[Metabolic mechanism and intervention strategy of atrial fibrillation in the elderly].

Atrial fibrillation (AF) is a cardiovascular epidemic that occurs primarily in the elderly with primary cardiovascular diseases, leading to severe consequences such as stroke and heart failure. The heart is an energy-consuming organ, which requires a high degree of metabolic flexibility to ensure a quick switch of metabolic substrates to meet its energy needs in response to physiological and pathological stimulation. Metabolism is closely related to the occurrence of AF, and AF patients manifest metabolic inflexibility, such as insulin resistance and the metabolic shift from aerobic metabolism to anaerobic glycolysis. Moreover, our research group and the others have shown that metabolic inflexibility is a crucial pathologic mechanism for AF. Energy metabolism is closely linked to the aging process and aging-related diseases, and impaired metabolic flexibility is considered as an essential driver of aging. Therefore, this review focuses on the alteration of metabolic flexibility in the elderly and reveals that impaired metabolic flexibility may be an important driver for the high prevalence of AF in the elderly, hoping to provide intervention strategies for the prevention and treatment of AF in the elderly.

Rare-Earth-Metal-Complex-Catalyzed Hydroalkoxylation and Tandem Hydroalkoxylation/Cyclohydroamination of Isocyanates: Synthesis of Carbamates and Oxazolidinones.

Novel N,N,N-tridentate ß-diketiminato rare-earth-metal dialkyl complexes LRE(CH2SiMe3)2 [RE = Y (1a), Gd (1b), Yb (1c), Lu (1d); L = MeC(NDipp)CHC(Me)N(CH2)2NC4H8, where Dipp = 2,6-iPr2C6H3] have been conveniently synthesized by one step from reactions of the rare-earth-metal trialkyl complexes RE(CH2SiMe3)3(THF)2 (THF = tetrahydrofuran) with a pyrrolidine-functionalized ß-diketiminate HL, and their catalytic behaviors toward hydroalkoxylation and tandem hydroalkoxylation/cyclohydroamination of isocyanates have been described. These rare-earth-metal catalysts exhibited high efficiency in the hydroalkoxylation of isocyanates, providing a variety of N-alkyl and N-aryl carbamate derivatives under mild reaction conditions with a rather low catalyst loading (0.04 mol %). More significantly, they can promote a tandem hydroalkoxylation/cyclohydroamination reaction between terminal and internal propargylic alcohols with substituted arylisocyanates, leading to the efficient synthesis of methylene and (Z)-selective arylidene oxazolidinones in good-to-high yields via consecutive C-O and C-N bond formation. The stoichiometric reaction of 1a with p-tolylisocyanate generated an unusual dinuclear yttrium complex, {[η2-(4-MePhNCO)(CH2SiMe3)]Y[µ-η2:η1:η1-(4-MePhNCO)CC(Me)(NDipp)C(Me)N(CH2)2NC4H8]}2 (7a), with two different amidate units, which underwent an sp2 C-H bond activation of the ß-diketiminato backbone, followed by the insertion of isocyanate.

Serum TBA and GCA Levels Across Pregnancy and the Gestational Age-Specific Reference Intervals for Pregnant Chinese.

BACKGROUND: Reference intervals of clinical laboratory indexes are the basis of interpretation of test results. While intrahepatic cholestasis of pregnancy (ICP) could severely threaten maternal and fetal health, reference intervals of the biomarkers serum total bile acids (TBA) and glycocholic acid (GCA) are unsatisfactory. The purpose of this study was to derive gestational age-specific reference intervals for serum TBA and GCA in a Chinese population to promote early diagnosis of ICP. METHODS: A total of 416 healthy pregnant Chinese were recruited and divided into three groups by gestational age: 140 in the first trimester (1 - 13 weeks) group, 136 in the second trimester (14 - 27 weeks) group, and 140 in the third trimester (≥ 28 weeks) group. Serum TBA and GCA levels were measured respectively by cyclic enzymatic method and latex enhanced immune turbidimetry. Reference intervals were calculated with non-parametric method. RESULTS: The reference intervals of serum TBA are 0.90 - 6.60 µmol/L, 1.20 - 9.10 µmol/L, and 1.50 - 8.90 µmol/L respectively in the first, second, and third trimester. The reference intervals of serum GCA are 0.24 - 1.14 µg/mL in the first and second trimesters (combined) and 0.00 - 2.04 µg/mL in the third trimester. CONCLUSIONS: Gestational age-specific reference intervals of serum TBA and GCA for pregnant Chinese were derived in strict accordance with CLSI C28-A3 guidelines, which will be valuable for early diagnosis of ICP.

