Crucial role of interfacial thermal dissipation in the operational stability of organic field-effect transistors.

The operational stability becomes a key issue affecting the commercialization for organic field-effect transistors (OFETs). It is widely recognized to be closely related to the defects and traps at the interface between dielectric and organic semiconductors, but this understanding does not always effectively address operational instability, implying that the factors influencing the operational stability have not been fully understood. Here, we reveal that the self-heating effect is another crucial factor in operational stability. By using hexagonal boron nitride (hBN) to assist interfacial thermal dissipation, the dinaphtho[2,3-b:2',3'-f]thieno[3,2-b]thiophene (DNTT) FETs exhibit high mobility of 14.18 cm2 V-1 s-1 and saturated power density up to 1.8 × 104 W cm-2. The OFET can operate at a power density of 1.06 × 104 W cm-2 for 30,000 s with negligible performance degradation, showing excellent operational stability under high power density. This work deepens the understanding on operational stability and develops an effective way for ultrahigh stable devices.

Management of complications associated with percutaneous left atrial appendage closure with or without ablation: experience from 512 cases over a 4-year period.

Background: Percutaneous left atrial appendage closure (LAAC) serves as an alternative prophylactic strategy for patients with non-valvular atrial fibrillation (AF) who cannot undergo anti-coagulation therapy. Proper management of associated complications is crucial to enhancing the procedure's success rate and mitigating perioperative risks and adverse events during follow-up. Aims: This study aims to summarize our center's experience and strategies in managing procedural-related complications encountered in 512 cases of LAAC with or without ablation for AF conducted from January 2020 to December 2023. Results: We identified 11 significant intervention-requiring complications associated with LAAC with or without Ablation procedure. These included three cases of intraoperative thrombosis, three instances of pericardial effusion or tamponade, one case of device-related thrombosis, one peri-device leak, one systemic embolism, one bleeding episode, and one additional device-related complication. The categorization of intraoperative thrombosis was as follows: one patient exhibited heparin resistance; one experienced thrombosis due to prolonged device implantation during the LAAC with ablation procedure; and one had unexplained intraoperative thrombosis. The pericardial effusion or tamponade likely resulted from damage to the atrial appendage during LAAC device insertion. Two patients encountered device-related thrombosis and systemic embolism events possibly caused by non-standard postoperative antithrombotic medication use; one patient's peri-device leak may have resulted from incomplete endothelialization of the occluder post-surgery; one patient experienced postoperative bladder bleeding; and one patient's device-related complications occurred due to a dislodged strut frame that damaged the left atrial appendage, leading to pericardial effusion. Our proactive interventions enabled all patients with these surgical-related complications to be safely discharged, with subsequent follow-ups showing no adverse events. Conclusion: Implementing targeted interventions for immediate procedural-related complications during the LAAC with or without ablation procedures enhances procedural success rates, diminishes postoperative mortality and patient disability, and bolsters stroke prevention efforts. This approach underscores the importance of a strategic response to complications, affirming the procedure's viability and safety in managing non-valvular AF in patients contraindicated for anticoagulation.

Association between serum osmolality and 28-day all-cause mortality in patients with heart failure and reduced ejection fraction: a retrospective cohort study from the MIMIC-IV database.

