Changes of cerebral structure and perfusion in subtypes of systemic sclerosis: a brain magnetic resonance imaging study.

OBJECTIVES: The characteristics of brain impairment in different subtypes of systemic sclerosis (SSc) (dcSSc, diffuse cutaneous SSc; lcSSc, limited cutaneous SSc) remain unclear. This study aimed to characterize cerebral structure and perfusion changes in different subtype of SSc patients using magnetic resonance (MR) imaging. METHODS: Seventy SSc patients (46.0 ± 11.7 years, 62 females) and 30 healthy volunteers (44.8 ± 13.7 years, 24 females) were recruited and underwent brain MR imaging and Montreal Cognitive Assessment (MoCA) test. Gray matter (GM) volumes were measured using voxel-based morphometry analysis on T1-weighted images. Voxel-based and regional cerebral blood flow (CBF) was calculated on arterial spin labelling images. The cerebral structural and perfusion measurements by MR imaging were compared among dcSSc, lcSSc and healthy subjects using one-way ANOVA. The correlations between clinical characteristics and MR imaging measurements were also analyzed. RESULTS: The dcSSc patients exhibited a significant reduction in GM volume in the para-hippocampal region (cluster p < 0.01, FWE corrected) compared with healthy volunteers. Whereas, SSc patients, particularly lcSSc patients, showed elevated CBF in cerebellum, insula, cerebral cortex, and subcortical structures (regional analyses: all p < 0.05; voxel-based analyses: cluster p < 0.01, FWE corrected). Furthermore, clinical characteristics of modified Rodnan skin score (mRSS) (r value ranged from -0.29 to -0.45), MoCA scores (r = 0.40) and antinuclear antibody (ANA) positivity (r=-0.33) were significantly associated with CBF in some regions (all p < 0.05). CONCLUSION: The manifestations of brain involvement vary among different subtypes of SSc. In addition, severe skin sclerosis may indicate higher risk of brain involvement in SSc patients.

Knowledge status of skin tear prevention and its demographic and occupational influencing factors: A National cross-sectional survey among nurses.

AIM: A skin tear (ST) is a common skin injury that is often misdiagnosed or overlooked. This study examined the current state of nurses' ST knowledge and its influencing factors. DESIGN: A national cross-sectional survey combined with a quantitative analysis was used to provide evidence of poor ST knowledge among nurses and its influencing factors. METHODS: An electronic questionnaire survey was conducted among 1293 nurses from 32 hospitals in 18 provinces across China, including a General Information Questionnaire, ST Knowledge Assessment Instrument (OASES) and a Self-directed Learning Competence Scale for Nurses (SLCS-N). RESULTS: The mean OASES score was 9.51 ± 3.15, with a score rate of 47.55%. Pearson's correlation analysis showed positive correlations, ranging from none to strong, between every dimension in the OASES and from strong to extremely strong between every dimension in the SLCS-N. Multivariate analysis revealed multiple independent factors influencing ST knowledge, such as hospital tier, specialized nurses in wound/ostomy/incontinence care, participation in training for wound/ostomy/incontinence management, willingness to undergo ST training, self-assessed grade in ST care and the degree of emphasis of managers. CONCLUSION: ST knowledge status was generally poor among nurses nationwide. Managers should establish a comprehensive and specialized curriculum-based system, develop evidence-based standardized nursing processes, and provide tailored training programs to address nurses' unique characteristics and individualized needs, thereby enhancing their proficiency in ST-related knowledge and skills. IMPACT: This study is the first to identify a poor level of ST knowledge among nurses nationwide, particularly in the four dimensions of risk assessment: prevention, treatment, classification, and observation. Based on the findings regarding demographic factors and ST experiences, an integrated management system and educational program should be implemented to improve nurses' awareness and knowledge in this field. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contributions.

The skin tears knowledge among geriatric ward nurses and associated factors: A cross-sectional study.

