Aims
Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for
AHF.
Methods and results
The 6128 patients from the RELAX‐AHF‐2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93–0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post‐discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non‐ischaemic aetiology and absent in those with de novo
HF.
Conclusion
In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all‐cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre‐existing
HF.
The problem of hydrogen station location is often studied through understanding refueling behavior or reviewing the experience of gasoline stations. Driven by the notion "where you drive more is where you more likely need refueling", this paper develops a new approach where station siting is treated as a fuel-travel-back problem and the only required data is VMT distribution. Such a fuel-travel-back problem is a typical transportation problem and is solved as mix-integerprogramming model. When the total fuel-travel-back time is minimized, so is the average refueling travel time of a random motorist, for which theoretical deduction is provided. The model is applied to derive an optimal station roll-out scheme for Southern California. The results show that, if station size constraints are relaxed, only 18% of existing gas station number is needed to achieve the current fuel accessibility of gasoline in the region. Fewer stations lead to larger station size, suggesting a need to re-examine the current speculation on designs of hydrogen station and distribution system and to conduct more regional studies for discovery of optimistic and pessimistic regions for hydrogen. The results also indicate that early stations should be located strategically and even at low-demand locations, which is contradictory to existing proposition.
In the recent years, great importance has been shown toward the cultural creativity in Taiwan. Cultural identification and determining how best to apply it to commercial products require investigating and compiling a vast amount of cultural information, along with the individual ideas of designers, to develop new cultural products. During the product development and design process, the color scheme is the final and most important element. It not only represents the first image of the product but also elicits the important first-sight impression of consumers. Consequently, color ranks first in cultural commodity development. By understanding the Taiwanese culture, as well as assessing, verifying, and internalizing it into the materials that can be used by the designers, this study uses an artificial neural network system and simplifies the collected pictures that are representative of the Taiwanese culture into groups of different matching colors to assist designers in developing cultural commodities with different features and according to different cultural styles.
Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. Results: In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen’s kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. Conclusions: TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
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