Search

Background: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. Methods: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization. Results: During a median follow-up of 11.8 years (interquartile range, 10.6–12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88–1.56]; P =0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75–1.53]; P =0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65–1.67]; P =0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06–3.27]; P =0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58–2.32]; P Conclusions: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT05125367 and NCT00997828.

Optical vortices host the orbital nature of photons, which offers an extra degree of freedom in photonic applications. Unlike vortices in other physical entities, optical vortices require structural singularities, which restrict their abilities in terms of dynamic and interactive characteristics. In this study, we present the spontaneous generation and external magnetic field-induced manipulation of an optical vortex and antivortex. A gradient-thickness optical cavity (GTOC) consisting of an Al/SiO2/Ni/SiO2 multilayer structure realised the distinct transition between the trivial and non-trivial topological phases, depending on the magneto-optic effects of the Ni layer. In the non-trivial topological phase, the mathematical singularities generating the optical vortex and antivortex pair in the reflected light existed in the generalised parameter space of the thicknesses of the top and bottom SiO2 layers, which is bijective to the real space of the GTOC. Coupled with the magnetisation, the optical vortex and antivortex in the GTOC experienced an effective spin-orbit interaction and showed topology-dependent dynamics under external magnetic fields. We expect that field-induced engineering of optical vortices will pave the way for the study of topological photonic interactions and their applications., 22 pages, 4 figures

Adverse drug reactions (ADRs) pose a global public health threat, substantially contributing to death. Due to the relative paucity of clinical evidence regarding fatal ADRs, this study was performed to characterize the epidemiology of fatal ADRs in Korea. This was a retrospective, cross-sectional analysis of ADR cases reported to the Korea Adverse Event Reporting System from 2010 to 2019. All ADRs were coded using the World Health Organization-Adverse Reaction Terminology system and classified as either fatal or non-fatal events. Logistic regression was performed to identify factors associated with fatal events. Among 289,756 ADR records, 629 fatal events (0.2%) occurred. The most common causative agent of fatal ADRs was antibacterials (20.3%), followed by antimycobacterials (5.4%), analgesics (4.0%), and contrast media (1.9%). Among antimicrobials, vancomycin was most frequently implicated without significantly increasing the risk of fatal events. The risk for fatal ADRs was significantly increased with male sex; advanced age; polypharmacy; piperacillin/β-lactamase inhibitor; cefotetan; ceftriaxone; combination antimycobacterial therapy consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol; morphine; and iopromide (reporting odds ratio > 1, p < 0.05 for all). Although fatal ADRs are uncommon (

Background: Data regarding prognosis and management after nuisance bleeding (NB) is limited. The purpose was to examine the prognostic significance of NB in patients receiving potent dual antiplatelet treatment (DAPT) after acute myocardial infarction and the impact of de-escalation of DAPT on clinical outcomes thereafter. Methods: From the TALOS-AMI trial (Ticagrelor Versus Clopidogrel in Stabilized Patients With Acute Myocardial Infarction)‚ 2583 patients were used to investigate the clinical impact of NB (defined as Bleeding Academic Research Consortium [BARC] 1 bleeding) during 1-month treatment with ticagrelor-based DAPT after acute myocardial infarction. We assessed the associations between NB within 1 month and BARC 2, 3, or 5 bleeding and major adverse cardiovascular event (a composite of cardiovascular death, myocardial infarction, stroke) from 1 to 12 months. We also evaluated the effect of de-escalation to clopidogrel in patients with or without NB. Results: NB occurred in 416 patients (16.7%) after 1 month of ticagrelor-based DAPT. At 1 year, NB was not associated with increase in BARC 2, 3, or 5 bleeding (hazard ratio [HR]‚ 1.29 [95% CI‚ 0.7–2.14]) and major adverse cardiovascular event (HR‚ 1.72 [95% CI‚ 0.87–3.39]). However, patients with NB had an increased risk of BARC 2, 3, or 5 bleeding at 6 months (HR, 1.94 [95% CI, 1.08–3.48]; P =0.026), which diminished over the next 6 months. De-escalation from ticagrelor to clopidogrel reduced the incidence of BARC 2, 3, or 5 bleeding compared with ticagrelor plus aspirin in NB (HR‚ 0.31 [95% CI‚ 0.10–0.92]) and non-NB patients (HR‚ 0.58 [95% CI‚ 0.37–0.90]) without heterogeneity ( P interaction=0.291). There was no increase in major adverse cardiovascular event after DAPT de-escalation, irrespective of NB. Conclusions: NB was frequent in patients with acute myocardial infarction on 1-month ticagrelor-based DAPT and was associated with an early increase of bleeding. DAPT de-escalation after NB may reduce bleeding without increasing ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02018055.

