• Title/Summary/Keyword: Early Failure

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Surgical Outcomes of Centrifugal Continuous-Flow Implantable Left Ventricular Assist Devices: Heartmate 3 versus Heartware Ventricular Assist Device

  • Kinam Shin;Won Chul Cho;Nara Shin;Hong Rae Kim;Min-Seok Kim;Cheol Hyun Chung;Sung-Ho Jung
    • Journal of Chest Surgery
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    • v.57 no.2
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    • pp.184-194
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    • 2024
  • Background: Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD). Methods: Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications. Results: In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure. Conclusion: The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.

Postbuckling response and failure of symmetric laminated plates with rectangular cutouts under in-plane shear

  • Singh, S.B.;Kumar, Dinesh
    • Structural Engineering and Mechanics
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    • v.34 no.2
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    • pp.175-188
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    • 2010
  • This paper deals with the buckling and postbuckling responses, and the progressive failure of square laminates of symmetric lay-up with a central rectangular cutout under in-plane shear load. A detailed investigation is made to show the effects of cutout size and cutout aspect ratio on the buckling and postbuckling responses, failure loads and failure characteristics of $(+45/-45/0/90)_{2s}$, $(+45/-45)_{4s}$ and $(0/90)_{4s}$ laminates. The 3-D Tsai-Hill criterion is used to predict the failure of a lamina while the onset of delamination is predicted by the interlaminar failure criterion. In addition, the effects of boundary conditions on buckling loads, failure loads, failure modes, and maximum transverse deflection for a $(+45/-45/0/90)_{2s}$ laminate with and without a square cutout have been presented. It is concluded that because of early onset of delamination at the net section of cutouts before first-ply failure, total strength of the laminate with very small cutouts can not be utilized.

Diencephalic syndrome: a frequently neglected cause of failure to thrive in infants

  • Kim, Ahlee;Moon, Jin Soo;Yang, Hye Ran;Chang, Ju Young;Ko, Jae Sung;Seo, Jeong Kee
    • Clinical and Experimental Pediatrics
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    • v.58 no.1
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    • pp.28-32
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    • 2015
  • Purpose: Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. Methods: We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. Results: Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was $18{\pm}10.5$ months, and diagnosis after symptom onset was made at the mean age of $11{\pm}9.7$ months. The mean z score was $-3.15{\pm}1.14$ for weight, $-0.12{\pm}1.05$ for height, $1.01{\pm}1.58$ for head circumference, and $-1.76{\pm}1.97$ for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. Conclusion: Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.

Update of Sepsis: Recent Evidences about Early Goal Directed Therapy

  • Cho, Woo Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.78 no.3
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    • pp.156-160
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    • 2015
  • Severe sepsis and septic shock is a life-threatening disease. It is combined with multi-organ failure. In the past decade, early goal directed therapy has been proposed as an effective treatment strategy for better outcome. Recent epidemiologic studies showed that the outcome of sepsis has been improved with the introduction of early goal directed therapy. However, it is unclear which elements of early goal directed therapy contributed to the better outcome. Recent prospective and randomized trials suggested that some elements of early goal directed therapy did not have any effect on the outcome benefit. In this paper, recent articles about early goal directed therapy will be reviewed and the effectiveness of individual elements of early goal directed therapy will be discussed.

Stability dip, the obstacle of early loading protocol, how can it be figured out? (임상가를 위한 특집 2 - Early loading의 난제 stability dip, 어떻게 극복할 것인가?)

  • Park, Chang-Joo
    • The Journal of the Korean dental association
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    • v.51 no.4
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    • pp.198-203
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    • 2013
  • Nowadays, it seems like that the concept of the early loading protocol has been intruded between the concept of the immediate loading supported by advanced clinicians and the concept of the conventional loading supported by the prudent clinicians. In particular, the stability dip, which is found to occur usually at 4~6 weeks after dental implant placement because the decrease of the primary mechanical stability is not compensated by the increase of the secondary biologic stability, is frequently pointed out as one of the major causes of early loading failure. In this article, based on our recent clinical investigation about the crestal bone preservation effect of the early loaded NanoTite$^{TM}$ Tapered Certain Prevail$^{(R)}$ (Biomet 3i, USA), the concept of the early loading is revisited. In addition, various methods to overcome the stability dip are reviewed as the oral and maxillofacial surgeon's view point.

