Mineralocorticoid Receptor Antagonist Use in Hospitalized Patients With Heart Failure, Reduced Ejection Fraction, and Diabetes Mellitus (from the EVEREST Trial)

Despite the well-established benefits of mineralocorticoid receptor agonists (MRAs) in heart failure with reduced ejection fraction, safety concerns remain in patients with concomitant diabetes mellitus (DM) because of common renal and electrolyte abnormalities in this population. We analyzed all-cause mortality and composite cardiovascular mortality and HF hospitalization over a median 9.9 months among 1,998 patients in the placebo arm of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial by DM status and discharge MRA use. Of the 750 patients with DM, 59.2% were receiving MRAs compared with 62.5% in the non-DM patients. DM patients not receiving MRAs were older, more likely to be men, with an ischemic heart failure etiology and slightly worse renal function compared with those receiving MRAs. After adjustment for baseline risk factors, among DM patients, MRA use was not associated with either mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.75 to 1.15) or the composite end point (HR 0.94; 95% CI 0.80 to 1.10). Similar findings were seen in non-DM patients (mortality [HR 1.01; 95% CI 0.84 to 1.22] or the composite end point [HR 0.98; 95% CI 0.85 to 1.13] [p >0.43 for DM interaction]). In conclusion, in-hospital initiation of MRA therapy was low (15% to 20%), and overall discharge MRA use was only 60% (with regional variation), regardless of DM status. There does not appear to be clear, clinically significant in-hospital hemodynamic or even renal differences between those on and off MRA. Discharge MRA use was not associated with postdischarge end points in patients hospitalized for worsening heart failure with reduced ejection fraction and co-morbid DM. DM does not appear to influence the effectiveness of MRA therapy.

Meta-Analysis of Predictors of All-Cause Mortality After Transcatheter Aortic Valve Implantation

The aim of this study was to identify predictors of 30-day and midterm mortality after transcatheter aortic valve implantation (TAVI) by means of a systemic review. TAVI was demonstrated to be safe and efficacious in patients with severe aortic stenosis. An accurate estimation of procedural risk of these patients represents an actual challenge. The PubMed and Cochrane Collaboration databases were systematically searched for studies reporting on the incidence and independent predictors of 30-day and midterm mortality. Adverse events were pooled with random effect, whereas independent predictors are reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 25 studies with 8,874 patients were included (median age 82.5 ± 1.5 years, 54.6% women). At 30 days, 7.5% of patients (n = 663) died. At midterm follow-up (median 365 days, interquartile range 267 to 365 days), the cumulative mortality rate was 21.6% (n = 1,917). Acute kidney injury (AKI) stage ≥2 (OR 18.0, 95% CI 6.3 to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI 2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6 to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR 5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of 30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction <30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of midterm mortality. In conclusion, in this large meta-analysis of patients undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI were the strongest independent predictors of both 30-day and 1-year mortality. These findings may contribute to a better understanding of the risk assessment process of patients undergoing TAVI.

Mageeibacillus indolicus gen. nov., sp. nov.: A novel bacterium isolated from the female genital tract

Three isolates of a bacterium recovered from human endometrium using conventional culture methods were characterized biochemically and subjected to 16S rRNA gene sequencing and phylogenetic analysis. Isolates were non-motile, obligately anaerobic, non-spore forming, asaccharolytic, non-cellulolytic, indole positive, Gram positive rods. Cell wall fatty acid profiling revealed C14:0, C16:0, C18:2 ω6, 9c, C18:1 ω9c and C18:0 to be the major fatty acid composition. The DNA mol % G+C was determined to be 44.2%. 16S rRNA gene sequence analysis revealed only 91% sequence similarity with the closest cultivated bacterial isolate, Saccharofermentans acetigenes. Based on genotypic and phenotypic data, all three isolates are considered to be members of the same species and data suggest it represents a novel genus and species in the order Clostridiales with an association with Clostridium rRNA cluster III within the family Ruminococcaceae. We propose the name, Mageeibacillus indolicus gen. nov., sp. nov. The type strain is BAA-2120(T) and CCUG 59143(T).

Priorities for Emergency Department Syncope Research

There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of ED-based syncope research.

