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Atom-intercalated transition metal disulfides (TMDs) have attached much attention mainly due to their highly improved conductivity. But it is few reported that the atom intercalation can enable the TMDs have unexpected catalytic properties, caused by the unit-cell deformation in them. In this work, a type of V0.25-intercalated VS2 (V5S8) nanoflakes was designed via a direct vulcanization method combining Kirkendall heat diffusion effect, and used as the promotor for lithium-sulfur batteries (LSBs). The V5S8 possesses a NiAs crystal structure, in which V atoms occupy the interlayer spacing between VS2 monolayers, which will unavoidably cause the unit-cell deformation. As expected, the CNF@V5S8/S cathodes show a specific capacity of 1260 mAh g−1 at 0.2 C, and can keep 73.65% of the capacity with charge/discharge rate increasing 10 times; while the CNF@VS2/S ones can only retain 54.0% of the initial capacity. Moreover, the CNF@V5S8/S cathodes show an ultralow decay rate of only 0.0312% per cycle for 1500 cycles at 5 C. Furthermore, the catalysis effect of V5S8 on the conversion of lithium polysulfide (Li2Sn, n = 1, 2, 4, 6 and 8) and S8 clusters were systematically discusses. Besides, the V5S8 can further enable LSBs achieve a high areal capacity (8.2 mAh cm−2 with sulfur loading of 7.8 mg cm−2) and a high dynamic flexible stability at bending angle between 0 and 180 °.

Lithium-sulfur batteries (LSBs) are still limited by the shuttle of lithium polysulfides (LiPS) and the slow Li-S reaction. Herein, we demonstrate that when using cobalt sulfide as a catalytic additive, an external magnetic field generated by a permanent magnet can significantly improve the LiPS adsorption ability and the Li-S reaction kinetics. More specifically, the results show both experimentally and theoretically how an electron spin polarization of Co ions reduces electron repulsion and enhances the degree of orbital hybridization, thus resulting in LSBs with unprecedented performance and stability. Under an external magnetic field, LSBs with 0.0084 % per cycle decay rate at 2 C during 8150 cycles are produced. Overall, this work not only demonstrates an effective strategy to promote LiPS adsorption and electrochemical conversion in LSBs at no additional energy cost but also enriches the application of the spin effect in the electrocatalysis fields., This work was supported by the National Natural Science Foundation of China (Grant Nos.: 51572118 and 21975123) and partially by the Fundamental Research Funds for the Central Universities (Grant Nos.: lzujbky-2021-it33). C. Y. Zhang, C. Q. Zhang, and L. Gong thank the China Scholarship Council for the scholarship support. A. Cabot thanks financial support from the Combenergy project (PID2019-105490RB-C32) from the Spanish Ministerio de Ciencia e Innovación. The authors also greatly acknowledge the support supported by the Supercomputing Center of Lanzhou University, China., With funding from the Spanish government through the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000917-S).

It was demonstrated that the electrochemical performance enhancements in KOH-activated carbon materials should be mainly due to the created polar oxygen-containing functional groups (OFGs, such as such as C–O, C O, –OH, and O–C O), while the role of each OFGs on the electrochemical enhancements is still unclear. In this work, KOH activation treatments were systematically conducted on carbon nanotubes (CNTs) to explore the role of each OFG on the performance enhancements of Li–S batteries (LSBs). Results showed that the capacity of activated-CNT-sulfur (a-CNT-S) cathodes is 33% higher than that of the pristine CNT-S cathodes, and their rate capability and cycling stability are also enhanced. And the electrochemical analysis combining with Fourier transform infrared spectroscopy indicated that the formed C–O bonds are the real factor for the enhanced electrochemical performances of a-CNT-S cathodes. Furthermore, the optimal activation conditions on CNT-based cathodes for LSBs were optimized to be 10 min at 700 °C.

