Identification and Functional Characterization of a Surfactant-like Protein Region in Flagellin FliC for Stabilizing Selenium Nanoparticles and Enhancing Bioavailability.

Biogenic selenium nanoparticles (SeNPs) are the most favorable Se form for nutritional supplementation due to their high stability, low toxicity, and high activity. However, the interaction between the surface-binding proteins and their stable biogenic SeNPs, as well as their impact on the stability and bioavailability of SeNPs, remains to be understood. In vitro stabilization experiments revealed an amino acid segment (F(235-386)) in Rahnella aquatilis' flagellin FliC, with surfactant-like properties, stabilizing SeNPs under harsh conditions. FliC and F(235-386) were employed as stabilizers to synthesize SeNPs (FliC@SeNPs and F(235-386)@SeNPs), and surface chemistry analysis revealed coordination reactions between the proteins and Se atoms on the surface of SeNPs. Both FliC and F(235-386) enhanced SeNPs uptake in wheat seedlings but reduced it in bacteria and yeast. This study highlights FliC's core function in stabilizing SeNPs and enhancing their bioavailability, paving the way for agricultural and nutritional applications.

Fluorination modification enhanced the water resistance of Universitetet i Oslo-67 for multiple volatile organic compounds adsorption under high humidity conditions: Mechanism study.

The construction of metal-organic frameworks (MOFs) with highly efficient capture for volatile organic compounds (VOCs) adsorption under humid conditions is a significant yet formidable task. Herein, series of fluorinated UiO-67 modified with trifluoroacetic acid (TFA) and 4-fluorobenzoic acid were successfully synthesized for VOCs adsorption under high humidity conditions. Experiments results showed that UiO-67 modified with 4-fluorobenzoic acid (67-F) presented excellent adsorption capacity of 345 mg/g for toluene adsorption and exhibited great water resistance (10.0 vol% H2O, 374 mg/g toluene adsorption capacity). Characterization results indicated that the introduction of 4-fluorobenzoic acid induced the competitive coordination between 4-fluorobenzoic acid and 4,4-biphenyl dicarboxylic acid (BPDC) with Zr4+, causing the formation of abundant defects to provide extra adsorption sites. Meanwhile, the benzene ring in 4-fluorobenzoic acid enhanced the π-π conjugation, causing the further promotion of VOCs adsorption capacity. More importantly, the water resistance mechanism was investigated and elucidated that the introduction of F decreased the surface energy of 67-F and its affinity with water. Meanwhile, the metal complex induced by the fluorinated modification produced an electron-dense pore environment, which greatly improved its chemical and water stability. This work provided a strategy for preparing an adsorbent with high water resistance for real-world VOCs adsorption at high humidity conditions.

Insight into the Critical Role of Oxygen Vacancies and V=O Bonds Length in V2O5 for Advanced Zinc Ion Storage.

Due to the larger sizes and stronger positive polarity of Zn2+ than dominant univalent ions, Zn2+ sluggish diffusion within V2O5 host electrodes is an essential issue in developing aqueous zinc-ion batteries (ZIBs) of higher energy densities. Herein, a high-performance V2O5 cathode was developed through subtly synthesizing and tuning V2O5 with oxygen vacancies-enriched and elongated apical V=O1 bond by altering the gradient concentration of hydrazine hydrate in the gas-solid reaction system. This strategy can enhance both intrinsic and extrinsic conductivity to a large extent. The electrochemical testing demonstrated the oxygen vacancies-enriched and elongated apical V=O1 bond can not only increase the intrinsic electronic conductivity of V2O5, but also induce additional pseudocapacitance to enhance the Zn2+ diffusion kinetics. We used infrared spectroscopy and Raman spectroscopy to characterize the change in the bond length structure of V2O5. Simultaneously, the long-term cyclability (capacity retention of 76.9 % after 1200 cycles at 4.0 A g-1) and rate capabilities (218 mAh g-1 at 4.0 A g-1) are promoted as well. We believe that our work might shed light on the bond length engineering of V2O5 and provide insights for the reasonable designing of novel cathodes for practical rechargeable ZIBs.

