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关键词： complex PCI   high bleeding risk   major adverse cardiac events   percutaneous coronary intervention   clinical outcomes   ARC   Academic Research Consortium   CAD   Coronary artery disease   DAPT   Dual antiplatelet therapy   HBR   High-bleeding risk   MACE   Major adverse cardiac events   MI   Myocardial infarction   PCI   Percutaneous coronary intervention   TLR   Target lesion revascularization   TVR   Target vessel revascularization  

摘要： The impact of complex coronary anatomy on outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Patients from a large PCI referral center were labeled as HBR in presence of ≥1 major or ≥2 minor Academic Research Consortium HBR criteria and undergoing complex PCI if they had any of the following: ≥3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, stent length >60 mm, bifurcation lesion with ≥2 stents, PCI of chronic total occlusion, left main, saphenous venous graft or requiring the use of atherectomy. Primary outcomes at 1 year were major adverse cardiac event (MACE), a composite of all-cause death, myocardial infarction or target vessel revascularization, and major bleeding. Of 16,966 patients, 7,295 (43.0%) were HBR with 3,611 (49.5%) undergoing complex PCI and 9,671 (57.0%) were non-HBR with 4,103 (42.4%) undergoing complex PCI. At 1 year, patients with complex PCI had a higher risk of MACE in both HBR (adjusted Hazard Ratio [adj. HR] 1.78, 95% Confidence Interval [95% CI] 1.54 to 2.06) and non-HBR (adj. HR 1.82 95% CI 1.55 to 2.12, respectively, p_int 0.64) groups and a higher risk of major bleeding (adj. HR 1.55, 95% CI 1.29 to 1.87 and adj. HR 1.36, 95% CI 1.03 to 1.78, respectively; p_int = 0.46), as compared to patients undergoing noncomplex PCI. In conclusion, complex PCI was associated with significantly higher risk of ischemic and bleeding adverse outcomes at 1-year in both HBR and non-HBR patients.

关键词： Drug-eluting stent   Polymer-free stent   Vascular healing   Percutaneous coronary intervention   Stent thrombosis   ACS   Acute coronary syndrome   CAD   Coronary artery disease   DES   Drug-eluting stent   PCI   Percutaneous coronary intervention   TLF   Target lesion failure  

摘要： In contemporary coronary intervention, an intriguing shift is taking place. The central question may no longer be which drug-eluting stent performs best, but rather which revascularization strategy allows the vessel to heal best. This perspective ...

关键词： Tropane alkaloids   Atropine   Scopolamine   Stability   Degradation   Charged Aerosol Detection   Mixed Mode Column  

摘要： Medicines often have a much longer shelf life than stated by the manufacturer. Due to the high costs of emergency stockpiling, but also due to supply shortages, an extended shelf life can offer many advantages. In this study, three injection solutions containing atropine, scopolamine and belladonna total alkaloids, respectively, manufactured between 1940 and 1960 and stored under uncontrolled conditions, were tested, to show that pharmaceutical products, containing tropane alkaloids, are significantly more stable than expected after some 80 years. To analyze the stability of the main alkaloids atropine and scopolamine, a method using charged aerosol detection (CAD) was developed and validated. CAD enables the detection of degradation products that lack a chromophore and cannot be detected using pharmacopoeial (UV) methods. For separation a SIELC Primesep 200 column (4.6 ×150 mm; 100 Å; 3 µm) and gradient elution with water, acetonitrile and formic acid were used. The results indicated a high stability of atropine, with a determined content of 101.9 % and a small amount of degradation products. Scopolamine, however, showed higher degree of degradation with a remaining content of 68 %.

关键词： Cup positioning   dual mobility prosthesis   intraprosthetic impingement   prosthesis neck design   thumb biomechanics   trapeziometacarpal arthroplasty  

