Lupus Myocarditis Presenting as Acute Congestive Heart Failure: A Case Report

A young woman who had a delivery history 3 months previously presented with dyspnea and orthopnea. Initial findings of physical examination, chest radiography, and echocardiogram showed typical congestive heart failure with severe left ventricular (LV) dysfunction. At first, we considered peripartum cardiomyopathy because she had given birth to a baby 3 months previously. However, even though we massively tried conventional drug therapy for 10 days, the patient still remained with refractory heart failure. We performed additional laboratory studies such as complement level and autoantibodies, of which the results supported systemic lupus erythematosus. We could make the diagnosis of acute lupus myocarditis and treated her with corticosteroid. The symptoms were dramatically disappeared and LV function also improved

Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease 5-Year Outcomes of the PRECOMBAT Study

AbstractBackgroundIn a previous randomized trial, we found that percutaneous coronary intervention (PCI) was not inferior to coronary artery bypass grafting (CABG) for the treatment of unprotected left main coronary artery stenosis at 1 year.ObjectivesThis study sought to determine the 5-year outcomes of PCI compared with CABG for the treatment of unprotected left main coronary artery stenosis.MethodsWe randomly assigned 600 patients with unprotected left main coronary artery stenosis to undergo PCI with a sirolimus-eluting stent (n = 300) or CABG (n = 300). The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE: a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target vessel revascularization) and compared on an intention-to-treat basis.ResultsAt 5 years, MACCE occurred in 52 patients in the PCI group and 42 patients in the CABG group (cumulative event rates of 17.5% and 14.3%, respectively; hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.84 to 1.90; p = 0.26). The 2 groups did not differ significantly in terms of death from any cause, myocardial infarction, or stroke as well as their composite (8.4% and 9.6%; HR, 0.89; 95% CI, 0.52 to 1.52; p = 0.66). Ischemia-driven target vessel revascularization occurred more frequently in the PCI group than in the CABG group (11.4% and 5.5%, respectively; HR: 2.11; 95% CI: 1.16 to 3.84; p = 0.012).ConclusionsDuring 5 years of follow-up, our study did not show significant difference regarding the rate of MACCE between patients who underwent PCI with a sirolimus-eluting stent and those who underwent CABG. However, considering the limited power of our study, our results should be interpreted with caution. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease [PRECOMBAT]; NCT00422968

Gel-type autologous chondrocyte (Chondron™) implantation for treatment of articular cartilage defects of the knee

<p>Abstract</p> <p>Background</p> <p>Gel-type autologous chondrocyte (Chondron™) implantations have been used for several years without using periosteum or membrane. This study involves evaluations of the clinical results of Chondron™ at many clinical centers at various time points during the postoperative patient follow-up.</p> <p>Methods</p> <p>Data from 98 patients with articular cartilage injury of the knee joint and who underwent Chondron™ implantation at ten Korean hospitals between January 2005 and November 2008, were included and were divided into two groups based on the patient follow-up period, i.e. 13~24-month follow-up and greater than 25-month follow-up. The telephone Knee Society Score obtained during telephone interviews with patients, was used as the evaluation tool.</p> <p>Results</p> <p>On the tKSS-A (telephone Knee Society Score-A), the score improved from 43.52 ± 20.20 to 89.71 ± 13.69 (P < 0.05), and on the tKSS-B (telephone Knee Society Score-B), the score improved from 50.66 ± 20.05 to 89.38 ± 15.76 (P < 0.05). The total improvement was from 94.18 ± 31.43 to 179.10 ± 24.69 (P < 0.05).</p> <p>Conclusion</p> <p>Gel-type autologous chondrocyte implantation for chondral knee defects appears to be a safe and effective method for both decreasing pain and improving knee function.</p

New prognostic scoring system for mortality in idiopathic pulmonary fibrosis by modifying the gender, age, and physiology model with desaturation during the six-minute walk test

BackgroundIdiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD) with variable and heterogeneous clinical course. The GAP (gender, age, and physiology) model had been used to predict mortality in patients with IPF, but does not contain exercise capacity. Therefore, our aim in this study was to develop new prognostic scoring system in the Korea IPF Cohort (KICO) registry.Materials and methodsThis is a retrospective study of Korean patients with IPF in KICO registry from June 2016 to August 2021. We developed new scoring system (the GAP6) based on the GAP model adding nadir saturation of percutaneous oxygen (SpO2) during six-minute walk test (6MWT) in the KICO registry and compared the efficacy of the GAP and the GAP6 model.ResultsAmong 2,412 patients in KICO registry, 966 patients were enrolled. The GAP6 model showed significant prognostic value for mortality between each stage [HR Stage II vs. Stage I = 2.89 (95% CI = 2.38–3.51), HR Stage III vs. Stage II = 2.68 (95% CI = 1.60–4.51)]. In comparison the model performance with area under curve (AUC) using receiver operating characteristic (ROC) curve analysis, the GAP6 model showed a significant improvement for predicting mortality than the GAP model (AUC the GAP vs. the GAP6, 0.646 vs. 0.671, p &lt; 0.0019). Also, the C-index values slightly improved from 0.674 to 0.691 for mortality.ConclusionThe GAP6 model adding nadir SpO2 during 6WMT for an indicator of functional capacity improves prediction ability with C-index and AUC. Additional multinational study is needed to confirm these finding and validate the applicability and accuracy of this risk assessment system

