Case report: Catheter ablation for persistent atrial fibrillation in a patient with heart of stone.

Myocardial calcification is a rare condition, with only a few reports in the literature. For the first time, we report a case of diffuse myocardial calcification who underwent successful catheter ablation for persistent atrial fibrillation (AF). In this case, catheter ablation was recommended due to repeated hospitalization for palpitation and heart failure, but preoperative computed tomography showed massive myocardial calcification. Electroanatomic mapping of the atrium was performed with a Pentaray catheter before ablation, which showed areas of low voltage in the calcified region. As the persistent AF was terminated after circumferential pulmonary vein isolation and posterior wall isolation, and no further ablation was performed. The patient recovered well, with no recurrence of palpitation or heart failure during the one-year follow-up.

Associations between neutrophil-lymphocyte ratio and monocyte to high-density lipoprotein ratio with left atrial spontaneous echo contrast or thrombus in patients with non-valvular atrial fibrillation.

BACKGROUND: The importance of inflammation in thrombosis is increasingly appreciated. Neutrophil-lymphocyte ratio (NLR) and monocyte to high-density lipoprotein ratio (MHR) are important indicators of systemic inflammation. This study aimed to investigate the associations between NLR and MHR with left atrial appendage thrombus (LAAT) and spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation. METHODS: This retrospective, cross-sectional study enrolled 569 consecutive patients with non-valvular atrial fibrillation. Multivariable logistic regression analysis was used to investigate independent risk factors of LAAT/SEC. Receiver operating characteristic (ROC) curves were used to evaluate the specificity and sensitivity of NLR and MHR in predicting LAAT/SEC. Subgroup and Pearson correlation analyses were used to assess the correlations between NLR and MHR with the CHA2DS2-VASc score. RESULTS: Multivariate logistic regression analysis showed that NLR (OR: 1.49; 95%CI: 1.173-1.892) and MHR (OR: 2.951; 95%CI: 1.045-8.336) were independent risk factors for LAAT/SEC. The area under the ROC curve of NLR (0.639) and MHR (0.626) was similar to that of the CHADS2 score (0.660) and CHA2DS2-VASc score (0.637). Subgroup and Pearson correlation analyses showed significant but very weak associations between NLR (r = 0.139, P < 0.05) and MHR (r = 0.095, P < 0.05) with the CHA2DS2-VASc score. CONCLUSION: Generally, NLR and MHR are independent risk factors for predicting LAAT/SEC in patients with non-valvular atrial fibrillation.

Telomere length and the risk of cardiovascular diseases: A Mendelian randomization study.

Background: The causal direction and magnitude of the associations between telomere length (TL) and cardiovascular diseases (CVDs) remain uncertain due to susceptibility of reverse causation and confounding. This study aimed to investigate the associations between TL and CVDs using Mendelian randomization (MR). Materials and methods: In this two-sample MR study, we identified 154 independent TL-associated genetic variants from a genome-wide association study (GWAS) consisting of 472,174 individuals (aged 40-69) in the UK Biobank. Summary level data of CVDs were obtained from different GWASs datasets. Methods of inverse variance weighted (IVW), Mendelian Randomization-Egger (MR-Egger), Mendelian Randomization robust adjusted profile score (MR-RAPS), maximum likelihood estimation, weighted mode, penalized weighted mode methods, and Mendelian randomization pleiotropy residual sum and outlier test (MR-PRESSO) were conducted to investigate the associations between TL and CVDs. Results: Our findings indicated that longer TL was significantly associated with decreased risk of coronary atherosclerosis [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.75-0.95; P = 4.36E-03], myocardial infarction (OR, 0.72; 95% CI, 0.63-0.83; P = 2.31E-06), ischemic heart disease (OR, 0.87; 95% CI, 0.78-0.97; P = 1.01E-02), stroke (OR, 0.87; 95% CI, 0.79-0.95; P = 1.60E-03), but an increased risk of hypertension (OR, 1.12; 95% CI, 1.02-1.23; P = 2.00E-02). However, there was no significant association between TL and heart failure (OR, 0.94; 95% CI, 0.87-1.01; P = 1.10E-01), atrial fibrillation (OR, 1.01; 95% CI, 0.93-1.11; P = 7.50E-01), or cardiac death (OR, 0.95; 95% CI, 0.82-1.10; P = 4.80E-01). Both raw and outlier corrected estimates from MR-PRESSO were consistent with those of IVW results. The sensitivity analyses showed no evidence of pleiotropy (MR-Egger intercept, P > 0.05), while Cochran's Q test and MR-Egger suggested different degrees of heterogeneity. Conclusion: Our MR study suggested that longer telomeres were associated with decreased risk of several CVDs, including coronary atherosclerosis, myocardial infarction, ischemic heart disease, and stroke, as well as an increased risk of hypertension. Future studies are still warranted to validate the results and investigate the mechanisms underlying these associations.

