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Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST-elevation myocardial infarction (STEMI) between 1995 and 2014. Over the past 20 years, 1,658 patients presenting to our center with anterior STEMI underwent primary percutaneous coronary intervention within 12 hours of presentation. We divided these into 4 quartiles, 1995 to 1999 (n = 312), 2000 to 2004 (n = 408), 2005 to 2009 (n = 428), and 2010 to 2014 (n = 510). Across the 4 quartiles, mean age decreased (64.4, 62, 60.3, and 60 years, p 0.01). In all groups, there was a significant rise in prevalence of smoking, hypertension, and obesity. The median length of hospital stay decreased (6, 4.4, 4.2, and 3.6 days, p 0.01), as did the median door-to-balloon time (DBT) (217, 194, 135, and 38 minutes, p 0.01). Thirty-day and 1-year mortality improved over time (14.4%, 11.8%, 8.4%, and 7.8%; and 20.5%, 16.4%, 15.9%, and 13.9%) (p = 0.01 both). Also, 3-year mortality improved (25.3%, 21.6%, 21.3%, and 16.5%, p = 0.02). After adjusting for age, gender, co-morbidities, ejection fraction, clinical shock, and mitral regurgitation, shorter DBT was associated with lower long-term mortality (compared with DBT60 minutes; 60 to 90 minutes hazard ratio [HR] 1.67, 95% confidence interval [CI] 0.93 to 3.00, p = 0.084; 90 to 120 minutes, HR 1.74, 95% CI 1.02 to 2.95, p = 0.04;120 minutes, HR 1.91, 95% CI 1.23 to 2.96, p = 0.004). In conclusion, over the past 2 decades, long-term outcomes improved in patients presenting with anterior STEMI associated with shortening of DBT.

Ischemic mitral regurgitation (IMR) has been associated with worse outcome myocardial infarction. However, severity of mitral regurgitation (MR) and its impact on patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) remains unknown. We sought to determine impact of increasing severity of IMR on outcomes in patients with STEMI undergoing primary PCI. All patients presenting with STEMI who underwent primary PCI within 12 hours of symptoms from 1994 to 2014 were included. IMR was graded from 0 to 4+ within 3 days of index myocardial infarction by echocardiography. Overall, 4,005 patients with STEMI were included. None, 1+, 2+, 3+, and 4+ MR were present in 3,200 (79.9%), 427 (10.7%), 260 (6.5%), 91 (2.3%), and 27 (0.7%) patients, respectively. On multivariate logistic regression analysis, more severe MR was associated with older age, female gender, lower body mass index, anemia, inferior STEMI, and longer door-to-balloon time. The 30-day mortality rates were 6.8%, 7.3%, 8.8%, 19.8%, and 26.1%, respectively, with increasing grade of MR. The 1-year mortality rates were 10.8%, 12.4%, 20.8%, 37.4%, and 37.1%, whereas 5-year mortality rates were 16.2%, 23.1%, 36.5%, 53.8%, and 63%, respectively (p0.001 all), for none to 4+ MR. After adjusting for age, gender, co-morbidities, ejection fraction, and shock by multivariate analysis, severity of IMR was associated with incremental effect on long-term mortality (hazard ratios of 1.42, 1.83, 2.41, and 2.95 for 1+ to 4+ MR respectively, p0.01 for all). In conclusion, higher grades of MR in patients with STEMI undergoing primary PCI are associated with worse short- and long-term outcomes.

In this paper, we report the structural and optical properties of Nb-doped TiO 2 thin films deposited by e-beam evaporation technique. After post annealing in air at 500 °C for 1 h, the samples were characterized by various techniques such as X-ray diffraction (XRD), Raman spectroscopy, UV–Vis spectrophotometry and spectroscopic Ellipsometer. Both XRD and Raman analyses indicate that the films were crystallized into the polycrystalline anatase TiO 2 structure. However it was observed that the crystallinity of the films decreases with the addition of Nb atoms and tends to become amorphous at 20% Nb content in TiO 2 film. Moreover, no new phases such as Nb 2 O 5 , NbO 2 or Nb metal were observed. The band gap energy was found to decrease with the increasing of Nb concentration which was verified by ellipsometric study. Ellipsomtric measurements also indicate that refractive index (n) of the films decreases while extinction coefficient (k) increases with the increasing of Nb content. All these analyses elucidate that the incorporation of Nb atom into TiO 2 may tune the structural and optical properties of TiO 2 thin films.

