Self-driven carbon atom implantation into fullerene embedding metal-carbon cluster.

Hundreds of members have been synthesized and versatile applications have been promised for endofullerenes (EFs) in the past 30 y. However, the formation mechanism of EFs is still a long-standing puzzle to chemists, especially the mechanism of embedding clusters into charged carbon cages. Here, based on synthesis and structures of two representative vanadium-scandium-carbido/carbide EFs, VSc2C@Ih (7)-C80 and VSc2C2@Ih (7)-C80, a reasonable mechanism-C1 implantation (a carbon atom is implanted into carbon cage)-is proposed to interpret the evolution from VSc2C carbido to VSc2C2 carbide cluster. Supported by theoretical calculations together with crystallographic characterization, the single electron on vanadium (V) in VSc2C@Ih (7)-C80 is proved to facilitate the C1 implantation. While the V=C double bond is identified for VSc2C@Ih (7)-C80, after C1 implantation the distance between V and C atoms in VSc2C2@Ih (7)-C80 falls into the range of single bond lengths as previously shown in typical V-based organometallic complexes. This work exemplifies in situ self-driven implantation of an outer carbon atom into a charged carbon cage, which is different from previous heterogeneous implantation of nonmetal atoms (Group-V or -VIII atoms) driven by high-energy ion bombardment or high-pressure offline, and the proposed C1 implantation mechanism represents a heretofore unknown metal-carbon cluster encapsulation mechanism and can be the fundamental basis for EF family genesis.

Toward Low-Carbon Rice Production in China: Historical Changes, Driving Factors, and Mitigation Potential.

Under the "Double Carbon" target, the development of low-carbon agriculture requires a holistic comprehension of spatially and temporally explicit greenhouse gas (GHG) emissions associated with agricultural products. However, the lack of systematic evaluation at a fine scale presents considerable challenges in guiding localized strategies for mitigating GHG emissions from crop production. Here, we analyzed the county-level carbon footprint (CF) of China's rice production from 2007 to 2018 by coupling life cycle assessment and the DNDC model. Results revealed a significant annual increase of 74.3 kg CO2-eq ha-1 in the average farm-based CF (FCF), while it remained stable for the product-based CF (PCF). The CF exhibited considerable variations among counties, ranging from 2324 to 20,768 kg CO2-eq ha-1 for FCF and from 0.36 to 3.81 kg CO2-eq kg-1 for PCF in 2018. The spatiotemporal heterogeneities of FCF were predominantly influenced by field CH4 emissions, followed by diesel consumption and soil organic carbon sequestration. Scenario analysis elucidates that the national total GHG emissions from rice production could be significantly reduced through optimized irrigation (48.5%) and straw-based biogas production (18.0%). Moreover, integrating additional strategies (e.g., advanced crop management, optimized fertilization, and biodiesel application) could amplify the overall emission reduction to 76.7% while concurrently boosting the rice yield by 11.8%. Our county-level research provides valuable insights for the formulation of targeted GHG mitigation policies in rice production, thereby advancing the pursuit of carbon-neutral agricultural practices.

Advancing nuanced pollution control: Local improvements and spatial spillovers of policies on key enterprises.

This paper examines the impact of air pollution control policies targeting key polluting enterprises, highlighting a strategic shift towards precision pollution control that concentrates on high-emission, high-risk businesses. The paper explores the efficacy of these policies and their potential spatial spillover effects, utilizing panel data from 259 Chinese cities from 2013 to 2021. Employing the difference-in-differences (DID) model and spatial Durbin model, the study analyzes both the direct local effects and the broader spatial consequences of these regulatory measures on air quality. The findings indicate a significant reduction in air pollutant concentrations in urban areas, attributing this improvement to factors such as industrial restructuring, increased investment in science and technology, and economic growth. Spatial econometric analysis further reveals a substantial positive correlation in air quality among Chinese cities. However, estimates of the spillover effect indicate that while such policies successfully reduce pollution locally, they could unintentionally degrade air quality in adjacent areas. The study highlights the need for nuanced policy strategies to mitigate unintended spatial spillovers and enhance overall effectiveness. It recommends tailored policies that integrate environmental and socioeconomic objectives, national and regional coordination for consistent enforcement, technology-driven compliance strategies, and incentives for sustainable enterprise practices.