Accepting the heterogeneity of amputees and enabling them to walk comfortably using little effort with light weights is the main goal of prostheses. Moreover, providing the capability of walking on various ground conditions including uneven surfaces and obstacles is a challenging but important requirement. This letter presents a 2-DOF ankle-foot prosthesis having a compact size and low inertia. It has two active degrees of freedom in the sagittal and coronal plane using a parallel linkage mechanism. A unique spring mechanism strengthens the propulsion of walking without increasing the mass of the foot. In addition, heavy elements such as actuators, springs, batteries, and controller circuits are placed at the proximal part to reduce the inertia felt by patients and to minimize the metabolic cost. Capacitive type force sensors placed at the shank frame enable the precise measurement of force from the ground without increasing foot mass. The mass including the battery is 2.25 kg which is lightweight among 2-DOF ankle-foot prostheses and the low height of 204 mm allows a broad range of amputees with various physical conditions to use it. This letter describes a gait algorithm for uneven ground by using impedance control. The force sensor test and the preliminary walking test on uneven ground verify the effectiveness of the proposed prosthesis.

Summary Background In patients with acute myocardial infarction receiving potent antiplatelet therapy, the bleeding risk remains high during the maintenance phase. We sought data on a uniform unguided de-escalation strategy of dual antiplatelet therapy (DAPT) from ticagrelor to clopidogrel after acute myocardial infarction. Methods In this open-label, assessor-masked, multicentre, non-inferiority, randomised trial (TALOS-AMI), patients at 32 institutes in South Korea with acute myocardial infarction receiving aspirin and ticagrelor without major ischaemic or bleeding events during the first month after index percutaneous coronary intervention (PCI) were randomly assigned in a 1:1 ratio to a de-escalation (clopidogrel plus aspirin) or active control (ticagrelor plus aspirin) group. Unguided de-escalation without a loading dose of clopidogrel was adopted when switching from ticagrelor to clopidogrel. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or bleeding type 2, 3, or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months. A non-inferiority test was done to assess the safety and efficacy of de-escalation DAPT compared with standard treatment. The hazard ratio (HR) for de-escalation versus active control group in a stratified Cox proportional hazards model was assessed for non-inferiority by means of an HR margin of 1·34, which equates to an absolute difference of 3·0% in the intention-to-treat population and, if significant, a superiority test was done subsequently. To ensure statistical robustness, additional analyses were also done in the per-protocol population. This trial is registered at ClinicalTrials.gov, NCT02018055. Findings From Feb 26, 2014, to Dec 31, 2018, from 2901 patients screened, 2697 patients were randomly assigned: 1349 patients to de-escalation and 1348 to active control groups. At 12 months, the primary endpoints occurred in 59 (4·6%) in the de-escalation group and 104 (8·2%) patients in the active control group (pnon-inferiority Interpretation In stabilised patients with acute myocardial infarction after index PCI, a uniform unguided de-escalation strategy significantly reduced the risk of net clinical events up to 12 months, mainly by reducing the bleeding events. Funding ChongKunDang Pharm, Medtronic, Abbott, and Boston Scientific.

Controlling the orientation of two-dimensional materials is essential to optimize or tune their functional properties. In particular, aligning MXene, a two-dimensional carbide and/or nitride material, has recently received much attention due to its high conductivity and high-density surface functional group properties that can easily vary based on its arranged directions. However, erecting 2D materials vertically can be challenging, given their thinness of few nanometres. Here, vertical alignment of Ti3C2Tx MXene sheets is achieved by applying an in-plane electric field, which is directly observed using polarised optical microscopy and scanning electron microscopy. The electric field-induced vertical alignment parallel to the applied alternating-current field is demonstrated to be reversible in the absence of a field, back to a random orientation distribution. Interdigitated electrodes with uniaxially aligned MXene nanosheets are demonstrated. These can be further modulated to achieve various patterns using diversified electrode substrates. Anisotropic electrical conductivity is also observed in the uniaxially aligned MXene nanosheet film, which is quite different from the randomly oriented ones. The proposed orientation-controlling technique demonstrates potential for many applications including sensors, membranes, polarisers, and general energy applications.