CdS thin films with different Cu concentrations were grown on glass substrates at room temperature by using the resistive thermal evaporation technique. The effect of Cu doping on the structural, optical and vibrational properties of CdS thin films was investigated. The structural, optical and vibrational analysis was completed using an X-ray diffractrometer and a Raman and a UV-VIS-NIR spectrophotometer. X-ray diffraction data revealed that incorporation of Cu ions improved the crystalline structure but did not change the cubic phase of the CdS thin film with a preferential orientation along the (111) direction. Various optical parameters, like the refractive index, extinction co-efficient, absorption co-efficient, urbach tail energy E e and optical band gap, were determined by using transmission data at different copper concentrations. The Raman peaks appearing at 299 cm−1 and 592 cm−1 for CdS were attributed to the 1LO and 2LO phonons of cubic CdS, and a shift towards low wavenumber region was observed with increasing Cu concentration.

AIM Transcatheter mitral valve implantation (TMVI) is a novel technology for patients with severe mitral valve disease but at high surgical risk. Imaging guidance during the procedure is critical for successful device deployment. Identification of the mitral annular plane (MAP) with fluoroscopy during the procedure is limited by lack of clearly defined landmarks. We hypothesized that a plane defined by left circumflex-right coronary arteries (LCX-RCA) would have a consistent relationship to MAP. METHODS AND RESULTS We studied 25 patients with gated cardiac computed tomography. We identified the MAP and the LCX-RCA plane in mid systole and diastole. The distance between the two planes in prespecified four points (anterior, posterior, medial, and lateral) in the apical 2 and 3-chamber views. Alignment of the planes was described by cranial/caudal angulation for both planes in RAO 30° and LAO 90° (lateral) angulation. Mean age was 81 ± 9 years, 56% of patients had ≥2+ mitral regurgitation. In mid systole, the distances between the LCX-RCA plane and the MAP in the four points were

Primary mitral regurgitation (MR) owing to degenerative changes in the structural components of the mitral valve is a common acquired valvular pathology in the elderly. Surgical correction with mitral valve repair (MVRe) or replacement (MVR) is the mainstay of therapy. A significant proportion of patients are ineligible for MVRe/MVR owing to prohibitive surgical risk from advanced age, poor ventricular function, or associated comorbidities. Percutaneous mitral valve repair techniques have been developed to fill this void. The edge-to-edge MitraClip has accrued the largest human experience. This paper reviews the available literature on the MitraClip device for treatment of primary MR.

Here we report the influence of Sb doping on the structural and optical properties of Zn 1− x Sb x Se (0 ⩽ x ⩾ 0.15) thin films prepared by thermal evaporation technique on glass substrate. Various characterization techniques such as X-ray diffraction (XRD), EDS, Raman spectroscopy and spectroscopic ellipsometer are employed to assess the structural and optical properties of the deposited films. XRD analysis reveals the formation of polycrystalline cubic structure having preferred growth orientation along (1 1 1) plane without any evidence of secondary phases. Crystallographic parameters like grain size, micro strain, dislocation density, number of crystallites per unit area and texture coefficient point out the structural modification in ZnSe films with Sb inclusion. Raman analysis shows the existence of three 1LO, 2LO and 3LO phonon modes at 251, 511 and 745 cm −1 in pure ZnSe while 3LO mode disappears by the incorporation of Sb atoms in ZnSe matrix. Increase in FWHM of Raman peaks with Sb concentration also indicates the change in crystalline quality of ZnSe films which is in accordance with our XRD results. Spectroscopic ellipsometry results demonstrate a decreasing trend for the optical band gap energy (from 2.61 eV to 1.81 eV) with increasing Sb content.

