Search results for: cardiac repair

Authors: Ana Rahma Yuniarti, Ki Moo Lim

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Slowed myocardial conduction velocity (CV) and shortened action potential duration (APD) due to some reason are associated with an increased risk of re-entrant excitation, predisposing to cardiac arrhythmia. That is because both of CV reduction and APD shortening induces shortening of wavelength. In this study, we investigated quantitatively the cardiac mechanical responses under various CV and APD using multi-scale computational model of the heart. The model consisted of electrical model coupled with the mechanical contraction model together with a lumped model of the circulatory system. The electrical model consisted of 149.344 numbers of nodes and 183.993 numbers of elements of tetrahedral mesh, whereas the mechanical model consisted of 356 numbers of nodes and 172 numbers of elements of hexahedral mesh with hermite basis. We performed the electrical simulation with two scenarios: 1) by varying the CV values with constant APD and 2) by varying the APD values with constant CV. Then, we compared the electrical and mechanical responses for both scenarios. Our simulation showed that faster CV and longer APD induced largest resultants wavelength and generated better cardiac pumping efficacy by increasing the cardiac output and consuming less energy. This is due to the long wave propagation and faster conduction generated more synchronous contraction of whole ventricle.

Keywords: conduction velocity, action potential duration, mechanical contraction model, circulatory model

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Authors: Sarka Keprdova, Nikol Zizkova

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This paper focuses on the presentation of results which were obtained as a part of the project FR-TI 3/742: “System of Lightweight Materials for Finishing of Buildings with Waste Raw Materials”. Attention was paid to the lightweighting of polymer-modified mortars applicable as adhesives, screeds and repair mortars. In terms of repair mortars, they were ones intended for the sanitation of aerated concrete.

Keywords: additives, light aggregates, lightweight materials, lightweight mortars, polymer-modified mortars

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of In- Hospital Cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditions and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90mmHg, respiratory rate <8 or > 28 breaths per minute, O2 saturation < 90%, acute change in conscious state, acute chest pain or worried about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in In-Hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in In-Hospital cardiac arrest and overall hospital mortality rate. We conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed Chi -square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010 ,139 calls in 2011 and 245 calls in 2012.The number of ERT calls per 1000 admissions in year 2009-10 was 7.69, 5.61 in 2011 and 9.38 in 2013. The number of Code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, But we have not found difference in overall hospital mortality rate.

Keywords: emergency response team, ERT, cardiac arrest, emergency medicine

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Authors: Pranee Tridhoskul

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This research paper is aimed to examine a relationship between the service marketing mix and customers’ frequency of use of service at Mercedes Benz Auto Repair Centres under Thonburi Group, Thailand. Based on 2,267 customers who used the service of Thonburi Group’s Auto Repair Centres as the population, the sampling of this research was a total of 340 samples, by use of Probability Sampling Technique. Systematic Random Sampling was applied by use of questionnaire in collecting the data at Thonburi Group’s Auto Repair Centres. Mean and Pearson’s basic statistical correlations were utilized in analyzing the data. The study discovered a medium level of customers’ perception towards product and service of Thonburi Group’s Auto Repair Centres, price, place or distribution channel and promotion. People who provided service were perceived also at a medium level, whereas the physical evidence and service process were perceived at a high level. Furthermore, there appeared a correlation between the physical evidence and service process, and customers’ frequency of use of automobile service per year.

Keywords: service marketing mix, behavior, Mercedes Auto Service Centre, frequency of use

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: Nicholas Bayfield, Liam Bibo, Charley Budgeon, Robert Larbalestier, Tom Briffa

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Introduction: Stress hyperglycaemia is common following cardiac surgery. Its optimal management is uncertain and may differ by diabetic status. This study assesses the in-hospital glycaemic management of cardiac surgery patients and associated postoperative outcomes. Methods: A retrospective cohort analysis of all patients undergoing cardiac surgery at Fiona Stanley Hospital from February 2015 to May 2019 was undertaken. Management and outcomes of hyperglycaemia following cardiac surgery were assessed. Follow-up was assessed to 1 year postoperatively. Multivariate regression modelling was utilised. Results: 1050 non-diabetic patients and 689 diabetic patients were included. In the non-diabetic cohort, patients with mild (peak blood sugar level [BSL] < 14.3), transient stress hyperglycaemia managed without insulin were not at an increased risk of wound-related morbidity (P=0.899) or mortality at 1 year (P=0.483). Insulin management was associated with wound-related readmission to hospital (P=0.004) and superficial sternal wound infection (P=0.047). Prolonged or severe stress hyperglycaemia was predictive of hospital re-admission (P=0.050) but not morbidity or mortality (P=0.546). Diabetes mellitus was an independent risk factor 1-year mortality (OR; 1.972 [1.041–3.736], P=0.037), graft harvest site wound infection (OR; 1.810 [1.134–2.889], P=0.013) and wound-related readmission (OR; 1.866 [1.076–3.236], P=0.026). In diabetics, postoperative peak BSL > 13.9mmol/L was predictive of graft harvest site infections (OR; 3.528 [1.724-7.217], P=0.001) and wound-related readmission OR; 3.462 [1.540-7.783], P=0.003) regardless of modality of management. A peak BSL of 10.0-13.9 did not increase the risk of morbidity/mortality compared to a peak BSL of < 10.0 (P=0.557). Diabetics with a peak BSL of 13.9 or less did not have significantly increased morbidity/mortality outcomes compared to non-diabetics (P=0.418). Conclusion: In non-diabetic patients, transient mild stress hyperglycaemia following cardiac surgery does not uniformly require treatment. In diabetic patients, postoperative hyperglycaemia with peak BSL exceeding 13.9mmol/L was associated with wound-related morbidity and hospital readmission following cardiac surgery.

