The role of inflammation in the propagation of atherosclerosis and susceptibility to cardiovascular (CV) events is well established. Of the wide array of inflammatory biomarkers that have been ...studied, high-sensitivity C-reactive protein (hsCRP) has received the most attention for its use in screening and risk reclassification and as a predictor of clinical response to statin therapy. Although CRP is involved in the immunologic process that triggers vascular remodeling and plaque deposition and is associated with increased CV disease (CVD) risk, definitive randomized evidence for its role as a causative factor in atherothrombosis is lacking. Whether measurement of hsCRP levels provides consistent, clinically meaningful incremental predictive value in risk prediction and reclassification beyond conventional factors remains debated. Despite publication of guidelines on the use of hsCRP in CVD risk prediction by several leading professional organizations, there is a lack of clear consensus regarding the optimal clinical use of hsCRP. This article reviews 4 distinct points from the literature to better understand the current state and application of hsCRP in clinical practice: 1) the biology of hsCRP and its role in atherosclerosis; 2) the epidemiological association of hsCRP with CVD; 3) the quality of hsCRP as a biomarker of risk; and 4) the use of hsCRP as a tool to initiate or tailor statin therapy. Furthermore, we highlight recommendations from societies and important considerations when using hsCRP to guide treatment decisions in the primary prevention setting.
Infective endocarditis (IE) is associated with marked morbidity and mortality in the United States and parallels the opioid pandemic. Few studies explore this interaction and its effect on clinical ...outcomes. We analyzed contemporary patients admitted with IE to determine predictors of readmission in the United States. The 2017 National Readmission Database was used to identify index admissions in adults with the diagnosis of IE, based on the International Classification of Disease, 10th Revision codes. The primary outcome of interest was 30-day readmission. Secondary outcomes were mortality, hospital charges, and predictors of hospitalization readmission. Of 40,413 index admissions for IE, 5,558 patients (13.8%) were readmitted within 30 days. Patients who were readmitted were younger (55 ± 20 vs 61 ± 19 years, p <0.001) and more likely to have end-stage renal disease (12.2% vs 10.5%, p <0.001), hepatitis C virus (19.4% vs 12.6%, p <0.001), HIV (1.8% vs 1.2%, p = 0.001), opioid abuse (23.9% vs 15%, p <0.001), cocaine use (7.3% vs 4.4%, p <0.001), and other substance abuse (8.5 vs 5.6, p <0.001). Patients readmitted were less likely to have diabetes mellitus (27.8% vs 29.4%, p = 0.01), hypertension (56.9% vs 64%, p <0.001), heart failure (37.7% vs 40%, p <0.001), chronic kidney disease (31.2% vs 32%, p <0.001), and peripheral vascular disease (3.6% vs 4.6%, p = 0.001). The median cost of index admission for the total cohort was $84,325 (39,922 to 190,492). After adjusting for age, diabetes mellitus, heart failure, hypertension, and end-stage renal disease, opioid abuse (odds ratio OR 1.34; 95% confidence interval CI 1.23 to 1.46; p <0.001), cocaine use (OR 1.32; 95% CI 1.17 to 1.48; p <0.001), other substance abuse (OR 1.16; 95% CI 1.04 to 1.30; p = 0.008), and hepatitis C virus (OR 1.32; 95% CI 1.21 to 1.43; p <0.001) correlated with higher odds of 30-day readmission. These factors may present targets for future intervention.
To investigate the dynamic fracture mechanism related to blast-induced borehole breakdown and crack propagation, circular rock models containing a single centrally located source of explosive were ...numerically blasted using the AUTODYN 2D code. According to the material properties and loading conditions, four kinds of equations of state, linear, shock, compaction and ideal gas, are used. A modified principal stress failure criterion is applied to determining material status. The dynamic stresses at the selected target points in a rock sample are computed as a function of time following application of explosive load. It is shown that shear stress (resulting from intense compressive stress) causes a crushed zone near the borehole, the major tensile principal stress causes radial cracks, and the reflected stress wave from free boundary causes circumferential cracks some distance away from the free boundary. The influences of the factors of boundary condition, coupling medium, borehole diameter, decoupling and joint on rock dynamic fracture are discussed.