Metastatic adenocarcinoma of the jaw (MAJ) is a rare disease that accounts for 1%-3% of all oral and maxillofacial malignant tumours. Oral and maxillofacial pain may be the first symptom of metastatic spread of an occult primary tumour. Therefore, early identification of oral and maxillofacial pain by dental professionals is critical.To explore the clinical and computerized tomography (CT) features of MAJ with oral and maxillofacial pain as the first symptom.The medical records of all patients who were treated in our hospital between January 2006 and February 2020, and diagnosed with MAJ with oral and maxillofacial pain as the first symptom, were reviewed retrospectively. Clinical data were collected on age, sex, medical history, clinical manifestations, site of metastasis, and site of the primary lesion. CT features were analysed in detail, and a radiological classification scheme comprising five types: Osteolytic, osteoblastic, mixed, cystic, and alveolar bone resorption was proposed.The primary sites of MAJ were the lungs (MAJ has complex clinical and CT features. Oral and maxillofacial pain may be the first sign of a primary tumour affecting other sites.

Vanadium sulfides, such as VS2, have been often used as sulfur host materials for lithium–sulfur batteries (LSBs), however, their high-symmetry and layered crystalline structure often lead to a poor rate-capability and a limited cycling stability of the resultant LSBs. Thus, in this work, a type of distorted NiAs-type structured V2S3 phase was designed and attempted to use it as a sulfur host for LSBs. The results showed that the prepared V2S3-nanocrystal decorated carbon nanofiber (CNF@V2S3) electrode films are freestanding, highly conductive and flexible. And the resultant CNF@V2S3/S cathodes show a high specific capacity (1169 mA h g−1 at 0.1C), an excellent rate capability (retain 78.9% at 2.0C), an ultra-low delay rate per cycle of 0.0071%, and a low self-discharge rate of 3.65% per month. A series of analyses indicate that these high electrochemical performances are mainly due to the high polarity, high conductivity and high catalytic activity of V2S3 nanocrystals, as well as the improved diffusivities of Li ions. This research could provide some new insight into the design of sulfur host materials for high-performance LSBs.

SnO2/AgIO4 hybrids were fabricated by an in-situ synthetic method at room temperature. The structure, morphology, light response range, separation efficiency of the electron-hole pairs and elements of the as-synthesized samples were characterized by adopting X-ray diffraction, scanning electron microscopy, UV-Vis diffuse reflectance spectroscopy, electrochemical impedance spectroscopy and X-ray photoelectron spectroscopy, respectively. The synergistically photocatalytic degradation mechanism of the as-synthesized composites was also proposed. The experimental results reveal that under the visible light irradiation the as-synthesized SnO2/AgIO4 hybrids can enhance the photocatalytic degradation efficiency of rhodamine B compared to pure samples. With increasing the molar ratios of AgIO4 to SnO2, it displays the trend of first increasing and then decreasing. When it is 1:2 in 150 min, the as-prepared hybrids have the highest degradation efficiency of 93.1%, which increases by 6550.0%, 30.5%, and 1505.0% compared to those of pure SnO2, AgIO4, and TiO2 (P25), respectively. Moreover, the Sn-O-Ag cross-linking bonds are formed at the interfaces of SnO2 and AgIO4. In addition, superoxide anion radicals and holes play a major role in the process of photodegradation.

The mechanical behavior of CuZr-based bulk metallic glass composites with different B2-CuZr phase transformation ability was investigated. The B2 phase transformation is conducive to enhance the mechanical properties of CuZr-based bulk metallic glass composites. The mechanical properties of the austenitic B2 phase specimens were also studied to understand the mechanism of phase transformation effect. It was found that the B2 phase with martensitic transformation exhibits lower yield strength and stronger work-hardening capability than the B2 phase without martensitic transformation. Thus, the phase transformation effect of B2-CuZr phase, accompanying with its lower yield strength and stronger work-hardening capability, is the main reason for the CuZr-based bulk metallic glass composites possess outstanding mechanical properties.

Ordered array structures will greatly reduce the stress formation in wearable electric devices during dynamic bending operation. In this work, highly flexible TiN-based fiber counter electrodes (FCEs) were designed via a post-ammonization treatment on the hydrothermally grown TiO2 nanowire arrays. Results show that the obtained TiN nanorod arrays (NRAs) are well aligned with a diameter of 200–320 nm and a length of several hundred nanometers to ∼1 μm. Moreover, fiber-shaped dye-sensitized solar cells assembled using TiN FCEs showed the maximum photoelectric conversion efficiency (PCE) of 5.69%, which is 16.3% higher than that of the ones based on Pt FCEs. Analysis indicated that this enhancement in PCE could be mainly due to the better electrochemical catalytic activity of TiN NRAs. Furthermore, the optimizations of the nanoscale morphologies of TiN NRAs suggest that both small diameters and large lengths can benefit the PCE and the dynamic bending stability, while the diameters show a major influence on them. The optimal FCEs show an ultralow decay rate of 0.017‰ per bending cycle.

Post-grown hierarchical pseudocapacitive nanostructures often suffer from their bad long-term cycling stability. In this work, a type of hierarchical partially-embedded MnO nanocube/electrospun carbon nanofiber composites (pe-MnO/ECNFs) was designed. Results show the MnO nanocubes are partially embedded into the ECNFs skeletons, showing a strong joint between them. The pe-MnO/ECNFs electrodes exhibit a high specific capacitance of 146 F g−1 (to the whole electrode mass) at scan rate of 5 mV s−1, and an ultralow decay rate of 0.004‰ per cycle for 20,000 cycles at 10 A g−1, which is much better than those of the MnO2/ECNF ones (96 F g−1, decay rate of 0.015‰ per cycle). Furthermore, the assembled flexible symmetric supercapacitors show an high energy density of 6.8 W h kg−1, a high dynamic bending stability, and a robust long cycling stability (low decay rate of 0.003‰ per cycle for 6000 cycles at 1 A g−1).

The In2.77S4/SrCO3 heterojunction photocatalyst had been prepared by one-step hydrothermal method. X-ray diffraction, transmission electron microscopy, X-ray photoelectron spectrometry, UV–Vis diffuse reflectance spectroscopy and electrochemical impedance spectroscopy were used to analyze the structure, morphology, chemical compositions, optical properties and charge carrier behaviors of the as-prepared In2.77S4/SrCO3 hybrids, respectively. Experimental results revealed the SrCO3 could obviously improve the recyclability and photocatalytic activities of In2.77S4 nanosheets for both methyl orange and tetracycline oxidation under visible light. The photocatalytic degradation efficiency of the as-obtained In2.77S4/SrCO3 hybrids was first increased and then decreased with increasing the molar ratio of Sr(NO3)2 to In(NO3)3·4.5H2O. When it was 0.4:1, that of the as-prepared hybrids with the band gap of 1.63 eV reached the maximum of 96.0% in 30 min for methyl orange and 82.7% in 20 min for tetracycline. These were higher than 88.0% and 40.0% of In2.77S4 nanosheets as well as 0.8 and 1.8% of SrCO3 particles, respectively. After three cycles, its photocatalytic efficiency still possessed 92.7% for methyl orange and 80.3% for tetracycline, which were much higher than 35.3% and 11.3% of In2.77S4 nanosheets. Moreover, the possible photocatalytic degradation mechanism of the In2.77S4/SrCO3 hybrids was also proposed.

The early hydration process was investigated using ultrasonic monitoring apparatus for pastes made with various mineral admixtures: silica fume (4%, 13%), slag (10%, 30%, 50%, 70%), and fly ash (10%, 30%, 50%). The influence of water to binder ratio (0.23, 0.35 and 0.53) was also studied. The results show that the hydration rate of cementitious material is obviously accelerated with decreasing in water to cement ratio and Silica fume addition, while the reverse phenomenon is observed when fly ash and slag are incorporated.

The method of the second intrusion mercury in MIP was used to investigate the pore characteristics of hardened cement paste with w/c ratio 0.23, 0.35 and 0.53, respectively, in order to research the quantitative relationship between transport properties and pore characteristics in cement-based composite materials. The results show the second intrusion mercury could well determine the effective pore structure parameters, and effective porosity accounts for 25% to 50% of total porosity in cement paste. At the same time, the existence of the first and second peak in pore size distribution curves is confirmed by MIP, such as, the first peak in hardened cement paste with water to cement ratio 0.53 is very distinct, however, with the decrease of water to cement ratio, the first peak gradually disappears. The pore diameter corresponding to the first and second peak is critical pore diameter of capillary pore and gel pore, respectively.

The knowledge of the microstructure is a point of major importance to understand the transport, mechanics, creep and shrinkage properties. The present work proposes a method to quantitatively predict the volume percentage of each of phases in Portland cement pastes. The saturated density of C-S-H is revised as a function of degree of hydration and water to cement ratio (w/c). The computed results are consistent with experimental values for cement paste that performed in this study.

