Aims
To study the long-term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with ...haemoglobin levels and anaemia status.
Methods and results
During a 2-year period, we studied 628 consecutive patients (aged 71 years interquartile range, IQR: 61-77, 68% male) hospitalized with AHF. Demographic, clinical, echocardiographic, and laboratory characteristics were registered at discharge and patients were closely followed-up for 38.1 months 16.5-49.1. Median RDW was 14.4% 13.5-15.5 and was higher among decedents (15.0% 13.8-16.1 vs. 14.2 13.3-15.3, P < 0.001). After adjustment for other prognostic factors in a multivariable Cox proportional-hazards model, RDW remained a significant predictor (P = 0.004, HR 1.072, 95% CI 1.023-1.124); whereas, haemoglobin or anaemia status did not add prognostic information. RDW levels above the median were associated with a significantly lower survival rate on long-term follow-up (log rank <0.001). These levels were predictive of death in anaemic patients (n = 263, P = 0.029) and especially in non-anaemic patients (n = 365) (P < 0.001, HR 1.287, 95% CI 1.147-1.445), even after adjustment in the multivariable model.
Conclusion
Higher RDW levels at discharge were associated with a worse long-term outcome, regardless of haemoglobin levels and anaemia status.
Similarity solutions for the two‐phase Rubinstein binary‐alloy solidification problem in a semi‐infinite material are developed. These new explicit solutions are obtained by considering two cases: A ...heat flux or a convective boundary conditions at the fixed face, and the necessary and sufficient conditions on data are also given in order to have an instantaneous solidification process. We also show that all solutions for the binary‐alloy solidification problem are equivalent under some restrictions for data. Moreover, this implies that the coefficient that characterizes the solidification front for the Rubinstein solution must verify an inequality as a function of all thermal and boundary conditions.
ABSTRACT
Aims
Dapagliflozin improves the prognosis of patients with heart failure (HF), regardless of left ventricular ejection fraction (LVEF). However, its effect on cardiac remodelling parameters, ...specifically left atrial (LA) remodelling, is not well established.
Methods and results
The DAPA‐MODA trial (NCT04707352) is a multicentre, single‐arm, open‐label, prospective and interventional study that aimed to evaluate the effect of dapagliflozin on cardiac remodelling parameters over 6 months. Patients with stable chronic HF receiving optimized guideline‐directed therapy, except for any sodium–glucose cotransporter 2 inhibitor, were included. Echocardiography was performed at baseline, 30 and 180 days, and analysed by a central core‐lab in a blinded manner to both patient and time. The primary endpoint was the change in maximal LA volume index (LAVI). A total of 162 patients (64.2% men, 70.5 ± 10.6 years, 52% LVEF >40%) were included in the study. At baseline, LA dilatation was observed (LAVI 48.1 ± 22.6 ml/m2) and LA parameters were similar between LVEF‐based phenotypes (≤40% vs. >40%). LAVI showed a significant reduction at 180 days (−6.6% 95% confidence interval −11.1, −1.8, p = 0.008), primarily due to a decrease in reservoir volume (−13.8% 95% confidence interval −22.5, −4, p = 0.007). Left ventricular geometry improved with significant reductions in left ventricular mass index (−13.9% 95% confidence interval −18.7, −8.7, p < 0.001), end‐diastolic volume (−8.0% 95% confidence interval −11.6, −4.2, p < 0.001) and end‐systolic volume (−11.9% 95% confidence interval −16.7, −6.8, p < 0.001) at 180 days. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) showed a significant reduction at 180 days (−18.2% 95% confidence interval −27.1, −8.2, p < 0.001), without changes in filling Doppler measures.
Conclusion
Dapagliflozin administration in stable out‐setting patients with chronic HF and optimized therapy results in global reverse remodelling of cardiac structure, including reductions in LA volumes and improvement in left ventricular geometry and NT‐proBNP concentrations.
