Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary ...syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population.
We did a randomised, open-label, non-inferiority trial at 31 centres in South Korea. Patients were eligible if they had unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction, and underwent percutaneous coronary intervention. Enrolled patients were randomly assigned, via a web-based system by computer-generated block randomisation, to either the 6-month DAPT group or to the 12-month or longer DAPT group, with stratification by site, clinical presentation, and diabetes. Assessors were masked to treatment allocation. The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke at 18 months after the index procedure in the intention-to-treat population. Secondary endpoints were the individual components of the primary endpoint; definite or probable stent thrombosis as defined by the Academic Research Consortium; and Bleeding Academic Research Consortium (BARC) type 2–5 bleeding at 18 months after the index procedure. The primary endpoint was also analysed per protocol. This trial is registered with ClinicalTrials.gov, number NCT01701453.
Between Sept 5, 2012, and Dec 31, 2015, we randomly assigned 2712 patients; 1357 to the 6-month DAPT group and 1355 to the 12-month or longer DAPT group. Clopidogrel was used as a P2Y12 inhibitor for DAPT in 1082 (79·7%) patients in the 6-month DAPT group and in 1109 (81·8%) patients in the 12-month or longer DAPT group. The primary endpoint occurred in 63 patients in the 6-month DAPT group and in 56 patients in the 12-month or longer DAPT group (cumulative event rate 4·7% vs 4·2%; absolute risk difference 0·5%; upper limit of one-sided 95% CI 1·8%; pnon-inferiority=0·03 with a predefined non-inferiority margin of 2·0%). Although all-cause mortality did not differ significantly between the 6-month DAPT group and the 12-month or longer DAPT group (35 2·6% patients vs 39 2·9%; hazard ratio HR 0·90 95% CI 0·57–1·42; p=0·90) and neither did stroke (11 0·8% patients vs 12 0·9%; 0·92 0·41–2·08; p=0·84), myocardial infarction occurred more frequently in the 6-month DAPT group than in the 12-month or longer DAPT group (24 1·8% patients vs ten 0·8%; 2·41 1·15–5·05; p=0·02). 15 (1·1%) patients had stent thrombosis in the 6-month DAPT group compared with ten (0·7%) in the 12-month or longer DAPT group (HR 1·50 95% CI 0·68–3·35; p=0·32). The rate of BARC type 2–5 bleeding was 2·7% (35 patients) in the 6-month DAPT group and 3·9% (51 patients) in the 12-month or longer DAPT group (HR 0·69 95% CI 0·45–1·05; p=0·09). Results from the per-protocol analysis were similar to those from the intention-to-treat analysis.
The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care.
Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors Inc, and Dong-A ST.
Self‐healable and stretchable energy‐harvesting materials can provide a new avenue for the realization of self‐powered wearable electronics, including electronic skins, whose main materials are ...required to be robust to and stable under external damage and severe mechanical stresses. However, thermoelectric (TE) materials showing both self‐healing properties and stretchability have not yet been demonstrated despite their great potential to harvest thermal energy in the human body. As most existing TE materials are either mechanically brittle or unrecoverable after being subjected to damage, a novel approach is necessary for designing such materials. Herein, self‐healable and stretchable TE materials based on all‐organic composite system wherein polymer semiconductor nanowires are p‐doped with a molecular dopant and embedded in a thermoplastic elastomer matrix are reported. The polymer nanowires are electrically percolated in the matrix, and the resulting composite materials exhibit good TE performance. The composites also exhibit both excellent self‐healing properties under mild heat and pressure conditions and good stretchability. It is believed that this work can be a cornerstone for the design of self‐healable and stretchable energy‐harvesting materials as it provides useful guidelines for imparting electrical conductivity to insulating thermoplastic elastomers, which typically possess versatile and useful mechanical properties.
A novel conceptual approach for the realization of self‐healable and stretchable thermoelectric materials is reported. To meet these mechanical criteria, a thermoplastic elastomer is employed as the matrix of an all‐organic composite system in which p‐doped polymer nanowires are electrically percolated to impart thermoelectric properties. The thermoelectric composites exhibit excellent self‐healing and stretching properties under external damage and mechanical stresses.
