Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation.

Background: With the establishment of the cardiac-gut axis concept, increasing evidence has suggested the involvement and important regulatory role of the gut microbiota (GM) and short chain fatty acid (SCFA) in cardiovascular diseases. However, the relationship between GM and atrial fibrillation (AF) is still poorly understood. Objectives: The aim of this study was to investigate whether there were differences in GM and SCFA between AF patients and healthy controls. Methods: In this study, we enrolled 30 hospitalized patients with AF and 30 matched patients with sinus rhythm (SR). GM species in fecal samples were evaluated through amplicon sequencing targeting the 16Sribosomal RNA gene. The feces SCFAs were describe step by step the quantitative analysis using gas chromatography-mass spectrometry (GC-MS). GM species richness, diversity, differential abundance of individual taxa between AF and SR were analyzed. Results: AF patients showed decreased species richness and α-diversity compared to SR patients, but there was no statistical difference. The phylogenetic diversity was significant decreased in AF group. The ß-diversity indexes revealed significant differences in GM community structure between the AF group and the SR group. After investigated the individual taxa, AF group showed altered relative abundance in several taxa compared to the SR group. linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed, a significant decrease in Bifidobacterium and a greater abundance of Lactobacillus, Fusobacterium, Haemophilus in AF group compared with the SR group. The abundance of haemophilus was negative correlated with isovaleric acid and isobutyric acid. Conclusions: In AF patients, the GM phylogenetic diversity and ß-diversity decreased, the relative abundance altered in several taxa and the bacterial community structure changed as well as the SCFA level. GM and SCFA dysbiosis might play a crucial part in the occurrence and development of AF.

Recent Developments of Photodeformable Polymers: From Materials to Applications.

Photodeformable polymer materials have a far influence in the fields of flexibility and intelligence. The stimulation energy is converted into mechanical energy through molecular synergy. Among kinds of photodeformable polymer materials, liquid crystalline polymer (LCP) photodeformable materials have been a hot topic in recent years. Chromophores such as azobenzene, α-cyanostilbene, and 9,10-dithiopheneanthracene have been widely used in LCP, which are helpful for designing functional molecules to increase the penetration depth of light to change physical properties. Due to the various applications of photodeformable polymer materials, there are many excellent reports in intelligent field. In this review, we have systematized LCP containing azobenzene into 3 categories depending on the degree of crosslinking liquid crystalline elastomers, liquid crystalline networks, and linear LCPs. Other structural, typical polymer materials and their applications are discussed. Current issues faced and future directions to be developed for photodeformable polymer materials are also summarized.

Normal thyroid stimulating hormone is associated with all-cause mortality in patients with acute myocardial infarction after percutaneous coronary intervention.

BACKGROUND: Circulating thyroid-stimulating hormone (TSH) levels within the normal reference range can affect the cardiovascular system. The present study investigated the prognostic value of normal TSH levels in patients presenting with acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). METHODS: Between January 2013 and July 2019, 1240 patients with AMI and normal thyroid function were enrolled and classified according to TSH tertile. The trial endpoint was all-cause mortality. The integrated discrimination index (IDI) and the net reclassification index (NRI) were used to assess the combined predictive values of the TSH levels and the Global Registry of Acute Coronary Events (GRACE) scores. RESULTS: After a median 44.25-month follow-up, 195 individuals died. Even after covariate adjustment by multivariate Cox regression (HR: 1.56; 95% CI 1.08-2.25; P = 0.017), the patients in the third TSH tertile were at the highest risk of all-cause mortality. A subgroup analysis revealed significant interactions between the TSH levels and the GRACE scores (high risk vs. low/medium risk) (P = 0.019). The addition of the TSH levels to the GRACE scores substantially improved the prediction of all-cause mortality, especially for high-risk patients (NRI = 0.239; IDI = 0.044; C-statistic value range 0.649-0.691; all significant). CONCLUSIONS: The third TSH tertile is associated with a higher incidence of all-cause mortality than the first TSH tertile in high-risk patients presenting with AMI after PCI.

Highly Twisted Thermally Activated Delayed Fluorescence (TADF) Molecules and Their Applications in Organic Light-Emitting Diodes (OLEDs).