AIMS Patients with severe secondary mitral regurgitation (MR) and normal ejection fraction are being excluded from clinical trials evaluating transcatheter mitral devices. We sought to evaluate the long-term mortality with medical management alone in this patient population. METHODS AND RESULTS We retrospectively evaluated patients diagnosed with ≥3+ MR at our institution over 15 years. Only patients with an ejection fraction ≥60% were included in the study. Those with degenerative mitral valve disease, papillary muscle dysfunction, or hypertrophic cardiomyopathy, and those who underwent mitral valve intervention were excluded. The study included 400 patients (age 71.1±14.8, 25.1% male, ejection fraction 62.5±3.6%). Mechanism of secondary MR was restricted valve motion, annular dilation and apical tethering in 91.5, 4.5 and 4%, respectively. One-year and three-year mortality were 19.1 and 26.3%, respectively. On multivariable Cox proportional regression analysis, older age, New York Heart Association functional Class III or IV, >3+ MR and larger left atrium were independent predictors of mortality. CONCLUSIONS Severe secondary MR with normal left ventricular systolic function has significant mortality with medical management alone. This initial observation needs to be confirmed in larger prospective studies. These patients should be included in future transcatheter clinical trials.

Thin films of CuxZn1−xSe (0 ≤ x ≤ 0.20) have been prepared on glass substrates at room temperature by closed space sublimation. The effect of copper (Cu) concentration on the structural, optical and electrical properties of the prepared films has been investigated using x-ray diffraction (XRD), Raman spectroscopy (RS), spectrophotometery and Hall effect measurements. XRD spectra show that all the films are cubic with (111) preferred orientation. The lattice constants, crystallite size, strain, and dislocation density were calculated from the XRD spectra. The structural analysis shows that crystallite size and crystallinity increase while strain and dislocation density decrease up to 10% Cu addition. However, an opposite trend has been observed beyond 10% Cu concentration. RS was carried out to investigate different phonon bands and crystalline phases. The strong reflection corresponding to the (111) texture in the XRD and the observed longitudinal optical (LO) phonon bands at 251 cm−1 and 497 cm−1 in the Raman spectra reveal the formation of single phase zinc-blende structure. The band gap energy decreases from 2.67 eV to 2.24 eV as the Cu concentration is increased from 0% to 20%. Hall effect measurements shows that electrical resistivity (ρ) is decreased by about three orders of magnitude from 10.4 × 10−03 Ω-cm to 47.9 × 10−03 Ω-cm while, carrier concentration and mobility (μ) is increased with Cu addition.

DC reactive magnetron sputtering technique has been used for the preparation of AlN thin films. The deposition temperature and the flow ratio of N2/Ar were varied and subsequent dependency of the films crystallites orientation/texture has been addressed. In general, deposited films were found hexagonal polycrystalline with a (002) preferred orientation. The X-ray diffraction (XRD) data revealed that the film crystallinity improves, with the increase of substrate temperature from 300 °C to 500 °C. The dropped in full width half maximum (FWHM) of the XRD rocking curve value further confirmed it. However, increasing substrate temperature above 500 °C or reducing the nitrogen condition (from 60 to 30% in the environment) induced the growth of crystallites with (102) and (103) orientations. The rise of rocking curve FWHM for the corresponding conditions depicted that the films texture quality deteriorated. A further confirmation of the variation in film texture/orentation with the growth conditions has been obtained from the variation in FWHM values of a dominant E1 (TO) mode in the Fourier transform infrared (FTIR) spectra and the E2 (high) mode in Raman spectra. We have correlated the columnar structure in AFM surface analyses with the (002) or c-axis orientation as well. Spectroscopic ellipsometry of the samples have shown a higher refractive index at 500 °C growth temperature.

