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Data on coronary revascularization in patients with cirrhosis are scarce because it is often deferred in the setting of significant comorbidities and coagulopathies. It is unknown whether patients with cardiac cirrhosis have a worse prognosis. The National Inpatient Sample was surveyed to identify patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) from 2016 to 2018. Those with and without liver cirrhosis were propensity score–matched and compared within the PCI and CABG cohorts. Primary outcome was in-hospital mortality. Patients with cirrhosis were further classified into cardiac and noncardiac cirrhosis and their in-hospital mortalities were compared. A total of 1,069,730 PCIs and 273,715 CABGs were performed for ACS, of which 0.6% and 0.7%, respectively, were performed in patients with cirrhosis. In both the PCI cohort (odds ratio = 1.56; 95% confidence interval, 1.10–2.25; P = 0.01) and the CABG cohort (odds ratio = 2.34; 95% confidence interval, 1.19–4.62; P = 0.01), cirrhosis was associated with higher in-hospital mortality. In-hospital mortality was greatest in cardiac cirrhosis (8.4% and 7.1%), followed by noncardiac cirrhosis (5.5% and 5.0%) and no cirrhosis (2.6% and 2.3%) in PCI and CABG cohorts, respectively. Higher in-hospital mortality and periprocedural morbidities should be considered when performing coronary revascularization in patients with cirrhosis.

The prevalence and incidence of end-stage renal disease (ESRD) has been increasing. However, data on inpatient outcomes of hypertensive emergencies in patients with ESRD are lacking. We performed a retrospective study using the largest inpatient database in the United States. Hospitalizations for hypertensive emergency between 2016 and 2018 were identified from the National Inpatient Sample. Propensity score matching was performed between those with and without ESRD. The primary outcome was in-hospital mortality, and secondary outcomes included end-organ complications of hypertensive emergency. Multivariable logistic regression was used to identify potential risk factors of in-hospital mortality. Of 105,565 hospitalizations for hypertensive emergency, 15% occurred in patients with ESRD. Hospitalizations for hypertensive emergency in patients with ESRD were associated with higher odds of cardiac arrest (odds ratio [OR] 4.52, 95% confidence interval [CI] 1.53–13.3, P = 0.01) and acute pulmonary edema (OR 2.80, 95% CI 2.15–3.65, P

Introduction: Protein energy malnutrition (PEM) is associated with adverse clinical outcomes for various cardiac diseases, but its effect on outcomes of hypertensive emergencies (HTNE) has not been studied. We examined the impact of PEM on in-hospital outcomes of HTNE using the largest inpatient database in the United States. Methods: We reviewed the National Inpatient Database from 2017 to 2018 to identify admissions for HTNE and stratified them to those with PEM (PEM+) and without PEM (PEM-). Multivariable logistic regression was used to compare categorical and continuous variables after adjusting for confounders. Primary outcome included in-hospital mortality. Secondary outcomes included mean length of stay (LOS), total hospital charge (THC), and acute kidney injury (AKI). Results: Of 749,115 admissions with HTNE, 34,555(4.6 %) had PEM. A total of 27,855 (3.72%) deaths were observed inpatient for HTNE. Among PEM + cohort, 2,310 of 34,555 (6.68 %) died compared with 25,545 of 714,560 (3.57 %) among PEM- cohort [AOR 1.29, 95% CI 1.17-1.45, p Conclusion: Concomitant diagnosis of PEM in HTNE is associated with higher odds of in-hospital mortality and AKI . It also increases burden on healthcare.Higher vigilance and early risk stratification may be important for better outcomes in HTNE admissions with PEM. Further prospective studies are required to evaluate the measures to mitigate negative outcomes.

Background The transcatheter aortic valve replacement (TAVR) procedure has been increasingly utilized in the management of aortic stenosis among the elderly. In this study, we sought to assess the hospital outcomes and major adverse events (MAEs) associated with TAVR in patients aged ≥80 years compared to those aged80 years. Methodology We performed a retrospective observational study using the National Inpatient Sample in 2018. We divided TAVR patients into two cohorts based on age, namely, ≥80 years old and80 years old. The primary outcomes included the comparison of in-hospital mortality and MAEs in the two cohorts. Results We identified 63,630 patients who underwent TAVR from January 1 to December 31, 2018. Among them, 35,115 (55%) were ≥80 years and 28,515 (45%) were80 years of age. There was a higher rate of post-procedural in-hospital mortality in patients ≥80 years old (1.6% vs. 1.1%, adjusted odds ratio (aOR) = 1.56, [confidence interval (CI) = 1.13-2.16], p = 0.006). They also had higher rates of pacemaker insertion compared to those80 years old (7.4% vs. 6.5%, aOR = 1.17 [CI = 1-1.35], p = 0.03). On subgroup analysis, the rates of MAEs were not different between the two cohorts (23.8% vs. 23.4%, p = 0.09); however, patients aged ≥80 years who experienced MAEs had higher in-hospital mortality (5.7% vs. 4.3%, aOR = 1.58 [CI = 1.08-2.32], p = 0.01) and shorter length of hospital stay (7.2 vs. 8.7 days, p = 0.03) compared to those aged80 years. Anemia, liver disease, chronic kidney disease, and previous stroke were associated with higher odds of in-hospital MAEs in both groups. Conclusions The results of our study show that patients older than 80 years of age undergoing TAVR had higher rates of in-hospital mortality and pacemaker insertion compared to those less than 80 years of age. The rates of MAEs were not significantly different between the two groups.

