Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring

Aims Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). Methods and results The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m2] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m2, P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21). Conclusions In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes

Negative area compressibility in silver(i) tricyanomethanide

The metal–organic framework copper(I) tricyanomethanide, Cu(tcm), undergoes a ferroelastic transition on cooling below Tf = 240 K. Thermal expansion measurements reveal an order-of-magnitude variation in framework flexibility across Tf. The low-temperature phase α-Cu(tcm) exhibits colossal positive and negative thermal expansion that is the strongest ever reported for a framework material. On exposure to acetonitrile, Cu(tcm) undergoes a reconstructive solid-phase transition to acetonitrilocopper(I) tricyanomethanide. This transition can be reversed by heating under vacuum. Infrared spectroscopy measurements are sensitive to the phase change, suggesting that Cu(tcm) may find application in solid-phase acetonitrile sensing

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Thermocapillary pumping of discrete drops in microfabricated analysis devices

A nonmechanical pumping mechanism, thermocapillary pumping (TCP), is described for moving nanoliter- and picoliter-sized drops of liquid within microfabricated flow channels. In TCP, one end of a single drop is heated to create a surface tension difference between the ends of the drop. The induced surface tension difference causes a capillary pressure difference between the two drop ends and results in drop motion. TCP velocities of up to 20 mm/min were measured for several liquids at temperature differences between 10 and 70°C. An expression developed for TCP velocity yields predictions that agree with experimental velocities within corresponding uncertainty limits. Several techniques for assisting TCP are also suggested when contact angle hysteresis, the major factor limiting TCP velocities, is too large. These techniques include using surface treatments to reduce the contact angle hysteresis, converging channels to offset hysteresis, or an applied pressure to assist in movement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34237/1/690450215_ftp.pd

Dimensionality-property relationships in functional hexahydroxytriphenylene- and cyanide-containing materials

This thesis focuses on materials whose properties are directly linked with the dimensionality of their structures. We utilise diffraction techniques to characterise three systems. The first of these is an organic crystal, 2,3,6,7,10,11-hexahydroxytriphenylene tetrahydrate that contains one-dimensional water channels. These channels are polar and net polarity is achieved at low temperatures. The structure undergoes a phase transition to a non-polar state at higher temperatures. Mapping this finding onto an Ising model is undertaken in this thesis. We also investigate the possibility of transforming the same crystals to an organic metal with oxidation. Furthermore, this work characterises two-dimensional layered structures silver(I) tricyanomethanide and nickel(II) cyanide. We show that the former possesses the unprecedented property of negative area compressibility and the latter shows ordinary compressibility behaviour. Both these structures exhibit area negative thermal expansion. Finally, we investigate copper(II) and cobalt(II) doping into the structure of nickel(II) cyanide and demonstrate that the latter leads to a 10-fold increase in area negative thermal expansion.</p

Dimensionality-property relationships in functional hexahydroxytriphenylene- and cyanide-containing materials

This thesis focuses on materials whose properties are directly linked with the dimensionality of their structures. We utilise diffraction techniques to characterise three systems. The first of these is an organic crystal, 2,3,6,7,10,11-hexahydroxytriphenylene tetrahydrate that contains one-dimensional water channels. These channels are polar and net polarity is achieved at low temperatures. The structure undergoes a phase transition to a non-polar state at higher temperatures. Mapping this finding onto an Ising model is undertaken in this thesis. We also investigate the possibility of transforming the same crystals to an organic metal with oxidation. Furthermore, this work characterises two-dimensional layered structures silver(I) tricyanomethanide and nickel(II) cyanide. We show that the former possesses the unprecedented property of negative area compressibility and the latter shows ordinary compressibility behaviour. Both these structures exhibit area negative thermal expansion. Finally, we investigate copper(II) and cobalt(II) doping into the structure of nickel(II) cyanide and demonstrate that the latter leads to a 10-fold increase in area negative thermal expansion.This thesis is not currently available in OR

Dynamic Chiral Cyclohexanohemicucurbit[12]uril

This research with title "Dynamic chiral cyclohexanohemicucurbit[12]uril" is dedicated to the memory of late Professor Hans J. Reich.Abstract:NMR and DFT studies of chiral cyclohexanohemicucurbit[12]uril indicate that the macrocycle adopts a concave octagon shape with three distinct ranges of conformational flexibility in solution. Methylene bridge flipping occurs at temperatures above 265 K, while urea monomers rotate at temperatures above 308 K resulting in the loss of confined space within the macrocycle