The diffusion performance of chloride ion in concrete under the coupling action of dynamic load and environment was researched by a new set of experimental system. The experiment are composed of study of saturated performance of concrete, diffusion performance of chloride ion with different water binder ratio and under coupling action of dynamic load and temperature. The results show that the transport mechanism of chloride ion in concrete accounted with diffusion theory due to the 99% of saturation degree of concrete; the diffusion coefficient of chloride ion is decreased with the increasing water binder ratio, but is increased with temperature increase; and the diffusion coefficient of chloride ion is changed with cycle number.

To assess the clinical features and therapeutic effect of free thin anterolateral thigh flap for the reconstruction of intraoral defects.The clinicopathologic data of 34 cases with oral carcinoma were obtained from Institute and Hospital of Stomatology, Nanjing University Medical School, from December 2008 to December 2011. These 34 patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free thin anterolateral thigh flaps. The defects were located at tongue, buccal, mouth floor, and so on. The subcutaneous fat thickness of the flap at the site of the perforator is usually measured by ultrasound before the operation. If the thickness of the subcutaneous fat at the site of the perforator exceeded 1.5 cm, the patient was excluded from the study.There were 16 male and 18 female patients. The mean age was 55.4 years. Among the 34 patients, 26 flaps with musculocutaneous perforators and 8 flaps with septo-cutaneous perforators were used. Partial flap necrosis occurred in 2 patients.The free thin anterolateral thigh flap is the ideal soft tissue flap for the intraoral defects reconstruction. Satisfactory functional results can he achieved at recipient area with minimal morbidity at the donor site area.

BACKGROUND: The purpose of this study was to search for a more effective transfusion-monitoring system than the existing system of retrospective peer review. STUDY DESIGN AND METHODS: This research used a study-control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood-ordering process: 1) the number of crossmatches ordered per admission, 2) the transfusion-to- crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self-auditing. The study used two outcome indicators to reflect overall blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month. RESULTS: The prospective physician self-audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.

Extraction atherectomy utilizes suction aspiration as an attempt to limit distal emboll during atherectomy. We sought to test the hypothesis that extraction atherectomy produces less distal embolization than balloon angioplasty when treating saphenous vein grafts. Among 163 consecutive, nonrandomized patients, 103 patients underwent transluminal extraction catheter (TEC)® atherectomy with or without adjunctive balloon angioplasty, and 60 patients had conventional balloon angioplasty. Both groups showed comparably high procedural success rates (TEC 90.3%, angioplasty 83.3%, P = NS). TEC cases had a significantly lower incidence of angiographic distal embolization, compared with angioplasty (3.9% vs. 16.7%, P = 0.005). In cases with angiographic evidence of thrombus in the grafts, TEC maintained a significantly lower incidence of distal embolization than angioplasty (5.6% vs. 31.8%, P = 0.004). There were no statistical differences between the two groups regarding the incidence of other procedure-related complications, including death, myocardial infarction, or emergency coronary artery bypass grafting. TEC atherectomy appears to have a significantly lower incidence of distal embolization than balloon angioplasty when treating saphenous vein grafts, particularly in the presence of angiographically apparent thrombus. © 1996 Wiley-Liss, Inc.

The use of bivariable selection (BVS) for selecting variables to be used in multivariable analysis is inappropriate despite its common usage in medical sciences. In BVS, if the statistical p value of a risk factor in bivariable analysis is greater than an arbitrary value (often p = 0.05), then this factor will not be allowed to compete for inclusion in multivariable analysis. This type of variable selection is inappropriate because the BVS method wrongly rejects potentially important variables when the relationship between an outcome and a risk factor is confounded by any confounder and when this confounder is not properly controlled. This article uses both hypothetical and actual data to show how a nonsignificant risk factor in bivariable analysis may actually be a significant risk factor in multivariable analysis if confounding is properly controlled. Furthermore, problems resulting from the automated forward and stepwise modeling with or without the presence of confounding are also addressed. To avoid these improper procedures and deficiencies, alternatives in performing multivariable analysis, including advantages and disadvantages of the BVS method and automated stepwise modeling, are reviewed and discussed.

