensitivity. Firstly, the multimode fiber with core/cladding diameters of 105/ 125 jitm has access to the system by means of single mode optical fiber. Secondly, SMS device structure is manufactured by welding the eccentric shaft of multimode optical fiber. Afterwards, mode interference effect and spectral response characteristics of the structure of single mode-multimode-single mode optical fiber are analyzed theoretically. Finally, with the help of a wide spectrum light source and a spectrum analyzer, the transmission spectra characteristics of SMS optical fiber with strain is tested. By observing the curve that the wave changes with stress, the sensitivity is calculated and it is consistent with theoretical value .

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.

BRAKE TEST OF SiCp/A356 BRAKE DISK AND INTERPRETATION OF EXPERIMENTAL RESULTS

Material properties are obvious different between aluminum matrix composites and iron and steel materials. After the brake disk braked at the same speed, the average temperature of the aluminum brake disk is 1.5 times as high as one of iron and steel brake disk, the thermal expansion value of the aluminum brake disk is 2 times as big as one of iron and steel brake disk. Mechanical property of the material decreases with the temperature increasing generally during braking, on the other hand, the big thermal stress in the brake disk happens because the material expansion is constrained. Firstly, the reasons of the thermal stress generation and the fracture failure of brake disks during braking are analyzed qualitatively by virtue of three-bar stress frame and sandwich deformation principles in physic, and then the five constraints which cause the thermal stress are summarized. On the base of the experimental results on the 1：1 emergency brake test, the thermal stress and temperature fields are simulated; The behavior of the fracture failure is interpreted semi-quantitatively by finite element analysis, There is the coincident forecast for the fraction position in term of the two methods. In the end, in the light of the analysis and calculation results, it is the general principles observed by the structure design and assembly of the brake disk that are summarized.

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.

A recoverable stress testing algorithm for compression and encryption cards

This study proposes a recoverable stress testing algorithm （RSTA） for such special devices as compression/decompression card and encryption/deeryption card. It uses a chaos function to generate a random sequence, and then, according to the random sequence, generates an effective command sequence. The dispatch of command obeys a special schedule strategy we designed for such devices, i.e., the commands are sent according to the command sequence, and the complete commands are put in a buffer for further result check. RSTA is used to test the HIFN compression acceleration card SAICHI-1000. Test results show that RSTA can make the card work continuously and adequately.

Research on Stress Testing of OSPF Protocol Implementation

The stability and robustness of routing protocol implementations (RPI) in a router are becoming more and more important with the growth of Internet scale. A novel approach named stress testing is proposed to test the properties of RPI. Compared with some traditional test techniques, stress testing is remarkably necessary to inspect and analyze RPI. The test environment is proposed and the test process of OSPF RPI is illustrated by a stochastic Petri Net model with large-scale route simulation and OSPF protocol emulation. Based on this model, the integrated performance tester (IP-TEST) is designed and developed, with which we test a CISCO2600 router. With mathematical methods, we find that the computational complexity of OSPF implementation in this router is O((lnN) 4)to the number of its routing table entries. This experiment shows that this technique can inspect the stability, the computational complexity and the scalability of RPI. Furthermore, it can also be widely used with other routing protocols, such as RIP and BGP.

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.

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.

Detonator stepping stress acceleration life test

Through the failure mechanism analysi s and simulation test of a certain kind of detonator,this paper confirms the str ess level of the stepping stress acceleration life test of the detonator,and t hen e stablishes the data processing mathematical model and storage life forecasting m ethod.At last,according to the result of the stepping stress acceleration lif e test of the detonator,this paper forecasts the reliable storage life of the detonator under the normal stress level.

Parameter Estimation Based on Censored Data under Partially Accelerated Life Testing for Hybrid Systems due to Unknown Failure Causes

In general,simple subsystems like series or parallel are integrated to produce a complex hybrid system.The reliability of a system is determined by the reliability of its constituent components.It is often extremely difficult or impossible to get specific information about the component that caused the system to fail.Unknown failure causes are instances in which the actual cause of systemfailure is unknown.On the other side,thanks to current advanced technology based on computers,automation,and simulation,products have become incredibly dependable and trustworthy,and as a result,obtaining failure data for testing such exceptionally reliable items have become a very costly and time-consuming procedure.Therefore,because of its capacity to produce rapid and adequate failure data in a short period of time,accelerated life testing(ALT)is the most utilized approach in the field of product reliability and life testing.Based on progressively hybrid censored(PrHC)data froma three-component parallel series hybrid system that failed to owe to unknown causes,this paper investigates a challenging problem of parameter estimation and reliability assessment under a step stress partially accelerated life-test(SSPALT).Failures of components are considered to follow a power linear hazard rate(PLHR),which can be used when the failure rate displays linear,decreasing,increasing or bathtub failure patterns.The Tempered random variable(TRV)model is considered to reflect the effect of the high stress level used to induce early failure data.The maximum likelihood estimation(MLE)approach is used to estimate the parameters of the PLHR distribution and the acceleration factor.A variance covariance matrix(VCM)is then obtained to construct the approximate confidence intervals(ACIs).In addition,studentized bootstrap confidence intervals(ST-B CIs)are also constructed and compared with ACIs in terms of their respective interval lengths(ILs).Moreover,a simulation study is conducted to demonstrate the performance of the estimation procedures and the methodology discussed in this paper.Finally,real failure data from the air conditioning systems of an airplane is used to illustrate further the performance of the suggested estimation technique.

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.

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。

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.

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.

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.