Development and validation of a score predicting mortality for older patients with mitral regurgitation.

OBJECTIVE: To develop and validate a user-friendly risk score for older mitral regurgitation (MR) patients, referred to as the Elder-MR score. METHODS: The China Senile Valvular Heart Disease (China-DVD) Cohort Study functioned as the development cohort, while the China Valvular Heart Disease (China-VHD) Study was employed for external validation. We included patients aged 60 years and above receiving medical treatment for moderate or severe MR (2274 patients in the development cohort and 1929 patients in the validation cohort). Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion. RESULTS: Eight predictors were identified: age ≥ 75 years, body mass index < 20 kg/m2, NYHA class III/IV, secondary MR, anemia, estimated glomerular filtration rate < 60 mL/min per 1.73 m2, albumin < 35 g/L, and left ventricular ejection fraction < 60%. The model displayed satisfactory performance in predicting one-year mortality in both the development cohort (C-statistic = 0.73, 95% CI: 0.69-0.77, Brier score = 0.06) and the validation cohort (C-statistic = 0.73, 95% CI: 0.68-0.78, Brier score = 0.06). The Elder-MR score ranges from 0 to 15 points. At a one-year follow-up, each point increase in the Elder-MR score represents a 1.27-fold risk of death (HR = 1.27, 95% CI: 1.21-1.34, P < 0.001) in the development cohort and a 1.24-fold risk of death (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001) in the validation cohort. Compared to EuroSCORE II, the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort (C-statistic = 0.71 vs. 0.70, net reclassification improvement = 0.320, P < 0.01; integrated discrimination improvement = 0.029, P < 0.01). CONCLUSIONS: The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.

Intracranial Hemorrhage in Hospitalized Patients Following Percutaneous Coronary Intervention: A Large Cohort Analysis from a Single Center.

BACKGROUND: There are several reports on the prevalence and characteristics of intracranial hemorrhage (ICH) following percutaneous coronary intervention (PCI), which is a rare but severe complication with high mortality. However, the clinical landscapes of computed tomography (CT)-confirmed, symptomatic ICH in hospitalized patients are not fully characterized. METHODS: Among 121,066 patients receiving PCI treatment in the Fu Wai Hospital between 2013 and 2022, there were 18 CT-defined, symptomatic patients with ICH occurring during post-PCI hospitalization. Symptomatic ICH was defined as clinical suspicion of hemorrhage and/or new focal neurological signs. We analyzed ICH timing, clinical and imaging features, and subsequent outcomes. RESULTS: Overall, in this retrospective analysis, the incidence of CT-defined, symptomatic ICH was 0.015% (18/121,066). More than half of the cases (55.6%) occurred within the first 12 h following PCI. The most common initial manifestation of ICH patients was disturbance of consciousness. Thirteen patients (72.2%) had a hematoma volume ≥ 30 cm3. Additionally, the ICH was observed in the cerebral lobe (66.7%), cerebellum (22.2%), and the basal ganglia and thalamus (11.1%). The 90-day mortality of ICH patients undergoing PCI was very high (72.2%). Consciousness disturbance (p = 0.036), intracerebral hemorrhage volume > 30 mm3 (p = 0.001), and intracerebral hemorrhage originating from the infratentorial origin (p = 0.044) were significantly higher in patients who died. CONCLUSIONS: Symptomatic ICH events occur with a rate of around 0.015%, with significantly higher short-term mortality risk in our cohort receiving PCI, which has not yet been demonstrated in other cohorts.

Designable Guest-Molecule Encapsulation in Metal-Organic Frameworks for Proton Conductivity.

Metal-organic frameworks (MOFs), as a porous frame material, exhibit considerable electrical conductivity. In recent decades, research on the proton conductivity of MOFs has made gratifying progress. In this review, the designable guest molecules encapsulated into MOFs are summarized and generalized into four types in terms of promoting proton conductive performance, and then recent progress in the promotion of proton conductivity by MOFs encapsulating guest molecules is discussed. The existing challenges and prospects for the development of this strategy for promoting MOFs' proton conductivity are also listed.