Background: Previous studies have not thoroughly explored the impact of serum osmolality levels on early mortality in heart failure and reduced ejection fraction (HFrEF) patients. The purpose of this study was to investigate the relationship between serum osmolality levels and early all-cause mortality in patients with HFrEF. Methods: The open access MIMIC-IV database was the source of data for our study. We collected demographic data, vital signs, laboratory parameters, and comorbidities of the included patients and divided them into 3 groups based on their initial serum osmolality on admission, with the primary outcome being all-cause mortality within 28 days of admission. Smoothing Spline Fitting Curve, the Kaplan-Meier survival curve, and Threshold effect analysis were used to assess the relationship between serum osmolality and early mortality in HFrEF patients. Results: A total of 6228 patients (55.31% male) were included. All-cause mortality within 28 days on admission was 18.88% in all patients. After adjusting for confounders, higher serum osmolality levels were independently associated with an increased risk of 28-days all-cause mortality compared with the reference group (Reference group Q2: 290-309 mmol/L, Q4: HR, 1.82 [95% CI 1.19-2.78] P<0.05, Q5: HR, 1.99 [95% CI 1.02-3.91] P<0.05). Smooth spline fitting revealed a U-shaped association between serum osmolality and 28-days all-cause mortality. Further threshold effect analysis results suggested that each unit increase in serum osmolality level was associated with a 2% increase in 28-days all-cause mortality when serum osmolality levels were ≥ 298.8 mmol/L (HR, 1.019 [95% CI 1.012-1.025] P<0.05). Conclusion: A U-shaped correlation between initial serum osmolality and 28-days all-cause mortality in HFrEF patients was identified, revealing higher osmolality levels significantly increase mortality risk. These results underscore serum osmolality's critical role in early mortality among HFrEF patients, highlighting the need for further, larger-scale studies for validation.

Structurally diverse macrocycle co-crystals for solid-state luminescence modulation.

Organic co-crystals offer an opportunity to fabricate organic functional materials. Traditional co-crystals are generally packed following the segregated or mixed stacking mode, leading to the lack of structural and functional diversity. Herein, we report three sets of macrocycle co-crystals with identical co-constitutions. The macrocycle co-crystals differ in the stoichiometric ratios (2:1, 1:1, and 2:3) of the constituents and molecular packing modes. The co-crystals are constructed using triangular pyrene-macrocycle and 1,2,4,5-tetracyanobenzene exploiting exo-wall charge-transfer interactions. Interestingly, the three co-crystals exhibit distinct, tunable emission properties. The corresponding emission peaks appear at 575, 602, and 635 nm, covering yellow via orange to red. The X-ray diffraction analyses and the density functional theory calculations reveal the superstructure-property relationships that is attributed to the formation of different ratios of charge-transfer transition states between the donor and acceptor motifs, resulting in red-shifted luminescence.

Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies.

Transcatheter Aortic Valve Replacement (TAVR) marks a significant advancement in treating aortic stenosis (AS), especially for patients with high surgical risks. This concise review outlines TAVR's development, its broader application to include lower-risk patients, and innovations in the device and procedural technology. Clinical trials, notably the PARTNER series, affirm TAVR's efficacy, showing it matches or surpasses surgical aortic valve replacement (SAVR) in mortality reduction, hemodynamic benefits, and symptom alleviation, including heart failure. However, TAVR entails complications such as paravalvular leakage (PVL), conduction disorders, and increased cerebrovascular event risks. We evaluate these issues, their prevalence, causative factors, and clinical consequences, emphasizing improvements in valve design and technique that have significantly lowered PVL rates. The role of aortic valve anatomy and calcification in PVL and conduction issues is analyzed, underlining the necessity for meticulous patient selection and procedural planning. Further, the review delves into cerebrovascular event risks, their origins, and preventative strategies, including cerebral protection devices and the judicious use of anticoagulant and antiplatelet therapies. TAVR presents a less invasive, promising alternative to SAVR, but requires careful complication management to optimize patient results. Ongoing innovation and research are vital for advancing TAVR's techniques, improving valve designs, and extending its reach, thereby enhancing AS patients' quality of life.

Achieving Zero-Temperature Coefficient Point Behavior by Defect Passivation for Temperature-Immune Organic Field-Effect Transistors.

Organic field-effect transistors (OFETs) have broad prospects in biomedical, sensor, and aerospace applications. However, obtaining temperature-immune OFETs is difficult because the electrical properties of organic semiconductors (OSCs) are temperature-sensitive. The zero-temperature coefficient (ZTC) point behavior can be used to achieve a temperature-immune output current; however, it is difficult to achieve in organic devices with thermal activation characteristics, according to the existing ZTC point theory. Here, the Fermi pinning in OSCs is eliminated using the defect passivation strategy, making the Fermi level closer to the tail state at low temperatures; thus threshold voltage (VT) is negatively correlated with temperature. ZTC point behaviors in OFETs are achieved by compensation between VT and mobility at different temperatures to improve its temperature immunity. A temperature-immune output current can be realized in a variable-temperature bias voltage test over 50000 s by biasing the device at the ZTC point. This study provides an effective solution for temperature-immune OFETs and inspiration for their practical application.