In this study, experiments, simulations, and optimization were performed to evaluate heat transfer performance of ferrofluids. Ferrofluids are colloidal suspensions containing magnetic-nano particles with a diameter of 5 to 15 nm in a base fluid such as oil or water. Recently, as many devices are miniaturized, the design of heat dissipation systems are being diversified to consider cost and safety, and it is becoming important to separate an ancillary device for cooling from main unit. In ferrofluids, the behavior and vortex of magnetic-nano particles are actively generated by an external magnetic field, and the cooling system can be designed in a simplified manner by using this characteristic. The main design parameter is the arrangement of permanent magnets, and the output variable is the temperature inside the magnetic nanofluid. The permanent magnet can be moved up and down, and the temperature inside the magnetic nanofluid was measured at various locations. A predictive model was created using a design of experiments (DOE) and response surface method (RSM) using selected design and temperature variables. Based on the generated regression model, an optimization was applied to find a permanent magnet arrangement that maximizes heat transfer performance. Through the optimization technique used in this study, economic efficiency in terms of time and cost was obtained by reducing the number of experiments.

This paper presents an approach to optimize the control torque of heavy-duty redundant manipulators used for dismantling nuclear power plants. Such manipulators must endure intensive and repetitive tasks over long periods. In this regard, the torque minimization is essential for decreasing power consumption and the fatigue load acting on the joint bearings. This in turn can increase the lifespan of the manipulators and lead to saving on maintenance costs. Because of the design specifications of the manipulators, gravity entirely dominates the Coriolis and centrifugal torques. Hence, it is challenging to reduce the driving torque through the application of a conventional optimization method, known as the minimum kinetic energy method, where the configuration of the manipulator changes extremely slowly from the beginning to the end of the trajectory. In this study, we propose a new torque minimization method based on the advantage of the redundancy of the manipulator. In particular, the norm of the static torque caused by the manipulator gravity itself tends to decrease owing to the application of the gradient projection method for the redundancy resolution at the acceleration level. Simultaneously, the dynamic torque is minimized to lessen the local acceleration triggered by the change mentioned above. The generalized effectiveness of this proposed method is evaluated through simulations and experiments with two different trajectories and speeds. The results show that the proposed method is more effective in reducing the overall driving torque and dissipated energy compared with the conventional technique, especially in the case of the 7-DOF heavy-duty redundant manipulator, and would be applicable for the revolute robot type.

The optimal duration of dual-antiplatelet therapy (DAPT) after implantation of a drug-eluting stent (DES), especially recently developed polymer-free DESs, is unknown. This study examined the efficacy and safety of 3- versus 6-month DAPT in patients implanted with Coroflex ISAR polymer-free DESs.Between May 2015 and August 2020, 488 patients who underwent Coroflex ISAR stent implantation were enrolled in the study and randomly assigned to the 3-month (n=244) or 6-month (n=244) DAPT group.At 1 year, the primary endpoint (composite of cardiovascular death, myocardial infarction, target vessel revascularization, and Bleeding Academic Research Consortium [BARC] type 2-5 bleeding) occurred in 9 (3.7%) patients in the 3-month DAPT group and in 7 (2.9%) patients in the 6-month DAPT group (hazard ratio 1.31; P=.60). There was no difference between the 3- and 6-month DAPT groups in either BARC type 2-5 bleeding (1.6% vs 0.8%; hazard ratio 2.00; P=.42) or any bleeding (2.9% vs 3.3%; hazard ratio 0.87; P=.80).Compared with 6 months of DAPT, 3 months of DAPT did not increase the risk of primary endpoint 1 year after Coroflex ISAR stent implantation, although it should be noted that the trial has limited power to see differences due to low event rate and low recruitment rate.

Numerous studies have been conducted on a MoS2 material owing to its high capacity and good rate capability as a promising substitute for commercial graphite materials in lithium-ion batteries. How...

Nanostructured transition metal oxides, employed as anode materials for lithium-ion batteries, exhibit a higher capacity than the theoretical capacity based on the conversion reaction. To date, the reasons behind this phenomenon are unclear. For the one-step evolution of anode material for lithium-ion batteries, it is essential to understand the lithium storage reaction mechanism of the anode material. Herein, we provide a detailed report on the lithium storage and release mechanism of MnO2, using synchrotron-based X-ray techniques. X-ray diffraction and X-ray absorption spectroscopy results indicate that during the first discharge, MnO2 is reduced in the order of MnO2 → LixMnO2 (1