Characteristics and outcome of patients with left atrial appendage closure in China: a single-center experience.

BACKGROUND: Clinical characteristics and long-term data on the safety and efficacy of LAAC in preventing cerebrovascular accident and thromboembolism among Chinese patients with non-valvular AF (NVAF) remain limited. METHODS: Data of consecutive NVAF patients who underwent LAAC at Beijing Anzhen Hospital, Capital Medical University, from June 1, 2014, to December 31, 2021, were collected and analyzed retrospectively. The primary effectiveness endpoint was the composite endpoint of stroke/transient ischemic attack, systemic embolism, and death from cardiovascular causes. The primary safety endpoint is the severe bleeding defined by the LAAC Munich consensus. RESULTS: Of the 222 patients enrolled, the mean age was 66.90 ± 9.62 years, with a majority being male (77.03%). Many patients are non-paroxysmal AF (71.19%) with a median duration of AF of 4.00 years. The mean CHA2DS2-VASc score was 3.78 ± 1.49, and the mean HAS-BLED score was 1.68 ± 0.86. Thromboembolic events (76.58%) were the most common indication for LAAC. The device, technical, and procedural success rates were 98.65%, 98.65%, and 93.69%, respectively. The anticoagulation continuation rate was 56.36%, 31.25%, and 22.60% at 3-, 6- and 12 months post-procedure, respectively. Throughout a mean 2.81 years of follow-up, the incidence of the primary efficacy endpoint was 4.27 per 100 patient-years, predominantly attributable to stroke/TIA (3.12 per 100 PYs). Five patients experienced major bleeding during the follow-up period. Post-procedure imaging revealed minimal complications, with only one substantial peri-device leak. Device-related thrombus occurred in 2.33% of patients, resolving with anticoagulation. CONCLUSION: The study demonstrates that LAAC is a safe and effective alternative option for Chinese patients with AF, with a high success rate, few complications as well as fewer long-term adverse outcome events.

Clinical and Genomic Characteristics of a Clinical Listeria Monocytogenes ST120 Isolate Recovered from a Pregnant Woman.

Background: Maternal-fetal listeriosis, caused by Listeria monocytogenes, is a rare but serious infection. Herein, we report the clinical and genomic characteristics of a clinical L. monocytogenes ST120 isolate recovered from a pregnant woman. Methods: The clinical symptoms and treatment in pregnant woman were described in detail. Whole genome sequencing (WGS) was performed on the L. monocytogenes isolate SJZ_LM001, and the genomic characterization of the isolate was deeply analyzed. Results: The clinical symptoms in pregnant women were mainly fever, and the placenta experienced severe inflammation. The pregnant woman was treated with ampicillin for effective anti-infective therapy. Genomic analysis showed that isolate SJZ_LM001 is sequence type (ST) 120, belong to clonal complex (CC)8 and lineage II of L. monocytogenes. Additionally, the isolates SJZ_LM001 harbored a novel plasmid pSJZ_LM001, which carried arsenical resistance genes (arsACD and acr3), and cadmium resistance genes (cadAC). Drug susceptibility testing showed that the isolate SJZ-LM001 was susceptible to ampicillin, meropenem, penicillin, and cotrimoxazole. Conclusion: This is the first to identify a clinical case of infection in a pregnant woman caused by ST120 L. monocytogenes in China. These findings could benefit our understanding of the genomic characteristics of L. monocytogenes, and the pregnancy-related listeriosis and providing early diagnosis and effective targeted treatment.

Coplanar Conformational Structure of π-Conjugated Polymers for Optoelectronic Applications.