High porosity combined with mechanical durability in conductive materials is in high demand for special applications in energy storage under limiting conditions, and it is fundamentally important for ...establishing a relationship between the structure/chemistry of these materials and their properties. Herein, polymer‐assisted self‐assembly and cross‐linking are combined for reduced graphene oxide (rGO)‐based aerogels with reversible compressibility, high elasticity, and extreme durability. The strong interplay of cross‐linked rGO (x‐rGO) aerogels results in high porosity and low density due to the re‐stacking inhibition and steric hinderance of the polymer chains, yet it makes mechanical durability and structural bicontinuity possible even under compressive strains because of the coupling of directional x‐rGO networks with polymer viscoelasticity. The x‐rGO aerogels retain >140% and >1400% increases in the gravimetric and volumetric capacitances, respectively, at 90% compressive strain, showing reversible change and stability of the volumetric capacitance under both static and dynamic compressions; this makes them applicable to energy storage devices whose volume and mass must be limited.
Reversibly compressible graphene‐based aerogels are demonstrated for energy storage where volume and mass must be limited. Taking advantage of the polymer‐assisted self‐assembly and cross‐linking, high porosity and low density yet mechanical durability and elasticity are achieved in cross‐linked reduced graphene oxide (x‐rGO) aerogels. They are compressible while maintaining 3D interconnecting networked pathways for applications in ultra‐compact electrochemical capacitors.
•IRB/AML fixed-dose regimens show superior antihypertensive efficacy over IRB monotherapy.•A potential benefit of IRB/AML regimens was noted in the elderly and T2DM patients.•IRB/AML combinations are ...well-tolerated and have comparable safety to IRB monotherapy.
This study aimed to evaluate the efficacy and tolerability of irbesartan (IRB) and amlodipine (AML) combination therapy in patients with essential hypertension whose blood pressure (BP) was not controlled by IRB monotherapy.
Two multicenter, randomized, double-blind, placebo-controlled, phase III studies were conducted in Korea (the I-DUO 301 study and the I-DUO 302 study). After a 4-week run-in period with either 150 mg IRB (I-DUO 301 study) or 300 mg IRB (I-DUO 302 study), patients with uncontrolled BP (ie, mean sitting systolic BP MSSBP ≥140 mmHg to <180 mmHg and mean sitting diastolic BP <110 mmHg) were randomized to the placebo, AML 5 mg, or AML 10 mg group. A total of 428 participants were enrolled in the 2 I-DUO studies. In the I-DUO 301 study, 271 participants were randomized in a 1:1:1 ratio to receive either IRB/AML 150/5 mg, IRB/AML 150/10 mg, or IRB 150 mg/placebo. In the I-DUO 302 study, 157 participants were randomized in a 1:1 ratio to receive IRB/AML 300/5 mg or IRB 300 mg/placebo. The primary endpoint was the change in MSSBP from baseline to week 8. Tolerability was assessed according to the development of treatment-emergent adverse events (TEAEs) and clinically significant changes in physical examination, laboratory tests, pulse, and 12-lead electrocardiography.
In I-DUO 301, the mean (SD) changes of MSSBP at week 8 from baseline were −14.78 (12.35) mmHg, −21.47 (12.78) mmHg, and −8.61 (12.19) mmHg in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively. In I-DUO 302, the mean (SD) changes of MSSBP at week 8 from baseline were −13.30 (12.47) mmHg and −7.19 (15.37) mmHg in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively. In both studies, all combination groups showed a significantly higher reduction in MSSBP than the IRB monotherapy groups (P < 0.001 for both). TEAEs occurred in 10.00%, 10.99%, and 12.22% of participants in the IRB/AML 150/5 mg, IRB/AML 150/10 mg, and IRB 150 mg/placebo groups, respectively, in I-DUO 301 and in 6.33% and 10.67% of participants in the IRB/AML 300/5 mg and IRB 300 mg/placebo groups, respectively, in I-DUO 302, with no significant between-group differences. Overall, there was one serious adverse event throughout I-DUO study.