On-Chip Detection of Optical Spin-Orbit Interactions in Plasmonic Nanocircuits.

On-chip manipulating and controlling the temporal and spatial evolution of light are of crucial importance for information processing in future planar integrated nanophotonics. The spin and orbital angular momentum of light, which can be treated independently in classical macroscopic geometrical optics, appear to be coupled on subwavelength scales. We use spin-orbit interactions in a plasmonic achiral nanocoupler to unidirectionally excite surface plasmon polariton modes propagating in seamlessly integrated plasmonic slot waveguides. The spin-dependent flow of light in the proposed nanophotonic circuit allows on-chip electrical detection of the spin state of incident photons by integrating two germanium-based plasmonic-waveguide photodetectors. Consequently, our device serves as a compact (∼6 × 18 µm2) electrical sensor for photonic spin Hall dynamics. The demonstrated configuration opens new avenues for developing highly integrated polarization-controlled optical devices that would exploit the spin-degree of freedom for manipulating and controlling subwavelength optical modes in nanophotonic systems.

Sub-wavelength grating assisted mode order converter on the SOI substrate.

We have designed three mode order converters using the sub-wavelength grating on the silicon-on-insulator substrate. The proposed mode order converters can separately realize the mode order conversion from the fundamental transverse electric mode to the first-order transverse electric mode (TE0-to-TE1), the second-order transverse electric mode (TE0-to-TE2) and the third-order transverse electric mode (TE0-to-TE3) with compact device sizes and good performances. The simulation results show that the mode order conversion efficiencies of TE0-to-TE1, TE0-to-TE2 and TE0-to-TE3 are larger than 94.4%, 95.7% and 83.7% in the wavelength ranging from 1.5 µm to 1.6 µm, the corresponding device length are 8.72 µm, 4.98 µm and 14.54 µm. In addition, the mode order converter can be fabricated with only once etching which will be advantage to the device fabrication.

Nonradiating anapole states in nanophotonics: from fundamentals to applications.

Nonradiating sources are nontrivial charge-current distributions that do not generate fields outside the source domain. The pursuit of their possible existence has fascinated several generations of physicists and triggered developments in various branches of science ranging from medical imaging to dark matter. Recently, one of the most fundamental types of nonradiating sources, named anapole states, has been realized in nanophotonics regime and soon spurred considerable research efforts and widespread interest. A series of astounding advances have been achieved within a very short period of time, uncovering the great potential of anapole states in many aspects such as lasing, sensing, metamaterials, and nonlinear optics. In this review, we provide a detailed account of anapole states in nanophotonics research, encompassing their basic concepts, historical origins, and new physical effects. We discuss the recent research frontiers in understanding and employing optical anapoles and provide an outlook for this vibrant field of research.

Reference Intervals for Serum Creatinine with Jaffe's Method in Healthy Chinese Geriatric Population.