Reconstructing Solvation Structure by Steric Hindrance-Coordination Push-Pull of Dipolymer-H2O-Zn2+ toward Long-life Aqueous Zinc-Metal Batteries.

Aqueous zinc-metal batteries are prospective energy storge devices due to their intrinsically high safety and cost effectiveness. Yet, uneven deposition of zinc ions in electrochemical reduction and side reactions at the anode interface significantly hinder their development and application. Here, we propose a solvation-interface attenuation strategy enabled by a frustrated tertiary amine amphiphilic dipolymer electrolyte additive. The configuration of superhydrophilic segments with covalently bonded lipophilic spacers enables coupled steric hindrance/coordination, which establishes a balanced push-pull dynamic of dipolymer-H2O-Zn2+. Such interplay reconstructs the solvation structure of Zn2+ and allows the formation of a stable dipolymer-inorganic hybrid solid electrolyte interface (SEI) layer. This SEI layer effectively shields the zinc-metal anode from water and anions, significantly reducing side reactions. In addition, the dipolymer adsorbed at the zinc-metal anode interface regulates the interfacial electrochemical reduction kinetics and ensures uniform zinc deposition. As a result, the Zn-Zn symmetric cells with dipolymer-containing electrolyte exhibit remarkable cycling stability exceeding 5800 h (242 days). The Zn-NVO batteries and Zn-AC hybrid ion supercapacitors also deliver stable cycling for up to 1440 h (60 days) with high-capacity retention over 80 %. This research demonstrates the potential to facilitate the development and commercialization of zinc-based energy storage devices.

Two Metastable Endohedral Metallofullerenes Sc2C2@C1(39656)-C82 and Sc2C2@C1(51383)-C84: Direct-C2-Insertion Products from Their Most Stable Precursors.

Endohedral metallofullerenes (EMFs) are sub-nano carbon materials with diverse applications, yet their formation mechanism, particularly for metastable isomers, remains ambiguous. The current theoretical methods focus mainly on the most stable isomers, leading to limited predictability of metastable ones due to their low stabilities and yields. Herein, we report the successful isolation and characterization of two metastable EMFs, Sc2C2@C1(39656)-C82 and Sc2C2@C1(51383)-C84, which violate the isolated pentagon rule (IPR). These two non-IPR EMFs exhibit a rare case of planar and pennant-like Sc2C2 clusters, which can be considered hybrids of the common butterfly-shaped and linear configurations. More importantly, the theoretical results reveal that despite being metastable, these two non-IPR EMFs survived as the products from their most stable precursors, Sc2C2@C2v(5)-C80 and Sc2C2@Cs(6)-C82, via a C2 insertion during the post-formation annealing stages. We propose a systematic theoretical method for predicting metastable EMFs during the post-formation stages. The unambiguous molecular-level structural evidence, combined with the theoretical calculation results, provides valuable insights into the formation mechanisms of EMFs, shedding light on the potential of post-formation mechanisms as a promising approach for EMF synthesis.

Portable Visual Photoelectrochemical Biosensor Based on a MgTi2O5/CdSe Heterojunction and Reversible Electrochromic Supercapacitor for Dual-Modal Cry1Ab Protein Detection.

Reversible electrochromic supercapacitors (ESCs) have attracted considerable interest as visual display screens. The use of ESCs in combination with a photoelectrochemical (PEC) biosensor promises to improve the detection efficiency. Herein, a visual PEC biosensor is developed by introducing a circuit module between a PEC-sensing platform (PSP) and a reversible ESC for Cry1Ab protein detection. In PSP, a type II MgTi2O5/CdSe heterojunction effectively drives charge separation by their cross-matched band gap structures, generating an amplified photocurrent. Next, the circuit module is designed to connect the PSP and ESC, realizing the signal conversion from photocurrent to voltage. ESC, as a visual display screen, produces reversible color changes with different voltages. As the concentration of Cry1Ab increases, the photocurrent decreases due to the specific binding between the aptamer and Cry1Ab in PSP, while the color of the reversible ESC changes from green to blue. To improve the integrity of the device, a portable PEC biosensor is further constructed via three-dimensional printing for dual-modal Cry1Ab protein detection, thus collecting both PEC and visual signals. The linear ranges are 0.3-3000 ng mL-1 for PEC mode and 1-1000 ng mL-1 for visual mode. This work presents a portable, efficient, sensitive, and visualized detection system, providing an important reference for practical visualization applications.