Relationships among gut microbes, the interleukin family, and hypertension: a mediation Mendelian randomization study.

Purpose: Observational studies have increasingly recognized the influence of gut microbes on blood pressure modulation. Despite these findings, a direct causal link between gut flora and hypertension remains unestablished due to inherent confounders and the challenges of reverse causality in observational research. In this study, we sought to elucidate the causal relationship between specific gut flora and hypertension and its intermediary mediators. Methods: We employed a two-sample Mendelian randomization (MR) and mediation MR analysis, analyzing 211 species of gut bacteria, with a focus on the interleukin family as potential mediators and hypertension as the primary outcome. The central methodological technique was inverse variance-weighted estimation, supplemented by various other estimators. Results: Our findings revealed that two bacterial species positively correlated with hypertension risk, while five exhibited a negative association. Further validation was conducted using sensitivity analyses. Notably, our mediation MR results suggest interleukin-1 receptor type 2 (IL-1R2) as a mediator for the effect of the genus Clostridium innocuum group on hypertension, accounting for a mediation proportion of 14.07% [mediation effect: (b = 0.0007, 95%CI: 0.0002-0.0011); proportion mediation = 14.07% (4.26-23.40%)]. Conclusion: Our research confirms a genetic causal relationship between specific gut microbes and hypertension, emphasizing the potential mediating role of interleukin-1 receptor type 2 (IL-1R2) and offering insights for clinical hypertension interventions.

Methylation and transcriptomic expression profiles of HUVEC in the oxygen and glucose deprivation model and its clinical implications in AMI patients.

The obstructed coronary artery undergoes a series of pathological changes due to ischemic-hypoxic shocks during acute myocardial infarction (AMI). However, the altered DNA methylation levels in endothelial cells under these conditions and their implication for the etiopathology of AMI have not been investigated in detail. This study aimed to explore the relationship between DNA methylation and pathologically altered gene expression profile in human umbilical vein endothelial cells (HUVECs) subjected to oxygen-glucose deprivation (OGD), and its clinical implications in AMI patients. The Illumina Infinium MethylationEPIC BeadChip assay was used to explore the genome-wide DNA methylation profile using the Novaseq6000 platform for mRNA sequencing in 3 pairs of HUVEC-OGD and control samples. GO and KEGG pathway enrichment analyses, as well as correlation, causal inference test (CIT), and protein-protein interaction (PPI) analyses identified 22 hub genes that were validated by MethylTarget sequencing as well as qRT-PCR. ELISA was used to detect four target molecules associated with the progression of AMI. A total of 2,524 differentially expressed genes (DEGs) and 22,148 differentially methylated positions (DMPs) corresponding to 6,642 differentially methylated genes (DMGs) were screened (|Δß|>0.1 and detection p < 0.05). After GO, KEGG, correlation, CIT, and PPI analyses, 441 genes were filtered. qRT-PCR confirmed the overexpression of VEGFA, CCL2, TSP-1, SQSTM1, BCL2L11, and TIMP3 genes, and downregulation of MYC, CD44, BDNF, GNAQ, RUNX1, ETS1, NGFR, MME, SEMA6A, GNAI1, IFIT1, and MEIS1. DNA fragments BDNF_1_ (r = 0.931, p < 0.0001) and SQSTM1_2_NEW (r = 0.758, p = 0.0043) were positively correlated with the expressions of corresponding genes, and MYC_1_ (r = -0.8245, p = 0.001) was negatively correlated. Furthermore, ELISA confirmed TNFSF10 and BDNF were elevated in the peripheral blood of AMI patients (p = 0.0284 and p = 0.0142, respectively). Combined sequencing from in vitro cellular assays with clinical samples, aiming to establish the potential causal chain of the causal factor (DNA methylation) - mediator (mRNA)-cell outcome (endothelial cell ischemic-hypoxic injury)-clinical outcome (AMI), our study identified promising OGD-specific genes, which provided a solid basis for screening fundamental diagnostic and prognostic biomarkers of coronary endothelial cell injury of AMI. Moreover, it furnished the first evidence that during ischemia and hypoxia, the expression of BNDF was regulated by DNA methylation in endothelial cells and elevated in peripheral blood.