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Lithography Hotspot Detection

The lithography process for chip manufacturing has been playing a critical role in keeping Moor\u27s law alive. Even though the wavelength used for the process is bigger than actual device feature size, which makes it difficult to transfer layout patterns from the mask to wafer, lithographers have developed a various technique such as Resolution Enhancement Techniques (RETs), Multi-patterning, and Optical Proximity Correction (OPC) to overcome the sub-wavelength lithography gap. However, as feature size in chip design scales down further to a point where manufacturing constraints must be applied to early design phase before generating physical design layout. Design for Manufacturing (DFM) is not optional anymore these days. In terms of the lithography process, circuit designer should consider making their design as litho-friendly as possible. Lithography hotspot is a place where it is susceptible to have fatal pinching (open circuit) or bridging (short circuit) error due to poor printability of certain patterns in a design layout. To avoid undesirable patterns in layout, it is mandatory to find hotspots in early design stage. One way to find hotspots is to run lithography simulation on a layout. However, lithography simulation is too computationally expensive for full-chip design. Therefore, there have been suggestions such as pattern matching and machine learning (ML) technique for an alternative and practical hotspot detection method. Pattern matching is fast and accurate. Large hotspot pattern library is utilized to find hotspots. Its drawback is that it can not detect hotspots that are unseen before. On contrast, ML is effective to find previously unseen hotspots, but it may produce false positives. This research presents a novel geometric pattern matching methodology using edge driven dissected rectangles and litho award machine learning for hotspot detection. 1. Edge Driven Dissected Rectangles (EDDR) based pattern matching EDDR pattern matching employs member concept inside a pattern bounding box. Unlike the previous pattern matching, the idea proposed in this thesis uses simple Design Rule Check (DRC) operations to create member rectangles for pattern matching. Our approach shows significant speedup against a state-of-art commercial pattern matching tool as well as other methods. Due to its simple DRC edge operation rules, it is flexible for fuzzy pattern match and partial pattern match, which enable us to check previously unseen hotspots as well as the exact pattern match. 2. Litho-aware Machine Learning A new methodology for machine learning (ML)-based hotspot detection harnesses lithography information to build SVM (Support Vector Machine) during its learning process. Unlike the previous research that uses only geometric information or requires a post-OPC (Optical Proximity Correction) mask, our method utilizes detailed optical information but bypasses post-OPC mask by sampling latent image intensity and use those points to train an SVM model. Our lithography-aware machine learning guides learning process using actual lithography information combined with lithography domain knowledge. While the previous works for SVM modeling to identify hotspots have used only geometric related information, which is not directly relevant to the lithographic process, our SVM model was trained with lithographic information which has a direct impact on causing pinching or bridging hotspots. Furthermore, rather than creating a monolithic SVM trying to cover all hotspot patterns, we utilized lithography domain knowledge and separated hotspot types such as HB(Horizontal Bridging), VB (Vertical Bridging), HP(Horizontal Pinching), and VP(Vertical Pinching) for our SVM model. Out results demonstrated high accuracy and low false alarm, and faster runtime compared with methods that require a post-OPC mask. We also showed the importance of lithography domain knowledge to train ML for hotspot detection

Geometric Pattern Match Using Edge Driven Dissected Rectangles and Vector Space

In this paper, we propose novel algorithms for pattern matching which dissects patterns into rectangles based on polygon edges. Unlike other design rule check (DRC)-based pattern matching algorithms, our solution utilizes simple DRC edge length rules to create rectangles for hotspot pattern descriptions. This approach has at least three advantages over other solutions. First, it is faster than other state-of-the-art pattern matching tools. Second, it is intuitive and simple for pattern matching engineers to understand and describe patterns. Third, it scales well for parallel computation. We also show how to improve pattern matching run time using vector space created by an origin rectangle and other reference rectangles inside a pattern bounding box. By adopting the vector concept, we iterate only once or twice when detecting different pattern orientations. Other pattern matching techniques usually iterate eight times (4 rotations × 2 mirrored images) to detect all of the eight different orientations. Our method eliminates these unnecessary iterations