AIM: To determine the level of knowledge about skin tears among geriatric ward nurses and identify associated factors. METHODS: In this cross-sectional study in Southwest China, 1172 geriatric ward nurses from 10 hospitals participated. Data were collected using Sojump, a Chinese web-based platform, and the Skin Tear Knowledge Assessment Instrument was used to assess their knowledge. The analysis involved descriptive statistics, correlation analysis, and multiple linear regression. RESULTS: The study involved participants with an average age of 36.73 (SD = 6.54) years. More than half of the participants had less than 10 years of experience in geriatric wards. 27 % specialized in wound care, and 68.1 % lacked specific training in skin tear (ST) knowledge. Additionally, 82.7 % of geriatric nurses had never been exposed to guidelines on ST prevention and management. In the geriatric ward, 36.6 % of nurses received training in ST prevention. The average knowledge score about Skin Tears (STs) was 9.52 (SD = 2.39) out of 18. 'Treatment' had the lowest mean score, while 'Specific patient groups' had the highest. The multiple linear regression analysis found that nurses' knowledge of STs was influenced by sex(ß = 0.096, P < 0.001), educational level(ß = 0.062, P < 0.001), participation in ST (ß = -0.193, P < 0.001 and wound care training(ß = -0.120, P = 0.004), and specialization as a wound care nurse(ß = -0.350, P = 0.001). These factors explained 61.3 % of the variance in knowledge about STs among the participants. CONCLUSION: The geriatric ward had limited knowledge of STs. To improve their skills in dealing with STs, managers should provide tailored training to nurses and establish a standardized, evidence-based nursing process.

The Mechanisms of Ferroptosis Under Hypoxia.

Ferroptosis is a new form of programmed cell death, which is characterized by the iron-dependent accumulation of lipid peroxidation and increase of ROS, resulting in oxidative stress and cell death. Iron, lipid, and multiple signaling pathways precisely control the occurrence and implementation of ferroptosis. The pathways mainly include Nrf2/HO-1 signaling pathway, p62/Keap1/Nrf2 signaling pathway. Activating p62/Keap1/Nrf2 signaling pathway inhibits ferroptosis. Nrf2/HO-1 signaling pathway promotes ferroptosis. Furthermore, some factors also participate in the occurrence of ferroptosis under hypoxia, such as HIF-1, NCOA4, DMT1. Meanwhile, ferroptosis is related with hypoxia-related diseases, such as MIRI, cancers, and AKI. Accordingly, ferroptosis appears to be a therapeutic target for hypoxia-related diseases.

Lysinibacillus capsici 38,328 isolated from agricultural soils as a promising probiotic candidate for intestinal health.

There is an increasing interest in the use of spore-forming Bacillus spp. as probiotic ingredients on the market. However, probiotics Bacillus species are insufficient, and more safe Bacillus species were required. In the study, traditional fermented foods and soil samples were collected from more than ten provinces in China, and 506 Bacillus were selected from 109 samples. Using the optimized procedure, we screened nine strains, which successfully passed the acid, alkali, bile salt, and trypsin resistance test. Drug sensitivity test results showed that three Bacillus out of the nine isolates exhibited antibiotic sensitivity to more than 29 antibiotics. The three strains sensitive to antibiotics were identified by 16S ribosomal RNA, recA, and gyrB gene analysis, two isolates (38,327 and 38,328) belong to the species Lysinibacillus capsici and one isolate (37,326) belong to Bacillus halotolerans. Moreover, the three strains were confirmed safe through animal experiments. Finally, L. capsici 38,327 and 38,328 showed protections in the Salmonella typhimurium infection mouse model, which slowed down weight loss, reduced bacterial load, and improved antioxidant capacity. Altogether, our data demonstrated that selected L. capsici strains can be used as novel probiotics for intestinal health.

Electrically switchable structural colors based on liquid-crystal-overlaid aluminum anisotropic nanoaperture arrays.

Actively tunable or reconfigurable structural colors are highly promising in future development for high resolution imaging and displaying applications. To this end, we demonstrate switchable structural colors covering the entire visible range by integrating aluminum nanoaperture arrays with nematic liquid crystals. The geometrically anisotropic design of the nanoapertures provides strong polarization-dependent coloration. By overlaying a nematic liquid crystal layer, we further demonstrate switchable ability of the structural colors by either changing the polarization of the incident light or applying an external voltage. The switchable structural colors have a fast response time of 28 ms at a driving voltage of 6.5 V. Furthermore, colorful patterns are demonstrated by coding the colors with various dimensions of nanoaperture arrays with dual switching modes. Our proposed technique in this work provides a dual-mode switchable structural colors, which is highly promising for polarimetric displays, imaging sensors, and visual cryptography.

