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Abstract Background To explore the altered functional connectivity (FC) of the nucleus tractus solitarii (NTS) in patients with chronic cough after lung surgery using resting‐state functional magnetic resonance imaging (rs‐fMRI), and the association between abnormal FC and clinical scale scores. Methods A total of 22 patients with chronic cough after lung surgery and 22 healthy controls were included. Visual analog scale (VAS), Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ‐MC), and Hamilton anxiety rating scale (HAMA) scores were assessed, and rs‐fMRI data were collected. The FC analysis was performed using the NTS as the seed point, and FC values with all voxels in the whole brain were calculated. A two‐sample t‐test was used to compare FC differences between the two groups. The FC values of brain regions with differences were extracted and correlated with clinical scale scores. Results In comparison to healthy controls, FC values in the NTS and anterior cingulate cortex(ACC) were reduced in patients with chronic cough after lung surgery (GRF correction, p‐voxel

Background Concomitant atrial fibrillation and end‐stage renal disease is common and associated with an unfavorable prognosis. Although oral anticoagulants have been well established to prevent thromboembolism, the applicability in patients under long‐term dialysis remains debatable. The study aimed to determine the efficacy and safety of anticoagulation in the dialysis‐dependent population. Methods and Results An updated network meta‐analysis based on MEDLINE, EMBASE, and the Cochrane Library was performed. Studies published up to December 2022 were included. Direct oral anticoagulants (DOACs, dabigatran, rivaroxaban, apixaban 2.5/5 mg twice daily), vitamin K antagonists (VKAs), and no anticoagulation were compared on safety and efficacy outcomes. The outcomes of interest were major bleeding, thromboembolism, and all‐cause death. A total of 42 studies, including 3 randomized controlled trials, with 185 864 subjects were pooled. VKAs were associated with a significantly higher risk of major bleeding than either no anticoagulation (hazard ratio [HR], 1.47; 95% CI, 1.34–1.61) or DOACs (DOACs versus VKAs; HR, 0.74 [95% CI, 0.64–0.84]). For the prevention of thromboembolism, the efficacies of VKAs, DOACs, and no anticoagulation were equivalent. Nevertheless, dabigatran and rivaroxaban were associated with fewer embolic events. There were no differences in all‐cause death with the administration of VKAs, DOACs, or no anticoagulation. Conclusions For dialysis‐dependent populations, dabigatran and rivaroxaban were associated with better efficacy, while dabigatran and apixaban demonstrated better safety. No anticoagulation was a noninferior alterative, and VKAs were associated with the worst outcomes.

Anti-hypertensive medications may affect plasma renin activity and/or plasma aldosterone concentration, misleading the interpretation of the aldosterone-to-renin ratio when screening for primary aldosteronism. The Task Force of Taiwan PA recommends that, when necessary, using α-adrenergic receptor blocking agents, centrally acting α-adrenergic agonists, and/or non-dihydropyridine calcium channel blockers should be considered to control blood pressure before screening for PA. We recommend temporarily holding β-adrenergic receptor blocking agents, mineralocorticoid receptor antagonists, dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and all diuretics before screening for PA. Further large-scale randomized controlled studies are required to confirm the recommendations.

Background Pulmonary hypertension (PH) is highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF), and it is a strong predictor of adverse outcomes. We aimed to determine possible echocardiographic parameters to predict the presence of PH in patients with HFpEF Methods and Results A total of 113 patients with HFpEF were prospectively enrolled from November 2017 to July 2022. The patients underwent invasive cardiac catheterization and simultaneous echocardiography at rest and during exercise. The parameters indicating right ventricle‐pulmonary artery uncoupling, including tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and tricuspid annular systolic velocity (TAS’)/PASP were calculated. Receiver operating characteristic curve analysis was used to determine the optimal cut‐off points of TAPSE/PASP and TAS’/PASP to differentiate patients with HFpEF with PH from those without PH. Sixty‐eight patients with HFpEF with PH and 45 without PH were included. Those with PH had lower TAPSE/PASP and TAS’/PASP at rest and during exercise compared with those without PH. Both resting/stress TAPSE/PASP and TAS’/PASP were correlated with rest/exercise pulmonary capillary wedge pressure and mean pulmonary artery pressure. In multivariable regression analysis, TAPSE/PASP remained a significant predictor of exercise pulmonary capillary wedge pressure and mean pulmonary artery pressure. In receiver operating characteristic curve analysis, the optimal cut‐off points of TAPSE/PASP and TAS’/PASP to differentiate patients with HFpEF with PH from those without PH were ≤0.62 and ≤0.47, respectively. Conclusions Right ventricle‐pulmonary artery uncoupling is closely correlated with abnormal rest/exercise hemodynamics (pulmonary capillary wedge pressure and mean pulmonary artery pressure) in patients with HFpEF. TAPSE/PASP and TAS’/PASP can be useful parameters to detect PH in patients with HFpEF.