Ejection fraction is a major determinant of morbidity and mortality for patients with ischemic heart disease. Patients with an ejection fraction of 0.40 or less are generally recognized as having a poorer prognosis than those patients with an ejection fraction of 0.50 or better and remain a heterogeneous group. It would be useful if patients with a favorable surgical prognosis could be identified preoperatively. Fifty-five patients who underwent coronary artery bypass grafting and had an ejection fraction less than 0.40 (mean of 0.23 ± 0.07 standard deviation) were studied by catheter measurement of pulmonary arterial pressure and radionuclide left ventriculography. Heart rate, systemic blood pressure, pulmonary artery pressures, cardiac output, and ejection fraction were measured, at rest, after nitroglycerin was given intravenously and with supine bicycle exercise. Forty-seven patients who had follow-up longer than 4 years were divided into two groups according to their life status (alive or dead) 4 years after operation. Measured variables of exercise stress tests and clinical characteristics were entered into factor analysis to obtain a cardiac function factor score for predicting the life status after 4 years. The cardiac function factor score was highly loaded by stroke index (rest, nitroglycerin), cardiac index (exercise), systemic vascular resistance index (exercise), and history of congestive heart failure. The cardiac function factor provided a predictive value superior to that of any individual variable. By dividing the patients into two groups by cardiac function factor score, the actuarial 5-year survival was 72% versus 17% for good and poor prognosis groups, respectively (p < 0.0001). Preoperative exercise stress testing data integrated by factor analysis provide a predictive tool for patients with a low ejection fraction.

To assess the clinical features and therapeutic efficacy of anterolateral thigh (ALT) flaps for the intraoral defects reconstruction.The clinicopathologic data of 67 cases with oral tumors were obtained from School of Stomatology, Nanjing University Medical Center from Dec. 2008 to Dec. 2010. All the patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. The defects included the tongue, buccal, gingival, mouth floor, and so on. The descending branch of lateral femoral circumflex artery was anastomosed to the external maxillary artery or superior thyroid artery; the vein was anastomosed to the common facial vein or external jugular vein. The flaps were divided into three types: musculocutaneous ALT flap, fasciocutaneous ALT flap and thinned ALT flap.There were 38 male patients and 29 female. The anterolateral thigh flaps included 35 musculocutaneous flaps, 17 fasciocutaneous flaps and 15 thinned flaps. The success rate was 98.5% (66/67). Partial necrosis happened in one case with diabetes, which healed after debridement and dressing. 1 flap was totally necrosis. Double venous anastomosis was performed in 41 flaps, and one venous anastomosis was performed in 26 flaps. 8 patients required operative exploration in the perioperative period including 6 flaps with thrombotic events (5 flaps were complete survival after the salvages, and 1 flap was failure) , 1 flap with hematoma, and 1 flap with twisting of perforator. The follow-up period ranged from 2 to 24 months( mean, 8.7 months). The result was satisfied. The donor sites were closed directly in all patients, and the wounds healed uneventfully.The free anterolateral thigh flap is an ideal soft tissue flap for the intraoral defects reconstruction with good functional result at recipient area and less morbidity at the donor site.

We discuss estimation and prediction in a Markov renewal model where intensities of the one-step transitions follow a Cox regression model with baseline hazards and covariates depending on the backward recurrence time. A modification of the Andersen and Gill results is given to extend the asymptotic properties of the partial likelihood estimates to this setting. We further consider prediction of the realization of the process in a single individual based on the follow-up information. Data of the International Bone Marrow Transplant Registry are used for illustration purposes.

This study compares the effects of the cancer experience on various aspects of marital and sexual functioning (e.g., communication, emotional support, body image, sexual satisfaction and frequency) for two groups of long-term cancer survivors (testicular cancer and Hodgkin's disease) and their spouses. Comparisons between the two patient groups showed significantly more survivors of Hodgkin's disease than testicular cancer reporting the emergence of special issues and changes in the marital relationship. No differences emerged between the spouse groups on sexual functioning variables; however, spouses of survivors of Hodgkin's disease were more likely than spouses of survivors of testicular cancer to report the development of special issues and communication difficulties. A substantial proportion of both survivor groups disclosed negative changes in body image and sexual frequency. Majorities of both survivors and spouses acknowledged that the illness had drawn them closer together. When representative marital/sexual functioning variables were used to predict Family Environment Scale (FES) scores for survivors and for spouses, changes in the spouse's importance, influence of the illness on the relationship, and changes in sexual frequency emerged as significant predictors. The clinical significance of long-term changes in marital and sexual functioning for the couple and the need for therapeutic interventions are discussed.

