BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Pote...BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho展开更多
Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have a...Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.展开更多
针对某变电站发生的一起220 k V变压器高压侧A相避雷器爆炸事故,经现场勘查、设备解体和试验分析,得出该故障主要是由于密封圈老化造成避雷器内部阀片受潮所致。提出了在避雷器日常运维中的注意事项及预防措施,并建议对同批次及运行超...针对某变电站发生的一起220 k V变压器高压侧A相避雷器爆炸事故,经现场勘查、设备解体和试验分析,得出该故障主要是由于密封圈老化造成避雷器内部阀片受潮所致。提出了在避雷器日常运维中的注意事项及预防措施,并建议对同批次及运行超过10年的避雷器进行隐患排查,尽早发现阀片受潮、劣化的缺陷,提升设备运行可靠性。展开更多
The spherical valve plate/cylinder block pair has the advantages of strong overturning resistance and large bearing area.However,the configurations of the unloading and pre-boosting triangular grooves on the spherical...The spherical valve plate/cylinder block pair has the advantages of strong overturning resistance and large bearing area.However,the configurations of the unloading and pre-boosting triangular grooves on the spherical valve plate are different from those in the planar valve plate,resulting in special cavitation phenomenon on the spherical port plate pair.In order to study cavitation characteristics of spherical port plate pair,a dynamic CFD model of the piston pump including turbulence model,cavitation model and fluid compressibility is established.A detailed UDF compilation scheme is provided for modelling of the micron-sized spherical oil film mesh,which makes up for the lack of research on the meshing of the spherical oil film.In this paper,using CFD simulation tools,from the perspectives of pressure field,velocity field and gas volume fraction change,a detailed analysis of the transient evolution of the submerged cavitation jet in a axial piston pump with spherical valve plate is carried out.The study indicates the movement direction of the cavitation cloud cluster through the cloud image and the velocity vector direction of the observation point.The sharp decrease of velocity and gas volume fraction indicates the collapse phenomenon of bubbles on the part wall surface.These discoveries verify the special erosion effect in case of the spherical valve plate/cylinder block pair.The submerged cavitation jet generated by the unloading triangular grooves distributed on the spherical valve plate not only cause denudation of the inner wall surface of the valve plate,but also cause strong impact and denudation on the lower surface of the cylinder body.Finally,the direction of the unloading triangular groove was modified to extend the distance between it and the wall surface which can effectively alleviate the erosion effect.展开更多
文摘BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho
文摘Pacemaker post-transcatheter aortic valve replacement is related to multifactorial risk.Nwaedozie et al brought to the body of evidence electrocardiogram and clinical findings.However,procedural characteristics have at least as much impact on the final need for a permanent pacemaker and potentially on the pacing rate.In this regard,long-term follow-up and understanding of the impact of long-term stimulation is of utmost importance.
文摘针对某变电站发生的一起220 k V变压器高压侧A相避雷器爆炸事故,经现场勘查、设备解体和试验分析,得出该故障主要是由于密封圈老化造成避雷器内部阀片受潮所致。提出了在避雷器日常运维中的注意事项及预防措施,并建议对同批次及运行超过10年的避雷器进行隐患排查,尽早发现阀片受潮、劣化的缺陷,提升设备运行可靠性。
基金Supported by National Natural Science Foundation of China(Grant No.51605322)Shanxi Provincial Natural Science Foundation of China(Grant No.201901D111054)+1 种基金International Cooperation Project of Shanxi Province(Grant No.2016-002)Key Laboratory of Fluid and Power Machinery,Ministry of Education(Grant No.GZKF-201815).
文摘The spherical valve plate/cylinder block pair has the advantages of strong overturning resistance and large bearing area.However,the configurations of the unloading and pre-boosting triangular grooves on the spherical valve plate are different from those in the planar valve plate,resulting in special cavitation phenomenon on the spherical port plate pair.In order to study cavitation characteristics of spherical port plate pair,a dynamic CFD model of the piston pump including turbulence model,cavitation model and fluid compressibility is established.A detailed UDF compilation scheme is provided for modelling of the micron-sized spherical oil film mesh,which makes up for the lack of research on the meshing of the spherical oil film.In this paper,using CFD simulation tools,from the perspectives of pressure field,velocity field and gas volume fraction change,a detailed analysis of the transient evolution of the submerged cavitation jet in a axial piston pump with spherical valve plate is carried out.The study indicates the movement direction of the cavitation cloud cluster through the cloud image and the velocity vector direction of the observation point.The sharp decrease of velocity and gas volume fraction indicates the collapse phenomenon of bubbles on the part wall surface.These discoveries verify the special erosion effect in case of the spherical valve plate/cylinder block pair.The submerged cavitation jet generated by the unloading triangular grooves distributed on the spherical valve plate not only cause denudation of the inner wall surface of the valve plate,but also cause strong impact and denudation on the lower surface of the cylinder body.Finally,the direction of the unloading triangular groove was modified to extend the distance between it and the wall surface which can effectively alleviate the erosion effect.