Keywords: cardiac surgery, pulmonary embolism, pulmonary embolectomy, cardiopulmonary bypass

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Authors: Gary Young, David Zepeda, Gilbert Nyaga

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This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions. A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals. The study was conducted as an observational investigation based on a pooled, cross-sectional database. The study sample comprised over hospitals in the State of California. The time frame for the study was 2010 to 2012. The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions. These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires the cooperation of a hospital’s physicians. Data for this measure was obtained from a federal website that presents performance scores for U.S. hospitals. The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians. Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals. Additional sources of data included the American Hospital Association and the U.S. Census. Empirical models were estimated with generalized estimating equations (GEE). Findings suggest that physician employment is positively associated with better hospital performance for cardiac care. However, findings also suggest that information technology is a substitute for physician employment.

Keywords: physician employment, hospitals, verical integration, cardiac care

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Authors: Vignesh Ratnaraj, Jaewon Chang

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Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. The primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with an increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than non-frail counterparts and are at an increased risk of developing various perioperative complications.

Keywords: cardiac surgery, gait speed, recovery, frailty

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Authors: Syed Sameer Aga, Saniya Nissar

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The Xeroderma pigmentosum group D gene (XPD) plays a key role in nucleotide excision repair (NER) pathway of the damaged DNA. Genetic polymorphisms in the coding region of the XPD gene may alter DNA repair capacity of the protein and hence can modulate the risk of colorectal cancer (CRC) risk. The aim of the study was to determine the genetic association of XPD Lys751Gln polymorphism with the risk of colorectal cancer (CRC) development. 120 CRC patients and 160 normal controls were assessed for genotype frequencies of XPD Lys751Gln polymorphism using PCR-RFLP technique. We observed a significant association (p < 0.05) between the XPD Lys751Gln polymorphism and the risk of developing CRC (p < 0.05). Additionally, Gln/Gln genotype of the XPD gene doubled the risk for the development of CRC [p < 0.05; OR=2.25 95% CI (1.07-4.7)]. Our results suggest that there is a significant association between the XPD Lys751Gln polymorphism and the risk of CRC.

Keywords: colorectal cancer, polymorphism, RFLP, DNA Repair, NER, XPD

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Authors: M. A. Lawal, A. Uzairu, M. S. Sallau

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The presence and bioaccumulation of lead (Pb), cadmium (Cd), and chromium (Cr) in blood, urine, nail, and hair samples of electronic repair technicians in Kaduna-Nigeria were assessed using Fast Sequential Atomic Absorption Spectrophotometry. 10 electronic repair technicians from within Kaduna Metropolis volunteered for the pilot study. The mean blood concentrations of Pb, Cd, and Cr in the subjects were 29.33 ± 4.80, 7.78 ± 10.57, and 24.78 ± 21.77 µg/dL, respectively. The mean urine concentrations of Pb, Cd, and Cr were 24.18 ± 2.98, 6.81 ± 10.05, and 14.78 ± 14.20 µg/dL, respectively. Mean nail metal values of 37.13 ± 4.08, 1.00 ± 1.21, and 18.49 ± 12.71 µg/g were obtained for Pb, Cd, and Cr, respectively while mean hair metal values of 39.41 ± 5.63, 1.09 ± 1.14, and 19.13 ± 11.61 µg/g for Pb, Cd, and Cr, respectively. Positive Pearson correlation coefficients were observed between Pb/Cd, Pb/Cr, and Cd/Cr in all samples and they indicate the metals are likely from the same pollution source. The mean concentrations of the metals in all samples were higher than the WHO, ILO, and ACGIH standards, implying the repairers are likely occupationally exposed and are subject to serious health concerns. Social habits like smoking were found to significantly affect the concentrations of these metals. The level of education, use of safety devices, period of exposure, the nature of electronics and the age of the repairers were also found to remarkably affect the concentrations of the metals.