To investigate the application of titanium mesh and free forearm flap for reconstruction of maxillary defect resulted from tumor resection.From 2004 to 2008, 19 cases with maxillary tumor underwent tumor resection. The defects were reconstructed immediately with titanium mesh for bony defects and free forearm flap for oral mucosa defects.16 cases achieved satisfactory functional and cosmetic results. The speech assessment was good without oronasal reflux. The titanium mesh was exposed and infected in 3 cases. Then the meshes were taken out and the defects were covered with the forearm flap to close the oronasal fistula. The midface was slightly depressed with no functional morbidity.It is simple and practical to reconstruct maxillary defect with titanium mesh and free forearm flap. Both the functional and cosmetic results are satisfactory.

The efficacy of low-energy T wave shocks for induction of ventricular fibrillation (VF) was evaluated in 33 patients undergoing implantable cardioverter defibrillator (ICD) implantation (33 sessions) or predischarge ICD testing (20 sessions). To induce VF, the ventricle was paced for eight cycles at a 400-ms cycle length (S1-S1), and the T wave was scanned with a monophasic shock (S2) delivered via the defibrillating lead system. Of 294 attempts, the T wave shocks induced VF in 65%, nonsustained ventricular tachycardia in 10%, and less than five ventricular beats in 25%. As compared with the failed T shocks, the mean energy of successful T wave shocks was higher and the S1-S2 coupling interval was shorter. When the S2 timing was examined in relation to the T wave peak, the VF induction efficacy was 37% for shocks delivered more than 70 ms before the T wave peak, 82% for shocks delivered 30-70 ms before the T wave peak, and 50% for shocks delivered less than 30 ms before or just after the T wave peak (P.001). Thus, in patients undergoing ICD implantation or ICD conversion testing, the use of low-energy T wave shocks is an effective and safe method to provoke VF.

Whether higher operator case volume is associated with improved percutaneous transluminal coronary angioplasty (PTCA) clinical and cost outcomes is the subject of this study. Hospital volume-related improvement in clinical outcomes has been shown for coronary artery bypass grafting (CABG) and PTCA. Physician case volume-related differences in clinical outcomes have not been clearly demonstrated, and differences in hospital costs have not been examined. For clinical and cost outcomes, risk-adjusted analysis of differences in PTCA outcomes has not been reported. In addition, controversy exists about the appropriate annual case volume considered adequate to maintain skills and achieve optimal clinical outcomes in performing PTCA procedures. We studied 2,350 PTCAs performed between March 1, 1991, and February 28, 1994. Physicians were divided into 2 volume groups: high (50 cases/year) and low (50 cases/year). The rate of emergency CABG after PTCA was 2.1% for high- and 3.9% for low-volume operators (p = 0.009). Hospital morbidity associated with PTCA was lower in high-than in low-volume operators (6.46% vs 10.73%, p0.001). The risk-adjusted ratios for emergency CABG and morbidity were 2.05 (p = 0.005) and 1.79 (p0.001), respectively. The length of stay averaged 4.07 +/- 4.54 days for high- and 4.49 +/- 4.33 days for low-volume operators (p = 0.003). Hospital costs averaged $7,977 +/-$7,269 for high- and $8,278 +/- $6,289 for low-volume operators (p = 0.065). The risk adjusted ratio was 1.091 (p = 0.004) for length of stay and 1.050 (p = 0.029) for cost. Thus, PTCA performed by high-volume operators is significantly less likely to require emergency CABG and is also significantly associated with lower hospital morbidity, shorter hospital length of stay, and lower hospital costs.

