Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent im...Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent impairment of the intestinal barrier.Levosimendan,a novel inotropic agent,binds to cardiac troponin C to enhance calcium sensitivity,activates ATP-dependent potassium channels in cardiomyocytes and vascular smooth muscle cells,exerts positive inotropic and vasodilatory effects,and reduces free radical generation,thereby improving systemic hemodynamics including intestinal circulation.However,clinical evidence regarding its protective effects on the intestinal barrier in HF patients remains limited,and the underlying mechanisms require further clarification.This study aims to investigate whether levosimendan confers protective effects on the intestinal barrier in HF patients and to explore its potential mechanisms.Methods:Network pharmacology was first used to analyze potential mechanisms of levosimendan in treating intestinal barrier dysfunction among HF patients.A total of 62 hospitalized patients with acute exacerbation of HF with reduced ejection fraction(HFrEF)were enrolled based on echocardiographic left ventricular ejection fraction.According to clinical medication regimens,patients were assigned to a conventional treatment group(n=31)or a levosimendan treatment group(n=31).The conventional treatment group received standard anti-HF therapy,while the levosimendan treatment group received levosimendan in addition to standard therapy.Enzyme-linked immunosorbent assays were used to measure plasma levels and changes in the intestinal-barrier proteins zonulin,intestinal fatty acid binding protein(I-FABP),proinflammatory cytokines[interleukin(IL)-17,IL-6,and tumor necrosis factor(TNF)-α],anti-inflammatory cytokine IL-10,and N-terminal probrain natriuretic peptide(NT-proBNP).Improvements in cardiac function and gastrointestinal symptoms were evaluated using the Kansas City Cardiomyopathy Questionnaire(KCCQ)and the Gastrointestinal Symptom Rating Scale(GSRS).Results:Network pharmacology indicated that the effects of levosimendan on intestinal barrier dysfunction in HF patients may involve inflammation-related pathways such as IL-17 and TNF.Clinically,after treatment,zonulin decreased by 32.94 ng/mL in the levosimendan treatment group versus 15.05 ng/mL in the conventional treatment group(P<0.05).I-FABP decreased by 6.97 pg/mL in the levosimendan treatment group but increased by 35.16 pg/mL in the conventional treatment group(P<0.05).IL-6,IL-17,and TNF-αdecreased by 1.11 pg/mL,1.21 pg/mL,and 2.83 pg/mL,respectively,in the levosimendan treatment group,whereas they increased by 7.68 pg/mL,0.67 pg/mL,and 2.38 pg/mL in the conventional treatment group(all P<0.05).IL-10 decreased by 24.48 pg/mL in the conventional treatment group but increased by 24.98 pg/mL in the levosimendan treatment group(P<0.05).NT-proBNP increased by 7.35 pg/mL in the conventional treatment group but decreased by 4.73 pg/mL in the levosimendan treatment group(P<0.05).KCCQ scores increased by 0.36 in the conventional treatment group and 1.86 in the levosimendan treatment group,GSRS scores decreased by 1.00 in the conventional treatment group and 2.40 in the levosimendan treatment group,respectively,but the differences were not statistically significant(both P>0.05).Conclusion:Levosimendan not only improves HF and gastrointestinal symptoms in hospitalized patients with acute exacerbation of HFrEF but also reduces plasma intestinal barrier factor levels.These effects may be associated with decreased plasma proinflammatory cytokines and increased anti-inflammatory cytokines after treatment,potentially involving IL-17 and TNF signaling pathways.展开更多
In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat...In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat’s launch speed,ejection direction,ejection angle,altitude of the aircraft,distance/height from the aircraft rudder and canopy,pilot and ejection seat weight.With the model algorithm proposed,the ejection seat trajectory model was developed on MATLAB.The ejection seat trajectory model is based on point mass trajectory mathematical model.In this study,an analytical study of the problem has been made for modeling the flight trajectory of the ejection seat after it has been ejected.Past studies were used as a basis for validation and simulation.By writing a generic MATLAB code,a user interface was developed and presented to the user as a module.This generic code that has been developed could be used for simulations by users in the future by revising it in accordance with their own job descriptions.展开更多
