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Background: Type 2 myocardial infarction (MI) is an imbalance between myocardial oxygen demand and supply, leading to myocardial ischemia. It is not due to plaque rupture, and is usually caused by a condition other than coronary artery disease (CAD). However, limited data are available comparing the prevalence of traditional coronary risk factors and mortality between type 1 and type 2 MI. We hypothesize that type 2 MI carries a higher mortality than type 1. Methods: We searched the databases of PubMed, EMBASE, CENTRAL, and MEDLINE for studies comparing type 1 MI with type 2 MI. The baseline variables were compared in each cohort. Summary risk ratios and 95% confidence intervals were calculated using the random effects model to compare mortality between the two groups. Results: The included studies yielded 25,872 patients of whom 2683 (10%) had type 2 MI. Compared to the type 1 cohort, the type 2 cohort had significantly higher inpatient (15% vs. 4.7 %, P vs. 5.3%, P vs. 13%, P vs. 9%, P Conclusions: Type 2 MI is a common entity and is more common in females, older age groups, and in patients with multiple comorbidities: it also tends to result in higher mortality.

We study the effect of the substrate material (ceramic versus metallic) on the steady-state and transient performance of monolith reactors using a one-dimensional two-phase model with position dependent transfer coefficients. When the operation of the reactor is on the ignited branch, it is shown that monoliths with metallic substrate clearly lead to a superior steady-state performance compared to those with ceramic substrate. In such cases, the ignited branch extends to lower inlet gas temperatures (typically 60–100 °C in after-treatment applications) for the same catalyst loading. For transient operation where the time to light-off is important, it is shown that for the case of back-end ignition (corresponding to low inlet temperatures or low catalyst loading), metallic substrates are again superior. However, for the case of front-end ignition, ceramic converters may lead to lower cumulative emissions at lower inlet gas velocities while the converse is true at higher velocities. It is shown that the transient heating time and hence the cumulative emissions decrease with decrease in the channel hydraulic diameter and thermal capacitance of the substrate but are not monotonic with the inlet gas velocity. We present mathematical analysis and simulations to support these conclusions. Some novel results on the effect of substrate conductivity on the number of steady-states and upstream propagation of temperature fronts are also presented.

BACKGROUND Dual calcium-channel blocker (CCB) with a dihydropyridine (DHP) and a nondihydropyridine (NDHP) has been proposed for hypertension treatment. However, the safety and efficacy of this approach is not well known. METHODS A MEDLINE/EMBASE/CENTRAL search for randomized clinical trials published on this topic from 1966 to February 2012 was performed. Efficacy outcomes of decrease in systolic (SBP) and diastolic (DBP) blood pressures from baseline, changes in heart rate (HR), and adverse effects were compared between dual CCB therapy vs. DHP or NDHP. SBP, DBP, and HR were expressed as weighted mean deviation (WMD). RESULTS A total of 6 studies with 153 patients were included. Dual CCB produced a significantly greater reduction in SBP (21.6±9.2 mmHg) from baseline than DHP (10.3±6.3 mmHg (WMD = 10.9 mmHg, P < 0.0001)) or NDHP (8.9±4.2 mmHg (WMD = 14.1 mmHg, P = 0.002)). Dual CCB therapy reduced DBP from baseline more than either monotherapy (dual CCB = 17.5±10.2 mmHg vs. DHP = 11.6±8.7 mmHg, WMD = 5.5 mmHg, P < 0.001; and NDHP = 10.5±5.6 mmHg, WMD = 5.3 mmHg, P = 0.03). Dual CCB therapy had significantly lower HR compared to DHP (P < 0.001) but was comparable to NDHP (P = 0.12) (Delta change dual CCB = -4.0±3.5 vs. DHP = -2.0±1.5 and NDHP = -6.0±5.0 beats/min). Dual CCB therapy did not increase adverse effects. CONCLUSIONS Dual CCB therapy lowers blood pressure significantly better than CCB monotherapy, without an increase in adverse events. However, given the lack of long-term outcome data on efficacy and safety, dual CCB therapy should be used with restraint, if at all. Large-scale long-term trials are needed to further evaluate such a strategy.

