1,876 research outputs found

    Recurrent heart failure hospitalizations in heart failure with preserved ejection fraction: an analysis of TOPCAT trial

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    Abstract Aims Recurrent heart failure hospitalization (HFH) is an important feature of the progression of heart failure (HF). In the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, we analysed risk factors for recurrent HFH events in HF patients with preserved ejection fraction (HFpEF) and developed a risk prediction model for recurrent HFH. Methods and results This analysis focused on the subset of TOPCAT participants enrolled in the Americas (n¬†=¬†1767). Recurrent HFH was defined as two or more hospitalizations for HF during the follow‚Äźup period. Lasso regression and multivariate logistic regression were used to screen the risk factors, and the risk prediction model of recurrent HFH was established. During a median follow‚Äźup period of 3.4 (95% confidence interval: 3.3‚Äď3.6) years, 72.2% (542 of 751 total hospitalizations) of HFH events occurred in 9.4% (n¬†=¬†163) of patients with recurrent HFHs. Patients in the recurrent HFH group had higher cardiovascular mortality rate [6.2 per 100 patient‚Äźyears (PY) vs. 3.8 per 100 PY, P¬†=¬†0.016] and all‚Äźcause mortality rate (10.0 per 100 PY vs. 6.8 per 100 PY, P¬†=¬†0.015) than those in the non‚Äźrecurrent HFH group. The model consisting of nine predictors has moderate predictive power for recurrent HFH events in patients with HFpEF (AUC¬†=¬†0.75, Brier score¬†=¬†0.08). Decision curve analysis showed a net clinical benefit from the application of the prediction model. Conclusions In patients with HFpEF, the majority of HFHs occur in a small proportion of patients with repeated hospitalizations, who typically have more comorbidities and are at higher risk of death. The predictive model developed in this study helps to identify patients at high risk of recurrent HFH

    Competitive Adsorption: Reducing the Poisoning Effect of Adsorbed Hydroxyl on Ru Single-Atom Site with SnO for Efficient Hydrogen Evolution

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    Ruthenium (Ru) has been theoretically considered a viable alkaline hydrogen evolution reaction electrocatalyst due to its fast water dissociation kinetics. However, its strong affinity to the adsorbed hydroxyl (OHad) blocks the active sites, resulting in unsatisfactory performance during the practical HER process. Here, we first reported a competitive adsorption strategy for the construction of SnO2 nanoparticles doped with Ru single-atoms supported on carbon (Ru SAs-SnO2/C) via atomic galvanic replacement. SnO2 was introduced to regulate the strong interaction between Ru and OHad by the competitive adsorption of OHad between Ru and SnO2, which alleviated the poisoning of Ru sites. As a consequence, the Ru SAs-SnO2/C exhibited a low overpotential at 10 mAcm2 (10 mV) and a low Tafel slope of 25 mVdec1. This approach provides a new avenue to modulate the adsorption strength of active sites and intermediates, which paves the way for the development of highly active electrocatalysts

    Staurosporine-producing <i>Streptomyces</i> sp. strain 11‚ÄČ√ó‚ÄČ1 cell-free culture filtrates control diseases caused by the oomycete plant pathogens <i>Pythium myriotylum</i> and <i>Phytophthora sojae</i>

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    Oomycetes are devastating soil-borne plant pathogens, and cause numerous losses on diverse crops worldwide. In this study, our aim was to identify actinomycetes with antimicrobial activity towards oomycetes from the rhizosphere of soybean. Strong growth inhibition of P. myriotylum was found in dual culture with a strain called 11‚ÄČ√ó‚ÄČ1, and also from using the 11‚ÄČ√ó‚ÄČ1 cell-free culture filtrate and EtOAc extract. The P. myriotylum growth-inhibiting activity of the 11‚ÄČ√ó‚ÄČ1 culture filtrates was stable at high temperatures, and acidic and alkaline conditions. The 11‚ÄČ√ó‚ÄČ1 strain was identified as a Streptomyces strain with the highest 16S rDNA sequence identity to S. scabiei, and phylogenomic analysis also showed clustering with S. scabiei strains. Applying the 11‚ÄČ√ó‚ÄČ1 culture filtrates to ginger and soybean leaves inhibited the necrosis caused by P. myriotylum and P. sojae, respectively. Pot assay experiments showed a strong control effect of the 11‚ÄČ√ó‚ÄČ1 culture filtrate against P. myriotylum-caused soft-rot disease of ginger, and against P. sojae caused root-rot of soybean. Analysis of the biosynthetic gene clusters from the genome of 11‚ÄČ√ó‚ÄČ1 predicted the production of staurosporine, and staurosporine was subsequently identified from LC-MS analysis of the 11‚ÄČ√ó‚ÄČ1 extract. The concentrations of staurosporine quantified in the 11‚ÄČ√ó‚ÄČ1 extracts were in the range of the staurosporine minimum inhibitory concentrations for P. myriotylum, supporting the contribution of staurosporine to the biocontrol effect of 11‚ÄČ√ó‚ÄČ1. The use of 11‚ÄČ√ó‚ÄČ1 culture filtrate to control both ginger and soybean diseases could be beneficial in an intercropping system of ginger and the leguminous nitrogen-fixing soybean.</p

    On-Site Ratiometric Analysis of UO<sub>2</sub><sup>2+</sup> with High Selectivity

