[Relationship between bioelectrical impedance analysis-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis].

Objective: To explore the relationship between bioelectrical impedance analysis (BIA)-derived fluid status and nutritional indicators and the prognosis in patients undergoing maintenance hemodialysis (MHD). Methods: A retrospective cohort study was conducted. The clinical data of MHD patients in Jiangsu Province Hospital between January 2014 and December 2016 were analyzed. BIA data of healthy volunteers in Gulou District, Nanjing City, collected between April and October 2022, were used to determine the cut-off value of body cell mass index (BCMI). Referring to previous research, using 0.15 as the cut-off value for the ratio of overhydration and extracellular water (OH/ECW). The data were transformed into binary variables based on these cut-off values to categorize patients into different groups. Kaplan-Meier analysis was used to plot survival curves, and the Cox proportional hazards model was performed to analyze risk factors for all-cause mortality. Results: A total of 706 MHD patients (407 males and 299 females) were included, aged (54±15) years. MHD patients were classified into four groups based on whether BCMI was<5.4 kg/m2 and OH/ECW was≥0.15, which included non-overhydration and non-malnutrition group, overhydration group, malnutrition group, and overhydration and malnutrition group, with 269, 186, 151, and 100 patients, respectively. During a median follow-up of [M(Q1, Q3)] 33 (26, 37) months, 162 patients died. Kaplan-Meier analysis showed that the median survival periods of the four groups were 52 months (95%CI: 41-54 months), 46 months (95%CI: 44-49 months), 37 months (95%CI: 34-40 months), and 34 months (95%CI: 30-38 months), respectively, with a statistically significant difference (P<0.001). The 1-year survival rates were 95.5%, 93.5%, 92.1%, and 88.0% (P<0.001), respectively, and the 2-year mortality rates were 92.6%, 87.1%, 83.4%, and 77.0% (P<0.001), respectively. Multivariate Cox regression analysis showed that compared with non-overhydration and non-malnutrition group, the risk of all-cause mortality increased by 1.18 times in the malnutrition group (HR=2.18, 95%CI: 1.29-3.71, P=0.004), and by 1.59 times in the overhydration and malnutrition group (HR=2.59, 95%CI: 1.48-4.54, P=0.001). Conclusions: BIA-derived fluid status and nutritional indicators are associated with the prognosis of MHD patients. Compared with patients without fluid overload and malnutrition, patients with malnutrition and fluid overload have an increased risk of all-cause mortality.

[Association between sarcopenia and abdominal aortic calcification in maintenance hemodialysis patients].

Objective: To investigate the relationship between sarcopenia and abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients. Methods: A cross-sectional study was conducted. MHD patients who underwent regular dialysis between January 2021 and January 2022 at hemodialysis center in Jiangdu People's Hospital Affiliated to Yangzhou University were enrolled. The incidence of sarcopenia in these patients was examined by measuring handgrip strength, gait speed and appendicular skeletal muscle mass index (ASMI) using bioelectrical impedance analysis. AAC score was measured by a lateral lumbar spinal radiograph. The general information of the patients was collected and the blood biochemical indexes were detected. These patients were divided into non-calcification group (n=104) and calcification group (n=127) according to the score of AAC. Multivariate logistic regression was used to analyze the related factors of AAC. Results: A total of 231 MHD patients (134 males and 97 females) were enrolled in the study, with the mean age of (57.1±11.4) years. Among 231 hemodialysis patients, the incidence of sarcopenia and AAC were 46.3% (107 cases) and 55.0% (127 cases), respectively. The age [(60.2±11.1) vs (53.4±12.2) years, P<0.001] and dialysis vintage [86 (46, 135) vs 57 (27, 109) months, P=0.005] in calcification group were longer than these in the non-calcification group. The level of 25(OH)D3 [17.7 (13.5, 24.3) vs 20.5 (15.1, 28.1) µg/L, P=0.008] and gait speed [(0.88±0.23) vs (1.01±0.20) m/s, P=0.024], handgrip strength [(17.9±9.1) vs (20.7±9.9) kg, P=0.013], ASMI [(6.65±2.24) vs (7.83±2.46) kg/m2, P<0.001] were lower. While, AAC score [12 (9, 19) vs 0 (0, 3), P<0.001] and the incidence of sarcopenia [58.3% (74/127) vs 31.7% (33/104), P<0.001] were higher in the calcification group than these in the non-calcification group. Multivariate logistic regression analysis indicated that sarcopenia (OR=1.928, 95%CI: 1.302-2.855, P=0.001), decrease of 25(OH)D3 level (OR=0.969, 95%CI: 0.940-1.000, P=0.047), age (OR=1.043, 95%CI: 1.015-1.072, P=0.002), and dialysis vintage (OR=1.009, 95%CI: 1.004-1.015, P=0.001) were related factors of AAC. Conclusions: Sarcopenia is associated with AAC in MHD patients. In clinical practice, attention should be paid to sarcopenia in MHD patients.