Physics-informed neural networks (PINNs) have recently emerged and attracted extensive attention as an alternative approach to computational fluid dynamics (CFD) methods, which can provide competitive solutions to a variety of forward and inverse fluid problems. In this study, we reconstruct a 3D wind field around a building model in wind tunnel test with a Reynolds number of 2.4 × 104 by formulating a novel PINN framework, which is the first exploration of PINNs for building wind engineering problems. To surmount the hurdle in multi-objective optimization for PINN training, a dynamic prioritization (dp) self-adaptive loss balance strategy is proposed (termed dpPINN), which adaptively reconciles the loss terms of distinct scales to facilitate convergence in PINN training. A zero-equation turbulence model and the wind velocity data collected in near-wall regions are embedded in dpPINN training. Comparison results indicate that dpPINN predictions show good consistency with observation data, which is superior to two current PINN paradigms in prediction accuracy. Furthermore, the influence of neural network configurations, turbulence models, and the layout arrangements of training points on the dpPINN prediction is investigated. It is demonstrated that the dpPINN could be a powerful auxiliary means for airflow simulation and reconstruction in wind engineering applications.

The high-speed railway has become an important passenger transport mode. Relying on the abundant passenger transport experience and expansive railway network, the high-speed freight train (HSFT) is feasible to be developed and has great application potential. As a critical component of HSFT, the cargo plays an important role in the overturning safety of HSFT under strong wind conditions. Previous studies about the aerodynamic performance of the high-speed train usually regarded the loaded carbody as an individual rigid body. Limited attention was paid to the variability inside the vehicle. In order to improve the running safety of HSFT under strong wind conditions, the multibody dynamics simulation is adopted to demonstrate the effect of cargo property on the overturning risk of HSFT under the aerodynamic loads obtained through the computational fluid dynamics (CFD) simulations. It is demonstrated that the inner side crosswind is more dangerous than the outer side crosswind. The speed of HSFT should be limited according to the cargo quantity, and the maximum speed for a fully loaded HSFT can be 305 km/h when the crosswind velocity is 20 m/s. The larger cargo density should be encouraged because it is good for train overturning safety in severe working conditions.

Bilateral vertical noise barriers have been widely used along high-speed railway lines in coastal cities where typhoons are frequent. When a high-speed train (HST) enters (or exits) a noise barrier under strong crosswind conditions, its running safety will be more severely tested because of the instantaneous switching of aerodynamic environment. Installing a buffer structure at the end of the noise barrier is necessary to ensure the running safety of HSTs. In this study, two types of aerodynamic buffer structures (triangle and fence types) for the end of the noise barrier are proposed. The buffering effects of the two structures on the sudden change amplitude of the aerodynamic load of the carriage are compared by using an improved delayed detached eddy simulation method. The difference in the influence of the two buffer structures on the aerodynamic responses of the carriage is discussed by using a wind–train–bridge coupling dynamic response calculation method. The buffer mechanisms of the two structures are revealed in terms of the flow field. Results show that the buffering effect of fence type is superior triangle type, and the buffer length of 4 L is the most reasonable.

Background: Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown. Objective: To investigate the effect of concomitant albuminuria on arterial stiffness in PA. Design: Prospective cohort study. Methods: A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed. Results: A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria ( p = 0.012) and positively correlated with urine albumin–creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM ( p = 0.001). The magnitude of improvement in PWV increased with urine albumin–creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis. Conclusion: Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin–creatinine ratio levels, reaching a plateau when the urine albumin–creatinine ratio surpassed 100 mg/g.

Severe weather, especially strong rain-loaded wind, appears in coastal areas frequently. The strong wind driving raindrops worsens the wind effect and aggravates its impact on the intercity railway bridge and running trains. Based on the Euler multiphase model, for evaluating the effect of raindrops in wind and rain environment on running trains, a numerical simulation approach was adopted in this study, and the influence of the crosswind speed and rainfall with varying characteristic parameters on the aerodynamic performances of intercity trains was analysed. The results showed that the airflow around the train drove some raindrops to show a parabolic projectile feature, and the projectile distance increased as the crosswind speed increased, but the projectile distance showed no noticeable change with the rise in the rainfall, because the impact of the crosswind played a dominant role, while the raindrops provided additional effects in the wind and rain environment. Furthermore, in the wind and rain environment, as the crosswind speed increased and compared to that of the 10 m/s conditions, an increase of 354.37 %, 369.60 % and 355.07 % in CS, CL and CM of the whole train was shown in 30 m/s wind speed conditions, respectively, while, as the rainfall increased to 100 mm/h compared to that of the 20 mm/h, an increase of 6.41 % and 6.25 % in CS and CM of the whole train, as well as a decrease of 0.71 % in CL of the whole train was shown, respectively.

