Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Vascular Healing after Coronary Stenting Evaluated by Optical Coherence Tomography

Optical coherence tomography (OCT) is a novel intracoronary imaging application for the assessment of native lesions and coronary stents. The purpose of this thesis was to evaluate the safety and feasibility of frequency-domain OCT (FD-OCT) based on experiences of the Satakunta Central Hospital (I). Early vascular healing was evaluated after implantation of endothelial progenitor cell capturing (II) and bio-active titanium-nitride-oxide coated stents (III) in two studies, each with 20 patients. Vascular healing was also compared after implantation of bio-active and everolimus-eluting stents on 28 patients after 9-month follow-up (IV). Long-term vascular healing of bio-active and paclitaxel-eluting stents was assessed in the last study with 18 patients (V). The results indicate that FD-OCT is safe and feasible (I). Both bio-active and endothelial progenitor cell capturing stents showed near-complete endothelialisation after one-month follow-up, which is desirable when prolonged dual anti-platelet therapy needs to be avoided after stenting (II and III). Endothelialisation of bio-active stents showed a predictable pattern at mid-term and long-term follow up (IV and V). Endothelialisation of everolimus-eluting stents was not complete at 9 months follow-up, which may suggest that interruption of dual antiplatelet therapy at this time point may not be safe (IV). Finally, delayed vascular healing may be present in patients treated with paclitaxel-eluting stents as long as 4 years from implantation, which reinforces the previously raised concerns on the long-term safety of this device (V).

Coatings on Composites

Polymer based composite materials coated with thin layers of wear resistant materials have been proposed as replacements for steel components for certain applications with the advantage of reduced mass. Magnetron sputtered coatings can be successfully deposited on composite materials. Nevertheless there are number of issues which must be addressed such as limited temperature, which the composite can withstand because of the epoxy binder which is used, the adhesion of the coating to the composite and the limited mechanical support, the hard coating can obtain from the relatively soft epoxy. We have investigated the deposition of chromium nitride, titanium carbide and titanium doped DLC coatings on carbon fibre reinforced composites and various polymers. The adhesion of the coatings has been studied by the pull-off adhesion tester. In general, the failure mechanism has been noticed to be due to the cohesive failure for a wide range of conditions. The wear behavior of the coatings has been noticed to be complicated. Wear tests on coated composites have shown that where the reinforcing fibres are near the surface, the composite samples do not perform well due to breakage of the fibres from the polymer matrix. A fibre free surface has been noticed to improve the wear resistance.

Identification of Turning Points in the Research on Titanium Dioxide Production and Application

This dissertation "Identification of turning points in the research on titanium dioxide production and application" aims at detecting in scientific literatures emerging trends and sudden changes in titanium dioxide production and application. These key changes are then studied to determine its transient patterns and its effect on the research on titanium dioxide production and application The source of information is from bibliographic data which discussed titanium dioxide production and application. These bibliographic data where obtained from ISI Web of Knowledge and then formed into a network of clusters by applying software called Citespace.

Time-Resolved Photoluminescence in Antimonide and Dilute Nitride Quantum Well Structures

This Master's thesis is devoted to semiconductor samples study using time-resolved photoluminescence. This method allows investigating recombination in semiconductor samples in order to develop quality of optoelectronic device. An additional goal was the method accommodation for low-energy-gap materials. The first chapter gives a brief intercourse into the basis of semiconductor physics. The key features of the investigated structures are noted. The usage area of the results covers saturable semiconductor absorber mirrors, disk lasers and vertical-external-cavity surface-emittinglasers. The experiment set-up is described in the second chapter. It is based on up-conversion procedure using a nonlinear crystal and involving the photoluminescent emission and the gate pulses. The limitation of the method was estimated. The first series of studied samples were grown at various temperatures and they suffered rapid thermal annealing. Further, a latticematched and metamorphically grown samples were compared. Time-resolved photoluminescence method was adapted for wavelengths up to 1.5 µm. The results allowed to specify the optimal substrate temperature for MBE process. It was found that the lattice-matched sample and the metamorphically grown sample had similar characteristics.

