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Data on coronary revascularization in patients with cirrhosis are scarce because it is often deferred in the setting of significant comorbidities and coagulopathies. It is unknown whether patients with cardiac cirrhosis have a worse prognosis. The National Inpatient Sample was surveyed to identify patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) from 2016 to 2018. Those with and without liver cirrhosis were propensity score–matched and compared within the PCI and CABG cohorts. Primary outcome was in-hospital mortality. Patients with cirrhosis were further classified into cardiac and noncardiac cirrhosis and their in-hospital mortalities were compared. A total of 1,069,730 PCIs and 273,715 CABGs were performed for ACS, of which 0.6% and 0.7%, respectively, were performed in patients with cirrhosis. In both the PCI cohort (odds ratio = 1.56; 95% confidence interval, 1.10–2.25; P = 0.01) and the CABG cohort (odds ratio = 2.34; 95% confidence interval, 1.19–4.62; P = 0.01), cirrhosis was associated with higher in-hospital mortality. In-hospital mortality was greatest in cardiac cirrhosis (8.4% and 7.1%), followed by noncardiac cirrhosis (5.5% and 5.0%) and no cirrhosis (2.6% and 2.3%) in PCI and CABG cohorts, respectively. Higher in-hospital mortality and periprocedural morbidities should be considered when performing coronary revascularization in patients with cirrhosis.

The prevalence and incidence of end-stage renal disease (ESRD) has been increasing. However, data on inpatient outcomes of hypertensive emergencies in patients with ESRD are lacking. We performed a retrospective study using the largest inpatient database in the United States. Hospitalizations for hypertensive emergency between 2016 and 2018 were identified from the National Inpatient Sample. Propensity score matching was performed between those with and without ESRD. The primary outcome was in-hospital mortality, and secondary outcomes included end-organ complications of hypertensive emergency. Multivariable logistic regression was used to identify potential risk factors of in-hospital mortality. Of 105,565 hospitalizations for hypertensive emergency, 15% occurred in patients with ESRD. Hospitalizations for hypertensive emergency in patients with ESRD were associated with higher odds of cardiac arrest (odds ratio [OR] 4.52, 95% confidence interval [CI] 1.53–13.3, P = 0.01) and acute pulmonary edema (OR 2.80, 95% CI 2.15–3.65, P

This study compares outcomes of patients admitted for atrial fibrillation (AF) with and without coexisting systemic lupus erythematosus (SLE). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic cardioversion and electrical cardioversion were secondary outcomes of interest. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for adult hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal diagnosis of AF, out of which, 2645 (0.3%) had SLE as secondary diagnosis. Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, adjusted OR (AOR): 1.0, 95% CI 0.47 to 2.14, p=0.991), LOS (4.2 vs 3.4 days, p=0.525), total hospital charges ($51,351 vs $39,121, p=0.056), odds of undergoing pharmacologic cardioversion (0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22 to 3.69, p=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66 to 1.15, p=0.324) compared with those without SLE. However, SLE group had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3 to 2.7, p

The present investigations aims to improve weld characteristics of Aluminum (Al-6001) plate using a pulsed TIG welding. The welding speed of the current study has been controlled by PUG machine coupled with TIG machine for automatic operation. The similar welding of the of Al-6001 plate have been performed by varying welding process parameters for full depth of penetration. Single side welding of Al-6001 plate has been studied. The influence of welding current & welding speed on the weld characteristics of the welded joint have been studied. The weld zone features have been analyzed with the microstructure images using Optical Microscopic and SEM (Scanning electron microscope) and on the other hand different phases have been characterized using XRD (X-ray diffraction) analysis. The hardness variation across the weld zone has also been quantified to study the change in mechanical property of the welded zone.