As train speeds continuously increase, the crosswind stability of high-speed trains (HSTs) has been a prominent research topic. Benefiting from advances in railway technology, the coupled operation of different HSTs has been proven to be permissible, but the crosswind performance of double-connected train groups composed of different kinds of HSTs has rarely been studied. This paper therefore studied the differences in the aerodynamic performance of double-connected train groups composed of same and different train units under crosswinds. We employed an improved delayed detached-eddy simulation (IDDES) method to investigate the flow features around different groups of double-connected train. Two one-eighth-scale standard HSTs—Train 1 (T 1) and Train 2 (T 2)—currently operating in China were selected to form different group configurations for double-connected trains: T 1-T 1 (Case 1–1), T 1-T 2 (Case 1–2), T 2-T 1 (Case 2–1), and T 2-T 2 (Case 2–2). First, the reliability of the numerical algorithm and mesh independence were verified to ensure the accuracy of the numerical results. Second, the aerodynamic force coefficients, time-averaged, and instantaneous flow structures of different double-connected train group types were compared and analyzed.

This paper designs two single-stage LC-tank injection-locked frequency sixtuplers (ILFSs) fabricated in a 90 nm CMOS process and it describes the circuit design, operation principle, and measurement results of the ILFSs. The ILFS circuit with a differential input and single-phase output is made of a first-harmonic injection-locked oscillator (ILO), a frequency tripler, and a push-push doubler. The first ILFS uses an octagonal inductor. For a supply voltage of 0.4 V, the free-running frequency is around 41.52 GHz, DC power consumption is 9.03 mW at the incident power of 0 dBm, and the output locking range at 0 dBm input power is 10.21 %. The second ILFS uses an 8-shaped inductor for low electromagnetic (EM) noise generation. The free-running frequency is around 37.2 GHz, DC power consumption is 7.72 mW at the incident power of 0 dBm, and the output locking range at 0 dBm input power is 17.4 %. The two chips have the same area, $0.7\times0.7$ mm2. This paper also provides a further analysis and comparison of the RF performance of on-chip inductors designed. Simulation shows the substrate noise coupling and distance noise coupling between victim and aggressor, the 8-shaped inductor exhibits a significant reduction in coupling. By the measurement results, it is evident that the performance of the 8-shaped inductor ILFS is superior to that of the octagonal inductor ILFS.

To reduce the crosswind effect on high-speed trains, in this paper, by using the Improved Delayed Detached Eddy Simulation (IDDES) method and the SST [Formula: see text] turbulence model, a novel blowing measure is studied and compared by considering different positions of blowing slots on the train surface. The concerned blowing positions on the train surface include the top position (Top); windward side (WWS): the upper position (WU), middle position (WM), and lower position (WL); and leeward side (LWS): the upper position (LU), middle position (LM), and lower position (LL). The results show that in regard to the rolling moment coefficient around the leeward rail, CMxlee, the mitigation effect with LM for the head car is the largest, and the mitigation effect with WL for the middle car and tail car is superior to other cases. The corresponding drop percentages are 18.5%, 21.7%, and 30.8% for the head car, middle car, and tail car, respectively. The flow structures indicate that the blowing positions on the lower half of WWS and upper half of LWS would form a protective air gap to weaken the impact of coming flows and delay the vortex separation on LWS, and thus the train aerodynamic performance is improved.

BackgroundPrimary aldosteronism (PA) is the leading cause of curable endocrine hypertension, which is associated with a higher risk of cardiovascular and metabolic insults compared to essential hypertension. Aldosterone-producing adenoma (APA) is a major cause of PA, which can be treated with adrenalectomy. Somatic mutations are the main pathogenesis of aldosterone overproduction in APA, of which KCNJ5 somatic mutations are most common, especially in Asian countries. This article aimed to review the literature on the impacts of KCNJ5 somatic mutations on systemic organ damage.Evidence acquisitionPubMed literature research using keywords combination, including “aldosterone-producing adenoma,” “somatic mutations,” “KCNJ5,” “organ damage,” “cardiovascular,” “diastolic function,” “metabolic syndrome,” “autonomous cortisol secretion,” etc.ResultsAPA patients with KCNJ5 somatic mutations are generally younger, female, have higher aldosterone levels, lower potassium levels, larger tumor size, and higher hypertension cure rate after adrenalectomy. This review focuses on the cardiovascular and metabolic aspects of KCNJ5 somatic mutations in APA patients, including left ventricular remodeling and diastolic function, abdominal aortic thickness and calcification, arterial stiffness, metabolic syndrome, abdominal adipose tissue, and correlation with autonomous cortisol secretion. Furthermore, we discuss modalities to differentiate the types of mutations before surgery.ConclusionKCNJ5 somatic mutations in patients with APA had higher left ventricular mass (LVM), more impaired diastolic function, thicker aortic wall, lower incidence of metabolic syndrome, and possibly a lower incidence of concurrent autonomous cortisol secretion, but better improvement in LVM, diastolic function, arterial stiffness, and aortic wall thickness after adrenalectomy compared to patients without KCNJ5 mutations.