Chromium nitride (Cr2N) thin films were prepared by a DC magnetron sputtering technique. The deposition temperature was raised from 50 to 300°C, and its influence on the film structure and refractive index was investigated. X-ray diffraction analysis shows that the crystalline structure of the films transforms from the (101) to (002) oriented hexagonal Cr2N phase as the increase of substrate temperature above 50°C, and a highly textured film grows at 100°C. An empirical relation between the crystalline orientation and infrared active modes of the films is obtained, i.e., the Fourier transform infrared (FTIR) spectrum of the film prepared at 50°C exhibits only A1 (TO) mode. The prominent peak in the FTIR spectra of the film prepared above 50°C is assigned to the E1 (TO) mode and is correlated with the (002) or c-axis oriented hexagonal wurtzite phase of Cr2N. In the surface analysis of atomic force microscopy, a transformation from the featureless surface to columnar-type morphology is observed with the increase of substrate temperature from 50 to 100°C, exhibiting c-axis oriented crystallite growth. A further increase in substrate temperature to 200°C causes the c-axis crystallites to merge, resulting in the formation of voids. The refractive index (n) of the deposited films is obtained using spectroscopic ellipsometry.

Due to lack of adequate number of formally trained nephrologists, many patients with chronic kidney disease (CKD) are seen by general practitioners (GPs). This study was designed to assess the knowledge of the GPs regarding identification of CKD and its risk factors, and evaluation and management of risk factors as well as complications of CKD. We conducted a cross-sectional survey of 232 randomly selected GPs from Karachi during 2011. Data were collected on a structured questionnaire based on the kidney disease outcomes and quality initiative recommendations on screening, diagnosis, and management of CKD. A total of 235 GPs were approached, and 232 consented to participate. Mean age was 38.5 ± 11.26 years; 56.5% were men. Most of the GPs knew the traditional risk factors for CKD, i.e., diabetes (88.4%) and hypertension (80%), but were less aware of other risk factors. Only 38% GPs were aware of estimated glomerular filtration rate in evaluation of patients with CKD. Only 61.6% GPs recognized CKD as a risk factor for cardiovascular disease. About 40% and 29% GPs knew the correct goal systolic and diastolic blood pressure, respectively. In all, 41% GPs did not know when to refer the patient to a nephrologist. Our survey identified specific gaps in knowledge and approach of GPs regarding diagnosis and management of CKD. Educational efforts are needed to increase awareness of clinical practice guidelines and recommendations for patients with CKD among GPs, which may improve management and clinical outcomes of this population.

Coronary artery disease (CAD) is the leading cause of mortality around the world. We sought to study changes in the risk profile of patients presenting with ST elevation myocardial infarction (STEMI).We retrospectively studied all patients presenting with STEMI to our center between 1995 and 2014. Patients were divided into four quartiles, 5years each. Baseline risk factors and comorbidities were recorded. Sub-analysis was done for patients with established CAD and their household incomes.A total of 3913 patients (67.9% males) were included; 42.5% presented with anterior STEMI and 57.5% inferior STEMI. Ages were 64±12, 62±13, 61±13 and 60±13 in the four quartiles respectively. Obesity prevalence was 31, 37, 38 and 40% and diabetes mellitus prevalence was 24, 25, 24 and 31%, while hypertension was 55, 67, 70 and 77%, respectively, p0.01 for all. Smoking prevalence was 28, 32, 42 and 46, p0.01. When subgroup analysis was done for patients with history of CAD, prevalence of smoking, obesity, diabetes and hypertension significantly increased across the four quartiles. When patients were divided to four groups based on household income (poor, low middle, middle and high income), prevalence of diabetes, hypertension, smoking and obesity were significantly higher in patients with low income.Despite better understanding of cardiovascular risk factors and more focus on preventive cardiology, patients presenting with STEMI over the past 20years are getting younger and more obese, with more prevalence of smoking, hypertension, and diabetes mellitus. This trend is greater in the lower income population.