Schematic representation of main findings of DAPA MODA: administration of dapagliflozin over 6 months in stable patients, with chronic heart failure and optimized therapy, was associated with cardiac reverse remodelling, including reductions in left atrial volume, left ventricular mass and dimensions, and NT‐proBNP levels. LAVI, left atrial volume index; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; LVI, left ventricular indexed; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; SGLT2i, sodium–glucose cotransporter 2 inhibitor.
Metropolitan construction and demolition waste (CDW) is currently an important source of recycled materials that, despite having completed their useful life cycle, can be reincorporated into the ...circular economy process (CEP); however, the recycling process is very selective, and waste material is not always fully satisfactory due to the intrinsic nature of the waste. This work aims to demonstrate and establish how to increase the effectiveness of the construction and demolition waste in more resistant mortars, by mixing it with zeolitised cinerite tuff (ZCT) at varying normalised proportions. To attain the objectives of this research, a series of tests were done: First, a chemical, physical and mineralogical characterisation of the CDW and the ZCT through XRF, XRD, SEM and granulometric methods. Second, a technological test was made to determine the mechanical strength at 7, 28 and 90 days of specimens made with Portland cement (PC) and mixtures of PC/CDW, PC/ZCT, and PC/CDW-ZCT. The results obtained through the characterisation methods showed that the sample of construction and demolition waste consisted of the main phase made of portlandite and tobermorite, and by a secondary phase consisting of quartz, ettringite and calcite; whereas the ZCT has a main phase of mordenite and a secondary phase of smectite (montmorillonite), amorphous materials consisting of devitrified volcanic glass, quartz and plagioclase. Mechanical strength tests established that specimens made with PC/CDW mixtures have very discreet compressive strength values up to 44 MPa at 90 days, whereas specimens made with PC/ZCT mixtures achieved a remarkably high mechanical strength consisting of 68.5 MPa. However, the most interesting conclusion in this research is the good result obtained in mechanical strength of the specimens made up of mixtures of PC/CDW-ZCT, which increased from 52.5 to 62 MPa at 90 days of curing; this fact establishes the positive influence of ZCT on waste in the mortar mixtures, which permits the authors to establish that the objective of the work has been fulfilled. Finally, it can be argued that the results obtained in this research could contribute to more effective use of construction and demolition waste in metropolitan areas.
The effects of global climate change are becoming more evident and accelerating at an unprecedented pace. For this reason, human activities urgently need a paradigm shift to stop this entropic ...process before the consequences become irreversible. In this sense, the use of highly eco-efficient materials aimed at conveniently neutralizing CO2 greenhouse gas emissions entering into the atmosphere can contribute significantly to mitigating and reversing this process. This work aims to demonstrate the positive effects obtained when Portland cement is partially replaced by bentonite clays of volcano-sedimentary origin. The samples were initially characterized by various methods, such as Thin-Section Petrographic Study (TSP) and the analysis of mineral phases with XRD, chemical composition was determined via XRF, and morphological analysis was determined via scanning electron microscopy (SEM). To determine the technical properties of the samples, a qualitative chemical analysis (QCA) was performed, as well as a chemical analysis of pozzolanicity (CAP) at 8 and 15 days, respectively, and a study of the mechanical compressive strengths at 2, 7, 28 and 90 days. Characterization studies using TSP, DRX, FRX and SEM established that these bentonite clays have a complex mineralogical variety, composed mainly of smectite, mordenite, plagioclase and biotite, as well as altered volcanic glass and sericite. The results of the qualitative chemical analysis establish that more than 93% of the SiO2 present in the samples is reactive. Chemical analysis of pozzolanicity (CAP) showed significant pozzolanic behavior in all samples analyzed at both 8 and 15 days, while mechanical tests highlighted significant increases in mechanical strengths, with maximum values varying between 52.2 and 70.6 MPa at 90 days. These results show that the materials can be used as quality pozzolans for the manufacture of cements, mortars and concretes, which could be considered as a favorable factor and, therefore, relevant in the management and control of greenhouse gas emissions responsible for the deterioration of the environment.