Keywords: bioaccumulation, electronic repair technicians, heavy metals, occupational hazard

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Authors: Mohammad Ebrahim Kianifar, Ehsan Ahmadi

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Reinforced concrete structures experience local defects such as cracks over their lifetime under various environmental loadings. Consequently, they are repaired by mortars to avoid detrimental effects such as corrosion of reinforcement, which in long-term may lead to strength loss of a member or collapse of structures. However, repaired structures may need multiple repairs due to changes in load distribution, and thus, lack of compatibility between mortar and substrate concrete. On the other hand, waste tire rubber alkali-activated (WTRAA)-based materials have very high potential to be used as repair mortars because of their ductility and flexibility, which may delay the failure of repair mortar and thus, provide sufficient compatibility. Hence, this work presents a pioneering study on suitability of WTRAA-based materials as mortars for the repair of concrete structures through an experimental program. To this end, WTRAA mortars with 15% aggregate replacement, alkali-activated (AA) mortars, and ordinary mortars are made to repair a number of concrete beams. The WTRAA mortars are composed of slag as base material, sodium hydroxide as an alkaline activator, and different gradations of waste tire rubber (fine and coarse gradations). Flexural tests are conducted on the concrete beams repaired by the ordinary, AA, and WTRAA mortars. It is found that, despite having lower compressive strength and modulus of elasticity, the WTRAA and AA mortars increase the flexural strength of the repaired beams, give compatible failures, and provide sufficient mortar-concrete interface bondings. The ordinary mortars, however, show incompatible failure modes. This study demonstrates the promising application of WTRAA mortars in the practical repairs of concrete structures.

Keywords: alkali-activated mortars, concrete repair, mortar compatibility, flexural strength, waste tire rubber

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Authors: Rashid Azeem

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Introduction: Eosinophilia, which can be categorized as mild, moderate, and severe form on the basis of increasing eosinophil counts, might be responsible for a wide range of cardiac manifestations, varying from a simple myocarditis to a severe state like endomyocardial fibrosis. Eosinophils are involved in the pathogenesis of a variety of cardiovascular disorder like Loffler endocarditis, eosinophilic granulomatosis with polyangitis (EGPH), and hyper eosinophilic (HES). Among them HES carries and incidence rate b/w 48% and 75% and is the main causes of cardiac motility and mobility due to eosinophilia involvement. Aims and objectives: The aim of this study is to determine the frequency of eosinophilia in cardiac patients and to ascertain the evidence of endomyocardial diseases in eosinophilic patients in a cardiology institution Material and Methods: This cross sectional analytical study was conducted in hematology Department of Peshawar institute of Cardiology after approval from hospital ethical and research committee. All 70 patients were subjected to detailed history and clinical examination. Investigation like CBC, Chest X-ray, ECG, Echo, Angiography findings were used to monitor patient’s clinical status. Data is analyzed using SPSS version 25 and MS Excel. Results: Out of 70 patients in our study, a total of 66 patients(94 %) shows evidence of cardiac manifestations. In our study, we have observed a number of abnormal ECG patterns in cardiac patients presenting with eosinophilia, like T wave changes, loss of R wave, sinus bradycardia with LVH strain, and ST wave abnormality. abnormal echocardiographic findings were observed in our patients, like valvular abnormalities (in 45.7%), RWMA abnormalities (in 2.8%), isolated ventricular dysfunction (in 21.4%), and in 10% patients, normal echocardiography. We further noted abnormal coronary angiography findings in cardiac patients with eosinophilia ranging from single vessel to multi vessel occlusions. Conclusions: Eosinophils are involved in the pathogenesis of a variety of cardiovascular disorders which can be detected by various diagnostic means, and the severity of the disease increases with time and with increasing eosinophil count ranging from simple myocarditis to a fatal condition like endomyocardial fibrosis. Thus, increased eosinophilic count as a laboratory parameter in cardiac patients may be a sign of endomyocardial damage which will further help cardiologist to intervene more aggressively then routine approach to a cardiac patient.

Keywords: eosinophilia, endomyocardial fibrosis, cardiac, hypereosinophilic syndrome

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Authors: Ashvamedh, Chandra Bhushan Singh, Anil Kumar Sarda

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Introduction: Ileal perforation is a common cause for peritonitis in developing countries. Surgery is the ideal treatment as it eliminates soilage of peritoneal cavity in an effort to lessen the toxaemia and enhance the recovery of the patient. However, there is no uniformity of standardized operative procedure that is most effective for management. Material and method: The study was conducted on 66 patients of perforation peritonitis from November 2013 to February 2015 in Lok Nayak Hospital. Data of each patient were recorded on a pre-determined proforma. The methods used for repair were Primary repair, Resection anastomosis (RA) and Ileostomy. Result: Male preponderance was noticed among the patients with majority in their third decade. Of all perforations 40.9% were tubercular and 34.8% were typhoid. Amongst operated cases 27.3% underwent primary repair, RA was performed in 45.5%, Ileostomy in 27.3%patients. The average time taken for RA and ileostomy was more than primary repair. The type of repair bear no significance to size or no of perforation but was significant statistically for distance from I/C valve(P=.005) and edema of bowel wall(p=.002) when analysed for post op complications. Wound infection, dehiscence, intra-abdominal collections were complications observed bearing no significance to type of repair. Ileostomy per se has its own complications peristomal skin excoriation seen in 83.3%, electrolyte imbalance in 33.3%, duration for closure averaged 188 days (median 150 days, range 85-400 days). Conclusion: Primary closure is preferable in patients with single, small perforations. RA is advocated in patients with multiple or large perforation, perforation proximal to stricture. Ileostomy should not be considered as primary definitive procedure and reserved only for moribund patients as a lifesaving procedure. It has more morbidity and requires a second surgery for closure increasing the cost of treatment as well.

