Sex Differences in the Relationship between Abdominal Obesity and Cardiovascular Death in Elderly Patients with Permanent Pacemakers Implantation: A Retrospective Cohort Study.

Objectives: This study aims to investigate the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs). Methods: This is a retrospective cohort study that enrolled patients who underwent PPM implantation in Fuwai Hospital from May 2010 to April 2014, according to the BIOTRONIK Home Monitoring database. The WC was treated as sex-specific quartiles, and patients were divided into three groups according to body mass index (BMI): normal (≤22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (≥25 kg/m2). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for cardiovascular death according to WC and BMI in patients. Results: 492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men (n = 271)). Data showed that after a mean follow-up 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. Men in the third quartile of WC had an HR of 10.67 (Model 4, 95% CI: 1.00-115.21, p trend = 0.04) for cardiovascular death. However, the association disappeared in female patients (Model 4, HR = 3.99, 95% CI: 0.37-42.87, p trend = 0.25). There was no association between BMI and cardiovascular death or all-cause mortality in both male and female patients. Conclusions: Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs, and this relationship was only in male patients.

Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators.

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality. Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively. Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA

Cognitive basis for the development of aesthetic preference: Findings from symmetry preference.

Where is the visual aesthetic preference rooted from and what's its relationship with the perceptual preference that is emerging early? Do young children naturally prefer some visual stimuli or do they learn to appreciate visual stimuli for aesthetic pleasure? Here, for young preschool children who are on the age that the preferences are developing, we provide findings from a study to show that the interplay between early emerging perceptual sensitivity and perceptual exposure promotes the emergence of preschool children's aesthetic preferences for simple visual patterns. Specifically in the experiments, 4-year-old children were exposed to either symmetric or asymmetric non-figurative forms in a perceptually demanding game; the group of children who received exposure to symmetric patterns showed aesthetic preference to the exposed patterns, while no preference was found in the group that received exposure to asymmetric patterns. The following recognition test then showed that the symmetric objects were differentiated better and remembered more clearly by the children, indicating that the symmetry was perceptually encoded better. These findings suggest that the early emerging perceptual sensitivity to 'good features' such as symmetry provides the prior cognitive prerequisites, allowing visual perceptual exposure to nourish the eventual formation of aesthetic preference. Thus, the preferences for aesthetic appreciation are likely the outcome of the interplay between biological and ecological adaptation.

Plasma big endothelin-1 is an effective predictor for ventricular arrythmias and end-stage events in primary prevention implantable cardioverter- defibrillator indication patients.

OBJECTIVE: To investigate whether plasma big endothelin-1 (ET-1) predicts ventricular arrythmias (VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator (ICD) indication patigents. METHODS: In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1 (< 0.38 pmol/L, n = 68), tertile 2 (0.38-0.7 pmol/L, n = 69), and tertile 3 (> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation. RESULTS: During a mean follow-up period of 25.6 ± 13.9 months, 38 (18.4%) VAs and 78 (37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class (r = 0.165, P = 0.018), serum creatinine concentration (Scr; r = 0.147, P = 0.034), high-sensitivity C-reactive protein (hs-CRP; r = 0.217, P = 0.002), Lg NT-pro BNP (r = 0.463, P < 0.001), left ventricular end diastolic diameter (LVEDD; r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction (LVEF; r = -0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events (P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs (hazard ratio (HR) = 3.477, 95% confidence interval (CI): 1.352-8.940, P = 0.010, tertile 2 vs. tertile 1; HR = 4.112, 95% CI: 1.604-10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events (HR = 2.804, 95% CI: 1.354-5.806, P = 0.005, tertile 2 vs. tertile 1; HR = 4.652, 95% CI: 2.288-9.459, P < 0.001, tertile 3 vs. tertile 1). CONCLUSIONS: In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator.

BACKGROUND: Previous studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking. HYPOTHESIS: This study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD. METHODS: This study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m2 ), overweight and obese group (BMI≥24 kg/m2 ). The primary endpoint was all-cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock. RESULTS: During a median follow-up of 61 (1-95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26-0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models. CONCLUSIONS: Compared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.

Association of the Obesity Paradox With Objective Physical Activity in Patients at High Risk of Sudden Cardiac Death.

OBJECTIVE: To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death. METHODS: A total of 782 patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators in the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-Implantable Patients registry were retrospectively analyzed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5 ≤ BMI < 25) and overweight or class I obesity (25 ≤ BMI < 35). PA was measured with home monitoring and categorized into 4 groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality. RESULTS: During a mean follow-up period of 59.9 ±â€…21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P = 0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P < 0.001). Multivariate Cox analysis indicated BMI (hazard ratio, 0.918; 95% confidence interval, 0.866-0.974; P = 0.004) and PA (0.436, 0.301-0.631, Q2 vs Q1; 0.280, 0.181-0.431, Q3 vs Q1; 0.257, 0.158-0.419, Q4 vs Q1; P < 0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P = 0.049) and low PA group (log rank P = 0.010), but disappeared in the high PA group (log rank P = 0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups. CONCLUSIONS: The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.

Nonfullerene Ternary Organic Solar Cell with Effective Charge Transfer between Two Acceptors.