[Related factors for hyperkalemia and its recurrence in maintenance hemodialysis patients].

Objective: To investigate the prevalence of hyperkalemia and recurrent hyperkalemia in maintenance hemodialysis patients, and identify the related factors. Methods: The general information and clinical data of maintenance hemodialysis patients in the hemodialysis center of the First Affiliated Hospital of Nanjing Medical University from January to December 2020 were collected. According to the level of serum potassium, the patients were divided into normokalemia group and hyperkalemia group. Patients in the hyperkalemia group were further divided into single hyperkalemia group and recurrent hyperkalemia group according to the number of occurrences of hyperkalemia. Then, the prevalence of different serum potassium abnormalities and the related factors were explored. Results: Among the 352 patients included in the final analysis, 129 cases (36.6%) were in the normokalemia group [mean age: (62±15) years, 99 males] and 223 cases (63.4%) were in the hyperkalemia group [mean age: (60±14) years, 153 males]. Multivariate logistic regression analysis demonstrated that, compared with the normokalemia group, night-time dialysis (OR=4.012, 95%CI: 1.519-10.601, P=0.005), concurrent diabetes (OR=1.947, 95%CI: 1.148-3.304, P=0.013) and the number of serum potassium tested before hemodialysis (OR=1.561, 95%CI:1.292-1.885, P<0.001) were independent risk factors for hyperkalemia. Among 223 patients with hyperkalemia, 78 cases (35.0%) were in single hyperkalemia group and 145 cases (65.0%) were in recurrent hyperkalemia group. Multivariate logistic regression analysis demonstrated that, serum calcium (OR=21.885, 95%CI: 3.740-128.077, P=0.001), peak value of serum potassium before hemodialysis (OR=63.157, 95%CI: 25.265-157.876, P<0.001) and the number of serum potassium tested before hemodialysis (OR=1.814, 95%CI: 1.378-2.388, P<0.001) were the independent risk factors for the recurrence of hyperkalemia. Conclusions: The prevalence of hyperkalemia is high in maintenance hemodialysis patients, especially in those with diabetes or night-time dialysis. It is necessary to monitor serum potassium regularly. In addition, high serum calcium and peak value of serum potassium before hemodialysis are related factors for recurrent hyperkalemia.

[Association of urinary sodium excretion with fluid overload in patients with chronic kidney disease].

Objective: To investigate the relationship between urinary sodium excretion and fluid overload (FO) in non-dialysis patients with chronic kidney disease (CKD). Methods: Patients with CKD stage 1-4 who underwent bioelectrical impedance (BIA) in the Department of Nephrology, Jiangsu Province Hospital from December 2019 to January 2021 were recruited. All enrolled patients were categorized into two groups according to whether or not they develop FO. Further, clinical parameters were compared between the two groups. Spearman correlation analysis was used to investigate the association between over hydration/extracellular water (OH/ECW) and clinical characteristics. Multivariate logistic regression analysis was performed to evaluate the relationship between urinary sodium excretion and FO (FO was defined as OH/ECW≥7%). Results: A total of 385 patients with CKD stage 1-4 were finally included in the study, with a mean age of (46±15) years. There were 216 male cases (56.1%), and 150 cases (39.0%) existed FO. Spearman correlation analysis indicated that OH/ECW positively correlated with urinary sodium excretion (r=0.147, P=0.004), urinary protein excretion (r=0.555, P<0.001) and systolic blood pressure (r=0.241, P<0.001), but inversely related to estimated glomerular filtration rate (eGFR) (r=-0.111, P=0.030) and serum albumin (r=-0.659, P<0.001). After adjusting for confounding factors including age, systolic blood pressure, diabetes, urinary protein excretion, serum albumin, serum sodium, serum chlorine, urinary calcium excretion, urinary phosphorus excretion and use of diuretics, multivariate logistic regression analysis demonstrated that higher level of urinary sodium excretion was associated with increased risk of FO in patients with CKD (OR=1.005, 95%CI: 1.000-1.011, P=0.048). Conclusion: High urinary sodium excretion is independently associated with fluid FO in non-dialysis patients with CKD.

[Efficacy of endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique].

Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.