Keywords: ileal perforation, ileostomy, perforation peritonitis, typhoid perforation management

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Authors: Ravshan A. Ibadov, Sardor Kh. Ibragimov

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Objective. The aim of the study was to optimize the protocol of cardiopulmonary resuscitation (CPR) after cardiovascular surgical interventions. Methods. The experience of CPR conducted on patients after cardiovascular surgical interventions in the Department of Intensive Care and Resuscitation (DIR) of the Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V. Vakhidov is presented. The key to the new approach is the rapid elimination of reversible causes of cardiac arrest, followed by either defibrillation or electrical cardioversion (depending on the situation) before external heart compression, which may damage sternotomy. Careful use of adrenaline is emphasized due to the potential recurrence of hypertension, and timely resternotomy (within 5 minutes) is performed to ensure optimal cerebral perfusion through direct massage. Out of 32 patients, cardiac arrest in the form of asystole was observed in 16 (50%), with hypoxemia as the cause, while the remaining 16 (50%) experienced ventricular fibrillation caused by arrhythmogenic reactions. The age of the patients ranged from 6 to 60 years. All patients were evaluated before the operation using the ASA and EuroSCORE scales, falling into the moderate-risk group (3-5 points). CPR was conducted for cardiac activity restoration according to the American Heart Association and European Resuscitation Council guidelines (Ley SJ. Standards for Resuscitation After Cardiac Surgery. Critical Care Nurse. 2015;35(2):30-38). The duration of CPR ranged from 8 to 50 minutes. The ARASNE II scale was used to assess the severity of patients' conditions after CPR, and the Glasgow Coma Scale was employed to evaluate patients' consciousness after the restoration of cardiac activity and sedation withdrawal. Results. In all patients, immediate chest compressions of the necessary depth (4-5 cm) at a frequency of 100-120 compressions per minute were initiated upon detection of cardiac arrest. Regardless of the type of cardiac arrest, defibrillation with a manual defibrillator was performed 3-5 minutes later, and adrenaline was administered in doses ranging from 100 to 300 mcg. Persistent ventricular fibrillation was also treated with antiarrhythmic therapy (amiodarone, lidocaine). If necessary, infusion of inotropes and vasopressors was used, and for the prevention of brain edema and the restoration of adequate neurostatus within 1-3 days, sedation, a magnesium-lidocaine mixture, mechanical intranasal cooling of the brain stem, and neuroprotective drugs were employed. A coordinated effort by the resuscitation team and proper role allocation within the team were essential for effective cardiopulmonary resuscitation (CPR). All these measures contributed to the improvement of CPR outcomes. Conclusion. Successful CPR following cardiac surgical interventions involves interdisciplinary collaboration. The application of an optimized CPR standard leads to a reduction in mortality rates and favorable neurological outcomes.

Keywords: cardiac surgery, cardiac arrest, resuscitation, critically ill patients

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Authors: Sajjad Asefi, Hossein Afrakhte

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This paper presents the evaluation of reliability indices of an electrical distribution system using Monte Carlo simulation technique accounting Time To Switch (TTS) for each section. In this paper, the distribution system has been assumed by accounting random repair time omission. For simplicity, we have assumed the reliability analysis to be based on exponential law. Each segment has a specified rate of failure (λ) and repair time (r) which will give us the mean up time and mean down time of each section in distribution system. After calculating the modified mean up time (MUT) in years, mean down time (MDT) in hours and unavailability (U) in h/year, TTS have been added to the time which the system is not available, i.e. MDT. In this paper, we have assumed the TTS to be a random variable with Log-Normal distribution.

Keywords: distribution system, Monte Carlo simulation, reliability, repair time, time to switch (TTS)

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Authors: Angelis P. Barlampas

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The purpose of this study is to inform the reader, about the various applications of artificial intelligence (AI), in cardiac imaging. AI grows fast and its role is crucial in medical specialties, which use large amounts of digital data, that are very difficult or even impossible to be managed by human beings and especially doctors.Artificial intelligence (AI) refers to the ability of computers to mimic human cognitive function, performing tasks such as learning, problem-solving, and autonomous decision making based on digital data. Whereas AI describes the concept of using computers to mimic human cognitive tasks, machine learning (ML) describes the category of algorithms that enable most current applications described as AI. Some of the current applications of AI in cardiac imaging are the follows: Ultrasound: Automated segmentation of cardiac chambers across five common views and consequently quantify chamber volumes/mass, ascertain ejection fraction and determine longitudinal strain through speckle tracking. Determine the severity of mitral regurgitation (accuracy > 99% for every degree of severity). Identify myocardial infarction. Distinguish between Athlete’s heart and hypertrophic cardiomyopathy, as well as restrictive cardiomyopathy and constrictive pericarditis. Predict all-cause mortality. CT Reduce radiation doses. Calculate the calcium score. Diagnose coronary artery disease (CAD). Predict all-cause 5-year mortality. Predict major cardiovascular events in patients with suspected CAD. MRI Segment of cardiac structures and infarct tissue. Calculate cardiac mass and function parameters. Distinguish between patients with myocardial infarction and control subjects. It could potentially reduce costs since it would preclude the need for gadolinium-enhanced CMR. Predict 4-year survival in patients with pulmonary hypertension. Nuclear Imaging Classify normal and abnormal myocardium in CAD. Detect locations with abnormal myocardium. Predict cardiac death. ML was comparable to or better than two experienced readers in predicting the need for revascularization. AI emerge as a helpful tool in cardiac imaging and for the doctors who can not manage the overall increasing demand, in examinations such as ultrasound, computed tomography, MRI, or nuclear imaging studies.