Climate change is already an undeniable reality, and it is a direct consequence of our society’s lifestyle and the indiscriminate use of certain materials, such as Portland cement, which causes the ...emission of gases and waste that contributes to the greenhouse effect. The object of this work is to present the results obtained from research on pyroxenic andesites that have become altered to zeolite and their use as alternative, eco-efficient materials that improve the quality of cement through a standardized partial substitution. In this work, four samples of pyroxenic andesites altered to zeolites (PAAZ) and two samples of unaltered andesites (UPA) were analyzed. The methods used in this study are as follows: petrography of thin section (PTS), chemical analysis of X-ray fluorescence (XRF) and phase determination by X-ray diffraction (XRD). Other tests were carried out to determine the quality of the PAAZ from a technical and practical application point of view, such as chemical analysis of pozzolanicity (CPT) at 8 and 15 days, as well as mechanical compression tests at 2, 7, 28 and 90 days. Petrographic and phase analyses show that the original mineral components of the samples such as pyroxene, amphibole, plagioclase and mica were leached and replaced by more than 90% with mordenite and smectite. XRF analyses indicates an anomalous rise in SiO2, a drastic reduction in alumina Al2O3 and a significant increase in alkaline compounds over alkaline-earth compounds in samples of altered pyroxenic andesites (PAAZ) with respect to samples of unaltered andesites (UPA). The pozzolanicity test establishes that the samples of unaltered andesites do not behave like pozzolans at 8 or 15 days; however, altered andesites experienced remarkable pozzolanic reactivity in the same periods. The mechanical compression tests carried out on specimens made with PAAZ and Portland cement showed a growing increase in mechanical resistance from 2 days (15.2 MPa) to 90 days (72.1 MPa). These results suggest that pyroxenic andesites altered to zeolite can be an ideal alternative to partially replace Portland cement, which in turn could contribute to the preservation of the environment and a more rational use of traditional resources.
We consider an elliptic boundary value problem with unilateral constraints and subdifferential boundary conditions. The problem describes the heat transfer in a domain
D
⊂ ℝ
d
and its weak ...formulation is in the form of a hemivariational inequality for the temperature field, denoted by
P
. We associate to Problem
P
an optimal control problem, denoted by
Q
. Then, using appropriate Tykhonov triples, governed by a nonlinear operator
G
and a convex
K
˜
, we provide results concerning the well-posedness of problems
P
and
Q
. Our main results are Theorems 4.2 and 5.2, together with their corollaries. Their proofs are based on arguments of compactness, lower semicontinuity and pseudomonotonicity. Moreover, we consider three relevant perturbations of the heat transfer boundary valued problem which lead to penalty versions of Problem
P
, constructed with particular choices of
G
and
K
˜
. We prove that Theorems 4.2 and 5.2 as well as their corollaries can be applied in the study of these problems, in order to obtain various convergence results.
Reply: Interleukin-1β and sST2 Pascual-Figal, Domingo A; Lax, Antonio; Bayes-Genis, Antoni
Journal of the American College of Cardiology,
07/2019, Letnik:
74, Številka:
3
Journal Article
Recenzirano
Dr. Baldetti and colleagues suggest that an interaction between coronary artery disease and IL-1β may be missed in our analysis, as supported by results of the CANTOS trial (Canakinumab ...Antiinflammatory Thrombosis Outcome Study) (2). By contrast, our report sought to provide pathobiological insight into the interplay between IL1β and ST2: close correlation and interaction. Because this was the first report to establish a cut-point threshold for IL-1β concentrations in acute HF, we used the Youden index, as pointed out by Dr. Aimo and associates. For defining high sST2, we used the only Food and Drug Administration–approved prognostic cutoff value in HF, which is higher than the 90th of the reference group percentile in a healthy and general population (4).