[Correlation between DCE-MRI quantitative perfusion histogram parameters, apparent diffusion coefficient and Ki-67 in different pathological types of lung cancer].

Objective: To explore the efficacy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) histogram molecular imaging index, apparent diffusion coefficient (ADC) in different types of lung cancer and explore their correlation with Ki-67. Methods: A total of 33 cases of lung cancer patients confirmed by pathology in Shaoxing People's Hospital from March 2017 to March 2018 were collected, 28 males and 5 females aged 50-85 years old, including 15 cases of squamous cell carcinoma, 12 cases of adenocarcinoma, and 6 cases of small cell carcinoma. All patients performed DCE-MRI and DWI imaging within one week before surgery or puncture. ADC values, DCE-MRI quantitative perfusion parameters by histogram metrics analysis (mean value, skewness, kurtosis, uniformity, entropy, energy, quantile) of K(trans), K(ep), V(e), and V(p) were then collected. Ki-67 expression in lung cancer tissue was detected by immunohistochemical method. One-way analysis of variance and least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. Pearson correlation analysis was used to compare the correlations between quantitative perfusion histogram parameters, ADC values and immunohistochemical scores of Ki-67. Results: The Ki-67 count in small cell lung cancer(458±82, P=0.011) and squamous cell carcinoma(355±277, P=0.034)were significantly higher than that in adenocarcinoma (168±164). The correlation analysis showed that there was a significant negative correlation between ADC values and Ki-67 (P=0.018, r=-0.416). And V(e) (Q5, Q10) was negatively related to Ki-67 (P=0.017, r=-0.420; P=0.040, r=-0.366). In squamous cell carcinoma patients, V(e) (homogeneity) was significantly negatively correlated with the expression of Ki-67 (P=0.033, r=-0.570). K(trans)(homogeneity) and V(e) (homogeneity, Q5, Q10, Q25) were significantly positively correlated with ADC values (P value from 0.001 to 0.035, r value from 0.545 to 0.765). Conclusion: DCE-MRI quantitative perfusion histogram parameters, ADC value can evaluate the lung cancer cell proliferation activity in different pathological types.

Effect and safety of paroxetine combined with zolpidem in treatment of primary insomnia.

PURPOSE: Primary insomnia is a persistent and recurrent disorder as well as a risk factor for depression. The aim of this study was to determine whether the zolpidem combined with paroxetine would be effective in the treatment of patients with primary insomnia. METHODS: Ninety patients meeting DSM-IV criteria for primary insomnia were randomly assigned to 8 weeks of treatment with zolpidem combined with paroxetine (the combined treatment group, n = 45) or zolpidem combined with placebo (the control group, n = 45). Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), and the Treatment Emergent Symptom Scale (TESS). RESULTS: Compared with the control group, the combined treatment group was more significantly improved on wake time after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and total PSQI scores, but not the sleep onset latency (SOL). CONCLUSIONS: Eight weeks of the zolpidem combined with paroxetine treatment to patients with primary insomnia is more effective than zolpidem treatment only in sleep maintenance and early morning awakenings.

The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients.

BACKGROUND: The previously published "Dose Response Multicentre International Collaborative Initiative (DoReMi)" study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT. METHODS: We prospectively enrolled all consecutive patients admitted to 21 intensive care units (ICUs) from nine countries and collected baseline characteristics, comorbidities, severity of illness, presence of sepsis, daily physiologic parameters and fluid intake-output, AKI stage, need for RRT and survival status. Daily fluid balance was computed and fluid overload (FO) was defined as percentage of admission body weight (BW). Maximum fluid overload (MFO) was the peak value of FO. RESULTS: We analysed 1734 patients. A total of 991 (57 %) had N-AKI, 560 (32 %) had AKI but did not have RRT and 183 (11 %) had AKI-RRT. ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI (p < 0.0001). Progressive fluid accumulation was seen in all three groups. Maximum fluid accumulation occurred on day 2 in N-AKI patients (2.8 % of BW), on day 3 in AKI patients not receiving RRT (4.3 % of BW) and on day 5 in AKI-RRT patients (7.9 % of BW). The main findings were: (1) the odds ratio (OR) for hospital mortality increased by 1.075 (95 % confidence interval 1.055-1.095) with every 1 % increase of MFO. When adjusting for severity of illness and AKI status, the OR changed to 1.044. This phenomenon was a continuum and independent of thresholds as previously reported. (2) Multivariate analysis confirmed that the speed of fluid accumulation was independently associated with ICU mortality. (3) Fluid accumulation increased significantly in the 3-day period prior to the diagnosis of AKI and peaked 3 days later. CONCLUSIONS: In critically ill patients, the severity and speed of fluid accumulation are independent risk factors for ICU mortality. Fluid balance abnormality precedes and follows the diagnosis of AKI.