Hierarchical structure of conjugated polymers is critical to dominating their optoelectronic properties and applications. Compared to nonplanar conformational segments, coplanar conformational segments of conjugated polymers (CPs) demonstrate favorable properties for applications as a semiconductor. Herein, recent developments in the coplanar conformational structure of CPs for optoelectronic devices are summarized. First, this review comprehensively summarizes the unique properties of planar conformational structures. Second, the characteristics of the coplanar conformation in terms of optoelectrical properties and other polymer physics characteristics are emphasized. Five primary characterization methods for investigating the complanate backbone structures are illustrated, providing a systematical toolbox for studying this specific conformation. Third, internal and external conditions for inducing the coplanar conformational structure are presented, offering guidelines for designing this conformation. Fourth, the optoelectronic applications of this segment, such as light-emitting diodes, solar cells, and field-effect transistors, are briefly summarized. Finally, a conclusion and outlook for the coplanar conformational segment regarding molecular design and applications are provided.

Amorphous structure and crystal stability determine the bioavailability of selenium nanoparticles.

Microorganisms play a critical role in the biogeochemical cycling of selenium, often reducing selenite/selenate to elemental selenium nanoparticles (SeNPs). These SeNPs typically exist in an amorphous structure but can transform into a trigonal allotrope. However, the crystal structural transition process and its impact on selenium bioavailability have not been well studied. To shed light on this, we prepared chemosynthetic and biogenic SeNPs and investigated the stability of their crystal structure. We found that biogenic SeNPs exhibited a highly stable amorphous structure in various conditions, such as lyophilization, washing, and laser irradiation, whereas chemosynthetic SeNPs transformed into a trigonal structure in the same conditions. Additionally, a core-shell structure was observed in biogenic SeNPs after electron beam irradiation. Further analysis revealed that biogenic SeNPs showed a coordination reaction between Se atoms and surface binding biomacromolecules, indicating that the outer layer of Se-biomacromolecules complex prevented the SeNPs from crystallizing. We also investigated the effects of SeNPs crystal structures on the bioavailability in bacteria, yeast, and plants, finding that the amorphous structure of SeNPs determined Se bioavailability.

Impact of Sodium-Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Diabetes: A Propensity-Score Matching Study and Meta-Analysis.

BACKGROUND: The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and atrial fibrillation (AF) recurrence after catheter ablation among patients with diabetes and AF remains unclear. METHODS AND RESULTS: Patients with AF undergoing initial catheter ablation with a history of diabetes from the China AF registry were included. Patients using SGLT2i were identified and matched by propensity score with non-SGLT2i patients in a 1:3 ratio. The main outcome was AF recurrence during the 18-month follow-up. A total of 138 patients with diabetes with SGLT2i therapy and 387 without SGLT2i were analyzed. AF recurrence occurred in 37 patients (26.8%) in the SGLT2i group and 152 patients (39.3%) in the non-SGLT2i group during a total of 593.3 person-years follow-up. The SGLT2i group was associated with lower AF recurrence compared with the non-SGLT2i group (hazard ratio, 0.63 [95% CI, 0.44-0.90], P=0.007). A total of 4 studies were analyzed in our meta-analysis demonstrating that SGLT2i was associated with lower AF recurrence after catheter ablation (odds ratio, 0.61 [95% CI, 0.54-0.69]; P<0.001, I2=0.0%). CONCLUSIONS: Our prospective study coupled with a meta-analysis demonstrated a lower risk of AF recurrence with the use of SGLT2i among patients with diabetes after AF ablation.

Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history: a prospective propensity score-matched cohort study.

BACKGROUND: Patients with atrial fibrillation (AF) and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy. It is unclear whether catheter ablation (CA) has further benefits in these patients. METHODS: AF patients with a previous history of stroke or systemic embolism (SE) from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis. Patients were matched in a 1:1 ratio to CA or medical treatment (MT) based on propensity score. The primary outcome was a composite of all-cause death or ischemic stroke (IS)/SE. RESULTS: During a total of 4.1 ± 2.3 years of follow-up, the primary outcome occurred in 111 patients in the CA group (3.3 per 100 person-years) and in 229 patients in the MT group (5.7 per 100 person-years). The CA group had a lower risk of the primary outcome compared to the MT group [hazard ratio (HR) = 0.59, 95% CI: 0.47-0.74, P < 0.001]. There was a significant decreasing risk of all-cause mortality (HR = 0.43, 95% CI: 0.31-0.61, P < 0.001), IS/SE (HR = 0.73, 95% CI: 0.54-0.97, P = 0.033), cardiovascular mortality (HR = 0.32, 95% CI: 0.19-0.54, P < 0.001) and AF recurrence (HR = 0.33, 95% CI: 0.30-0.37, P < 0.001) in the CA group compared to that in the MT group. Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants. CONCLUSIONS: In AF patients with a prior stroke history, CA was associated with a lower combined risk of all-cause death or IS/SE. Further clinical trials are warranted to confirm the benefits of CA in these patients.