Background: Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. Objective: To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria. Design: Prospective cohort study. Methods: The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations. Results: A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m 2 , p = 0.023), and medial E/e′ ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70

Background: Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown. Objectives: The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients. Design: Prospective cohort study. Methods: We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors. Results: A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p

The aim of this study was to update the information on internationally acceptable standards and clinical practice recommendations for the management of patients with primary aldosteronism (PA). The Taiwan Society of Aldosteronism (TSA) Task Force acknowledged the novel issues of PA and reached a group consensus on PA in Taiwan by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. Unilateral adrenalectomy is the preferred treatment for patients with aldosterone-producing adenoma (APA). For medical treatment with mineralocorticoid receptor antagonists (MRAs), spironolactone is the first-line treatment, and eplerenone is a reasonable alternative in PA patients intolerant or contraindicated to spironolactone. The dose of MRAs can be titrated according to plasma renin activity (PRA). For screening PA-related comorbidities, we suggest albuminuria to predict a post-treatment decline in renal function, echocardiography as cardiac evaluation, bone mineral density scan for osteoporosis, and obstructive sleep apnea. In tissue and genetic surveys, we suggest immunohistochemical staining and somatic mutation screening for post-operative adrenal specimens in APA patients. With this consensus, we hope to update the information on PA for clinical physicians to facilitate better identification, management and treatment of patients with PA.

Background: Data on the efficacy and safety of balloon pulmonary angioplasty (BPA) in Taiwanese patients with chronic thromboembolic pulmonary hypertension (CTEPH) are lacking. In this study, we evaluated the effects of BPA on clinical parameters including hemodynamics, echocardiography and functional status in patients with inoperable CTEPH in Taiwan. Methods: We retrospectively collected the clinical data of inoperable CTEPH patients who underwent ≥3 BPA sessions. Pulmonary hemodynamic parameters of right heart catheterization, echocardiography, 6-min walk distance and World Health Organization (WHO) functional class were collected and analyzed before and after BPA treatment. Results: A total of 59 BPA sessions were performed in 13 inoperable CTEPH patients. No periprocedural deaths or major complications requiring tracheal intubation with mechanical ventilation occurred. WHO functional class significantly improved in all 13 patients (P

ObjectivePrimary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status.MethodsWe enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed.ResultsAfter propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P

Background: Aldosterone excess in primary aldosteronism (PA) has been linked to insulin resistance, and diabetes mellitus has been associated with increased arterial stiffness and worse cardiovascular outcomes. However, the impact of diabetes on baseline and post-treatment arterial stiffness in patients with PA is unknown. Methods: This study prospectively enrolled 1071 PA patients, of whom 177 had diabetes and 894 did not. Clinical, biochemical, and brachial-ankle pulse wave velocity (baPWV) data were analyzed at baseline and 1 year after PA-specific treatment. After propensity score matching of age, sex, body mass index, systolic and diastolic blood pressure, hypertension duration, and number of antihypertensive medications, 144 patients with diabetes and 320 without diabetes were included for further analysis. Results: After propensity score matching, the baseline characteristics were balanced between the diabetes and nondiabetes groups except for fasting glucose, HbA1c, and lipid profiles. The patients with diabetes had significantly worse baseline baPWV compared with those without diabetes. After multivariable linear regression, the presence of diabetes mellitus remained a significant predictor of worse baseline mean baPWV (β: 46.3, 95% confidence interval: 2.9–89.7, p = 0.037). After 1 year of PA-specific treatment, only the nondiabetes group had significant recovery of mean baPWV (1661.8 ± 332.3 to 1565.0 ± 329.2 cm/s, p

We study noise generation at the blade tips of propellers designed for future electric aircraft propulsion and, furthermore, analyze the interrelationship between noise mitigation and aerodynamics improvement in terms of propeller geometric designs. Classical propellers with three or six blades and a conceptual propeller with three joined dual-blades are compared to understand the effects of blade tip vortices on the noise generation and aerodynamics. The dual blade of the conceptual propeller is constructed by joining the tips of two sub-blades. These propellers are designed to operate under the same freestream flow conditions and similar electric power consumption. The Improved Delayed Detached Eddy Simulation (IDDES) is adopted for the flow simulation to identify high-resolution time-dependent noise sources around the blade tips. The acoustic computations use a time-domain method based on the convective Ffowcs Williams–Hawkings (FW-H) equation. The thrust of the 3-blade conceptual propeller is 4% larger than the 3-blade classical propeller and 8% more than the 6-blade one, given that they have similar efficiencies. Blade tip vortices are found emitting broadband noise. Since the classical and conceptual 3-blade propellers have different geometries, especially at the blade tips, they introduce deviations in the vortex development. However, the differences are small regarding the broadband noise generation. As compared to the 6-blade classical propeller, both 3-blade propellers produce much larger noise. The reason is that the increased number of blades leads to the reduced strength of tip vortices. The findings indicate that the noise mitigation through the modification of the blade design and number can be traded-off by the changed aerodynamic performance.

