BACKGROUND:Procedural results for percutaneous coronary intervention (PCI) in coronary vessels with chronic total occlusion (CTO) have improved in recent years, and PCI strategies have moved toward ...more complete revascularization with more liberal use of CTO-PCI. However, evidence evaluating CTO-PCI is limited to observational studies and small clinical trials.
METHODS:In this open-label, multicenter, randomized, noninferiority trial, PCI-eligible patients were assigned to receive either 1 of 2 strategiesPCI or no PCI for the qualifying de novo CTO lesion with the option for PCI of obstructive non-CTO lesions at the discretion of the operator. The primary end point was a composite of death, myocardial infarction, stroke, or any revascularization. Health-related quality of life was assessed at baseline and at 1, 6, 12, 24, and 36 months. Because of slow recruitment, the trial was stopped before completion of the 1284 planned enrollments.
RESULTS:Between March 2010 and September 2016, 834 patients were randomly assigned to the CTO-PCI (n=417) or no CTO-PCI (n=398) strategy. Among the patients assigned to the no CTO-PCI strategy, 78 (19.6%) crossed over to receive staged CTO-PCI within 3 days of randomization. The overall CTO-PCI success rate was 90.6%. Serious nonfatal complications associated with CTO-PCI occurred in 3 patients (1 stroke, 1 cardiac tamponade, and 1 patient with recurrent episodes of ventricular tachyarrhythmia induced by intracoronary thrombus). Approximately half of the patients in each group underwent PCI for an average of 1.3 non-CTO lesions, resulting in a comparable residual SYNTAX score (Synergy Between PCI With TAXUS and Cardiac Surgery; 3.7±5.4 versus 4.0±5.9, P=0.42) confined to non-CTO vessels. During a median follow-up of 4.0 years (interquartile range, 2.4 to 5.1 years), there was no significant difference between the CTO-PCI and the no CTO-PCI strategies in the incidence of the primary end point (22.3% versus 22.4%, hazard ratio, 1.03; 95% CI, 0.77 to 1.37; P=0.86). Both CTO-PCI and no CTO-PCI strategy were associated with significant improvements but without between-group differences in disease-specific health status that was sustained through 36 months.
CONCLUSIONS:CTO-PCI was feasible with high success rates. There was no difference in the incidence of major adverse cardiovascular events with CTO-PCI versus no CTO-PCI, but the study was limited by low power for clinical end points and high crossover rates between groups.
CLINICAL TRIAL REGISTRATION:URLhttps://www.clinicaltrials.gov. Unique identifierNCT01078051.
It is crucial for leaping forward renewable energy technology to develop highly active oxygen evolution reaction (OER) catalysts with fast OER kinetics, and the novel design of high‐performance ...catalysts may come down to unveiling the origin of high catalytic behavior. Herein, a new class of heterogeneous OER electrocatalyst (metallic Co nanoparticles anchored on yttrium ruthenate pyrochlore oxide) is provided for securing fast OER kinetics. In situ X‐ray absorption spectroscopy (in situ XAS) reveals that fast OER kinetics can be achieved by the harmonious catalytic synergy of a pyrochlore oxide support to Co nanoparticles. By the facile oxidation of yttrium (A‐site) and ruthenium (B‐site) cations, the pyrochlore oxide support helps to expel the electrons generated from the catalytic behavior of Co to the inner layers of the support, facilitating the electrostatic adsorption of OH− ions and reducing the barrier energy for the formation of CoOOH intermediates. This work affords the rational design of transition metal nanoparticles anchored on pyrochlore oxide heterogeneous catalysts and the fundamental insight of catalytic origin associated with self‐reconstruction of OER electrocatalysts.
Boosting self‐reconstruction of oxy‐hydroxide intermediates from transition metals is crucial for improving OER catalytic activity. This study suggests a new strategy for the effective utilization of a pyrochlore oxide support, which can facilitate the formation of transition metal–oxy‐hydroxide intermediates by efficient electron transport.