Keywords: artificial intelligence, cardiac imaging, ultrasound, MRI, CT, nuclear medicine

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Authors: Gehan A. Hegazy, Hesham N. Mustafa, Sally A. El Awdan, Marawan AbdelBaset

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Doxorubicin (DOX) is a chemotherapeutic agent used for the treatment of different cancers and its clinical usage is hindered by the oxidative injury-related cardiotoxicity. This work aims to declare if the harmful effects of DOX on the heart can be alleviated with the use of Coenzyme Q10 (CoQ10) or L-carnitine. The study was performed on seventy-two female Wistar albino rats divided into six groups, 12 animals each: Control group; DOX group (10 mg/kg); CoQ10 group (200 mg/kg); L-carnitine group (100 mg/kg); DOX + CoQ10 group; DOX + L-carnitine group. CoQ10 and L-carnitine treatment orally started five days before a single dose of 10 mg/kg DOX that injected intraperitoneally (IP) then the treatment continued for ten days. At the end of the study, serum biochemical parameters of cardiac damage, oxidative stress indices, and histopathological changes were investigated. CoQ10 or L-carnitine showed noticeable effects in improving cardiac functions evidenced reducing serum enzymes as serum interleukin-1 beta (IL-1), tumor necrosis factor alpha (TNF-), leptin, lactate dehydrogenase (LDH), Cardiotrophin-1, Troponin-I and Troponin-T. Also, alleviate oxidative stress, decrease of cardiac Malondialdehyde (MDA), Nitric oxide (NO) and restoring cardiac reduced glutathione levels to normal levels. Both corrected the cardiac alterations histologically and ultrastructurally. With visible improvements in -SMA, vimentin and eNOS immunohistochemical markers. CoQ10 or L-carnitine supplementation improves the functional and structural integrity of the myocardium.

Keywords: CoQ10, doxorubicin, L-Carnitine, cardiotoxicity

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Authors: Azim Khodadadi, Sahar Sadaat Vakili, Ebrahim Babaei

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This study presents a numerical method to optimize the failure rate and repair time of a typical radial distribution system. Failure rate and repair time are effective parameters in customer and energy based indices of reliability. Decrease of these parameters improves reliability indices. Thus, system stability will be boost. The penalty functions indirectly reflect the cost of investment which spent to improve these indices. Constraints on customer and energy based indices, i.e. SAIFI, SAIDI, CAIDI and AENS have been considered by using a new method which reduces optimization algorithm controlling parameters. Imperialist Competitive Algorithm (ICA) used as main optimization technique and particle swarm optimization (PSO), simulated annealing (SA) and differential evolution (DE) has been applied for further investigation. These algorithms have been implemented on a test system by MATLAB. Obtained results have been compared with each other. The optimized values of repair time and failure rate are much lower than current values which this achievement reduced investment cost and also ICA gives better answer than the other used algorithms.

Keywords: imperialist competitive algorithm, failure rate, repair time, radial distribution network

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Authors: Izadi Banafsheh, Sedaghat Reza

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Maintenance, Repair, and Overhaul (MRO) of machinery are a key recent issue concerning the automotive industry. It has always been a debated question what order or priority should be adopted for the MRO of machinery. This study attempts to examine several criteria including process sensitivity, average time between machine failures, average duration of repair, availability of parts, availability of maintenance personnel and workload through a literature review and experts survey so as to determine the condition of the machine. According to the mentioned criteria, the machinery were ranked in four modes below: A) Need for inspection, B) Need for minor repair, C) Need for part replacement, and D) Need for major repair. The Fuzzy AHP was employed to determine the weighting of criteria. At the end, the obtained weights were ranked through the AHP for each criterion, three groups were specified: shaving machines, assembly and painting in four modes. The statistical population comprises the elite in the Iranian automotive industry at IKCO covering operation managers, CEOs and maintenance professionals who are highly specialized in MRO and perfectly knowledgeable in how the machinery function. The information required for this study were collected from both desk research and field review, which eventually led to construction of a questionnaire handed out to the sample respondents in order to collect information on the subject matter. The results of the AHP for weighting the criteria revealed that the availability of maintenance personnel was the top priority at coefficient of 0.206, while the process sensitivity took the last priority at coefficient of 0.066. Furthermore, the results of TOPSIS for prioritizing the IKCO machinery suggested that at the mode where there is need for inspection, the assembly machines took the top priority while paining machines took the third priority. As for the mode where there is need for minor repairs, the assembly machines took the top priority while the third priority belonged to the shaving machines. As for the mode where there is need for parts replacement, the assembly machines took the top priority while the third belonged to the paining machinery. Finally, as for the mode where there is need for major repair, the assembly machines took the top priority while the third belonged to the paining machinery.