BackgroundPrimary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). However, the effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension.MethodsWe performed the meta-analysis of the randomized or observational studies that investigated the incidence rate of NOAF in PA patients receiving MRA treatment versus PA patients receiving adrenalectomy from database inception until December 01, 2020 which were identified from PubMed, Embase, and Cochrane Library.ResultsA total of 172 related studies were reviewed, of which three fulfilled the inclusion criteria, including a total of 2,705 PA patients. The results of meta-analysis demonstrated a higher incidence of NOAF among the PA patients receiving MRA treatment compared to the PA patients receiving adrenalectomy (pooled odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.76–4.57 in the random effects model, I2 = 0%). The pooled OR for the PA patients receiving MRA treatment compared to the patients with essential hypertension was 1.91 (95% CI: 1.11–3.28). The pooled OR for the PA patients receiving adrenalectomy compared to the patients with essential hypertension was 0.70 (95% CI: 0.28–1.79).ConclusionCompared to the essential hypertension patients and the PA patients receiving adrenalectomy, the patients with PA receiving MRA treatment had a higher risk of NOAF.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021222022.

Under strong winds, the effect of sudden windbreak transition (WT) on high-speed trains is severe, leading to a deterioration of train aerodynamics and sudden yawing motion of the car body. To address these problems, based on a high-speed train and the specific geometric conditions derived from Xinjiang railway, first, the impact of a WT on the train and reasons for sudden changes in aerodynamic forces were determined by flow structural analysis. Furthermore, based on a multibody system dynamic model, the dynamic responses to WT were analysed. The results show that the impacts of WT were the strongest on the head car. WT had a strong effect on the train due to the unreasonable structural shape and the insufficient height of the windbreak in the transition region. This led to a strong push effect on the train; subsequently, the train’s dynamic characteristics deteriorated.

Excessive aldosterone secretion causes endothelial dysfunction, vascular inflammation, and vascular fibrosis in patients with primary aldosteronism (PA). Endothelial function is closely related to endothelial mitochondria. However, the effects of elevated aldosterone levels on endothelial mitochondria remain unclear. In this study, we used primary cultured human umbilical vein endothelial cells (HUVECs) to investigate the effects of aldosterone on endothelial mitochondria. Mineralocorticoid receptor (MR) small interfering (si)RNA or glucocorticoid receptor (GR) siRNA were used to confirm the pathway by which aldosterone exerts its effects on the mitochondria of HUVECs. The results showed that excess aldosterone suppressed mitochondrial DNA copy numbers, anti-mitochondrial protein, and SOD2 protein expression in a dose- and time-dependent manner. These effects were attenuated by treatment with MR siRNA, but not with GR siRNA. Furthermore, it was attenuated by treatment with a mitochondria-targeted antioxidant (Mito-TEMPO, associated with mitochondrial reactive oxygen species (ROS) production), but not N-acetyl-L-cysteine (associated with cytosolic ROS production), which suggests that the process was through the mitochondrial ROS pathway, but not the cytosolic ROS pathway. In conclusion, aldosterone excess suppressed endothelial mitochondria through the MR/mitochondrial ROS pathway.

As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease, myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemic attack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-to-date findings on the association between PA and cerebrovascular diseases.

ObjectivesPatients with primary aldosteronism (PA) have cardiac remodeling due to hemodynamic and non-hemodynamic causes. However, component analysis of cardiac remodeling and reversal in PA patients is lacking. We investigated components of cardiac remodeling and reversal after adrenalectomy in patients with aldosterone-producing adenoma (APA).MethodsThis study prospectively enrolled 304 APA patients who received adrenalectomy and 271 with essential hypertension (EH). Clinical, biochemical and echocardiographic data were collected in both groups and 1 year after surgery in the APA patients. The hemodynamic and non-hemodynamic components of left ventricular (LV) remodeling were represented by predicted left ventricular mass index (LVMI) (pLVMI) and inappropriately excessive LVMI (ieLVMI, defined as LVMI-pLVMI).ResultsAfter propensity score matching, 213 APA and 213 EH patients were selected. APA patients had higher hemodynamic (pLVMI) and non-hemodynamic (ieLVMI) components of LV remodeling than EH patients. In multivariate analysis, baseline pLVMI was correlated with systolic blood pressure (SBP) and serum potassium, whereas ieLVMI was correlated with log plasma aldosterone concentration but not blood pressure. Post-operative echocardiography was available in 207 patents and showed significant decreases in both pLVMI and ieLVMI after adrenalectomy. In multivariate analysis, ΔpLVMI was correlated with SBP, ΔSBP, and pre-operative pLVMI, whereas ΔieLVMI was correlated with Δlog aldosterone-to-renin ratio (ARR) and pre-operative ieLVMI.ConclusionsThis study concluded that extensive cardiac remodeling in APA patients occurs through hemodynamic and non-hemodynamic causes. Adrenalectomy can improve both hemodynamic and non-hemodynamic components of LV remodeling. Regressions of pLVMI and ieLVMI were correlated with decreases in blood pressure and ARR, respectively.