High power conversion efficiency can be realized by using a ternary bulk heterojunction with complementary absorption spectra in organic solar cells. However, as the development of nonfullerene acceptors with a broad absorption spectrum makes the absorption efficiency of the photovoltaic devices close to optimal, such a strategy needs modifying. In particular, charge transfer between the two acceptors is necessary to be considered. Herein, we purposely design a ternary system based on PTB7-Th:COi8DFIC:ITIC-4F. Though the presence of ITIC-4F in PTB7-Th:COi8DFIC could not broaden the absorption spectrum obviously, the formed cascade-energy-level alignment is beneficial for promoting and balancing exciton separation and charge transport between the donor and two acceptors and even between the acceptors. Insights into the charge transport route in the completed system are provided via using the techniques including photoluminescence spectroscopy and pump-probe photoconductivity spectroscopy. This work provides a new idea for designing highly efficient ternary organic solar cells.

Insights into Charge Separation and Transport in Ternary Polymer Solar Cells.

Although ternary polymer solar cells have more potential in realizing a high power conversion efficiency than the binary counterparts, the mechanism of exciton separation and charge transport in such complicated ternary systems is far from being understood. Herein, we focus on this issue and give a clear view on the detailed roles of the ternary components contributing to the device performance, through utilizing the technique of pump-probe photoconductivity spectroscopy combined with transient photoluminescence spectroscopy, for the first time for ternary polymer solar cells. The ternary photovoltaic devices are based on PBDB-T:ITIC:PC71BM and present a dramatic improvement in efficiency in comparison to that of the binary counterparts. Systematic investigation reveals that the excitons generated in ITIC could be separated at the interface of PBDB-T:ITIC rather than ITIC:PC71BM with holes injecting to PBDB-T. These holes together with those generated in PBDB-T contribute to the photocurrent of the devices. The aggregation of holes in PBDB-T would also weaken the exciton generation herein, and the electron injection to PC71BM and ITIC would also be influenced. The key role of PC71BM in the ternary devices is accepting the electrons from PBDB-T and transporting them to the cathode with a higher rate than that of ITIC. Thus, this article is of importance in constructing high-efficiency ternary polymer solar cells.

The aesthetic preference for symmetry dissociates from early-emerging attention to symmetry.

Symmetry is a basic geometry property that affects people's aesthetic experience in common ways across cultures and historical periods, but the origins of the universal preference for symmetrical patterns is not clear. We assessed four-year-old children's and adults' reported aesthetic preferences between symmetrical and asymmetrical visual patterns, as well as their spontaneous attentional preferences between the patterns. We found a striking dissociation between these two measures in the children: Children looked longer at the symmetrical patterns, relative to otherwise similar but asymmetrical patterns, but they showed no explicit preference for those patterns. These findings suggest that the human's aesthetic preferences have high postnatal plasticity, calling into question theories that symmetry is a "core feature" mediating people's aesthetic experience throughout life. The findings also call into question the assumption, common to many studies of human infants, that attentional choices reflect subjective preferences or values.

Trend in young coronary artery disease in China from 2010 to 2014: a retrospective study of young patients ≤ 45.

BACKGROUND: The incidence of young coronary heart disease (CHD, ≤45 years) in China is increasing. Secondary prevention to counter this trend is an important contemporary public health issure. METHODS: A total of 5288 patients (≤45 years) diagnosed with CHD and hospitalized at the Chinese PLA General Hospital and Anzhen Hospital, both in Beijing, were enrolled after satisfying the inclusion criteria. RESULTS: Young CHD patients increased in number from 2010 to 2014, especially men. Among the studied patients, there was no significant change over those years in blood pressure, but heart rate increased significantly (P < 0.05) and body mass index showed a rising trend (P > 0.05). The incidence of hypertension increased from 40.7 to 47.5%, diabetes from 20.3 to 26.1%, and hyperlipidemia from 27.3 to 35.7% (P < 0.05). However, the incidences of smoking and drinking both trended downward (P < 0.05). The levels of total cholesterol and triglycerides also showed a downward trend (P < 0.05), as did levels of low-density lipoprotein, but not to the point of statistical significance (P > 0.05). Mortality during hospitalization decreased significantly from 2010 to 2014 (P < 0.05), but there was no significant improvement in the incidences of cardiac death and major adverse cardiovascular events (MACE) after 1-year follow-up (P > 0.05). CONCLUSIONS: Over the 5 years studied, the overall incidence of cardiac death and MACE for young CHD patients (≤45 years) has shown little improvement. Secondary prevention of young CHD, and its risk factors, as well as appropriate courses of medical treatment must be further elucidated.

[Qualitative and quantitative analysis of fluoxetine hydrochloride by 19F NMR].

The chemical shift of fluoxetine hydrochloride appears at delta 14.15 in 19F NMR analysis. The delta moved upfield slightly from 14.158 to 14.145 when the concentration of solution became diluted from 2.00 to 0.05 mmol x L(-1). Spiking test was suggested to confirm the existence of the compound for qualitative analysis. 19F NMR detection sensitivity test illustrated that a concentration of 17 mg in 1 L water could be detected while the sample was scanned 500 times with optimum parameters. In quantitative analysis, standard curve of concentration versus fluorine signal intensity was proposed to determine the amount of fluoxetine. Long capillary tube containing trifluoroacetic acid was used as internal standard for the integration measurements and straight line was obtained with good fitting. Direct additions of trifluoroethanol to fluoxetine solutions gave a poorer standard curve.