•A concise account of Industry 4.0 and Industry 5.0 is given.•Questions are raised about the situation of Industry 4.0 and Industry 5.0 co-existing.•Discussions, guided by the questions, are given to ...clarify the two terminologies.
Industry 4.0, an initiative from Germany, has become a globally adopted term in the past decade. Many countries have introduced similar strategic initiatives, and a considerable research effort has been spent on developing and implementing some of the Industry 4.0 technologies. At the ten-year mark of the introduction of Industry 4.0, the European Commission announced Industry 5.0. Industry 4.0 is considered to be technology-driven, whereas Industry 5.0 is value-driven. The co-existence of two Industrial Revolutions invites questions and hence demands discussions and clarifications. We have elected to use five of these questions to structure our arguments and tried to be unbiased for the selection of the sources of information and for the discussions around the key issues. It is our intention that this article will spark and encourage continued debate and discussion around these topics.
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes ...affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
The effect of low-density lipoprotein cholesterol-lowering therapy with alirocumab or evolocumab on individual clinical efficacy and safety endpoints remains unclear. We aimed to evaluate the ...efficacy and safety of alirocumab and evolocumab in patients with dyslipidaemia or atherosclerotic cardiovascular disease.
We performed a review of randomized controlled trials (RCTs) comparing treatment with alirocumab or evolocumab vs. placebo or other lipid-lowering therapies up to March 2018. Primary efficacy endpoints were all-cause death, cardiovascular death, myocardial infarction (MI), and stroke. We estimated risk ratios (RR) and 95% confidence intervals (CI) using random effect models. We included 39 RCTs comprising 66 478 patients of whom 35 896 were treated with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (14 639 with alirocumab and 21 257 with evolocumab) and 30 582 with controls. Mean weighted follow-up time across trials was 2.3 years with an exposure time of 150 617 patient-years. Overall, the effects of PCSK9 inhibition on all-cause death and cardiovascular death were not statistically significant (P = 0.15 and P = 0.34, respectively). Proprotein convertase subtilisin-kexin type 9 inhibitors were associated with lower risk of MI (1.49 vs. 1.93 per 100 patient-year; RR 0.80, 95% CI 0.74-0.86; I 2 = 0%; P < 0.0001), ischaemic stroke (0.44 vs. 0.58 per 100 patient-year; RR 0.78, 95% CI 0.67-0.89; I 2 = 0%; P = 0.0005), and coronary revascularization (2.16 vs. 2.64 per 100 patient-year; RR 0.83, 95% CI 0.78-0.89; I 2 = 0%; P < 0.0001), compared with the control group. Use of these PCSK9 inhibitors was not associated with increased risk of neurocognitive adverse events (P = 0.91), liver enzymes elevations (P = 0.34), rhabdomyolysis (P = 0.58), or new-onset diabetes mellitus (P = 0.97).
Proprotein convertase subtilisin-kexin type 9 inhibition with alirocumab or evolocumab was associated with lower risk of MI, stroke, and coronary revascularization, with favourable safety profile.
Atherosclerosis and plaque disruption have a central pathological role in the majority of patients who present with an acute coronary syndrome (ACS), but non-atherosclerotic processes are also ...important contributors to a substantial number of ACS events and require different diagnostic and therapeutic strategies. In the absence of obstructive coronary artery disease, intravascular imaging techniques might be needed to delineate the underlying aetiology, together with a high index of suspicion for other important causes of ACS. In this Review, we discuss five non-atherosclerotic causes of ACS, including spontaneous coronary artery dissection, coronary artery embolism, vasospasm, myocardial bridging and stress-induced cardiomyopathy (Takotsubo syndrome). Important diagnostic findings, management strategies and prognostic data for these non-atherosclerotic mechanisms of ACS are reviewed.
The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ...ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR—atrial functional MR (AF-MR)—is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.
Display omitted
•Atrial functional MR is an underrecognized cause of secondary MR.•Atrial fibrillation and HFpEF are associated with atrial functional MR.•Preliminary evidence suggests that rhythm control may reduce the severity of AF-MR, but further studies are needed.
It remains unknown what percentage of patients treated with percutaneous coronary artery intervention (PCI) have high residual inflammatory risk (RIR). Moreover, the impact of RIR on clinical ...outcomes has not been established. The objective of this study is to determine the prevalence of patients with persistent high levels of inflammation after PCI and to evaluate clinical outcomes according to inflammatory response.