Mixed-phase clouds(MPCs)involve complex microphysical and dynamical processes of cloud formation and dissipation,which are crucial for numerical weather prediction and cloud-climate feedback.However,satellite remote s...Mixed-phase clouds(MPCs)involve complex microphysical and dynamical processes of cloud formation and dissipation,which are crucial for numerical weather prediction and cloud-climate feedback.However,satellite remote sensing of MPC properties is still challenging,and there is seldom MPC result inferred from passive spectral observations.This study examines the spectral characteristics of MPCs in the shortwave-infrared(SWIR)channels over the wavelength of 0.4–2.5μm,and evaluates the potential of current operational satellite spectroradiometer channels for MPC retrievals.With optical properties of MPCs based on the assumption of uniform mixing of both ice and liquid water particles,the effects of MPC ice optical thickness fraction(IOTF)and effective radius on associated optical properties are analyzed.As expected,results indicate that the MPC optical properties show features for ice and liquid water clouds,and their spectral variations show noticeable differences from those for homogeneous cases.A radiative transfer method is employed to examine the sensitivity of SWIR channels to given MPC cloud water path(CWP)and IOTF.MPCs have unique signal characteristics in the SWIR spectrum.The 0.87-μm channel is most sensitive to CWP.Meanwhile,the 1.61-and 2.13-μm channels are more sensitive to water-dominated MPCs(IOTF approaching 0),and the 2.25-μm channel is sensitive to both water-dominated and ice-dominated MPCs(IOTF approaching 1).Such spectral differences are potentially possible to be used to infer MPC properties based on radiometer observations,which will be investigated in future studies.展开更多
Na_(2)Ti_(3)O_(7)and Na_(2)Ti_(6)O_(13)are two typical titanate-based sodium-storage materials,featuring the high theoretical capacity and favorable structure stability,respectively.Regulating the ratio of them in the...Na_(2)Ti_(3)O_(7)and Na_(2)Ti_(6)O_(13)are two typical titanate-based sodium-storage materials,featuring the high theoretical capacity and favorable structure stability,respectively.Regulating the ratio of them in the composite material is the key to strengthen its electrochemical characteristics.Herein,based on the high specific surface area and abundant surface functional groups of carbon dots(CDs),sodium titanate precursors containing CDs were in situ prepared by one-step hydrothermal method.After the thermal conversion of the precursors,a composite material(NNTO/C)of Na_(2)Ti_(3)O_(7)and Na_(2)Ti_(6)O_(13)was obtained,containing conductive carbon derived from CDs.The introduc⁃tion of conductive carbon not only adjusts the composition ratio of the mixed phases,but also provides a small charge transfer impedance(Rct,7.48Ω)and a big specific surface area(100.8 m^(2)/g).As a result,NNTO/C composites exhibit better sodium storage behavior while playing the synergistic interaction of mixed phases.When employed as the anode,after 200 cycles at 0.05 A/g,NNTO/C still maintains a specific capacity of 143.8 mA‧h/g.After 400 cycles at 1.00 A/g,the specific capacity remains as high as 108 mA‧h/g.This study suggests an innovative thinking for designing two-phase structures of electrode materials and the greater use of CDs in electrochemical energy storage.展开更多
BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes be...BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always f...The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always focused on the mercury injection curves themselves, neglecting the important geologicalinformation conveyed by the mercury ejection curves. This paper quantitatively describes the fractalcharacteristics of ejection curves by using four fractal models, i.e.,. Menger model, Thermodynamicmodel, Sierpinski model, and multi- fractal model. In comparison with mercury injection curves, weexplore the fractal significance of mercury ejection curves and define the applicability of different fractalmodels in characterizing pore architectures. Investigated tight sandstone samples can be divided intofour types (Types A, B, C and D) based on porosity, permeability, and mercury removal efficiency. Type Dsamples are unique in that they have higher permeability (>0.6 mD) but lower mercury removal effi-ciency (<35%). Fractal studies of the mercury injection curve show that it mainly reflects the pore throatcharacteristics, while the mercury ejection curve serves to reveal the pore features, and porosity andpermeability correlate well with the fractal dimension of the injection curve, while mercury removalefficiency correlates only with the Ds' value of the ejection curve. The studies on the mercury ejectioncurves also reveal that the small pores and micropores of the Type C and Type D samples are moredeveloped, with varying pore architecture. The fractal dimension Ds' value of Type D samples is greaterthan that of Type C samples, and the dissolution of Type D samples is more intense than that of Type Csamples, which further indicates that the Type D samples are smaller in pore size, rougher in surface, andwith greater difficulty for the hydrocarbon to enter, resulting in their reservoir capacity probably lessthan that of Type C samples. In this regard, the important information characterized by the mercuryejection curve should be considered in evaluating the tight sandstone reservoirs. Finally, the Menger andThermodynamic models prove to be more suitable for describing the total pore architecture, while theSierpinski model is better for characterizing the variability of the interconnected pores.展开更多
Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for ...Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for efficient combustion in a singular Stirling engine combustor at different oxygen atmospheres were investigated and determined. Numerical simulations were performed to investigate the effects of ejection ratio and pressure on combustion performance. In an oxygen/carbon dioxide atmosphere, the results show that increasing the ejection ratio substantially alters the flame distribution in the Stirling engine combustor, increasing heat transfer and external combustion efficiency. In contrast, increasing the ejection ratio reduces the average and maximum temperatures of the Stirling engine combustor. Increased pressure affects the flame distribution in the Stirling engine combustor and impedes the flow and convective heat transfer in the combustor, reducing the overall external combustion efficiency at pressures above 6.5 MPa. In an air/carbon dioxide atmosphere, an increased ejection ratio reduces the average and maximum temperatures in the Stirling engine combustor. However, the overall flame distribution does not change substantially. The external combustion efficiency tends to increase and then decrease because of two opposing factors: the increase in the convective heat transfer coefficient and the decrease in the temperature difference. Increasing pressure inhibits forced convection heat transfer in the Stirling engine combustor, reducing external combustion efficiency, which drops from 78% to 65% when pressure increases from 0.2 MPa to 0.5 MPa.展开更多
Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fracti...Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.展开更多
BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(...BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(CCB)are commonly used for symptom control and comorbidity management,but their comparative effectiveness and safety remain unclear.AIM To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.METHODS Simulated data for 4000 HFpEF patients(2000 BB,2000 CCB)were generated based on distributions extracted from electronic medical records spanning 2014-2023.Inclusion criteria included adults with left ventricular ejection fraction≥50%and initiation of BB or CCB.Effectiveness outcomes encompassed mortality,heart failure hospitalizations,and changes in clinical parameters.Safety outcomes included bradycardia,hypotension,and drug discontinuation.Statistical analyses used t-tests,χ2 tests,Cox proportional hazards models for hazard ratios(HR),and incidence rate ratios(IRR)in R software.Propensity score matching(PSM)was performed to balance baseline characteristics,with outcomes reassessed in the matched cohort.RESULTS Baseline characteristics were largely balanced,with minor differences in sex,chronic kidney disease,systolic blood pressure,and left atrial volume index.BB demonstrated lower all-cause mortality(crude HR 0.78,95%CI:0.70-0.87,P=0.003),heart failure hospitalization(crude HR 0.86,95%CI:0.77-0.96,P=0.031),and composite endpoint(crude HR 0.85,95%CI:0.79-0.91,P<0.001)rates compared to CCB.IRR for heart failure hospitalizations and emergency visits favored BB.Safety profiles showed higher symptomatic bradycardia(9.2%vs 4.9%,P<0.001)and drug discontinuation(11.3%vs 9.3%,P=0.043)with BB,and higher hypotension(7.2%vs 11.5%,P<0.001)with CCB.Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB(HR 0.96,95%CI:0.85-1.08),heart failure hospitalization rates of 0.0751 vs 0.0888(HR 0.84,95%CI:0.75-0.94),and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB(95%CI:1.51-1.80,P<0.001).CONCLUSION BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB,with distinct safety considerations.PSM confirmed these trends with reduced confounding.Personalized therapy is recommended,warranting prospective trials for validation.展开更多