(1) Background: The role of using artificial intelligence (AI) with electrocardiograms (ECGs) for the diagnosis of significant coronary artery disease (CAD) is unknown. We first tested the hypothesis that using AI to read ECG could identify significant CAD and determine which vessel was obstructed. (2) Methods: We collected ECG data from a multi-center retrospective cohort with patients of significant CAD documented by invasive coronary angiography and control patients in Taiwan from 1 January 2018 to 31 December 2020. (3) Results: We trained convolutional neural networks (CNN) models to identify patients with significant CAD (>70% stenosis), using the 12,954 ECG from 2303 patients with CAD and 2090 ECG from 1053 patients without CAD. The Marco-average area under the ROC curve (AUC) for detecting CAD was 0.869 for image input CNN model. For detecting individual coronary artery obstruction, the AUC was 0.885 for left anterior descending artery, 0.776 for right coronary artery, and 0.816 for left circumflex artery obstruction, and 1.0 for no coronary artery obstruction. Marco-average AUC increased up to 0.973 if ECG had features of myocardial ischemia. (4) Conclusions: We for the first time show that using the AI-enhanced CNN model to read standard 12-lead ECG permits ECG to serve as a powerful screening tool to identify significant CAD and localize the coronary obstruction. It could be easily implemented in health check-ups with asymptomatic patients and identifying high-risk patients for future coronary events.

Background Primary aldosteronism (PA) is associated with higher atrial fibrillation prevalence and other cardiovascular complications. However, the effect of target treatment to prevent new‐onset atrial fibrillation (NOAF) remains unclear. This study investigated incidence of NOAF under different treatment strategies in patients with PA. Methods and Results We analyzed longitudinal data for patients with PA without atrial fibrillation history from 1997 to 2009 within the National Health Insurance Research Database in Taiwan. Patients with essential hypertension matched by propensity score were enrolled as controls. The primary outcome measurement was NOAF, and secondary outcome measurements were mortality, major cardiac and cardiac/cerebrovascular events, and a combined end point of NOAF and mortality. We identified 2202 patients with PA (534 adrenalectomy, 1668 mineralocorticoid receptor antagonist [MRA] therapy) and 8808 essential hypertension controls with mean follow‐up of 4.4 years. In primary outcome measurement, patients with PA who underwent adrenalectomy had a lower incidence of NOAF (adjusted hazard ratio; 0.28, P=0.011) than controls. In contrast, the patients with PA who received MRA therapy had comparable risk of NOAF (adjusted hazard ratio, 1.20; P=0.224). In secondary outcome measurement, patients with PA who underwent adrenalectomy had a lower rate of mortality and combined end point of NOAF and mortality than controls. Patients with PA who received MRA therapy had a higher risk of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality than the essential hypertension controls. Conclusions Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF. However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy.

BackgroundThe correlation between echocardiographic parameters and hemodynamics data in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. It is important to find a non-invasive echocardiographic parameter for predicting exercise pulmonary capillary wedge pressure (PCWP).AimThis study sought to determine the correlation between echocardiographic parameters and hemodynamics data at rest and during exercise in HFpEF patients.Methods and ResultsThis study was a cross-sectional cohort exploratory analysis of baseline data from the ILO-HOPE trial. A total of 34 HFpEF patients were enrolled. The average age was 70 ± 12 years, and most (74%) were women. The patients underwent invasive cardiac catheterization and expired gas analysis at rest and during exercise. Echocardiography including tissue Doppler imaging was performed, and global longitudinal strain and other novel diastolic function indexes were analyzed at rest and during exercise. At rest, no significant correlation was noted between resting PCWP and echocardiographic parameters. However, a significant correlation was observed between post-exercise PCWP and stress E/e′ (septal, lateral, and mean) ratio (p = 0.003, 0.031, 0.012). Moreover, post-exercise ΔPCWP showed a good correlation with stress E/e′ (septal, lateral, and mean; all p ≤ 0.001) and global longitudinal strain (GLS) during exercise (p = 0.03). After multivariate regression analysis with adjustment for possible confounding factors including age and sex, there was still a significant correlation between post-exercise ΔPCWP and E/e′ (r = 0.62, p < 0.001 for E/e′mean).ConclusionOnly stress echocardiography derived tissue Doppler E/e′ ratio is closely correlated with abnormal exercise hemodynamics (PCWP and post-exercise ΔPCWP) in HFpEF. This echocardiographic marker is substantially more sensitive than other novel echocardiographic parameters during exercise, and may have significant diagnostic utility for ambulatory HFpEF patients with dyspnea.Clinical Trial Registrationhttps://www.clinicaltrials.gov, identifier NCT03620526.