We review and compare the literature correlations for estimating the heat and mass transfer coefficients as well as pressure drop in catalytic monoliths with simultaneously developing velocity, concentration and temperature profiles. We present accurate correlations for estimating the local Nusselt and Sherwood numbers for developing flows with constant flux (slow reaction) and constant wall concentration or temperature (fast reaction) cases for a channel of arbitrary shape. These new correlations need only a single parameter, namely, the asymptotic value, which depends on the channel geometric shape. We establish the accuracy of the proposed correlations by comparing the predicted values with the exact numerical values available for a few cases. We use the new correlations to analyze the effect of flow conditions near the inlet of the channel on the ignition and extinction behavior of catalytic monoliths used in combustion and after-treatment applications as well as laboratory experiments. It is shown that the bifurcation behavior, such as the number and location of the ignition/extinction points, the number of stable steady-states and the hysteresis locus is sensitive to the flow conditions in the entry region, and hence the heat and mass transfer correlations used, especially for large values of the transverse Peclet number (high space velocities or very short monoliths) or adiabatic temperature rise or when the axial catalyst loading is not uniform.

We examine pattern formation in a two-phase system consisting of a catalytic wire or ribbon or a string of catalyst particles suspended in a well-mixed fluid phase in an adiabatic reactor. We assume that a single exothermic reaction of the type A → B occurs in the solid phase and account for the variation in the interphase heat and mass transfer coefficients with the flow rate of the reactants. First, we examine the case of uniform activity, conductivity and diffusivity in the solid phase and use linear stability theory to show that steady non-uniform patterned states emerge from the unstable middle branch of the spatially uniform state. Unlike the Turing patterns, these transport limited patterns exist only in the region of multiple homogeneous (uniform) states. They always emerge as unstable branches but may gain stability through a limit point bifurcation when the fluid Lewis number (ratio of fluid thermal diffusivity to the mass diffusivity of the reacting species) Le f 1 but the solid phase Lewis number (ratio of solid thermal diffusivity to the effective species diffusivity in the solid) can be larger than unity. For a fixed set of kinetic constants, the range of Damkohler numbers or residence times over which stable patterned states exist increases with increased interphase heat and mass transfer resistances and with decreased intraphase conduction in the solid. Local bifurcation analysis and transient simulations show that when the activity, conductivity and diffusivity in the solid phase are constant, only moving temperature and concentration fronts exist when Le f ≥ 1 , while both stationary and moving fronts exist when Le f 1 for the practical range of other parameters. Next, we examine pattern formation with non-uniform activity but uniform conductivity and diffusivity within the solid and show that both stationary and moving patterns can exist for any value of Le f . We also determine the influence of the length scale and magnitude of the heterogeneity in activity on pattern formation. The last case examined is that of non-uniform activity, conductivity and diffusivity within the solid phase with profiles of these corresponding to the case of discrete particles in a string with point contacts. In this case, we show that stationary patterns can exist for any Le f and realistic values of all other parameters. This last result explains the differences between various literature results on pattern formation using discrete and continuum models with uniform properties. It also shows that one of main reasons for stationary pattern formation in catalytic packed-bed reactors is the spatial non-uniformity in activity and conductivity caused due to discrete nature of the solid phase (particles) with point contacts.