This is a retrospective cohort study assessing patients undergoing PCI between 2009 and 2016 with serial inflammatory status assessment from a large, prospective, and single-centre PCI registry. Assessment of inflammation status with at least two high sensitive C-reactive protein (hsCRP) measurements at baseline and follow-up with >4 weeks apart. High RIR was defined as an hsCRP≥ 2 mg/L. Patients were divided into four groups: persistent high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistent low RIR. The primary endpoint was all-cause mortality at 1 year follow-up. Occurrence of myocardial infarction (MI) was assessed as secondary outcome. Seven thousand and twenty-six patients were identified with serial hsCRP measurements (30.8% of all PCI patients). Of these patients 2654 (38%) had persistent high RIR, 719 patients (10%) had increased RIR, 1088 patients (15%) had attenuated RIR, and persistent low RIR was seen in 2565 patients (37%). All-cause mortality at 1 year was 2.6% in patients with persistent high RIR, compared with 1.0% in increased RIR, 0.3% in attenuated RIR, and 0.7% in persistent low RIR patients, P < 0.01. MI at 1 year was observed in 7.5% of persistent high RIR, compared with 6.4% in increased RIR, 4.6% in attenuated RIR, and 4.3% in persistent low RIR, P < 0.01. In an adjusted model, including accounting for diabetes mellitus, acute coronary syndrome, and baseline low-density lipoprotein, results were sustained.
Persistent high RIR is observed frequently in patients undergoing PCI. In these patients, significantly higher all-cause mortality and MI rates are observed at 1 year follow-up. Residual inflammatory risk in patients undergoing PCI should be identified and treatment options should be further explored.
Dieses Werk fasst Beiträge zum Stand der Technik und der Forschung von Agentensystemen zusammen, die im GMA-Fachausschuss 5.15 »Agentensysteme« von Fachleuten aus Wissenschaft und Industrie ...erarbeitet wurden. Ein sich fl exibel auf Änderungen anpassendes Automatisierungssystem ist einer der Schlüssel von Industrie 4.0. Dies zeigt sich bereits heute in der hohen Vernetzung eingebetteter Systeme in den verschiedensten industriellen und öffentlichen Bereichen. Um die Funktionalität weiter zu verbessern, nimmt die Instrumentierung zu und damit die Komplexität im Maschinen- und Anlagenbau, der Gebäudeautomatisierung sowie im Energiemanagement. Die Automatisierungssoftware muss fl exibel und ohne großen Aufwand anpassbar sein, um diesen Anforderungen an Flexibilität, Zuverlässigkeit Adaptivität und Adaptierbarkeit zu genügen. Agenten sind ein Schlüsselparadigma um diese Herausforderungen zu lösen. Mit Agenten kann der Schritt in Richtung Industrie 4.0 vollzogen werden – weg von hierarchischen, statischen Systemen, hin zu flexiblen und dezentralen Netzwerken, die sich aus kooperierenden, rekonfi gurierbaren, selbst heilenden und nach Störungen wiederanlaufenden Elementen zusammensetzen.
The distributed blocking flowshop scheduling problem (DBFSP) with new job insertions is studied. Rescheduling all remaining jobs after a dynamic event like a new job insertion is unreasonable to an ...actual distributed blocking flowshop production process. A deep reinforcement learning (DRL) algorithm is proposed to optimise the job selection model, and local modifications are made on the basis of the original scheduling plan when new jobs arrive. The objective is to minimise the total completion time deviation of all products so that all jobs can be finished on time to reduce the cost of storage. First, according to the definitions of the dynamic DBFSP problem, a DRL framework based on multi‐agent deep deterministic policy gradient (MADDPG) is proposed. In this framework, a full schedule is generated by the variable neighbourhood descent algorithm before a dynamic event occurs. Meanwhile, all newly added jobs are reordered before the agents make decisions to select the one that needs to be scheduled most urgently. This study defines the observations, actions and reward calculation methods and applies centralised training and distributed execution in MADDPG. Finally, a comprehensive computational experiment is carried out to compare the proposed method with the closely related and well‐performing methods. The results indicate that the proposed method can solve the dynamic DBFSP effectively and efficiently.
•Patients with atrial fibrillation (AF) are at high risk of costly post-percutaneous coronary intervention (PCI) complications.•Recent trials have explored antithrombotic options after PCI in ...patients with AF.•Non-vitamin K antagonist oral anticoagulant-based regimens were associated with lower bleeding risk than vitamin K antagonist-based options.•This benefit may lead to lower costs overall in addition to better overall outcomes.
Patients undergoing percutaneous coronary intervention (PCI) have an increased risk of both ischemic events and bleeding complications resulting from antithrombotic therapy. These events are particularly common in patients with a concomitant indication for oral anticoagulation, such as those with atrial fibrillation, and are associated with a substantial healthcare resource burden. Advances in procedural aspects of PCI have led to marked improvements in outcomes and a consequent reduction in the costs resulting from PCI-associated complications. Furthermore, recent randomized clinical trials have investigated the optimal antithrombotic strategy in the specific case of patients with atrial fibrillation undergoing PCI, leading to a shift toward the tailoring of antithrombotic therapy according to the patient’s individual stroke and bleeding risks. Here we review these recent advances, with a particular focus on the improvements in antithrombotic strategies offered by the non-vitamin K antagonist oral anticoagulants.
PDF