The Combined treatment of UV Light and Titanium Dioxide (TiO2) in Grease Filtration Technique

The aim of this thesis was to identify the best grease removal technique with the application of low power of UV light to TiO2 coated grease filters. The treatment with various power series of ozone generating and ozone free lamps to normal grease filters and TiO2 coated grease filters were examined and the obtained results are compared to each other in this paper. The effect of ozone reaction was observed and compared with the effect of TiO2. The experiments were solely based on the photo oxidation and photo catalytic oxidation reactions. TiO2 is a green catalyst used in the photocatalytic reaction. Sunflower oil was used for grease production and tetracholoroethylene as a solvent. Grease samples were collected from the ventilation duct connected to the cooking hood system. Sample extraction was done in ultrasonic bath with the principle of sonication. The sample analysis was done by FTIR machine. The result determining the concentration of grease was the quantification of saturated C-H bonds in the chosen peak group of the spectrum. A very low power of UVC light functions perfectly with the Titanium dioxide. The experimental results have shown the combined treatment of titanium dioxide and UV light is an effective method in grease removal process. The photocatalytic reaction with titanium dioxide is better than photo oxidation reaction with ozone treatment. Photocatalytic reaction is environmentally friendly, energy efficient and economical.

Hydrogen Sensor Application of Anodic Titanium Oxide Nanostructures

Hydrogen (H2) fuel cells have been considered a promising renewable energy source. The recent growth of H2 economy has required highly sensitive, micro-sized and cost-effective H2 sensor for monitoring concentrations and alerting to leakages due to the flammability and explosiveness of H2 Titanium dioxide (TiO2) made by electrochemical anodic oxidation has shown great potential as a H2 sensing material. The aim of this thesis is to develop highly sensitive H2 sensor using anodized TiO2. The sensor enables mass production and integration with microelectronics by preparing the oxide layer on suitable substrate. Morphology, elemental composition, crystal phase, electrical properties and H2 sensing properties of TiO2 nanostructures prepared on Ti foil, Si and SiO2/Si substrates were characterized. Initially, vertically oriented TiO2 nanotubes as the sensing material were obtained by anodizing Ti foil. The morphological properties of tubes could be tailored by varying the applied voltages of the anodization. The transparent oxide layer creates an interference color phenomena with white light illumination on the oxide surface. This coloration effect can be used to predict the morphological properties of the TiO2 nanostructures. The crystal phase transition from amorphous to anatase or rutile, or the mixture of anatase and rutile was observed with varying heat treatment temperatures. However, the H2 sensing properties of TiO2 nanotubes at room temperature were insufficient. H2 sensors using TiO2 nanostructures formed on Si and SiO2/Si substrates were demonstrated. In both cases, a Ti layer deposited on the substrates by a DC magnetron sputtering method was successfully anodized. A mesoporous TiO2 layer obtained on Si by anodization in an aqueous electrolyte at 5°C showed diode behavior, which was influenced by the work function difference of Pt metal electrodes and the oxide layer. The sensor enabled the detection of H2 (20-1000 ppm) at low operating temperatures (50–140°C) in ambient air. A Pd decorated tubular TiO2 layer was prepared on metal electrodes patterned SiO2/Si wafer by anodization in an organic electrolyte at 5°C. The sensor showed significantly enhanced H2 sensing properties, and detected hydrogen in the range of a few ppm with fast response/recovery time. The metal electrodes placed under the oxide layer also enhanced the mechanical tolerance of the sensor. The concept of TiO2 nanostructures on alternative substrates could be a prospect for microelectronic applications and mass production of gas sensors. The gas sensor properties can be further improved by modifying material morphologies and decorating it with catalytic materials.

Investigation of adsorption of dyes onto modified titanium dioxide

Titanium dioxide (TiO2) nanoparticles with different sizes and crystalloid structures produced by the thermal method and doped with silver iodide (AgI), nitrogen (N), sulphur (S) and carbon (C) were applied as adsorbents. The adsorption of Methyl Violet (MV), Methylene Blue (MB), Methyl Orange (MO) and Orange II on the surface of these particles was studied. The photocatalytic activity of some particles for the destruction of MV and Orange II was evaluated under sunlight and visible light. The equilibrium adsorption data were fitted to the Langmuir, Freundlich, Langmuir-Freundlich and Temkin isotherms. The equilibrium data show that TiO2 particles with larger sizes and doped with AgI, N, S and C have the highest adsorption capacity for the dyes. The kinetic data followed the pseudo-first order and pseudo-second order models, while desorption data fitted the zero order, first order and second order models. The highest adsorption rate constant was observed for the TiO2 with the highest anatase phase percentage. Factors such as anatase crystalloid structure, particle size and doping with AgI affect the photocatalytic activity significantly. Increasing the rutile phase percentage also decreases the tendency to desorption for N-TiO2 and S-TiO2. Adsorption was not found to be important in the photocatalytic decomposition of MV in an investigation with differently sized AgI-TiO2 nanoparticles. Nevertheless C-TiO2 was found to have higher adsorption activity onto Orange II, as the adsorption role of carbon approached synchronicity with the oxidation role.