Workplace-based primary prevention intervention reduces incidence of hypertension: a post hoc analysis of cluster randomized controlled study.

BACKGROUND: A workplace-based primary prevention intervention be an effective approach to reducing the incidence of hypertension (HTN). However, few studies to date have addressed the effect among the Chinese working population. We assessed the effect of a workplace-based multicomponent prevention interventions program for cardiovascular disease on reducing the occurrence of HTN through encouraging employees to adopt a healthy lifestyle. METHODS: In this post hoc analysis of cluster randomized controlled study, 60 workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20). All employees in each workplace were asked to complete a baseline survey after randomization for obtaining sociodemographic information, health status, lifestyle, etc. Employees in the intervention group were given a 2-year workplace-based primary prevention intervention program for improving their cardiovascular health, including (1) cardiovascular health education, (2) a reasonable diet, (3) tobacco cessation, (4) physical environment promotion, (5) physical activity, (6) stress management, and (7) health screening. The primary outcome was the incidence of HTN, and the secondary outcomes were improvements of blood pressure (BP) levels and lifestyle factors from baseline to 24 months. A mix effect model was used to assess the intervention effect at the end of the intervention in the two groups. RESULTS: Overall, 24,396 participants (18,170 in the intervention group and 6,226 in the control group) were included (mean [standard deviation] age, 39.3 [9.1] years; 14,727 men [60.4%]). After 24 months of the intervention, the incidence of HTN was 8.0% in the intervention groups and 9.6% in the control groups [relative risk (RR) = 0.66, 95% CI, 0.58 ~ 0.76, P < 0.001]. The intervention effect was significant on systolic BP (SBP) level (ß = - 0.7 mm Hg, 95% CI, - 1.06 ~ - 0.35; P < 0.001) and on diastolic BP (DBP) level (ß = - 1.0 mm Hg, 95% CI, - 1.31 ~ - 0.76; P < 0.001). Moreover, greater improvements were reported in the rates of regular exercise [odd ratio (OR) = 1.39, 95% CI, 1.28 ~ 1.50; P < 0.001], excessive intake of fatty food (OR = 0.54, 95% CI, 0.50 ~ 0.59; P < 0.001), and restrictive use of salt (OR = 1.22, 95% CI, 1.09 ~ 1.36; P = 0.001) in intervention groups. People with a deteriorating lifestyle had higher rates of developing HTN than those with the same or improved lifestyle. Subgroup analysis showed that the intervention effect of BP on employees with educational attainment of high school above (SBP: ß = - 1.38/ - 0.76 mm Hg, P < 0.05; DBP: ß = - 2.26/ - 0.75 mm Hg, P < 0.001), manual labor workers and administrative worker (SBP: ß = - 1.04/ - 1.66 mm Hg, P < 0.05; DBP: ß = - 1.85/ - 0.40 mm Hg, P < 0.05), and employees from a workplace with an affiliated hospital (SBP: ß = - 2.63 mm Hg, P < 0.001; DBP: ß = - 1.93 mm Hg, P < 0.001) were significantly in the intervention group. CONCLUSIONS: This post hoc analysis found that workplace-based primary prevention interventions program for cardiovascular disease were effective in promoting healthy lifestyle and reducing the incidence of HTN among employees. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

Air pollution is associated with abnormal left ventricular diastolic function: a nationwide population-based study.