Thermally activated delayed fluorescence (TADF) materials have attracted great potential in the field of organic light-emitting diodes (OLEDs). Among thousands of TADF materials, highly twisted TADF emitters have become a hotspot in recent years. Compared with traditional TADF materials, highly twisted TADF emitters tend to show multi-channel charge-transfer characters and form rigid molecular structures. This is advantageous for TADF materials, as non-radiative decay processes can be suppressed to facilitate efficient exciton utilization. Accordingly, OLEDs with excellent device performances have also been reported. In this Review, we have summarized recent progress in highly twisted TADF materials and related devices, and give an overview of the molecular design strategies, photophysical studies, and the performances of OLED devices. In addition, the challenges and perspectives of highly twisted TADF molecules and the related OLEDs are also discussed.

Association of the Systemic Immune-Inflammation Index with Outcomes in Acute Coronary Syndrome Patients with Chronic Kidney Disease.

Background: The systemic immune-inflammation index (SII; neutrophil × platelet/lymphocyte) is a novel marker for immune and inflammatory status and is associated with adverse prognosis in cardiovascular disease. Methods: In total, 744 patients diagnosed with acute coronary syndrome (ACS) and chronic kidney disease (CKD) were included in our study, received standard therapies, and were followed up. Patients were divided into high and low SII groups according to the baseline SII. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Results: During a median follow-up of 2.5 years, a total of 185 (24.9%) MACEs were recorded. Analysis of the ROC curve revealed that the best cutoff value of SII was 1159.84×109/L for predicting MACEs. The Kaplan-Meier analysis showed that those patients in the low SII group had higher survival rates than those in the high SII group (p < 0.001). Compared to those in the low SII group, patients in the high SII group were at significantly higher risk of MACEs (134 (38.8%) vs 51 (12.8%), p < 0.001). Univariate and multivariable Cox regression analyses revealed that a high SII level was independently associated with MACEs in ACS patients with CKD (adjusted hazard ratio [HR]: 1.865, 95% confidence interval [CI]: 1.197-2.907, p = 0.006). Conclusion: The present study showed that an elevated SII is associated with adverse cardiovascular outcomes in ACS with CKD patients, suggesting that SII may be a valuable predictor of poor prognosis in ACS with CKD patients. Further studies are needed to confirm our findings.

Room Temperature Strengthening and High-Temperature Superplasticity of Mg-Li-Al-Sr-Y Alloy Fabricated by Asymmetric Rolling and Friction Stir Processing.

Magnesium-lithium alloy is the lightest alloy to date. To explore its room temperature strength and high-temperature ductility, a plate of a new fine-grained Mg-9.13Li-3.74Al-0.31Sr-0.11Y alloy was fabricated by asymmetric rolling, and the rolled plate was subjected to friction stir processing (FSP). The microstructure and mechanical properties at room and elevated temperatures were investigated by optical microscopy, X-ray diffraction (XRD), energy dispersive spectroscopy (EDS), and tensile tester. Grain refinement with an average grain size in the α-Mg phase of 1.65 µm and an average grain size in the ß-Li phase of 4.24 µm was achieved in the water-cooled FSP alloy. For room temperature behavior, the ultimate tensile strength of 208 ± 4 MPa, yield strength of 193 ± 2 MPa, and elongation of 48.2% were obtained in the water-cooled FSP alloy. XRD and EDS analyses revealed that the present alloy consists of α-Mg and ß-Li phases, Al2Y, Al4Sr, MgLi2Al, and AlLi intermetallic compounds. For high-temperature behavior, the maximum superplasticity or ductility of 416% was demonstrated in this fine-grained alloy with an average grain size of 10 µm at 573 K and 1.67 × 10-3 s-1. A power-law constitutive equation was established. The stress exponent was 2.29 (≈2) (strain rate sensitivity 0.44), and the deformation activation energy was 162.02 kJ/mol. This evidence confirmed that the dominant deformation mechanism at elevated temperatures is grain boundary and interphase boundary sliding controlled by lattice diffusion.

Room-Temperature Strengthening, Portevin-Le Chatelier Effect, High-Temperature Tensile Deformation Behavior, and Constitutive Modeling in a Lightweight Mg-Gd-Al-Zn Alloy.

