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BACKGROUND AND OBJECTIVES The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. METHODS We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (

In this paper is presented a sense-amplifier-based physically unclonable function (PUF) with individually embedded non-volatile memory (eNVM) that offers 100% stable random bits. The proposed eNVM, which stores the initially generated random key, biases the sense-amplifier to reproduce always the same key as the initial value through a feedback path. In order to verify the performance of the proposed architecture, a 256-bit PUF with a core area of 0.160 mm2 was implemented in a 180 nm standard CMOS process. The measurement results of the implemented PUF show an intra-chip Hamming Distance (HD) of 0 (100% stability) and inter-chip HD of 0.5047.

Pectus excavatum (PE) is known as one of the most common congenital deformities of the anterior chest wall. The Nuss procedure is an effective surgical therapy to correct PE. Here, we report a case of recurrent cardiac tamponade due to hemopericardium that occurred after 16 months following the Nuss procedure. The cause of recurrent hemopericardium was thought to be local, repetitive irritation of the pericardium by the Nuss steel bar. We should keep in mind that this serious complication can occur after the Nuss procedure, even in the late phase.

Left main coronary artery (LMCA) thrombosis is rare and the cause should be determined. A previously healthy young man presented with severe chest pain and dyspnea. The electrocardiogram showed typical ST-segment elevation myocardial infarction with clinical instability. Emergency coronary angiography revealed complete LMCA occlusion by thrombosis. After reperfusion, the patient was admitted to the cardiac care unit. He was diagnosed with hemolytic anemia and tested positive for antinuclear antibodies. Systemic lupus erythematosus (SLE) and LMCA disease due to systemic thrombosis were diagnosed. Steroids were started and the patient was discharged without complications. We report this rare case of LMCA thrombosis as an initial presentation of SLE.

Purulent pericarditis is defined as a localized pericardial infection with gross pus formation in the pericardial space. Although purulent pericarditis is now rare in the antibiotic era, it may be life-threatening. We describe a rare case of purulent pericarditis that originated from a subdiaphragmatic suppurative focus in an immunocompromised host.

Objective: Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. Methods: A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. Results: Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (&beta, = 0.345, p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (&beta, = 0.249, p = 0.036 and &beta, = 0.467, p &lt, 0.001, respectively). Conclusions: Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients.

This paper presents a fractional gain-control technique for a digitally controlled oscillator (DCO). The proposed fine-fractional gain-control scheme improves the jitter performance by suppressing the nonlinear effect of a bang-bang digital phase-locked loop (BB-DPLL). In addition, the proposed structure significantly reduces the chip area, because the proposed fractional DCO dithering circuit requires only one accumulator with an N-2-bit width, while conventional topologies require multiple accumulators with N-bit widths. The simulation result shows that the period jitter of the proposed structure (0.83 ps) is three times better than that of a digital PLL based on a conventional second-order sigma-delta modulator (2.58 ps).

Background In this study, the prevalence, characteristics, and clinical significance of concomitant specific cardiomyopathies were investigated in subjects with bicuspid aortic valve (BAV). Methods We retrospectively evaluated 1,186 adults with BAV (850 males, mean age 56 ± 14 years). Left ventricular non-compaction, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy were diagnosed when patients fulfilled current clinical and echocardiographic criteria. Clinical and echocardiographic characteristics including comorbidities, heart failure presentation, BAV morphology, function, and aorta phenotypes in BAV subjects with or without specific cardiomyopathies were compared. Results Overall, 67 subjects (5.6 %) had concomitant cardiomyopathies: 40 (3.4%) patients with left ventricular non-compaction, 17 (1.4%) with hypertrophic cardiomyopathy, and 10 (0.8%) with dilated cardiomyopathy. BAV subjects with hypertrophic cardiomyopathy had a higher prevalence of diabetes mellitus, heart failure with preserved ejection fraction, and tended to have type 0 phenotype, while BAV subjects with dilated cardiomyopathy showed a higher prevalence of chronic kidney disease and heart failure with reduced ejection fraction. BAV subjects with left ventricular non-compaction were significantly younger, predominantly male, and had greater BAV dysfunction and a higher prevalence of normal aorta shape. In multiple regression analysis, presence of cardiomyopathy was independently associated with heart failure (odds ratio 2.866, 95% confidential interval 1.652–4.974, p Conclusion Concomitant cardiomyopathies were observed in 5.6% of subjects with BAV. A few clinical and echocardiographic characteristics including comorbidities, heart failure presentation, BAV morphology, function, and presence of aortopathy were found. The presence of cardiomyopathy was independently associated with heart failure.