BACKGROUND: Air pollution is a growing public health concern of global significance. Till date, few studies have explored the associations between air pollutants and cardiac imaging phenotypes. In this study, we aim to explore the association of ambient air pollution and abnormal left ventricular diastolic function (ALVDF) among a large-scale free-living population. METHODS: The participants were from a national representative large-scale cross-sectional study, i.e., the China Hypertension Survey (CHS), 2012-15. After exclusion, 25,983 participants from 14 provinces and 30 districts in China were included for the final analysis. The annual average ambient PM2.5, PM10 and NO2 concentrations were obtained from the chemical data assimilation system (ChemDAS). The clinical evaluation of left ventricular function was conducted in the survey field which was based on echocardiography. Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). RESULTS: The mean age of 25,983 participants was 56.8 years, 46.5% were male, and the crude prevalence of GradeI-III ALVDF were 48.1%, 1.6% and 1.1%, respectively. The ORs (95% CI) for ALVDF in the fully adjusted model were 1.31 (1.11-1.56), 1.11 (1.01-1.21) and 1.18 (0.90-1.54) for an increase of 10 µg/m3 of PM2.5, PM10 and NO2, respectively. And for different grades of ALVDF, elevated concentration of PM2.5 and PM10 exposures significantly increased the risk of gradeIinstead of gradeII ~ III ALVDF. There was a positive linear and "J" shape concentration-response association between annual average ambient PM2.5 and NO2 and the ALVDF risk assessed by the restricted cubic spline. The exposure level of most participants to PM10 was less than 130 µg/m3, and the risk of ALVDF increased significantly with the concentration rise. CONCLUSIONS: This large-scale nationwide population study demonstrated a significantly positive association between ambient PM2.5, PM10 and NO2 with ALVDF, especially for mild ALVDF. The functional abnormality may partially explain the enhanced cardiovascular morbidity and mortality associated with air pollution, which highlights the importance of appropriate interventions to reduce ambient air pollution in China.

Cardiovascular disease and all-cause mortality associated with individual and combined cardiometabolic risk factors.

BACKGROUND: Previous studies have investigated the association between cardiometabolic risk factors and cardiovascular disease (CVD), but evidence of the attributable burden of individual and combined cardiometabolic risk factors for CVD and mortality is limited. We aimed to investigate and quantify the associations and population attributable fraction (PAF) of cardiometabolic risk factors on CVD and all-cause mortality, and calculate the loss of CVD-free years and years of life lost in relation to the presence of cardiometabolic risk factors. METHODS: Twenty-two thousand five hundred ninety-six participants aged ≥ 35 without CVD at baseline were included between October 2012 and December 2015. The outcomes were the composite of fatal and nonfatal CVD events and all-cause mortality, which were followed up in 2018 and 2019 and ascertained by hospital records and death certificates. Cox regression was applied to evaluate the association of individual and combined cardiometabolic risk factors (including hypertension, diabetes and high low-density lipoprotein cholesterol (LDL-C)) with CVD risk and all-cause mortality. We also described the PAF for CVD and reductions in CVD-free years and life expectancy associated with different combination of cardiometabolic conditions. RESULTS: During the 4.92 years of follow-up, we detected 991 CVD events and 1126 deaths. Hazard ratio were 1.59 (95% confidential interval (CI) 1.37-1.85), 1.82 (95%CI 1.49-2.24) and 2.97 (95%CI 1.85-4.75) for CVD and 1.38 (95%CI 1.20-1.58), 1.66 (95%CI 1.37-2.02) and 2.97 (95%CI 1.88-4.69) for all-cause mortality, respectively, in participants with one, two or three cardiometabolic risk factors compared with participants without diabetes, hypertension, and high LDL-C. 21.48% of CVD and 15.38% of all-cause mortality were attributable to the combined effect of diabetes and hypertension. Participants aged between 40 and 60 years old, with three cardiometabolic disorders, had approximately 4.3-year reductions life expectancy compared with participants without any abnormalities of cardiometabolic disorders. CONCLUSIONS: Cardiometabolic risk factors were associated with a multiplicative risk of CVD incidence and all-cause mortality, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of CVD.

Blood urea nitrogen to creatinine ratio is associated with physical frailty in older-aged Chinese: a cross-sectional study.