Plasma FGF23 levels and heart rate variability in patients with stage 5 CKD.

UNLABELLED: Fibroblast growth factor 23(FGF23) is a bone-derived hormone which regulates mineral homeostasis but may also have a role in cardiovascular disease. Here, we found that higher plasma FGF23 was independently associated with decreased heart rate variability in stage 5 CKD patients and parathyroidectomy may reverse these abnormal indicators. INTRODUCTION: Lower heart rate variability (HRV) in patients with chronic kidney disease (CKD) compared with healthy controls is associated with increased risk of cardiovascular disease (CVD). Higher levels of plasma FGF23 also predict higher risk of CVD. Here, we aimed to evaluate the relationship between plasma FGF23 levels and HRV in patients with stage 5 CKD and to investigate longitudinal changes of them together with the correlation between their changes in two severe secondary hyperparathyroidism (SHPT) subgroups with successful parathyroidectomy (PTX) and persistent SHPT. METHODS: This cross-sectional study included 100 stage 5 CKD patients, 78 controls, and a prospective study in two PTX subgroups classified as successful PTX (n = 24) and persistent SHPT (n = 4) follow-up. Blood examination and 24-h Holter monitoring for HRV were measured. RESULTS: Most HRV indices were lower in stage 5 CKD patients than in healthy controls, and plasma FGF23 levels were higher. In multivariate stepwise regression models, levels of plasma FGF23 and serum parathyroid hormone (PTH) were correlated with HRV. The successful PTX subgroup had significant improvements over baseline in HRV indices. Persistent SHPT subgroup had numerically similar changes in HRV indices. However, plasma FGF23 levels decreased in both subgroups. CONCLUSIONS: Plasma FGF23 levels were higher in CKD patients than in controls, much higher in patients with severe SHPT. FGF23 was independently associated with decreased HRV in stage 5 CKD. Successful PTX may reverse these abnormal indicators and contribute to decreases in the risk of cardiovascular disease.

Unconventional resistive switching behavior in ferroelectric tunnel junctions.

We investigate an unconventional resistive switching (RS) behavior in La0.67Sr0.33MnO3/BaTiO3/metal (LSMO/BTO) ferroelectric tunnel junctions (FTJs), which is dominated by the variation of the barrier potential profile modulated by the migration of oxygen vacancies in the p-LSMO/n-BTO junction. The LSMO/BTO/Co junction exhibits a remarkable self-rectifying effect ascribed to the high-density interface state at the BTO/Co interface, in contrast to the symmetric conductivity when the top metal electrode is inert Pt. The effects of ferroelectric polarization on the RS behavior are also emphasized. Our work builds a bridge between FTJs and resistive random access memory devices.

Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome.

OBJECTIVE: To investigate the effects of coupled plasma filtration adsorption (CPFA) on the immune function of patients with multiple organ dysfunction syndrome (MODS). METHODS: This study was a prospective, pilot, before-and-after self-crossover, clinical trial. Seven patients diagnosed with MODS and severe infection were randomly allocated to both 10 hours of CPFA and 10 hours of high-volume hemofiltration (HVHF) with a 12-hour interval and in random order. Serum concentrations of 7 cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-1beta (IL-1beta), interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), and soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) were measured during each treatment. The HLA-DR expression by the blood monocytes and the TNF-alpha production by the patients' blood (both spontaneous and lipopolysaccharide stimulated) were tested before and after the treatment. TNF-alpha production of normal human monocytes (THP-1 cells) incubated in vitro with the patient plasma was also measured. RESULTS: During CPFA, the fall in serum TNF-alpha and rise in serum IL-1Ra coincided with the rise in ratios of sTNFR2/TNF-alpha and IL-1Ra/IL-1beta (p<0.05), which were different from those seen within HVHF (p<0.05). HLA-DR expression increased after CPFA (84.32%-/+4.63% vs. 73.65%-/+11.52%, p=0.037), but there was no change after HVHF (p>0.05). Spontaneous and lipopolysaccharide-induced TNF-alpha production increased over time with CPFA (p=0.038, p=0.034, respectively), but did not change with HVHF (p>0.05). Patient plasma suppressed the production of TNF-alpha by cultured normal monocytes. This effect decreased over time with CPFA (p=0.041), but there was no effect with HVHF (p>0.05). CONCLUSIONS: CPFA was superior to HVHF in increasing the ratios of antiinflammatory to proinflammatory mediators, improving antigen presentation ability, and restoring leukocyte responsiveness. These findings suggest a potential role for CPFA in the treatment of MODS.