Background Coronary microvascular dysfunction(CMD)is a critical pathological mechanism underlying left ventricular ejection fraction(LVEF)decline after primary percutaneous coronary intervention(PPCI)in ST-segment ele...Background Coronary microvascular dysfunction(CMD)is a critical pathological mechanism underlying left ventricular ejection fraction(LVEF)decline after primary percutaneous coronary intervention(PPCI)in ST-segment elevation myocardial infarction(STEMI)patients.Angiography-derived microcirculatory resistance(AMR),a novel wire-free index,offers noninvasive assessment of CMD.This study aimed to validate AMR's predictive value for post-PPCI LVEF impairment.Methods A total of 190 STEMI patients who underwent PPCI at four centers between March 2017 and May 2022 were retrospectively enrolled.Patients were categorized into two groups based on whether their LVEF was below 50%when measured after 72 hours post-PPCI:the normal LVEF group(n=114)and the reduced LVEF group(n=76).The clinical characteristics of the two groups were compared.AMR was computed using quantitative flow ratio(QFR)analysis.Multivariable logistic regression,linear regression,and receiver operating characteristic(ROC)curves were applied to assess predictive performance.Results The reduced LVEF group exhibited significantly higher post-PPCI AMR(268 mmHg·s/m vs.229 mmHg·s/m,P<0.001)compared to the normal LVEF group.Multivariable logistic and linear regression confirmed that elevated AMR(OR:1.01;95%CI:1.00-1.02,P=0.001)was an independent predictor of LVEF decline to<50%after PPCI.ROC analysis revealed a moderate predictive capacity of AMR,with an area under the curve(AUC)of 0.684(95%CI:0.608-0.760).The optimal AMR cutoff of 262.5 mmHg·s/m demonstrated 55.26%sensitivity and 72.81%specificity for identifying LVEF decline in reperfused STEMI patients.Conclusions Post-PPCI AMR was an independent predictor of LVEF decline to<50%in STEMI patients.The data demonstrated that an AMR threshold of≥262.5 mmHg·s/m after PPCI was associated with a statistically significant increase in the likelihood of LVEF reduction compared to in dividuals with AMR values within the normal range.展开更多
Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the mo...Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.展开更多
micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising bi...micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.展开更多
Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Va...Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.展开更多
In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.Th...In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.The formation and development of such burst undergoes three stages:(1)instability and propagation of the cracks in the stress concentration zone,(2)emerging of a layered energy storage structure in the zone,and(3)ejection of coal mass or coal burst due to instability.Moreover,we figured out the initial strength of periodic cracks is parallel to the maximal dominant stress direction in the stress concentration zone and derived from the damage strain energy within the finite area of the zone based on the Griffith energy theory.In addition,we analyzed the formation process of the layered energy storage structure in the zone,simplified it as a simply supported restraint sheet,and calculated the minimum critical load and the internally accumulated elastic energy at the instable state.Furthermore,we established a criterion for occurrence of the coal burst based on the variational principle,and analyzed the coal mass ejection due to instability and coal burst induced by different intensity disturbances.At last,with the stratum conditions of Junde Coalmine as the model prototype,we numerically simulated the load displacement distribution of the stress concentration zone ahead of the working face disturbed by the main roof-fracture-induced dynamic load during the mining process as well as their varying characteristics,and qualitatively verified the above model.展开更多
Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of p...Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.展开更多
Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailur...Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.展开更多
Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to anal...Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.展开更多
In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations...In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction.展开更多
The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(...The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(CFD)simulation and flight dynamics coupling method,the parachute container cover ejection separation is simulated.The rationality of the ejection separation speed and dynamic characteristics of the separation process is analyzed.Meanwhile,the influences of angle of attack,Mach number and ejection separation speed on the parachute container cover ejection are also investigated.Results show that the ejection separation speed design is reasonable.It has a certain design margin for parachute container cover to escape from the wake region,and to pull out the drag parachute completely.The results may provide a theoretical basis for recovery system engineering design of the lunar exploration project.展开更多
基金supported by the Hunan Provincial Science and Technology Major Special Fund(2021SK1020)the Natural Science Foundation of Hunan Province(2023JJ30948)+1 种基金the Health Commission of Hunan Province(202203014687)the International Medical Exchange Cardiovascular Multidisciplinary Integrated Thinking Research Foundation(Z-2016-23-2101-20),China.
