Background Epidemiological studies have suggested a potential connection between psoriasis and an increased risk of aortic valve stenosis(AS),though the impact of psoriasis on AS progression remains uncertain.The stud...Background Epidemiological studies have suggested a potential connection between psoriasis and an increased risk of aortic valve stenosis(AS),though the impact of psoriasis on AS progression remains uncertain.The study aims to investigate the causal relationship between psoriasis and AS using Mendelian randomization(MR)analysis,as well as to uncover potential mechanisms underlying this association.Methods A two-sample MR analysis was conducted using publicly available summary statistics from genome-wide association studies(GWAS)of psoriasis and AS.Cis-eQTL and significant genes were identified for each causal single-nucleotide polymorphisms(SNPs),followed by pathway enrichment and protein-protein interaction(PPI)analysis for functional evaluation.Hub genes were pinpointed by Cytospace.The transcriptional profile of AS population was acquired,and interconnected genes networks were clustered using Molecular Complex Detection(MCODE).Results Our results demonstrate a significant causal relationship between psoriasis and AS,with a genetic predisposition to psoriasis associated with a higher AS risk(odds ratio:1.46).Pathway and PPI analyses unveiled 15 hub genes,including HLA-C,HLA-B,ISG15,IFIT3,and MX2,along with immune-related pathways linking psoriasis and AS.Moreover,the transcriptional profiling of the AS database highlighted the significant involvement of adaptive immune cells in AS development.Notably,among the 15 hub genes,ISG15,MX2,OAS3,OASL,IFI6,and EPSTI1 exhibited higher expression in the AS population.Conclusion Our study provides compelling evidence supporting a causal relationship between psoriasis and AS.Furthermore,the identified hub genes and immune-related pathways may play an important role in the development of both diseases.展开更多
Background Left main coronary bifurcation lesions account for 50%of left main coronary artery disease cases.Although a drugcoated balloon(DCB)has the advantages of immediate release of the drug to the arterial wall an...Background Left main coronary bifurcation lesions account for 50%of left main coronary artery disease cases.Although a drugcoated balloon(DCB)has the advantages of immediate release of the drug to the arterial wall and no remaining struts,there is no conclusive evidence to support DCB use.Methods&Results We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses(PRISMA)statement.Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis.The studies were divided into two groups according to the type of DCB used:DCB only and DCB+stent.At the midterm follow-up,the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons,whether for de novo or in-stent restenosis lesions.Additionally,side branch late lumen enlargement was observed in several of the included studies,which indicates that DCBs may have the advantage of side branch protection.Conclusions According to our descriptive analysis,the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions.However,additional studies,especially randomized controlled trials,are needed to establish standards for the DCB technique.展开更多
Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship be...Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older.Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer.Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.Results We included 157,097 UK Biobank participants(78,151 women and 78,946 men)in our study,with mean age of 64±2.9 years.During a median follow-up of 8.1(7.4–8.8)years,1543(1.0%)participants developed incident aortic stenosis.Compared with those with the lowest handgrip strength(tertile 1),the adjusted hazard ratios(95%confidence interval)of incident aortic stenosis in the middle(tertile 2)and the highest(tertile 3)were 0.86(0.77–0.97)and 0.76(0.67–0.87),respectively.Conclusions Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults.Future studies warrant preventive strategies for older adults with lower handgrip strength.展开更多
Traditional ceramic materials are generally brittle and not flexible with high production costs,which seriously hinders their practical applications.Multifunctional nanofiber ceramic aerogels are highly desirable for ...Traditional ceramic materials are generally brittle and not flexible with high production costs,which seriously hinders their practical applications.Multifunctional nanofiber ceramic aerogels are highly desirable for applications in extreme environments,however,the integration of multiple functions in their preparation is extremely challenging.To tackle these challenges,we fabricated a multifunctional SiC@SiO_(2) nanofiber aerogel(SiC@SiO_(2) NFA)with a threedimensional(3D)porous cross-linked structure through a simple chemical vapor deposition method and subsequent heat-treatment process.The as-prepared SiC@SiO_(2) NFA exhibits an ultralow density(~11 mg cm^(-3)),ultra-elastic,fatigue-resistant and refractory performance,high temperature thermal stability,thermal insulation properties,and significant strain-dependent piezoresistive sensing behavior.Furthermore,the SiC@SiO_(2) NFA shows a superior electromagnetic wave absorption performance with a minimum refection loss(RL_(min))value of-50.36 d B and a maximum effective absorption bandwidth(EAB_(max))of 8.6 GHz.The successful preparation of this multifunctional aerogel material provides a promising prospect for the design and fabrication of the cutting-edge ceramic materials.展开更多
Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in...Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward.展开更多
BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data...BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit(ICCU).METHODS We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017.Data were captured after systematic inspection of individual medical records regarding current demographics,primary diagnosis,comorbidities,illnesses severity,and in-hospital outcomes.RESULTS The mean age was 65.6±14.2 years,and females accounted for 32.0%of patients.The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4±1.8 and 22.5±10.4,respectively.The top reason for admission was ST-segment elevation myocardial infarction(32.0%),and nonischaemic heart diseases accounted for 31.2%of all primary diagnoses.Noncardiovascular diseases were prevalent in the ICCU population,including chronic illnesses and acute noncardiovascular critical illnesses(ANCIs);in particular,21.7%of patients were marked by acute respiratory failure(14.6%),acute kidney injury(13.7%),sepsis(4.2%),or gastrointestinal bleeding(3.3%).The median length of stay in the ICCU and hospital were 1.1 days[interquartile range(IQR):0.8–2.6 days]and 6.3 days(IQR:3.8−10.9 days),respectively.The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6%(n=177).Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes.CONCLUSIONS Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population.Particularly,noncardiovascular diseases were prevalent and associated with adverse outcomes.Reformation of organization and staffing practices may be considered to adapt to the changed landscape.展开更多
BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 ...BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.展开更多
Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgro...Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgroups. Methods A total of 3176 CAD patients confirmed by coronary angiography were included. OMT was defined as the combination of anti-platelet drugs, statins, beta blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Factors for OMT and its prognostic value were analyzed in CAD patients across different subgroups. Results Out of 3176 patients, only 39.8% （n = 1265） were on OMT at discharge. Factors associated with OMT at discharge were pre-admission OMT and discharge department. All-cause mortality occurred in 6.8% （n = 217） of patients. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality （HR： 0.65, 95% CI： 0.45~0.95; P = 0.025）. Sub-group analyses indicate that male acute coronary syndrome （ACS） patients were more likely to receive survival benefits with OMT at discharge. The positive impact of OMT at discharge was more apparent after 24 months, regardless of revascularization therapy. Four-drug combination of OMT was superior to 3-drug combination therapy in ACS patients but not in stable patients. Conclusions OMT was asso- ciated with significant improvement in survival in patients with CAD. The positive impact of OMT was distinct in the CAD patients with different characteristics.展开更多
BACKGROUND Left ventricular hypertrophy(LVH)is prevalent in obese individuals.Besides,both of LVH and obesity is as-sociated with subclinical LV dysfunction.The study aims to investigate the interplay between body fat...BACKGROUND Left ventricular hypertrophy(LVH)is prevalent in obese individuals.Besides,both of LVH and obesity is as-sociated with subclinical LV dysfunction.The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease(CAD).METHODS In this retrospective cohort study,a total of 2243 patients with angiographically proven CAD were included.Body fat and LV mass were calculated using established formulas.Patients were grouped according to body fat percentage and pres-ence or absence of LVH.Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.RESULTS Of 2243 patients enrolled,560(25%)had a higher body fat percentage,and 1045(46.6%)had LVH.After a median follow-up of 2.2 years,the cumulative mortality rate was 8.2%in the group with higher body fat and LVH,2.5%in those with lower body fat and no LVH,5.4%in those with higher body fat and no LVH,and 7.8%in those with lower body fat and LVH(log-rank P<0.001).There was a statistically significant interaction between body fat percentage and LVH(P interaction was 0.003).After correcting for confounding factors,patients with higher body fat and LVH had the highest risk of all-cause death(HR=3.49,95%CI:1.40-8.69,P=0.007)compared with those with lower body fat and no LVH;in contrast,patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH(HR=2.03,95%CI:0.70-5.92,P=0.195).CONCLUSION A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD,strat-ified by coexistence of LVH or not.Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.展开更多
BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood...BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.展开更多
The host structure of polymers significantly influences ion transport and interfacial stability of electrolytes,dictating battery cycle life and safety for solid-state lithium metal batteries.Despite promising propert...The host structure of polymers significantly influences ion transport and interfacial stability of electrolytes,dictating battery cycle life and safety for solid-state lithium metal batteries.Despite promising properties of ethylene oxide-based electrolytes,their typical clamp-like coordination geometry leads to crowd solvation sheath and overly strong interactions between Li^(+)and electrolytes,rendering difficult dissociation of Li+and unfavorable solid electrolyte interface(SEI).Herein,we explore weakly solvating characteristics of polyacetal electrolytes owing to their alternately changing intervals between–O–coordinating sites in the main chain.Such structural asymmetry leads to unique distorted helical solvation sheath,and can effectively reduce Li^(+)-electrolyte binding and tune Li^(+)desolvation kinetics in the insitu formed polymer electrolytes,yielding anion-derived SEI and dendrite-free Li electrodeposition.Combining with photoinitiated cationic ring-opening polymerization,polyacetal electrolytes can be instantly formed within 5 min at the surface of electrode,with high segmental chain motion and well adapted interfaces.Such in-situ polyacetal electrolytes enabled more than 1300-h of stable lithium electrodeposition and prolonged cyclability over 200 cycles in solid-state batteries at ambient temperatures,demonstrating the vital role of molecular structure in changing solvating behavior and Li deposition stability for high-performance electrolytes.展开更多
Background Epicardial adipose tissue(EAT)radiomics derived from cardiac computed tomography(CT)images may pr-ovide insights into EAT characteristics,which can further predict regression of left ventricular mass index(...Background Epicardial adipose tissue(EAT)radiomics derived from cardiac computed tomography(CT)images may pr-ovide insights into EAT characteristics,which can further predict regression of left ventricular mass index(LVMI)after transcath-eter aortic valve replacement(TAVR).This study aimed to develop and validate a radiomics nomogram based on pre-procedural EAT CT to predict inadequate LVMI regression following TAVR.Methods Inadequate LVMI regression was defined asΔLVMI%<15%at one-year post TAVR.Radiomics features from pre-procedural CT images were selected mainly by least absolute shrinkage and selection operator algorithm.The patients were ran-domly divided into the training and validation cohorts to establish and evaluate three feature classifier models based on the selec-ted features,using which the Radiomics scores(Radscores)were then calculated.A radiomics nomogram was constructed using independent risk factors and further assessed using area under the curve,calibration curve,and decision curve analysis.Results A total of 144 consecutive TAVR patients(42 patients with inadequate and 102 patients with adequate LVMI regres-sion)were randomly assigned to the training and validation cohorts(116 patients and 28 patients,respectively).A total of 1130 radiomics features from each patient yielded 6 features for the Radscore construction after selection,with logistic regression and support vector machine models favored.Subsequently,a nomogram based solely on the Radscore was constructed,with an area under the curve of 0.743 in the validation cohort,along with favorable decision curve analysis and calibration curves.Conclusions The developed radiomics nomogram,serving as a non-invasive tool,achieved satisfactory preoperative predic-tion of inadequate LVMI regression in TAVR patients,thereby facilitating clinical management.展开更多
基金supported by the National Natural Science Foundation of China(81970325,and82170375)Sichuan Science and Technology Program(2023YFS0296)+3 种基金Key Research and Development Project of Science&Technology Department of Sichuan Province(2022ZDZX0020 and 2023YFS-0296)Key Research and Development Support Project of Science&Technology Department of Chengdu(2021-YF08-00121-GX)Chinese Medical Association Cardiovascular Branch(CSC)Clinical Research Special Fund Project(CSCF2020B04)West China Hospital“1·3·5”Discipline of Excellence Project-“Percutaneous transcatheter aortic valve implantation”and“Mechanisms of aortic stenosis a nd the clinical applications”。