Influence of preoperative risk factors on hospital mortality in cardiac surgeries has been investigated, but no one has identified differences in risk factors on early (postop day ≤ 2) and late death (postop day ≤ 3). To explore proper preventive strategies for each death, data were reviewed in 4351 adult patients who underwent cardiac surgery between 1/1/90 and 6/30/94. There were 93 (2.14%) early deaths and 171 (4.02%) late deaths in this series. Patients who died are older (early: 67.8 vs. 64.2, p = 0.002; late: 71.1 vs. 63.9, p l 0.001) Proportion of females is higher in late deaths (41.5% vs. 29.7%. p = 0.001). but not in early deaths (32.3% vs. 30.2%, p = 0.6). The early and late mortality are 1.65% and 2.78% for isolated CABGs (n = 3037). 1.82% and 4.0% for isolated valves (n = 713), 3.79% and 9.61% for CABG + valve (n = 422), 7.82% and 12.73% for others (n = 179). To adjust influence of preoperative risk factors on each type of death. stepwise logistic regression was applied. Early Death Late Death Risk Factor Odds Ratio p Risk Factor Odds Ratio p Cardiac arrest 5.98 l0.001 Cardiogenic shock 6.93 l0.001 Refuse blood 5.84 l0.001 Renal disease 5.50 l0.001 Age≥ 85 years 5.01 0.008 CV disease 4.08 l0.001 Emergency 3.67 l0.001 MI l30 days 3.36 0.004 Re-operation 2.85 l0.001 Cardiac arrest 3.31 l0.001 Rheumatic dis. 2.79 0.001 Respiratory dis 3.19 l0.001 Preop EF l35% 2.71 l0.001 Liver disease 3.04 0.051 Hypotension 2.26 0.009 Age ≥ 75 years 2.80 l0.001 MI l 10 days 2.10 0.005 Rheumatic dis 2.19 0.002 IABP support 1.92 0.042 Emergency 1.56 0.035 Age 65–64 years 1.77 0.017 Heart Failure 1.48 0.050 Diabetes 1.47 0.055 Chronic Isch. HD 0.37 l0.001 Conclusions (1) Acute cardiac factors dominate early mortality. (2) Chronic organ system function is more important in late deaths than in early deaths. (3) Risk adjusted mortality does not differ significantly in genders.

The 1,25-dihydroxy-16-ene-23-yne-vitamin D3 [1,25(OH)2-16-ene-23-yne-D3] is a vitamin D analog that is very potent in inhibiting proliferation and inducing differentiation of myeloid leukemic cells in vitro. Also, 1,25(OH)2-16-ene-23-yne-D3 is 300 times less active in mediating intestinal calcium absorption and bone calcium mobilization as compared to 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the physiologically active metabolite. Furthermore, 1,25(OH)2-16-ene-23-yne-D3 is 10-25 times less potent than 1,25(OH)2D3 in causing hypercalcemia in BALB/c mice injected intraperitoneally (i.p.) every other day (q.o.d.) for 6 weeks. We explored the therapeutic potential of 1,25(OH)2-16-ene-23-yne-D3 by developing and using the following three leukemia models. (i) Injection of 2.5 x 10(5) myeloid leukemic cells (WEHI 3BD+) into syngeneic BALB/c mice resulted in leukemic death of all diluent-injected mice by day 26. Mice who received the same number of leukemic cells and also received 1,25(OH)2D3 (0.1 micrograms q.o.d., i.p.) had nearly an identical survival curve. Those who received the leukemic cells and 1,25(OH)2-16-ene-23-yne-D3 (1.6 micrograms q.o.d., i.p.) had a significantly (P = 0.003) longer survival, with the last mouse dying of leukemia on day 50. (ii) Injection of 50% fewer leukemic cells (1 x 10(5) cells) into syngeneic BALB/c mice resulted in 86% dead of leukemia at 51 days. Experimental mice who received the same number of leukemic cells and 1,25(OH)2-16-ene-23-yne-D3 (0.8 microgram q.o.d.) had a significantly (P = 0.0006) longer survival than controls; only 53% of the mice were dead by day 100. (iii) After injection of 1.5 x 10(4) leukemic cells, 13% of syngeneic BALB/c mice were free of disease at day 180. In contrast, 43% of mice who received leukemic cells and 1,25(OH)2-16-ene-23-yne-D3 (1.6 micrograms q.o.d.) were still free of disease at day 180. In summary, 1,25(OH)2-16-ene-23-yne-D3 is a vitamin D analog that significantly increased survival of mice who had myeloid leukemia.