To explore room-temperature strengthening and high-temperature ductility, a lightweight novel Mg-1.85Gd-0.64Al-0.62Zn alloy was fabricated by innovative multidirectional forging and a hot-rolling technique. Microstructures and mechanical properties were studied at room and elevated temperatures with an optical microscope, an X-ray diffractometer, and a tensile tester. An ultimate tensile strength of 260 MPa, yield strength of 171 MPa, and elongation of 20.4% were demonstrated at room temperature. The room-temperature strengthening mechanisms were identified by strengthening the model estimation. A type C Portevin-Le Chatelier effect was discovered and elucidated in this alloy. X-ray diffraction analysis revealed that the phase composition is α-Mg solid solution and (Mg, Al)3Gd, Al7Zn3, and Al2Gd intermetallic compounds. Examination of the microstructure at elevated temperatures revealed that dynamic recrystallization and dynamic grain growth occur. In particular, it was discovered that bimodal microstructures or incomplete dynamic recrystallization microstructures exist in high-temperature deformation. A maximum quasi-superplasticity of 228.4% was demonstrated in this alloy at 673 K and 5.0 × 10-4 s-1. Flow stress curves showed that the present alloy exhibits Sotoudeh-Bate curves or a long intermediate strain-hardening stage followed by a strain-softening stage. A modified Zerilli-Armstrong constitutive equation incorporating the number of dislocations was established. The power-law constitutive equation was established to identify the deformation mechanism. Both constitutive models had good predictability. At 673 K and 5.0 × 10-4 s-1, the stress exponent was 4, and the average deformation activation energy was 104.42 kJ/mol. The number of dislocations inside a grain was 146. This characteristic evidence confirmed that dislocation motion controlled by pipe diffusion dominates the rate-controlling process under this condition.

High Strain Rate Quasi-Superplasticity Behavior in an Ultralight Mg-9.55Li-2.92Al-0.027Y-0.026Mn Alloy Fabricated by Multidirectional Forging and Asymmetrical Rolling.

To explore new approaches to severe plastic deformation and the ductility of a multicomponent magnesium-lithium alloy, an ultralight microduplex Mg-9.55Li-2.92Al-0.027Y-0.026Mn alloy was made by novel multidirectional forging and asymmetrical rolling, and the superplasticity behavior was investigated by optical microscope, hot tensile test, and modeling. The average grain size is 1.9 µm in this alloy after multidirectional forging and asymmetrical rolling. Remarkable grain refinement caused by such a forming, which turns the as-cast grain size of 144.68 µm into the as-rolled grain size of 1.9 µm, is achieved. The elongation to failure of 228.05% is obtained at 523 K and 1 × 10-2 s-1, which demonstrates the high strain rate quasi-superplasticity. The maximum elongation to failure of 287.12% was achieved in this alloy at 573 K and 5 × 10-4 s-1. It was found that strain-induced grain coarsening at 523 K is much weaker than the strain-induced grain coarsening at 573 K. Thus, the ductility of 228.05% is suitable for application in high strain rate superplastic forming. The stress exponent of 3 and the average activation energy for deformation of 50.06 kJ/mol indicate that the rate-controlling deformation mechanism is dislocation-glide controlled by pipe diffusion.

Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in "real-world" settings. Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke. Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556-1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164-0.949; p = 0.038]. Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA.

Spironolactone Improves the All-Cause Mortality and Re-Hospitalization Rates in Acute Myocardial Infarction with Chronic Kidney Disease Patients.

