Combined atrial fibrillation ablation and left atrial appendage occlusion procedure in the United States: a propensity score matched analysis from 2016-2019 national readmission database.

AIMS: The safety and feasibility of combining percutaneous catheter ablation (CA) for atrial fibrillation with left atrial appendage occlusion (LAAO) as a single procedure in the USA have not been investigated. We analyzed the US National Readmission Database (NRD) to investigate the incidence of combined LAAO + CA and compare major adverse cardiovascular events (MACEs) with matched LAAO-only and CA-only patients. METHODS AND RESULTS: In this retrospective study from NRD data, we identified patients undergoing combined LAAO and CA procedures on the same day in the USA from 2016 to 2019. A 1:1 propensity score match was performed to identify patients undergoing LAAO-only and CA-only procedures. The number of LAAO + CA procedures increased from 28 (2016) to 119 (2019). LAAO + CA patients (n = 375, mean age 74 ± 9.2 years, 53.4% were males) had non-significant higher MACE (8.1%) when compared with LAAO-only (n = 407, 5.3%) or CA-only patients (n = 406, 7.4%), which was primarily driven by higher rate of pericardial effusion (4.3%). All-cause 30-day readmission rates among LAAO + CA patients (10.7%) were similar when compared with LAAO-only (12.7%) or CA-only (17.5%) patients. The most frequent primary reason for readmissions among LAAO + CA and LAAO-only cohorts was heart failure (24.6 and 31.5%, respectively), while among the CA-only cohort, it was paroxysmal atrial fibrillation (25.7%). CONCLUSION: We report an 63% annual growth (from 28 procedures) in combined LAAO and CA procedures in the USA. There were no significant difference in MACE and all-cause 30-day readmission rates among LAAO + CA patients compared with matched LAAO-only or CA-only patients

Ginkgo biloba for the treatment of vitilgo vulgaris: an open label pilot clinical trial

<p>Abstract</p> <p>Background</p> <p>Vitiligo is a common hypopigmentation disorder with significant psychological impact if occurring before adulthood. A pilot clinical trial to determine the feasibility of an RCT was conducted and is reported here.</p> <p>Methods</p> <p>12 participants 12 to 35 years old were recruited to a prospective open-label pilot trial and treated with 60 mg of standardized <it>G. biloba </it>two times per day for 12 weeks. The criteria for feasibility included successful recruitment, 75% or greater retention, effectiveness and lack of serious adverse reactions. Effectiveness was assessed using the Vitiligo Area Scoring Index (VASI) and the Vitiligo European Task Force (VETF), which are validated outcome measures evaluating the area and intensity of depigmentation of vitiligo lesions. Other outcomes included photographs and adverse reactions. Safety was assessed by serum coagulation factors (platelets, PTT, INR) at baseline and week 12.</p> <p>Results</p> <p>After 2 months of recruitment, the eligible upper age limit was raised from 18 to 35 years of age in order to facilitate recruitment of the required sample size. Eleven participants completed the trial with 85% or greater adherence to the protocol. The total VASI score improved by 0.5 (P = 0.021) from 5.0 to 4.5, range of scale 0 (no depigmentation) to 100 (completely depigmented). The progression of vitiligo stopped in all participants; the total VASI indicated an average repigmentation of vitiligo lesions of 15%. VETF total vitiligo lesion area decreased 0.4% (P = 0.102) from 5.9 to 5.6 from baseline to week 12. VETF staging score improved by 0.7 (P = 0.101) from 6.6 to 5.8, and the VETF spreading score improved by 3.9 (P < 0.001)) from 2.7 to -1.2. There were no statistically significant changes in platelet count, PTT, or INR.</p> <p>Conclusions</p> <p>The criteria for feasibility were met after increasing the maximum age limit of the successful recruitment criterion; participant retention, safety and effectiveness criteria were also met. Ingestion of 60 mg of <it>Ginkgo biloba </it>BID was associated with a significant improvement in total VASI vitiligo measures and VETF spread, and a trend towards improvement on VETF measures of vitiligo lesion area and staging. Larger, randomized double-blind clinical studies are warranted and appear feasible.</p> <p>Trial Registration</p> <p>Clinical trials.gov registration number <a href="http://www.clinicaltrials.gov/ct2/show/NCT00907062">NCT00907062</a></p

Development of blast furnace quality pellet optimising blue dust, hard ore and friable ore ratio

Three types of ore fines such as hard ore (HO), blue dust (BD) and friable ore (FO), normally available from a mine show different physical and physicochemical properties. Each of the properties of any individual ore among three may not be suitable to use independently in pelletisation. However, uses of all these three are mandatory. Ores of some poor properties may show other properties excellent. Therefore, any specific poor property of any individual ore can be modified by adding (mixing) other ore which shows that particular property excellent. In order to utilise those three ore fines in pelletisation, mixing of above three ores have been done to get good pellet properties. In industry, the fluctuation in mixing ratio often creates problem in maintaining pellet quality and consistency in spite of maintaining identical basicity and MgO content. Therefore, the required mixing ratio and pellet chemistry has also been optimised in this study. BD, FO and HO has been found to be suitable in the mixing ratio of 70:25:5 with 1.4% MgO. However, with increase in FO beyond 50%, reduction degradation index (RDI) becomes very high (25%). RDI has been decreased to very low level by increasing MgO content from 1.4 to 2% which enables to use FO up to 70% for good quality pellet preparation

Improving reductibility of iron ore pellets by optimization of physical parameters

Reducibility of iron bearing material is an important property which represents its suitability of reduction in iron making furnaces. It has direct influence on improving productivity and lowering energy consumption in iron making process. The reducibility of iron ore pellets of a specific chemistry can be improved by the optimization of physical parameters such as induration temperature, improving size distribution of fines, improving apparent porosity etc. In this study, the reference pellet is prepared in a typical plant condition and the properties of the reference pellet are considered as base value to improve reducibility index (RI) maintaining other properties at the acceptable limit without altering pellet chemistry. Optimization of induration temperature at the 1250-1275 degrees C shows around 74 % RI, which is 5 points more than the base value of 69.5 %. Furthermore, on optimizing additives size, such as limestone fines and anthracite coal fines at -350 mesh and induration temperature of 1250-1275 degrees C, RI is improved to 77 %, i.e., 8 points improvement is achieved with respect to the base value

Ultrasound Simulation on the Cell Broadband Engine Using the Westervelt Equation

Abstract. The simulation of realistic medical ultrasound imaging is a computationally intensive task. Although this task may be divided and parallelized, temporal and spatial dependencies make memory bandwidth a bottleneck on performance. In this paper, we report on our implementation of an ultrasound simulator on the Cell Broadband Engine using the Westervelt equation. Our approach divides the simulation region into blocks, and then moves a block along with its surrounding blocks through a number of time steps without storing intermediate pressures to memory. Although this increases the amount of floating point computation, it reduces the bandwidth to memory over the entire simulation which improves overall performance. We also analyse how performance may be improved by restricting the simulation to regions that are affected by the transducer output pulse and that influence the final scattered signal received by the transducer