Prognostic Comparison of the Estimations of Renal Function in Patients With Acute Heart Failure.

BACKGROUND: The prognostic significance of the eGFR calculated by either the four-level Race Chronic Kidney Disease-Epidemiology Collaboration study equation (CKD-EPI4R) or the Chinese-modified Modification of Diet in Renal Disease equation (cMDRD) has not been compared in Asian populations with acute heart failure (AHF).Methods and Results:A total of 3,044 patients hospitalized for AHF were enrolled. The National Death Registry was linked to identify deaths within a 5-year follow-up. Net reclassification improvement (NRI) was calculated to compare the prognostic value of either eGFR equation. During a median follow-up of 23.3 months, 1,424 (47%) patients died. Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently predictive of death in the total study population (hazard ratio and 95% confidence intervals per 1-SD: 0.76, 0.71-0.81 and 0.74, 0.70-0.79, respectively), and in the subgroups of either reduced (HFrEF) or preserved (HFpEF) ejection fraction, after accounting for important confounders. With reference to eGFRcMDRD, eGFRCKD-EPI4Rmay improve the NRI by 2.0% (0.8-3.2%) for the prediction of death. The prognostic value of the CKD stages categorized by eGFRCKD-EPI4Rsignificantly outperformed eGFRcMDRDwith a categorical NRI of 9.5% (4.7-14.3%) in the total study population, 11.5% in HFrEF, and 8.3% in HFpEF. CONCLUSIONS: Both eGFRcMDRDand eGFRCKD-EPI4Rwere independently associated with long-term survival in patients with AHF. However, the CKD stages derived from eGFRCKD-EPI4Rimproved the risk stratification of death, compared with eGFRcMDRD.

Determinants and Prognostic Impact of Hyperuricemia in Hospitalization for Acute Heart Failure.

BACKGROUND: Hyperuricemia is a prognostic factor in patients with chronic heart failure, but whether uric acid level can predict clinical outcome of acute heart failure (AHF) remains to be elucidated. We therefore investigated the association of uric acid with mortality in patients hospitalized for AHF. METHODS AND RESULTS: Data for patients hospitalized for AHF were drawn from an intramural registry. Biochemistry data, echocardiographic characteristics, and uric acid level were collected. National Death Registry was linked for the identification of mortality data. Among a total of 1,835 participants (age, 75 ± 13 years, 68% men), 794 patients died during follow-up. Patients who died were older, had lower hemoglobin and estimated glomerular filtration rate, and higher pulmonary artery systolic pressure, NT-proBNP, and uric acid. Uric acid was a significant predictor of mortality on univariate analysis (HR per 1 SD, 1.18; 95% CI: 1.11-1.26) and in multivariate Cox models (HR, 1.15; 95% CI: 1.02-1.29). Survival analysis showed an increasing risk of death along the quartile distribution of uric acid level. Given renal function, cardiac performance, and kidney perfusion as major determinants of hyperuricemia, the prognostic impact of uric acid level was diminished as renal function deteriorated. CONCLUSIONS: Uric acid level was an independent predictor of mortality in patients hospitalized for AHF, but the prognostic impact of hyperuricemia was attenuated by worsening renal function.

A Highly Efficient and Reusable Palladium(II)/Cationic 2,2'-Bipyridyl-Catalyzed Stille Coupling in Water.

A water-soluble PdCl2(NH3)2/cationic 2,2'-bipyridyl system was found to be a highly efficient catalyst for Stille coupling of aryl iodides and bromides with organostannanes. The coupling reaction was conducted at 110 °C in water, under aerobic conditions, in the presence of NaHCO3 as a base to afford corresponding Stille coupling products in good to high yields. When aryltributylstannanes were employed, the reactions proceeded smoothly under a very low catalyst loading (as little as 0.0001 mol %). After simple extraction, the residual aqueous phase could be reused in subsequent runs, making this Stille coupling economical. In the case of tetramethylstannane, however, a greater catalyst loading (1 mol %) and the use of tetraethylammonium iodide as a phase-transfer agent were required in order to obtain satisfactory yields.

The effect of position of (S)-2-octyloxy tail on the formation of frustrated blue phase and antiferroelectric phase in Schiff base liquid crystals.

Two series of chiral salicylaldimine-based liquid crystals which differ from each other in the position of the (S)-2-octyloxy tail have been synthesized and characterized by polarizing optical microscopy, differential scanning calorimetry, and electrical switching. Compounds OH I (n = 6-7) having (S)-2-octyloxy tail close to the salicylaldimine core and compounds OH II (n = 6-11) having (S)-2-octyloxy tail far from the salicylaldimine core exhibit polymorphism of mesophases including frustrated blue phase and antiferroelectric (SmC*(A)) phases. Notably, as compared with structurally similar Schiff base compounds H I (n = 7), intramolecular hydrogen bonding in antiferroelectric salicylaldimine-based compounds OH I (n = 7) induces the frustrated blue phase. However, as compared with structurally similar Schiff base compounds OH II (n = 8), the lack of intramolecular hydrogen bonding in Schiff base compounds H II (n = 8) suppresses antiferroelectric properties.

