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Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions.Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pThe 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

Drug combinations rather than increasing doses of one drug can achieve greater efficacy and lower risks. Thus, as an alternative to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy can lower LDL cholesterol concentrations effectively while reducing adverse effects. However, evidence from randomised trials to compare long-term clinical outcomes is needed.In this randomised, open-label, non-inferiority trial, patients with atherosclerotic cardiovascular disease (ASCVD) at 26 clinical centres in South Korea were randomly assigned (1:1) to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke, in the intention-to-treat population with a non-inferiority margin of 2·0%. This trial is registered with ClinicalTrials.gov, NCT03044665 and is complete.Between Feb 14, 2017, and Dec 18, 2018, 3780 patients were enrolled: 1894 patients to the combination therapy group and 1886 to the high-intensity statin monotherapy group. The primary endpoint occurred in 172 patients (9·1%) in the combination therapy group and 186 patients (9·9%) in the high-intensity statin monotherapy group (absolute difference -0·78%; 90% CI -2·39 to 0·83). LDL cholesterol concentrations of less than 70 mg/dL at 1, 2, and 3 years were observed in 73%, 75%, and 72% of patients in the combination therapy group, and 55%, 60%, and 58% of patients in the high-intensity statin monotherapy group (all p0·0001). Discontinuation or dose reduction of the study drug by intolerance was observed in 88 patients (4·8%) and 150 patients (8·2%), respectively (p0·0001).Among patients with ASCVD, moderate-intensity statin with ezetimibe combination therapy was non-inferior to high-intensity statin monotherapy for the 3-year composite outcomes with a higher proportion of patients with LDL cholesterol concentrations of less than 70 mg/dL and lower intolerance-related drug discontinuation or dose reduction.Hanmi Pharmaceutical.

BACKGROUND: Moderate-intensity statin role with ezetimibe combination therapy following percutaneous coronary intervention (PCI) has not been thoroughly investigated, particularly compared to high-intensity statin monotherapy. We aimed to investigate the effect of ezetimibe combination with moderate-intensity statin in patients with atherosclerotic cardiovascular disease following PCI. METHODS: This was a post-hoc analysis of a subset of patients who underwent PCI in the RACING trial. At 26 centres in South Korea, patients with atherosclerotic cardiovascular disease (ASCVD) were randomly assigned to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The prespecified endpoints of the RACING trial were used. The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, and nonfatal stroke. Event rates between the two groups were compared using log-rank tests, and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox regression analysis. Consistent with the RACING trial, the primary and secondary efficacy endpoints were evaluated using an intention-to-treatment approach, and the safety endpoints were assessed in the safety population. The RACING trial was registered at ClinicalTrials.gov (NCT03044665). FINDINGS: Between Feb 14, 2017, and Dec 18, 2018, 3780 participants were enrolled in the RACING trial. Prior history of PCI was found in 2497 patients (67%, median 64 years, 79% male), and was associated with higher rates of the primary endpoint (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.06–1.69; p = 0.014). Among patients with prior PCI, moderate-intensity statin therapy with ezetimibe combination versus high-intensity statin therapy did not increase the risk of the primary endpoint (HR, 0.95; 95% CI, 0.74–1.24; p = 0.781). The proportion of patients with low-density lipoprotein cholesterol (LDL-C)

Background It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years' TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis. Conclusions The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

The effect of slag composition under M’O (monoxide, M = Fe,Mg) saturation and fully liquid conditions on dephosphorization and slag foamability was evaluated in an electric arc furnace (EAF) steelmaking plant operation by considering thermodynamics and phase equilibria. It was confirmed that M’O saturation slag is more favorable for higher dephosphorization than fully liquid slag due to its high activity of CaO as a thermodynamic driving force. As a quantitative measure of slag foamability, the foaming index was clearly dependent on the temperature and slag composition. Moreover, foam stability was evaluated by applying the predominance stability diagram based on phase equilibria. Consequently, it can be suggested that an efficient direction for dephosphorization and slag foaming during the EAF process is to generate high CaO activity as well as small amounts of M’O monoxide and dicalcium silicate (Ca2SiO4) compounds.

