A Risk Stratification Scheme for In-Hospital Cardiogenic Shock in Patients With Acute Myocardial Infarction

Objective: Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) despite advances in care. This study aims to derive and validate a risk score for in-hospital development of CS in patients with AMI. Methods: In this study, we used the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS) registry of 76,807 patients for model development and internal validation. These patients came from 158 tertiary hospitals and 82 secondary hospitals between 2014 and 2019, presenting AMI without CS upon admission. The eligible patients with AMI were randomly assigned to derivation (n = 53,790) and internal validation (n = 23,017) cohorts. Another cohort of 2,205 patients with AMI between 2014 and 2016 was used for external validation. Based on the identified predictors for in-hospital CS, a new point-based CS risk scheme, referred to as the CCC–ACS CS score, was developed and validated. Results: A total of 866 (1.1%) and 39 (1.8%) patients subsequently developed in-hospital CS in the CCC–ACS project and external validation cohort, respectively. The CCC–ACS CS score consists of seven variables, including age, acute heart failure upon admission, systolic blood pressure upon admission, heart rate, initial serum creatine kinase-MB level, estimated glomerular filtration rate, and mechanical complications. The area under the curve for in-hospital development of CS was 0.73, 0.71, and 0.85 in the derivation, internal validation and external validation cohorts, respectively. Conclusion: This newly developed CCC–ACS CS score can quantify the risk of in-hospital CS for patients with AMI, which may help in clinical decision making. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02306616

The effect of packing mickostructure on the effective conductivity of random sphere packing for sintering applications

Sintering is a thermally activated solid diffusion process. Study of the heat transfer process is one of the key elements for the improvement of sintering technology. Within sphere packings, the three-dimensional interconnected network of spheres and the interconnected pore structures are very complex. In order to bypass this complexity, typically, the porous medium approach has been used for applications allow relative coarse resolution. However, for sintering studies, the traditional effective conductivity determination may not be directly applicable. Firstly, the porosity variation may be very rigorous due to the non-uniform densification process with a stiff temperature gradient. Furthermore, a fine control volume is required for the fine temperature resolution for studying the effect on unbalance densification rate within packings. Therefore, it is necessary to investigate the dependence of the effective conductivity of the small packing on the detailed packing parameters, such as coordination number and the contact radius ratio. Indeed, this study was one of the first attempts to investigate such effect. A numerical study was performed. The results showed that porosity is indeed not the unique parameter for describing the packing structure while the mean coordination number and the mean contact radius ratio are more appropriate for small population size of spheres. With the developed correlation, the effective conductivity can be directly determined for any packing with the known mean coordination number and the known contact radius ratio without requiring any empirical determination

Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients

Aim To estimate the prevalence of erectile dysfunction (ED) in Chinese diabetic men and to identify its risk factors, we carried out a cross-sectional survey of 500 Chinese diabetic men attending a community hospital diabetic clinic in Hong Kong.Methods Patients were interviewed and asked to report on their experience of ED as defined in the National Institutes of Health Consensus Conference 1993. Diabetic complications and patient clinical data were obtained from patients\u27 medical records.Results Of the 486 patients studied, the prevalence of ED was 63.6% (95% confidence interval 59.3&ndash;67.9%). The prevalence of ED increased with age, from 33.3% to 73.8% for diabetic men aged between 21 and 80 years (P = 0.001). Severity of ED also increased with age. Among diabetic men with ED, there was no report of complete ED for diabetic men aged 40 years and below, whereas the proportion of patients with complete ED increased from 7.4% to 71.1% between the ages of 41 and 80 years. ED occurred early in the course of the disease, with a prevalence increasing from 56.0% in men with diabetes mellitus (DM) for &lt; 5 years to 72.0% in those with DM for &gt; 20 years (P = 0.038). Duration of DM was also associated with severity; the proportion of patients with complete ED increased from 30.8% for those with DM for &lt; 5 years to 72.2% for those with DM for &ge; 20 years (P &lt; 0.001). Using logistic regression analysis, DM duration, diabetic complications including retinopathy, abnormal albuminuria and sensory neuropathy, and higher level of education were associated with a higher risk of ED. By polychotomous logistic regression, age was the only factor found to be associated with the severity of ED, after adjusting for other variables.Conclusions Chinese diabetic patients have a prevalence of self-reported ED that appears to be higher than that of Western populations. This may be due to cultural differences and the association of abnormal albuminuria and hypertension.<br /