Oxygen-Induced Lattice Strain for High-Performance Organic Transistors with Enhanced Stability.

Integrating the merits of low cost, flexibility, and large-area processing, organic semiconductors (OSCs) are promising candidates for the next-generation electronic materials. The mobility and stability are the key figures of merit for its practical application. However, it is greatly challenging to improve the mobility and stability simultaneously owing to the weak interactions and poor electronic coupling between OSCs molecules. Here, an oxygen-induced lattice strain (OILS) strategy is developed to achieve OSCs with both high mobility and high stability. Utilizing the strategy, the maximum mobility of dinaphtho[2,3-b:2',3'-f]thieno[3,2-b]thiophene (DNTT) organic field-effect transistor (OFET) rises to 15.3 cm2  V-1  s-1 and the contact resistance lowers to 25.5 Ω cm. Remarkably, the thermal stability of DNTT is much improved, and a record saturated power density of ≈3.4 × 104  W cm-2 is obtained. Both the experiments and theoretical calculations demonstrate that the lattice compressive strain induced by oxygen is responsible for their high performance and stability. Furthermore, the universality of the strategy is manifested in both n-type and p-type small OSCs. This work provides a novel strategy to improve both the mobility and the stability of OSCs, paving the way for the practical applications of organic devices.

Oxygen-Induced Barrier Lowering for High-Performance Organic Field-Effect Transistors.

Organic field-effect transistors (OFETs) have the advantages of low-cost, large-area processing and could be utilized in a variety of emerging applications. However, the generally large contact resistance (Rc) limits the integration and miniaturization of OFETs. The Rc is difficult to reduce due to an incompatibility between obtaining strong orbit coupling and the barrier height reduction. In this study, we developed an oxygen-induced barrier lowering strategy by introducing oxygen (O2) into the nanointerface between the electrodes and organic semiconductors layer and achieved an ultralow channel width-normalized Rc (Rc·W) of 89.8 Ω·cm and a high mobility of 11.32 cm2 V-1 s-1. This work demonstrates that O2 adsorbed at the nanointerface of metal-semiconductor contact can significantly reduce the Rc from both experiments and theoretical simulations and provides guidance for the construction of high-performance OFETs, which is conducive to the integration and miniaturization of OFETs.

General Spatial Confinement Recrystallization Method for Rapid Preparation of Thickness-Controllable and Uniform Organic Semiconductor Single Crystals.

Organic semiconductor single crystals (OSSCs) are ideal materials for studying the intrinsic properties of organic semiconductors (OSCs) and constructing high-performance organic field-effect transistors (OFETs). However, there is no general method to rapidly prepare thickness-controllable and uniform single crystals for various OSCs. Here, inspired by the recrystallization (a spontaneous morphological instability phenomenon) of polycrystalline films, a spatial confinement recrystallization (SCR) method is developed to rapidly (even at several second timescales) grow thickness-controllable and uniform OSSCs in a well-controlled way by applying longitudinal pressure to tailor the growth direction of grains in OSCs polycrystalline films. The relationship between growth parameters including the growth time, temperature, longitudinal pressure, and thickness is comprehensively investigated. Remarkably, this method is applicable for various OSCs including insoluble and soluble small molecules and polymers, and can realize the high-quality crystal array growth. The corresponding 50 dinaphtho[2,3-b:2″,3″-f]thieno[3,2-b]thiophene (DNTT) single crystals coplanar OFETs prepared by the same batch have the mobility of 4.1 ± 0.4 cm2 V-1 s-1 , showing excellent uniformity. The overall performance of the method is superior to the reported methods in term of growth rate, generality, thickness controllability, and uniformity, indicating its broad application prospects in organic electronic and optoelectronic devices.