BACKGROUND: The relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and physical frailty in elderly patients remains unclear. The study aims to investigate the association between the BUN/Cr ratio and physical frailty in the elderly Chinese population. METHODS: In this cross-sectional analysis, the clinical data of 5213 participants from 2015 were selected from the China Health and Retirement Longitudinal Study (CHARLS). The demographic variables (including age and gender) and health behavior (including smoking and drinking history), anthropometric (including systolic and diastolic blood pressure, waist circumference (WC), etc.), physical performances (i.e., grip strength, repeated chair stands, etc.), and biochemical indicators (i.e., blood urea nitrogen (BUN), creatinine(Cr), total cholesterol (TC), triglycerides (TG), etc.) were measured. The association between the BUN/Cr ratio and physical frailty was analyzed. RESULTS: After adjusting for potential confounding factors, smooth curve fitting showed a linear relationship between the BUN/Cr ratio and grip strength, a non-linear relationship between the BUN/Cr ratio, and repeated chair-rising time. The fully adjusted linear regression results showed a negative association between the BUN/Cr ratio and grip strength. In the multivariate, piecewise linear regression, when the BUN/Cr ratio was greater than 18.60, the repeated chair-rising time increased with the increase in BUN/Cr ratio (ß = 0.046, 95%CI 0.025, 0.066; p < 0.001). However, we did not observe a significant correlation when the BUN/Cr ratio was less than 18.60 (ß = -0.007, 95%CI -0.046, 0.032; p = 0.717). CONCLUSION: This study demonstrated that the BUN/Cr ratio might be associated with physical frailty in older-aged Chinese, and this association requires further investigation.

Air pollution attenuated the benefits of physical activity on blood pressure: Evidence from a nationwide cross-sectional study.

INTRODUCTION: Although physical activity (PA) has multiple health benefits, the inhaled dose of fine particulate matter (PM2.5) during PA may increase. The trade-off between harmful effects of PM2.5 exposure and protective effects of PA remain unclear. Our study aims to examine the joint effects of PA and PM2.5 exposure on blood pressure (BP) in Chinese adults. METHODS: A total of 203,108 adults aged ≥ 18 years from the China Hypertension Survey study (2012-2015) were included. Individual-level PA was assessed as minutes of metabolic equivalent tasks per week (MET-min/week). The average weekly PM2.5 exposures were estimated by using a spatial resolution of 10 km, integrating multiple data sources, including monitoring values, satellite measurements and model simulations. BP was measured with a professional portable BP monitor. Generalized linear regressions were used to estimate joint associations and to further explore two-dimensional nonlinear associations. RESULTS: The median PA and 4-week PM2.5 average exposures were 3213.0 MET-min/week and 47.8 µg/m3, respectively. PA was negatively associated with BP, while PM2.5 exposure was positively with BP. The associations between PA and systolic BP were significantly modified by PM2.5 exposure (Pinteraction < 0.001). Compared with inactive participants under low PM2.5 exposure, those with highest level of PA under low PM2.5 exposure had a 0.90 (95 % CI: 0.53, 1.26) mmHg decrease in systolic BP, whereas they had a 0.48 (95 % CI: 0.07, 0.89) mmHg increase under high PM2.5 exposure. When PM2.5 exposure was approximately > 25 µg/m3, the joint exposure to total PA and PM2.5 was associated with an increase in systolic BP. CONCLUSIONS: The benefits of PA on BP were counteracted by high PM2.5 levels.

Surface Re-Engineering of Perovskites with Buckybowls to Boost the Inverted-Type Photovoltaics.

Despite their multifaceted advantages, inverted perovskite solar cells (PSCs) still suffer from lower power conversion efficiencies (PCEs) than their regular counterparts, which is largely due to recombination energy losses (Eloss) that arise from the chemical, physical, and energy level mismatches, especially at the interfaces between perovskites and fullerene electron transport layers (ETLs). To address this problem, we herein introduce an aminium iodide derivative of a buckybowl (aminocorannulene) that is molecularly layered at the perovskite-ETL interface. Strikingly, besides passivating the PbI2-rich perovskite surface, the aminocorannulene enforces a vertical dipole and enhances the surface n-type character that is more compatible with the ETL, thus boosting the electron extraction and transport dynamics and suppressing interfacial Eloss. As a result, the champion PSC achieves an excellent PCE of over 22%, which is superior compared to that of the control device (∼20%). Furthermore, the device stability is significantly enhanced, owing to a lock-and-key-like grip on the mobile iodides by the buckybowls and the resultant increase of the interfacial ion-migration barrier. This work highlights the potential of buckybowls for the multifunctional surface engineering of perovskite toward high-performance and stable PSCs.