Dual-Functional Coordination Polymer with High Proton Conductivity and a Low-Detection-Limit Fluorescent Probe.

A coordination polymer with dual functions of high proton conductivity and highly sensitive fluorescent sensors demonstrates a great application potential. In this work, a cadmium-based coordination polymer (denoted as CP 1) with hydrothermal stability was synthesized. The abundant coordination water, lattice water, and amino groups make an extended hydrogen-bonding pathway for efficient proton migration, which endows CP 1 with the highest proton conductivity of 2.41 × 10-3 S·cm-1 at 353 K and 98% RH. Especially, the proton conductivity of the chitosan (CS) hybrid membrane containing CP 1 reaches a maximum value of 2.62 × 10-2 S·cm-1 under 343 K and 98% RH, which increases almost 7 times higher than that of the pure CS membrane due to the host-guest collaboration. Furthermore, luminescence studies revealed that CP 1 is a high-sensitivity and good-selectivity fluorescent probe for the detection of trace amounts of l-histidine with a lowest detection limit of 1.0 × 10-8 M.

Promotion of Proton Conductivity by Encapsulation of Metal-Organic Polyhedra in Metal-Organic Frameworks.

A Zr-based metal-organic polyhedron (MOP) was self-assembled in a porous MOF host, DUT-68, successfully to synthesize MOP-1@DUT-68. The MOP guest (MOP-1) has a diameter of about 20 Å, larger than that of the square windows (pore sizes of ∼14 Å) of DUT-68 but smaller than that of the rhombicuboctahedral cage (27.7 Å), which means that the migration and leaching of MOP-1 could be effectively prohibited if MOP-1 is encapsulated in the MOF's cavities. The proton conductivity of MOP-1@DUT-68 is 1.14×10-3  S cm-1 (at 80 °C under 98 % relative humidity), which is three orders of magnitude higher than that of DUT-68. Compared with MOP-1⊂DUT-68, which was synthesized by impregnation, MOP-1@DUT-68 is more prone to form faster proton-conduction pathways and thus provides higher proton conductivity.

Dual-functional coordination polymers with high proton conduction behaviour and good luminescence properties.

Two coordination polymers, [M(5-hip)(H2O)3]n (M = Cd2+ (1), Zn2+ (2), 5-hip = 5-hydroxyisophthalic acid), have been synthesized under hydrothermal conditions. The crystal structure reveals that complexes 1 and 2 have 1D chain structures by the coordination of metal ions and 5-hip. 1D chains are connected by hydrogen bonds to form a 3D structure. AC impedance analysis shows that the proton conductivity of complexes 1 and 2 comes up to 1.58 × 10-3 S cm-1 (98%RH, 343 K) and 5.27 × 10-4 S cm-1 (98%RH, 353 K), respectively. To further improve the proton conductivity, a hybrid membrane was prepared by the solution casting method with complexes as fillers and sulfonated polyether ether ketone (SPEEK) as the organic matrix. The proton conductivity of hybrid membranes 1@SPEEK-5 and 2@SPEEK-5 is 1.97 and 1.58 times higher than that of pure SPEEK membranes, respectively. Furthermore, the two complexes are excellent fluorescent sensors, which could detect Cr2O72- in aqueous solution with high sensitivity and selectivity. Both of them have low detection limits for Cr2O72- in aqueous solution, where the detection limit of complex 1 is 0.8 µM and that of complex 2 is 1 µM. The above work demonstrates that the two complexes are dual-functional materials with high proton conduction and good fluorescence properties.

TMPyP-bound guanosine-borate supramolecular hydrogel as smart hemoperfusion device with real-time visualized/electrochemical bi-modal monitoring for selective blood lead elimination.

