Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus

Objective. To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. Methods. The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A ( BG < 7.8 mmol/L), B ( 7.8 mmol / L ≤ BG < 11.1 mmol / L ), and C ( BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. Results. There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction ( p > 0.05 ). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups ( p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A ( p < 0.05 ). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B ( p < 0.05 ). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. Conclusion. Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.

FMECA and MFCC-Based Early Wear Detection in Gear Pumps in Cost-Aware Monitoring Systems

Gear pump failures in industrial settings are common due to their exposure to uneven high-pressure outputs within short time periods of machine operation and uncertainty. Improving the field and line clam are considered as the solutions for these failures, yet they are quite insufficient for optimal reliability. This research, therefore, suggests a method for early wear detection in gear pumps following an extensive failure modes, effects, and criticality analysis (FMECA) of an AP3.5/100 external gear pump manufactured by BESCO. To replicate this condition, fine particles of iron oxide (Fe2O3) were mixed with the experimental fluid, and the resulting vibration data were collected, processed, and exploited for wear detection. The intelligent wear detection process was explored using various machine learning algorithms following a mel-frequency cepstral coefficient (MFCC)-based discriminative feature extraction process. Among these algorithms, extensive performance evaluation reveals that the random forest classifier returned the highest test accuracy of 95.17%, while the k-nearest neighbour was the most cost efficient following cross validations. This study is expected to contribute to improved evaluations of gear pump failure diagnosis and prognostics.

Synus node dysfunction in heart failure is characterized by reduced CaMKII signaling

Heart failure (HF) is a complex syndrome in which death rates are over 50%. The main cause of death among HF patients is pump failure and ventricular arrhythmias, but severe bradycardia is also a common cause of sudden cardiac death, pointing to sinoatrial node (SAN) dysfunction. SAN pacemaker activity is regulated by voltage-clock and Ca2+-clock mechanisms and, although voltage-clock dysfunction in SAN has been largely proved in HF, Ca2+-clock dysfunction mechanisms in SAN remains undiscovered. Here, we used a HF model in mice with transverse aortic constriction (TAC) and using telemetry saw slower heart rhythm under autonomic nervous system blockade. Then, using confocal microscopy we analyzed Ca2+ handling in HF SAN tissue and found that intracellular Ca2+ transient rates were slower in addition to less frequency of Ca2+ sparks than in SHAM SAN tissue. Next, we studied protein expression of key excitation–contraction coupling proteins and found reduced expression of the Na+/Ca2+ exchanger and reduced phosphorylated status of ryanodine receptor and phospholamban in the CaMKII sites for the SAN in TAC mice. Finally, the application of the CaMKII inhibitor KN93 caused less effect in slowing the Ca2+ transient rates in HF SAN tissue, confirming the reduced CaMKII activation. In conclusion, our data demonstrate a reduction in CaMKII activation in the Ca2+-clock function of the SAN tissue in a mouse model of HF.

Synus node dysfunction in heart failure is characterized by reduced CaMKII signaling

Heart failure (HF) is a complex syndrome in which death rates are &gt;50%. The main causes of death among HF patients are pump failure and ventricular arrhythmias, but severe bradycardia is also a common cause of sudden cardiac death, pointing to sinoatrial node (SAN) dysfunction. SAN pacemaker activity is regulated by voltage-clock and Ca2+-clock mechanisms and, although voltage-clock dysfunction in SAN has been largely proved in HF, Ca2+-clock dysfunction mechanisms in SAN remains unraveled. Here, we used an HF model in mice with transverse aortic constriction (TAC) and, using telemetry, saw slower heart rhythm under autonomic nervous system blockade. Then, by confocal microscopy, we analyzed Ca2+ handling in HF SAN tissue and found that intracellular Ca2+ transients rate were slower together with less frequency of Ca2+ sparks than in SHAM SAN tissue. Next, we studied protein expression of key excitation–contraction coupling proteins and found reduced expression of the Na+/Ca2+ exchanger and reduced phosphorylated status of ryanodine receptor and phospholamban in the CaMKII sites for the SAN in TAC mice. Finally, the application of the CaMKII inhibitor, KN93, caused less effect in slowing the Ca2+ transient rates in HF SAN tissue, confirming the reduced CaMKII activation. In conclusion, our data demonstrates a reduction in CaMKII activation in the Ca2+-clock function of the SAN tissue in a mouse model of HF.

