Publications

The spatial and temporal characteristics of the internal temperature field of the box-type composite wall have great significance to high temperature mechanical response and fire resistance performance of composite wall subjected to fire. A series of assumptions for the simplified model were made after determining the influence of various thermal parameters, the boundary conditions of surface and the contact conditions. And the finite element software(ABAQUS) was used to establish the temperature field analysis model to conduct nonlinear transient temperature response analysis, then the validity of the model was verified by relevant test results. On this basis, the distribution of temperature field during the whole process and its key measuring points under fire are analyzed, and the parameters of each component are researched. The results show that the thickness of rock wool, the type, the thickness and number of layers of cladding plates have obvious influence on the temperature field distribution inside the composite wall, and other factors have little effect. According to the analysis results, the fire-resistant design idea of the composite wall and the temperature prediction formulas of the key temperature-control point are proposed, which provide the basis for the application of the boxtype steel structure system.

The current guidelines have recommended postponing noncardiac surgery (NCS) for ≥6 weeks after bare metal stent (BMS) placement and for ≥1 year after drug-eluting stent (DES) placement. However, much debate has ensued about these intervals. The aim of the present study was to assess the influence of different intervals between stenting and NCS and the use of dual antiplatelet therapy on the occurrence of perioperative major adverse cardiac events (MACEs). We identified 550 patients (376 with a DES and 174 with a BMS) by cross-matching the Erasmus Medical Center percutaneous coronary intervention (PCI) database with the NCS database. The following intervals between PCI-BMS (<30 days, <3 months, and >3 months) or PCI-DES (<30 days, <3 months, 3 to 6 months, 6 to 12 months, and >12 months) and NCS were studied. MACEs included death, myocardial infarction, and repeated revascularization. In the PCI-BMS group, the rate of MACEs during the intervals of <30 days, 30 days to 3 months, and >3 months was 50%, 14%, and 4%, respectively (overall p <0.001). In the PCI-DES group, the rate of MACE changed significantly with the interval after PCI (35%, 13%, 15%, 6%, and 9% for patients undergoing NCS <30 days, 30 days to 3 months, 3 to 6 months, 6 to 12 months, and >12 months, respectively, overall p <0.001). Of the patients who experienced a MACE, 45% and 55% were receiving single and dual antiplatelet therapy at NCS, respectively (p = 0.92). The risk of severe bleeding in patients with single and dual therapy at NCS was 4% and 21%, respectively (p <0.001). In conclusion, we found an inverse relation between the interval from PCI to NCS and perioperative MACEs. Continuation of dual antiplatelet therapy until NCS did not provide complete protection against MACEs.

Background Computerized quantitative coronary angiography (QCA) has fundamentally altered our approach to the assessment of coronary interventional techniques and strategies aimed at the prevention of recurrence and progression of stenosis. It is essential, therefore, that the performance of QCA systems, upon which much of our scientific understanding has become integrally dependent, is evaluated in an objective and uniform manner. Methods and Results We validated 10 QCA systems at core laboratories in North America and Europe. Cine films were made of phantom stenoses of known diameter (0.5 to 1.9 mm) under four experimental conditions: in vivo (coronary arteries of pigs) calibrated at the isocenter or by use of the catheter as a scaling device and in vitro with 50% contrast and 100% contrast. The cine films were analyzed by each automated QCA system without observer interaction. Accuracy and precision were taken as the mean and SD of the signed differences between the phantom stenoses, and the measured minimal luminal diameters and the correlation coefficient ( r ), the SEE, the y intercept, and the slope were derived by their linear regression. Performance of the 10 QCA systems ranged widely: accuracy, +0.07 to +0.31 mm; precision, ±0.14 to ±0.24 mm; correlation ( r ), .96 to .89; SEE, ±0.11 to ±0.16 mm; intercept, +0.08 to +0.31 mm; and slope, 0.86 to 0.64. Conclusions There is a marked variability in performance between systems when assessed over the range of 0.5 to 1.9 mm. The range of accuracy, intercept, and slope values of this report indicates that absolute measurements of luminal diameter from different multicenter angiographic trials may not be directly comparable and additionally suggests that such absolute measurements may not be directly applicable to clinical practice using an on-line QCA system with a different edge detection algorithm. Power calculations and study design of angiographic trials should be adjusted for the precision of the QCA system used to avoid the risk of failing to detect small differences in patient populations. This study may guide the fine-tuning of algorithms incorporated within each system and facilitate the maintenance of high standards of QCA for scientific studies.