Purpose We compared the efficacy and safety of third-standard-dose triple and third-standard-dose dual antihypertensive combination therapies in patients with mild to moderate hypertension. Methods This was a phase II multicenter, randomized, double-blind, parallel-group trial. After a 4-week placebo run-in period, 245 participants were randomized to the third-dose triple combination (ALC group; amlodipine 1.67 mg + losartan potassium 16.67 mg + chlorthalidone 4.17 mg) or third-dose dual combination (AL group; amlodipine 1.67 mg + losartan potassium 16.67 mg, LC group; losartan potassium 16.67 mg + chlorthalidone 4.17 mg, AC group; amlodipine 1.67 mg + chlorthalidone 4.17 mg) therapy groups and followed up after 8 weeks. Results The mean systolic blood pressure (BP) reduction was − 18.3 ± 13.2, -13.0 ± 13.3, -16.3 ± 12.4, and − 13.8 ± 13.2 mmHg in the ALC, AL, LC, and AC groups, respectively. The ALC group showed significant systolic BP reduction compared to the AL and AC groups at weeks 4 (p = 0.010 and p = 0.018, respectively) and 8 (p = 0.017 and p = 0.036, respectively). The proportion of systolic BP responders was significantly higher in the ALC group (42.6%) than in the AL (22.0%), LC (23.3%), and AC (27.1%) groups (p = 0.013, p = 0.021 and p = 0.045, respectively) at week 4. The proportion of systolic and diastolic BP responders was significantly higher in the ALC group (59.7%) than in the AL (39.3%) and AC (42.4%) groups (p = 0.022 and p = 0.049, respectively) at week 8. Conclusion Third-standard-dose triple antihypertensive combination therapy demonstrated early effective BP control compared to third-standard-dose dual combination therapies, without increasing adverse drug reactions in patients with mild-to-moderate hypertension. Trial Registration NCT04959305

Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P P P P values were Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01642992 and NCT03068494.

The composition of slags of an electric arc furnace (EAF) in a commercial melt shop was systematically analyzed with a focus on slag foaming. Basic behavior of FeO in an EAF slag was confirmed using fundamental thermodynamics. Monoxide ([Mg,Fe,Mn]O = M’O) and spinel ([Mg,Fe]Al2O4) phases in EAF slag were confirmed by X-ray diffraction analysis, and these results were interpreted in the context of equilibrium cooling calculation using FactSage™ software. Furthermore, the distribution of MgO with respect to the M’O-saturation limit at different basicity ratios (=CaO/SiO2=C/S) and temperatures was evaluated. In particular, the relationship between MgO and FeO for C/S ratios ranging from 1.3 to 1.6 was considered with reference to phase equilibria. Foam height was affected by slag viscosity (η) and gas generation according to changes in C/S ratio and FeO content. Foaming index (Σ) decreased with the increasing C/S ratio and FeO content. The measured foam heights were relatively higher than the calculated values, and the result indicates that the effect of M’O on slag foaming in commercial process is remarkable. Therefore, slag chemistry should be optimized based on thermodynamic considerations and thermophysical properties to achieve good foaming characteristics.