Disrupted intrinsic functional brain topology in patients with major depressive disorder.

Aberrant topological organization of whole-brain networks has been inconsistently reported in studies of patients with major depressive disorder (MDD), reflecting limited sample sizes. To address this issue, we utilized a big data sample of MDD patients from the REST-meta-MDD Project, including 821 MDD patients and 765 normal controls (NCs) from 16 sites. Using the Dosenbach 160 node atlas, we examined whole-brain functional networks and extracted topological features (e.g., global and local efficiency, nodal efficiency, and degree) using graph theory-based methods. Linear mixed-effect models were used for group comparisons to control for site variability; robustness of results was confirmed (e.g., multiple topological parameters, different node definitions, and several head motion control strategies were applied). We found decreased global and local efficiency in patients with MDD compared to NCs. At the nodal level, patients with MDD were characterized by decreased nodal degrees in the somatomotor network (SMN), dorsal attention network (DAN) and visual network (VN) and decreased nodal efficiency in the default mode network (DMN), SMN, DAN, and VN. These topological differences were mostly driven by recurrent MDD patients, rather than first-episode drug naive (FEDN) patients with MDD. In this highly powered multisite study, we observed disrupted topological architecture of functional brain networks in MDD, suggesting both locally and globally decreased efficiency in brain networks.

Retrograde Recanalization for Proximal Occlusion of the Right Renal Artery through a Compensated Collateral Artery in a 10-year-old Patient.

BACKGROUND: To describe a retrograde recanalization for the proximal occluded lesion in right renal artery (RRA) in young patient with fibromuscular dysplasia (FMD). METHODS: A 10-year-old girl presented to our hospital with proximal RRA occlusion and refractory hypertension though she took anti-hypertension medicines. Her renin and aldosterone were beyond the normal level in both base state and excited state. Her glomerular filtration rate at right kidney was only 18.4 ml/min. Angiography revealed proximal RRA occlusion and a compensated collateral artery (CCA) from the infrarenal aorta to the RRA. She was thus diagnosed with focal FMD. A retrograde recanalization was performed through this CCA. RESULTS: Angioplasty and stenting were successfully performed to treat the proximal RRA occlusion. Postoperatively, the glomerular filtration rate in the right kidney improved. One-year follow-up revealed that, the blood pressure maintained at normal range without any antihypertensive agents. No other discomfort was complained. CONCLUSIONS: It is feasible to establish a working pathway with patient's compensated collateral artery to treat the renal artery occlusion.

Total Aortic and Branches Repair with Hybrid Therapy in the setting of Marfan Syndrome: A Case Report.

OBJECTIVE: Currently, no standard treatment has been established for the total lesion in patient with Marfan Syndrome (MFS). This case report aims to present a total aortic and branches repair with hybrid therapy in a young patient with MFS. METHODS: Clinical data including imaging manifestation, surgical document, and follow-up results were retrospectively collected and presented. RESULTS: A young patient with MFS underwent multi-stage endovascular aortic management and open surgical repair. On-the-table fenestration technique was applied to reconstruct the branches of the abdominal aorta. A bypass from superior mesenteric artery to celiac trunk was performed. A Bentall operation was conducted to repair his ascending aorta and aortic valves. Finally, in situ fenestration technique was adopted to recanalize the branches of aortic arch. The 18 month follow-up computed tomography angiography demonstrated patency of all the aorta branches. CONCLUSION: It may be feasible to perform the total aortic and branches repair with hybrid therapy in patients with MFS.

The prevalence and characteristics of metabolic syndrome according to different definitions in China: a nationwide cross-sectional study, 2012-2015.