Background/Introduction Prediction of bleeding risk in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has been repeatedly attempted and resulted in multiple risk models. To promote the adoption and use of risk stratification among clinicians, a consortium in the South East of the Netherlands, the "ZON-HR", has created a simple binary variant of the existing logistic models. This model includes commonly available factors which can be incorporated into the PCI report to generate stratification. In this "parsimonious" model, high bleeding risk (HBR) is stratified according to: history of intracranial haemorrhage, previous spontaneous bleeding, Hb &amp;lt; 11 g/dL, eGFR&amp;lt; 30. Purpose We aimed to perform an external validation of our model for bleeding risk and to demonstrate its discriminative value in comparison with the PRECISE DAPT score, an acknowledged risk score. Methods We performed a post hoc analysis of the GLOBAL LEADERS trial, a multicenter randomized trial, comparing ticagrelor monotherapy after one month of DAPT with standard DAPT after PCI. We stratified the patients for HBR according to the ZON-HR or a PRECISE-DAPT score ≥ 25. Bleeding events one year after PCI were compared in the entire population and in subgroups for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), Ticagrelor monotherapy and DAPT. Results Of the 15968 patients included in GLOBAL LEADERS, 1059 patients were excluded due to missing variables required for either model. Among the 14909 patients, 17% had HBR according to the PRECISE DAPT score, 4% according to ZON-HR and 3% according to both. Bleeding events occurred in 8.5% and 13% of HBR defined by PRECISE DAPT or ZON-HR respectively. Patients with HBR according to both models showed 13% bleedings as opposed to 5% in non-HBR. Table 1 presents the sensitivity and specificity. Regression analysis (figure 1) demonstrated that patients with HBR according to either model have significantly more bleedings. This was also significant in all subgroups except for ACS patients receiving standard DAPT when the ZON-HR model was used. Conclusion The ZON-HR model is more conservative compared to the PRECISE DAPT score as depicted by the sensitivity and specificity. This can be explained by the larger number of risk factors used in the PRECISE DAPT score that cumulatively contributes to the sensitivity as opposed to the binary ZON-HR model which is more specific. However, the survival curves and hazard ratios showed good predictive value of both models for bleeding risk in the overall population.Table 1.Figure 1.

Drug-eluting stents (DES) are still the standard of care in percutaneous coronary intervention (PCI) since the fall of bioresorbable scaffolds with respect to safety. The unbeatable advantage of a metallic stent when compared with a scaffold is a stronger mechanical property and more sustainable vascular support. Recent development of contemporary metallic stent has focused on the reduction of strut thickness. However, there will always be a trade-off between improvement in deliverability, flexibility, and radial strength.This review aims to discuss the designs of metallic stent platform and mechanical properties as well as mechanical performance of contemporary DES from bench studies and clinical trials.Mechanical properties of stents affect short- and long-term clinical outcomes. Ultrathin-strut DES have become popular and clinical trials have shown impressive results. Thinner struts may improve device flexibility and deliverability but the radial strength and longitudinal integrity might have been compromised as well. Ultrathin-strut cobalt chromium or platinum chromium DES will become standard of care in PCI practice in the near future. Information on the stent design, stent material and mechanical properties of the stent are essential for a rational selection of the appropriate stent in selected lesions and patients.

Introduction: Peripheral and central airways nitric oxide (NO) can be partitioned using the multiple constant exhalation flows (Tsoukias et al 1998). We hypothesized that the choice of different flows and breath-hold periods may affect the results. Objective: To investigate the effect of different combinations of multiple exhalation flow rates and breath hold on the bronchial production (JawNO) and alveolar concentration of NO(CANO) in healthy subjects. Methods: Fractional exhaled NO (FeNO) was measured (Niox Flex, Aerocrine, Sweden) in 18 healthy subjects (34.5± 6.52 years), using different sets of flows: Set1: 10,30,50,100,200,300 ml/sec; Set2: 30,50,100,200,300ml/sec; Set3: 50,100,200,300ml/sec; Set4: 100,200,300ml/sec; Set5:50,100,200ml/sec; Set6: 30,50,100,200ml/sec; Set7:10,50,100,200ml/sec; Set8: 10,30,50,100,200ml/sec. In addition, in a separate experiment, eExhaled NO was measured after a 20 seconds breath-hold at total lung capacity. Results: JawNO and CANO were significantly affected by different sets of flow rates and varied between 632.5± 70.58 pl/sec and 892.0±109.4 pl/sec (p Conclusion: The choice of different sets of exhalation flow rates significantly affect JawNO and CANO, therefore, standardization of the measurements is required. In addition, breath holding should be avoided as it significantly affects NO parameters. We acknowledge the support of the ERS, Fellowship STRTF 373-2011.