Background: Recent studies have suggested new P2Y12 antagonists (prasugrel /ticagrelor) are more effective in high thrombotic conditions than conventional clopidogrel The aim of this study was to compare the clinical outcomes between clopidogrel abd new P2Y12 antagonist in acute myocardial infarction patients treated with percutaneous coronary intervention (PCI). Methods: Between November 2011 and January 2016, a total of 11,731 AMI patients treated with PCI (7580 patients were prescribed clopidogrel and 4151 patients new P2Y12 antagonists) were enrolled in the Korean Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) database. Propensity score matching was performed to adjust for differences in baseline clinical variables. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial infarction, target-lesion revascularization (TLR), and stroke. Results: After propensity matching (4151 pairs), the rate of MACCEs were more frequently occurred in the clopidogrel group than in the new P2Y12 (8.2% vs. 6.4%, p=0.002). The difference in MACCE between two groups was driven by cardiac death (4.7% vs. 3.3%, p Conclusion: Our study shows that new P2Y12 antagonist was associated lower rate of MACCE and cardiac mortality in AMI patients treated with PCI.

Patient Initials or Identifier Number 26066764 ### Relevant Clinical History and Physical Exam A 78 - year - old man was referred for treatment of asymptomatic Abdominal aorta aneurysm (AAA). Previous medical history included a hypertension, stable angina, atrial fibrillation and peripheral

Patient Initials or Identifier Number LDS ### Relevant Clinical History and Physical Exam A 74 year-old man visited our hospital for dyspnea (NYHA III). He had a medical history of hypertension, diabetes mellitus, and stable angina. Physical examination showed regular heart beat with systolic

Background Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. Methods A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI−, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. Results The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI−, P

BACKGROUND Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. METHODS A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI-, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. RESULTS The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI-, P

The clinical impact of BMI especially in old age patients have not yet been sufficiently evaluated. The aim of this study was to investigate the clinical impact of body mass index (BMI) in old age patients (≥80 years) with acute myocardial infarction (AMI). We analyzed a total of 2,489 AMI

Mid-ventricular obstruction (MVO) occurs in approximately 10% of patients with hypertrophic cardiomyopathy (HCM). Without HCM, small ventricular chamber or hypercontractility may play an important role in producing dynamic MVO. A 50 year-old female patient was consulted to cardiology department for

Cardiogenic embolic stroke accounts for approximately 20% of ischemic strokes and the likelihood of its recurrence is high. Paradoxical embolism may be an important cause of cardioembolic stroke, which can be evaluated through multiple diagnostic modalities including transesophageal echocardiography (TTE) or transcranial Doppler. A persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly, which mainly drains to the right atrium via the coronary sinus. Although rare, PLSVC draining into the left heart predisposes the patient to paradoxical embolism through a right-to-left shunt. We report on a 78year-old female patient with an ischemic stroke associated with PLSVC draining into the left atrium through the pulmonary vein, which was investigated via TTE with an agitated saline test and computed tomography.

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.

Double-chambered right ventricle (DCRV) is a rare heart defect in which the right ventricle (RV) is separated into a high pressure proximal chamber and a low pressure distal chamber. Involvement of RV in hypertrophic cardiomyopathy (HCM) complicated with DCRV is very uncommon, however, can cause