文摘Objective:In addition to dyspnea and edema,gastrointestinal discomfort is common among patients with heart failure(HF).Reduced cardiac output can lead to inadequate perfusion of the intestinal mucosa and subsequent impairment of the intestinal barrier.Levosimendan,a novel inotropic agent,binds to cardiac troponin C to enhance calcium sensitivity,activates ATP-dependent potassium channels in cardiomyocytes and vascular smooth muscle cells,exerts positive inotropic and vasodilatory effects,and reduces free radical generation,thereby improving systemic hemodynamics including intestinal circulation.However,clinical evidence regarding its protective effects on the intestinal barrier in HF patients remains limited,and the underlying mechanisms require further clarification.This study aims to investigate whether levosimendan confers protective effects on the intestinal barrier in HF patients and to explore its potential mechanisms.Methods:Network pharmacology was first used to analyze potential mechanisms of levosimendan in treating intestinal barrier dysfunction among HF patients.A total of 62 hospitalized patients with acute exacerbation of HF with reduced ejection fraction(HFrEF)were enrolled based on echocardiographic left ventricular ejection fraction.According to clinical medication regimens,patients were assigned to a conventional treatment group(n=31)or a levosimendan treatment group(n=31).The conventional treatment group received standard anti-HF therapy,while the levosimendan treatment group received levosimendan in addition to standard therapy.Enzyme-linked immunosorbent assays were used to measure plasma levels and changes in the intestinal-barrier proteins zonulin,intestinal fatty acid binding protein(I-FABP),proinflammatory cytokines[interleukin(IL)-17,IL-6,and tumor necrosis factor(TNF)-α],anti-inflammatory cytokine IL-10,and N-terminal probrain natriuretic peptide(NT-proBNP).Improvements in cardiac function and gastrointestinal symptoms were evaluated using the Kansas City Cardiomyopathy Questionnaire(KCCQ)and the Gastrointestinal Symptom Rating Scale(GSRS).Results:Network pharmacology indicated that the effects of levosimendan on intestinal barrier dysfunction in HF patients may involve inflammation-related pathways such as IL-17 and TNF.Clinically,after treatment,zonulin decreased by 32.94 ng/mL in the levosimendan treatment group versus 15.05 ng/mL in the conventional treatment group(P<0.05).I-FABP decreased by 6.97 pg/mL in the levosimendan treatment group but increased by 35.16 pg/mL in the conventional treatment group(P<0.05).IL-6,IL-17,and TNF-αdecreased by 1.11 pg/mL,1.21 pg/mL,and 2.83 pg/mL,respectively,in the levosimendan treatment group,whereas they increased by 7.68 pg/mL,0.67 pg/mL,and 2.38 pg/mL in the conventional treatment group(all P<0.05).IL-10 decreased by 24.48 pg/mL in the conventional treatment group but increased by 24.98 pg/mL in the levosimendan treatment group(P<0.05).NT-proBNP increased by 7.35 pg/mL in the conventional treatment group but decreased by 4.73 pg/mL in the levosimendan treatment group(P<0.05).KCCQ scores increased by 0.36 in the conventional treatment group and 1.86 in the levosimendan treatment group,GSRS scores decreased by 1.00 in the conventional treatment group and 2.40 in the levosimendan treatment group,respectively,but the differences were not statistically significant(both P>0.05).Conclusion:Levosimendan not only improves HF and gastrointestinal symptoms in hospitalized patients with acute exacerbation of HFrEF but also reduces plasma intestinal barrier factor levels.These effects may be associated with decreased plasma proinflammatory cytokines and increased anti-inflammatory cytokines after treatment,potentially involving IL-17 and TNF signaling pathways.
文摘In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat’s launch speed,ejection direction,ejection angle,altitude of the aircraft,distance/height from the aircraft rudder and canopy,pilot and ejection seat weight.With the model algorithm proposed,the ejection seat trajectory model was developed on MATLAB.The ejection seat trajectory model is based on point mass trajectory mathematical model.In this study,an analytical study of the problem has been made for modeling the flight trajectory of the ejection seat after it has been ejected.Past studies were used as a basis for validation and simulation.By writing a generic MATLAB code,a user interface was developed and presented to the user as a module.This generic code that has been developed could be used for simulations by users in the future by revising it in accordance with their own job descriptions.