Transcatheter aortic valve replacement (TAVR) is a viable option for patients with severe chronic obstructive pulmonary disease (COPD) who are deemed inoperable or high risk for surgery. We sought to determine outcomes of patients with severe aortic stenosis (AS) and severe COPD referred for aortic valve replacement (AVR). One hundred thirty-one patients with severe AS and severe COPD (GOLD criteria) were evaluated at our center between 2008 and 2013 and were divided retrospectively into 4 groups: 1-medical management, 2-balloon aortic valvuloplasty, 3-surgical aortic valve replacement (SAVR), and 4-TAVR. Baseline, clinical, and echo data were recorded. Primary outcome was cardiovascular death. From the study cohort, 54 (41.2%), 29 (22.1%), 21 (16.0%), and 27 (20.6%) were included in groups 1-4, respectively; the age was 74.9 ± 8.8, 76.2 ± 8.8, 78.8 ± 7.4, and 82.8 ± 6.8 years, respectively (P0.01). There was no significant difference between the groups for hypertension, diabetes, aortic valve area or gradients, forced expiratory volume in first second, right ventricular systolic pressure, ejection fraction, and Society of Thoracic Surgeons predicted risk of mortality score. At 3 ± 1.5 years, death occurred in 87%, 97%, 47.7%, and 51.8% of patients in groups 1-4, respectively. Heart failure readmissions occurred in 43%, 42%, 9.6%, and 14.8% of patients in groups 1-4, respectively. When SAVR and TAVR groups were compared, there was no significant difference in survival (P = 0.719) or heart failure readmissions (P = 0.19). In patients with severe or very severe COPD and severe AS, replacing the severely stenotic aortic valve by either SAVR or TAVR improves survival and reduces rehospitalization compared with medical therapy or balloon aortic valvuloplasty.

Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

Data are limited about the prevalence trends of risk factors, lesion morphology, and clinical outcomes of coronary artery disease in patients, aged ≤45 years, undergoing percutaneous coronary intervention (PCI), between the bare-metal stent (BMS; 1994 to 2002) and drug-eluting stent (DES; 2003 to 2012) eras. From the PCI database at the Cleveland Clinic, we identified 1,640 patients aged ≤45 years and without a history of coronary artery bypass grafting who underwent PCI from 1994 to 2012. There were 883 patients in the BMS era cohort with a mean follow-up period of 13.15 years and 757 in the DES era cohort with a mean follow-up of 5.02 years. The DES era had more obese (51.8% vs 44.7%, p0.001) and diabetes (23.0% vs 19.5%, p = 0.09) patients. DES era patients had more B2/C lesions (74.0% vs 32.5%, p0.001), more severe preprocedural stenosis (86.1 ± 12.9 vs 72.2 ± 21.3, p0.001), and longer lesions (15.5 ± 9.9 vs 9.6 ± 6.8, p0.001). No difference was observed in the 30-day mortality between the DES and BMS eras. Irrespective of era, diabetics had worse long-term mortality (19.4% vs 9.3%, p0.001) compared with nondiabetics. Obese patients had similar long-term outcomes compared with nonobese patients. In conclusion, patients aged ≤45 years, who underwent a PCI procedure in the DES era had worse risk factor profiles, including obesity, compared with patients in the BMS era. They also had more complex lesions. Procedural and long-term outcomes of these patients have not changed between the 2 eras. Young diabetic patients have worse long-term outcomes compared with nondiabetics.

Percutaneous repair or replacement techniques for the aortic and mitral valves have widespread acceptance as effective alternatives for patients who are not surgical candidates. Similar techniques for the tricuspid valve are now on the rise. Tricuspid valve disease is prevalent in a diverse population of patients ranging from 8 to almost 80 years of age. Currently there is a substantial division between the treated and diseased population, with the latter increasing in number. Experience and studies have shown that surgery for moderate or severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Progressive TR in itself has been shown to be a risk factor for decreased survival. Percutaneous techniques for management of TR offer these patients an attractive and efficient option. Novel devices have been constructed with the intent to restore the anatomy and physiology of the tricuspid valve complex. TR is most commonly due to secondary causes like left heart failure. Results so far are promising for most devices, and some human trials are underway. In coming years, feasibility and safety data along with experience with these devices will grow. It is possible that percutaneous tricuspid repair may become an alternative for some patients with TR.