BACKGROUND: Reliable reference intervals (RIs) for the serum creatinine (SCr), assayed by Jaffe's method and categorized in small intervals, are still lacking in elderly population. The study aims to establish RIs for SCr with Jaffe's method in healthy geriatric population of China. METHODS: Eight hundred twenty cases from six representative geographical regions in China (including 369 male cases and 374 female cases) of apparently healthy Chinese elderly aged 60 - 90 years were recruited. SCr were analyzed by an ARCHITECT c8000 biochemical analyzer with Jaffe's method, and RIs for Scr with Jaffe's method were determined following CLSI C28-A3 guidelines using a nonparametric method. RESULTS: In apparently healthy Chinese geriatric population of China, the RIs for Scr with Jaffe's method were 69.4 ~ 113.1, 74.1 ~ 122.1, 75.2 ~ 126.9 µmol/L, respectively, for males aged 61 - 70, 71 - 80, 81 - 90 years and 60.7 ~ 91.6, 62.2 ~ 102.5, 86.5 ~ 107.2 µmol/L, respectively, for females aged 61 - 70, 71 - 80, 81 - 90 years. CONCLUSIONS: The RIs for Scr using Jaffe's method were established within apparently healthy geriatric Chinese population according to CLSI C28-A3 document, providing a reference for clinical practice.

Association of hepatitis B infection with high-risk complications in total joint arthroplasty.

BACKGROUND: An increasing number of patients with hepatitis B virus (HBV) infection are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations and the purpose of this study is to assess the effect of HBV infection on the prognosis TJAs. METHODS: We retrospectively reviewed patients who underwent elective primary hip and knee arthroplasties in Shanghai Huashan Hospital from 2013 to 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 196 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects. RESULTS: Among all the patients with TJAs, 5.5% of patients were infected with HBV for the first time. The incidence rate of complications in patients after arthroplasty with hepatitis B infection was significantly higher than that in patients without hepatitis B (10.2% compared to 4.7%, P < 0.01). Surgical related complications (6.1% compared to 3.4%) and general medical complications (4.1% compared to 1.3%) were higher than those in non-B hepatitis group. Compared with non-B hepatitis group, the overall risk of hepatitis B infection increased by 25% (95% CI, 1.04-1.46; p < 0.01). Similar results were obtained for medical and surgical complications. HBV infection presented a 31% increased risk (95% CI, 1.02-1.62; p < 0.01) for medical complication and an 18% increased risk (95% CI, 1.10-1.26; p < 0.01) for surgical complication. No statistical difference was found between the surgical methods and sex. However, a significant difference of C-reactive protein (CRP) level was found between HBV infection group and the matched non-infected group (P < 0.01). CONCLUSION: This is the first study to investigate the risk of perioperative complications of hepatitis B in Chinese TJAs patients. In consideration of the large population of HBV infection in China, more attention and medical care should be provided to patients with HBV infection who need to undergo TJA operation.

Reference intervals for serum bilirubin, urea, and uric acid in healthy Chinese geriatric population.

OBJECTIVES: The study aims to establish the reference intervals (RIs) for total bilirubin (TBIL), direct bilirubin (DBIL), urea (UR), and uric acid (UA) in healthy Chinese geriatric population. METHODS: Eight hundred and twenty cases from six representative geographical regions in China (including male 413 cases and female 407 cases) of apparently healthy individuals aged 60-96 years were recruited. Serum TBIL, DBIL, UR, and UA were analyzed by automatic biochemical analyzer and RIs were determined following CLSI C28-A3 guidelines using a non-parametric method. RESULTS: In apparently healthy Chinese geriatric population of China, the RIs of TBIL, DBIL, UR, and UA were 6.6~21.8 µmol/L, 1.9~8.0 µmol/L, 3.60~9.51 mmol/L, 179.2~460.9 µmol/L in males and 6.1~20.0 µmol/L, 1.8~7.1 µmol/L,3.35~8.89 mmol/L, 130.2~443.4 µmol/L in females, respectively. CONCLUSIONS: The RIs of TBIL, DBIL, UR, and UA were established within apparently healthy geriatric Chinese population according to CLSIC28-A3 document, providing a reference for the clinical.

The predictive value of preoperative neutrophil-lymphocyte ratio (NLR) on the recurrence of the local pigmented villonodular synovitis of the knee joint.