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

  • Daichi Maeda;Yudai Fujimoto;Taisuke Nakade;Takuro Abe;Shiro Ishihara;Kentaro Jujo;Yuya Matsue
    • Korean Circulation Journal
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    • v.54 no.7
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    • pp.363-381
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    • 2024
  • With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILEHF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.

Failure Analysis of Carburized Gears by Microstructural Observation (침탄처리된 기어의 미세 조직학적 손상 원인분석)

  • Chun, Hae Dong;Chang, Sung Ho;Kim, Kyung Wook;Kuk, Youn Ho
    • Journal of the Korean Society for Heat Treatment
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    • v.27 no.4
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    • pp.191-201
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    • 2014
  • The gear was made of SNC815 case-carburized, quench hardened and tempered steel. The gears were failed far earlier than the expected service life used in the industrial site. Causes of the failed gear were analyzed by microstructure observation. By the SEM and micro structure examinations, the damaged surfaces had been weared and failed by fatigue. Through microscope observation on the damaged surface, it was found that the cause of failure was determined by external overloading and the initial stage of the damage was closely related to complex contact fatigue failure. The overload and contact fatigue contributed to the early failure cause.

A Classification Structure of Information Systems Failures: An Empirical Investigation of IS developers' perception (정보시스템 실패의 구조 규명을 위한 실증연구: 프로그래머를 중심으로)

  • Kim, Jong-Uk
    • Asia pacific journal of information systems
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    • v.8 no.2
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    • pp.121-132
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    • 1998
  • Many cases of information systems (IS) failure have still continued to be reported ever since computer-based information systems were introduced to process business transactions in the early 1950s. Because an enormous amount of budgets is currently invested on information technology in many organizations, failures and problems of information systems may serve as key culprits to serious business problems which will face the organizations. Thus, there have been a number of studies on IS failures which aimed to identify causes and reasons for such failures and reveal their inherent nature, Some studies developed conceptual frameworks to classify categories of diverse IS failure phenomena. However, little research performed an empirical study to investigate the underlying structure of IS failures perceived by IS professionals by measuring their perception. In this regard, the current study collected systems developers perceptual data towards IS failure phenomena to identify what constitute IS failure. The data was analyzed using a multidimensional scaling program and ten categories of problems were identified to constitute the IS failure structure, It was found that most categories were related to problems with users, hardware, and systems quality.

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Right ventricular failure in congenital heart disease

  • Cho, Young Kuk;Ma, Jae Sook
    • Clinical and Experimental Pediatrics
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    • v.56 no.3
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    • pp.101-106
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    • 2013
  • Despite developments in surgical techniques and other interventions, right ventricular (RV) failure remains an important clinical problem in several congenital heart diseases (CHD). RV function is one of the most important predictors of mortality and morbidity in patients with CHD. RV failure is a progressive disorder that begins with myocardial injury or stress, neurohormonal activation, cytokine activation, altered gene expression, and ventricular remodeling. Pressure-overload RV failure caused by RV outflow tract obstruction after total correction of tetralogy of Fallot, pulmonary stenosis, atrial switch operation for transposition of the great arteries, congenitally corrected transposition of the great arteries, and systemic RV failure after the Fontan operation. Volume-overload RV failure may be caused by atrial septal defect, pulmonary regurgitation, or tricuspid regurgitation. Although the measurement of RV function is difficult because of many reasons, the right ventricle can be evaluated using both imaging and functional modalities. In clinical practice, echocardiography is the primary mode for the evaluation of RV structure and function. Cardiac magnetic resonance imaging is increasingly used for evaluating RV structure and function. A comprehensive evaluation of RV function may lead to early and optimal management of RV failure in patients with CHD.