In this study, we investigated the effect of CaO/SiO2 (C/S) ratio on the crystallization behavior of the CaO-SiO2-FetO-Al2O3 slag system, which simulates the mixed mineral wastes of red mud, mine tailings, and waste limestone, using a differential scanning calorimetry (DSC) technique. The crystallization behavior of both isothermal and non-isothermal cooling was simultaneously evaluated using X-ray diffraction (XRD) analysis and scanning electron microscopy (SEM) images. The calculated equilibrium phases, such as pseudo-wollastonite (ps-CaSiO3) and melilite (Ca2[Al,Fe][Si,Al]2O7), crystallized during the cooling process at different C/S ratios (=0.65–1.02). The C/S ratios were varied by simulating the various mixing ratios among red mud, mine tailings, and waste limestone. Even with a relatively low cooling rate of 5 °C/min, none of the exothermic peaks were detected during cooling, irrespective of the C/S ratio. However, pseudo-wollastonite and melilite phases in the slag samples were identified by the XRD and SEM analyses, except for the C/S = 0.65 slag. Ability of crystallization increased with increasing C/S ratio due to increased fluidity of the slags based on the structural consideration. As a result, our findings show that crystallization is increasingly difficult with a decrease in C/S ratio. Although the isothermal holding process remains between 900 °C and 1200 °C for a long period of time at relatively high basicity (C/S = 1.02) in the present system, weak and delayed crystallization was observed in the slag. Consequently, this study provides evidence that CaO-SiO2-FetO-Al2O3 (C/S = 0.65–1.02) slags exhibit strong vitrification characteristics and control of melts viscosity is important to granulation process to produce commercial grade of glass ball by using mineral wastes such as red mud, mine tailing and waste limestone.

This study investigated the reaction between CaO-SiO2-Al2O3-xFeO-MgO-MnO (CaO/SiO2 = 1.2, x = 20–50 wt%) slag and magnesia refractory. Using SEM-EDS analysis, we confirmed the formation of a (Mg,Fe)Oss(solid_solution), called magesiowustite (MW), intermediate layer at the slag-refractory interface. MgO dissolved from refractory and reacted with the bulk slag to form MW layer at the interface. Simultaneously, slag penetrated through micro-pores and reacted with the refractory to form MW layer. In other words, the MW layer built up in both directions from initial refractory-slag interface. The thickness of the MW layer increased as the FeO content in the slag increased, and using EDS line scanning, a Mg and Fe concentration gradient was confirmed within the MW layer. The slag, which penetrated into the refractory, had a chemical composition of the CaO-SiO2-Al2O3-MgO system without FeO, indicating that FeO was consumed by forming a MW layer at the refractory hot face. The slag-refractory interfacial reaction was simulated using thermochemical software, FactSage™7.0. The results predicted a MW monoxide composed of MgO and FeO. A spinel phase was formed when FeO was greater than 40 wt%. These thermochemical computations were comparable to our experimental findings.

The carbothermic smelting reduction process of ilmenite ore at high temperature was investigated by thermodynamic calculations in conjunction with smelting experiments. Based on thermodynamic calculations, conducting the smelting process at a higher temperature was recommended to achieve a larger amount of FeO reduction, i.e., higher Ti-enrichment, as less precipitate and thus large amounts of a liquid slag were predicted. However, even though the reduction of FeO in ilmenite ore at the initial stage seemed to be faster as the temperature increased, no significant difference in the TiO2 or FeO concentration was observed after the reaction was complete, regardless of the temperature. This was caused by the precipitation of pseudobrookite due to the local depletion of FeO during reaction at higher temperatures, by which further reduction reaction was prohibited. The apparent rate constant increased with increasing temperature and the activation energy of the reduction process was estimated to be 144 kJ/mol, from which it was concluded that the reduction reaction of FeO in ilmenite slag by carbonaceous reductant was generally controlled through the mass transfer in the slag phase. Additionally, the formation of TiC also occurred in the iron bath. At 1923 K (1650 °C), approx. 20 pct more TiC was generated as compared to TiC formation at 1823 K (1550 °C), which also prevented further reduction of Fe at higher temperatures.

We investigated the effect of Al-C composite pellets (ACCP) on the reduction behavior of FeO in electric arc furnace (EAF) slag and the iron recovery at different nAl/(nAl + nC) at 1823 K (1550 °C). A carbothermic reaction was the dominant process at nAl/(nAl + nC) 0.6; these observations are based on the final content of FeO and Al2O3 in the molten slag. The aluminum and carbon present in the ACCP competitively affected the reaction stoichiometry (i.e., the material balance) between the production of CO + Al2O3 and the consumption of FeO. Iron recovery increased up to a yield of approx. 90 pct as the nAl/(nAl + nC) ratio increased. Because Al in the ACCP readily reacts to reduce FeO in the molten slag, iron recovery is proportional to the nAl/(nAl + nC) ratio. The precipitation of solid compounds in the slag phase, such as monoxide ([Mg,Fe]·O) and spinel (MgO·Al2O3), occurred during FeO reduction; this was experimentally confirmed as well as by thermochemical computation. Furthermore, we proposed a schematic reaction mechanism in the present study.

Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p

Background: The optimal side branch (SB) treatment strategy after simple crossover stenting in bifurcation lesions is still controversial. Objectives: The purpose of this study was to compare the long-term outcomes of a 1-stent strategy with simple crossover alone versus with an additional SB–opening procedure in patients with left main (LM) and non-LM coronary bifurcation lesions. Methods: Patients who underwent percutaneous coronary intervention with a 1-stent strategy for bifurcation lesions including LM were selected from the COBIS (Coronary Bifurcation Stenting) III registry and divided into the simple crossover–alone group and SB-opening group. Clinical outcomes were assessed by the 5-year rate of target lesion failure (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization). Results: Among 2,194 patients who underwent the 1-stent strategy, 1,685 (76.8%) patients were treated with simple crossover alone, and 509 (23.2%) patients were treated with an additional SB-opening procedure. Although the baseline SB angiographic disease was more severe in the SB-opening group, the final lumen diameter of the SB was larger. The 5-year observed target lesion failure rate was similar between the 2 groups (7.0% in the simple crossover vs. 6.7% in SB-opening group; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.48; p = 0.947), even in the subgroup analyses including LM (9.5% vs. 11.3%; p = 0.442) and true bifurcation (5.3% vs. 7.8%; p = 0.362). The results were not changed after an inverse probability of treatment weighting adjustment. There was no difference in the overall and SB-related target lesion revascularization rate in both groups. Conclusions: The long-term clinical outcome of the 1-stent strategy with simple crossover alone for coronary bifurcation lesions was acceptable compared to those of additional SB-opening procedures. (Korean Coronary Bifurcation Stenting [COBIS] Registry III [COBIS III]; NCT03068494)

Endurance exercise training (ET) can improve outcomes for patients with heart failure (HF). We investigated the preventive effects of ET on serum biomarkers for HF in mice treated with doxorubicin (DOX).A cohort of male wild-type mice were randomly assigned to 3 groups: sedentary control (CON), DOX-treated sedentary (DOX), and DOX-treated endurance ET (ET-DOX) groups. ET groups performed moderate intensity endurance ET on a motor treadmill for 8 weeks. After 8 weeks, the DOX and ET-DOX groups were treated with DOX via weekly intraperitoneal injections of 8 mg/kg for a total of 4 weeks. We compared M-mode echocardiography, histology, and biomarkers for HF between groups.A total of 30 mice survived during the study period and were analyzed: CON (n=9), DOX (n=9) and ET-DOX (n=12). There was no significant difference in left ventricular ejection fraction (LVEF) or fractional shortening (FS) between DOX and ET-DOX groups. The ET-DOX group had a significantly lower soluble ST2 level (176.6±44.1 vs. 225.4±60.5 pg/mL, p=0.021) compared to the DOX group. Also similar between the ET-DOX and the DOX groups were the serum N-terminal prohormone of brain natriuretic peptide (30.3±12.5 vs. 34.0±21.7 pg/mL, p=0.849), troponin I (685.7±99.2 vs. 722.5±126.7 pg/mL, p=0.766), and neutrophil gelatinase-associated lipocalin (324.3±82.4 vs. 312.7±68.2 pg/mL, p=0.922) levels. Histologically, there was no significant difference in degree of perivascular fibrosis between DOX and ET-DOX groups.Endurance ET is effective for preventing increases in serum soluble ST2 in mice treated with DOX.