Mechanisms of gefitinib-induced QT prolongation.

Gefitinib, a tyrosine kinase inhibitor, was the first targeted therapy for non-small cell lung cancer (NSCLC). Gefitinib could block human Ether-à-go-go-Related Gene (hERG) channel, an important target in drug-induced long QT syndrome. However, it is unclear whether gefitinib could induce QT interval prolongation. Here, whole-cell patch-clamp technique was used for evaluating the effect of gefitinib on rapidly-activating delayed rectifier K+ current (IKr), slowly-activating delayed rectifier K+ current (IKs), transient outward potassium current (Ito), inward rectifier K+ current (IK1) and on action potentials in guinea pig ventricular myocytes. The Langendorff heart perfusion technique was used to determine drug effect on the ECG. Gefitinib depressed IKr by binding to open and closed hERG channels in a concentration-dependent way (IC50: 1.91 µM). The inhibitory effect of gefitinib on wildtype hERG channels was reduced at the hERG mutants Y652A, S636A, F656V and S631A (IC50: 8.51, 13.97, 18.86, 32.99 µM), indicating that gefitinib is a pore inhibitor of hERG channels. In addition, gefitinib accelerated hERG channel inactivation and decreased channel steady-state inactivation. Gefitinib also decreased IKs with IC50 of 23.8 µM. Moreover, gefitinib increased action potential duration (APD) in guinea pig ventricular myocytes and the corrected QT interval (QTc) in isolated perfused guinea pig hearts in a concentration-dependent way (1-30 µM). These findings indicate that gefitinib could prolong QTc interval by potently blocking hERG channel, modulating kinetic properties of hERG channel. Partial block of KCNQ1/KCNE1 could also contribute to delayed repolarization and prolonged QT interval. Thus, caution should be taken when gefitinib is used for NSCLC treatment.

Strategies for Improving the Stability of Tin-Based Perovskite (ASnX3) Solar Cells.

Although lead-based perovskite solar cells (PSCs) are highly efficient, the toxicity of lead (Pb) limits its large-scale commercialization. As such, there is an urgent need to find alternatives. Many studies have examined tin-based PSCs. However, pure tin-based perovskites are easily oxidized in the air or just in glovebox with an ultrasmall amount of oxygen. Such a characteristic makes their performance and stability less ideal compared with those of lead-based perovskites. Herein, how to address the instability of tin-based perovskites is introduced in detail. First, the crystalline structure, optical properties, and sources of instability of tin-based perovskites are summarized. Next, the preparation methods of tin-based perovskite are discussed. Then, various measures for solving the instability problem are explained using four strategies: additive engineering, deoxidizer, partial substitution, and reduced dimensions. Finally, the challenges and prospects are laid out to help researchers develop highly efficient and stable tin-based perovskites in the future.

Unveiling the Effects of Hydrolysis-Derived DMAI/DMAPbI x Intermediate Compound on the Performance of CsPbI3 Solar Cells.