Despite the growing demand for hydrogen peroxide it is almost exclusively manufactured by the energy-intensive anthraquinone process. Alternatively, H2O2 can be produced electrochemically via the ...two-electron oxygen reduction reaction, although the performance of the state-of-the-art electrocatalysts is insufficient to meet the demands for industrialization. Interestingly, guided by first-principles calculations, we found that the catalytic properties of the Co–N4 moiety can be tailored by fine-tuning its surrounding atomic configuration to resemble the structure-dependent catalytic properties of metalloenzymes. Using this principle, we designed and synthesized a single-atom electrocatalyst that comprises an optimized Co–N4 moiety incorporated in nitrogen-doped graphene for H2O2 production and exhibits a kinetic current density of 2.8 mA cm−2 (at 0.65 V versus the reversible hydrogen electrode) and a mass activity of 155 A g−1 (at 0.65 V versus the reversible hydrogen electrode) with negligible activity loss over 110 hours.Producing H2O2 electrochemically currently use electrocatalysts that are insufficient to meet the demands for industrialization. A single-atom electrocatalyst with an optimized Co–N4 moiety incorporated in nitrogen-doped graphene is shown to exhibit enhanced performance for H2O2 production.
In a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary ...artery stenosis at 1 year.
This study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.
We randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.
At 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio HR: 1.27; 95% confidence interval CI: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).
During 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease PRECOMBAT; NCT00422968).
Herein, we describe simple, fast and reproducible halide ion exchange reactions in CsPbX3 (X = Cl, Br, I) nanocrystals (NCs) at room temperature. Through the simple adjustment of the halide ion ...concentration, the photoluminescence of these NCs can be tuned over the entire visible region (425-655 nm). Photodetector devices based on entirely inorganic CsPbI3 NCs are demonstrated for the first time. The photodetectors exhibited a good on/off photocurrent ratio of 10(5).
Microgrid is becoming an essential part of the power grid regarding reliability, economy, and environment. Renewable energies are main sources of energy in microgrids. Long-term solar generation ...forecasting is an important issue in microgrid planning and design from an engineering point of view. Solar generation forecasting mainly depends on solar radiation forecasting. Long-term solar radiation forecasting can also be used for estimating the degradation-rate-influenced energy potentials of photovoltaic (PV) panel. In this paper, a comparative study of different deep learning approaches is carried out for forecasting one year ahead hourly and daily solar radiation. In the proposed method, state of the art deep learning and machine learning architectures like gated recurrent units (GRUs), long short term memory (LSTM), recurrent neural network (RNN), feed forward neural network (FFNN), and support vector regression (SVR) models are compared. The proposed method uses historical solar radiation data and clear sky global horizontal irradiance (GHI). Even though all the models performed well, GRU performed relatively better compared to the other models. The proposed models are also compared with traditional state of the art methods for long-term solar radiation forecasting, i.e., random forest regression (RFR). The proposed models outperformed the traditional method, hence proving their efficiency.
The outbreak of coronavirus disease 2019 (COVID-19), which began in December 2019, is still ongoing in Korea, with >9,000 confirmed cases as of March 25, 2020. COVID-19 is a severe acute respiratory ...syndrome Coronavirus 2 (SARS-CoV-2) infection, and real-time reverse transcription-PCR is currently the most reliable diagnostic method for COVID-19 around the world. Korean Society for Laboratory Medicine and the Korea Centers for Disease Prevention and Control propose guidelines for diagnosing COVID-19 in clinical laboratories in Korea. These guidelines are based on other related domestic and international guidelines, as well as expert opinions and include the selection of test subjects, selection of specimens, diagnostic methods, interpretation of test results, and biosafety.
The current paradigm in the treatment of patients with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a diagnostic lobectomy rather than complete ...thyroidectomy and postoperative radioiodine treatment. Consequently, preoperative diagnosis of NIFTP is considered to be important.