Blood lead poisoning is a universal and severe health problem that greatly threatens human health in various industries. Elimination of blood lead relying on chelating agents and combination with hemoperfusion adsorbents has achieved considerable progress, but it is still suffering from the compromised selectivity of adsorbents as well as in absence of real time monitoring during treatment. Herein, we proposed a selective blood lead adsorbent integrated with real-time visualized/electrochemical bi-modal monitoring based on TMPyP-bound guanosine-borate (GB) supramolecular hydrogel as potential smart hemoperfusion device. The GB hydrogel possessed stability in physiological environment, self-healing ability resistant to fluid shear, blood compatibility, selective adsorption of lead ions superior to conventional adsorbents, anti-fouling performance to blood components and renewability. Benefiting from binding with TMPyP and the intrinsic conductivity, GB hydrogel was endowed with the ability to qualitatively diagnose the presence of blood lead via simple color change and quantitatively reflect the amount of adsorbed lead from blood accurately through electrochemical technique. This work puts forward an integrated treatment/monitoring hemoperfusion device with high selectivity, simple fabrication and low-cost, providing a paradigm for next generation design of intelligent, monitorable theranostic hemopurification system, which is also an extensible platform for the other research fields such as environmental monitoring and remediation.

Transforming sustained release into on-demand release: self-healing guanosine-borate supramolecular hydrogels with multiple responsiveness for Acyclovir delivery.

Supramolecular hydrogels derived from natural biomolecules have promising applications for drug delivery due to their inherent biocompatibility and tunable responsiveness to various stimuli. However, conventional hydrogels only modulate the release kinetics roughly to achieve sustained drug release, exhibiting fast-then-slow release behavior without on/off control. Herein, a guanosine (G)-quartet·Na+-borate supramolecular hydrogel (GB hydrogel) cross-linked via a guanosine-borate diester and intertwined by G4-nanofibres formed by π-π stacking of G4-quartets stabilized by Na+ is developed for on-demand release of Acyclovir (Acv). This GB hydrogel is facilely prepared by a one-pot hierarchical assembly involving hydrogen bonds, dynamic borate ester bonds and cation coordination, which endow it with tunable mechanical properties, excellent self-healing properties and reversible degradation behavior in response to pH, glucose and ion concentration. Benefiting from that the guanosine analog Acv is able to assemble into a G4-quartet by replacing guanosine via reversible hydrogen bonding, the Acv-loaded GB hydrogel showed favorable stability in physiological medium without undesired release and achieved external stimulus-triggered on-demand release with switchable on/off control and tunable release kinetics. Moreover, the GB hydrogel also exhibited excellent in vitro and in vivo biocompatibility. Such a natural nucleoside-based supramolecular hydrogel with on-demand drug release, self-healing property, biodegradability and biocompatibility provides a precisely controlled paradigm to overcome early burst release behavior of conventional hydrogels for the development of injectable hydrogel delivery systems.

Preprocedural circulating galectin-3 and the risk of mortality after transcatheter aortic valve replacement: a systematic review and meta-analysis.

BACKGROUND: Galectin-3 may predict mortality for patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). However, the results were inconsistent. We aimed to evaluate the association between baseline galectin and mortality after TAVR in a meta-analysis. METHODS: Related follow-up studies were obtained by systematic search of PubMed, Cochrane's Library, and Embase databases. Both the fixed- and the random-effect models were used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome. RESULTS: Five prospective cohort studies with 854 patients were included, with a follow-up period between 1 and 1.9 years. Patients with higher baseline circulating galectin-3 had an increased risk of all-cause mortality after TAVR (random-effects model: risk ratio [RR]: 1.63, 95% confidence interval [CI]: 1.19-2.23, P=0.002; fixed-effects model: RR: 1.62, 95% CI: 1.19-2.20, P=0.002; I2 = 4%). Adjustment of estimated glomerular filtration rate (RR: 1.73, P=0.02) or B-type natriuretic peptide (BNP) or N-terminal pro-BNP (RR: 1.83, P=0.02) did not significantly affect the result. A trend of stronger association between higher baseline circulating galectin-3 and increased risk of all-cause mortality after TAVR was observed in studies with an enzyme-linked fluorescent assay (ELFA) (RR: 3.04, P=0.003) compared with those with an enzyme-linked immunosorbent assay (ELISA) (RR: 1.42, P=0.04; P for subgroup difference =0.06). CONCLUSION: Higher circulating galectin-3 before the procedure may predict all-cause mortality of AS patients after TAVR.