BACKGROUND: To explore and evaluate the predictive value of preoperative Neutrophil-lymphocyte ratio (NLR) on the recurrence of pigmented villonodular synovitis (PVNS) of the knee joint treated by arthroscopic surgery combining local radiotherapy. METHODS: Sixty pathological-proven PVNS cases of the knee joint in our department from April 2006 to March 2017 were included. All of them are treated by arthroscopic synovectomy combined with adjuvant radiotherapy. The pre-operative hematological indexes such as c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, Platelet-lymphocyte ratio (PLR) and Lymphocyte-monocyte ratio (LMR) were collected retrospectively and their relationship with postoperative recurrence was analyzed by using univariate and multivariate analysis, the receiver operating characteristic curves (ROC curve), the Kappa correspondence test and the Mc Nemar Chi-square test. RESULTS: All 60 patients were followed up for a median of 52.8 months (7-138 months) and the recurrence rate is about 23.3% (14/60). There is a significant difference in NLR between the recurrent and non-recurrent group (P = 0.002). It had a certain correlation with postoperative recurrence (correlation coefficient r = 0.438, P = 0.001). The optimal thresholds in ROC curve were 2.42 (sensitivity 71.4%, specificity 78.3% respectively). which had predictive ability for recurrence after arthroscopic treatment. CONCLUSION: The preoperative NLR is an easy and cost-effective predictor for relapse in PVNS of the knee joint after the arthroscopic surgery combined with local radiotherapy, which is of profound significance to guide clinical work.

Direct Amplitude-Phase Near-Field Observation of Higher-Order Anapole States.

Anapole states associated with the resonant suppression of electric-dipole scattering exhibit minimized extinction and maximized storage of electromagnetic energy inside a particle. Using numerical simulations, optical extinction spectroscopy, and amplitude-phase near-field mapping of silicon dielectric disks, we demonstrate high-order anapole states in the near-infrared wavelength range (900-1700 nm). We develop the procedure for unambiguously identifying anapole states by monitoring the normal component of the electric near-field and experimentally detect the first two anapole states as verified by far-field extinction spectroscopy and confirmed with the numerical simulations. We demonstrate that higher-order anapole states possess stronger energy concentration and narrower resonances, a remarkable feature that is advantageous for their applications in metasurfaces and nanophotonics components, such as nonlinear higher-harmonic generators and nanoscale lasers.

The epigenetic mechanism for discordance of autoimmunity in monozygotic twins.

Monozygotic twins share an identical DNA sequence but are not truly "identical". In fact, when it comes to health and disease, they may often display some level of phenotypic discordance. The cause of this discordance is often unknown. Epigenetic modifications such as DNA methylation, histone modification, and microRNAs-mediated regulation regulate gene expression and are sensitive to external stimuli. These modifications may be seen to bridge the gap between genetics and the environment. Over the years, the importance of epigenetics as a primary mechanism for the role that the environment plays in defining phenotype has been increasingly appreciated. Mechanisms of epigenetics include DNA methylation, histone modifications and microRNAs. Discordance rates in monozygotic twins vary depending on the specific condition, from 11% in SLE to 64% in psoriasis and 77% in PBC. Other autoimmune diseases in which discordance is found among monozygotic twins has also been studied include type 1 diabetes, multiple sclerosis, rheumatoid arthritis, dermatomyositis and systemic sclerosis. In some cases, the differences in various epigenetic modifications is slight, even though the concordance rate is low, suggesting that epigenetics is not the only factor that needs to be considered. Nonetheless, the study of phenotypic discordance in monozygotic twins may shed light on the pathogenesis of autoimmune diseases and contribute to the development of new methodologies for the diagnosis and treatment of these diseases.

All-dielectric KTiOPO4 metasurfaces based on multipolar resonances in the terahertz region.

We employ ferroelectrics to study the multipolar scattering in all-dielectric metasurfaces based on KTiOPO4 (KTP) micro-disks for efficient manipulation of electromagnetic waves in the THz spectral region (0.6-1.5 THz). By adjusting the aspect ratio of the disks near the multipolar resonances, we show that the KTP disk array can form a multifunctional metasurface that covers the entire range of the electromagnetic response with resonantly enhanced anisotropic properties. The proposed ferroelectric metasurfaces will provide a versatile platform to manipulate THz waves, and open possibilities to monolithically combine it with THz generation.