We performed the comprehensive analysis for diagnosis of preoperative 20 NIFTPs in comparison with 41 invasive encapsulated follicular papillary thyroid carcinomas (I-EFVPTCs) using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and molecular analysis for BRAF and RAS mutations.
K-TIRADS 3 was identified as the most common sonographic diagnosis in both NIFTP and I-EFVPTC. Unlike I-EFVPTC, K-TIRADS 5 was not identified in NIFTP. AUS/FLUS was the most common cytopathological diagnosis and none of the cases were classified as malignant category in both groups, although the difference in distribution was not significant between the groups. BRAF mutation was not found in NIFTP but was present in 9.8% of cases in I-EFVPTC. The frequency of RAS mutation in I-EFVPTCs was twice as high as that of NIFTP. Wild-type BRAF and RAS in NIFTP was significantly higher than I-EFVPTC.
The existence of overlapping features between the groups was evident, hence conclusive distinction between radiology, cytology and molecular analysis could not be achieved. Apparently, the diagnosis of NIFTP based on comprehensive analysis was not confirmable but could perceive or at least favor the diagnosis of NIFTP.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The poor cycling stability and low volumetric energy density of lithium–sulfur batteries compared with lithium‐ion batteries are hindering their practical applications. Here, it is demonstrated that ...a dense sulfur electrode containing heavy TiS2/TiO2@MXene heterostructures can tackle these issues. It is observed that the TiO2 part functionally anchors the lithium polysulfides through the strong chemical affinity, and the TiS2 part serves as an efficient electrocatalyst to enhance the kinetics of sulfur evolution reactions. Benefitting from these synergistic effects, the TiS2/TiO2@MXene heterostructures effectively suppress the shuttle effects, leading to superior cyclability of the sulfur cathode with a low capacity decay of 0.038% per cycle for 500 cycles at a current rate of 1 C. More encouragingly, a highly dense S/TiS2/TiO2@MXene cathode exhibits a high volumetric energy density of 2476 Wh L−1 (based on the volume of the composite) at a high sulfur mass loading of 7.5 mg cm−2 and lean electrolyte of 5 µL mg−1. The electrochemical performance is comparable to or even superior to the lithium‐ion and lithium–sulfur batteries reported in the literature. This study provides an effective strategy to design stable and high‐volumetric‐energy‐density lithium–sulfur batteries for practical energy storage applications.
Heavy TiS2/TiO2@MXene heterostructures simultaneously possessing superior adsorption capability and catalytic properties toward lithium polysulfides can be used as a cathode host of Li–S batteries with excellent cyclability and high volumetric energy density.
In an asymptomatic population, we determined the relationship between serum gamma-glutamyl transferase (GGT) and subclinical atherosclerosis, using coronary computed tomography angiography (CCTA). ...This was a retrospective observational cohort study which analyzed 5120 consecutive asymptomatic individuals with no prior history of coronary artery disease or significant alcohol intake who voluntarily underwent CCTA as part of a general health examination. All subjects were stratified into tertiles based on GGT levels. Degree and extent of subclinical coronary atherosclerosis were evaluated using CCTA. Cardiac events were a composite of all-cause death, myocardial infarction, unstable angina, and coronary revascularization. After adjustment for cardiovascular risk factors, there were no significant differences among GGT tertiles in terms of adjusted odds ratios for non-calcified and mixed plaques. The risk of any atherosclerotic and calcified plaques, significant stenosis, multi-vessel disease, and significant stenosis in the left main or proximal left anterior descending artery was higher in the third GGT tertile than in the first tertile (all p < 0.05). Over a median 5.4-year follow-up, the third GGT tertile had significant adjusted hazards ratios for cardiac events than did the first GGT tertile, even after stepwise adjustment for cardiovascular risk factors (all p < 0.01). In asymptomatic individuals, elevated GGT was independently associated with high-risk feature atherosclerosis and poorer cardiac outcomes.
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