文摘Background Epidemiological studies have suggested a potential connection between psoriasis and an increased risk of aortic valve stenosis(AS),though the impact of psoriasis on AS progression remains uncertain.The study aims to investigate the causal relationship between psoriasis and AS using Mendelian randomization(MR)analysis,as well as to uncover potential mechanisms underlying this association.Methods A two-sample MR analysis was conducted using publicly available summary statistics from genome-wide association studies(GWAS)of psoriasis and AS.Cis-eQTL and significant genes were identified for each causal single-nucleotide polymorphisms(SNPs),followed by pathway enrichment and protein-protein interaction(PPI)analysis for functional evaluation.Hub genes were pinpointed by Cytospace.The transcriptional profile of AS population was acquired,and interconnected genes networks were clustered using Molecular Complex Detection(MCODE).Results Our results demonstrate a significant causal relationship between psoriasis and AS,with a genetic predisposition to psoriasis associated with a higher AS risk(odds ratio:1.46).Pathway and PPI analyses unveiled 15 hub genes,including HLA-C,HLA-B,ISG15,IFIT3,and MX2,along with immune-related pathways linking psoriasis and AS.Moreover,the transcriptional profiling of the AS database highlighted the significant involvement of adaptive immune cells in AS development.Notably,among the 15 hub genes,ISG15,MX2,OAS3,OASL,IFI6,and EPSTI1 exhibited higher expression in the AS population.Conclusion Our study provides compelling evidence supporting a causal relationship between psoriasis and AS.Furthermore,the identified hub genes and immune-related pathways may play an important role in the development of both diseases.
文摘Background Left main coronary bifurcation lesions account for 50%of left main coronary artery disease cases.Although a drugcoated balloon(DCB)has the advantages of immediate release of the drug to the arterial wall and no remaining struts,there is no conclusive evidence to support DCB use.Methods&Results We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses(PRISMA)statement.Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis.The studies were divided into two groups according to the type of DCB used:DCB only and DCB+stent.At the midterm follow-up,the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons,whether for de novo or in-stent restenosis lesions.Additionally,side branch late lumen enlargement was observed in several of the included studies,which indicates that DCBs may have the advantage of side branch protection.Conclusions According to our descriptive analysis,the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions.However,additional studies,especially randomized controlled trials,are needed to establish standards for the DCB technique.
基金supported by the National Natural Science Foundation of China (81970325, and 82170375)Key Research and Development Project of Science&Technology Department of Sichuan Province (2022ZDZX0020)+2 种基金Key Research and Development Support Project of Science&Technology Department of Chengdu (2021-YF08-00121-GX)Chinese Medical Association Cardiovascular Branch (CSC) Clinical Research Special Fund Project(CSCF2020B04)West China Hospital 1·3·5 Discipline of Excellence Project-Percutaneous transcatheter aortic valve implantation and Mechanisms of aortic stenosis and the clinical applications
文摘Objective To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.Methods We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older.Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer.Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.Results We included 157,097 UK Biobank participants(78,151 women and 78,946 men)in our study,with mean age of 64±2.9 years.During a median follow-up of 8.1(7.4–8.8)years,1543(1.0%)participants developed incident aortic stenosis.Compared with those with the lowest handgrip strength(tertile 1),the adjusted hazard ratios(95%confidence interval)of incident aortic stenosis in the middle(tertile 2)and the highest(tertile 3)were 0.86(0.77–0.97)and 0.76(0.67–0.87),respectively.Conclusions Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults.Future studies warrant preventive strategies for older adults with lower handgrip strength.
基金financially supported by the National Natural Science Foundation of China(No.U2004177 and U21A2064)Outstanding Youth Fund of Henan Province(No.212300410081)+1 种基金Scientific and Technological Innovation Talents in Colleges and Universities in Henan Province(22HASTIT001)The Research and Entrepreneurship Start-up Projects for Overseas Returned Talents。
文摘Traditional ceramic materials are generally brittle and not flexible with high production costs,which seriously hinders their practical applications.Multifunctional nanofiber ceramic aerogels are highly desirable for applications in extreme environments,however,the integration of multiple functions in their preparation is extremely challenging.To tackle these challenges,we fabricated a multifunctional SiC@SiO_(2) nanofiber aerogel(SiC@SiO_(2) NFA)with a threedimensional(3D)porous cross-linked structure through a simple chemical vapor deposition method and subsequent heat-treatment process.The as-prepared SiC@SiO_(2) NFA exhibits an ultralow density(~11 mg cm^(-3)),ultra-elastic,fatigue-resistant and refractory performance,high temperature thermal stability,thermal insulation properties,and significant strain-dependent piezoresistive sensing behavior.Furthermore,the SiC@SiO_(2) NFA shows a superior electromagnetic wave absorption performance with a minimum refection loss(RL_(min))value of-50.36 d B and a maximum effective absorption bandwidth(EAB_(max))of 8.6 GHz.The successful preparation of this multifunctional aerogel material provides a promising prospect for the design and fabrication of the cutting-edge ceramic materials.