Keywords: maintenance, repair, overhaul, MRO, prioritization of machinery, fuzzy logic, AHP, TOPSIS

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Authors: Leena Korpinen, Rauno Pääkkönen, Fabriziomaria Gobba, Vesa Virtanen

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The number of persons with implanted cardiac pacemakers (PM) has increased in Western countries. The aim of this paper is to investigate the possible situations where persons with a PM may be exposed to extremely low frequency (ELF) electric (EF) and magnetic fields (MF) that may disturb their PM. Based on our earlier studies, it is possible to find such high public exposure to EFs only in some places near 400 kV power lines, where an EF may disturb a PM in unipolar mode. Such EFs cannot be found near 110 kV power lines. Disturbing MFs can be found near welding machines. However, we do not have measurement data from welding. Based on literature and earlier studies at Tampere University of Technology, it is difficult to find public EF or MF exposure that is high enough to interfere with PMs.

Keywords: cardiac pacemaker, electric field, magnetic field, electrical engineering

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Authors: Abraham J. Rizkalla, Tristan D. Yan

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Atrial myxoma is the most common primary cardiac tumor, and can result in cardiac failure secondary to obstruction, or systemic embolism due to fragmentation. Traditionally, excision of atrial an myxoma has been performed through median sternotomy, however the robotic approach offers several advantages including less pain, improved cosmesis, and faster recovery. Here, we highlight the less well recognized advantages and technical aspects to robotic myxoma resection. This video-presentation demonstrates the resection of a papillary subtype left atrial myxoma using the DaVinci© Xi surgical robot. The 10x magnification and 3D vision allows for the interface between the tumor and the interatrial septum to be accurately dissected, without the need to patch the interatrial septum. Several techniques to avoid tumor fragmentation and embolization are demonstrated throughout the procedure. The tumor was completely excised with clear margins. There was no atrial septal defect or mitral valve injury on post operative transesophageal echocardiography. The patient was discharged home on the fourth post-operative day. This video-presentation highlights the advantages of the robotic approach in atrial myxoma resection compared with sternotomy, as well as emphasizing several technical considerations to avoid potential complications.

Keywords: cardiac surgery, left atrial myxoma, cardiac tumour, robotic resection

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Authors: Santosh Sharma Parajuli, Diwas Manandhar

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Background: Perioperative pain management plays an integral part in patients undergoing cardiac surgery. We studied the effect of Erector Spinae Plane block on acute postoperative pain reduction and 24 hours opioid consumption in adult cardiac surgical patients. Methods: Twenty-five adult cardiac surgical patients who underwent cardiac surgery with sternotomy in whom ESP catheters were placed preoperatively were kept in group E, and the other 25 patients who had undergone cardiac surgery without ESP catheter and pain management done with conventional opioid injection were placed in group C. Fentanyl was used for pain management. The primary study endpoint was to compare the consumption of fentanyl and to assess the numeric rating scale in the postoperative period in the first 24 hours in both groups. Results: The 24 hours fentanyl consumption was 43.00±51.29 micrograms in the Erector Spinae Plane catheter group and 147.00±60.94 micrograms in the control group postoperatively which was statistically significant (p <0.001). The numeric rating scale was also significantly reduced in the Erector Spinae Plane group compared to the control group in the first 24 hours postoperatively. Conclusion: Erector Spinae Plane block is superior to the conventional opioid injection method for postoperative pain management in CABG patients. Erector Spinae Plane block not only decreases the overall opioid consumption but also the NRS score in these patients.

Keywords: erector, spinae, plane, numerical rating scale

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Authors: Elena Ivany, Leanne Aitken

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Little is known about the delivery of end-of-life care in cardiac intensive care unit (CICU) settings. The aims of this study were to highlight the nurse-identified barriers and facilitators to delivering end-of-life care in the CICU, and to identify whether any of the barriers and/or facilitators are specific to the CICU setting. This was an exploratory qualitative study utilizing semi-structured individual interviews as the data collection method and inductive thematic analysis to structure the data. Six CICU nurses took part in the study. Five key themes were identified, each theme including both barriers and facilitators. The five key themes are as follows: patient-centered care, emotional challenges, reaching concordance, nursing contribution and the surgical intensive care unit.

Keywords: end-of-life, cardiovascular disease, cardiac surgery, critical care

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Authors: Tim D. Sass

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The experience of engineers and architects practicing today is typically limited to current building code requirements and modern construction methods and materials. However, many cities have a mix of new and old buildings with many buildings constructed over one hundred years ago when building codes and construction methods were much different. When a brick building sustains damage, a structural engineer is often hired to determine the cause of damage as well as determine the necessary repairs. Forensic studies of dozens of brick buildings shows an appreciation of historical building methods and materials is needed to correctly identify the cause of damage and design an appropriate repair. Damage on an older, brick building can be mistakenly attributed to storms or seismic events when the real source of the damage is deficient original construction. Assessing and remediating damaged brickwork on older brick buildings requires an understanding of the original construction, an understanding of older repair methods, and, an understanding of current building code requirements.

