Comparative efficacy of vericiguat to sacubitril/valsartan for patients with heart failure reduced ejection fraction: Systematic review and network meta-analysis.

BACKGROUND: Despite the established efficacy of vericiguat compared to placebo, uncertainties remain regarding its comparative efficacy to sacubitril/valsartan for patients with heart failure reduced ejection fraction (HFrEF). This study aimed to assess the relative efficacy of vericiguat and sacubitril/valsartan through a systematic review, network meta-analysis, and non-inferiority tests. METHODS: A systematic review was conducted to identify the randomized phase 3 clinical trials involving vericiguat and sacubitril/valsartan. The hazard ratios (HRs) with 95% confidence intervals (CI) for cardiovascular death (CVD) and hospitalization due to HF (hHF) were extracted from these trials and synthesized via network meta-analysis. Non-inferiority testing of vericiguat was performed using a fixed-margin method with a predefined non-inferiority margin (1.24). Sensitivity analyses explored the impact of the time from hHF to screening. RESULTS: Among the 1366 studies, two trials (VICTORIA and PARADIGM-HF) met the inclusion criteria. Network meta-analysis demonstrated that the HR for CVD or hHF with vericiguat did not significantly differ from that for sacubitril/valsartan (HR: 0.88, 95% CI:0.62-1.23). The upper limit of the 95% CI was less than the predefined margin of 1.24, confirming vericiguat's non-inferiority to sacubitril/valsartan. Sensitivity analyses affirmed the robustness of the base-case results. CONCLUSION: Vericiguat exhibited a comparable risk of CVD or hHF when contrasted with sacubitril/valsartan. Importantly, in patients with HFrEF, vericiguat's efficacy was not statistically inferior to that of sacubitril/valsartan. These findings reinforce the potential of vericiguat as a viable treatment option for this patient population.

Morphologically Controlled Synthesis of Reduced-Dimensional ZnO/Zn(OH)2 Nanosheets.

Conventional two-dimensional materials either have natural layered structures or are produced, with large surface areas, via physical or chemical synthesis. However, to form a two-dimensional material from a non-layered material, a method different from the existing ones is required. In this study, a surfactant-assisted method was utilized to synthesize Zn(OH)2 (a nonlayered transition metal oxide) nanosheets. This study described the synthesis of Zn(OH)2 nanosheets using an anionic sulfate layer and demonstrated a method of controlling the thickness and shape of the synthesized nanosheets by varying the surfactant concentration. Further, the characteristics of oxygen evolution reaction using ZnO/Zn(OH)2 nanosheets, obtained by annealing the synthesized sheets, as catalysts were studied.

Atomic Arrangements of Graphene-like ZnO.

ZnO, which can exist in various dimensions such as bulk, thin films, nanorods, and quantum dots, has interesting physical properties depending on its dimensional structures. When a typical bulk wurtzite ZnO structure is thinned to an atomic level, it is converted into a hexagonal ZnO layer such as layered graphene. In this study, we report the atomic arrangement and structural merging behavior of graphene-like ZnO nanosheets transferred onto a monolayer graphene using aberration-corrected TEM. In the region to which an electron beam is continuously irradiated, it is confirmed that there is a directional tendency, which is that small-patched ZnO flakes are not only merging but also forming atomic migration of Zn and O atoms. This study suggests atomic alignments and rearrangements of the graphene-like ZnO, which are not considered in the wurtzite ZnO structure. In addition, this study also presents a new perspective on the atomic behavior when a bulk crystal structure, which is not an original layered structure, is converted into an atomic-thick layered two-dimensional structure.

Anisotropic Angstrom-Wide Conductive Channels in Black Phosphorus by Top-down Cu Intercalation.

Intercalation in black phosphorus (BP) can induce and modulate a variety of the properties including superconductivity like other two-dimensional (2D) materials. In this perspective, spatially controlled intercalation has the possibility to incorporate different properties into a single crystal of BP. We demonstrate anisotropic angstrom-wide (∼4.3 Å) Cu intercalation in BP, where Cu atoms are intercalated along a zigzag direction of BP because of its inherent anisotropy. With atomic structure, its microstructural effects, arising from the angstrom-wide Cu intercalation, were investigated and extended to relation with macrostructure. As the intercalation mechanism, it was revealed by in situ transmission electron microscopy and theoretical calculation that Cu atoms are intercalated through top-down direction of BP. The Cu intercalation anisotropically induces transition of angstrom-wide electronic channels from semiconductor to semimetal in BP. Our findings throw light on the fundamental relationship between microstructure changes and properties in intercalated BP, and tailoring anisotropic 2D materials at angstrom scale.

Dedicated preparation for in situ transmission electron microscope tensile testing of exfoliated graphene.

Graphene, which is one of the most promising materials for its state-of-the-art applications, has received extensive attention because of its superior mechanical properties. However, there is little experimental evidence related to the mechanical properties of graphene at the atomic level because of the challenges associated with transferring atomically-thin two-dimensional (2D) materials onto microelectromechanical systems (MEMS) devices. In this study, we show successful dry transfer with a gel material of a stable, clean, and free-standing exfoliated graphene film onto a push-to-pull (PTP) device, which is a MEMS device used for uniaxial tensile testing in in situ transmission electron microscopy (TEM). Through the results of optical microscopy, Raman spectroscopy, and TEM, we demonstrate high quality exfoliated graphene on the PTP device. Finally, the stress-strain results corresponding to propagating cracks in folded graphene were simultaneously obtained during the tensile tests in TEM. The zigzag and armchair edges of graphene confirmed that the fracture occurred in association with the hexagonal lattice structure of graphene while the tensile testing. In the wake of the results, we envision the dedicated preparation and in situ TEM tensile experiments advance the understanding of the relationship between the mechanical properties and structural characteristics of 2D materials.