Titanium dioxide based nanomaterials for photocatalytic water treatment

Water treatment using photocatalysis has gained extensive attention in recent years. Photocatalysis is promising technology from green chemistry point of view. The most widely studied and used photocatalyst for decomposition of pollutants in water under ultraviolet irradiation is TiO2 because it is not toxic, relatively cheap and highly active in various reactions. Within this thesis unmodified and modified TiO2 materials (powders and thin films) were prepared. Physico-chemical properties of photocatalytic materials were characterized with UV-visible spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray photoelectron spectrometry (XPS), inductively coupled plasma optical emission spectroscopy (ICP-OES), ellipsometry, time-of-flight secondary ion mass spectrometry (ToF-SIMS), Raman spectroscopy, goniometry, diffuse reflectance measurements, thermogravimetric analysis (TGA) and nitrogen adsorption/desorption. Photocatalytic activity of prepared samples in aqueous environment was tested using model compounds such as phenol, formic acid and metazachlor. Also purification of real pulp and paper wastewater effluent was studied. Concentration of chosen pollutants was measured with high pressure liquid chromatography (HPLC). Mineralization and oxidation of organic contaminants were monitored with total organic carbon (TOC) and chemical oxygen demand (COD) analysis. Titanium dioxide powders prepared via sol-gel method and doped with dysprosium and praseodymium were photocatalytically active for decomposition of metazachlor. The highest degradation rate of metazachlor was observed when Pr-TiO2 treated at 450ºC (8h) was used. The photocatalytic LED-based treatment of wastewater effluent from plywood mill using commercially available TiO2 was demonstrated to be promising post-treatment method (72% of COD and 60% of TOC was decreased after 60 min of irradiation). The TiO2 coatings prepared by atomic layer deposition technique on aluminium foam were photocatalytically active for degradation of formic and phenol, however suppression of activity was observed. Photocatalytic activity of TiO2/SiO2 films doped with gold bipyramid-like nanoparticles was about two times higher than reference, which was not the case when gold nanospheres were used.

Aqueous photocatalytic oxidation of steroid estrogens

Concerns have increased regarding the detection of endocrine-disrupting compounds in the effluents of sewage treatment plants (STPs). These compounds are able to disrupt normal function of the endocrine system of living organisms even at trace concentrations. Natural and synthetic steroid estrogens (SEs) are believed to be responsible for the majority of the endocrine-disrupting effects. Municipal sewage, the main source of SEs in the environment, is a complex mixture of a wide range of pollutants at concentrations much higher than those of SEs. Low concentrations of SEs in the presence of copollutants thus make their removal problematic. The main objectives of the present work were to study the potential of photocatalytic oxidation (PCO) to effectively treat SE-containing aqueous solutions and to identify the optimum conditions for such treatment. The results showed that SEs can be effectively degraded photocatalytically. Due to the adsorption properties of SEs on the TiO2 photocatalyst surface alkaline medium was found to be beneficial for SE oxidation despite the presence of co-pollutants in concentrations characteristic for the sanitary fraction of municipal sewage. The potential of PCO to selectively oxidise SEs was examined in the presence of copollutants of the sanitary fraction of sewage - urea, saccharose and human urine. The impact of ethanol, often used as a solvent in the preparation of SE stock solutions, was also studied and the results indicated the need to use organic solvent-free solutions for the study of SE behaviour. Photocatalytic oxidation of SEs appeared to be indifferent towards the presence of urea in concentrations commonly found in domestic sewage. The effect of other co-pollutants under consideration was far weaker than could be expected from their concentrations, which are from one hundred to a few thousands times higher than those of the SEs. Although higher concentrations can dramatically slow down the PCO of SEs, realistic concentrations of co-pollutants characteristic for the sanitary fraction of domestic sewage allowed selective removal of SEs. This indicates the potential of PCO to be a selective oxidation method for SE removal from the separate sanitary fraction of municipal sewage.