Apoptosis and oxidative stress of mouse breast carcinoma 4T1 and human intestinal epithelial Caco-2 cell lines caused by the phycotoxin gymnodimine-A.

Gymnodimine-A (GYM-A) is a cyclic imine phycotoxin produced by some marine dinoflagellates. It can cause rapid death of mice via intraperitoneal administration and frequently accumulate in shellfish potentially threatening human health. In this study, four different cell lines were exposed to GYM-A for the viability assessment. Results showed that GYM-A was cytotoxic with concentration-dependent pattern to each cell type, with mean IC50 values ranging from 1.39 to 2.79 µmol L-1. Results suggested that the loss of cell viability of 4T1 and Caco-2 cells was attributed to apoptosis. Furthermore, the collapse of mitochondrial membrane potential and caspases activation were observed in the GYM-A-treated cells. Reactive oxygen species (ROS) and lipid peroxides (LPO) levels were markedly increased in 4T1 and Caco-2 cells exposed to GYM-A at 2 µmol L-1, and the oxidative stress in 4T1 cells was more obvious than that in Caco-2 cells. Additionally, unusual ultrastructure impairment on mitochondria and mitophagosomes occurred in the GYM-A-treated cells. These results suggested that an ROS-mediated mitochondrial pathway for apoptosis and mitophagy was implicated in the cytotoxic effects induced by GYM-A. This is the first report to explore the cytotoxic mechanisms of GYM-A through apoptosis and oxidative stress, and it will provide theoretical foundations for the potential therapeutic applications of GYM-A.

Atrial fibrillation catheter ablation associated silent cerebral emboli: A narrative review.

The incidence of silent cerebral emboli (SCE) associated with atrial fibrillation catheter ablation (AFCA) is much higher than that of stroke/transient ischemic attack (TIA). Interventional electrophysiologists have been increasingly alerted to asymptomatic cerebral infarction over the years. Plentiful studies revealed that diagnostic definitions, detection modalities, energy sources, ablation strategies, perioperative anticoagulation regimens, and patient-related factors were associated with the risk of AFCA-associated SCE. Studies related to non-interventional procedures found that SCE may prompt stroke, cognitive decline, and dementia later in life, suggesting a possible role of AFCA-associated SCE in the cognitive function of patients with AF. However, there is no consistent evidence for this view to date. Given that the majority of patients with AF being elderly and the increased risk of cognitive impairment in AF itself, efforts should be made to minimize the occurrence of AFCA-associated SCE.

Synchronous decomplexation and mineralization of copper complexes by activating peroxymonosulfate with magnetic bimetallic biochar derived from municipal sludge.

Efficient removal of copper complexes is a challenging issue due to their robust stability and solubility. In this study, CoFe2O4-Co0 loaded sludge-derived biochar (MSBC), a magnetic heterogeneous catalyst, was prepared to activate peroxymonosulfate (PMS) for the decomplexation and mineralization of some typical copper complexes (including Cu(Ⅱ)-EDTA, Cu(Ⅱ)-NTA, Cu(Ⅱ)-citrate, and Cu(Ⅱ)-tartrate). The results showed that abundant cobalt ferrite and cobalt nanoparticles were decorated in the plate-like carbonaceous matrix, making it a higher degree of graphitization, better conductivity and more excellent catalytic activity than the raw biochar. Cu(Ⅱ)-EDTA was chosen as the representative copper complex. Under the optimum condition, the decomplexation and mineralization efficiency of Cu(Ⅱ)-EDTA in MSBC/PMS system were 98% and 68% within 20 min, respectively. The mechanistic investigation confirmed that the activation of PMS by MSBC followed both a radical pathway contributed by SO4•- and •OH and a nonradical pathway contributed by 1O2. In addition, the electron transfer pathway between Cu(Ⅱ)-EDTA and PMS facilitated the decomplexation of Cu(Ⅱ)-EDTA. Jointly, CO, Co0, and the redox cycles of Co(Ⅲ)/Co(Ⅱ) and Fe (Ⅲ)/Fe (Ⅱ) were found to play a critical role in the decomplexation process. Overall, the MSBC/PMS system provides a new strategy for efficient decomplexation and mineralization of copper complexes.