Background Primary aldosteronism is the most common cause of secondary hypertension and is associated with left ventricular hypertrophy. However, whether aldosterone excess is responsible for left ventricular (LV) diastolic dysfunction is unknown. Methods and Results We prospectively enrolled 129 patients with aldosterone‐producing adenoma and 120 patients with essential hypertension, and analyzed their clinical, biochemical, and echocardiographic data, including tissue Doppler images. The patients with aldosterone‐producing adenoma were reevaluated 1 year after adrenalectomy. After propensity score matching, there were 105 patients in each group. The patients with aldosterone‐producing adenoma had worse diastolic function than the patients with essential hypertension, as reflected by lower e′ (P

Primary aldosteronism (PA) is associated with higher arterial stiffness compared to essential hypertension (EH). However, few studies have compared different pulse wave velocity (PWV) parameters to detect aldosterone-induced arterial stiffness. In this study, we aimed to compare the sensitivity in detecting aldosterone-induced arterial stiffness between brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV). We prospectively enrolled 1006 PA patients and 983 EH patients. Detailed medical history, basic biochemistry data and two PWV measurements (baPWV and haPWV) were collected in both groups. We performed analysis on the original cohort and two propensity score matching (PSM) models (model 1 adjusted for age and sex; model 2 adjusted for age, sex, systolic and diastolic blood pressure). The DeLong test was used to compare areas under receiver operating characteristic curves (AUCs) between baPWV and haPWV to predict PA. In all models, the PA patients had significantly higher baPWV compared to the EH patients. The AUC of haPWV was greater than that of baPWV. In conclusion, haPWV seems to be a better PWV parameter than baPWV in detecting aldosterone-induced arterial stiffness.

Ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (UPLCâQ-TOF/MS) was developed to identify the absorbed parent components and metabolites in rat bile, plasma and urine after oral administration of Radix Paeoniae Alba extract (RPAE). A total of 65 compounds were detected in rat bile, plasma and urine samples, including 11 parent compounds and 54 metabolites. The results indicated that glucuronidation, hydroxylation and methylation were the major metabolic pathways of the components of RPAE. Furthermore, the results of this work demonstrated that UPLCâQ-TOF/MS combined with MetaboLynx⢠software and mass defect filtering (MDF) could provide unique high throughput capabilities for drug metabolism study, with excellent MS mass accuracy and enhanced MSE data acquisition. With the MSE technique, both precursor and fragment mass spectra can be simultaneously acquired by alternating between high and low collision energy during a single chromatographic run. Keywords: Radix Paeoniae Alba, Metabolite profiling, UPLCâQ-TOF/MS, Monoterpene glycosides

Primary aldosteronism (PA) is characterized by excess production of aldosterone from the adrenal glands and is the most common and treatable cause of secondary hypertension. Aldosterone is a mineralocorticoid hormone that participates in the regulation of electrolyte balance, blood pressure, and tissue remodeling. The excess of aldosterone caused by PA results in an increase in cardiovascular and cerebrovascular complications, including coronary artery disease, myocardial infarction, stroke, transient ischemic attack, and even arrhythmia and heart failure. Endothelial dysfunction is a well-established fundamental cause of cardiovascular diseases and also a predictor of worse clinical outcomes. Accumulating evidence indicates that aldosterone plays an important role in the initiation and progression of endothelial dysfunction. Several mechanisms have been shown to contribute to aldosterone-induced endothelial dysfunction, including aldosterone-mediated vascular tone dysfunction, aldosterone- and endothelium-mediated vascular inflammation, aldosterone-related atherosclerosis, and vascular remodeling. These mechanisms are activated by aldosterone through genomic and nongenomic pathways in mineralocorticoid receptor-dependent and independent manners. In addition, other cells have also been shown to participate in these mechanisms. The complex interactions among endothelium, inflammatory cells, vascular smooth muscle cells and fibroblasts are crucial for aldosterone-mediated endothelial dysregulation. In this review, we discuss the association between aldosterone and endothelial function and the complex mechanisms from a molecular aspect. Furthermore, we also review current clinical research of endothelial dysfunction in patients with PA.

