Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients.

This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting ß2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165-1.241) and MI (HR, 1.244; 95% CI, 1.182-1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.

Optimization of the clinically approved mg-Zn alloy system through the addition of ca.

BACKGROUND: Although several studies on the Mg-Zn-Ca system have focused on alloy compositions that are restricted to solid solutions, the influence of the solid solution component of Ca on Mg-Zn alloys is unknown. Therefore, to broaden its utility in orthopedic applications, studies on the influence of the addition of Ca on the microstructural, mechanical, and corrosion properties of Mg-Zn alloys should be conducted. In this study, an in-depth investigation of the effect of Ca on the mechanical and bio-corrosion characteristics of the Mg-Zn alloy was performed for the optimization of a clinically approved Mg alloy system comprising Ca and Zn. METHODS: The Mg alloy was fabricated by gravitational melting of high purity Mg, Ca, and Zn metal grains under an Ar gas environment. The surface and cross-section were observed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to analyze their crystallographic structures. Electrochemical and immersion tests in Hank's balanced salt solution were used to analyze their corrosion resistance. Tensile testing was performed with universal testing equipment to investigate the impact of Ca addition. The examination of cytotoxicity for biometric determination was in line with the ISO10993 standard. RESULTS: In this study, the 0.1% Ca alloy had significantly retarded grain growth due to the formation of the tiny and well-dispersed Ca2Mg6Zn3 phase. In addition, the yield strength and elongation of the 0.1% Ca alloy were more than 50% greater than the 2% Zn alloy. The limited cell viability of the 0.3% Ca alloy could be attributed to its high corrosion rate, whereas the 0.1% Ca alloy demonstrated cell viability of greater than 80% during the entire experimental period. CONCLUSION: The effect of the addition of Ca on the microstructure, mechanical, and corrosion characteristics of Mg-Zn alloys was analyzed in this work. The findings imply that the Mg-Zn alloy system could be optimized by adding a small amount of Ca, improving mechanical properties while maintaining corrosion rate, thus opening the door to a wide range of applications in orthopedic surgery.

Microstructure and Mechanical Properties of an Al-Mg-Si-Zr Alloy Processed by L-PBF and Subsequent Heat Treatments.

The aim of this study was to develop a new Al-Mg-Si-Zr alloy with a high magnesium content to achieve a wide range of mechanical properties using heat treatment and at a lower cost. Additive manufacturing was conducted using a powder bed fusion process with various scan speeds to change the volumetric energy density and establish optimal process conditions. In addition, mechanical properties were evaluated using heat treatment under various conditions. The characterization of the microstructure was conducted by scanning electron microscopy with electron backscatter diffraction and transmission electron microscopy. The mechanical properties were determined by tensile tests. The as-built specimen showed a yield strength of 447.9 ± 3.6 MPa, a tensile strength of 493.4 ± 6.7 MPa, and an elongation of 9.6 ± 1.1%. Moreover, the mechanical properties could be adjusted according to various heat treatment conditions. Specifically, under the HT1 (low-temperature artificial aging) condition, the ultimate tensile strength increased to 503.2 ± 1.1 MPa, and under the HT2 (high-temperature artificial aging) condition, the yield strength increased to 467 ± 1.3 MPa. It was confirmed that the maximum elongation (14.3 ± 0.8%) was exhibited with the HT3 (soft annealing) heat treatment.

Optimal target blood pressure for major adverse cardiovascular and cerebrovascular events in hypertensive patients: a nationwide population-based study.

