'CSXI' is an application and it is based on the programming in C++. This app is useful for the student of class XI. This app is useful for the students who need help regarding basics programs while coding. We tried to put some very important programs. 'CSXI' is an easy to use and very simple user interface (UI).

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Original Article Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure John J.V. McMurray, M.D., Milton Packer, M.D., Akshay S. Desai, M.D., M.P.H., Jianjian Gong, Ph.D., Martin P. Lefkowitz, M.D., Adel R.

Rizkala, Pharm.D., Jean L. Rouleau, M.D., Victor C. Shi, M.D., Scott D. Solomon, M.D., Karl Swedberg, M.D., Ph.D., and Michael R. Zile, M.D., for the PARADIGM-HF Investigators and Committees N Engl J Med 2014; 371:993-1004 DOI: 10.1056/NEJMoa1409077 open through September 17, 2014. Methods In this double-blind trial, we randomly assigned 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily), in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure, but the trial was designed to detect a difference in the rates of death from cardiovascular causes.

Results The trial was stopped early, according to prespecified rules, after a median follow-up of 27 months, because the boundary for an overwhelming benefit with LCZ696 had been crossed. At the time of study closure, the primary outcome had occurred in 914 patients (21.8%) in the LCZ696 group and 1117 patients (26.5%) in the enalapril group (hazard ratio in the LCZ696 group, 0.80; 95% confidence interval [CI], 0.73 to 0.87; P. Figure 1 Screening Criteria, Run-in Periods, and Randomization. The proportion of patients who withdrew from the study because of adverse events was higher during the enalapril run-in period than during the LCZ696 run-in period after adjustment for the longer duration of LCZ696 exposure. The most common reasons for withdrawal from the study during the run-in period were hypotension, cough, hyperkalemia, and renal dysfunction.

During the run-in period, 8 patients did not take enalapril and took only LCZ696. IQR denotes interquartile range, and GCP Good Clinical Practice. Angiotensin-converting–enzyme (ACE) inhibitors have been the cornerstone of the treatment for heart failure and a reduced ejection fraction for nearly 25 years, since enalapril was shown to reduce the risk of death in two trials. Long-term treatment with enalapril decreased the relative risk of death by 16% among patients with mild-to-moderate symptoms.