The angiotensin receptor-neprilysin inhibitor sacubitril-valsartan led to a reduced risk of hospitalization for heart failure or death from cardiovascular causes among patients with heart failure and ...reduced ejection fraction. The effect of angiotensin receptor-neprilysin inhibition in patients with heart failure with preserved ejection fraction is unclear.
We randomly assigned 4822 patients with New York Heart Association (NYHA) class II to IV heart failure, ejection fraction of 45% or higher, elevated level of natriuretic peptides, and structural heart disease to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or valsartan (target dose, 160 mg twice daily). The primary outcome was a composite of total hospitalizations for heart failure and death from cardiovascular causes. Primary outcome components, secondary outcomes (including NYHA class change, worsening renal function, and change in Kansas City Cardiomyopathy Questionnaire KCCQ clinical summary score scale, 0 to 100, with higher scores indicating fewer symptoms and physical limitations), and safety were also assessed.
There were 894 primary events in 526 patients in the sacubitril-valsartan group and 1009 primary events in 557 patients in the valsartan group (rate ratio, 0.87; 95% confidence interval CI, 0.75 to 1.01; P = 0.06). The incidence of death from cardiovascular causes was 8.5% in the sacubitril-valsartan group and 8.9% in the valsartan group (hazard ratio, 0.95; 95% CI, 0.79 to 1.16); there were 690 and 797 total hospitalizations for heart failure, respectively (rate ratio, 0.85; 95% CI, 0.72 to 1.00). NYHA class improved in 15.0% of the patients in the sacubitril-valsartan group and in 12.6% of those in the valsartan group (odds ratio, 1.45; 95% CI, 1.13 to 1.86); renal function worsened in 1.4% and 2.7%, respectively (hazard ratio, 0.50; 95% CI, 0.33 to 0.77). The mean change in the KCCQ clinical summary score at 8 months was 1.0 point (95% CI, 0.0 to 2.1) higher in the sacubitril-valsartan group. Patients in the sacubitril-valsartan group had a higher incidence of hypotension and angioedema and a lower incidence of hyperkalemia. Among 12 prespecified subgroups, there was suggestion of heterogeneity with possible benefit with sacubitril-valsartan in patients with lower ejection fraction and in women.
Sacubitril-valsartan did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among patients with heart failure and an ejection fraction of 45% or higher. (Funded by Novartis; PARAGON-HF ClinicalTrials.gov number, NCT01920711.).
The Tibetan Plateau is the highest and one of the most demanding environments ever inhabited by humans. We investigated the timing and mechanisms of its initial colonization at the Nwya Devu site, ...located nearly 4600 meters above sea level. This site, dating from 40,000 to 30,000 years ago, is the highest Paleolithic archaeological site yet identified globally. Nwya Devu has yielded an abundant blade tool assemblage, indicating hitherto-unknown capacities for the survival of modern humans who camped in this environment. This site deepens the history of the peopling of the "roof of the world" and the antiquity of human high-altitude occupations more generally.
This study aims to investigate the significance of erythropoietin-producing hepatocellular (Eph)A2 expression and the mechanism by which EphA2 is involved in the epithelial-mensenchymal transition ...(EMT) of gastric cancer cells. EphA2 expression levels were upregulated and positively correlated with metastasis and EMT markers in human gastric cancer specimens. Modulation of EphA2 expression levels had distinct effects on cell proliferation, cell cycle, migration, invasion and morphology in the gastric cancer cell lines SGC7901 and AGS in vitro and in vivo. Overexpression of EphA2 resulted in the upregulation of the EMT molecular markers N-cadherin and Snail, as well as the Wnt/β-catenin targets TCF4, Cyclin-D1 and c-Myc, while silencing EphA2 using short hairpin RNA had the opposite effect. Furthermore, inhibition of the Wnt/β-catenin pathway by XAV939 negated the effect of EphA2 overexpression, whereas activation of the Wnt/β-catenin pathway by LiCl impaired the effect of the EphA2 knockdown on EMT. These observations demonstrate that EphA2 upregulation is a common event in gastric cancer specimens that is closely correlated with cancer metastasis and that EphA2 promotes EMT of gastric cancer cells through activation of Wnt/β-catenin signaling.
Many studies have revealed pathways of epigenetic gene silencing by Polycomb repressive complex 2 (PRC2) in vivo, but understanding the underlying molecular mechanisms requires biochemistry. Here we ...analyze interactions of reconstituted human PRC2 with nucleosome complexes. Histone modifications, the H3K27M cancer mutation, and inclusion of JARID2 or EZH1 in the PRC2 complex have unexpectedly minor effects on PRC2-nucleosome binding. Instead, protein-free linker DNA dominates the PRC2-nucleosome interaction. Specificity for CG-rich sequences is consistent with PRC2 occupying CG-rich DNA in vivo. PRC2 preferentially binds methylated DNA regulated by its AEBP2 subunit, suggesting how DNA and histone methylation collaborate to repress chromatin. We find that RNA, known to inhibit PRC2 activity, is not a methyltransferase inhibitor per se. Instead, RNA sequesters PRC2 from nucleosome substrates, because PRC2 binding requires linker DNA, and RNA and DNA binding are mutually exclusive. Together, we provide a model for PRC2 recruitment and an explanation for how actively transcribed genomic regions bind PRC2 but escape silencing.
Aim
To investigate the effect of irrigation on the surface roughness and fatigue resistance of HyFlex and M3 controlled memory (CM) wire nickel‐titanium instruments.