Heavy metals toxicity is a major threat to public health throughout the world. Considerably, Lead exposure is decidedly common and capable of inducing permanent damage to various organs. Several evidence were showing the risk of lead toxicity on male reproductive system. But there is no comprehensive data available to deliver the adverse effects of lead in male reproductive parameters. So, this review attempts to explore the negative effects caused by lead exprosure's in experimental and clinical studies. Several studies shown that there is significant alteration takes place in antioxidant level, semen parametres, spermatogenesis and steroidogenesis. In addition, it also upadtes the reader about the possible adverse effects arise in gene expression and alteration takes place in reproductive hormones.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and the third leading cause of death in the US. Little is known about the impact of COPD on pts with cardiovascular disease, although it is a common coexisting condition. Methods: We used a statewide, all-payer hospital discharge database in Hawaii to identify pts discharged from 2011-13 with a primary diagnosis of acute myocardial infarction (AMI) or heart failure (HF). We compared characteristics and outcomes of pts with and without a secondary diagnosis of COPD. Multivariable logistic regression was used to assess associations between COPD and 30d readmission and inhospital mortality. Results: Overall, 6,581 pts accounted for 10,080 HF admissions and 6,520 pts accounted for 7,556 AMI admissions. COPD was noted in 11.5% of HF, 6.2% of AMI and 8.8% of pts with HF or AMI. After controlling for potential confounders, COPD was independently associated with 30d readmission for HF (OR=1.16, 95% CI: 1.00-1.33) and HF or AMI (OR=1.26, 95% CI: 1.11-1.42), with a trend for AMI alone (OR=1.19, 95% CI: 0.93-1.53). There was a trend for higher mortality with COPD for HF (OR-1.09, 95% CI: 0.80-1.50), AMI (OR=1.26, 95% CI: 0.91-1.75), and HF or AMI (OR=1.10, 95% CI: 0.87-1.37). Conclusion: Among pts hospitalized for HF or AMI, having COPD was associated with higher 30d readmission but similar inhospital mortality. As

Background: Hospital Medicine is the fastest growing subspecialty in the US. However, limited data compare care provided by Hospitalists (H) with Non-Hospitalists (NH) (ie, internal medicine, family practice). Because much of heart failure (HF) care is provided by non-cardiologists, we examined HF outcomes among pts treated by H and NH. Methods: All pts discharged with primary dx of HF from 2009-11 were identified from a statewide all-payer database in Hawaii (n=6,581). We categorized pts by specialty of discharging physician and examined length of stay (LOS), 30-day readmission and inhospital mortality comparing H and NH. Because pts discharged by cardiologists accounted for a minority of cases (345/6,581 or 5.2%) and may substantially differ from other pts, they were excluded from our study. Results: There were slight differences between pts cared by H and NH, while disease severity (Charlson Index) was similar. Readmissions were similar for H and NH, although inhospital mortality was significantly lower for H. These differences persisted after adjusting for potential confounders (readmission: OR=1.08, 95% CI: 0.96-1.20; mortality: OR=0.59, 95% CI: 0.46-0.75). Conclusions: In a statewide, all-payer hospital discharge database H care for the majority of HF pts. Compared with NH, 30-day readmission was similar but inhospital mortality was lower. Further research is needed to study the impact of cardiologists, who often serve as consultants for this population.

Background: The efficacy and safety of newer oral anticoagulants (NOAs) compared to vitamin K antagonist (VKA) in preventing the recurrence of venous thromboembolism (VTE) is well documented. However, it still needs to be determined whether this pattern holds when compared to the combination of low-molecular-weight heparin (LMWH) and VKA in patients with VTE and malignancy. Methods: For this analysis, the authors searched available databases for randomized controlled trials (RCTs) comparing the NOAs with standard treatment (combination of LMWH and VKA) in patients with VTE and those comparing NOAs with LMWH only for prevention of VTE. All these RCTs included small proportion of patients with cancer. The authors then assessed the pooled treatment effects of VTE recurrence, as well as major and non-major clinically relevant bleeding in the two groups. Results: Twelve studies met our inclusion criteria, yielding 2,054 patients. Five studies with rivaroxaban, three each with dabigatran and apixaban, and one with edoxaban compared NOAs with standard treatment. There was a non-significant reduction in VTE recurrence by the NOAs (3.95%) compared to standard treatment (5.62%) [risk ratio (RR) =0.68; 95% confidence interval (CI) =0.42–1.10; P=0.12]. The major bleeding rate with NOAs was (2.62%) compared to the corresponding rate for standard treatment (3.75%) (RR =0.66; 95% CI =0.36–1.20; P=0.17). The non-major clinically relevant bleeding rate with NOAs was (12.82%) compared to the rate for standard treatment (15.52%) (RR =0.85; 95% CI =0.65–1.10; P= 0.22). However, compared to LMWH only, both higher major (RR =2.18; 95% CI =0.32–14.80; P=0.42) and non-major clinically relevant (RR =2.39; 95% CI =0.75–7.56; P=0.14) bleeding rates were noted with NOAs use in acutely-ill hospitalized patients. Conclusions: NOAs seem to be comparable to standard treatment in both their efficacy and safety in patients with VTE and malignancy. However, increased rates of bleeding were observed with their use compared to LMWH use in acutely-ill hospitalized patients.