Introducing hydroiodic acid (HI) as a hydrolysis-derived precursor of the intermediate compounds has become an increasingly important issue for fabricating high quality and stable CsPbI3 perovskite solar cells (PSCs). However, the materials composition of the intermediate compounds and their effects on the device performance remain unclear. Here, a series of high-quality intermediate compounds are prepared and it is shown that they consist of DMAI/DMAPbI x . Further characterization of the products show that the main component of this system is still CsPbI3. Most of the dimethylammonium (DMA+) organic component is lost during annealing. Only an ultrasmall amount of DMA+ is doped into the CsPbI3 and its structure is stabilized. Meanwhile, excessive DMA+ forms Lewis acid-base adducts and interactions with Pb2+ on the CsPbI3 surface. This process passivates the CsPbI3 film and decreases the recombination rate. Finally, CsPbI3 film is fabricated with high crystalline, uniform morphology, and excellent stability. Its corresponding PSC exhibits stable property and improved power conversion efficiency (PCE) up to 17.3%.

Highly Eu3+ ions doped novel red emission solid solution phosphors Ca18Li3(Bi,Eu)(PO4)14: structure design, characteristic luminescence and abnormal thermal quenching behavior investigation.

To research and develop potential phosphors for ultraviolet-based white light emitting diodes, a novel red emission phosphate phosphor Ca18Li3Bi1-xEux(PO4)14 was synthesized and investigated in the full range of 0 ≤x≤ 1. The phase purity and crystal structure of the solid solution phosphors were investigated in detail by employing X-ray diffractometer structure refinement, scanning electron microscopy and energy dispersive spectrometry. The crystal structure information was confirmed and the structure as well as the doping concentration dependent characteristic photoluminescence properties were discussed in detail. The results indicated that high Eu3+ doping content x could be realized in Ca18Li3Bi1-xEux(PO4)14 solid solutions even when x = 1. The luminescence performance revealed that Ca18Li3Bi1-xEux(PO4)14 phosphors could emit intense red emission under 394 nm excitation with excellent CIE chromaticity coordinates and high color purity. The concentration dependent emission decay behavior at room temperature and the temperature dependent decay behavior were studied to investigate the luminescent dynamics. The abnormal thermal quenching behavior was investigated via the temperature dependent emission. The related mechanism was discussed through thermoluminescence analysis, charge compensation contrast test and the cooling emission curve measurement, and the thermal activation energy was studied. The above results indicated that the Ca18Li3Bi1-xEux(PO4)14 could be a promising red-emitting phosphor for white light emitting diodes.

Sustained localized reentry within the left atrial appendage as a mechanism of recurrent arrhythmia following atrial fibrillation ablation.

The current study investigated the electrophysiological characteristics and radiofrequency ablation in patients with localized reentry within the left atrial appendage during repeated ablation for recurrent atrial fibrillation (AF). A total of 76 patients (21 paroxysmal, 55 persistent) undergoing repeated catheter ablation for recurrent AF were enrolled in this study. Local reentry tachycardia within the left atrial appendage (LAA) was identified through combining activation and entrainment mapping. Left atriography was performed prior to radiofrequency ablation to identify the focus in the LAA. Three patients (1 paroxysmal, 2 persistent) with sustained atrial tachycardias (ATs) were identified during repeated ablation in this cohort. Combined activation and entrainment mapping were applied to localize the reentry. Postpacing interval-tachycardia cycle length differences were <30 msec at the possible site of reentry in varying segments with macro-reentry. This difference was only determined at the base of LAA for local reentry within the LAA. All 3 patients were free of atrial arrhythmias without any complications at the 6-month follow-up following the ablation in the LAA. Combining activation and entrainment mapping were necessary in approaching ATs within the LAA. Performing entrainments in opposite segments of possible loops were valuable in precluding macro-reentry. Focal ablation was safe and effective in this cohort. Therefore localized reentry within the LAA was not uncommon during repeat AF ablation. The present study may thus provide valuable information for clinicians to manage this type of arrhythmia.