Tilt engineering of exchange coupling at G-type SrMnO3/(La,Sr)MnO3 interfaces.

With the recent realization of hybrid improper ferroelectricity and room-temperature multiferroic by tilt engineering, "functional" octahedral tilting has become a novel concept in multifunctional perovskite oxides, showing great potential for property manipulation and device design. However, the control of magnetism by octahedral tilting has remained a challenging issue. Here a qualitative and quantitative tilt engineering of exchange coupling, one of the magnetic properties, is demonstrated at compensated G-type antiferromagnetic/ferromagnetic (SrMnO3/La2/3Sr1/3MnO3) interfaces. According to interfacial Hamiltonian, exchange bias (EB) in this system originates from an in-plane antiphase rotation (a(-)) in G-type antiferromagnetic layer. Based on first-principles calculation, tilt patterns in SrMnO3 are artificially designed in experiment with different epitaxial strain and a much stronger EB is attained in the tensile heterostructure than the compressive counterpart. By controlling the magnitude of octahedral tilting, the manipulation of exchange coupling is even performed in a quantitative manner, as expected in the theoretical estimation. This work realized the combination of tilt engineering and exchange coupling, which might be significant for the development of multifunctional materials and antiferromagnetic spintronics.

Imaging, clinical and pathological features of salivary gland adenolymphoma.

OBJECTIVE: Adenolymphoma (Warthin's tumor) is a common salivary gland benign tumors with poor diagnosis and ranking second after the parotid tumors. Presently, a rising tendency of the incidence of adenolymphoma has been noted. The aim of this study was to investigate the clinical, pathological and imaging features of this tumor. PATIENTS AND METHODS: 24 cases of confirmed adenolymphoma were retrospectively analyzed with clinical features, pathological data and CT imaging. RESULTS: Among 24 cases, 22 (91.7%) patients were male, two patients were female, 23 (95.8%) patients were more than 50 years old; 38 lesions were found in 24 patients including isolated lesions in 16 patients (66.7%), and multiple lesions in 8 patients (33.3%). 81.6% adenolymphoma lesions (31/38) were located in the posterior and inferior quadrant. The shapes of lesions were more oval or round, well-circumscribed, homogeneous (n=26) or inhomogeneous (n=12) with high density. 27 lesions were demonstrated with enhancement after contrast enhancement and 10 lesions showed small vessels penetrating through or surrounding the mass. CONCLUSIONS: Adenolymphoma of the parotid (Warthin tumor) should be first considered by the clinical data including age, gender, location and imaging manifestations of the lesions.

Tuning the entanglement between orbital reconstruction and charge transfer at a film surface.

The interplay between orbital, charge, spin, and lattice degrees of freedom is at the core of correlated oxides. This is extensively studied at the interface of heterostructures constituted of two-layer or multilayer oxide films. Here, we demonstrate the interactions between orbital reconstruction and charge transfer in the surface regime of ultrathin (La,Sr)MnO3, which is a model system of correlated oxides. The interactions are manipulated in a quantitative manner by surface symmetry-breaking and epitaxial strain, both tensile and compressive. The established charge transfer, accompanied by the formation of oxygen vacancies, provides a conceptually novel vision for the long-term problem of manganites--the severe surface/interface magnetization and conductivity deterioration. The oxygen vacancies are then purposefully tuned by cooling oxygen pressure, markedly improving the performances of differently strained films. Our findings offer a broad opportunity to tailor and benefit from the entanglements between orbit, charge, spin, and lattice at the surface of oxide films.

Strain engineering induced interfacial self-assembly and intrinsic exchange bias in a manganite perovskite film.

The control of complex oxide heterostructures at atomic level generates a rich spectrum of exotic properties and unexpected states at the interface between two separately prepared materials. The frustration of magnetization and conductivity of manganite perovskite at surface/interface which is inimical to their device applications, could also flourish in tailored functionalities in return. Here we prove that the exchange bias (EB) effect can unexpectedly emerge in a (La,Sr)MnO3 (LSMO) "single" film when large compressive stress imposed through a lattice mismatched substrate. The intrinsic EB behavior is directly demonstrated to be originating from the exchange coupling between ferromagnetic LSMO and an unprecedented LaSrMnO4-based spin glass, formed under a large interfacial strain and subsequent self-assembly. The present results not only provide a strategy for producing a new class of delicately functional interface by strain engineering, but also shed promising light on fabricating the EB part of spintronic devices in a single step.