This paper presents the results of a series of numerical modeling experiments aimed at quantifying blast-induced degradation of shear strength of discontinuities. Near-field vibration history of a ...single-row production blast in a limestone quarry was used as input to the numerical model. For this purpose, two rock blocks, representing a stiff massive sulfide rock and a weaker limestone rock, were simulated using the 2D Particle Flow Code (PFC2D). Rock mass containing a single inclined joint was modeled as Mohr-Coulomb. The results show that the crack generation rate is increased in both samples after repetitive vibration loading. Joint shear strength degradation rate in the stiffer massive sulfide rock sample is higher than the softer limestone rock, which is attributed to the higher seismic impedance mismatch. The results show that even low-amplitude blasting vibrations (<80 mm/s), when repeated as in multi-hole blasts, can significantly degrade joint shear strength in the nearby pit walls.
In order to investigate rock fracture and fragmentation mechanisms under dynamic loading, a cylindrical rock model with a centralized borehole is developed through the use of AUTODYN code. According ...to the material properties and loading conditions, four kinds of equation of state (EOS), linear, shock, compaction and ideal gas, are applied to the four kinds of materials employed in this numerical model. A modified principal stress failure criterion is applied to determining material status, and a well-behaved explosive, PETN, and a relatively homogeneous igneous rock, diorite, are used in this rock model. A single centrally located line source of explosive is fired numerically to produce the dynamic loadings operating on the surrounding rocks. This numerical model is applied to actual blasting conditions. The rock failure mechanism under dynamic loading is first analyzed, and then the influences of the following factors on rock fracturing are discussed: (a) coupling medium, (b) confinement, (c) boundary condition, (d) initiation location in an explosive column, and (e) air ducking. The results show that all these factors have significant effects on rock fracturing under dynamic loading.
Aortix™ is a novel percutaneous mechanical circulatory support device designed to facilitate diuresis in patients with cardiorenal syndrome. We describe for the first time the development of ...end-organ hypoperfusion from excess blood acceleration at the nominal setting and demonstrate through temporal-perfusion marker curves, the potential for speed modulation to optimize results. This will inform future device development and investigation of patient-specific device titration.
using a resolution 1000-fold higher than prior studies, we studied (1) the degree to which late gadolinium-enhancement (LGE) cardiac magnetic resonance tracks fibrosis from chronic myocardial ...infarction and (2) the relationship between intermediate signal intensity and partial volume averaging at distinct "smooth" infarct borders versus disorganized mixtures of fibrosis and viable cardiomyocytes.
sprague-Dawley rats underwent myocardial infarction by coronary ligation. Two months later, rats were euthanized 10 minutes after administration of 0.3 mmol/kg intravenous gadolinium. LGE images ex vivo at 7 T with a 3D gradient echo sequence with 50×50×50 μm voxels were compared with histological sections (Masson trichrome). Planimetered histological and LGE regions of fibrosis correlated well (y=1.01x-0.01; R(2)=0.96; P<0.001). In addition, LGE images routinely detected clefts of viable cardiomyocytes 2 to 4 cells thick that separated bands of fibrous tissue. Although LGE clearly detected disorganized mixtures of fibrosis and viable cardiomyocytes characterized by intermediate signal intensity voxels, the percentage of apparent intermediate signal intensity myocardium increased significantly (P<0.01) when image resolution was degraded to resemble clinical resolution consistent with significant partial volume averaging.
these data provide important validation of LGE at nearly the cellular level for detection of fibrosis after myocardial infarction. Although LGE can detect heterogeneous patches of fibrosis and viable cardiomyocytes as patches of intermediate signal intensity, the percentage of intermediate signal intensity voxels is resolution dependent. Thus, at clinical resolutions, distinguishing the peri-infarct border zone from partial volume averaging with LGE is challenging.
To improve resource allocation in face of the COVID‐19 pandemic, hospitals around the country are restricting the performance of elective surgery to preserve ventilators, operating rooms, ICU beds ...and protect anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter‐based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi‐disciplinary discussion and clinical trial data, and not a mentality of crisis management.
PDF