We investigated the carbothermic reduction process of ilmenite ore at 1873 K with flux addition. Without flux, the pseudobrookite phase with a high melting temperature was precipitated during ilmenite smelting. This could be the main reason for decreased reduction of iron in ilmenite. To accelerate reduction of ilmenite, two factors were considered. One is increasing the reduction driving force during smelting. Activity of FeO is the major factor to control reduction in driving force. The other factor is delay in formation of the pseudobrookite phase, a high-melting point precipitation phase. In this system, MgO in ilmenite could be used to form pseudobrookite. To control these factors, in this study, flux agent (i.e., Na2O or SiO2) addition was considered. The thermochemical simulation program, FactSageTM7.0 was used to calculate the viscosity of slag and the activity of components as fluxing agents were added. High-temperature experiments using an induction furnace were also conducted to confirm the computational results. To determine the composition of final products, i.e., titanium slag, X-ray fluorescence analysis was executed. As a result of Fe and Ti behaviours in slag, SiO2 addition showed no significant difference from the slag without flux. However, Fe reduction in ilmenite, i.e. TiO2-enrichment, was more accelerated when Na2O was added. X-ray diffraction, scanning electron microscopic and transmission electron microscopic analyses results also showed that even 1 wt% Na2O addition significantly influenced the titanium slag production compared to no flux addition.

BACKGROUND Recent studies have demonstrated that angiotensin receptor neprilysin inhibitors (ARNIs) can reverse the cardiac remodeling effects that occur in heart failure with reduced ejection fraction (HFrEF). These studies have also suggested that ARNIs have favorable effects on ventricular dyssynchrony. We assessed the changes in QRS duration associated with ARNIs in patients with HFrEF. METHODS We retrospectively investigated patients with HFrEF (defined by a left ventricular ejection fraction [LVEF] ≤ 35%) who were treated with ARNIs for at least six months. We divided the patients into QRS shortening and non-QRS shortening groups according to their electrocardiogram (ECG) findings. We also compared changes in echocardiographic parameters between the groups. RESULTS A total of 68 patients with HFrEF were included (mean age: 62.5 years, 74.6% male). Twenty-one patients had significant ischemic heart disease (IHD). Thirty-five patients exhibited QRS-duration shortening on follow-up ECGs (mean change: -7.8 msec), and 33 patients showed no changes or increased QRS duration (mean change: 5.1 msec). The QRS shortening group exhibited significant improvement in LVEF (12.5 ± 15.3% vs. 1.7 ± 9.5%; p < 0.001) when compared with the non-QRS shortening group. The QRS shortening group also had significantly lower LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD) and LV mass index (LVMI) than did the non-QRS shortening group. The change in QRS duration was significantly correlated with the change in LVEF (r = -0.329, p = 0.011) and LVESD (r = 0.298, p = 0.022). CONCLUSIONS Among patients with HFrEF treated with ARNIs, the QRS shortening group showed favorable LV systolic function recovery, and reversal of cardiac remodeling compared to those of the non-QRS shortening group. Change in the QRS duration, which reflects LV synchrony, may be associated with response to ARNIs in patients with HFrEF.

Background: Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. Methods: The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HR adj , 1.846 [95% CI, 1.317–2.588]; P P adj , 1.848 [95% CI, 1.045–3.266]; P =0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HR adj , 2.698 [95% CI, 1.276–5.706]; P =0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HR adj , 0.694 [95% CI, 0.306–1.572]; P =0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HR adj , 0.925 [95% CI, 0.428–2.001]; P =0.843). Conclusions: Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03068494.