Methodology
Two new files of each ...brand were analysed by atomic force microscopy (AFM). Then, the instruments were dynamically immersed in either 5.25% sodium hypochlorite (NaOCl) or 17% ethylene diamine tetraacetic acid (EDTA) solution for 10 min, followed by AFM analysis. The roughness average (Ra) and root mean square (RMS) values were analysed statistically using an independent sample t‐test. Then, 36 files of each brand were randomly assigned to three groups (n = 12). Group 1 (the control group) was composed of new instruments. Groups 2 and 3 were dynamically immersed in 5.25% NaOCl and 17% EDTA solutions for 10 min, respectively. The number of rotations to failure for various groups was analysed using the one‐way analysis of variance software.
Results
For M3 files, the Ra and RMS values significantly increased (P < 0.05) after the immersion. For the HyFlex file, the Ra and RMS values significantly increased (P < 0.05) only in EDTA, but not (P > 0.05) NaOCl. The resistance to cyclic fatigue of both HyFlex and M3 files did not significantly decrease (P > 0.05) by immersing in 5.25% NaOCl and 17% EDTA solutions.
Conclusions
Except the HyFlex files immersed in NaOCl, the surface roughness of other files exposed to irrigants increased. However, a change in the surface tomography of CM wire instruments caused by contact with irrigants for 10 min did not trigger a decrease in cyclic fatigue resistance.
We present the first results from an ongoing survey for damped Lyman-α systems (DLAs) in the spectra of z > 2 quasars observed in the course of the Baryon Oscillation Spectroscopic Survey (BOSS), ...which is part of the Sloan Digital Sky Survey (SDSS) III. Our full (non-statistical) sample, based on Data Release 9, comprises 12 081 systems with log N(H i) ≥ 20, out of which 6839 have log N(H i) ≥ 20.3. This is the largest DLA sample ever compiled, superseding that from SDSS-II by a factor of seven. Using a statistical sub-sample and estimating systematics from realistic mock data, we probe the N(H i) distribution at ⟨z⟩ = 2.5. Contrary to what is generally believed, the distribution extends beyond 1022 cm-2 with a moderate slope of index ≈−3.5. This result matches the opacity-corrected distribution observed at z = 0 surprisingly well. The cosmological mass density of neutral gas in DLAs is found to be \hbox{$\omegagdla \approx 10^{-3}$}ΩgDLA≈10-3, evolving only mildly over the past 12 billion years.
Purpose
The purpose of this study is to evaluate the effectiveness and safety of liraglutide/liraglutide + metformin in overweight/obese women with polycystic ovary syndrome (PCOS).
Methods
The ...related literatures published until April 2021 were searched in PubMed, Cochrane Library, MEDLINE and EmBase.
Results
Six randomized controlled trials of 127 related articles were obtained through searching. Three articles compared liraglutide with metformin, and four articles compared liraglutide combined with metformin with metformin. Our meta-analysis suggests that liraglutide was superior to metformin only in weight loss MD = − 2.74, 95% CI (− 4.29, − 1.18),
P
= 0.0006. Compared with metformin group, the combination group had significant advantages in weight loss MD = − 3.81, 95% CI (− 5.16, − 2.46),
P
< 0.001, BMI MD = − 2.59, 95% CI (− 3.12, − 2.07),
P
< 0.001, waist circumference MD = − 6.26, 95% CI (− 7.79, − 4.72),
P
< 0.001, fasting blood glucose MD = − 0.59, 95% CI (− 0.74, − 0.44),
P
< 0.001 and fasting insulin MD = − 1.52, 95% CI (− 2.69, − 0.35),
P
= 0.01, while the incidence of adverse reactions was relatively high RR = 2.91, 95% CI (1.55, 5.46),
P
= 0.00009.
Conclusion
The present results indicate that liraglutide and metformin have the similar effects in the treatment of overweight/obese PCOS patients. Liraglutide combined with metformin is more effective than metformin in improving PCOS, but it is necessary to master the correct medication method to reduce the occurrence of adverse reactions.
Humidity is a very important factor in representing the severity of electrostatic discharge (ESD). Low humidity indicates high risk of ESD problems; high humidity indicates low risk of ESD problems. ...Both relative humidity and absolute humidity can represent the level of humidity: which one is more important? The reported measurement result shows that relative humidity is more important in the discharge phase. The qualitative analysis is given.
Enhancer of Zeste Homolog 2 (EZH2) is the catalytic subunit of Polycomb Repressor Complex 2 (PRC2), the enzyme that catalyzes monomethylation, dimethylation, and trimethylation of lysine 27 on ...histone H3 (H3K27). Trimethylation at H3K27 (H3K27me3) is associated with transcriptional silencing of developmentally important genes. Intriguingly, H3K27me3 is mutually exclusive with H3K36 trimethylation on the same histone tail. Disruptions in this cross-talk result in aberrant H3K27/H3K36 methylation patterns and altered transcriptional profiles that have been implicated in tumorigenesis and other disease states. Despite their importance, the molecular details of how PRC2 “senses” H3K36 methylation are unclear. We demonstrate that PRC2 is activated in cis by the unmodified side chain of H3K36, and that this activation results in a fivefold increase in the k
cat of its enzymatic activity catalyzing H3K27 methylation compared with activity on a substrate methylated at H3K36. Using a photo-cross-linking MS strategy and histone methyltransferase activity assays on PRC2 mutants, we find that EZH2 contains a specific sensing pocket for the H3K36 methylation state that allows the complex to distinguish between modified and unmodified H3K36 residues, altering enzymatic activity accordingly to preferentially methylate the unmodified nucleosome substrate. We also present evidence that this process may be disrupted in some cases of Weaver syndrome.
PDF