Fat mass as an important predictor of persistent hypertension in patients with primary aldosteronism after adrenalectomy.

Aldosterone excess is present in obesity and is associated with involvement in the pathogenesis of obesity. We evaluate the impact of body obesity as measured by body composition monitor (BCM) on clinical outcomes in patients with unilateral primary aldosteronism (uPA) after adrenalectomy. The BCM device was used to assess body composition before and after adrenalectomy. We used fat mass (FM) and body mass index (BMI) to classify obesity and divided obesity into three groups: clinical overweight (BMI (kg/m2) ≥25); normal weight obesity (NWO, FM (%) ≥ 35 for women, >25 for men & BMI < 25); and no obesity (FM < 35 for women, <25 for men & BMI < 25). A total of 130 unilateral PA (uPA) patients received adrenalectomy, and 27 EH patients were identified; uPA patients with hypertension remission were found to have lower FM (p = 0.046), BMI (p < 0.001), and lower prevalence of overweight (p = 0.001). In the logistic regression model, patients with clinical overweight (OR = 2.9, p = 0.007), NWO (OR = 3.04, p = 0.041) and longer HTN duration (years, OR = 1.065, p = 0.013) were at the risk of persistent hypertension after adrenalectomy. Obesity status was strongly associated with persistent hypertension in uPA patients after adrenalectomy. However, patients in the NWO group also carried higher risk of persistent hypertension. Therefore, assessment of pre-obesity and overweight in uPA patients are extremely important, especially in those who have normal BMI.

Dermatophagoides pteronyssinus 2 regulates nerve growth factor release to induce airway inflammation via a reactive oxygen species-dependent pathway.

Group 2 allergen of Dermatophagoides pteronyssinus 2 (Der p2) induces airway inflammation without protease activity, and elevated nerve growth factor (NGF) levels are also found in this inflammation. How the allergen Der p2 regulates NGF release via reactive oxygen species (ROS) to induce inflammation remains unclear. In the present study, intratracheal administration of Der p2 to mice led to inflammatory cell infiltration, mucus gland hyperplasia, and NGF upregulation in the bronchial epithelium, as well as elevated ROS and NGF production in bronchoalveolar lavage fluids. In addition, Der p2 caused fibrocyte accumulation and mild fibrosis. p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK) inhibitors inhibited Der p2-induced NGF release in LA4 lung epithelial cells and MLg lung fibroblasts. Pretreatment with an antioxidant, tiron, reduced the Der p2-induced ROS production, NGF expression and release, p38 MAPK or JNK phosphorylation, and airway inflammation. These results suggest that Der p2 allergen-induced airway inflammation and elevated NGF release were through increasing ROS production and a MAPK-dependent pathway. The use of an antioxidant, tiron, may provide a new therapeutic modality for the treatment of allergic asthma.

Band Tunable Microcavity Perovskite Artificial Human Photoreceptors.

Electronic device versions of the neural functions of the human retina have high potential for use in artificial vision. This study demonstrates halide perovskite artificial human photoreceptors with specific photoresponses to red, green, and blue colors, which are consistent with human retinal photoreceiving cones and rods. In contrast to the current programmable spectral-response technologies, a novel microcavity structure is combined in this study with a perovskite absorber to achieve a targeted spectrum without using external optical filters. The fabricated artificial photoreceptors exhibit excellent performance including a high detectivity of more than 1013 Jones, a large linear dynamic range of 154 dB, and a short response time of 580 ns. These values are equal to or better than those of the natural human retina. These devices can easily be monolithically integrated on a single flexible substrate by using vacuum deposition, and a true proof-of-concept full-color image reconstruction is demonstrated.

Fabrication of Nanoporous IrO2/Ir Films for Bioelectrode and Neural Prosthesis Applications.

IrO2 and Ir are attractive materials for bio-interface applications due to their desirable stability, electrochemical performance, and biocompatibility. Nanostructured IrO2/Ir possesses several advantageous properties including large surface-to-volume ratio, light weight, super hydrophilic surface, desirable electrochemical capability, and cell adhesion. Herein, we employ a cost-effective process to fabricate uniform nanoporous IrO2/Ir film by chemical bath deposition, high-vacuum annealing, and electrochemical activation. High-vacuum annealing can remove oxygen from an IrO2 film to create a nanoporous structure, and we determine the optimized electrochemical activation to transform Ir to IrO2/Ir. The surface morphology, roughness, hydrophilicity, crystallinity, oxidation state, and charge storage capacity (CSC) of the films were analyzed. The nanoporous IrO2/Ir film showed a 25% increase of CSC compared to the dense IrO2 film, and this excellent performance makes it a promising candidate for bio-interface applications. In addition, this fabrication route can be cost-effective process without wasting the expensive noble metal Ir material.

Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure.

BACKGROUND: Nutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure. METHODS AND RESULTS: A total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). National Death Registry was linked to identify the clinical outcomes of all-cause and cardiovascular death. With increasing tertiles of PNI, age and N-terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow-up duration of 31.5 months, a higher PNI tertile was related to better survival free from all-cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on-admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66-0.87] and 0.79 [95% CI, 0.73-0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality. CONCLUSIONS: PNI is independently associated with long-term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction.