Zinc selenide (ZnSe) thin film on glass substrates were prepared by thermal evaporation under high vacuum using the quasi-closed volume technique at room temperature (300 ± 2 K). The deposited ZnSe properties were assessed via X-ray diffraction, atomic force microscope (AFM), UV-Vis specrophotometry, Raman spectroscopy, photo-luminescence, Fourier transform infrared spectroscopy (FT-IR) and spectroscopic ellipsometry. The X-ray diffraction patterns of the film exhibited reflection corresponding to the cubic (111) phase (2θ = 27.20°). This analysis indicated that the sample is polycrystalline and have cubic (Zinc blende) structure. The crystallites were preferentially oriented with the (111) planes parallel to the substrates. The AFM images showed that the ZnSe films have smooth morphology with roughness 6.74 nm. The transmittance spectrum revealed a high transmission of 89% in the infrared region (≥ 600 nm) and a low transmission of 40% at 450 nm. The maximum transmission of 89.6% was observed at 640 nm. Optical band-gap was calculated from the transmission data of specrophotometry, photo-luminescence and ellipsometry and was 2.76, 2.74 and 2.82 eV respectively. Raman spectroscopic studies revealed two longitudinal optical phonon modes at 252 cm -1 and 500 cm -1 . In photoluminescence study, the luminescence peaks was observed at 452 nm corresponding to band to band emission. FT-IR study illustrated the existence of Zn-Se bonding in ZnSe thin film. The optical constants were calculated using spectroscopic ellipsometry and were determined from the best fit ellipsometric data in the wavelength regime of interest from 370–1000 nm. These results manifested excellent room temperature ZnSe synthesis and characteristics for opto-electronics technologies.

This paper demonstrates the structural, vibrational and photoluminescence characteristics of (ZnO)1−x(V2O5)x (x = 0, 3, 6 and 9 mol%) composites semiconductor synthesized by using the solid state reaction method. X-ray diffraction (XRD) studies show that (ZnO)1−x(V2O5)x composites have the poly crystalline wurtzite structure of hexagonal ZnO. It is found from the XRD results that the lattice constants and the crystallite size increase while the dislocation density decreases with increase in doping concentration. The existence of E1 (TO) and E2 (high) Raman modes show that the ZnO still preserve wurtzite structure after doping vanadium oxide, which is in agreement with XRD results. Room temperature photoluminescence (PL) exhibit near band edge and broad deep level emission while indicating the suppression of deep level emission with the incorporation of V2O5 up to a certain concentration (x < 9). Moreover, the optical band gap increase with doping, which is accompanied by the blue shift of the NBE emission.

Background: Acute ischemic mitral regurgitation (MR) is a detrimental complication of ST elevation myocardial infarction (STEMI). We studied a) patient characteristics in acute ischemic MR in anterior versus inferior STEMI and b) its impact on outcomes. Methods: We retrospectively studied all patients presenting with STEMI complicated by acute ischemic MR to our center from 1994-2014. Patients were divided into two groups: anterior and inferior STEMI. Endpoints were 30-day and 1-year mortality. All cases with new development of > 2+ MR on baseline echo within 3 days of index MI were analyzed. Results: Out of 4005 STEMI patients, there were 221 patients (52.5% males) with acute MR at an incidence of 5.5% [74/1666 (4.4%) in anterior vs 147/2306 (6.4%) in inferior STEMI, p=0.02]. At baseline, there were no significant differences between anterior vs. inferior STEMI in age, co-morbidities or degree of MR (Table). Mean ejection fraction (EF) was 31±14 vs 45±13% (p Conclusion: Acute ischemic MR is seen more commonly with inferior yet has worse outcomes in anterior STEMI with increased short and long term mortality. Further, old age, low EF, higher degree of MR, shock on presentation, and need for blood transfusion are associated with worse outcomes.