Keywords: brick, damage, deterioration, facade

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Authors: Philippe Castaing, Thomas Jollivet

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As a result of their advantages, i.e. recyclability, weld-ability, environmental compatibility, long (continuous) fiber thermoplastic composites (LFTPC) are increasingly used in many industrial sectors (mainly automotive and aeronautic) for structural applications. Indeed, in the next ten years, the environmental rules will put the pressure on the use of new structural materials like composites. In aerospace, more than 50% of the damage are due to stress impact and 85% of damage are repaired on the fuselage (fuselage skin panels and around doors). With the arrival of airplanes mainly of composite materials, replacement of sections or panels seems difficult economically speaking and repair becomes essential. The objective of the present study is to propose a solution of repair to prevent the replacement the damaged part in thermoplastic composites in order to recover the initial mechanical properties. The classification of impact damage is not so not easy : talking about low energy impact (less than 35 J) can be totally wrong when high speed or weak thicknesses as well as thermoplastic resins are considered. Crash and perforation with higher energy create important damages and the structures are replaced without repairing, so we just consider here damages due to impacts at low energy that are as follows for laminates : − Transverse cracking; − Delamination; − Fiber rupture. At low energy, the damages are barely visible but can nevertheless reduce significantly the mechanical strength of the part due to resin cracks while few fiber rupture is observed. The patch repair solution remains the standard one but may lead to the rupture of fibers and consequently creates more damages. That is the reason why we investigate the repair of thermoplastic composites impacted at low energy. Indeed, thermoplastic resins are interesting as they absorb impact energy through plastic strain. The methodology is as follows: - impact tests at low energy on thermoplastic composites; - identification of the damage by micrographic observations; - evaluation of the harmfulness of the damage; - repair by reconsolidation according to the extent of the damage ; -validation of the repair by mechanical characterization (compression). In this study, the impacts tests are performed at various levels of energy on thermoplastic composites (PA/C, PEEK/C and PPS/C woven 50/50 and unidirectional) to determine the level of impact energy creating damages in the resin without fiber rupture. We identify the extent of the damage by US inspection and micrographic observations in the plane part thickness. The samples were in addition characterized in compression to evaluate the loss of mechanical properties. Then the strategy of repair consists in reconsolidating the damaged parts by thermoforming, and after reconsolidation the laminates are characterized in compression for validation. To conclude, the study demonstrates the feasibility of the repair for low energy impact on thermoplastic composites as the samples recover their properties. At a first step of the study, the “repair” is made by reconsolidation on a thermoforming press but we could imagine a process in situ to reconsolidate the damaged parts.

Keywords: aerospace, automotive, composites, compression, damages, repair, structural applications, thermoplastic

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Authors: Birgit Rasmussen, Thomas Maribo, Bente S. Toft

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BACKGROUND: Cardiac rehabilitation is the standard treatment for ischemic heart disease. Cardiac rehabilitation improves quality of life, reduces mortality and the risk of readmission, and provides patients with valuable knowledge and encouragement from peers and staff. Still, less than half of eligible patients enroll. Face-to-face interventions have the potential to support patients' decision-making and increase enrolment in cardiac rehabilitation. However, we lack knowledge of the content and characteristics of interventions. AIM: The aim was to outline and evaluate the content and characteristics of studies that have reported on face-to-face interventions to encourage enrolment in cardiac rehabilitation in patients with ischemic heart disease. METHOD: This scoping review followed the Joanne Briggs Institute methodology. Based on an a-priori protocol that defined the systematic search criteria, six databases were searched for studies published between 2001 and 2023. Two reviewers independently screened and selected studies. All authors discussed the summarized data prior to the narrative presentation. RESULTS: After screening and full text review of 5583 records, 20 studies of heterogeneous design and content were included. Four studies described the key contents in face-to-face interventions to be education, support of autonomy, addressing reasons for change, and emotional and cognitive support while showing understanding. Two studies used motivational interviewing to target patients' experiences and address worries and anticipated difficulties. Four quantitative studies found associations between enrolment and intention to attend, cardiac rehabilitation barriers, exercise self-efficacy, and perceived control. When patients asked questions, enrolment rates were higher, while providing reassurance and optimism could lead to non-attendance if patients had a high degree of worry. In qualitative studies, support to overcome barriers and knowledge about health benefits from participation in cardiac rehabilitation facilitated enrolment. Feeling reassured that the cardiac condition was good could lead to non-attendance. DISCUSSION AND CONCLUSION: To support patients' enrolment in cardiac rehabilitation, it is recommended that interventions integrate a person-centered dialogue. Individual worries and barriers to cardiac rehabilitation should be jointly explored. When talking with patients for whom worries predominate, the recommendation is to focus on the patients' perspectives and avoid too much focus on reassurance and problem-solving. The patients' perspectives, the mechanisms of change, and the process evaluation of the intervention including person-centeredness are relevant to include in future studies.