Failure prediction of reservoir pressure maintenance system at the Prirazlomnoye Arctic Offshore field

Failures of reservoir pressure maintenance system at offshore facilities cause production losses and a significant increase in OPEX. Predicting failures of a water injection pump or its parts can highly improve the overall performance by promptly adjusting operating parameters to prevent failure occurrence or by scheduling maintenance to reduce unplanned repairs and to minimize downtime. This is particularly relevant for Arctic offshore projects, characterized by considerable logistical challenges and substantial environmental safety risks. The paper presents a data-analytic approach for failure prediction for the water injection pump operated at the ice-resistant GBS Prirazlomnaya. The study used pump failure history and field sensor data to predict the technical condition and identify a failed component in advance. An ARIMA model implemented in the R software environment was developed for the analysis. The results demonstrate that the approach works appropriately based on the generalized risk assessment and feedback from subject matter experts.

A Study on Decisional Factors for Service Life of Fire Trucks

The lifetime of fire trucks depends on their built-in pumps. A fire truck delivers water to the site of a fire accident via its pump that is composed of an impeller and a casing. As its service time increases, the clearance between the two elements increases. This causes leakage in the pump to increase beyond its limit and the pump can no longer fulfill its principal role. In general, fatigue, erosion, and corrosion are considered to be the major mechanisms for pump failure. From this study, it has been observed that fatigue is not the main factor for failure because of the small magnitude of stress it induces. Erosion by particles shows a high erosion rate of the suction area of the impeller. Cavitation, which is a key mechanism of corrosion, is observed at a suction depth of 7 m and is observed to widen at 7.1 m depth. Finally, the lifetime of the fire trucks is found to be affected by the motion of sucking the natural water of ponds, rivers, etc.

Clinical Management of DMD-Associated Cardiomyopathy

Over the past decade, cardiomyopathy has become the leading cause of mortality among patients with Duchenne muscular dystrophy (DMD). The majority of DMD patients over the age of 18 experience some degree of cardiac involvement. The primary cardiac manifestations of DMD include progressive left ventricular (LV) wall stress leading to LV dilatation and wall thinning, and the development of cardiac fibrosis, all of which culminate in decreased LV contractility and reduced cardiac output. Mortality in these patients is predominantly related to pump failure and fatal arrhythmias leading to sudden cardiac death. While basic guidelines for the management of cardiomyopathy in DMD patients exist, these recommendations are by no means comprehensive, and this chapter aims to provide further insight into appropriate clinical diagnosis and management of DMD-associated cardiomyopathy. Notably, earlier and more frequent cardiac assessment and care can allow for better outcomes for these patients. Pharmacological treatments typically include an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, beta-adrenergic receptor blockers, mineralocorticoid receptor antagonists, and corticosteroids. Non-pharmacological therapies include automated implantable cardioverter defibrillators and left ventricular assist devices, as well as in rare cases cardiac transplantation. Additionally, many emerging therapies show great promise for improving standards of care. These novel therapies, based primarily on applied gene therapy and genome editing, have great potential to significantly alter the DMD care landscape in the near future.