基金supported by grants from the National Natural Science Foundation of China (No.81400267 & No.81370219)the Sichuan Provincial Department of Science and Technology (2016FZ0084)
文摘Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward.
基金This study was supported by the National Natural Science Foundation of China(No.81900258)and the Key Research and Development Projects of Science&Technology Department of Sichuan Province(2019YFS0351).
文摘BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care.We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit(ICCU).METHODS We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017.Data were captured after systematic inspection of individual medical records regarding current demographics,primary diagnosis,comorbidities,illnesses severity,and in-hospital outcomes.RESULTS The mean age was 65.6±14.2 years,and females accounted for 32.0%of patients.The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4±1.8 and 22.5±10.4,respectively.The top reason for admission was ST-segment elevation myocardial infarction(32.0%),and nonischaemic heart diseases accounted for 31.2%of all primary diagnoses.Noncardiovascular diseases were prevalent in the ICCU population,including chronic illnesses and acute noncardiovascular critical illnesses(ANCIs);in particular,21.7%of patients were marked by acute respiratory failure(14.6%),acute kidney injury(13.7%),sepsis(4.2%),or gastrointestinal bleeding(3.3%).The median length of stay in the ICCU and hospital were 1.1 days[interquartile range(IQR):0.8–2.6 days]and 6.3 days(IQR:3.8−10.9 days),respectively.The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6%(n=177).Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes.CONCLUSIONS Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population.Particularly,noncardiovascular diseases were prevalent and associated with adverse outcomes.Reformation of organization and staffing practices may be considered to adapt to the changed landscape.
基金This work was supported by the Key Research and Development Projects of Science&Technology Department of Sichuan Province(2019YFS0351).
文摘BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.
文摘Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgroups. Methods A total of 3176 CAD patients confirmed by coronary angiography were included. OMT was defined as the combination of anti-platelet drugs, statins, beta blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Factors for OMT and its prognostic value were analyzed in CAD patients across different subgroups. Results Out of 3176 patients, only 39.8% （n = 1265） were on OMT at discharge. Factors associated with OMT at discharge were pre-admission OMT and discharge department. All-cause mortality occurred in 6.8% （n = 217） of patients. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality （HR： 0.65, 95% CI： 0.45~0.95; P = 0.025）. Sub-group analyses indicate that male acute coronary syndrome （ACS） patients were more likely to receive survival benefits with OMT at discharge. The positive impact of OMT at discharge was more apparent after 24 months, regardless of revascularization therapy. Four-drug combination of OMT was superior to 3-drug combination therapy in ACS patients but not in stable patients. Conclusions OMT was asso- ciated with significant improvement in survival in patients with CAD. The positive impact of OMT was distinct in the CAD patients with different characteristics.
基金the Key Research and Development Projects of Science&Technology Department of Sichuan Province(2019YFS0351)。
文摘BACKGROUND Left ventricular hypertrophy(LVH)is prevalent in obese individuals.Besides,both of LVH and obesity is as-sociated with subclinical LV dysfunction.The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease(CAD).METHODS In this retrospective cohort study,a total of 2243 patients with angiographically proven CAD were included.Body fat and LV mass were calculated using established formulas.Patients were grouped according to body fat percentage and pres-ence or absence of LVH.Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.RESULTS Of 2243 patients enrolled,560(25%)had a higher body fat percentage,and 1045(46.6%)had LVH.After a median follow-up of 2.2 years,the cumulative mortality rate was 8.2%in the group with higher body fat and LVH,2.5%in those with lower body fat and no LVH,5.4%in those with higher body fat and no LVH,and 7.8%in those with lower body fat and LVH(log-rank P<0.001).There was a statistically significant interaction between body fat percentage and LVH(P interaction was 0.003).After correcting for confounding factors,patients with higher body fat and LVH had the highest risk of all-cause death(HR=3.49,95%CI:1.40-8.69,P=0.007)compared with those with lower body fat and no LVH;in contrast,patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH(HR=2.03,95%CI:0.70-5.92,P=0.195).CONCLUSION A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD,strat-ified by coexistence of LVH or not.Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.