Electrically Switchable, Polarization-Sensitive Encryption Based on Aluminum Nanoaperture Arrays Integrated with Polymer-Dispersed Liquid Crystals.

Metasurface-based structural coloration is a promising enabling technology for advanced optical encryption with a high-security level. Herein, we propose a paradigm of electrically switchable, polarization-sensitive optical encryption based on designed metasurfaces integrated with polymer-dispersed liquid crystals. The metasurfaces consist of anisotropic and isotropic aluminum nanoaperture arrays. Optical images can be encrypted by elaborately arranging anisotropic and isotropic nanoapertures based on their polarization-dependent plasmonic resonance characteristics. We demonstrate high-quality encrypted images and QR codes with electrically switchable, polarization-sensitive properties based on PDLC-integrated aluminum nanoaperture arrays. The proposed technique can be applied to many fields including high-security optical encryption, security tags, anticounterfeiting, multichannel imaging, and dynamic displays.

Linearly Polarized Emission from Shear-Induced Nematic Phase Upconversion Nanorods.

Lanthanide-doped particles exhibit unique polarization-dependent luminescence due to the anisotropic crystalline local symmetry surrounding the emitter. Precise control of the orientation of particles shows great significance for exploiting the luminescent polarization and their potential applications. Here, we demonstrated a facile polypropylene-aided shear-driven method to obtain large-scale orientationally ordered upconversion nanorods, showing a liquid-crystalline nematic phase. Upconversion nanorods with low aspect ratios were well-aligned with the crystalline c-axis along the shearing direction using monodispersed colloid nanorods as the nanoink. The order parameter of aligned upconversion nanorods can reach up to 0.95. The nematic upconversion nanorods demonstrated strong polarization-dependent luminescence with the high degrees of polarization of the 4F9/2 sublevels at 657 and 661 nm being 0.47 and 0.59, respectively. Taking advantage of these mesoscopic well-aligned upconversion nanorods, their peculiar polarized emissions are potentially useful for some interdisciplinary applications such as polarization-sensitive bioprobes and anticounterfeiting.

Electrically switchable photonic crystals based on liquid-crystal-infiltrated TiO2-inverse opals.

Electrically switchable photonic crystals are demonstrated based on TiO2 inverse opals infiltrated with liquid crystals. Macroporous anatase TiO2 inverse opals are fabricated from polystyrene opal templates through a sandwich vacuum backfilled method and followed by calcination. Upon liquid crystal infiltration, the optical properties of the hybrid organic/inorganic structure are characterized by reflectance measurements of the Bragg peak, the position of which can be switched using an external electric field. The physical mechanism underlying this switchable behavior is the reorientation of the liquid crystal molecules inside the spherical voids by the applied electric field, resulting in a significant change of the refractive index contrast between the liquid crystal and the TiO2 inverse opal. With advantageous features of cost-effective fabrication, easy integration, and electric control, such TiO2 inverse opals infiltrated with liquid crystals could play an important role in future development of active photonic devices.

The role and mechanism of AMPK in pulmonary hypertension.

Pulmonary hypertension (PH) is a chronic progressive disease with high mortality. There has been more and more research focusing on the role of AMPK in PH. AMPK consists of three subunits-α, ß, and γ. The crosstalk among these subunits ultimately leads to a delicate balance to affect PH, which results in conflicting conclusions about the role of AMPK in PH. It is still unclear how these subunits interfere with each other and achieve balance to improve or deteriorate PH. Several signaling pathways are related to AMPK in the treatment of PH, including AMPK/eNOS/NO pathway, Nox4/mTORC2/AMPK pathway, AMPK/BMP/Smad pathway, and SIRT3-AMPK pathway. Among these pathways, the role and mechanism of AMPK/eNOS/NO and Nox4/mTORC2/AMPK pathways are clearer than others, while the SIRT3-AMPK pathway remains still unclear in the treatment of PH. There are drugs targeting AMPK to improve PH, such as metformin (MET), MET combination, and rhodiola extract. In addition, several novel factors target AMPK for improving PH, such as ADAMTS8, TUFM, and Salt-inducible kinases. However, more researches are needed to explore the specific AMPK signaling pathways involved in these novel factors in the future. In conclusion, AMPK plays an important role in PH.