A Machine-Learning Method of Predicting Vital Capacity Plateau Value for Ventilatory Pump Failure Based on Data Mining

Ventilatory pump failure is a common cause of death for patients with neuromuscular diseases. The vital capacity plateau value (VCPLAT) is an important indicator to judge the status of ventilatory pump failure for patients with congenital myopathy, Duchenne muscular dystrophy and spinal muscular atrophy. Due to the complex relationship between VCPLAT and the patient’s own condition, it is difficult to predict the VCPLAT for pediatric disease from a medical perspective. We established a VCPLAT prediction model based on data mining and machine learning. We first performed the correlation analysis and recursive feature elimination with cross-validation (RFECV) to provide high-quality feature combinations. Based on this, the Light Gradient Boosting Machine (LightGBM) algorithm was to establish a prediction model with powerful performance. Finally, we verified the validity and superiority of the proposed method via comparison with other prediction models in similar works. After 10-fold cross-validation, the proposed prediction method had the best performance and its explained variance score (EVS), mean absolute error (MAE), mean squared error (MSE), root mean square error (RMSE), median absolute error (MedAE) and R2 were 0.949, 0.028, 0.002, 0.045, 0.015 and 0.948, respectively. It also performed well on test datasets. Therefore, it can accurately and effectively predict the VCPLAT, thereby determining the severity of the condition to provide auxiliary decision-making for doctors in clinical diagnosis and treatment.

Prepontine placement of an intrathecal baclofen pump catheter for treatment of dystonia

Background: Cerebral palsy with medically refractory spasticity and dystonia is a condition that often benefits from intrathecal baclofen pump therapy to treat these symptoms. In this case report, an intracranial baclofen catheter was placed in the prepontine space to improve withdrawal symptoms in a patient unable to undergo new lumbar catheter placement due to infection. Case Description: A 22-year-old female with past medical history of cerebral palsy presented with baclofen pump failure and was unable to undergo placement of a new lumbar baclofen catheter due to an infection in her lower back precluding safe and efficacious catheter placement. It was decided the patient would benefit from intrathecal baclofen administered in the prepontine space as a means to avoid a lumbar catheter and thus bypass this prior infection site. An endoscopic third ventriculostomy (ETV) was performed with the endoscope and the distal end of the baclofen pump catheter was fed through this ETV into the prepontine space. Placement in the prepontine space was confirmed by a follow-up head computed tomography. There was a significant improvement in autonomic symptoms and spasticity. By postoperative day 5, the patient was surgically and medically cleared for discharge. Conclusion: In cases of severe baclofen withdrawal due to dysfunctional pumps, immediate reversal is preferred but may not be feasible due to factors such as infection. This case report has demonstrated that prepontine catheter placement can be effective for the administration of baclofen to reverse withdrawal symptoms in these types of patients.

Can Fetuin A Be Utilized in the Evaluation of Elderly Patients with Acute Myocardial Infarction?

Background: Lower baseline Fetuin-A (FA) is associated with left ventricular remodeling and cardiovascular death (CVD) at 4 months after acute myocardial infarction (AMI). However, the association between FA levels, incomplete ST segment resolution (STR) following primary percutaneous coronary intervention (PCI) and early mortality in AMI has not been previously studied. Methods: We enrolled 100 patients with AMI, which we divided in two groups: 21 patients who suffered sudden cardiac death (SCD) in the first 7 days after PCI and 79 controls. We measured FA, NT-proBNP and troponin levels and correlated them with the occurrence of death in the first week after revascularization. We also tested the cut-off value of FA to determine STR at 90 min after PCI. Results: SCD was most frequently caused by pump failure (n = 10, 47.6%) and ventricular arrhythmias (n = 9, 42.5%). Plasma FA levels correlated with NT-proBNP values (r = −0.47, p = 0.04) and were significantly lower in patients presenting SCD (115 (95–175) vs. 180 (105–250) ng/mL, p = 0.03). Among all three biomarkers, FA was the only one associated with incomplete STR after PCI on the multivariate logistic regression (cut-off value of 175 ng/mL, Se = 74%, Sp = 61.1%). Death rate was highest (n = 16/55, 30%) in patients with FA levels below the cut-off value of 175 ng/mL. Conclusion: Lower FA is associated with higher early mortality and incomplete STR after primary percutaneous revascularization in patients with AMI. Measurement of FA levels in addition to NT-proBNP, troponin and STR might enable more accurate identification of high-risk patients.