基金This study was supported by the National Natural Science Foundation of China(No.81970325&No.81900348&No.81901825)the Science and Technology Support Plan of Sichuan Province(2019YFS0299&2019YFS0433)。
文摘BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.
基金financially supported by National Natural Science Foundation of China(52003231,22065037)Yunnan Fundamental Research Projects(202201AW070015)。
文摘The host structure of polymers significantly influences ion transport and interfacial stability of electrolytes,dictating battery cycle life and safety for solid-state lithium metal batteries.Despite promising properties of ethylene oxide-based electrolytes,their typical clamp-like coordination geometry leads to crowd solvation sheath and overly strong interactions between Li^(+)and electrolytes,rendering difficult dissociation of Li+and unfavorable solid electrolyte interface(SEI).Herein,we explore weakly solvating characteristics of polyacetal electrolytes owing to their alternately changing intervals between–O–coordinating sites in the main chain.Such structural asymmetry leads to unique distorted helical solvation sheath,and can effectively reduce Li^(+)-electrolyte binding and tune Li^(+)desolvation kinetics in the insitu formed polymer electrolytes,yielding anion-derived SEI and dendrite-free Li electrodeposition.Combining with photoinitiated cationic ring-opening polymerization,polyacetal electrolytes can be instantly formed within 5 min at the surface of electrode,with high segmental chain motion and well adapted interfaces.Such in-situ polyacetal electrolytes enabled more than 1300-h of stable lithium electrodeposition and prolonged cyclability over 200 cycles in solid-state batteries at ambient temperatures,demonstrating the vital role of molecular structure in changing solvating behavior and Li deposition stability for high-performance electrolytes.
基金supported by the National Natural Science Foundation of China (No.82170375 & No.8210 2129 & U23A20395)the 1·3·5 Project for Disciplines of Excellence from West China Hospital of Sichuan University (ZYGD23021)the Sichuan Science and Technology Program (No.2024NSFSC1714 & No.2024 NSFSC1716).
文摘Background Epicardial adipose tissue(EAT)radiomics derived from cardiac computed tomography(CT)images may pr-ovide insights into EAT characteristics,which can further predict regression of left ventricular mass index(LVMI)after transcath-eter aortic valve replacement(TAVR).This study aimed to develop and validate a radiomics nomogram based on pre-procedural EAT CT to predict inadequate LVMI regression following TAVR.Methods Inadequate LVMI regression was defined asΔLVMI%<15%at one-year post TAVR.Radiomics features from pre-procedural CT images were selected mainly by least absolute shrinkage and selection operator algorithm.The patients were ran-domly divided into the training and validation cohorts to establish and evaluate three feature classifier models based on the selec-ted features,using which the Radiomics scores(Radscores)were then calculated.A radiomics nomogram was constructed using independent risk factors and further assessed using area under the curve,calibration curve,and decision curve analysis.Results A total of 144 consecutive TAVR patients(42 patients with inadequate and 102 patients with adequate LVMI regres-sion)were randomly assigned to the training and validation cohorts(116 patients and 28 patients,respectively).A total of 1130 radiomics features from each patient yielded 6 features for the Radscore construction after selection,with logistic regression and support vector machine models favored.Subsequently,a nomogram based solely on the Radscore was constructed,with an area under the curve of 0.743 in the validation cohort,along with favorable decision curve analysis and calibration curves.Conclusions The developed radiomics nomogram,serving as a non-invasive tool,achieved satisfactory preoperative predic-tion of inadequate LVMI regression in TAVR patients,thereby facilitating clinical management.