Red Cell Distribution Width and the Risk of Mortality in Patients With Acute Heart Failure With or Without Cardiorenal Anemia Syndrome.

Red cell distribution width (RCDW) has not been fully investigated for its prognostic impact in patients with acute heart failure (AHF) with or without the cardiorenal anemia syndrome (CRAS). A total of 978 patients (age 75 ± 14 years, 70% men, 43% with CRAS) hospitalized for AHF were enrolled. During a median follow-up duration of 31 months, 472 subjects (48%) died. The postdischarge mortality was positively associated with the increasing RCDW. After accounting for age, gender, co-morbidities, hemoglobin, renal function, sodium level, and N-terminal probrain natriuretic peptide, RCDW remained an independent predictor of mortality (hazard ratio [HR] and 95% CI for a 1% increase of RCDW: 1.09, 1.00 to 1.17, p = 0.04). In the subgroups of patients with or without CRAS, RCDW was an independent predictor of total mortality for both subgroups (HR 1.05, 95% CI 1.00 to 1.10 and HR 1.11, 95% CI 1.07 to 1.15, respectively). In conclusion, elevated RCDW was independently associated with mortality in patients hospitalized for AHF, with or without CRAS.

Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure.

BACKGROUND: Hyponatremia predicts poor prognosis in patients with acute heart failure (AHF). However, the association of the severity of hyponatremia and changes of serum sodium levels with long-term outcome has not been delineated. METHODS AND RESULTS: The study population was drawn from the HARVEST registry (Heart Failure Registry of Taipei Veterans General Hospital), so that patients hospitalized for acute heart failure (AHF) composed this study. The National Death Registry was linked to identify the clinical outcomes of all-cause mortality and cardiovascular death, with a follow-up duration of up to 4 years. Among a total of 2556 patients (76.4 years of age, 67% men), 360 had on-admission hyponatremia, defined as a serum sodium level of <135 mEq/L on the first day of hospitalization. On-admission hyponatremia was a predictor for all-cause mortality (hazard ratio and 95% CI: 1.43, 1.11-1.83) and cardiovascular mortality (1.50, 1.04-2.17), independent of age, sex, hematocrit, estimated glomerular filtration rate, left ventricular ejection fraction, and prescribed medications. Subjects with severe hyponatremia (<125 mEq/L) would even have worse clinical outcomes. During hospitalization, a drop of sodium levels of >3 mEq/L was associated with a marked increase of mortality than those with minimal or no drop of sodium levels. In addition, subjects with on-admission hyponatremia and drops of serum sodium levels during hospitalization had an incremental risk of death (2.26, 1.36-3.74), relative to those with normonatremia at admission and no treatment-related drop of serum sodium level in the fully adjusted model. CONCLUSIONS: On-admission hyponatremia is an independent predictor for long-term outcomes in patients hospitalized for AHF. Combined the on-admission hyponatremia with drops of serum sodium levels during hospitalization may make a better risk assessment in AHF patients.

Surface Degradation and Nanoparticle Release of a Commercial Nanosilica/Polyurethane Coating Under UV Exposure.

Many coatings properties such as mechanical, electrical, and ultra violet (UV) resistance are greatly enhanced by the addition of nanoparticles, which can potentially increase the use of nanocoatings for many outdoor applications. However, because polymers used in all coatings are susceptible to degradation by weathering, nanoparticles in a coating may be brought to the surface and released into the environment during the life cycle of a nanocoating. Therefore, the goal of this study is to investigate the process and mechanism of surface degradation and potential particle release from a commercial nanosilica/polyurethane coating under accelerated UV exposure. Recent research at the National Institute of Standards and Technology (NIST) has shown that the matrix in an epoxy nanocomposite undergoes photodegradation during exposure to UV radiation, resulting in surface accumulation of nanoparticles and subsequent release from the composite. In this study, specimens of a commercial polyurethane (PU) coating, to which a 5 mass % surface treated silica nanoparticles solution was added, were exposed to well-controlled, accelerated UV environments. The nanocoating surface morphological changes and surface accumulation of nanoparticles as a function of UV exposure were measured, along with chemical change and mass loss using a variety of techniques. Particles from the surface of the coating were collected using a simulated rain process developed at NIST, and the collected runoff specimens were measured using inductively coupled plasma-optical emission spectroscopy (ICP-OES) to determine the amount of silicon released from the nanocoatings. The results demonstrated that the added silica nanoparticle solution decreased the photodegradation rate (i.e., stabilization) of the commercial PU nanocoating. Although the degradation was slower than the previous nanosilica epoxy model system, the degradation of the PU matrix resulted in accumulation of silica nanoparticles on the nanocoating surface and release to the environment by simulated rain. These experimental data are valuable for developing models to predict the long-term release of nanosilica from commercial PU nanocoatings used outdoors and, therefore, are essential for assessing the health and environmental risks during the service life of exterior PU nanocoatings.