Influence of risk factors on cerebrovascular accidents (CVA) in cardiac surgery has been investigated in several studies, but no one has identified differences in risk factors on intraoperative CVA (I-CVA) and postoperative CVA (P-CVA). I-CVA is identified when evidence of CVA is seen as patient emerges from anesthesia and P-CVA is identified if after emerging from anesthesia normally, signs of CVA then appear. To explore proper preventive strategies for each CVA, data were reviewed in 4351 adult patients who underwent cardiac surgery between 1/1/90 and 6/30194. Sixty (1.38%) patients suffered I-CVA and 53 (1.24%) patients experienced P-CVA. CVA patients are older (I-CVA: 69.6 vs. 64.2, p l 0.001; P-CVA: 70.1 vs. 64.1, P l 0.001) and I-CVA shows a higher proportion of females (45.0% vs. 30.0%. p = 0.01). The rates of I-CVA and P-CVA are 1.48% and 1.34% for isolated CABG patients (n = 3037). 0.28% and 0.70% for isolated valve patients (n = 713). 1.90% and 1.69% for patients who undervvent combined procedures (n = 422), 2.79% and 0.57% for other surgeries (n = 179). Patient age (p l 0.001) and proportion of females (p l 0.0011 differed by procedures (CABG: 64.6 ± 10.4.25.0%; Valve: 60.4 ± 15.7.46.1%; CABG + Valve: 704 ± 9.0, 34.8%; others: 58.4 ± 16.2.44.7%). In order to adjust influence of preoperative risk factors on each CVA. stepwise logistic regression was applied to a subset of isolated CABGs. Intraoperative CVA Postoperative CVA Risk Factor Odds Ratio p Risk Factor Odds Ratio p Carotid Disease 4.81 l0.001 Prior Stroke 7.33 l0.001 Renal Disease 4.04 l0.001 Refuse blood 6.68 0.003 Diabetes 2.62 0.003 Cardiac Arrest 6.60 l0.001 MI ≥ 30 Days 2.50 0.103 Carotid Disease 3.61 0.012 Age ≤ 65 Years 1.91 0.074 Cardiogenic Shock 3.02 0.014 Female Gender 1.80 0.063 Age≥ 75 Years 2.05 0.041 Conclusions (1) The risk of I-CVA or P-CVA is higher for CABG procedures, with or without associated valve procedure, than for isolated valve procedures. (2) Patient age is a predictor for I-CVA and P-CVA. (3) There may be a slightly increased risk for I-CVA in females.

Incremental ventricular pacing or alternating current have been traditionally used to induce ventricular fibrillation (VF) while testing defibrillating function of the ICD. The available data are limited on ventricular fibrillation induction efficacy of the low energy T-wave shocks. To determine this, we analyzed data in 14 patients with Medtronic ICDs (7219C 9 pts, 7219D 2 pts, PCD 3 pts) who had undergone a total of 110 VF induction attempts either at time of ICD implant or during follow-up noninvasive EPS. The underlying heart disease was coronary in all patients with prior myocardial infarction in 10 patients. The LV ejection fraction was 30 ± 12% (range 15–64%). QT interval 440 ± 57 ms (range 360–560 ms) and QTc interval 449 ± 49 ms (range 336–520 ms) The low energy synchronized shocks (0.2–2 J) were delivered to the T wave of last of the 8 beat paced train at 400 ms with Sl-T delays ranging between 290–340 ms. Of 110 attempts with T wave shocks, the inducible arrhythmia was VF in 69%. nonsustained polymorphic ventricular tachycardia (VT) in 15%, monomorphic VT in 2% and none in 14%. The VF induction efficacy was 75% (69 of 92 attempts) for T-wave shock energy of g0.6 J compared with 50% (9 of 18 attempts) for T-wave shock energy of ≤ 0.6 J (P l 0.05). In contrast, the VF induction efficacy was unaffected by S1-T delays ranging from 290–330 ms. It was 80% 14/5) at S1-T delay of 290 ms, 80% (4/5) at S1-T delay of 300 ms, 70% (44/66) at S1-T delay of 310 ms, 78% (7/9) at S1-Tdelay of 320 ms, 74% (17/23) at S1-T delay of 330 ms and 0% (0/2) at S1-T delay of 340 ms. In no patients incremental ventricular pacing or alternating current had to be used to induce VF. We conclude that a low energy (1–2 J) shock, when synchronized to the paced-T wave withS1-T delays of 290–330 ms, induces VF in over 70–80% of the attempts. This precludes the need for prolonged ventricular bursts or the use of alternating current and should, thus, be the preferred modality of choice while inducing VF to check ICD function.