Background: Mineralocorticoid receptor antagonists (MRA) improve outcomes in chronic kidney disease (CKD) and acute myocardial infarction (AMI) patients. However, the lack of evidence regarding long-term clinical outcomes in the use of MRA, including spironolactone, in patients with AMI combined with CKD. Objectives: This study aimed to investigate whether spironolactone could significantly reduce the risk of all-cause mortality and re-admission in patients with AMI and CKD. Methods: In this single center, observational, retrospective, registry based clinical study, a total of 2,465 AMI patients were initially screened; after excluding patients with estimated glomerular filtration rate more than 60 ml/min/1.73 m2, 360 patients in the standard treatment group and 200 patients in the spironolactone group met the criteria. All enrolled patients follow-up for 30 months. The primary outcomes were all-cause mortality and re-admission. The key safety outcome was hyperkalemia rates during the 30 months follow-up period. Results: 160 (44.4%) and 41 (20.5%) patients in the standard treatment and spironolactone groups died, respectively [hazard ratio (HR): 0.389; 95% confidence interval (CI): 0.276-0.548; p < 0.001]. Re-admission occurred in 217 (60.3%) and 95 (47.5%) patients in the standard treatment and spironolactone groups, respectively (HR: 0.664; 95% CI: 0.522-0.846; p = 0.004). The spironolactone group was divided into two based on the daily dose, low dose group (no more than 40 mg) and high dose group (more than 40 mg); the differences in the mortality rate between low dose group (16.7%) and the standard treatment group (44.4%) (HR: 0.309; 95% CI: 0.228-0.418; p < 0.001) and high dose group (34.1%) (HR: 0.429; 95% CI: 0.199-0.925; p = 0.007) were significant. The differences in re-hospitalization rate between low dose group (43.6%) and the standard treatment group (60.3%) (HR: 0.583; 95% CI: 0.457-0.744; p < 0.001) and high dose group (61.4%) (HR: 0.551; 95% CI: 0.326-0.930; p = 0.007) was significant. Hyperkalemia occurred in 18 (9.0%) and 18 (5.0%) patients in the spironolactone group and standard treatment group, respectively (HR: 1.879; 95% CI: 0.954-3.700; p = 0.068). Whereas, Hyperkalemia occurred in high dose group (20.5%) significantly more often than in the standard treatment group (p < 0.001) and low dose group (5.8%) (p = 0.003). Conclusion: Using MRA, such as spironolactone, may substantially reduce the risk of both all-cause mortality and re-admission in patients with AMI and CKD; the use of low-dose spironolactone has the best efficacy and safety. However, this was a relatively small sample size, single center, observational, retrospective, registry based clinical study and further prospective evaluation in adequately powered randomized trials were needed before further use of spironolactone in AMI with CKD population.

A prognostic nomogram for long-term major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention.

BACKGROUND: Accurate prediction of major adverse cardiovascular events (MACEs) is very important for the management of acute coronary syndrome (ACS) patients. We aimed to construct an effective prognostic nomogram for individualized risk estimates of MACEs for patients with ACS after percutaneous coronary intervention (PCI). METHODS: This was a prospective study of patients with ACS after PCI from January 2013 to July 2019 (n = 2465). After removing patients with incomplete clinical information, a total of 1986 patients were randomly divided into evaluation (n = 1324) and validation (n = 662) groups. Predictors included in the nomogram were determined by a multivariate Cox proportional hazards regression model based on the training set. Receiver operating characteristic (ROC) curves and calibration curves were used to assess the discrimination and predictive accuracy of the nomogram, which were then compared with those of the classic models. The clinical utility of the nomogram was assessed by X-tile analysis and Kaplan-Meier curve analysis. RESULTS: Independent prognostic factors, including lactate level, age, left anterior descending branch stenosis, right coronary artery stenosis, brain natriuretic peptide level, and left ventricular ejection fraction, were determined and contained in the nomogram. The nomogram achieved good areas under the ROC curve of 0.712-0.762 in the training set and 0.724-0.818 in the validation set and well-fitted calibration curves. In addition, participants could be divided into two risk groups (low and high) according to this model. CONCLUSIONS: A simple-to-use nomogram incorporating lactate level effectively predicted 6-month, 1-year, and 4-year MACE incidence among patients with ACS after PCI.

Autophagy modulates mesenchymal-to-endothelial transition via p53.

Mesenchymal-to-endothelial transition (MEndT) is one of the mechanisms that influences cardiac fibrosis, which is a key process in cardiac remodeling. It has been reported that autophagy inhibits endothelial cell transition. However, whether autophagy could modulate MEndT in cardiac fibrosis has not yet been investigated. Here, we discussed the association between autophagy and MEndT and its possible mechanism. In this study, we induced endothelial-to-mesenchymal transition using transforming growth factor-ß to generate mesenchymal cells and fibroblasts in wild-type human umbilical vein endothelial cells and cells with p53 knockout or overexpression. Then, autophagy was induced by Earle's balanced salt solution (EBSS) and was inhibited by bafilomycin A1 or lentivirus-ATG5-shRNA. The expression levels of MEndT and the autophagy markers CD31, VE-Cadherin, Vimentin, α-SMA, LC3, p62 and p53 were examined. We found that activation of autophagy could promote MEndT and increase cytoplasmic and total expression of p53, that but nuclear p53 expression was decreased, and that inhibition of autophagy activation could reverse the effect of EBSS. Moreover, after knockout of nuclear p53, autophagy promoted MEndT, while autophagy inhibited MEndT in p53 overexpressing cells. Our results demonstrate that autophagy modulate MEndT by nuclear p53 provide a new strategy for the treatment of fibrosis diseases.