Artificial neural networks (ANN) are receiving a lot of attention because of their nonlinear mapping ability in the field of short term load forecast (STLF). ANN based STLF model commonly use back propagation algorithm, that may not converge properly, that affects the forecast accuracy. A hybrid approach, based on artificial neural network (ANN) and genetic algorithm (GA) that combines the advantages of each technique is proposed in this research. Genetic algorithm is implemented for the optimization of the architecture of feedforward neural network and selection of its initial weight values. Error back propagation algorithm for the training of the optimized neural network will be implemented. The second stage of this research is related with the complete training of the neural network based on genetic algorithm, using genetic manipulation of chromosomes. The results show that this approach produced better output in terms of enhanced forecast accuracy.

The National Cardiovascular Data Registry defines major bleeding after percutaneous coronary intervention (PCI) as an absolute drop of hemoglobin (Hb) ≥3 g/dL. We sought to study impact of this across different baseline Hb levels. 2238 patients who underwent elective PCI in our center from 2011

Ischemic mitral regurgitation (IMR) is an established complication of ST elevation myocardial infarction (STEMI). We studied the change in incidence and outcomes of IMR in the past 20 years in a tertiary center. Amongst 3914 patients undergoing primary percutaneous coronary intervention within 12

Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST elevation myocardial infarction (STEMI) over twenty years in a tertiary-care center. Over the past twenty years, 1658 patients presented with anterior STEMI to our center and

Cardiovascular disease is the leading cause of mortality around the world. We sought to study changes in risk profile of patients presenting with ST elevation myocardial infarction (STEMI). We retrospectively studied all patients presenting with STEMI to our center between 1995 & 2014. Patients

We report on the tunability over the optical behavior of e-beam evaporated nanocrystalline thin films of Cd1−xNixTe (0 ≤ x ≤ 0.15). X-ray diffraction analysis reveals the polycrystalline nature of the film having zinc blend structure with a preferred growth direction along (111) plane parallel to the substrate. X-ray diffraction results also indicate that the grain size of the films decreases from 27.13 nm to 16.23 nm with an increase in Ni concentration from 0 to 15 at%. The compositional analysis of the film was carried out by energy dispersive x-ray analysis (EDX) which confirms the successful inclusion of Ni in CdTe matrix. Spectroscopic ellipsometery (SE) results demonstrate that the band gap of the grown films increases from 1.48 eV to 1.86 eV while refractive index (n) and extinction coefficient (k) decrease with the increasing Ni concentration. The increase in band gap energy of Cd1−xNixTe films as a function of Ni concentration was confirmed by spectrophotometric analysis.

Penile tissue consisting of corps cavernosum (cc) and tunica albuginea (TA) was obtained from 35 impotent patients undergoing surgery for implantation of penile prostheses and was examined for nor adrenaline content. 10 patients were classified as a non diabetic non neuropathic group, on the basis of their clinical history and differential diagnostic symptoms which included Peyronie's disease, vascular disease, hypertension and psychogenic impotence. The nor adrenaline content was found to be significantly lower in tunica albuginea than the corpus cavernosum (P0.02) in this group. The nor adrenaline content of corpus cavernosum from insulin dependent (IDDM) and non insulin dependent (NIDDM) diabetic neuropathic patients was also found to be significantly lower (P0.02) than that of non diabetic non neuropathic patients. The nor adrenaline content of tunica albuginea however, was similar in both groups. A non significant association in the content of nor adrenaline in corpus cavernosum and tunica albuginea among IDDM and NIDDM diabetic neuropathics was also observed. These results provide evidence that an underlying neuropathic factor itself causes vascular as well as metabolic changes in the adrenergic nerves of the penis in diabetics due to neuropathy in addition to the effect of the disease and thus may contribute to the development of impotence in these patients irrespective of their type of diabetes.