Photocatalytic oxidation of humic substances and lignins in aqueous solutions

Tässä tutkimuksessa tarkastellaan kahden yleisen, veden ympäristökuormitusta aiheuttavan kemikaaliryhmän, ligniinin ja humusaineiden, fotokatalyyttistahapetusta (photocatalytic oxidation, PCO) vesiliuoksessa. Fotokatalyyttina käytettiin titaanidioksidia, jota säteilytettiin ultraviolettivalolla. Työssä selvitettiin useiden eri olosuhdeparametrien vaikutusta fotokatalyysiin. Tutkittavia parametreja olivat mm. kontaminanttien alkukonsentraatio, pH, vetyperoksidilisäys, rauta-ionien lisäys, fotokatalyysimenetelmä, fotokatalyytin pintakonsentraatioja titaanidioksidin määrä lasisissa mikropartikkeleissa. Ultraviolettivalon lähteinä käytettiin sekä keinovaloa että auringonvaloa. Katalyytin kantoaineena käytettiin huokoisia lasisia mikropartikkeleita, joiden pintaan kiinnittynyt titaanidioksidi pystyi hyvin vähentämään kontaminanttien määrää vedessä. Fotokatalyysin tehokkuus kasvoi humusaine- ja ligniinikonsentraatioiden kasvaessa. Korkeimmat hapetustehokkuudet kumallakin kontaminantilla saavutettiin neutraaleissa jalievästi emäksisissä olosuhteissa huolimatta siitä, että paras adsorboituminen tapahtui happamissa olosuhteissa. Tämän perusteella voidaan olettaa, että humusaineiden ja ligniinin hapetus tapahtuu pääosin radikaalimekanismilla. Vetyperoksidin lisääminen humusaineliuokseen lisäsi hapettumisnopeutta, vaikka näennäinen hapetustehokkuus ei muuttunut. Tämän perusteella vetyperoksidi hapetti myös humusaineita referenssinäytteessä. Ligniinin fotokatalyyttinen hapettuminen parani vetyperoksidilisäyksellä happamissa olosuhteissa johtuen lisääntyneestä OH-radikaalien muodostumisesta. Ligniini ei hapettunut vetyperoksidilla, jos fotokatalyyttiä ei¿ollut läsnä. Rauta-ionit eivät lisänneet humushappojen fotokatalyyttistähapettumista, mutta Fe2+-ionien lisäys aina konsentraatioon 0.05 mM johti ligniinin hapettumistehokkuuden voimakkaaseen kasvuun. Rauta-ionikonsentraation kasvattaminen edelleen johti ligniinin hapetustehokkuuden alenemiseen.

PHOTOCATALYTIC OXIDATION OF AQUEOUS SOLUTIONS OF JET FUEL AND ICING INHIBITORS

The present paper is devoted to the results of experimental research undertaken into photocatalytical oxidation (PCO) of aqueous solutions of de-icing agents and aqueous extract of jet fuel. The report consists of introduction, literature review, description of materials and methods, discussion of results and conclusions. TiO2 was selected as a photocatalyst for the experiments with synthetic solutions of ethylene glycol, 2-ethoxyethanol and aqueous extract of jet fuel. To explain the PCO mechanisms affecting certain behaviour of de-icing agent under distinctive conditions, the following factors were studied: the impact of initial concentration of pollutant, the role of pH, the presence of tert-butanol as OH·-radicals scavenger and mineral admixtures. PCO under solar radiation performed in two ways: catalysed by irradiated TiO2 slurry or by TiO2 attached to buoyant hollow glass micro-spheres. Special attention was paid to the energy-saving PCO with reduced intensity mixing of the slurry. The effect of PCO was assessed by determination of residual chemical oxygen demand of solution (COD) and by measuring of concentration of glycols. The PCO process efficiency was assumed to be dependent on the TiO2 suspension fractional composition. Thus, the following effects of solutions’ media were viewed: presence of organic admixtures, pH influence, mixing mode during the PCO. The effects of mineral admixtures - Ca2+, Fe3+/2+, Mn2+, SO42- - that are often present in natural and wastewater systems or produced during the degradation of organic pollutants and which can affect the rate of PCO of de-icing agents, were also investigated.

