Background Sodium-glucose cotransporter 2 inhibitors reduce hospitalizations for heart failure and cardiovascular death, although the underlying mechanisms have not been resolved. The SIMPLE trial (The Effects of Empagliflozin on Myocardial Flow Reserve in Patients With Type 2 Diabetes Mellitus) investigated the effects of empagliflozin on myocardial flow reserve (MFR) reflecting microvascular perfusion, in patients with type 2 diabetes mellitus at high cardiovascular disease risk. Methods and Results We randomized 90 patients to either empagliflozin 25 mg once daily or placebo for 13 weeks, as add-on to standard therapy. The primary outcome was change in MFR at week 13, quantified by Rubidium-82 positron emission tomography/computed tomography. The secondary key outcomes were changes in resting rate-pressure product adjusted MFR, changes to myocardial flow during rest and stress, and reversible cardiac ischemia. Mean baseline MFR was 2.21 (95% CI, 2.08-2.35). There was no change from baseline in MFR at week 13 in either the empagliflozin 0.01 (95% CI, -0.18 to 0.21) or placebo groups 0.06 (95% CI, -0.15 to 0.27), with no treatment effect -0.05 (95% CI, -0.33 to 0.23). No effects on the secondary outcome parameters by Rubidium-82 positron emission tomography/computed tomography was observed. Treatment with empagliflozin reduced hemoglobin A1c by 0.76% (95% CI, 1.0-0.5; P less then 0.001) and increased hematocrit by 1.69% (95% CI, 0.7-2.6; P less then 0.001). Conclusions Empagliflozin did not improve MFR among patients with type 2 diabetes mellitus and high cardiovascular disease risk. The present study does not support that short-term improvement in MFR explains the reduction in cardiovascular events observed in the outcome trials. Registration URL https//clinicaltrialsregister.eu/; Unique identifier 2016-003743-10.Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brach the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.Background Despite its established effectiveness, adherence to cardiac rehabilitation remains suboptimal. The purpose of our study is to examine whether mobile technology improves adherence to cardiac rehabilitation and other outcomes. Methods and Results We identified all enrollees of the cardiac rehabilitation program at Boston Medical Center from 2016 to 2019 (n=830). Some enrollees used a mobile technology application that provided a customized list of educational content in a progressive manner, used the patient's smartphone accelerometer to provide daily step counts, and served as a 2-way messaging system between the patient and program staff. Adherence to cardiac rehabilitation was defined as the number of attended sessions and completion of the program. Enrollees had a mean age of 59 years; 32% were women, and 42% were Black. Using 31 propensity matching for age, sex, race/ethnicity, education, smoking status, transportation time, diagnosis, and baseline depression survey score, we evaluated change in exercise capacity, weight, functional capacity, and nutrition scores. Those in the mobile technology group (n=114) attended a higher number of prescribed sessions (mean 28 versus 22; relative risk, 1.17; 95% CI, 1.04-1.32; P=0.009), were 1.8 times more likely to complete the cardiac rehabilitation program (P=0.01), and had a slightly greater weight loss (pounds) following rehabilitation (-1.71; 95% CI, -0.30 to -3.11; P=0.02) as compared with those in the standard group (n=213); other outcomes were similar between the groups. Conclusions In a propensity-matched, racially diverse population, we found that adjunctive use of mobile technology is significantly associated with improved adherence to cardiac rehabilitation and number of attended sessions.Spontaneous emulsification of toluene with nonylphenol polyethoxylate (NPE) and sodium dodecylbenzenesulfonate (SDBS) surfactants in saltwater environments was studied. NaCl promoted the spontaneous emulsification of an otherwise non-spontaneous SDBS-toluene system. Dynamic light scattering and turbidity indicated that spontaneity increased with NaCl concentration. The mechanism of spontaneous emulsification was dependent on surfactant type; NPE emulsified via micelle swelling, and SDBS emulsified via nucleation and growth. Hydrophilic lipophilic difference (HLD) calculations were used to model spontaneous emulsification and spontaneity. As HLD approached zero, conditions became more favorable for spontaneous emulsification. Between HLD values of -2.4 and -2.05, samples transitioned from non-spontaneous to spontaneous. This study aids in predicting spontaneous emulsion formation in saltwater environments for applications in nanoemulsion formation and wastewater remediation.In situ-formed iron carbides (FeCx) are the key components responsible for Fischer-Tropsch synthesis (FTS, CO + H2 → long-chain hydrocarbons) on Fe-based catalysts in industry. https://www.selleckchem.com/products/brd3308.html The true active site is, however, highly controversial despite more than a century of study, which is largely due to the combined complexity in both FeCx structures and mechanism of CO hydrogenation. Herein powered by machine learning simulation, millions of structure candidates for FeCx bulk and surfaces are explored under FTS conditions, which leads to resolving the active site for CO activation. This is achieved without a priori input from experiment by first constructing the thermodynamics convex hull of bulk phases, followed by identifying the low surface energy surfaces and evaluating the adsorption ability of CO and H, and finally determining the lowest energy reaction pathway of CO activation. Rich information on FeCx structures and CO hydrogenation pathways is gleaned (i) Fe5C2, Fe7C3, and Fe2C are the three stable bulk phases under FTS in producing olefins, where Fe7C3 and Fe2C have multiple energetically nearly degenerate bulk crystal phases; (ii) only three low surface energy surfaces of these bulk phases, namely, χ-Fe5C2(510), χ-Fe5C2(111), and η-Fe2C(111), expose the Fe sites that can adsorb H atoms exothermically, where the surface FeC ratio is 2, 1.