Effects of Mn content on austenite stability and mechanical properties of low Ni alumina-forming austenitic heat-resistant steel: a first-principles study.

Low Ni alumina-forming austenitic (AFA) heat-resistant steel is an advanced high-temperature stainless steel with reduced cost, good machinability, high-temperature creep strength, and high-temperature corrosion resistance. Using the First-principles approach, this study examined the effect of Mn content on austenite stability and mechanical properties at the atomic level. Adding Mn to low Ni-AFA steel increases the unit cell volume with an accompanying increase in the absolute value of formation energy; the austenite formed more easily. The austenitic matrix binding energy decreases and remains negative, indicating austenite stability. As the Mn content increases from 3.2 to 12.8 wt%, the system's bulk modulus (B) rises significantly, and the shear modulus (G) falls. In addition, the system's strength and hardness decrease, and the Poisson ratio of the austenite matrix increases with improved elasticity; the system has excellent plasticity with an increase in the B/G. For the Fe22-Cr5-Ni3-Al2 system, with the increase of Mn content, the electron density distribution between the atoms is relatively uniform, and the electrons around the Mn atoms are slightly sparse, which will slightly reduce the structural stability of the matrix. The experiment demonstrated the matrix maintains the austenitic structure when adding 3.2-12.8 wt% Mn elements to low Ni-AFA steel. At an Mn content of 8 wt%, the overall mechanical properties of the high-Mn AFA steel are optimal, with a tensile strength of 581.64 MPa, a hardness of 186.17 HV, and an elongation of 39%.

Selected ssDNA aptamers-graphene oxide-based fluorescent biosensor to detect sulfameter in milk.

The abuse of sulfameter (SME) in animal husbandry can cause drug resistance and toxic or allergic reactions in humans. Therefore, it is very important to establish a simple, inexpensive, and efficient method for detecting SME in food. In this work, we propose a single fluorescent aptamer/graphene oxide (GO)-based biosensor to detect SME residues in milk. Aptamers that specifically bind to SME were screened using capture-SELEX and a ssDNA library immobilized on magnetic beads. The 68 active candidate aptamers were chemically synthesized for specificity and affinity characterization. Among the aptamers, the aptamer sulf-1 revealed the highest affinity (Kd = 77 ± 15 nM) to SME and was selected to construct a GO-based fluorescent biosensor for real milk sample detection. Under optimal conditions, the single fluorescent aptasensor had a wide linear range (R2 was 0.997) from 7 to 336 ng/ml and a low detection limit of 3.35 ng/ml that was calculated with a 3SD/slope. The single fluorescent method was also validated using SME-fortified milk samples, showing average recoveries ranging from 99.01% to 104.60% with a relative standard deviation of less than 3.88%. These results demonstrate that this novel aptamer sensor provides an opportunity for sensitive, convenient, and accurate detection of SME residues in milk.

Discovery of pentacyclic triterpenoid glycosides with anti-proliferative activities from Ardisialindleyana.

One new pentacyclic triterpenoid glycoside, ardisiapunine E (1), along with two known compounds were isolated from the root of Ardisia lindleyana D.Dietr. Their structures were elucidated by 1H and 13C NMR, DEPT, HMBC, HSQC, 1H-1H COSY and NOESY spectroscopic analyses, ESI-MS, and literature. Compounds 1-3 exhibited obvious anti-proliferative activities against the HeLa cell line in a dose- and time-dependent manner by inducing G2/M phase arrest and apoptosis in vitro, both consisting of pentacyclic triterpenes and sugar. Hence, this study identified a new and two known pentacyclic triterpenoid glycosides promoting apoptosis as a potential anti-proliferative agent.