BACKGROUND: Metabolic syndrome (MetS) is characterized by a cluster of signs of metabolic disturbance and has caused a huge burden on the health system. The study aims to explore the prevalence and characteristics of MetS defined by different criteria in the Chinese population. METHODS: Using the data of the China Hypertension Survey (CHS), a nationally representative cross-sectional study from October 2012 to December 2015, a total of 28,717 participants aged 35 years and above were included in the analysis. The MetS definitions of the International Diabetes Federation (IDF), the updated US National Cholesterol Education Program Adult Treatment Panel III (the revised ATP III), and the Joint Committee for Developing Chinese Guidelines (JCDCG) on Prevention and Treatment of Dyslipidemia in Adults were used. Multivariable logistic regression was used to identify factors associated with MetS. RESULTS: The prevalence of MetS diagnosed according to the definitions of IDF, the revised ATP III, and JCCDS was 26.4%, 32.3%, and 21.5%, respectively. The MetS prevalence in men was lower than in women by IDF definition (22.2% vs. 30.3%) and by the revised ATP III definition (29.2% vs. 35.4%), but the opposite was true by JCDCG (24.4%vs 18.5%) definition. The consistency between the three definitions for men and the revised ATP III definition and IDF definition for women was relatively good, with kappa values ranging from 0.77 to 0.89, but the consistency between the JCDCG definition and IDF definition (kappa = 0.58) and revised ATP III definition (kappa = 0.58) was poor. Multivariable logistic regression showed that although the impact and correlation intensity varied with gender and definition, area, age, education, smoking, alcohol use, and family history of cardiovascular disease were factors related to MetS. CONCLUSIONS: The prevalence and characteristics of the MetS vary with the definition used in the Chinese population. The three MetS definitions are more consistent in men but relatively poor in women. On the other hand, even if estimated according to the definition of the lowest prevalence, MetS is common in China.

Anesthetic choice during transcarotid artery revascularization and carotid endarterectomy affects the risk of myocardial infarction.

OBJECTIVE: Previous studies have shown no differences in the outcomes of transcarotid artery revascularization (TCAR) performed with general anesthesia (GA) vs local or regional anesthesia (LRA). To date, no study has specifically compared the outcomes of TCAR to those of carotid endarterectomy (CEA) stratified by anesthetic type. The aim of the present study was to identify the effect of the anesthetic type on the outcomes of TCAR vs CEA. METHODS: Patients undergoing CEA and TCAR for carotid artery stenosis from 2016 to 2019 in the Vascular Quality Initiative were included. We excluded patients who had undergone concomitant procedures, patients with more than two stented lesions, and patients who had undergone the procedure for a nonatherosclerotic indication. Propensity score matching was performed between the two procedures stratified by the anesthetic type for age, sex, race, presenting symptoms, major comorbidities (ie, hypertension, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease), previous coronary artery bypass grafting or percutaneous transluminal coronary intervention, previous CEA or carotid artery stenting, degree of ipsilateral stenosis, the presence of contralateral occlusion, and preoperative medications. Intergroup differences between the treatment groups and differences in the perioperative outcomes were tested using the McNemar test for categorical variables and the paired t test or Wilcoxon matched pairs signed rank test for continuous variables, as appropriate. The relative risk (RR) and 95% confidence intervals (CIs) were estimated as the ratio of the probability of the outcome event for the patients treated within each treatment group. RESULTS: A total of 65,337 patients were included. Of the 65,337 patients, 59,664 had undergone carotid revascularization under GA (91%). When performed with LRA, TCAR and CEA had similar rates of stroke, death, and MI. However, when performed with GA, patients undergoing TCAR had a 50% decreased risk of MI compared with those undergoing CEA under GA (0.5% vs 1.0%; RR, 0.50; 95% CI, 0.32-0.80; P < .01). When stratified by symptomatic status, patients undergoing TCAR with GA for symptomatic carotid disease had a 67% decreased risk of MI compared with those undergoing CEA with GA for symptomatic disease (0.4% vs 1.2%; RR, 0.33; 95% CI, 0.15-0.75; P < .01). In contrast, no difference was found in the risk of MI between patients undergoing CEA vs TCAR for asymptomatic carotid disease (0.6% vs 0.9%; RR, 0.64; 95% CI, 0.37-1.14; P = .13). CONCLUSIONS: The results from the present study have confirmed previous studies suggesting that TCAR confers a lower risk of MI compared with CEA. However, our findings demonstrated no differences in the MI rates between TCAR and CEA when performed with LRA. Patients undergoing TCAR under GA had lower rates of MI compared with patients undergoing CEA under GA. When stratified by symptomatic status, the benefit of TCAR persisted only for the symptomatic patients.