Keraamisten teräpalojen käyttö niukkaseosteisten terästen lastuamiseen normaaleissa toimitustiloissa

Tämän tutkimuksen tavoitteena oli tutkia keraamisten kääntöterien soveltuvuus niukkaseosteräksille ja M-käsittelyn vaikutus teränkestoaikoihin. Lisäksi tavoitteena oli tutkia keraamiseosten erityisominaisuudet ja muodostaa käsitys keraamisilla kääntöterillä sorvaamisen erityisvaatimuksista. Kirjallisuusosassa selvitettiin tutkimushetkellä saatavissa olleet keraamiset teräaineseokset ja niiden ominaisuudet sekä selvitettiin keraamisten kääntöterien viimeaikaiset kehitystrendit. Lastuamistutkimus toteutettiin standardin ISO 3685:1993 mukaisesti, minkä lisäksi mitattiin lastuamisvoimat ja tehtiin kokeessa käytetyille terille lastunmurtokoe. Koemateriaalit olivat Imatra Steelin GreenCut, Hydax 25, M-käsittelemätön 42CrMo4 ja M-käsitelty MoC410M. Kokeissa käytetyt kääntöterät olivat eri valmistajien alumiinioksiditeriä, titaanikarbidiseostettuja alumiinioksiditeriä, kuituvahvisteisia ja yksi puhdas titaanikarbidiseosteinen terä. Koetulosten perusteella hyvän teränkestoajan saavuttamiseksi on tärkeää valita oikea keraamiseos ja sille soveltuvat parametrit. Oikein valituilla parametreilla M-terästä sorvattaessa tulokset ylittävät kovametalleilla saavutettavissa olevat arvot. Tulosten perusteella niukkaseostettujen terästen sorvaus onnistuu hyvin keraamisilla kääntöterillä, mutta kovametallisorvaukseen verrattuna syöttöä on laskettava ja lastuamisnopeutta lisättävä. Tämän työn tuloksia voidaan soveltaa sopivissa olosuhteissa toteutettavassa kappaletavaratuotannossa. Sovelluksen onnistuminen vaatii tukevat työstöolosuhteet ja riittävien lastuamisnopeuksien saavuttamisen.

Titanyylisulfaatin elektrolyyttisen pelkistyslaitoksen esisuunnitelma

Työssä esisuunniteltiin Kemira Pigments Oy:lle uusi titanyylisulfaatin elektrolyyttinen pelkistyslaitos. Suurin syy uuden laitoksen suunnitteluun oli nykyisen laitoksen aiheuttamat korkeat H2SO4-pitoisuudet pelkistyslaitoksen läheisyydessä. Työn kirjallisuusosassa käsitellään elektrolyysilaitteiston suunnitteluun liittyviä seikkoja ja esitellään titanyylisulfaatin elektrolyyttiseen pelkistykseen liittyvää tutkimustietoa. Ennen uuden laitoksen suunnittelua suoritettiin nykyisellä pelkistyslaitoksella koeajoja, joiden tarkoituksena oli antaa lähtötiedot uuden laitoksen suunnittelulle. Koeajot osoittivat mm., että pelkistys on edullisinta suorittaa alhaisella virrantiheydellä n. 300…400 A/m2 ja vesilaimennuksen avulla anolyytin H2SO4-pitoisuus saadaan säädettyä tasolle, jossa titaani ei saostu. Kärynpoistoyhteisiin asennettujen pesuvesisuuttimien avulla saatiin titaanin saostuminen kärynpoistokanaviin estettyä. Uudesta titanyylisulfaatin elektrolyyttisestä pelkistyslaitoksesta laadittiin mm. seuraavat dokumentit: prosessin virtauskaavio ja ainevirtakenttä, PI-kaavio, layout-kuvat laitoksesta ja sen sijoituksesta sekä rakennepiirros elektrolyysialtaasta. Hankkeelle tehtiin kustannusarvio tarkkuudella ±20 %, jonka loppusummaksi saatiin 1 489 000 €. Laitoksen vuotuisten käyttökustannuksien arvioitiin olevan n. 105 000 €. Investoinnista aiheutuvien vuotuisten annuiteettikustannusten arvioitiin olevan n. 237 000 € 16,3 % korolla.