基金supported by the National Natural Science Foundation of China[Grant Nos.42205086 and 42122038]。
文摘Mixed-phase clouds(MPCs)involve complex microphysical and dynamical processes of cloud formation and dissipation,which are crucial for numerical weather prediction and cloud-climate feedback.However,satellite remote sensing of MPC properties is still challenging,and there is seldom MPC result inferred from passive spectral observations.This study examines the spectral characteristics of MPCs in the shortwave-infrared(SWIR)channels over the wavelength of 0.4–2.5μm,and evaluates the potential of current operational satellite spectroradiometer channels for MPC retrievals.With optical properties of MPCs based on the assumption of uniform mixing of both ice and liquid water particles,the effects of MPC ice optical thickness fraction(IOTF)and effective radius on associated optical properties are analyzed.As expected,results indicate that the MPC optical properties show features for ice and liquid water clouds,and their spectral variations show noticeable differences from those for homogeneous cases.A radiative transfer method is employed to examine the sensitivity of SWIR channels to given MPC cloud water path(CWP)and IOTF.MPCs have unique signal characteristics in the SWIR spectrum.The 0.87-μm channel is most sensitive to CWP.Meanwhile,the 1.61-and 2.13-μm channels are more sensitive to water-dominated MPCs(IOTF approaching 0),and the 2.25-μm channel is sensitive to both water-dominated and ice-dominated MPCs(IOTF approaching 1).Such spectral differences are potentially possible to be used to infer MPC properties based on radiometer observations,which will be investigated in future studies.
文摘Na_(2)Ti_(3)O_(7)and Na_(2)Ti_(6)O_(13)are two typical titanate-based sodium-storage materials,featuring the high theoretical capacity and favorable structure stability,respectively.Regulating the ratio of them in the composite material is the key to strengthen its electrochemical characteristics.Herein,based on the high specific surface area and abundant surface functional groups of carbon dots(CDs),sodium titanate precursors containing CDs were in situ prepared by one-step hydrothermal method.After the thermal conversion of the precursors,a composite material(NNTO/C)of Na_(2)Ti_(3)O_(7)and Na_(2)Ti_(6)O_(13)was obtained,containing conductive carbon derived from CDs.The introduc⁃tion of conductive carbon not only adjusts the composition ratio of the mixed phases,but also provides a small charge transfer impedance(Rct,7.48Ω)and a big specific surface area(100.8 m^(2)/g).As a result,NNTO/C composites exhibit better sodium storage behavior while playing the synergistic interaction of mixed phases.When employed as the anode,after 200 cycles at 0.05 A/g,NNTO/C still maintains a specific capacity of 143.8 mA‧h/g.After 400 cycles at 1.00 A/g,the specific capacity remains as high as 108 mA‧h/g.This study suggests an innovative thinking for designing two-phase structures of electrode materials and the greater use of CDs in electrochemical energy storage.
文摘BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
基金The research project was co-funded by the National Natural Science Foundation of China(No.42072172,No.41772120)Shandong Province Natural Science Fund for Distinguished Young Scholars(No.JQ201311)the Graduate Scientific and Technological Innovation Project Financially Supported by Shandong University of Science and Technology(No.SDKDYC190313).
文摘The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always focused on the mercury injection curves themselves, neglecting the important geologicalinformation conveyed by the mercury ejection curves. This paper quantitatively describes the fractalcharacteristics of ejection curves by using four fractal models, i.e.,. Menger model, Thermodynamicmodel, Sierpinski model, and multi- fractal model. In comparison with mercury injection curves, weexplore the fractal significance of mercury ejection curves and define the applicability of different fractalmodels in characterizing pore architectures. Investigated tight sandstone samples can be divided intofour types (Types A, B, C and D) based on porosity, permeability, and mercury removal efficiency. Type Dsamples are unique in that they have higher permeability (>0.6 mD) but lower mercury removal effi-ciency (<35%). Fractal studies of the mercury injection curve show that it mainly reflects the pore throatcharacteristics, while the mercury ejection curve serves to reveal the pore features, and porosity andpermeability correlate well with the fractal dimension of the injection curve, while mercury removalefficiency correlates only with the Ds' value of the ejection curve. The studies on the mercury ejectioncurves also reveal that the small pores and micropores of the Type C and Type D samples are moredeveloped, with varying pore architecture. The fractal dimension Ds' value of Type D samples is greaterthan that of Type C samples, and the dissolution of Type D samples is more intense than that of Type Csamples, which further indicates that the Type D samples are smaller in pore size, rougher in surface, andwith greater difficulty for the hydrocarbon to enter, resulting in their reservoir capacity probably lessthan that of Type C samples. In this regard, the important information characterized by the mercuryejection curve should be considered in evaluating the tight sandstone reservoirs. Finally, the Menger andThermodynamic models prove to be more suitable for describing the total pore architecture, while theSierpinski model is better for characterizing the variability of the interconnected pores.
