Time to Benefit of Sodium-Glucose Cotransporter-2 Inhibitors Among Patients With Heart Failure

IMPORTANCE Emerging evidence has consistently demonstrated that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF) hospitalization and cardiovascular (CV) death among patients with HF. However, it remains unclear how long a patient needs to live to potentially benefit from SGLT2 inhibitors in this population. OBJECTIVES To estimate the time to benefit from SGLT2 inhibitors among patients with HF. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study systematically searched PubMed for completed randomized clinical trials about SGLT2 inhibitors and patients with HF published until September 5, 2022; 5 trials with the year of publication ranging from 2019 to 2022 were eventually included. Statistical analysis was performed from April to October 2022. INTERVENTION Addition of SGLT2 inhibitors or placebo to guideline-recommended therapy. MAIN OUTCOMES AND MEASURES The primary outcome was the time to first event of CV death or worsening HF, which was broadly comparable across the included trials. RESULTS Five trials consisting of 21 947 patients with HF (7837 [35.7%] were female; mean or median age older than 65 years within each trial) were included. SGLT2 inhibitors significantly reduced the risk of worsening HF or CV death (hazard ratio [HR], 0.77 [95% CI, 0.73-0.82]). Time to first nominal statistical significance (P < .05) was 26 days (0.86 months), and statistical significance was sustained from day 118 (3.93 months) onwards. A mean of 0.19 (95% CI, 0.12-0.35) months were needed to prevent 1 worsening HF or CV death per 500 patients with SGLT2 inhibitors (absolute risk reduction [ARR], 0.002). Likewise, 0.66 (95% CI, 0.43-1.13) months was estimated to avoid 1 event per 200 patients with SGLT2 inhibitors (ARR, 0.005), 1.74 (95% CI, 1.07-2.61) months to avoid 1 event per 100 patients (ARR, 0.010), and 4.96 (95% CI, 3.18-7.26) months to avoid 1 event per 50 patients (ARR, 0.020). Further analyses indicated a shorter time to benefit for HF hospitalization and among patients with diabetes or HF with reduced ejection fraction. CONCLUSIONS AND RELEVANCE In this comparative effectiveness research study of estimating the time to benefit from SGLT2 inhibitors among patients with HF, a rapid clinical benefit in reducing CV death or worsening HF was found, suggesting that their use may be beneficial for most individuals with HF

Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke

Importance It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023.InterventionsEligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo. Conclusions and Relevance Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability.Trial RegistrationChiCTR.org.cn Identifier: ChiCTR210005172

Research on the Efficiency of Urban Infrastructure Investment under the Constraint of Carbon Emissions, Taking Provincial Capitals in China as an Example

With the aggravation of the global climate problem, various countries are gradually formulating relevant policies and targets for carbon emission reduction in the infrastructure industry. Some countries or cities may have the problem of insufficient investment in infrastructure construction or blind investment, so it is urgent to carry out related research on the efficiency of infrastructure investment. From the perspective of carbon emission constraints, this study takes Chinese cities as the research case, and uses the unexpected output ultra-efficiency SBM model to measure the infrastructure investment efficiency and total-factor productivity from 2010 to 2020, and analyzes the influencing factors of infrastructure investment efficiency. The study found that (1) the regions with high infrastructure investment efficiency have the following two characteristics: the first relates to the cities with high investment, high output and fewer carbon emissions, and these cities rank at the forefront of economic development and scientific and technological level in the country. The second relates to the cities with high investment, high output and large carbon emissions. These cities have a large urban scale, their industrial structure is dominated by the secondary and tertiary industries, and their high output level plays a benign leading role. (2) Cities with low infrastructure investment efficiency are mainly manifest a large input of some infrastructure resources, low output level, high carbon emissions, and insufficient scale efficiency. (3) Economic level, industrial structure and fiscal expenditure play a positive role in improving the efficiency of infrastructure investment, and the development strategy of policies also affects the infrastructure investment mode. Finally, there are recommendations for the sustainable and high-quality development of infrastructure investment in developing countries

Enhancing bioaerosol sampling by Andersen impactors using mineral-oil-spread agar plate.

As a bioaerosol sampling standard, Andersen type impactor is widely used since its invention in 1950s, including the investigation of the anthrax attacks in the United States in 2001. However, its related problems such as impaction and desiccation stress as well as particle bounce have not been solved. Here, we improved its biological collection efficiencies by plating a mineral oil layer (100 µL) onto the agar plate. An Andersen six-stage sampler and a BioStage impactor were tested with mineral-oil-spread agar plates in collecting indoor and outdoor bacterial and fungal aerosols. The effects of sampling times (5, 10 and 20 min) were also studied using the BioStage impactor when sampling environmental bioaerosols as well as aerosolized Bacillus subtilis (G+) and Escherichia coli (G-). In addition, particle bounce reduction by mineral-oil-plate was also investigated using an optical particle counter (OPC). Experimental results revealed that use of mineral-oil-spread agar plate can substantially enhance culturable bioaerosol recoveries by Andersen type impactors (p-values<0.05). The recovery enhancement was shown to depend on bioaerosol size, type, sampling time and environment. In general, more enhancements (extra 20%) were observed for last stage of the Andersen six-stage samplers compared to the BioStage impactor for 10 min sampling. When sampling aerosolized B. subtilis, E. coli and environmental aerosols, the enhancement was shown to increase with increasing sampling time, ranging from 50% increase at 5 min to ∼100% at 20 min. OPC results indicated that use of mineral oil can effectively reduce the particle bounce with an average of 66% for 10 min sampling. Our work suggests that enhancements for fungal aerosols were primarily attributed to the reduced impaction stress, while for bacterial aerosols reduced impaction, desiccation and particle bounce played major roles. The developed technology can readily enhance the agar-based techniques including those high volume portable samplers for bioaerosol monitoring

MOESM1 of Tracking of pigment accumulation and secretion in extractive fermentation of Monascus anka GIM 3.592

Additional file 1: Table S1. ORP of intracellular and extracellular in extractive cultivation of Monascus anka with different Triton X-100 concentrations

Europium Pyrimidine-4,6-dicarboxylate Framework with a Single-Crystal-to-Single-Crystal Transition and a Reversible Dehydration/Rehydration Process

In this paper, a novel three-dimensional (3D) porous lanthanide–organic framework, Eu₂(μ₄-pmdc)₂(OH)₂·3H₂O (<b>1</b>), which is stable up to 400 °C, has been hydrothermally synthesized and characterized. It shows intriguing single-crystal-to-single-crystal transformation and reversible dehydration/rehydration phenomenon upon removal and rebinding of the lattice water molecules, which is supported by single-crystal X-ray diffraction, powder X-ray diffraction, and photoluminescence data