Strain-Balanced Organic Semiconductor Film for Improving the Stability of Organic Field-Effect Transistors.

Strain-induced aggregate state instability in organic semiconductor (OSC) films is a critical and bottleneck issue in the practicalization process of organic field-effect transistors (OFETs), but this issue lacks deep insight and effective solutions for a long time. Herein, we developed a novel and general strain balance strategy for stabilizing the aggregate state of OSC films and enhancing the robustness of OFETs. The charge transport zone in OSC films located at the OSC/dielectric interface always suffers from the intrinsic tensile strain induced by substrates and tends to dewet. By introducing a compressive strain layer, the tensile strain can be well balanced and OSC films attain a highly stable aggregate state. Consequently, the OFETs based on strain-balanced OSC heterojunction films exhibit excellent operational and storage stability. This work provides an effective and general strategy to stabilize OSC films and gives guidance in constructing highly stable organic heterojunction devices.

Prevalence of anxiety, depressive and insomnia symptoms among the different groups of people during COVID-19 pandemic: An overview of systematic reviews and meta-analyses.

Since the pandemic of the novel 2019 coronavirus disease (COVID-19), in addition to the harm caused by the disease itself, the psychological damage caused to the public by the pandemic is also a serious problem. The aim of our study was to summarize the systematic reviews/meta-analyses (SRs/MAs) of the prevalence of anxiety, depression and insomnia in different populations during the COVID-19 pandemic and to qualitatively evaluate these SRs/MAs. We searched the Cochrane Library, PubMed and Web of Science to obtain SRs/MAs related to anxiety, depression, and insomnia in different populations during the COVID-19 pandemic. The main populations we studied were healthcare workers (HCWs), college students (CSs), COVID-19 patients (CPs), and the general populations (GPs). A subgroup analysis was performed of the prevalence of psychological disorders. A total of 42 SRs/MAs (8,200,330 participants) were included in calculating and assessing the prevalence of anxiety, depression, and insomnia in these populations. The results of subgroup analysis showed that the prevalence of anxiety in different populations were: HCWs (20-44%), CSs (24-41%), CPs (15-47%), and GPs (22-38%). The prevalence of depression were: HCWs (22-38%), CSs (22-52%), CPs (38-45%), and GPs (16-35%), statistically significant differences between subgroups (p < 0.05). The prevalence of insomnia were: HCWs (28-45%), CSs (27-33%), CPs (34-48%), and GPs (28-35%), statistically significant differences between subgroups (p < 0.05). The comparison revealed a higher prevalence of psychological disorders in the CP group, with insomnia being the most pronounced. The methodological quality of the included SRs/MAs was then evaluated using AMSTAR 2 tool. The results of the methodological quality evaluation showed that 13 SRs/MAs were rated "medium," 13 were rated "low," and 16 were rated "very low." Through the subgroup analysis and evaluation of methodological quality, we found a higher prevalence of insomnia than anxiety and depression among the psychological disorders occurring in different populations during the pandemic, but the sample size on insomnia is small and more high-quality studies are needed to complement our findings.

Balancing the film strain of organic semiconductors for ultrastable organic transistors with a five-year lifetime.

The instability of organic field-effect transistors (OFETs) is one key obstacle to practical application and is closely related to the unstable aggregate state of organic semiconductors (OSCs). However, the underlying reason for this instability remains unclear, and no effective solution has been developed. Herein, we find that the intrinsic tensile and compressive strains that exist in OSC films are the key origins for aggregate state instability and device degradation. We further report a strain balance strategy to stabilize the aggregate state by regulating film thickness, which is based on the unique transition from tensile strain to compressive strain with increasing film thickness. Consequently, a strain-free and ultrastable OSC film is obtained by regulating the film thickness, with which an ultrastable OFET with a five-year lifetime is realized. This work provides a deeper understanding of and a solution to the instability of OFETs and sheds light on their industrialization.

Long-Term Neurological Sequelae and Disease Burden of Japanese Encephalitis in Gansu Province, China.