Inhibitors of sodium-glucose cotransporter 2 (SGLT2i) reduce the risk of hospitalization for heart failure (HF). We aimed to examine the effect of empagliflozin on change of diuretics dose in outpatient HF patients.We retrospectively reviewed the medical records of 612 patients who were treated using both empagliflozin and diuretics. We excluded patients who did not meet the criteria for HF. Dose and duration of empagliflozin and diuretics were measured.Of 612 patients, a total of 251 was analyzed and followed for a mean 430.0±175.4 days. The mean age was 69.3, 51.8% were female, and 93.2% had type 2 diabetes. The distribution of initial diuretics type when starting empagliflozin showed that furosemide comprised 24.7%, spironolactone 20.7%, thiazide 36.9%, and others. Total 23.1% of patients reduced diuretic dose, 13.1% increased diuretic dose, 41.4% continued at the same diuretic dose, and 22.3% switched to different diuretics. Among patients who were using furosemide, 36.0% reduced diuretics dose. There was a diuretic reduction in 22.6% of HF preserved ejection fraction (HFpEF, left ventricular ejection fraction [LVEF] ≥50%) and in 26.5% of HF reduced EF (HFrEF, LVEF50%). The average doses furosemide at the start of empagliflozin decreased from 16.3mg/day to 8.5mg/day at the time of follow-up.Among outpatient clinic HF patients treated with both diuretics and empagliflozin, 23.1% of patients had their diuretics reduced, and the mean dose of furosemide was reduced by about half. This suggests that empagliflozin has clinical advantages in managing outpatient HF patients.

Many patients with end-stage renal disease (ESRD) on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). This study aimed to determine the factors associated with acute decompensation events among ESRD patients undergoing HD.We retrospectively investigated ESRD patients on HD using a medical record review. We divided the patients into those admitted to hospital due to acute decompensated heart failure (ADHF) and those who were not. We compared the medical histories, electrocardiograms, and echocardiographic and laboratory data between the two groups.Of the 188 ESRD patients on HD, 87 were excluded, and 101 were enrolled (mean age: 63.7 years; 52.1% male). Thirty patients (29.7%) were admitted due to ADHF. These patients exhibited similar left ventricular ejection fraction (LVEF), left ventricular (LV) mass index, and E/E' values compared to the non-ADHF group. However, the ADHF group exhibited significantly higher tricuspid regurgitation (TR) jet velocity (2.9±0.6 vs. 2.5±0.4 m/s; p=0.004) and right ventricular systolic pressure (RVSP) (43.5±17.2 vs. 34.2±9.9 mmHg; p=0.009) than the non-ADHF group, respectively. A multivariate logistic regression analysis demonstrated that the TR jet velocity (odds ratio, 8.356; 95% confidence interval, 1.806-38.658; p=0.007) was an independent predictor of ADHF after adjusting for age and sex, while the LVEF and E/E' were not.Our data showed that an increased TR jet velocity was an independent predictor of ADHF events in ESRD patients on HD, but the LVEF and E/E' were not.

We investigated the effect of direct reduced iron (DRI) addition on dephosphorization of molten steel by electric arc furnace (EAF) slag at 1823 K (1550 °C). Various phenomena such as CO gas evolution and slagmaking by gangue oxides in DRI were experimentally observed at each reaction step. Thermodynamic behaviors of phosphorus, oxygen, and carbon were strongly dependent on DRI content. Basicity, which is the thermodynamic driving force of dephosphorization, decreased with the increasing DRI content because SiO2 concentration in the slag was proportional to DRI addition. The excess free energy of P2O5 increased with the increasing SiO2 content in slag. A higher DRI content made dephosphorization difficult by decreasing the basicity and stability of P2O5 in the slag. Therefore, when using DRI in EAF process, it is very important to control the basicity of slag.

In 9 to 12 pct chromium steels, the high-temperature mechanical properties are known to be strongly dependent on the formation and coarsening of Laves phase precipitates at boundaries. During high-temperature deformation, the Laves phase precipitate coarsening to over a critical size has been considered to trigger cavity formation at the precipitate-matrix interfaces. This coarsening, accompanied by the diffusion of W, Mo, and Cr, should change the mechanical properties and chemical composition of both Laves phase precipitates and the matrix. In this study, we aimed to clarify the effects of compositional changes of Laves phase precipitates on cavity formation during coarsening. The values of the Fe/Cr and W/Mo ratios in Laves phase precipitates were shown to induce different levels of strain energy in the vicinity of the Laves phase precipitate, consequently promoting the formation of cavities. Therefore, the compositional change of Laves phase precipitates was found to play a critical role in the grain boundary embrittlement of high Cr steel at elevated temperature.