BACKGROUND: Generalizing an 'optimal' blood pressure (BP) level for individuals with hypertension remains controversial due to the implementation of different medical guidelines. This study investigated the association of BP with major adverse cardiovascular and cerebrovascular events (MACCE) and determined the optimal BP for patients with hypertension. METHOD: A total of 934 179 individuals who received antihypertensive medications were selected from the National Health Insurance Service Examination Database between 2003 and 2011 in Korea. Their BP was measured at the index date, which was the first health examination. The study outcomes were MACCE, including acute myocardial infarction, heart failure, stroke, and all-cause mortality. The participants were monitored until in December, 2017. The hazard ratios were calculated using Cox proportional hazard models. The cumulative incidence of MACCE for each BP group was estimated using the Kaplan-Meier method. RESULTS: A lower risk of MACCE was observed at a SBP of 120-129 mmHg and a DBP of 80-89 mmHg. The endpoint-specific incidence rates and hazard ratios for acute myocardial infarction, heart failure, stroke, and all-cause mortality were the lowest at a SBP of 120-129 mmHg and a DBP of 80-89 mmHg. CONCLUSION: Even though this observational study did not support inference of a causal relationship, a SBP of 120-129 mmHg and a DBP of 80-89 mmHg may be safely recommended considering the possibility of MACCE in Korean patients with hypertension. In addition, the target BP should be tailored individually according to age, sex, and comorbidities.

Lifetime survival and medical costs of lung cancer: a semi-parametric estimation from South Korea.

BACKGROUND: It is essential to have information on the disease burden of lung cancer at an individual level throughout the life; however, few such results have been reported. Thus, this study aimed to assess the lifetime disease burden in patients with lung cancer by assessing various factors, such as survival, years of life lost (YLL) and medical expenditure in South Korea based on real-world data and extrapolation. METHODS: Newly diagnosed lung cancer patients (n = 2919) in 2004-2010 were selected and observed until the end of 2015 using nationwide reimbursement claim database. The patients were categorised into the Surgery group, Chemo and/or Radiotherapy group (CTx/RTx), and Surgery+CTx/RTx according to their treatment modality. Age- and sex-matched control subjects were selected from among general population using the life table. The survival and cost data after diagnosis were analysed by a semi-parametric method, the Kaplan-Meier analysis for the first 100 months and rolling extrapolation algorithm for 101-300 months. YLL were derived from the difference in survival between patients and controls. RESULTS: Lifetime estimates (standard error) were 4.5 (0.2) years for patients and 14.5 (0.1) years for controls and the derived YLL duration was 10.0 (0.2) years. Lifetime survival years showed the following trend: Surgery (14.2 years) > Surgery+CTx/RTx (8.5 years) > CTx/RTx group (3.0 years), and YLL were increased as lifetime survival years decreased (2.3, 8.7, 12.2 years, respectively). The mean lifetime medical cost was estimated at 30,857 USD/patient. Patients in the Surgery group paid higher treatment cost in first year after diagnosis, but the overall mean cost per year was lower at 4359 USD compared with 7075USD of Surgery+CTx/RTx or 7626USD of CTx/RTx group. CONCLUSIONS: Lung cancer has resulted in about 10 years of life lost in overall patients. The losses were associated with treatment modality, and the results indicated that diagnosing lung cancer in patients with low stage disease eligible for surgery is beneficial for reducing disease burden in terms of survival and treatment cost per year throughout the life.

Influence of combinatory effects of STEM setups on the sensitivity of differential phase contrast imaging.

Differential phase-contrast (DPC) imaging in the scanning transmission electron microscopy (STEM) mode has been suggested as a new method to visualize the nanoscale electromagnetic features of materials. However, the quality of the DPC image is very sensitive to the electron-beam alignment, microscope setup, and specimen conditions. Unlike normal STEM imaging, the microscope setup variables in the DPC mode are not independent; rather, they are correlated factors decisive for field sensitivity. Here, we systematically investigated the independent and combinatory effects of microscope setups on the sensitivity of the DPC image in a hard magnet, Nd2Fe14B alloy. To improve sensitivity, a smaller overlap of the electron beam with annular detectors and a greater camera length were required. However, these factors cannot be controlled independently in the two-condenser-lens system. In this linked system, the effect of the camera length on the DPC sensitivity was slightly more predominant than the overlap. Furthermore, the DPC signal was noisy and scattered at a small overlap of less than 11%. The electron-beam current does not evidently affect the sensitivity. In addition, the DPC sensitivity was examined with respect to the sample thickness, and the optimum thickness for high sensitivity was approximately 65 nm for the hard magnetic material Nd2Fe14B. This practical approach to the STEM setup and sample thickness may provide experimental guidelines for further application of the DPC analysis method.