Introduction: Immune checkpoint inhibitors (ICIs) have become the cornerstone for treatment of advanced malignancies and have led to long-term tumor responses and improved survival. The body’s immune response to ICIs can lead to unintended consequences (immune-related cardiovascular adverse effects) sometimes involving the heart. Methods: Embase, Ovid, PubMed, and Scopus were searched for ICI randomized phase II or III clinical trials reporting adverse cardiovascular events with combination or monotherapy ICIs (experimental arm) and placebo or standard of care chemotherapy (control arm). The primary outcome was cumulative incidence of cardiovascular adverse effects, and secondary outcomes were isolated incidence of hypertension, myocardial infarction, myocarditis and pericardial effusion. Statistical heterogeneity was quantified using I 2 statistics. Publication bias was assessed with Egger’s regression test. P-value of 0.05 was deemed as statistically significant. Results: Twenty studies (N=13,525) met the inclusion criteria. The studies included 1 small cell and 8 non-small cell lung, 3 renal cell, 1 head & neck, 1 colorectal and 1 prostate cancer with 2 malignant melanoma, 2 multiple myeloma, and 1 mesothelioma. There were 7434 (54.96%) and 6091 (45.04%) patients in the ICI and non-ICI arms, respectively. There was no statistically significant difference in reported cardiovascular toxicity with ICI compared to placebo or standard of care (OR 0.953 95% CI 0.542-1.675, I 2 =89.49 p2 =94.98, P2 =0%, P=0.613), MI (OR 0.76, 95% CI 0.76-3.298 I 2 0%, P=0.83) and myocarditis (OR 2.12, CI 0.638-7.055, I 2 =0%, P=0.185). Conclusions: This meta-analysis demonstrates no significant difference in cardiovascular adverse effects in ICI group when compared to placebo or standard of care.

The prevalence of different cancers after heart transplant (HT) is unclear due to small and conflicting prior studies. Herein, we report a systematic review and meta-analysis to highlight the prevalence and pattern of malignancies post-HT. We conducted an extensive literature search on PubMed, Scopus, Cochrane databases for prospective or retrospective studies reporting malignancies after HT. The proportions from each study were subjected to random effects model that yielded the pooled estimate with 95% confidence intervals (CI). Fifty-five studies comprising 60,684 HT recipients reported 7759 total cancers during a mean follow-up of 9.8 ± 5.9 years, with an overall incidence of 15.3% (95% CI = 12.7%-18.1%). Mean time from HT to cancer diagnosis was 5.1 ± 4 years. The most frequent cancers were gastrointestinal (7.6%), skin (5.7%), and hematologic/blood (2.5%). Meta-regression showed no association between incidence of cancer and mean age at HT (coeff: -0.008; P = 0.25), percentage of male recipients (coeff: -0.001; P = 0.81), donor age (coeff: -0.011; P = 0.44), 5-year (coeff: 0.003; P = 0.12) and 10-year (coeff: 0.02; P = 0.68) post-transplant survival. There is a substantial risk of malignancies in HT recipients, most marked for gastrointestinal, skin, and hematologic. Despite their occurrence, survival is not significantly impacted.

Background The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be “high,” “moderate,” “low,” or “critically low.” Results Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of “critically low quality” and two were of “low quality.” These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2’s rating rules.

Background Heart failure (HF) constitutes a huge public health burden today with acute respiratory infections being among the main precipitating causes for hospitalization. On the other hand, HF is a known risk factor for pneumonia which is the most common cause of adult hospital admissions in the United States. Objective To examine the effect of HF on the in-hospital outcomes of pneumonia Methods The National Inpatient Sample (NIS) database, 2016–2018, was queried for inpatient principal diagnosis of all-cause pneumonia, and the study group was stratified into those with and without HF as a secondary diagnosis, using International Classification of Diseases-10 (ICD-10) codes. Multivariate logistic and linear regression analyses were used to adjust for confounding. Stata 16 software was used for data analysis. Results 1,929,598 adults were hospitalized with the primary diagnosis of pneumonia, of which 499,740 (25.9%) had HF. The incidence of mortality was 4.2% (n=20,785) in those with HF compared to 2.0% (n=28,365) in those without HF. The adjusted odds ratio (aOR) of inpatient mortality for pneumonia patients with HF compared to those without HF was 1.35 (95% CI, 1.29–1.42; p Conclusion In patients hospitalized for pneumonia, HF is associated with increased odds of inpatient mortality and longer LOS. Complications such as arrhythmias, acute hypoxic respiratory failure, acute kidney injury, septic shock, cardiogenic shock and cardiac arrest occur more frequently in pneumonia patients with HF. Funding Acknowledgement Type of funding sources: None. Figure 1

The current study investigates the effect of welding speed on the mechanical and microstructural properties in similar friction stir welding of Aluminium Alloy (AA-6351-T6). The contribution of intense plastic deformation and high-temperature exposure within the stirred zone during friction stir welding results in recrystallization and development of texture within the stirred zone and precipitate dissolution and coarsening within and around the stirred zone. Based on micro-structural characterization of grains and precipitates, three distinct zones, stirred (nugget) zone, thermo-mechanically affected zone (TMAZ), and heat-affected zone (HAZ).The micro-structural changes in various zones have significant effect on post weld mechanical properties.