Backgrounds: Identification of precursors of atrial fibrillation (AF) may lead to early detection and prevent associated morbidity and mortality. Atrial premature complexes (APCs) are commonly seen in healthy subjects. However, there was limited data about the clinical and electrocardiographic (ECG) characteristics for prediction of new-onset AF in asymptomatic patients with APCs in the long-term follow up. Methods: The Kosin University (No. 2014-02-04) 24-h holter monitoring, echocardiography, ECG database were reviewed from 2008 to 2016 to identify new- onset AF in patients with APCs. We analyzed demographic and clinical features and the nature of the APCs by ECG according to new-onset AF in those patients. Results: Among 652 patients who underwent 24-h holter monitoring, 226 (34.4%) patients had new-onset AF. There was no difference of the baseline characteristics between new-onset AF group and non-AF group. In univariate analysis, hypertension (HTN), renal failure (CRF), high APC burdens, fastest APC running heart rate (HR), minimal HR, left ventricular ejection fraction (LVEF), left atrial volume index, peak mitral flow velocity of the early rapid filling wave and tricuspid regurgitation grade were significantly associated with new-onset AF. In multivariate analysis, higher APCs burden (P = 0.047), higher fastest APCs running HR (P = 0.034) and lower minimal HR (P = 0.025) were independent risk factors for new-onset AF in asymptomatic patients with APCs. Conclusion: Higher APCs burden, higher fastest APCs running HR and lower minimal HR were associated with new-onset AF in asymptomatic patients with APCs in the long-term follow up. Keywords: Atrial premature complex, New onset atrial fibrillation, Electrocardiographic characteristics, Clinical outcomes

Introduction: Premature ventricular complex (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. However, there was limited data about the association between high PVCs burdens (>10%) and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up. Methods: The Kosin University 24-hours holter monitoring, echocardiography, electrocardiogram (ECG) database were reviewed from 2013 to 2015 to identify patients with frequent PVCs (>10%). We compared the long-term clinical outcomes between the patients with frequent PVCs (>10%) and control group without PVC. Results: Among 572 patients who underwent 24-hours holter monitoring, finally, 373 consecutive patients (mean age; 59.5 ± 15.8 years, 45.2% male) were enrolled. Among them, 203(54.4%) patients had high PVCs burdens (>10%). There was no difference of the baseline characteristics. In the long term follow-up, PVCs burden was not associated with PVCs -related symptoms (P = 0.210). In univariate analysis, female, non-sustained ventricular tachycardia (VT), sinus QRS duration, PVC coupling interval (CI), post- PVC CI, and late precordial R-wave transition of PVCs were associated with PVCs-related symptoms. In multivariate analysis, non-sustained VT (P = 0.022) and late precordial R-wave transition of PVCs (P = 0.044) were independent risk factors for PVCs-related stroke-like symptoms with frequent idiopathic PVCs > 10%. Conclusion: High PVCs burdens (>10%) were associated with and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up, suggesting more intensive medical therapy with close clinical follow-up will be required. Keywords: Premature ventricular complex, Stroke-like symptoms, Transient ischemic attack, Clinical outcomes

The use of industrial waste [mill scale (MS), red mud (RM), Al-dross (AD)] as fluxing agents in the sulfurization of Fe-Ni-Cu-Co alloy to matte (Fe-Ni-Cu-Co-S) by carbothermic reduction of CaSO4 was investigated at 1673 K (1400 °C). The sulfurization efficiency (SE) was 76 (± 2) pct at RM or AD single fluxing. However, SE drastically increased to approximately 89 pct at a ‘5AD + 5MS’ combination, which was equivalent to reagent-grade chemical ‘5Al2O3 + 5Fe2O3’ fluxing (SE = 88 pct). The present results can be used to improve the cost-effective recovery of rare metals (Ni and Co) from deep sea manganese nodules.