Light-Induced Pulling and Pushing by the Synergic Effect of Optical Force and Photophoretic Force.

Optical force, coming from momentum exchange during light-matter interactions, has been widely utilized to manipulate microscopic objects, though mostly in vacuum or in liquids. By contrast, due to the light-induced thermal effect, photophoretic force provides an alternative and effective way to transport light-absorbing particles in ambient gases. However, in most cases these forces work independently. Here, by employing the synergy of optical force and photophoretic force, we propose and experimentally demonstrate a configuration which can drive a micron-size metallic plate moving back and forth on a tapered fiber with supercontinuum light in ambient air. Optical pulling and oscillation of the metallic plate are experimentally realized. The results might open exhilarating possibilities in applications of optical driving and energy conversion.

Grating-assisted enhanced optical transmission through a seamless gold film.

In this paper, we experimentally demonstrate enhanced optical transmission through a seamless gold film based on the grating-insulator-metal (GIM) architecture. The transmittance of this GIM structure reaches 40% at 930 nm, showing 3.7 dB and 9.1 dB increase compared with a bare gold film and a continuous metal-insulator-metal stack, respectively. The enhanced transmission is polarization-sensitive and robust for oblique incidence. With tunable transmission peaks, such a device exhibits great potential for applications in optical filtering, polarization detecting and further integration in optoelectronics system.

Plasmonic sectoral horn nanoantennas.

In this Letter, plasmonic sectoral horn nanoantennas working at near-infrared wavelength (1550 nm) have been investigated. We demonstrate that, although there are certain differences between the plasmonic and classical radiofrequency (RF) sectoral horn antennas, the plasmonic horns still possess a number of attractive features, like their RF counterparts, such as tunable high directivities, simplicity in fabrication, and ease of coupling to waveguides. As a specific application, we further show how to exploit these findings to optimize an optical wireless nanolink using the proposed horn nanoantennas, and obtain a 60-fold increase in the received power compared with the situation of matched dipole nanoantennas.

Optimized grating as an ultra-narrow band absorber or plasmonic sensor.

Lamellar gratings are investigated via temporal coupled-mode theory and numerical simulations. Total absorption can be achieved by an optimized grating with shallow grooves under normal incidence and the full width at half-maximum (FWHM) is only 0.4 nm. For certain wavelengths, the structure shows high absorption only within an ultra-narrow angle, which suggests that it can be used as a highly directional thermal emitter according to Kirchhoff's law. Besides, the resonant wavelength is sensitive to the refractive index of the environmental dielectric. The large sensitivity (1400 nm/RIU) and simultaneous small FWHM result in a huge figure-of-merit of 2300/RIU, which enables the structure to have great potential in plasmonic sensing.

A case of recurrent proximal femoral fracture after open reduction and internal fixation with bilateral locking plates for a Rorabeck type II periprosthetic fracture.

INTRODUCTION AND IMPORTANCE: Periprosthetic distal femur fractures (PDFFs) are rare complications that may occur during or after total knee arthroplasty (TKA). The incidence of PDFFs is increasing. Plate internal fixation has demonstrated positive results. However, there is limited research available on the recurrence of periimplant fractures following open reduction and internal fixation with bilateral locking plates. CASE PRESENTATION: A 70-year-old female patient was diagnosed with a Rorabeck type II fracture. Based on the patient's physical condition and available surgical options, minimally invasive open reduction, bilateral plate fixation, and allograft artificial bone grafting were chosen. The postoperative recovery was successful. However, the patient experienced a fall 2 months after the surgery, resulting in a proximal femoral fracture. After considering the patient's condition and family preferences, conservative treatment was ultimately decided upon. CLINICAL DISCUSSION: Minimally invasive bilateral Locking Compression Plate (LCP) as a surgical approach can effectively reduce surgical risks prior to the procedure. Careful selection of screws and the use of C-arm fluoroscopy during plate contouring and fixation are essential to prevent screw penetration through the contralateral cortex. Treatment outcomes were not impacted in patients with normal bone mass; however, in this particular case, the patient had severe osteoporosis, significantly increasing the risk of refracture. It is crucial to improve postoperative monitoring and raise awareness about safety among patients and their families. CONCLUSION: The management of periprosthetic distal femur fractures (PDFFs) is influenced by the type of fracture and bone quality. Mechanical stability and stress dispersion of internal fixation are key factors to consider. In the perioperative setting, involving experienced clinicians is essential to reduce the risk of secondary injuries that may impact treatment outcomes, especially when choosing screws for fixation in patients with low bone density.