摘要： Introduction: Posteroanterior cup angulation relative to the proximal articular surface of the trapezium (PAST) and neck type (15 degrees offset or 0 degrees straight) may influence the risk of intraprosthetic impingement in the TOUCH (R) prosthesis. We assessed this relationship using a computer-aided design (CAD) simulation and a cadaver ***: In the CAD simulation, cup orientation was varied anteriorly and posteriorly from 0 to 30 degrees. For each cup placement, both necks were tested by simulating flexion and extension of the thumb until impingement occurred between the neck and the cup's rim. In the cadaver study, which included 24 hands, 14 cups were tilted between 0 and 15 degrees anteriorly, eight cups were tilted 15 degrees or more anteriorly and two cups were tilted between 0 and 15 degrees posteriorly. For all specimens, and both neck types, the occurrence of impingement was determined when the thumb was flexed to 10 degrees, then extended to 20 and 40 ***: For both necks and with the cup in a neutral position, there was no impingement. An incorrect cup orientation caused mechanical impingement when the thumb was extended. For extensions of 30 degrees (CAD) and 40 degrees (cadaver), impingement occurred when the cup was tilted 15 degrees anteriorly with the offset neck, whereas it occurred with a cup tilted 30 degrees anteriorly with the straight neck. The neck length did not influence the risk of ***: Posteroanterior cup angulation influences the choice of neck type. To minimize the risk of impingement, cup placement parallel to the PAST is optimal. When the cup is tilted 15 degrees or more anteriorly, we recommend using a straight neck to reduce the risk of impingement during thumb extension.

关键词： CABG   CAD   PCI   SAVR   TAVR  

摘要： The optimal management of patients presenting with the dual burden of severe aortic stenosis (AS) and concomitant coronary artery disease (CAD) is a hotly debated issue in cardiovascular medicine. Historically, surgical aortic valve replacement (S...

关键词： high-risk percutaneous coronary intervention   major adverse cardiovascular and cerebrovascular events   coronary artery calcification   atherectomy   PROTECT III   CABG   coronary artery bypass graft   CAC   coronary artery calcification   CAD   coronary artery disease   HRPCI   high-risk percutaneous coronary intervention   LVEF   left ventricular ejection fraction   MACCE   major adverse cardiovascular and cerebrovascular event(s)   MI   myocardial infarction   PCI   percutaneous coronary intervention   pLVAD   percutaneous left ventricular assist device   SYNTAX   synergy between percutaneous coronary intervention with taxus and cardiac surgery  

摘要： Severe coronary artery calcification (CAC) complicates high-risk percutaneous coronary intervention (HRPCI), particularly in patients with impaired left ventricular function. Atherectomy may facilitate lesion preparation, but its use in high-risk settings is limited. We therefore aimed to assess the impact of CAC severity and atherectomy on outcomes in Impella-supported HRPCI. In the PROTECT III study (NCT04136392), 1,015 of 1,237 patients had data on CAC severity and atherectomy. Patients were grouped as severe CAC without atherectomy (n = 298), severe CAC with atherectomy (n = 326), and no severe CAC (n = 400). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/TIA, or repeat revascularization) at 30- and 90-days. Secondary endpoints included 1-year mortality, PCI-related complications, and hemodynamic instability. Patients with severe CAC had higher baseline SYNTAX scores and more left main disease. Atherectomy was associated with slightly longer procedural times, but not increased periprocedural complications or hemodynamic instability. At 90 days, MACCE was highest in the untreated severe CAC group (16.1% vs 12.6% vs 9.2%; overall log-rank p = 0.048). One-year mortality was also highest in this group (23.7%; p = 0.02). However, CAC severity and atherectomy use were not independent predictors of outcomes. Sensitivity analysis excluding patients with atherectomy but no severe CAC showed higher mortality risk in untreated severe CAC cases (adjHR: 0.59; overall p = 0.026). In conclusion, Severe CAC is common in patients undergoing Impella-supported HRPCI and is associated with worse outcomes. Atherectomy was safe but its benefit remains uncertain. These findings highlight the prognostic relevance of CAC and the potential role of calcium modification in HRPCI.

关键词： CAM6   Cloud Physics Parameterization Scheme   Deep Convection Parameterization Scheme   ENSO simulation   Perturbed Parameter Ensemble   Shortwave Feedback  

摘要： Accurately representing the shortwave feedback during the El Ni & ntilde;o-Southern Oscillation (ENSO) cycle (alpha SW) remains a major challenge for climate models. This study examined the key parameters within the deep convection scheme and cloud physics scheme of Community Atmosphere Model version 6 (CAM6) to ascertain their impacts on simulating alpha SW. A suite of 128-member Perturbed Parameter Ensemble (PPE) experiments was first conducted by simultaneously perturbing 12 selected parameters. Empirical Orthogonal Function (EOF) analysis identifies two dominant modes of alpha SW simulation biases. The first mode is primarily controlled by cloud ice-related parameters (dcs, eii, ai, and ai*dcs), which exert their influence on alpha SW through modulating the ice water path (IWP) feedback;while the second mode is predominantly influenced by convection-related parameters (dmpdz, dmpdz*dmpdz, and tau), which act through the liquid water path (LWP) feedback. Our further physical interpretation reveals how these identified key parameters, as well as the nonlinear term ai*dcs (i.e., the interplay between ai and dcs), modulate cloud radiative processes and hence shape the simulated alpha SW in CAM6. Our findings regarding the identified key parameters and their underlying mechanisms are not only useful for the development of the widely-used CESM model, but also provide valuable insights for the advancement of other AGCMs.

