A Simple Nomogram to Predict Contrast-Induced Acute Kidney Injury in Patients with Congestive Heart Failure Undergoing Coronary Angiography.

BACKGROUND: Patients with congestive heart failure (CHF) are vulnerable to contrast-induced kidney injury (CI-AKI), but few prediction models are currently available. Therefore, we aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. METHODS: A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48-72 hours following the procedure. Predictors for the simple nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer-Lemeshow test and 1000 bootstrap samples. RESULTS: The incidence of CI-AKI was 9.06% (170) in the total sample, 8.64% (n = 109) in the development cohort, and 9.92% (n = 61) in the validation cohort (P=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction, and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs. 0.75, P=0.061), as well as a well-fitted calibration curve. CONCLUSIONS: The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed.

Impact of contrast-induced acute kidney injury on the association between renin-angiotensin system inhibitors and long-term mortality in heart failure patients.

INTRODUCTION: Renin-angiotensin system inhibitors (RASi) reduce mortality among heart failure (HF) patients, but their effect among those complicating contrast-induced acute kidney injury (CI-AKI) remains unexplored. We aimed to investigate whether the relationship between RASi prescription at discharge and mortality differs between HF patients with or without CI-AKI following coronary angiography (CAG). METHODS: About 596 HF patients from an observational cohort were divided into a CI-AKI group (n = 104) and a non-CI-AKI group (n = 492) based on whether they had CI-AKI following CAG. The endpoint was all-cause mortality. Multivariable Cox regression was performed in each group to explore the associations between RASi at discharge and mortality. RESULTS: During the median follow-up time of 2.26 (1.70; 3.24) years, higher mortality rate was observed in the CI-AKI group compared to the non-CI-AKI group (18.3% vs 8.9%, p = 0.002). Among HF patients with CI-AKI, after adjusting for confounding factors, the association was not significant between RASi prescription at discharge and mortality (HR: 0.39, 95%CI: 0.12-1.31, p = 0.128), while it was among those without CI-AKI (HR: 0.39, 95%CI: 0.18-0.84, p = 0.016). CONCLUSION: RASi prescription at discharge for HF patients complicating CI-AKI tended to be ineffective, while it benefited those without CI-AKI. Further randomized evidence is needed to confirm this trend.

Experimental Study of a Signal Modulation Method to Improve eLORAN Data Channel Communications.

There are mainly two types of data modulation methods used for enhanced LOng-RAnge Navigation (eLORAN) systems: pulse position modulation (PPM) and supernumerary interpulse modulation (SIM). The typical application for PPM is tri-state PPM (3S-PPM), also known as Eurofix. The typical application for SIM is ninth pulse modulation. Both of these methods are phase modulation methods. Phase modulation coding, a very mature technology, is used at present. To achieve a better demodulation success rate of eLORAN digital modulation signals at longer distances, a method of using the transmitting station duplex mode to transmit a digital modulation pulse group after LORAN-C transmitting a pulse group is proposed to realize modulation pulse on-off modulation. In this method, a broadcasting experiment was performed on the BPL (The call sign of eLORAN time service system in China) broadcaster station. After monitoring, a good receiving demodulation effect was initially obtained.

Experimental evidence and network pharmacology-based analysis reveal the molecular mechanism of Tongxinluo capsule administered in coronary heart diseases.

BACKGROUND: Tongxinluo (TXL) capsule, a polypharmacy derived from traditional Chinese medicine (TCM), has been widely used in coronary heart disease (CHD), while the underlying mechanism of TXL capsule is still unclear. The present study aimed at investigating the underlying mechanism of TXL acting on CHD patients and providing substantial evidence in molecular evidence by means of a network pharmacological analysis. METHOD: Active compounds and targeted genes of TXL were retrieved from TCM systems pharmacology (TCMSP) and TCM integrative database (TCMID). CHD and coronary artery disease were treated as search queries in GeneCards and Online Mendelian Inheritance in Man (OMIM) databases to obtain disease-related genes. Visualization of disease-targets network was performed under administration of Cytoscape software. Besides, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were administered. H9c2 cells were used to validate the predicted results in cardiomyocytes/reoxygenation model, and anti-inflammatory ability was examined. RESULTS: A network of a total of 212 nodes and 1016 edges was obtained. Peptide and ubiquitin-like protein ligase binding occupied a leading position of GO enrichment. For KEGG analysis, fluid shear stress and atherosclerosis, as well as inflammation-related pathways were enriched. Cellular validation revealed the anti-inflammatory effect of ß-sitosterol, eriodictyol, odoricarpin, and tirucallol as active compounds of TXL. CONCLUSION: Our study provided substantial molecular evidence that TXL capsule possessed the characteristics of multitargets with safe profile, and the main component is capable of regulating cytokine level in CHD patients.

Demodulation Method for Loran-C at Low SNR Based on Envelope Correlation-Phase Detection.

Loran-C is the most important backup and supplement system for the global navigation satellite system (GNSS). However, existing Loran-C demodulation methods are easily affected by noise and skywave interference (SWI). Therefore, this article proposes a demodulation method based on Loran-C pulse envelope correlation-phase detection (EC-PD), in which EC has two implementation schemes, namely moving average-cross correlation and matched correlation, to reduce the effects of noise and SWI. The mathematical models of the EC, calculation of the signal-to-noise ratio (SNR) gain, and selection of the EC schemes are given. The simulation results show that compared with an existing method, the proposed method has clear advantages: (1) The demodulation SNR threshold under Gaussian channel is only -2 dB, a reduction of 12.5 dB; (2) The probability of the demodulated SNR threshold, being less than zero under the SWI environment, can reach 0.78, a 26-fold increase. The test results show that the average data availability of the proposed method is 3.3 times higher than that of the existing method. Thus, our demodulation method has higher engineering application value. This will improve the performance of the modern Loran-C system, making it a more reliable backup for the GNSS.

Precise Loran-C Signal Acquisition Based on Envelope Delay Correlation Method.

The Loran-C system is an internationally standardized positioning, navigation, and timing service system. It is the most important backup and supplement for the global navigation satellite system (GNSS). However, the existing Loran-C signal acquisition methods are easily affected by noise and cross-rate interference (CRI). Therefore, this article proposes an envelope delay correlation acquisition method that, when combined with linear digital averaging (LDA) technology, can effectively suppress noise and CRI. The selection of key parameters and the performance of the acquisition method are analyzed through a simulation. When the signal-to-noise ratio (SNR) is -16 dB, the acquisition probability is more than 90% and the acquisition error is less than 1 µs. When the signal-to-interference ratio (SIR) of the CRI is -5 dB, the CRI can also be suppressed and the acquisition error is less than 5 µs. These results show that our acquisition method is accurate. The performance of the method is also verified by actual signals emitted by a Loran-C system. These test results show that our method can reliably detect Loran-C pulse group signals over distances up to 1500 km, even at low SNR. This will enable the modern Loran-C system to be a more reliable backup for the GNSS system.