High strength nanostructured Al-based alloys through optimized processing of rapidly quenched amorphous precursors.

We report the methods increasing both strength and ductility of aluminum alloys transformed from amorphous precursor. The mechanical properties of bulk samples produced by spark-plasma sintering (SPS) of amorphous Al-Ni-Co-Dy powders at temperatures above 673 K are significantly enhanced by in-situ crystallization of nano-scale intermetallic compounds during the SPS process. The spark plasma sintered Al84Ni7Co3Dy6 bulk specimens exhibit 1433 MPa compressive yield strength and 1773 MPa maximum strength together with 5.6% plastic strain, respectively. The addition of Dy enhances the thermal stability of primary fcc Al in the amorphous Al-TM -RE alloy. The precipitation of intermetallic phases by crystallization of the remaining amorphous matrix plays important role to restrict the growth of the fcc Al phase and contributes to the improvement of the mechanical properties. Such fully crystalline nano- or ultrafine-scale Al-Ni-Co-Dy systems are considered promising for industrial application because their superior mechanical properties in terms of a combination of very high room temperature strength combined with good ductility.

Local microstructure evolution at shear bands in metallic glasses with nanoscale phase separation.

At room temperature, plastic flow of metallic glasses (MGs) is sharply localized in shear bands, which are a key feature of the plastic deformation in MGs. Despite their clear importance and decades of study, the conditions for formation of shear bands, their structural evolution and multiplication mechanism are still under debate. In this work, we investigate the local conditions at shear bands in new phase-separated bulk MGs containing glassy nanospheres and exhibiting exceptional plasticity under compression. It is found that the glassy nanospheres within the shear band dissolve through mechanical mixing driven by the sharp strain localization there, while those nearby in the matrix coarsen by Ostwald ripening due to the increased atomic mobility. The experimental evidence demonstrates that there exists an affected zone around the shear band. This zone may arise from low-strain plastic deformation in the matrix between the bands. These results suggest that measured property changes originate not only from the shear bands themselves, but also from the affected zones in the adjacent matrix. This work sheds light on direct visualization of deformation-related effects, in particular increased atomic mobility, in the region around shear bands.

Remarkably stable amorphous metal oxide grown on Zr-Cu-Be metallic glass.

In the present study, we investigated the role of an aliovalent dopant upon stabilizing the amorphous oxide film. We added beryllium into the Zr50Cu50 metallic glass system, and found that the amorphous oxide layer of Be-rich phase can be stabilized even at elevated temperature above Tg of the glass matrix. The thermal stability of the amorphous oxide layer is substantially enhanced due to Be addition. As confirmed by high-temperature cross-section HR-TEM, fully disordered Be-added amorphous layer is observed, while the rapid crystallization is observed without Be. To understand the role of Be, we employed ab-initio molecular dynamics to compare the mobility of ions with/without Be dopant, and propose a disordered model where Be dopant occupies Zr vacancy and induces structural disorder to the amorphous phase. We find that the oxygen mobility is slightly suppressed due to Be dopant, and Be mobility is unexpectedly lower than that of oxygen, which we attribute to the aliovalent nature of Be dopant whose diffusion always accompany multiple counter-diffusion of other ions. Here, we explain the origin of superior thermal stability of amorphous oxide film in terms of enhanced structural disorder and suppressed ionic mobility due to the aliovalent dopant.

Imprinting bulk amorphous alloy at room temperature.