Current status and etiology of valvular heart disease in China: a population-based survey.

BACKGROUND: The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China. METHODS: We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD. RESULTS: The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD. CONCLUSIONS: In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD.

Aortic Intimo-intimal Intussusception: A Pooled Analysis of Published Reports.

AIM: Aortic intimo-intimal intussusception (AoII) is a rare manifestation of aortic dissection with high mortality. This study aimed to obtain a comprehensive understanding of AoII. METHODS: Three databases (PubMed, Scopus, Embase) were searched with predefined search terms ["intimal intussusception", "aortic intussusception", "(circumferential) AND (intimal dissection)" and "(circumferential) AND (aortic dissection)"]. Demographics, clinical manifestations, imaging methods, therapies, and follow-up data were recorded and analyzed. RESULTS: The literature search finally identified 81 papers comprising 87 patients (Mean age: 53.7 ± 14.9 years old; male: n = 63). According to morphologic criteria (orientation of AoII intimal flap), patients were divided into three groups: antegrade (n = 37), retrograde (n = 49) and bidirectional (n = 1) orientation. The most frequent symptoms in antegrade group were chest pain (62.2%), syncope (27%), and unconsciousness (21.6%), while in retrograde group, they were chest pain (71.4%), dyspnea (20.4%), and back pain (16.3%). Regarding applied imaging modalities, 67.5% of patients in antegrade group were diagnosed with≥2 methods, comparing with 87.7% in retrograde group. A total of 21 patients (24.1%) with AoII finally died, among which 13.8% (12/87) died before surgery. CONCLUSION: AoII is a rare form of aortic dissection with high mortality. Antegrade orientation of the intima flap was more accompanied with neurological disorders and asymmetric blood pressure, while retrograde orientation mostly manifested with aortic regurgitation. Application of multiple imaging examinations may detect this rare entity in time.

Fullertubes: Cylindrical Carbon with Half-Fullerene End-Caps and Tubular Graphene Belts, Their Chemical Enrichment, Crystallography of Pristine C90-D5h(1) and C100-D5d(1) Fullertubes, and Isolation of C108, C120, C132, and C156 Cages of Unknown Structures.

We report a chemical separation method to isolate fullertubes: a new and soluble allotrope of carbon whose structure merges nanotube, graphene, and fullerene subunits. Fullertubes possess single-walled carbon nanotube belts resembling a rolled graphene midsection, but with half-fullerene end-caps. Unlike nanotubes, fullertubes are reproducible in structure, possess a defined molecular weight, and are soluble in pristine form. The high reactivity of amines with spheroidal fullerene cages enables their removal and allows a facile isolation of C96-D3d(3), C90-D5h(1), and C100-D5d(1) fullertubes. A nonchromatographic step (Stage 1) uses a selective reaction of carbon cages with aminopropanol to permit a highly enriched sample of fullertubes. Spheroidal fullerenes are reacted and removed by attaching water-soluble groups onto their cage surfaces. With this enriched (100-1000 times) fullertube mixture, Stage 2 becomes a simple HPLC collection with a single column. This two-stage separation approach permits fullertubes in scalable quantities. Characterization of purified C100-D5d(1) fullertubes is done with samples isolated in pristine and unfunctionalized form. Surprisingly, C60 and C100-D5d(1) are both purplish in solution. For X-ray crystallographic analysis, we used decapyrrylcorannulene (DPC). Isomerically purified C90 and C100 fullertubes were mixed with DPC to obtain black cocrystals of 2DPC{C90-D5h(1)}·4(toluene) and 2DPC{C100-D5d(1)}·4(toluene), respectively. A serendipitous outcome of this chemical separation approach is the enrichment and purification of several unreported larger carbon species, e.g., C120, C132, and C156. Isolation of these higher cage species represents a significant advance in the unknown experimental arena of C100-C200 structures. Our findings represent seminal experimental evidence for the existence of two mathematically predicted families of fullertubes: one family with an axial hexagon with the other series based on an axial pentagon ring. Fullertubes have been predicted theoretically, and herein is their experimental evidence, isolation, and initial characterization.