Cd1−xZnxSe is an important semiconducting alloy because it is possible to tune its physical properties by controlling its composition x. Thin films of Cd1−xZnxSe with different compositions (x=0.2, 0.4, 0.6 and 0.8) were deposited onto a glass substrate by the resistive thermal evaporation technique. Optical properties such as optical constants and band gap energy of these films were examined by using a spectroscopic ellipsometer. It was found that the optical constants (n and k) decrease with the addition of Zn content in the alloy. In comparison, the band gap energy was also determined by using transmission spectra and found to agree with that of the ellipsometric results. These analyses confirm that the band gap energy increases with the increase of Zn content in the alloy. The composition of the films was estimated by energy dispersive analysis of x-ray studies. The structural properties of these films were studied by using an x-ray diffractometer (XRD). The XRD patterns reveal that the two binary compounds have been completely transformed into a ternary compound with hexagonal (wurtzite) structure having preferred orientation along the c-direction with (002) planes.

Crystalline zinc oxide (ZnO) thin films with highly preferential c-axis-oriented crystals were prepared using the reactive e-beam evaporation technique. Prior to deposition, ZnO targets were prepared from ZnO (99.999%) powder. Post-deposition thermal annealing was performed at various temperatures ranging from 200 to 700 °C for 2 h in air to investigate the effect of annealing on the structural and optical properties. Structural characterization including that of the crystal structure, crystal orientation, phase, stress, strain, grain size and surface morphology was carried out using x-ray diffraction (XRD) and atomic force microscopy (AFM). Optical characterization including transmission, absorption coefficient and band gap estimation was carried out using a spectrophotometer. The XRD results showed that the films were highly c-axis oriented before and after annealing. Crystallinity and grain size improved with annealing temperature. AFM results showed that the surface morphology improved with annealing temperature. Optical transmittance increases slightly and the band gap decreases with increasing annealing temperature. The effect of the stress formation during thin film deposition and its variation with post-deposition heat treatment and the effect of this stress on optical properties of the thin films were also studied. The residual compressive stress in as-deposited thin films relaxes with heat treatment and becomes tensile with further increase in annealing temperature. The optical band gap decreases with increasing grain size and decreases with increasing tensile stress.

The present paper reports on a systematic study of the influence of Zn alloying on the structural and optical properties of Cd1−xZnxS thin films. X-ray diffraction study for structural analysis reveals that the two binary compounds have been completely transformed into ternary compound with hexagonal (wurtzite) structure with preferred orientation along c-direction with (002) planes. The optical properties such as optical constants and band gap energy of the films were examined by using spectroscopic ellipsometer and Photospectrometery. It was found that the optical constants (n and k) decrease with the addition of Zn content in the alloy. It was also confirmed that the band gap increases with increasing Zn amount in the alloy and is attributed to quantum size effect in the grain size. Raman spectroscopy analysis shows one dominant phonon band at 326 cm−1, the so-called longitudinal optical (LO) mode for all the alloy composition (x). The appearance of a single phonon band in the Raman spectra established the formation of single phase hexagonal structured Cd1−xZnxS thin film. The LO band is asymmetrically broaden and high frequency shifted due to potential fluctuation caused by the dopant material. The AFM results showed that the surface roughness was decreased with increasing Zn content.

Aim of this research is to develop a hybrid prediction model based on Artificial Neural Network (ANN) and Genetic Algorithm (GA) that integrates the benefits of both techniques to increase the electrical load forecast accuracy. Precise Short Term Load Forecast (STLF) is of critical importance for the secure and reliable operation of power systems. ANNs are largely implemented in this domain due to their nonlinear mapping nature. The ANN architecture optimization, the initial weight values of the neurons, selection of training algorithm and critical analysis and selection of the most appropriate input parameters are some important consideration for STLF. Levenberg-Marquardt (LM) algorithm for the training of the neural network is implemented in the first stage. The second stage is based on a hybrid model which combines the ANN and GA.