基金Supported by the Shanghai Rising Star Program (Grant No. 21QB1403900)the Shanghai Municipal Commission of Science and Technology (Grant No. 22170712600)。
文摘Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for efficient combustion in a singular Stirling engine combustor at different oxygen atmospheres were investigated and determined. Numerical simulations were performed to investigate the effects of ejection ratio and pressure on combustion performance. In an oxygen/carbon dioxide atmosphere, the results show that increasing the ejection ratio substantially alters the flame distribution in the Stirling engine combustor, increasing heat transfer and external combustion efficiency. In contrast, increasing the ejection ratio reduces the average and maximum temperatures of the Stirling engine combustor. Increased pressure affects the flame distribution in the Stirling engine combustor and impedes the flow and convective heat transfer in the combustor, reducing the overall external combustion efficiency at pressures above 6.5 MPa. In an air/carbon dioxide atmosphere, an increased ejection ratio reduces the average and maximum temperatures in the Stirling engine combustor. However, the overall flame distribution does not change substantially. The external combustion efficiency tends to increase and then decrease because of two opposing factors: the increase in the convective heat transfer coefficient and the decrease in the temperature difference. Increasing pressure inhibits forced convection heat transfer in the Stirling engine combustor, reducing external combustion efficiency, which drops from 78% to 65% when pressure increases from 0.2 MPa to 0.5 MPa.
文摘Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.
文摘BACKGROUND Heart failure with preserved ejection fraction(HFpEF)accounts for approximately half of heart failure cases and is associated with high morbidity and mortality.Beta-blockers(BB)and calcium channel blockers(CCB)are commonly used for symptom control and comorbidity management,but their comparative effectiveness and safety remain unclear.AIM To compare the effectiveness and safety of BB vs CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.METHODS Simulated data for 4000 HFpEF patients(2000 BB,2000 CCB)were generated based on distributions extracted from electronic medical records spanning 2014-2023.Inclusion criteria included adults with left ventricular ejection fraction≥50%and initiation of BB or CCB.Effectiveness outcomes encompassed mortality,heart failure hospitalizations,and changes in clinical parameters.Safety outcomes included bradycardia,hypotension,and drug discontinuation.Statistical analyses used t-tests,χ2 tests,Cox proportional hazards models for hazard ratios(HR),and incidence rate ratios(IRR)in R software.Propensity score matching(PSM)was performed to balance baseline characteristics,with outcomes reassessed in the matched cohort.RESULTS Baseline characteristics were largely balanced,with minor differences in sex,chronic kidney disease,systolic blood pressure,and left atrial volume index.BB demonstrated lower all-cause mortality(crude HR 0.78,95%CI:0.70-0.87,P=0.003),heart failure hospitalization(crude HR 0.86,95%CI:0.77-0.96,P=0.031),and composite endpoint(crude HR 0.85,95%CI:0.79-0.91,P<0.001)rates compared to CCB.IRR for heart failure hospitalizations and emergency visits favored BB.Safety profiles showed higher symptomatic bradycardia(9.2%vs 4.9%,P<0.001)and drug discontinuation(11.3%vs 9.3%,P=0.043)with BB,and higher hypotension(7.2%vs 11.5%,P<0.001)with CCB.Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB vs 0.0649 for CCB(HR 0.96,95%CI:0.85-1.08),heart failure hospitalization rates of 0.0751 vs 0.0888(HR 0.84,95%CI:0.75-0.94),and IRR for number of heart failure hospitalizations of 1.65 for CCB vs BB(95%CI:1.51-1.80,P<0.001).CONCLUSION BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB,with distinct safety considerations.PSM confirmed these trends with reduced confounding.Personalized therapy is recommended,warranting prospective trials for validation.