As people living with human immunodeficiency virus (HIV) (PLWH) enjoy longer life expectancy with highly effective antiretroviral therapy, they are encountering challenging cardiovascular health risks.To retrospectively examine the increasing burden of cardiovascular diseases in PLWH over the past decade.All hospitalizations for heart failure (HF), ischemic heart disease (IHD), and cerebrovascular disease (CeVD) in PLWH were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes in the National Inpatient Sample from 2008 to 2018. Outcomes included number of hospitalizations, in-hospital mortality, length of stay, and total hospital charge. Trend of the outcomes from 2008 to 2018 were analyzed using Cochran-Armitage trend test and simple linear regression.The number of hospitalizations for HF in PLWH increased from 4212 in 2008 to 6700 in 2018 (The burden of cardiovascular diseases has significantly increased in hospitalizations of PLWH from 2008 to 2018. Continued efforts are needed to address the additional cardiovascular risks in this vulnerable population.

The coronavirus disease of 2019 (COVID-19) is a global pandemic with over 266 million cases and 5 million deaths worldwide. Anti-COVID-19 vaccinations have had exceptional success in subduing the incidence, prevalence, and disease severity of COVID-19, but rare cases of myocarditis have been reported after COVID-19 vaccinations.Myocarditis occurring after COVID-19 mRNA vaccinations have distinguishable clinical characteristics. They usually have a favorable prognosis.We performed a systematic literature search on PUBMED and MEDLINE database from inception to December 5, 2021. Studies were analyzed based on predetermined eligibility criteria.A total of 57 studies containing 275 cases of COVID-19 vaccine-associated myocarditis were catalogued. Mean age was 26.7 years and male to female ratio was 14:1. For 86.9% of patients, myocarditis occurred after the second dose. Average time to onset and length of hospitalization were 3.7 and 3.9 days, respectively. Prognosis was largely benign, but there was a 1.1% reported mortality. Chest pain (95.2%), elevation of troponin (100%), and ST elevation on electrocardiography (68.5%) were common. Nonsteroidal anti-inflammatory drugs (81.4%) were the most used medication, followed by colchicine (33.1%).Patients with COVID-19 vaccine-associated myocarditis are usually younger males presenting with chest pain 3-4 days after receiving their second dose of COVID vaccine. Diagnosis is made by exclusion of all other etiologies. Given significant population benefit from COVID-19 vaccination, physicians should continue to encourage vaccination while remaining vigilant of the very rare occurrence of myocarditis following COVID-19 vaccination.

BackgroundTranscatheter aortic valve replacement (TAVR) procedure has been increasingly utilized in the management of aortic stenosis in the elderly. We sought to assess the hospital outcomes and major adverse events of TAVR in patients ≥80 years old compared to those MethodsWe performed a retrospective observational study using the National Inpatient Sample - 2018. We divided TAVR patients into two cohorts based on age being ≥80 years and ResultsWe identified 63,630 patients who underwent TAVR procedures from January 1 to December 31, 2018. Among them, 35, 115(55%) were ≥80 years and 28,515(45%) were ConclusionThis study shows that in patients undergoing TAVR, those ≥80 years old had higher in-hospital mortality and higher rates of pacemaker insertion compared to those < 80 years. The rates of MAE were not significantly different between the two groups.

IntroductionAcute pulmonary embolism (PE) is known to be associated with significant short-term and long-term complications. However, with the evolution of PE management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in PE patients from the years 2010 to 2018.MethodsWe utilized the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute pulmonary embolism. Identified the total number of readmissions for acute PE from 2010 to 2018. A multivariate cox regression model was used to identify independent predictors of readmission.ResultsThe number of patients with 30-day readmissions has gradually increased from 14,508 in 2010 to 19,703 in 2018. The proportion of females admitted was higher than males in all years. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (pConclusionOur study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018, but an increase in all-cause readmissions. We also report an increase in non-major bleeding during readmissions, including ICH and UGI bleed. These findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission but possible causes for the increase in all-cause readmission in the hope of optimizing management and continuing improving outcomes.