Melted paraffin wax is widely used for the preparation block for anatomical sectioning. But very often the process encounters with irregular solidification. So the need for a modified procedure for block preparation in microtomy with an aim to control the irregular solidification of wax in a simple way is discussed here. For this purpose temperature controlling system was found to be successful. The temperature control system was developed based on a simple way, for this purpose a paper boat was prepared and a layer of paraffin wax was coated to the paper-boat. This help to control the entering of water to the paper-boat. Then the boat fixed in the tray with cold water. After this, the molted wax poured to the boat and it help to form the basal layer of the wax, following this, the material fixed in the basal layer and again added molted wax to the sample to create the upper layer. The cooling system helped to the solidification starts from the basal portion to the upper level at a controlled state.

Primary cardiac tumors are very rare. Atrial myxomas are the most common primary tumors and are commonly located in the left atrium. Myxomas can cause mitral valve inflow obstruction and can present with clinical signs and symptoms of mitral stenosis and the possibility of myxoma should be considered in differential diagnosis of mitral stenosis. Left atrial myxoma is rarely associated with rheumatic mitral stenosis. Transesophageal echocardiography plays a major role in the diagnosis of this tumor. We report a case of an extremely rare association between left atrial myxoma and rheumatic mitral stenosis. Because of its location and mobility, a thrombus in the left atrium may have a similar appearance to left atrial myxoma. However, a careful inspection of features of the left atrial mass may allow a diagnosis of left atrial myxoma. In our case, the site near the atrial septum, heterogeneous echogenicity, and detection of a stalk connecting the myxoma to the atrial septum were inspected. Such findings essentially exclude thrombus.

Chylothorax is a recognized complication of intrathoracic surgery, but its occurrence after coronary artery bypass grafting (CABG) is very rare. We report a case of a fatal pulmonary embolism as a complication of chylothorax following CABG. The patient was an 82-year-old woman who presented with increasing chest pain 2 weeks after discharge after an uncomplicated CABG. A computerized tomography (CT) scan with contrast angiogram showed a left-sided pleural effusion and no concurrent pulmonary embolus. Analysis of the pleural effusion revealed a chylothorax, which was treated with chest tube drainage and total parenteral nutrition followed by an oral medium-chain fatty acid diet. The patient improved steadily but, on day 6, she developed acute hypoxemic respiratory failure and shock. A CT angiogram revealed a massive pulmonary embolus and, despite thrombolysis, the patient died. Autopsy confirmed an acute saddle embolus in the pulmonary trunk. The patient had received appropriate venous thromboembolism prophylaxis with subcutaneous unfractionated heparin during her hospital course. This is the first reported case of a fatal pulmonary embolism that occurred in the setting of a post-CABG chylothorax in adults. The occurrence of this complication despite unfractionated heparin thromboprophylaxis may suggest a role for other, more effective medications, such as low molecular weight heparin or fondaparinux in patients with chylothorax.

Breast carcinoma is the commonest cancer among females in a majority of the Indian cities. The advances in the research and management have improved the breast cancer survival significantly in the past three decades globally. Adenocarcinoma is the commonest histological variant which arises from the ductal epithelia. The myoepithelial cells (ME) are the normal components of the breast parenchyma, which separate the ductal epithelia from the basement membrane and the stroma. The pure ME cell carcinoma is extremely rare and only 38 cases have been reported so far in the indexed literature. This may owe to the difficulties in the identification, and the non availability of established diagnostic criteria. We herein describe the clinical, radiological and the pathological characteristics of a case of myoepithelial carcinoma, to supplement the available literature. The possible impact of these cells in clinical practice was also reviewed. Identification and the further research on the genesis of these tumours, and the pathways by which the ME cells regulate the milieu interior of the breast epithelia, may unravel new molecular targets to prevent or treat both epithelial and myoepithelial cancers at early stages.