Exerkine ß-aminoisobutyric acid protects against atrial structural remodeling and atrial fibrillation in obesity via activating AMPK signaling and improving insulin sensitivity.

Moderate exercise decreases the risk for atrial fibrillation (AF), an effect which is probably mediated via exercise-stimulated release of exerkines. ß-Aminoisobutyric acid (BAIBA), a novel exerkine, has been reported to provide protective benefits against many cardiovascular diseases, yet its role in AF remains elusive. Herein, using a mouse model of obesity-related AF through high-fat diet (HFD) feeding, we found that 12-week drinking administration of BAIBA (170 mg/kg/day) decreased AF susceptibility in obese mice. Atrial remodeling assessment showed that BAIBA attenuated obesity-induced atrial hypertrophy and interstitial fibrosis, thereby ablating the substrate for AF. Of note, to our knowledge, this is the first report of the direct association of BAIBA and hypertrophy. BAIBA has been reported to be a key regulator of glucose and lipid metabolism, and we found that BAIBA alleviated insulin resistance in obese mice. Transcriptional analysis of metabolism-related genes showed that BAIBA increased the transcription of fatty acids metabolism-related genes in the atria of lean mice but not in that of obese mice. Mechanistic investigation showed that BAIBA stimulated AMP-activated protein kinase (AMPK) signaling in the atria of obese mice and palmitic acid (PA)-treated neonatal rat cardiomyocytes (NRCM), whereas inhibition of AMPK via Compound C attenuated BAIBA-conferred cardioprotection against hypertrophy and insulin resistance in PA-treated NRCM. Collectively, BAIBA attenuates AF susceptibility in obese mice via activated AMPK signaling and resultant improvement of insulin sensitivity, thereby providing perspectives on the potential therapeutic role of BAIBA in AF treatment.

Plasma Ionomic Profile and Interaction Patterns in Coronary Artery Disease Patients.

Humans are exposed to various chemical elements that have been associated with the development and progression of diseases such as coronary artery disease (CAD). Unlike previous research, we employed a multi-element approach to investigate CAD patients and those with comorbid conditions such as diabetes (CAD-DM2), high blood pressure (CAD-HBP), or high blood lipids (CAD-HBL). Plasma concentrations of 21 elements, including lithium (Li), boron (B), aluminum (Al), calcium (Ca), titanium (Ti), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), strontium (Sr), cadmium (Cd), tin (Sn), stibium (Sb), barium (Ba), and lead (Pb), were measured in CAD patients (n = 201) and healthy subjects (n = 110) using inductively coupled plasma-mass spectrometry (ICP-MS). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) models were utilized to analyze the ionomic profiles. Spearman correlation analysis was employed to identify the interaction patterns among individual elements. We found that levels of Ba, Li, Ni, Zn and Pb were elevated in the CAD group compared to the healthy group, while Sb, Ca, Cu, Ti, Fe, and Se were lower. Furthermore, the CAD-DM2 group exhibited higher levels of Ni and Cd, while the CAD-HBP group showed lower levels of Co and Mn. In the CAD-HBL group, Ti was increased, whereas Ba, Cr, Cu, Co, Mn, and Ni were reduced. In conclusion, ionomic profiles can be utilized to differentiate CAD patients from healthy individuals, potentially providing insights for future treatment or dietary interventions.