Introduction Visual estimation of vessel diameter and lesion length supported by balloon predilation (known length and diameter) has been a common strategy, when final stent implantation is anticipated. Quantitative coronary angiography (QCA) being highly accurate and reproducible can refine the visual estimate and provide several important parameters which have been accepted as surrogate endpoints in many clinical studies on new PCI technologies. However, stand-alone percent diameter/area stenosis measurements derived from conventional (single-vessel) twodimensional (2-D) QCA analysis fail to predict the functional significance of coronary vessel obstruction. This holds even more for the analysis of bifurcation lesions, where the discrepancy in vessel size proximal and distal to the carina (step-down phenomenon) results in stenosis being overestimated in the distal branches and underestimated in the proximal main vessel (PMV). Dedicated 2-D bifurcation software algorithms have been developed recently in order to make up for the shortcomings of 2-D singlevessel QCA by reporting angiographic parameters separately for the PMV and each of the distal branches. The proximal and the distal branches of a single bifurcation often do not lie on a single plane; thus vessel overlap and foreshortening together with the lesion eccentricity may compromise the results of 2-D angiographic analysis. In the last 10 years evidence has accumulated that three dimensional (3-D) angiographic reconstruction is accurate, precise and reproducible. Reduced time requirements for a single 3-D reconstruction facilitates realtime analysis; single-vessel as well as bifurcation lesions can be reconstructed and analysed via dedicated QCA algorithms. In this short review we will attempt to emphasise the relative merits of bifurcation QCA compared to visual assessment, report on the options currently available for 2-D and 3-D bifurcation QCA analysis and outline the challenges yet to be addressed.

To address the potential role of the chemokine macrophage inflammatory protein‐2 (MIP‐2) in airway inflammation, we examined whether MIP‐2 may play a role in ozone‐induced neutrophilic inflammation of airways and its modulation by dexamethasone in rat lung. Following ozone exposure, MIP‐2 mRNA expression in the lung peaked at 2 h after exposure and slowly declined thereafter. Dexamethasone suppressed ozone‐induced MIP‐2 mRNA expression and neutrophil accumulation in the lung. We suggest that the MIP‐2 mRNA induction may switch on the neutrophilic influx observed in this model of lung inflammation. Furthermore, the MIP‐2 expression is regulated by dexamethasone which may represent one of the mechanisms by which glucocorticoids exert their potent anti‐inflammatory properties.

Background Percutaneous coronary intervention (PCI) using drug‐eluting stents is an established strategy for the treatment of significant obstructive coronary artery disease. Evidence supports that intravascular imaging‐guided PCI offers advantages over conventional angiography‐guided PCI, though its use is limited, likely due to high costs. Angiography‐guided PCI relies on visual estimation, leading to inter‐ and intra‐observer variability and suboptimal outcomes. Quantitative coronary angiography (QCA) provides reliable information about vascular dimensions, overcoming these limitations. Poststenting postdilation with appropriately sized noncompliant balloons improves outcomes by increasing lumen area and reducing stent malapposition. Aims We investigated the procedural details of each modality used to guide PCI and assessed the utility of QCA‐guided PCI with routine postdilation when intravascular imaging is unavailable. Methods and Results A systematic search was conducted from inception to May 31, 2024, identifying nine randomized controlled trials (with over 500 patients) that compared outcomes of PCI guided by intravascular imaging versus conventional angiography or QCA. The findings indicate that intravascular imaging guidance significantly improves clinical outcomes compared to angiography guidance. Notably, QCA‐guided PCI with routine postdilation yielded outcomes comparable to those achieved with intravascular imaging‐guided PCI. Conclusions QCA‐guided PCI with routine postdilation may be a viable alternative for improving PCI outcomes, especially in settings where intravascular imaging is unavailable.