Background and objects: The study aimed to evaluate the long-term neurological sequelae and the disease burden of JE in Gansu, China. Methods: JE patients were included as study population from 2005-2011 in Gansu, and a follow-up survey was conducted in 2007-2014. Pair-matched healthy individuals were selected as controls. All subjects underwent a neurological examination and intelligence quotient (IQ) and memory quotient (MQ) assessments. Then, the disability-adjusted life years (DALYs), and direct and indirect medical expenses were systematic assessed. Results: Forty-four point seven percent of the JE patients had objective neurological deficits, compared with 2.4% of controls. Subnormal intelligence was found in 21.2% of JE subjects, compared with 1.2% control who exhibited a mildly reduced IQ. Abnormal MQ scores were noted in 56.3% JE subjects, compared with only 12.7% controls. Prevalence of each sequelae caused by JE were significantly higher in adults than in younger subjects. Furthermore, median DALY lost due to JE was 9.2 per subject. Median economic cost of JE was approximately $2776.6 per subject and significantly higher in adults than in younger subjects. Findings and Conclusions: JE patients suffered from severe neurological sequelae and high disease burden, resulting in a significant downstream burden for both the patients (especially adults) and the healthcare system.

Role of lncRNA LUCAT1 in cancer.

Long non-coding RNAs (lncRNAs) are RNA molecules with a transcript length of more than 200 nt and lack a protein-coding ability. They regulate gene expression by interacting with protein, RNA, and DNA. Their function is closely related to their subcellular localization. In the nucleus, lncRNAs regulate gene expression at the epigenetic and transcriptional levels, and in the cytoplasm, they regulate gene expression at the post-transcriptional and translational levels. Abnormalities in lncRNAs have been confirmed to exhibit tumor suppressor or carcinogenic effects and play an important role in the development of tumors. In particular, the lung cancer-related transcript 1 (LUCAT1) located in the antisense strand of the q14.3 region of chromosome 5 was first discovered in smoking-related lung cancer. Increasing evidence have showed that LUCAT1 is involved in breast cancer, ovarian cancer, thyroid cancer, renal cell carcinoma. It is highly expressed in liver cancer and other malignant tumors and has been confirmed to be induce various malignant tumors. It regulates tumor proliferation, invasion, and migration via various mechanisms and is related to the clinicopathological characteristics of tumor patients. Thus, LUCAT1 is a potential prognostic biological marker and therapeutic target for cancer. This article reviews its expression, function, and molecular mechanism in various malignant tumors.

Local delivery of thalidomide to inhibit neointima formation in rat model with artery injury.

OBJECTIVE: To observe the effect of local administration of thalidomide on neointimal formation after balloon-induced carotid artery injury in rats. METHODS: Forty-eight male Sprague-Dawley rats were randomly divided into 3 groups (n = 16): Sham operation group (group A), alone operation group (group B) and Thalidomide group (group C). The carotid arteries of group B and group C were injured by a conventional percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. Group C was treated by local delivery of thalidomide, and group B did not receive thalidomide. The arteries of group A were not injured. Seven and 14 days after balloon injury, rats were sacrificed. Serum concentrations of vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) were measured using enzyme-linked immunosorbent assay (ELISA). Neointima area, lumen area, macrophage infiltration and local expression of VEGF were measured using morphometric and immunohistochemical analyses. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) was used to examine VEGF mRNA expression. RESULTS: The VEGF levels were significantly increased in group B than in group C at 7 days (4.82 ±â€¯0.17 pg/mL vs 0.98 ±â€¯0.1 pg/mL, P < 0.01) and 14 days (6.3 ±â€¯0.16 pg/mL vs 1.03 ±â€¯0.09 pg/mL, P < 0.01). The TNF-α levels were also significantly increased in group B than in group C at 7 days (83 ±â€¯1.01 pg/mL vs 76.37 ±â€¯0.75 pg/mL, P < 0.01) and 14 days (84.06 ±â€¯1.11 pg/mL vs 78.46 ±â€¯0.94 pg/mL, P < 0.01). However, the area of neointimal formation was significantly reduced in group C than in group B at 14 days (0.07± 0.01 mm2 vs 0.12± 0.04 mm2, P < 0.01). Macrophage infiltration and local expression of VEGF in the injured arteries were significantly reduced in group C than in group B at 14 days. VEGF mRNA expression was significantly reduced in Group C than in group B at 14 days (6.3 ±â€¯0.16 vs 1.02 ±â€¯0.1, P < 0.01). CONCLUSIONS: Thalidomide, which is a specific VEGF inhibitor, significantly inhibited neointimal hyperplasia and vascular restenosis after balloon injury to the carotid artery in rats, thus potentially providing a novel method for the prevention and treatment of restenosis, especially in-stent restenosis.