The safety issue of lithium-ion batteries is a crucial factor limiting their large-scale application. Therefore, it is of practical significance to evaluate the impact of their overcharge behavior because of the severe levels of oxygen release of cathode materials during this process. Herein, by combining a variety of in situ techniques of spectroscopy and electron microscopy, this work studies the structural degradation of LiNi0.8Co0.1Mn0.1O2 (NCM811) accompanying the oxygen release in the overcharge process. It is observed that a small amount of O2 evolves from the initial surface at ≈4.7 V. When charging to a higher voltage (≈5.5 V), a large amount of O2 evolves on the newly formed surface due to the occurrence of microcracks. Based on experimental results and theoretical calculations, it is determined that the oxygen release mainly occurs in the near-surface regions, where the remaining oxygen vacancies accumulate to create voids. To suppress the oxygen release, single-crystalline NCM811 with integrated structure is introduced and serves as a cathode, which can effectively inhibit morphology destruction and reduce the activation of lattice oxygen in the surface region. These findings provide a theoretical basis and effective strategy for improving the safety performance of Ni-rich cathode materials in practical applications.

Aldosterone is a mineralocorticoid hormone involved in controlling electrolyte balance, blood pressure, and cellular signaling. It plays a pivotal role in cardiovascular and metabolic physiology. Excess aldosterone activates mineralocorticoid receptors, leading to subsequent inflammatory responses, increased oxidative stress, and tissue remodeling. Various mechanisms have been reported to link aldosterone with cardiovascular and metabolic diseases. However, mitochondria, responsible for energy generation through oxidative phosphorylation, have received less attention regarding their potential role in aldosterone-related pathogenesis. Excess aldosterone leads to mitochondrial dysfunction, and this may play a role in the development of cardiovascular and metabolic diseases. Aldosterone has the potential to affect mitochondrial structure, function, and dynamic processes, such as mitochondrial fusion and fission. In addition, aldosterone has been associated with the suppression of mitochondrial DNA, mitochondria-specific proteins, and ATP production in the myocardium through mineralocorticoid receptor, nicotinamide adenine dinucleotide phosphate oxidase, and reactive oxygen species pathways. In this review, we explore the mechanisms underlying aldosterone-induced cardiovascular and metabolic mitochondrial dysfunction, including mineralocorticoid receptor activation and subsequent inflammatory responses, as well as increased oxidative stress. Furthermore, we review potential therapeutic targets aimed at restoring mitochondrial function in the context of aldosterone-associated pathologies. Understanding these mechanisms is vital, as it offers insights into novel therapeutic strategies to mitigate the impact of aldosterone-induced mitochondrial dysfunction, thereby potentially improving the outcomes of individuals affected by cardiovascular and metabolic disorders. [ABSTRACT FROM AUTHOR]

The safety and stability of high-speed maglev trains traveling on viaducts in crosswinds critically depend on their aerodynamic characteristics. Therefore, this paper uses an improved delayed detached eddy simulation (IDDES) method to investigate the aerodynamic features of high-speed maglev trains with different marshaling lengths under crosswinds. The effects of marshaling lengths (varying from 3-car to 8-car groups) on the train's aerodynamic performance, surface pressure, and the flow field surrounding the train were investigated using the three-dimensional unsteady compressible Navier-Stokes (N-S) equations. The results showed that the marshaling lengths had minimal influence on the aerodynamic performance of the head and middle cars. Conversely, the marshaling lengths are negatively correlated with the time-average side force coefficient (CS) and time-average lift force coefficient (Cl) of the tail car. Compared to the tail car of the 3-car groups, the CS and Cl fell by 27.77% and 18.29%, respectively, for the tail car of the 8-car groups. It is essential to pay more attention to the operational safety of the head car, as it exhibits the highest time average CS. Additionally, the mean pressure difference between the two sides of the tail car body increased with the marshaling lengths, and the side force direction on the tail car was opposite to that of the head and middle cars. Furthermore, the turbulent kinetic energy of the wake structure on the windward side quickly decreased as marshaling lengths increased. [ABSTRACT FROM AUTHOR]

Bilateral vertical noise barriers have been widely used along high-speed railway lines in coastal cities where typhoons are frequent. When a high-speed train (HST) enters (or exits) a noise barrier under strong crosswind conditions, its running safety will be more severely tested because of the instantaneous switching of aerodynamic environment. Installing a buffer structure at the end of the noise barrier is necessary to ensure the running safety of HSTs. In this study, two types of aerodynamic buffer structures (triangle and fence types) for the end of the noise barrier are proposed. The buffering effects of the two structures on the sudden change amplitude of the aerodynamic load of the carriage are compared by using an improved delayed detached eddy simulation method. The difference in the influence of the two buffer structures on the aerodynamic responses of the carriage is discussed by using a wind--train--bridge coupling dynamic response calculation method. The buffer mechanisms of the two structures are revealed in terms of the flow field. Results show that the buffering effect of fence type is superior triangle type, and the buffer length of 4 L is the most reasonable. [ABSTRACT FROM AUTHOR]