Characterization of kidneys in patients with systemic sclerosis by multi-parametric magnetic resonance quantitative imaging.

PURPOSE: To determine the usefulness of multiparametric magnetic resonance (MR) quantitative imaging in characterizing the kidneys in systemic sclerosis (SSc) patients. MATERIAL AND METHODS: Forty-six SSc patients (47.9 ± 12.8 years, 40 females) and 22 age- and sex- matched healthy volunteers (46.1 ± 13.8 years, 20 females) were recruited and underwent renal MR imaging by acquiring blood oxygen level dependent and saturated multi-delay renal arterial spin labeling (SAMURAI) sequences. The T2* value, T1 value, renal blood flow (RBF), arterial bolus arrival time (aBAT), and tissue bolus arrival time (tBAT) of renal cortex were measured and compared among diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) groups and healthy controls using One-way ANOVA and analyzed by logistic regression. RESULTS: Compared to healthy volunteers, SSc patients with normal estimated glomerular filtration rate (n = 40) had significantly lower T2* value (P = 0.026) in the left renal cortex, longer T1 value (right: P = 0.015; left: P = 0.023), lower RBF (right: P < 0.001; left: P < 0.001), and shorter tBAT (right: P < 0.001; left: P = 0.005) in both right and left renal cortex after adjusting for demographics. The dcSSc patients (n = 23) had significantly lower RBF in both right (226.7 ± 65.2 mL/100 g/min vs. 278.2 ± 73.5 mL/100 g/min, P = 0.022) and left (194.5 ± 71.5 mL/100 g/min vs. 252.7 ± 84.4 mL/100 g/min, P = 0.020) renal cortex compared to the lcSSc patients (n = 23) after adjusting for demographics, but the significance of the difference was attenuated after further adjusting for modified Rodnan skin score and digital ulcers. CONCLUSION: Multi-parametric MR quantitative imaging, particularly multi-delay ASL perfusion imaging, is a useful technique for characterizing the kidneys and classification of SSc patients.

High-mobility group box 1 emerges as a therapeutic target for asthma.

High-mobility group box 1 (HMGB1) is a highly conserved nonhistone nuclear protein found in the calf thymus and participates in a variety of intracellular processes such as DNA transcription, replication and repair. In the cytoplasm, HMGB1 promotes mitochondrial autophagy and is involved in in cellular stress response. Once released into the extracellular, HMGB1 becomes an inflammatory factor that triggers inflammatory responses and a variety of immune responses. In addition, HMGB1 binding with the corresponding receptor can activate the downstream substrate to carry out several biological effects. Meanwhile, HMGB1 is involved in various signaling pathways, such as the HMGB1/RAGE pathway, HMGB1/NF-κB pathway, and HMGB1/JAK/STAT pathway, which ultimately promote inflammation. Moreover, HMGB1 may be involved in the pathogenesis of asthma by regulating downstream signaling pathways through corresponding receptors and mediates a number of signaling pathways in asthma, such as HMGB1/TLR4/NF-κB, HMGB1/RAGE, HMGB1/TGF-ß, and so forth. Accordingly, HMGB1 emerges as a therapeutic target for asthma.

The clinical characteristics and outcomes of patients with systemic sclerosis with myocardial involvement.

BACKGROUND: Myocardial involvement (MI) is the primary cause of death in patients with systemic sclerosis (SSc). We analyzed patients with SSc and MI to identify their characteristics and outcome. METHOD: We retrospectively collected data from SSc patients with MI admitted to Peking Union Medical College Hospital between January 2012 and May 2021. SSc patients without MI were randomly selected as controls after matching age and gender at a ratio of 1:3. RESULTS: In total, 21 SSc patients (17 females) with MI were enrolled. The mean age at SSc onset was 42.3 ± 15.1 years old. Compared with controls, myositis (42.9% vs. 14.3%, P = 0.014) and elevation of CK (33.3% vs. 4.8%, P = 0.002) were more common in patients with MI. Of the 7 patients without cardiovascular symptoms, 3 /5 showed elevations in cardiac troponin-I (cTnI), 6 showed elevations of N-terminal brain natriuretic peptide (NT-proBNP). Eleven patients were followed up for a median period of 15.5 months and four patients developed newly occurring left ventricular ejection fraction (LVEF) < 50%. CONCLUSION: One third of SSc patients with MI were asymptomatic. Regular monitoring of CTnI, NT-proBNP and echocardiography is helpful for the diagnosis of MI during the early stages. Its prognosis is poor.

