Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights From the International Takotsubo Registry

OBJECTIVE Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10$^{3}$ cells/μL emerged as independent predictors for thrombus formation or embolism. CONCLUSIONS Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621

Alternative Antriebe für Rangierlokomotiven

Überblick über die Ergebnisse zweier Studien zur Thematik alternativer Antriebe in Rangierlokomotiven. In der Studie "Machbarkeitsanalyse alternativer Antriebe im Einsatzgebiet von Rangierloks in Deutschland" im Auftrag der NOW wurden Anforderungen an alternative Antriebe auf Basis für verschiedene Einsatzfelder von Rangierlokomotiven ermittelt. Für fünf lokal emissionsfreie Antriebe wurden für eine dreiachsige und eine Drehgestelllokomotive Leistungstrajektorien für generische Profile simuliert, die erforderlichen Wandler- und Speicherkomponenten in Hinblick auf die zur Verfügung stehenden Bauräume dimensioniert. Schließlich wurden die Marktpotentiale alternativer Antriebe in Deutschland ermittelt. In der durch das MWIDE (Ministerium für Wirtschaft, Innovation, Digitalisierung und Energie Nordrhein-Westfalen) geförderten Vorstudie Wasserstoffrangierlokomotive (Projektpartner Duisport und ZBT) wurde die Machbarkeit von Brennstoffzellenhybrid-Rangierlokomotiven im Einsatzfeld von Duisport Rail ermittelt. Auf Basis einer Messdatenauswertung wurden typische Einsatzprofilkategorien abgeleitet und die dafür erforderlichen Energiewandler und Energiespeicher ausgelegt und hinsichtlich der Fahrzeugintegrierbarkeit bewertet

Modelling the Influence of the 2.4 GHz Electromagnetic Field on the User of a Wearable Internet of Things (IoT) Device for Monitoring Hazards in the Work Environment

The aim was to test the hypothesis that there is an insignificant influence on humans from the absorption of an 2.4 GHz electromagnetic field (EMF) emitted by wearable Internet of Things (IoT) devices (using Meandered Inverted-F Antenna (MIFA) for Wi-Fi and Bluetooth technologies) for monitoring hazards in the work environment. To quantify problem, the specific energy absorption rate (SAR) was calculated in a multi-layer ellipsoidal model of the IoT device user’s head exposed to EMF from MIFA attached to a headband or to a helmet. SAR values may be significant when a modelled IoT wearable device is attached to a headband, but not to a helmet.Results of a research tasks (II.PB.15, 2.G.04, 2.G.05) carried out within the National Programme “Improvement of safety and working conditions” partly supported in Poland in 2017–2022—within the scope of research and development—by the Ministry of Science and Higher Education/National Centre for Research and Development and within the scope of state services—by the Ministry of Family, Labour, and Social Policy (CIOPPIB is the Programme’s main co-ordinator) and the project ‘Electromagnetic Characterization in Smart Environments of Healthcare and their involvement in Personnel. Occupational and Environmental Health’ (PI14CIII/00056) funding from Sub-Directorate-General for Research Assessment and Promotion in Spain (Instituto de Salud Carlos III) and as part of the research activity of the Warsaw University of Technology.S

Kernergebnisse der Machbarkeitsanalyse alternativer Antriebe im Einsatzgebiet von Rangierloks in Deutschland

Das DLR-Institut für Fahrzeugkonzepte hat im Auftrag der NOW GmbH die Machbarkeit und die Potenziale alternativer Antriebe im Einsatzfeld von Rangierlokomotiven in Deutschland untersucht. Die untersuchten alternativen Antriebskonzepte umfassen: Akkuantrieb (ohne Oberleitungsanbindung), Brennstoffzellenhybrid, Wasserstoff-Verbrennungsmotor, BiMode-Akku-Oberleitungs-Hybrid sowie BiMode-Brennstoffzellen-Oberleitungs-Hybrid. Als repräsentative Fahrzeuge wurden eine dreiachsige und eine Drehgestell-Rangierlokomotive herangezogen. Diese Broschüre fasst die wesentlichen Ergebnisse der Studie zusammen