Keywords: ischemic heart disease, cardiac rehabilitation, enrolment, person-centered, in-hospital interventions

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Authors: Adedeji W. Oyediran, Yekini N. Asafe

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Mechatronics is synergistic integration of mechanical engineering, with electronics and intelligent computer control in the design and manufacturing of industrial products and processes. Automobile (auto car, motor car or car is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor) is a mechatronic system which served as major means of transportation around the world. Virtually all community has a need for automobile. This makes automobile issues as related to diagnostic and repair interesting to all communities. Consequent to the diversification of skill in diagnosing automobile faults and approaches in solving some problems and innovation in automobile industry. It is appropriate to say that repair and diagnostic of automobile will be better enhanced if community has opportunity of sharing knowledge and idea globally. This paper discussed the desirable elements in automobile as mechatronics system and present conceptual framework of virtual community model for automobile users.

Keywords: automobile, automobile users, knowledge sharing, mechatronics system, virtual community

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Authors: Xuhui Lin, Qiuchen Lu, Yi An, Tao Yang

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As global climate change intensifies, extreme weather events such as floods increasingly threaten urban infrastructure, making the vulnerability of urban road networks a pressing issue. Existing static repair strategies fail to adapt to the rapid changes in road network conditions during flood events, leading to inefficient resource allocation and suboptimal recovery. The main research gap lies in the lack of repair strategies that consider both the dynamic characteristics of networks and the progression of flood propagation. This paper proposes a topology-based dynamic repair strategy that adjusts repair priorities based on real-time changes in flood propagation and traffic demand. Specifically, a novel method is developed to assess and enhance the resilience of urban road networks during flood events. The method combines road network topological analysis, flood propagation modelling, and traffic flow simulation, introducing a local importance metric to dynamically evaluate the significance of road segments across different spatial and temporal scales. Using London's road network and rainfall data as a case study, the effectiveness of this dynamic strategy is compared to traditional and Transport for London (TFL) strategies. The most significant highlight of the research is that the dynamic strategy substantially reduced the number of stranded vehicles across different traffic demand periods, improving efficiency by up to 35.2%. The advantage of this method lies in its ability to adapt in real-time to changes in network conditions, enabling more precise resource allocation and more efficient repair processes. This dynamic strategy offers significant value to urban planners, traffic management departments, and emergency response teams, helping them better respond to extreme weather events like floods, enhance overall urban resilience, and reduce economic losses and social impacts.

Keywords: Urban resilience, road networks, flood response, dynamic repair strategy, topological analysis

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Authors: Heru Al Amin

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Sarcoidosis is a granulomatous inflammatory disorder of unclear etiology that can affect multiple different organ systems. Isolated cardiac sarcoidosis is a very rare condition that causes lethal arrhythmia and heart failure. A definite diagnosis of cardiac sarcoidosis remains challenging. The use of multimodality imaging plays a pivotal role in the diagnosis of this entity. Case summary: In this report, we discuss a case of a 50-year-old woman who presented with recurrent palpitation, dizziness, vertigo and presyncope. Electrocardiogram revealed variable heart blocks, including first-degree AV block, second-degree AV block, high-degree AV block, complete AV block, trifascicular block and sometimes supraventricular arrhythmia. Twenty-four hours of Holter monitoring show atrial bigeminy, first-degree AV block and trifascicular block. Transthoracic echocardiography showed Thinning of basal anteroseptal and inferred septum with LV dilatation with reduction of Global Longitudinal Strain. A dual-chamber pacemaker was implanted. CT Coronary angiogram showed no coronary artery disease. Cardiac magnetic resonance revealed basal anteroseptal and inferior septum thinning with focal edema with LGE suggestive of sarcoidosis. Computed tomography of the chest showed no lymphadenopathy or pulmonary infiltration. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body showed. We started steroids and followed up with the patient. Conclusion: This case serves to highlight the challenges in identifying and managing isolated CS in a young patient with recurrent syncope with variable heart block. Early, even late initiation of steroids can improve arrhythmia as well as left ventricular function.

Keywords: cardiac sarcoidosis, conduction abnormality, syncope, cardiac MRI

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Authors: S. A. Anuar, N. H. Hamid, M. H. Hashim, S. M. D. Salleh

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This paper present the experimental work on the seismic performance of double unit tunnel form building (TFB) subjected to in-plane lateral cyclic loading. A one third scale of 3-storey double unit of TFB is tested at ±0.01%, ±0.1%, ±0.25%, ±0.5%, ±0.75% and ±1.0% drifts until the structure achieves its strength degradation. After that, the TFB is repaired and retrofitted using additional shear wall, steel angle and CFRP sheet. A similar testing approach is applied to the specimen after repair and retrofit. The crack patterns, lateral strength, stiffness, ductility and equivalent viscous damping (EVD) were analyzed and compared before and after repair and retrofit. The result indicates that the lateral strength increases by 22 in pushing direction and 27% in pulling direction. Moreover, the stiffness and ductility obtained before and after retrofit increase tremendously by 87.87% and 39.66%, respectively. Meanwhile, the energy absorption measured by equivalent viscous damping obtained after retrofit increase by 12.34% in pulling direction. It can be concluded that the proposed retrofit method is capable to increase the lateral strength capacity, stiffness and energy absorption of double unit TFB.

Keywords: tunnel form building, in-plane lateral cyclic loading, crack pattern, lateral strength, stiffness, ductility, equivalent viscous damping, repair and retrofit

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