Controlling the properties of piezoelectric thin films is a key aspect for designing highly efficient flexible electromechanical devices. In this study, the crystallographic phenomena of PbZr1–x Ti x O3 (PZT) thin films caused by distinguished interfacial effects are deeply investigated by overlooking views, including not only an experimental demonstration but also ab initio modeling. The polymorphic phase balance and crystallinity, as well as the crystal orientation of PZT thin films at the morphotropic phase boundary (MPB), can be stably modulated using interfacial crystal structures. Here, interactions with MgO stabilize the PZT crystallographic system well and induce the texturing influences, while the PZT film remains quasi-stable on a conventional Al2O3 wafer. On the basis of this fundamental understanding, a high-output flexible energy harvester is developed using the controlled-PZT system, which shows significantly higher performance than the unmodified PZT generator. The voltage, current, and power densities are improved by 556%, 503%, and 822%, respectively, in comparison with the previous flexional single-crystalline piezoelectric device. Finally, the improved flexible generator is applied to harvest tiny vibrational energy from a real traffic system, and it is used to operate a commercial electronic unit. These results clearly indicate that atomic-scale designs can produce significant impacts on macroscopic applications.

This study deals with an enhanced assumed strain (EAS) three-dimensional element for free vibration analysis of laminated composite and sandwich structures. The three-dimensional finite element (FE) formulation based on the EAS method for composite structures shows excellence from the standpoints of computational efficiency, especially for distorted element shapes. Using the EAS FE formulation developed for this study, the effects of side-to-thickness ratios, aspect ratios and ply orientations on the natural frequency are studied and compared with the available elasticity solutions and other plate theories. The numerical results obtained are in good agreement with those reported by other investigators. The new approach works well for the numerical experiments tested, especially for complex structures such as sandwich plates with laminated composite faces.

This study deals with parametric effects on bucking behaviors of laminated composite structures containing an embedded rectangular delamination using the enhanced assumed strain (EAS) three-dimensional element. The three-dimensional finite element (FE) formulation based on the EAS method for composite structures shows excellence from the standpoints of computational efficiency, especially for distorted element shapes. Using the EAS FE formulation developed for this study, the effects of embedded delamination sizes and ply orientations on the elastic buckling behaviors for various aspect ratios and width-to-thickness ratios are studied. The numerical results obtained are in good agreement with those reported by other investigators. Furthermore, the new results reported in this paper show the progression of local buckling and its influence on global buckling and vice versa. Key observation points are discussed and a brief design guideline is given.

During construction of the cable-stayed bridge, not only shape of deck and pylon but also cable forces are main factors for geometry control. Especially, geometry control of deck must be controlled for adjusting design value of vertical and lateral alignment as well as closing of key segment. Also, both the deck level error and cable force error occur necessarily during the construction stage in cable stayed bridge. The errors are caused by different of material properties and computer modeling, and construction mistake, and so on. These causes bring about that the forces of cable and the displacement of deck show different tendency from the theoretical values. Therefore, these errors must necessarily be adjusted and can be improved through adjustment of cable length. In this study, a new optimization tool is proposed to adjust the errors of the second Dolsan cable-stayed bridge.

This study investigates free vibration characteristics of laminated composite structures with different embedded delamination sizes and locations using the solid element. The three-dimensional finite element (FE) delamination model described in this paper, in comparison with the conventional approaches, is more attractive not only because it shows better accuracy but also it shows the entire mode shape. The FE model using ABAQUS is used for studying free vibrations of laminates containing an various embedded delamination. The numerical results obtained are in good agreement with those reported by other investigators. In particular, new results reported in this paper are focused on the significant effects of the local vibration mode for various parameters, such as size of delamination, aspect ratio, and location of delamination.

This paper presents the flexural behavior of a hybrid Glass Fiber-Reinforced Polymer(GFRP)-steel decks for use in deteriorated bridge decks replacement. Static load tests were conducted to investigate the structural characteristics of the hybrid FRP-steel deck. The tested deck panel satisfied the design criteria. The failure mode of the hybrid deck was demonstrated ductility with deformation beyond initial yielding. The responses were compared with the ANSYS finite element predictions. It was found that the presented hybrid deck was efficient for use in bridges. The thickness of the hybrid deck may be decreased when compared to that of the all FRP deck with similar flexural rigidity.