关键词： Attention mechanism   Convolution   Fault diagnosis   Interpretability   Weight-CAM  

摘要： The structure integrating the advantages of convolutional local feature extraction and Transformer-based global feature analysis exhibits distinct strengths in bearing fault diagnosis. However, there is often noise interference in actual working conditions, and such structures typically require large-scale training datasets to maintain performance, which poses a significant limitation in fault diagnosis scenarios. Additionally, the decision principles of these structures cannot be explored, and interpretability remains insufficient. To address these challenges, an interpretable fault diagnosis framework is proposed, wherein channel-level and region-level feature information are jointly optimized. A variable bandwidth filter module is first designed for signal preprocessing, with spectral attention heat maps generated via filter channel weight mapping. Joint distributed self-attention is employed to perform interactive weighting across regional and channel dimensions, thereby reducing model parameters. A multi-head weighted link classification layer is developed for feature classification, with inherent interpretability embedded. Based on this, Weight-CAM method is designed to obtain accurate post-hoc activation maps without invoking original model computations. Experimental results show that the proposed model can maintain classification accuracy in the presence of noise, limited samples, and the need to cross speeds. Through the incorporation of variable bandwidth filtering and weighted link layers, spectral heat maps and post-hoc activation maps are utilized to cross-locate model focus in both time and frequency domains, validating the interpretability of the framework.

关键词： chemical disinfection   colorimetry   denture hygiene   nano-filled coating   surface properties  

摘要： Purpose: To evaluate the impact of surface treatments and chemical denture cleansers on the surface color stability, gloss, and wettability of compression-molded, 3D-printed, and milled denture base materials. Materials and methods: Specimens (12 & times;16 & times;7 mm) were fabricated from a standardized STL file in three denture base materials (compression-molded, 3D-printed, and milled resins;n = 80 each) and assigned to polish-only or protective-coated (Optiglaze) subgroups. Specimens were immersed in one of four cleaning solutions: Polident (alkaline peroxide), Val-Clean (potassium caroate), Renew (alkaline hypochlorite), or distilled water (control group). Thirty immersion cycles per day were performed for 12 days, for a total of 360 cycles, simulating approximately 1 year of once-daily denture cleaning. Color stability was evaluated using a spectrophotometer with the CIEDE2000 (Delta E-00) formula. Surface gloss was measured with a gloss meter, and wettability was assessed by static contact angle using an optical tensiometer. Statistical analyses were conducted using three-way ANOVA. Color changes on acceptability and perceptibility were evaluated using one-sided, one-sample t-tests (thresholds of 1.8 and 0.8, alpha = 0.05). Results: Renew produced the highest mean Delta E-00 (3.90 +/- 0.33), exceeding distilled water (1.76 +/- 0.33), Polident (0.92 +/- 0.80), and Val-Clean (0.78 +/- 0.56). Using the acceptability threshold (AT) of Delta E-00 = 1.8, all Polident and Val-Clean groups remained acceptable for milled and 3D-printed materials. In contrast, compression-molded materials exhibited greater color instability. All Renew groups exceeded the AT regardless of surface treatment or fabrication method. Gloss change was also significant;Optiglaze combined with Val-Clean caused some of the largest gloss losses in 3D-printed samples (-17.99 +/- 9.82, p < 0.0001) and compression-molded samples (-13.13 +/- 4.21, p < 0.0001). Polished surfaces generally lost less

关键词： Cognition   Brain   Ageing   Neuroimaging   Reserve   Maintenance  

摘要： The Cambridge Centre for Ageing and Neuroscience (Cam-CAN, ***) was established 15 years ago to investigate the cognitive and brain bases of healthy adult ageing. Demographic, health and lifestyle data, cognitive data and a wide range of brain imaging data, were shared with other researchers around the world, resulting in many scientific findings. Here we review these findings under the broad headings of 'neuroscience of ageing', 'methodological developments' and 'clinical/translational use', and look to future longitudinal continuation and sharing of further data.