Projects for Increasing Job Satisfaction and Creating a Healthy Work Environment

Workplace culture is one of the biggest factors driving employee commitment and engagement. Multiple studies have shown that hospitals will perform better over time if employees are committed to their jobs and engaged in what they do. By creating and implementing multiple projects during a three‐year period, a team at the University of Florida Health Shands Hospital, Gainesville, increased job satisfaction. Projects included ensuring meal breaks were offered, creating a serenity area, developing the patient ambassador role, actively addressing bullying and unprofessional behavior, assigning a student mentee to work with staff members on culture change, offering regular fun activities, redesigning the unit, reorganizing schedules to reduce stress, implementing education and training initiatives, establishing a Unit Practice Council, and implementing reward and recognition programs. Survey results and anecdotal evidence suggest that these projects combined to increase employee satisfaction and employee retention rates.

TiO2-supported catalysts for the steam reforming of ethanol

TiO2 was used as support for Ni, Co and Cu to prepare catalysts for the steam reforming of ethanol, due to its known tendency to form strong metal–support interaction (SMSI) with some metals. The samples were prepared following different procedures, tuning the reducibility of the active phase and its interaction with the support. The latter parameter showed pivotal to impart suitable catalytic activity and most of all stability towards coking. Indeed, the insurgence of SMSI may allow to keep the active phase dispersed, improving activity and inhibiting the formation of carbon filaments over the active phase.The comparison between different active phases (Ni, Co, Cu, 10 wt%) confirmed Ni as very active, although it has a higher tendency to form carbon filaments. This drawback may be at least partially controlled by favouring high Ni dispersion through the formation of a mixed oxide with the support. The calcination temperature, and in general the preparation procedure for the catalyst, showed of pivotal importance to establish SMSI. In particular, calcination at relatively low temperature (i.e. 500 °C) induced initially a higher dispersion of the active phase (mean Ni crystal size 7 nm), however not accompanied by sufficient stabilisation during activity testing (mean Ni crystal size increased to 44 nm). By contrast, calcination at higher temperature (i.e. 800 °C) favoured the instauration of a SMSI and the formation of a mixed oxide (NiTiO3), which, after activation, allowed the coexistence of smaller particles, more active and resistant to deactivation and sintering, together with the more sintered ones (mean Ni crystal size 27 nm before and after activity testing). Different characterisation data (XRD, FT-IR, TPR, TEM) allowed to conclude the need of calcination at high temperature to achieve sufficient activity and resistance of the catalyst for this application.Co and Cu proved more promising as for C balance, although their activity at low temperature was unsatisfactory, mainly due to poor activity for Csingle bondC bond cleavage.The characterisation of the spent catalysts by XRD, TEM and Raman allowed to evidence the different types of C deposed and to check for active phase stability against sintering

Zinc sulfide functionalized with ruthenium nanoparticles for photocatalytic reduction of CO2

Industrial utilization of CO2 is an important research area not only due to the potential contribution to the reduction of emissions into atmosphere, but also for saving carbon resources through the recycle of carbon. The use of solar energy in the conversion of CO2 appears to be a major challenge and opportunity for the future. A group of nanocrystalline zinc sulfide surface-modified with ruthenium(0) has been designed and characterized. Spectral, structural and electrochemical properties of powders have been determined. Photocatalytic properties of prepared materials were tested towards CO2 reduction to C1 compounds. Formic acid and carbon monoxide were found as the major reduction products proving solar to chemical energy conversion. The amount and ratio of products were influenced by the deposited ruthenium(0) co-catalyst and solvent polarity. The mechanism of HCOOH and CO formation, involves a transient CO2•– radical generation

Experimental study of the relationship between injection rate shape and Diesel ignition using a novel piezo-actuated direct-acting injector

Injection rate shaping is one of the most attractive alternatives to multiple injection strategies; however, its implementation has been for long time impeded by limitations in the injector technology and therefore, the experimental information available in the literature about this topic is lacking.

A fuzzy Lyapunov function approach for stabilization andH∞control of switched TS fuzzy systems

Rehabilitation of Walking: Are Key Kinetics Disrupted by Body Weight Support?