We present investigations on the plastic deformation behavior of a brittle bulk amorphous alloy by simple uniaxial compressive loading at room temperature. A patterning is possible by cold-plastic forming of the typically brittle Hf-based bulk amorphous alloy through controlling homogenous flow without the need for thermal energy or shaping at elevated temperatures. The experimental evidence suggests that there is an inconsistency between macroscopic plasticity and deformability of an amorphous alloy. Moreover, imprinting of specific geometrical features on Cu foil and Zr-based metallic glass is represented by using the patterned bulk amorphous alloy as a die. These results demonstrate the ability of amorphous alloys or metallic glasses to precisely replicate patterning features onto both conventional metals and the other amorphous alloys. Our work presents an avenue for avoiding the embrittlement of amorphous alloys associated with thermoplastic forming and yields new insight the forming application of bulk amorphous alloys at room temperature without using heat treatment.

Micro-to-nano-scale deformation mechanisms of a bimodal ultrafine eutectic composite.

The outstading mechanical properties of bimodal ultrafine eutectic composites (BUECs) containing length scale hierarchy in eutectic structure were demonstrated by using AFM observation of surface topography with quantitative height measurements and were interpreted in light of the details of the deformation mechanisms by three different interface modes. It is possible to develop a novel strain accommodated eutectic structure for triggering three different interface-controlled deformation modes; (I) rotational boundary mode, (II) accumulated interface mode and (III) individual interface mode. A strain accommodated microstructure characterized by the surface topology gives a hint to design a novel ultrafine eutectic alloys with excellent mechanical properties.

Synthesis of nanoparticles using electrical explosion of Ni wire in Pt solution.

The structure, size and morphology of nanoparticles produced by electrical explosion of Ni wire in Pt(NH3)2(NO2)2 solution were investigated. TEM results showed the formation of Ni and Pt nanoparticles as a result of the procedure. Ni nanoparticles were formed by the explosion of the Ni wire due to the passage of high current, evaporation, ionization, and cooling in the liquid medium. Ni nanoparticles were near spherical and showed particle sizes ranging from a few nanometers up to 50 nm. Pt nanoparticles were possible formed by the dissolution of OH- in Pt(NH3)2(NO2)2 solution during the electrical explosion of the Ni wire resulting in a plasma reaction. The formed Pt nanoparticles were ellipsoidal and showed particle sizes ranging to less than 5 nm. The lattice parameter of the Pt nanoparticles almost corresponded to the standard values reported. The obtained results indicate that Pt nanoparticles can be formed from a Pt solution without a reducing agent by electrical explosion of a metallic wire resulting in a plasma reaction.

Capillary flow of amorphous metal for high performance electrode.

Metallic glass (MG) assists electrical contact of screen-printed silver electrodes and leads to comparable electrode performance to that of electroplated electrodes. For high electrode performance, MG needs to be infiltrated into nanometer-scale cavities between Ag particles and reacts with them. Here, we show that the MG in the supercooled state can fill the gap between Ag particles within a remarkably short time due to capillary effect. The flow behavior of the MG is revealed by computational fluid dynamics and density funtional theory simulation. Also, we suggest the formation mechanism of the Ag electrodes, and demonstrate the criteria of MG for higher electrode performance. Consequently, when Al85Ni5Y8Co2 MG is added in the Ag electrodes, cell efficiency is enhanced up to 20.30% which is the highest efficiency reported so far for screen-printed interdigitated back contact solar cells. These results show the possibility for the replacement of electroplating process to screen-printing process.

Phase separating bulk metallic glass: a hierarchical composite.

Phase separating systems present a unique opportunity for designing composites with hierarchical microstructure at different length scales. We report here our success in synthesizing phase separating metallic glasses exhibiting the entire spectrum of microstructural possibilities expected from a phase separating system. In particular, we report novel core shell and hierarchical structures of spherical glassy droplets, resulting from critical wetting behavior and limited diffusion. We also report synthesis of a bulk phase separating glass in a metallic glass system. The combination of unique core shell and hierarchical structures in metallic glass systems opens a new avenue for the microstructure design of metallic glasses.