Welding is one of the most commonly joining processes used in industry at widespread. Austenitic stainless steel are application in fabrication pressure vessels. Thin sheets of 304L can be welded by pulsed Tungsten Inert Gas (TIG) joining process. The current study investigates the numerical modelling of pulsed TIG welding of austenitic stainless steel using ANSY APDL. Double ellipsoidal heat source have been used for modelling the pulsed TIG welding. The objective of the present investigation is to study the effect of varying welding current on the temperature distribution curve. Temperature profile affects the microstructure, mechanical properties and the residual stresses developed in the welded joint during TIG welding. It has been observed that the peak temperature increases with increasing welding current.

Cardiovascular effects of hypothyroidism include bradycardia, diastolic hypertension, atrial fibrillation, prolonged QT interval leading to torsades de pointes, varying degrees of AV block, accelerated coronary artery disease, and pericardial effusion. Cardiac tamponade is rare in patients with hypothyroidism because of pericardial distensibility and slow accumulation of fluid. The amount and rate of accumulation of pericardial effusion are related to the severity of hypothyroidism. Though rare, significant pericardial effusion can be a manifestation of subclinical hypothyroidism.

The preoperative differentiation of left ventricular aneurysm from pseudoaneurysm is a diagnostic challenge. This distinction is critical as the timing of surgical correction varies; elective for true aneurysm versus urgent for pseudoaneurysm. Our aim is to present a case report demonstrating these difficulties and to review imaging characteristics and the approach to distinguish the two entities.

The prognostic implications of ST-segment and T-wave (ST/T) abnormalities in patients undergoing stress SPECT-myocardial perfusion imaging (MPI) are not well defined. This was a single-center, retrospective cohort study of consecutive patients who underwent regadenoson stress SPECT-MPI. Patients with baseline electrocardiogram (ECG) abnormalities that impede ST/T analysis or those with known coronary artery disease were excluded. Patients were categorized as having primary ST abnormalities, secondary ST/T abnormalities due to ventricular hypertrophy or right bundle branch block, T-wave abnormalities, or normal ECG. The primary outcome was major adverse cardiovascular events (MACE) defined as the composite of cardiac death or myocardial infarction. Among 6,059 subjects, 1912 (32%) had baseline ST/T abnormalities. During a mean follow-up of 2.3 ± 1.9 years, the incidence of MACE was significantly higher among patients with secondary ST/T abnormalities compared to those with normal ECG (HR 2.05; 95% confidence interval [CI], 1.04-4.05; P = 0.039). No significant difference in MACE was observed among patients with primary ST abnormalities (HR 1.64; CI 0.87-3.06; P = 0.124) or T-wave abnormalities (HR 1.15; CI 0.62-2.16; P = 0.658) compared with patients who had normal ECG. Among patients with secondary ST/T changes, abnormal MPI was not associated with a significant increase in MACE rates compared to normal MPI (HR 1.18; CI 0.31-4.58; P = 0.808). However, abnormal MPI was associated with higher MACE rates among patients with primary ST abnormalities (HR 4.50; CI 1.44-14.10; P = 0.005) and T-wave abnormalities (HR 3.74; CI 1.20-11.68; P = 0.015). Similarly, myocardial ischemia on regadenoson stress SPECT-MPI was not associated with a significant increase in MACE rates in patients with secondary ST/T abnormalities (HR 1.45; CI 0.38-5.61; P = 0.588), while it was associated with a higher incidence of MACE in patients with primary ST abnormalities (HR 3.012; CI 0.95-9.53; P = 0.049) and T-wave abnormalities (HR 5.06; CI 1.60-15.96; P = 0.002). While patients with secondary ST/T abnormalities had significantly higher MACE risk, abnormal MPI or presence of myocardial ischemia on regadenoson SPECT-MPI in this group does not add prognostic information. Patients with primary ST abnormalities and T-wave abnormalities do not seem to have a significantly higher MACE risk compared to those with normal ECG; however, abnormal MPI or presence of myocardial ischemia, in these groups, correlates with higher MACE rates.

