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Differences between heart failure specialists and non-specialists regarding heart failure drug implementation and up-titration.
Hypercrosslinked polyHIPEs as precursors to designable, hierarchically porous carbon foams
Hierarchically porous carbon foams were produced by carbonization of hypercrosslinked polymerized high internal phase water-in-styrene/divinylbenzene emulsions (HIPEs). The hypercrosslinking of these poly(ST-co-DVB)HIPEs was achieved using a dimethoxymethane external crosslinker to ‘knit’ together aromatic groups within the polymers using FriedelCrafts alkylation. By varying the amount of divinylbenzene (DVB) in the HIPE templates and subsequent polymers, the BET surface area and micropore volume of the hypercrosslinked analogues can be varied systematically, allowing for the production of carbon foams, or ‘carboHIPEs’, with varied surface areas, micropore volumes and pore-size distributions. The carboHIPEs retain the emulsion-templated macropores of the original polyHIPE, display excellent electrical conductivities and have surface areas of up to 417 m2/g, all the while eliminating the need for inorganic templates. The use of emulsion templates allows for pourable, mouldable precursors to designable carbonaceous materials
Cardiovascular and renal outcomes with empagliflozin in heart failure
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure in patients regardless of the presence or absence of diabetes. More evidence is needed regarding the effects of these drugs in patients across the broad spectrum of heart failure, including those with a markedly reduced ejection fraction. METHODS In this double-blind trial, we randomly assigned 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure. RESULTS During a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001). The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70; 95% CI, 0.58 to 0.85; P<0.001). The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (-0.55 vs. -2.28 ml per minute per 1.73 m2 of body-surface area per year, P<0.001), and empagliflozin-treated patients had a lower risk of serious renal outcomes. Uncomplicated genital tract infection was reported more frequently with empagliflozin. CONCLUSIONS Among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes