Abstract : A new thermal regime of QCD, featuring decoupled scale-invariant infrared glue, has been proposed to exist both in pure-glue (N f =0) and “real-world” (N f =2+1 at physical quark masses) QCD. In this IR phase, elementary degrees of freedom flood the infrared, forming a distinct component independent from the bulk. This behavior necessitates non-analyticities in the theory. In pure-glue QCD, such non-analyticities have been shown to arise via Anderson-like mobility edges in Dirac spectra (λ IR = 0, ±λ A ≠ 0), as manifested in the dimension function d IR(λ). Here, we present the first evidence, based on lattice QCD calculation at a=0.105 fm, that this mechanism is also at work in real-world QCD, thus supporting the existence of the proposed IR regime in nature. An important aspect of our results is that, while at T = 234 MeV we find a dimensional jump between zero modes and lowest near-zero modes very close to unity (d IR = 3 to d IR ≃ 2), similar to the IR phase of pure-glue QCD, at T = 187 MeV we observe a continuous λ-dependence. This suggests that thermal states just above the chiral crossover are non-analytically (in T) connected to thermal state at T = 234 MeV, supporting the key original proposition that the transition into the IR regime occurs at a temperature strictly above the chiral crossover.

Aims

Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort.

Methods and results

This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein-Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann-Whitney estimator 0.54, 95% confidence interval [CI] 0.47-0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200-370 mL (60% of patients) (Mann-Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death.

Conclusion

The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.

The ODYSSEY OUTCOMES trial, comprising over 47 000 patient-years of placebo-controlled observation, demonstrated important reductions in the risk of recurrent ischaemic cardiovascular events with the monoclonal antibody to proprotein convertase subtilisin/kexin type 9 alirocumab, as well as lower all-cause death. These benefits were observed in the context of substantial and persistent lowering of low-density lipoprotein cholesterol with alirocumab compared with that achieved with placebo. The safety profile of alirocumab was indistinguishable from matching placebo except for a ∼1.7% absolute increase in local injection site reactions. Further, the safety of alirocumab compared with placebo was evident in vulnerable groups identified before randomization, such as the elderly and those with diabetes mellitus, previous ischaemic stroke, or chronic kidney disease. The frequency of adverse events and laboratory-based abnormalities was generally similar to that in placebo-treated patients. Thus, alirocumab appears to be a safe and effective lipid-modifying treatment over a duration of at least 5 years.