Recent studies have proposed resection of the T2 FLAIR hyperintensity beyond the T1 contrast enhancement (supramarginal resection SMR) for IDH-wild-type glioblastoma (GBM) to further improve ...patients' overall survival (OS). GBMs have significant variability in tumor cell density, distribution, and infiltration. Advanced mathematical models based on patient-specific radiographic features have provided new insights into GBM growth kinetics on two important parameters of tumor aggressiveness: proliferation rate (ρ) and diffusion rate (D). The aim of this study was to investigate OS of patients with IDH-wild-type GBM who underwent SMR based on a mathematical model of cell distribution and infiltration profile (tumor invasiveness profile).
Volumetric measurements were obtained from the selected regions of interest from pre- and postoperative MRI studies of included patients. The tumor invasiveness profile (proliferation/diffusion ρ/D ratio) was calculated using the following formula: ρ/D ratio = (4π/3)2/3 × (6.106/VT21/1 - VT11/1)2, where VT2 and VT1 are the preoperative FLAIR and contrast-enhancing volumes, respectively. Patients were split into subgroups based on their tumor invasiveness profiles. In this analysis, tumors were classified as nodular, moderately diffuse, or highly diffuse.
A total of 101 patients were included. Tumors were classified as nodular (n = 34), moderately diffuse (n = 34), and highly diffuse (n = 33). On multivariate analysis, increasing SMR had a significant positive correlation with OS for moderately and highly diffuse tumors (HR 0.99, 95% CI 0.98-0.99; p = 0.02; and HR 0.98, 95% CI 0.96-0.99; p = 0.04, respectively). On threshold analysis, OS benefit was seen with SMR from 10% to 29%, 10% to 59%, and 30% to 90%, for nodular, moderately diffuse, and highly diffuse, respectively.
The impact of SMR on OS for patients with IDH-wild-type GBM is influenced by the degree of tumor invasiveness. The authors' results show that increasing SMR is associated with increased OS in patients with moderate and highly diffuse IDH-wild-type GBMs. When grouping SMR into 10% intervals, this benefit was seen for all tumor subgroups, although for nodular tumors, the maximum beneficial SMR percentage was considerably lower than in moderate and highly diffuse tumors.
Irritable bowel syndrome (IBS) is a prevalent chronic functional gastrointestinal disorder, characterised by recurrent abdominal discomfort and altered bowel movements. IBS cause a significantly ...negative impact on quality of life (QoL). Growing pharmacological evidence suggests that berberine (BBR) and curcumin (CUR) may mitigate IBS symptoms through multiple complementary synergistic mechanisms, resulting in the attenuation of intestinal inflammation and regulation of bowel motility and gut functions. In the present observational study conducted under real-life routine clinical practice settings, 146 patients diagnosed with IBS were enrolled by general practitioner clinics and pharmacies in Belgium. For the first time, this study assessed the potential synergistic pharmacological effect of a combined oral BBR/CUR supplement (Enterofytol
PLUS, containing 200 mg BBR and 49 mg CUR) (two tablets daily for 2 months), serving as complementary therapy in the management of IBS. Following the 2-month supplementation, significant improvements were observed in the patients' IBS severity index (IBSSI) (47.5%) and all the primary IBS symptoms, such as abdominal discomfort (47.2%), distension (48.0%), intestinal transit (46.8%), and QoL (48.1%) (all
< 0.0001). The improvement in the patients' IBSSI was independent of age, sex, and IBS sub-types. The patients' weekly maximum stool passage frequency decreased significantly (
< 0.0001), and the stool status normalized (
< 0.0001). The patients' need for concomitant conventional IBS treatment decreased notably: antispasmodics by 64.0% and antidiarrhoeals by 64.6%. Minor adverse effects were reported by a small proportion (7.1%) of patients, mostly gastrointestinal. The majority (93.1%) experienced symptom improvement or resolution, with a high satisfaction rate (82.6%) and willingness to continue the supplementation (79.0%). These findings support the potential synergistic pharmacological role of BBR and CUR in IBS, and their co-supplementation may alleviate IBS symptoms and improve QoL.
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