基金supported by the Natural Science Foundation of Guangdong Province(No.2024A1515012943 and No.2023A1515010177)。
文摘Background Coronary microvascular dysfunction(CMD)is a critical pathological mechanism underlying left ventricular ejection fraction(LVEF)decline after primary percutaneous coronary intervention(PPCI)in ST-segment elevation myocardial infarction(STEMI)patients.Angiography-derived microcirculatory resistance(AMR),a novel wire-free index,offers noninvasive assessment of CMD.This study aimed to validate AMR's predictive value for post-PPCI LVEF impairment.Methods A total of 190 STEMI patients who underwent PPCI at four centers between March 2017 and May 2022 were retrospectively enrolled.Patients were categorized into two groups based on whether their LVEF was below 50%when measured after 72 hours post-PPCI:the normal LVEF group(n=114)and the reduced LVEF group(n=76).The clinical characteristics of the two groups were compared.AMR was computed using quantitative flow ratio(QFR)analysis.Multivariable logistic regression,linear regression,and receiver operating characteristic(ROC)curves were applied to assess predictive performance.Results The reduced LVEF group exhibited significantly higher post-PPCI AMR(268 mmHg·s/m vs.229 mmHg·s/m,P<0.001)compared to the normal LVEF group.Multivariable logistic and linear regression confirmed that elevated AMR(OR:1.01;95%CI:1.00-1.02,P=0.001)was an independent predictor of LVEF decline to<50%after PPCI.ROC analysis revealed a moderate predictive capacity of AMR,with an area under the curve(AUC)of 0.684(95%CI:0.608-0.760).The optimal AMR cutoff of 262.5 mmHg·s/m demonstrated 55.26%sensitivity and 72.81%specificity for identifying LVEF decline in reperfused STEMI patients.Conclusions Post-PPCI AMR was an independent predictor of LVEF decline to<50%in STEMI patients.The data demonstrated that an AMR threshold of≥262.5 mmHg·s/m after PPCI was associated with a statistically significant increase in the likelihood of LVEF reduction compared to in dividuals with AMR values within the normal range.
文摘Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.
基金Supported by The European Union,Biomar Ca RE,No.HEALTH-2011-278913
文摘micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.
文摘Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.
基金supported by the Science Foundation of the National Natural Science Foundation of China(Nos.51634001and 51774023)the Fundamental Research Funds for the Central Universities of China(No.FRF-TP-18-007C1)
文摘In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.The formation and development of such burst undergoes three stages:(1)instability and propagation of the cracks in the stress concentration zone,(2)emerging of a layered energy storage structure in the zone,and(3)ejection of coal mass or coal burst due to instability.Moreover,we figured out the initial strength of periodic cracks is parallel to the maximal dominant stress direction in the stress concentration zone and derived from the damage strain energy within the finite area of the zone based on the Griffith energy theory.In addition,we analyzed the formation process of the layered energy storage structure in the zone,simplified it as a simply supported restraint sheet,and calculated the minimum critical load and the internally accumulated elastic energy at the instable state.Furthermore,we established a criterion for occurrence of the coal burst based on the variational principle,and analyzed the coal mass ejection due to instability and coal burst induced by different intensity disturbances.At last,with the stratum conditions of Junde Coalmine as the model prototype,we numerically simulated the load displacement distribution of the stress concentration zone ahead of the working face disturbed by the main roof-fracture-induced dynamic load during the mining process as well as their varying characteristics,and qualitatively verified the above model.
文摘Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.
文摘Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.
基金supported by the he National Natural Science Foundation of China (No. 81770441, No. 81700398, No. 81970309)Nanjing Municipal Healthcare Grant YKK16127
文摘Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.
基金Project supported by the Natural Science Foundation of Jiangsu Province,China(Grant No.KYLX 0341)the National Natural Science Foundation of China(Grant No.61405147)
文摘In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction.
基金Supported by the Aeronautical Science Foundation of China(2012ZC52035)
文摘The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(CFD)simulation and flight dynamics coupling method,the parachute container cover ejection separation is simulated.The rationality of the ejection separation speed and dynamic characteristics of the separation process is analyzed.Meanwhile,the influences of angle of attack,Mach number and ejection separation speed on the parachute container cover ejection are also investigated.Results show that the ejection separation speed design is reasonable.It has a certain design margin for parachute container cover to escape from the wake region,and to pull out the drag parachute completely.The results may provide a theoretical basis for recovery system engineering design of the lunar exploration project.
