Angiotensin receptor-neprilysin inhibitor in patients with heart failure and chronic kidney disease

Despite significant advances in the management of heart failure with reduced ejection fraction (HFrEF), there remains an enormous health problem with high morbidity and mortality over the last few decades. The neprilysin inhibitor enhances the activity of natriuretic peptides, producing vasodilation, natriuresis, and diuresis. Angiotensin receptor blockers inhibit the renin-angiotensin-aldosterone system. Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI), has been shown to improve cardiovascular outcomes in HFrEF and delay the progression of chronic kidney disease (CKD) in patients with HFrEF. The PARADIGM-HF study showed a reduction in diuretic need in the ARNI group. While the use of diuretics is effective in volume control in patients with HFrEF, their use has the potential to adversely affect renal function. Therefore, ARNI therapy could benefit patients with heart failure and CKD by reducing cardiovascular morbidity and mortality and possibly retarding the progression of CKD, although more clinical evidence is required in patients with severe CKD and end-stage renal disease

Geomagnetic field influences probabilistic abstract decision-making in humans

To resolve disputes or determine the order of things, people commonly use binary choices such as tossing a coin, even though it is obscure whether the empirical probability equals to the theoretical probability. The geomagnetic field (GMF) is broadly applied as a sensory cue for various movements in many organisms including humans, although our understanding is limited. Here we reveal a GMF-modulated probabilistic abstract decision-making in humans and the underlying mechanism, exploiting the zero-sum binary stone choice of Go game as a proof-of-principle. The large-scale data analyses of professional Go matches and in situ stone choice games showed that the empirical probabilities of the stone selections were remarkably different from the theoretical probability. In laboratory experiments, experimental probability in the decision-making was significantly influenced by GMF conditions and specific magnetic resonance frequency. Time series and stepwise systematic analyses pinpointed the intentionally uncontrollable decision-making as a primary modulating target. Notably, the continuum of GMF lines and anisotropic magnetic interplay between players were crucial to influence the magnetic field resonance-mediated abstract decision-making. Our findings provide unique insights into the impact of sensing GMF in decision-makings at tipping points and the quantum mechanical mechanism for manifesting the gap between theoretical and empirical probability in 3-dimensional living space.Comment: 32 pages, 5 figures, 4 supplementary figures, 2 supplementary tables, and separate 15 ancillary file