The combination of IRB and AML has superior antihypertensive effects compared with IRB alone over an 8-week treatment period, with placebo-like tolerability.
ClinicalTrials.gov identifier: NCT05476354 (I-DUO 301), NCT05475665 (I-DUO 302).
Objective Human microRNA-185 (miR-185) has been reported to act as a regulator of fibrosis and angiogenesis in cancer. However, miR-185 has not been investigated in patients with ST-segment elevation ...myocardial infarction (STEMI). We hypothesized that the changes in miR-185 levels in STEMI patients are related to the processes of myocardial healing and remodeling. Methods Between January 2011 and December 2013, 145 patients with STEMI (65.9±11.6 years old; 41 women) were enrolled. Initial and discharge serum samples collected from 20 patients with STEMI and mixed sera from 8 healthy controls were analyzed by a microarray. A quantitative reverse transcription polymerase chain reaction (RT-qPCR) analysis of miR-185 was performed in all 145 patients. The correlation between the miR-185 levels and the clinical, laboratory, angiographic, and echocardiographic parameters was analyzed. Results The microarray analysis revealed a biphasic pattern in miR-185 levels, with an initial decrease followed by an increase at discharge. The miR-185 levels at discharge were significantly correlated with the troponin-I, CK-MB, and area under the curve of CK-MB levels. There was a positive correlation between the transforming growth factor-β and miR-185 levels at discharge (ρ=0.242, p=0.026). A high wall motion score index and a low ejection fraction, as measured by echocardiography, and high B-type natriuretic peptide level at one month after STEMI were related to high miR-185 levels. Conclusion Our results showed that elevated miR-185 levels at the late stage of STEMI were related to a large amount of myocardial injury and adverse remodeling.
Field Programmable Gate Array (FPGA) is gaining popularity because of their reconfigurability which brings in security concerns like inserting hardware trojan. Various detection methods to overcome ...this threat have been proposed but in the ASIC's supply chain and cannot directly apply to the FPGA application. In this paper, the authors aim to implement a structural feature-based detection method for detecting hardware trojan in a cell-level netlist, which is not well explored yet, where the nets are segmented into smaller groups based on their interconnection and further analyzed by looking at their structural similarities. Experiments show positive performance with an average detection rate of 95.41%, an average false alarm rate of 2.87% and average accuracy of 96.27%.
Metal oxide nanosheets having high mesoporosity, grain size distribution of 5–10 nm, and ultrathin thickness have attracted much attention due to their intriguing properties such as high ...surface‐to‐volume ratio and superior chemical activities. However, 2D nanostructures tend to restack, inducing a decrease in accessible surface area and a number of pores. To solve this problem, herein, a unique synthetic method of crumpled metal oxide nanosheets using spray pyrolysis of metal ion–coated graphene oxide, followed by heat treatment, is reported. This method is applicable not only to single‐component metal oxides but also to heterogeneous multicomponent metal oxides in which composition can be controlled. Crumpled SnO2, ZnO, and Co3O4 as well as SnO2/ZnO and SnO2/Co3O4 nanosheets with heterogeneous interfaces are successfully synthesized and used as superior gas sensing layers. Because of the abundant reaction sites, well‐developed porosity for high gas accessibility, the formation of heterojunctions, the crumpled SnO2/ZnO and SnO2/Co3O4 nanosheets exhibit outstanding sensing performance (Rair/Rgas = 20.25 toward 5 ppm formaldehyde, and Rair/Rgas = 14.13 toward 5 ppm acetone, respectively). This study can contribute to the realization of a family of heterogeneous crumpled metal oxide nanosheets that can be applied to various research fields.
A general synthetic platform of hierarchically structured holey metal oxide nanosheets is achieved via a graphene oxide templating route and spray pyrolysis technique. The crumpled heterogeneous 2D metal oxide (crumpled H_2D MO) as a sensing layer exhibits improved sensing performance of formaldehyde (crumpled 2D SnO2/ZnO) and acetone (crumpled 2D SnO2/Co3O4) molecules due to the high porosity, surface area, and heterojunction effect.
Accessory minerals in granitic rocks are unlikely significant radionuclide contributions to groundwater due to their remarkable durability. However, accessory minerals incorporating U and Th may ...suffer structural damages due to the radioactivity and become highly susceptible to alteration. This study investigates geochemistry coupled with textural analysis of the U–Th bearing accessory minerals using a field emission scanning electron microscope and an electron probe micro-analyzer. Altered zircons with numerous open structures related to the radioactive decay show higher contents of U and Th and low analytical totals. Some thorites show high contents of U and non-formula elements due to the hydrothermal alteration in the metamicted thorite. The cerianite including U occurs as micro-veinlet in fracture with trace of Fe and Mn oxides, which indicates secondary phase formation from the decomposed accessory minerals in an oxidizing environment. Some accessory minerals with the high content of U and Th have been found in Mesozoic granite terrain in South Korea, where high concentration levels of radionuclide in groundwater were also reported. The leaching of U may be more likely when the accessory minerals are highly metamicted or altered as found in our samples. The altered zircon and thorite of the study area could be major carriers of radioelement in Mesozoic granitic aquifers where the occurrence of soluble U-minerals has not been reported.
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•High radionuclides concentration in groundwater poses a threat to human health.•Accessary minerals can enrich groundwater with radionuclides in granite aquifers.•Altered zircons contain high U and Th levels with open structures.•Thorites show elevated U levels and non-formula elements due to alteration.•Metamicted and/or altered accessory minerals increase uranium leaching potential.
Using third-party intellectual properties (3PIP) has been a norm in IC design development process to meet the time-to-market demand and at the same time minimizing the cost. But this flow introduces ...a threat, such as hardware trojan, which may compromise the security and trustworthiness of underlying hardware, like disclosing confidential information, impeding normal execution and even permanent damage to the system. In years, different detections methods are explored, from just identifying if the circuit is infected with hardware trojan using conventional methods to applying machine learning where it identifies which nets are most likely are hardware trojans. But the performance is not satisfactory in terms of maximizing the detection rate and minimizing the false positive rate. In this paper, a new hardware trojan detection approach is proposed where gate-level netlist is segmented into regions first before analyzing which nets might be hardware trojans. The segmentation process depends on the nets' connectivity, more specifically by looking on each fanout points. Then, further analysis takes place by means of computing the structural similarity of each segmented region and differentiate hardware trojan nets from normal nets. Experimental results show 100% detection of hardware trojan nets inserted on each benchmark circuits and an overall average of 1.38% of false positive rates which resulted to a higher accuracy with an average of 99.31%.
Very recently, MXene‐based wearable hydrogels have emerged as promising candidates for epidermal sensors due to their tissue‐like softness and unique electrical and mechanical properties. However, it ...remains a challenge to achieve MXene‐based hydrogels with reliable sensing performance and prolonged service life, because MXene inevitably oxidizes in water‐containing system of the hydrogels. Herein, catechol‐functionalized poly(vinyl alcohol) (PVA‐CA)‐based hydrogels is proposed to inhibit the oxidation of MXene, leading to rapid self‐healing and superior strain sensing behaviors. Sufficient interaction of hydrophobic catechol groups with the MXene surface reduces the oxidation‐accessible sites in the MXene for reaction with water and eventually suppresses the oxidation of MXene in the hydrogel. Furthermore, the PVA‐CA‐MXene hydrogel is demonstrated for use as a strain sensor for real‐time motion monitoring, such as detecting subtle human motions and handwriting. The signals of PVA‐CA‐MXene hydrogel sensor can be accurately classified using deep learning models.
This study provides an avenue for the synthesis of oxidation‐resistant MXene‐based catechol‐grafted poly (vinyl alcohol) hydrogels (PVA‐CA‐MXene hydrogel) with prolonged service life intended for strain sensors in real‐time motion monitoring, such as detecting subtle human motions and handwriting. The signals of PVA‐CA‐MXene hydrogel sensor are further accurately classified using deep learning models.
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