Cerebral infarction as initial presentation in stress cardiomyopathy: Case report and literature review.

RATIONALE: The typical symptoms of stress cardiomyopathy include sudden-onset chest pain and breathlessness or collapse as well as classical symptoms of cardiovascular disease; however, rare reports have described nervous system symptoms as the initial manifestation. Here, we report the case of a young man who presented with a large cerebral infarction as the main clinical symptom of stress cardiomyopathy to increase recognition of the disease. PATIENT CONCERNS: A 28-year-old man was admitted to our hospital for sudden-onset weakness of the right limbs and unconsciousness for 1 day. Ten days prior, he began consuming copious amounts of alcohol (500 mL/day) secondary to reactive depression. DIAGNOSES: Imaging revealed a left internal carotid artery occlusion as assessed by carotid artery ultrasonography. Brain magnetic resonance imaging/magnetic resonance angiography showed new large left cerebral infarction complicated by a reperfusion injury. Moreover, cardiac ultrasonography showed decreased motion of the left ventricular apex, a 3.7 cm mural thrombus in the ventricular apex. The results of coronary and renal artery angiography did not reveal any significant epicardial coronary disease with thrombolysis in the myocardial infarction grade 3 in any of the coronary arteries. INTERVENTIONS: The patient was administered antiplatelet, anticoagulation, antihypertension, antibiotic, and neurotrophic therapies. OUTCOMES: The symptoms of cerebral infarction improved significantly after 12 days of admission. Cardiac ultrasonography showed that the wall movement of the left ventricular apex had recovered fully and the mural thrombus resolved completely. LESSONS: Patients with stress cardiomyopathy exhibit various clinical manifestations and characteristics. On the basis of our in-depth understanding of stress cardiomyopathy, clinicians should diagnose early and develop reasonable and effective therapies to prevent the harmful effects of related complications.

Association between Antihypertensive Drug Use and the Incidence of Cognitive Decline and Dementia: A Meta-Analysis of Prospective Cohort Studies.

BACKGROUND: Antihypertensive drug use is inconsistently associated with the risk of dementia, Alzheimer's disease, cognitive impairment, and cognitive decline. Therefore, we conducted a meta-analysis of available prospective cohort studies to summarize the evidence on the strength of these relationships. METHODS: Three electronic databases including MedLine, Embase, and the Cochrane Library were searched to identify studies from inception to April 2017. Only prospective cohort studies that reported effect estimates with corresponding 95% confidence intervals (CIs) of dementia, Alzheimer's disease, cognitive impairment, and cognitive decline for antihypertensive drug use versus not using antihypertensive drugs were included. RESULTS: We included 10 prospective cohort studies reporting data on 30,895 individuals. Overall, participants who received antihypertensive drugs had lower incidence of dementia (relative risk [RR]: 0.86; 95% CI: 0.75-0.99; p = 0.033), while there was no significant effect on the incidence of Alzheimer's disease (RR: 0.83; 95% CI: 0.64-1.09; p = 0.154), cognitive impairment (RR: 0.89; 95% CI: 0.57-1.38; p = 0.596), and cognitive decline (RR: 1.11; 95% CI: 0.86-1.43; p = 0.415). Further, the incidence of Alzheimer's disease might be affected by antihypertensive drug use in participants with specific characteristics. CONCLUSIONS: Antihypertensive drug use was associated with a significantly reduced risk of dementia, but not with the risk of Alzheimer's disease, cognitive impairment, and cognitive decline.