BRASH syndrome is characterized by bradycardia, renal failure, use of an atrioventricular nodal blocker (AVNB), shock, and hyperkalemia. These symptoms represent an ongoing vicious cycle in a patient with a low glomerular filtration rate taking an AVNB. Decreased clearance of the medication and hyperkalemia associated with renal failure synergize to cause bradycardia and hypoperfusion. This reaction causes renal function to worsen, thereby perpetuating the cycle of BRASH syndrome.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with varied natural history and multisystemic involvement. The pathogenesis is multifactorial and complex precipitating the formation of autoantibodies. One of the main factors in SLE is the interaction between environmental triggers and genetic factors. Genome-wide association study technology has led to the identification of more than 80 loci which produce key proteins that lead to small pathophysiological changes and are associated with SLE. There has been an improvement in the management of the disease with newly standardized scores that have been validated in assessing disease activity and quality of life, and have helped in clinical care as well as research. The last five decades have seen a marked improvement in the prognosis of SLE, thanks to better general care and the development of newer immunosuppressive drugs, more specifically biological agents.

Over ongoing decades, the global demand for potable water is expanding quickly; at the same time, the supply of potable water is restricted due to fast advancement in industrialization, the devastation of trees, less awareness towards the plantation, and population growth. There are numerous freshwater production methods available in this world, in that solar-based still (Solar still) is one of the most normal and least expensive techniques. A lot of examinations have been portrayed experimentally and theoretically on the solar stills for evaluating its performance under different climatic and working environment. Heat and mass transfer are the two key factors that play a vital role in the evaluation of solar still's performance. In this study various experimental and theoretical methodologies that have been utilized to evaluate the heat and mass transfer analysis of solar stills using wick materials are critically reviewed. While looking into consideration, the reviewed articles demonstrate that the efficiency of the solar stills relies upon the various outside and inside working parameters. The result revealed that the wick materials with high porous values are produced better productivity than the low porous wick materials.

108 Background: Cook County Health (CCH) is one of the largest public safety net hospitals in the United States. COVID-19 pandemic significantly affected patient care. Although hospitals took measures to keep patients safe, there is a general level of anxiety in patients about coming to the hospital. This study was undertaken to see the impact of COVID-19 and anxiety in patients actively receiving infusional therapy at our institution. Methods: All patients coming to our Infusion Center were offered an anonymous written questionnaire. The survey was given for 10 calendar days in June 2020 after Chicago moved into Phase-3 of re-opening that indicated significant control of COVID-19. The survey was offered in English, Spanish and Polish. It also included the GAD scale for anxiety assessment. Statistics were done using the t-test and z-test. Results: A total of 107 patients completed the survey. About 55% were women with 67% patients over 50 years old. Of the 90 people that specified their race, 44% were black and 42% were Hispanic, 9% whites, and 5% others. Overall 68% had high school or less level of education with Hispanics having significantly lower education than blacks. About 30% had testing for COVID-19 with 81% being negative. Treatment interruption occurred in 39% patients. Despite 75% finding our infusion center extremely or very safe for treatments 28% still felt moderately or severely anxious on the GAD scale. Blacks had similar levels of anxiety compared to Hispanics in March 2020 but no significant change over the months compared to Hispanics who had a significant reduction in anxiety over time. Blacks also had significantly higher rates of moderate to severe anxiety on the GAD scale (33%), while no Hispanic had severe anxiety and 18% had moderate anxiety. Despite a higher level of anxiety, blacks were less likely to have treatment interruptions compared to Hispanics (Table). Conclusions: Despite low levels of anxiety, Hispanics were more likely to have treatment interruptions during the COVID pandemic compared to blacks who had a higher level of anxiety but lower levels of treatment interruptions. The cause of this may be the level of education and awareness between the groups. However, overall there is still a significant amount of anxiety in the inner-city minority population regarding COVID-19. [Table: see text]

BackgroundIncreasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight.MethodsComplete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations.ResultsAmong 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice.ConclusionDeaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.

A majority of the elderly suffer from chronic pain that significantly alters their daily activities and imposes an enormous burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it a challenge to determine the appropriate drug, dosage, and maintenance of therapy. Opioids are the most commonly used agents for this purpose in the elderly. The aim of this article is to discuss both the current well-established therapies used for managing chronic pain in the elderly and also the emerging newer therapies.

Retinal edema (RE) is commonest macular syndrome which is caused by formation of cyst segments within intraretinal pathology. RE can cause severe visual impairments or even blindness. Optical coherence tomography (OCT) imaging is the recently introduced eye testing technique that can detect early syndromes of retinal pathology. Many researchers have worked on the automated diagnosis of retinal pathology from fundus images. However, it is very difficult to detect early RE from fundus images and here we propose a discriminant analysis (DA) classifier based fully automated algorithm for the classification of RE using OCT images. We studied 75 OCT scans of 62 patients in which 14 persons had RE and 48 patients were healthy. Our proposed system achieved 100% accuracy for classification of RE patients and 91.86% for healthy subjects.