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    Uranyl ions (UO22+) are recognized as important indicators for monitoring sudden nuclear accidents. However, the interferences coexisting in the complicated environmental matrices impart serious constraints on the reliability of current on-site monitoring methods. Herein, a novel ratiometric method for the highly sensitive and selective detection of UO22+ is reported based on a [Eu(diaminoterephthalic acid)] (Eu-DATP) metal‚Äďorganic framework. Benefiting from the unique chemical structure of Eu-DATP, energy transfer from DATP to UO22+ was enabled, resulting in the up-regulated fluorescence of UO22+ and the simultaneous down-regulated fluorescence of Eu3+. The limit of detection reached as low as 2.7 nM, which was almost 2 orders of magnitude below the restricted limit in drinking water set by the United States Environmental Protection Agency (130 nM). The Eu-DATP probe showed excellent specificity to UO22+ over numerous interfering species, as the intrinsic emissions of UO22+ were triggered. This unprecedentedly high selectivity is especially beneficial for monitoring UO22+ in complicated environmental matrices with no need for tedious sample pretreatment, such as filtration and digestion. Then, by facilely equipping a Eu-DATP-based sampler on a drone, remotely controlled sampling and on-site analysis in real water samples were realized. The concentrations of UO22+ were determined to be from 16.5 to 23.5 nM in the river water of the Guangzhou downtown area, which was consistent with the results determined by the gold-standard inductively coupled plasma mass spectrometry. This study presents a reliable and convenient method for the on-site analysis of UO22+

    Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China

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    Abstract Background Headache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists. Methods In the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021. Results The study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of ‚ÄúNervous headache‚ÄĚ was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study. Conclusions While there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future

    The Design and Technology Development of the JUNO Central Detector

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    International audienceThe Jiangmen Underground Neutrino Observatory (JUNO) is a large scale neutrino experiment with multiple physics goals including deter mining the neutrino mass hierarchy, the accurate measurement of neutrino oscillation parameters, the neutrino detection from the super nova, the Sun, and the Earth, etc. JUNO puts forward physically and technologically stringent requirements for its central detector (CD), including a large volume and target mass (20 kt liquid scintillator, LS), a high energy resolution (3% at 1 MeV), a high light transmittance, the largest possible photomultiplier (PMT) coverage, the lowest possible radioactive background, etc. The CD design, using a spherical acrylic vessel with a diameter of 35.4 m to contain the LS and a stainless steel structure to support the acrylic vessel and PMTs, was chosen and optimized. The acrylic vessel and the stainless steel structure will be immersed in pure water to shield the radioactive back ground and bear great buoyancy. The challenging requirements of the acrylic sphere have been achieved, such as a low intrinsic radioactivity and high transmittance of the manufactured acrylic panels, the tensile and compressive acrylic node design with embedded stainless steel pad, one-time polymerization for multiple bonding lines. Moreover, several technical challenges of the stainless steel structure have been solved: the production of low radioactivity stainless steel material, the deformation and precision control during production and assembly, the usage of high strength stainless steel rivet bolt and of high friction efficient linkage plate. Finally, the design of the ancillary equipment like the LS filling, overflowing and circulating system was done

    Flashpoints Signal Hidden Inherent Instabilities in Land-Use Planning

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    Land-use decision-making processes have a long history of producing globally pervasive systemic equity and sustainability concerns. Quantitative, optimization-based planning approaches, e.g. Multi-Objective Land Allocation (MOLA), seemingly open the possibility to improve objectivity and transparency by explicitly evaluating planning priorities by the type, amount, and location of land uses. Here, we show that optimization-based planning approaches with generic planning criteria generate a series of unstable "flashpoints" whereby tiny changes in planning priorities produce large-scale changes in the amount of land use by type. We give quantitative arguments that the flashpoints we uncover in MOLA models are examples of a more general family of instabilities that occur whenever planning accounts for factors that coordinate use on- and between-sites, regardless of whether these planning factors are formulated explicitly or implicitly. We show that instabilities lead to regions of ambiguity in land-use type that we term "gray areas". By directly mapping gray areas between flashpoints, we show that quantitative methods retain utility by reducing combinatorially large spaces of possible land-use patterns to a small, characteristic set that can engage stakeholders to arrive at more efficient and just outcomes.Comment: 9 pages, 5 figure

    Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in extremely preterm infants with respiratory distress syndrome: study protocol for a multicentre randomised controlled, superiority trial

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    Introduction Tracheal intubation and invasive mechanical ventilation (IMV) significantly decreased mortality of respiratory distress syndrome (RDS) in extremely preterm infants (28 weeks’ gestational age) whereas bronchopulmonary dysplasia increased. Thus, consensus guidelines recommend the use of non-invasive ventilation (NIV), as the preferred first-line approach for these infants. This trial aims to compare the effect of nasal continuous positive airway pressure (NCPAP) and non-invasive high-frequency oscillatory ventilation (NHFOV) as the primary respiratory support in extremely preterm infants with RDS.Methods and analysis We designed a multicentre, randomised, controlled, superiority trial investigating the effect of NCPAP and NHFOV as the primary respiratory support in extremely preterm infants with RDS in neonatal intensive units in China. At least 340 extremely preterm infants with RDS will be randomised to NHFOV or NCPAP as a primary mode of NIV. The primary outcomes will be the respiratory support failure determined by the need for IMV within 72 hours from birth.Ethics and dissemination Our protocol has been approved by the Ethics Committee of Children’s Hospital of Chongqing Medical University. We will present our findings at national conferences and peer-reviewed paediatrics journals.Trial registration number NCT05141435
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