Alternative Antriebe für Rangierlokomotiven - Machbarkeitsanalyse

In diesem Vortrag wird die Eignung verschiedener alternativer Antriebe für Rangierlokomotiven dargestellt. Zudem werden Potentiale und Limitationen batterie- und wasserstoffbasierter Antriebe aufgezeigt sowie das zukünftige Marktpotential von Rangierlokomotiven mit alternativen Antrieben in Deutschland abgeschätzt

Einsatzpotenziale alternativer Antriebe in Rangierlokomotiven

In diesem Beitrag wird die grundsätzliche Eignung verschiedener alternativer Antriebe für Rangierlokomotiven untersucht, basierend auf betrieblich-technischen Anforderungen. Zudem werden Potentiale und Limitationen batterie- und wasserstoffbasierter Antriebe aufgezeigt sowie das zu-künftige Marktpotential von Rangierlokomotiven mit alternativen Antrieben in Deutschland abgeschätzt

Alternative powertrains for shunting locomotives - analysis of feasibility and limitations

Zero-emission powertrain technologies for shunting locomotives are becoming increasingly relevant as potential replacement candidates to diesel operated powertrains. We investigate the feasibility of zero-emission technologies in light of generic operational shunter locomotive profiles and available limited space and mass of a widely in use MaK G 1206 four axle center-cab shunting locomotive. Two generic shunting locomotive operational cycle profiles were defined based on a survey among German shunting locomotive operators: a pure shunting profile and a mixed shunting and mainline service profile. Daily energy demand at DC link level in both scenarios is similar (1,469 and 1,368 kWh respectively), but average power is higher in the mixed mainline/shunting profile. Powertrain candidates were fuel cell hybrid, battery electric, overhead wire battery electric, BiMode overhead battery electric and hydrogen internal combustion engine. Key powertrain component dimensioning for both scenarios is done using a hybridization tool incorporating volumetric and efficiency specifications of state-of-the-art railway components. The fuel cell hydrogen and overhead wire battery electric drivetrains can fulfill the energy and power requirements for the defined operational profiles, whereas the hydrogen internal combustion engine powertrain has limitations due to installation space restrictions in terms of hydrogen storage tanks. Advancements in energy storage technologies might influence the applicability of alternative powertrain systems, not only of hydrogen-based but also of battery-based propulsion systems. Further research and demonstration projects on zero-tailpipe emission shunting locomotives are recommended

Clinical characteristics and outcomes of patients with takotsubo syndrome versus spontaneous coronary artery dissection

BACKGROUND Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are now increasingly recognized. Both conditions predominantly affect females; however, the exact pathophysiology remains unclear. Large multi-center databases can help elucidate the underlying mechanism and optimize treatments to improve outcomes by allowing us to compare features and outcomes of patients with TTS and patients with SCAD. METHODS Takotsubo syndrome patients were enrolled from the International Takotsubo Registry and compared to SCAD patients from the Canadian Spontaneous Coronary Artery Dissection Cohort Study. In total 2098 TTS patients and 750 SCAD patients were included in the present study. RESULTS More than 85% of patients in both groups were females. TTS patients were older compared to SCAD patients. Physical triggers were more common in TTS patients, while emotional triggers and non-identifiable triggering events were more common in SCAD patients. Left ventricular ejection fraction was more impaired in TTS compared to SCAD. TTS patients had more major cardiovascular risk factors, while SCAD patients had a higher rate of migraines and anxiety disorders than TTS patients. Thirty-day mortality was significantly higher in TTS patients, while 30-day stroke rates were comparable between groups. CONCLUSIONS These findings suggest that women are at higher risk for TTS and SCAD compared to men, which should be considered in the differential diagnosis of those presenting with acute coronary syndrome. Additionally, emotional stressors play a significant role in triggering events particularly in younger women suffering from SCAD. The present findings may help clinicians better differentiate these 2 entities and aid in the appropriate risk stratification, diagnosis, and management. TRIAL REGISTRATION ClinicalTrials.gov no. NCT01947621