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Background Diuretic resistance is associated with increased mortality in patients with heart failure (HF). Qi Li Qiang Xin Jiao Nang, a Traditional Chinese Medicine, are used in the treatment of HF. However, clinical evidence of their effectiveness in improving diuretic resistance is lacking. Objective To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure (ADCHF) . Methods This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022. Patients were divided into diuretic resistance (118 patients) and non-diuretic resistance groups (256 patients) based on the occurrence of diuretic resistance. Patient data and laboratory results were collected. A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality. Kaplan-Meyer survival curves were plotted for each group, and the Log-rank test was used for comparison. Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance. Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients. Results The diuretic resistance group showed higher age, body mass, NT-proBNP, blood urea nitrogen, creatinine, uric acid, and international normalized ratio (INR) but lower 24-hour fluid intake, estimated glomerular filtration rate (eGFR), lymphocyte count, and usage of Qi Li Qiang Xin Jiao Nang. Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang (OR=0.363, 95%CI=0.186-0.708, P=0.003) and increased 24-hour fluid intake (OR=0.286, 95%CI=0.177-0.461, P

The Eulerian two‐phase boiling model of the subcooled boiling of coolant in a 3 × 3 fuel assembly is established and compared with the experimental data to verify its accuracy. The effects of four shapes of bow deformation on subcooled boiling flow and heat transfer characteristics are obtained by comparing and analyzing the distributions of thermal–hydraulic parameters, including the axial wall superheat, liquid phase temperature, axial void fraction, various heat fluxes, heat transfer coefficient, and turbulent kinetic energy. All shapes of bow deformation will lead to the redistribution of coolant among different subchannels, and the distributions of thermal–hydraulic parameters would be greatly affected. The bow deformation of fuel rod easily causes local boiling, which results in local high temperature of liquid phase and bubble accumulation, and a decrease in the area of high liquid phase heat transfer coefficient on the surface of bowing fuel rod. Additionally, the non‐uniform distribution of turbulent kinetic energy caused by bow deformation in different axial sections not only affects the heat transfer performance of coolant, but also causes the increment in pressure drop, which has negative effects on the safe operation of the nuclear reactor. This paper can provide data and theoretical support for engineering design. [ABSTRACT FROM AUTHOR]

Background: For women presenting with stable chest pain (SCP), the appropriate risk assessment strategy to identify individuals unlikely to benefit from further cardiovascular imaging testing (CIT) is debatable. Thus, the present study intended to compare two risk assessment strategies in these individuals.Methods: 2592 women with SCP who underwent coronary computed tomography angiography (CCTA) were divided into low and high risk group according to 2016 National Institute of Health and Care Excellence guideline-determined strategy (NICE strategy) and 2019 European Society of Cardiology guideline-determined strategy (ESC strategy), respectively. The associations of coronary artery disease (CAD), major adverse cardiovascular event (MACE) and other subsequent clinical outcomes with risk groups and net reclassification improvement (NRI) were evaluated to compare different strategies.Results: Both NICE strategy which focused on symptom evaluation and ESC strategy which was based on pretest probability (PTP) determined by ESC-PTP model and coronary artery calcium score-weighted clinical likelihood (CACS-CL) model classified a proportion (34.49% and 63.97%, respectively) of individuals into the low risk group. Compared to NICE strategy, ESC strategy indicated stronger associations between risk groups and obstructive CAD (odds ratio: 27.63 versus 3.57), MACE (hazard ratios: 4.24 versus 1.91), more intensive clinical management as well as a positive NRI (27.71%, p < 0.0001).Conclusion: Compared to NICE strategy, ESC strategy which sequentially incorporated ESC-PTP model with CACS-CL model seemed to be associated with greater effectiveness in identifying individuals who may derive maximum benefit from further CIT in women presenting with SCP. [ABSTRACT FROM AUTHOR]

Background: The dilation of lymphatic vessels plays a critical role in maintaining heart function, while a lack thereof could contribute to heart failure (HF), and subsequently to an acute myocardial infarction (AMI). Macrophages participate in the induction of lymphangiogenesis by secreting vascular endothelial cell growth factor C (VEGF-C), although the precise mechanism remains unclear., Methods: Intramyocardial injections of adeno-associated viruses (AAV9) to inhibit the expression of VEGFR3 ( VEGFR3 shRNA) or promote the expression of VEGFR3 ( VEGFR3 ORF) in the heart; Myh6-mCherry B6 D2-tg mice and flow cytometry were used to evaluate the number of myocellular debris in the mediastinal lymph nodes; fluorescence staining and qPCR were used to evaluate fluorescence analysis; seahorse experiment was used to evaluate the level of glycolysis of macrophages; Lyz2𝐶𝑟𝑒 , VEGFCfl/fl , and PFKFB3fl/fl mice were used as a model to knock out the expression of VEGF-C and PFKFB3 in macrophages., Results: The escalation of VEGFR3 in cardiac tissue can facilitate the drainage of myocardial debris to the mediastinal lymph nodes, thereby improving cardiac function and reducing fibrosis after reperfusion injury. Conversely, myeloid VEGF-C deficiency displayed an increase in macrophage counts and inflammation levels following reperfusion injury. The inhibition of the critical enzyme PFKFB3 in macrophage glycolysis can stimulate the manifestation of VEGF-C in macrophages. A deficiency in myeloid PFKFB3 is associated with induced lymphangiogenesis following reperfusion injury., Conclusions: Our initial investigations suggest that the suppression of PFKFB3 expression in macrophages could potentially stimulate the production of VEGF-C in these immune cells, which in turn may facilitate lymphangiogenesis and mitigate the inflammatory effects of I/R injury., Competing Interests: The authors declare no conflict of interest., (© 2023 The Author(s). Published by IMR Press.)