High glucose-induced glucagon resistance and membrane distribution of GCGR revealed by super-resolution imaging.

The glucagon receptor (GCGR) is a member of the class B G protein-coupled receptor family. Many research works have been carried out on GCGR structure, glucagon signaling pathway, and GCGR antagonists. However, the expression and fine distribution of GCGR proteins in response to glucagon under high glucose remain unclear. Using direct stochastic optical reconstruction microscopy (dSTORM) imaging, nanoscale GCGR clusters were observed on HepG2 cell membranes, and high glucose promoted GCGR expression and the formation of more and larger clusters. Moreover, glucagon stimulation under high glucose did not inhibit GCGR levels as significantly as that under low glucose and did not increase the downstream cyclic 3,5'-adenosine monophosphate-protein kinase A (cAMP-PKA) signal, and there were still large-size clusters on the membranes, indicating that high glucose induced glucagon resistance. In addition, high glucose induced stronger glucagon resistance in hepatoma cells compared with hepatic cells. Our work will pave a way to further our understanding of the pathogenesis of diabetes and develop more effective drugs targeting GCGR.

Occurrence and spatial distribution of paralytic shellfish toxins in seawater and marine organisms in the coastal waters of Qinhuangdao, China.

In recent years, paralytic shellfish toxins (PSTs) have been prevalent in the coastal waters of Qinhuangdao, the west coast of the Bohai Sea, China. The content of PSTs in shellfish often exceeded the regulatory limit of 800 µg STX equivalent (eq.) kg-1, which poses a serious threat to human health. In this study, two surveys were conducted in May 2021 and May 2022 to investigate the distribution of PSTs in the coastal waters of Qinhuangdao. Seawater, surface sediment, phytoplankton, zooplankton, and other marine organism samples were collected, and the composition and concentration of PSTs were analyzed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results showed that multiple PST components were detected in all seawater samples collected at different depths, mainly including GTX1/4, GTX2/3, dcGTX2, STX and C1/2, and the highest concentration of PSTs reached 244 ng STX eq. L-1. The sediment samples also contained low levels of C1/2 and GTX2/3. Trace amounts of C1/2 and GTX1-4 were detected in phytoplankton and zooplankton. Moreover, all bivalve shellfish samples were found to contain PSTs, and the scallop Azumapecten farreri and the ark clam Anadara kagoshimensis showed relatively high concentrations of 607 and 497 µg STX eq. kg-1, respectively. In addition, low levels of PSTs were also found in some non-traditional PST vectors, including whelk Rapana venosa, octopus Amphioctopus ovulum, goby Ctenotrypauchen chinensis, and greenling Hexagrammos agrammus. Results of this study improve the understanding of the distribution of PSTs in seawater and marine organisms and the potential risk of persistent PSTs in seawater to marine ecosystems and human health.

Cytotoxicity and intestinal permeability of phycotoxins assessed by the human Caco-2 cell model.

Phycotoxins are a class of multiple natural metabolites produced by microalgae in marine and freshwater ecosystems that bioaccumulate in food webs, particularly in shellfish, having a great impact on human health. Phycotoxins are mainly leached and absorbed in the small intestine when human consumers accidentally ingest toxic aquatic products contaminated by them. To assess the intestinal uptake and damage of phycotoxins, a typical in vitro model was developed and widely applied using the human colorectal adenocarcinoma Caco-2 cell line. In this review, the application cases were summarized for multiple phycotoxins, including microcystins (MCs), cylindrospermopsins (CYNs), domoic acids (DAs), saxitoxins (STXs), palytoxins (PLTXs), okadaic acids (OAs), pectenotoxins (PTXs) and azaspiracids (AZAs). The results of the previous studies showed that each group of phycotoxins presented different cytotoxicity and mechanisms to Caco-2 cells, and significant discrepancies in the transport of phycotoxin across the Caco-2 cell monolayers. Therefore, this review describes the evaluation assays of the Caco-2 cell monolayer model, illustrates the principles of several primary cytotoxicity evaluation assays, and summarizes the cytotoxicity of each group of phycotoxins to Caco-2 cells line and their cellular transport, and finally proposes the development of multicellular intestinal models for future comprehensive studies on the toxicity and absorption of phycotoxins in the intestine. It will improve the understanding of Caco-2 cell monolayer models in the toxicology studies on phycotoxins and the potentially detrimental effects of microalgal toxins on the human intestine.

Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review.

Introduction: Persistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated by the existence of PLSVC, which could act as an important arrhythmogenic mechanism in AF. Methods and results: We reported a case series of patients with PLSVC who underwent CA for AF at our center between 2018 and 2021. A systematic search was also performed on PubMed, EMBASE, and Web of Science for research reporting CA for AF in patients with PLSVC. Sixteen patients with PLSVC were identified at our center. Ablation targeting PLSVC was performed in 5 patients in the index procedures and in four patients receiving redo procedures. One patient experienced acute procedure failure. After a median follow-up period of 15 months, only 6 (37.5%) patients remained free from AF/atrial tachycardia (AT) after a single procedure. In the systematic review, 11 studies with 167 patients were identified. Based on the included studies, the estimated prevalence of PLSVC in patients undergoing CA for AF was 0.7%. Ablation targeting PLSVC was performed in 121 (74.7%) patients. Major complications in patients with PLSVC receiving AF ablation procedure included four cases of cardiac tamponades (2%), three cases of cardiac effusion (1.5%), one case of ischemic stroke, and three cases of phrenic nerve injury (1.5%) (one left phrenic nerve and two right phrenic nerve). Pooled analysis revealed that after a median follow-up period of 15.6 months (IQR 12.0-74.0 months), the long-term AF/AT-free rate was 70.6% (95% CI 62.8-78.4%, I 2 = 0.0%) (Central illustration). Different ablation strategies for PLSVC were summarized and discussed in the systematic review. Conclusion: In patients with PLSVC, recurrence of atrial arrhythmia after CA for AF is relatively common. Ablation aiming for PLSVC isolation is necessitated in most patients. The overall risk of procedural complications was within an acceptable range.

Validation of T-MoCA in the Screening of Mild Cognitive Impairment in Chinese Patients With Atrial Fibrillation.

Background: Atrial fibrillation (AF) is associated with a high risk of mild cognitive impairment (MCI) and dementia. However, feasible and simple instruments that facilitate the regular assessment of cognitive status in patients with AF remain underdeveloped. Methods: Cognitive function was first evaluated using telephone Montreal cognitive assessment (T-MoCA), and then patients were invited for an in-person interview for cognitive assessment using both Clinical Dementia Rating (CDR) and mini-mental status evaluation (MMSE). Using CDR = 0.5 as a reference standard, the ability of T-MoCA and MMSE to discriminate cognitive dysfunction, stratified by education level, was tested by receiver-operating curve (ROC) analysis. The net reclassification index was calculated for comparison between the performance of T-MoCA and MMSE. Results: One hundred and one patients completed both telephone and in-person interview. Thirty-five MCI patients were identified as MCI using the criteria of CDR = 0.5. The areas under the ROC curve of T-MoCA were 0.80 (0.71-0.89), 0.83 (0.71-0.95), and 0.85 (0.64-0.92) for all patients, patients with high educational level, and patients with low education level, respectively. The optimal threshold was achieved at 16/17 with a sensitivity of 85.7% and a specificity of 69.7% in overall patients, 15/16 with a sensitivity of 88.2% and a specificity of 64.5% in the low educational level patients, and 16/17 with a sensitivity of 77.8% and a specificity of 87.9% in the high educational level patients. Compared to the criterion MMSE ≤ 27 and MMSE norms for the elderly Chinese community, the stratified T-MoCA threshold improves correct classification by 23.7% (p = 0.033) and 30.3% (p = 0.020), respectively. Conclusion: T-MoCA is a feasible and effective instrument for MCI screening in patients with AF.