Ferroptosis triggers airway inflammation in asthma.

Ferroptosis is a regulatory cell death characterized by intracellular iron accumulation and lipid peroxidation that leads to oxidative stress. Many signaling pathways such as iron metabolism, lipid metabolism, and amino acid metabolism precisely regulate the process of ferroptosis. Ferroptosis is involved in a variety of lung diseases, such as acute lung injury, chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. Increasing studies suggest that ferroptosis is involved in the development of asthma. Ferroptosis plays an important role in asthma. Iron metabolism disorders, lipid peroxidation, amino acid metabolism disorders lead to the occurrence of ferroptosis in airway epithelial cells, and then aggravate clinical symptoms in asthmatic patients. Moreover, several regulators of ferroptosis are involved in the pathogenesis of asthma, such as Nrf2, heme oxygenase-1, mevalonate pathway, and ferroptosis inhibitor protein 1. Importantly, ferroptosis inhibitors improve asthma. Thus, the pathogenesis of ferroptosis and its contribution to the pathogenesis of asthma help us better understand the occurrence and development of asthma, and provide new directions in asthma treatment. This article aimed to review the role and mechanism of ferroptosis in asthma, describing the relationship between ferroptosis and asthma based on signaling pathways and related regulatory factors. At the same time, we summarized current observations of ferroptosis in eosinophils, airway epithelial cells, and airway smooth muscle cells in asthmatic patients.

Diffusing capacity of lungs for carbon monoxide associated with subclinical myocardial impairment in systemic sclerosis: A cardiac MR study.

BACKGROUND: Systemic sclerosis (SSc) is characterised by microvascular and fibrotic lesions, which are located not only in skin but also in lungs and heart. OBJECTIVE: This study aimed to investigate the association between lung function and myocardial T1 values using cardiac MR (CMR) imaging in patients with SSc without cardiovascular symptoms. METHODS: The SSc patients and age- and sex-matched healthy subjects underwent CMR. The cardiac function and native T1 values of myocardium and lung function were measured. Spearman's rank correlations and linear regression analyses were performed to determine the association between lung function and myocardial T1. RESULTS: Forty-five SSc patients (aged 47.7±13.2 years, 40 females) and 23 (aged 46.0±14.4 years, 20 females) healthy subjects were enrolled. SSc patients exhibited considerably higher native T1 values compared with healthy subjects (1305.9±49.8 ms vs 1272.6±37.6 ms, p=0.006). Linear regression analysis revealed that decrease of diffusing capacity of lungs for carbon monoxide (DLCO) in SSc patients was notably associated with myocardial native T1 value before (ß -1.017; 95% CI -1.883 to -0.151; p=0.022) and after adjusting for confounding factors (ß -1.108; 95% CI -2.053 to -0.164; p=0.023). Moderate-to-severe decrease of DLCO was found to be significantly associated with myocardial native T1 value (ß 48.006; 95% CI 17.822 to 78.190; p=0.003) after adjusting for confounding factors. CONCLUSION: DLCO inversely correlates with myocardial native T1 values in SSc patients, particularly moderate-to-severely decreased DLCO, suggesting that DLCO might be a potential indicator for subclinical myocardial impairment in SSc patients.

A simple system for measuring the transmittance curve of x-ray filters at low x-ray energies.

To prevent the x-ray detectors from the interference of optical photons, x-ray filters are widely used in x-ray space missions. As the flux of low energy x-rays would be significantly attenuated by the filters, it is important to derive the transmittance of the filters below 10 keV. In this paper, we present a simple experimental apparatus and data processing method to measure the transmittance curve of x-ray filters in the energy range from 1.6 to 10 keV. The measured spectra were further processed with Geant4 Monte Carlo simulation results and a direct demodulation algorithm. The obtained transmittance is in good accordance with the theoretical calculation and the synchrotron radiation test result, which proves that the proposed system with the algorithm is a reasonable way to characterize the x-ray transmittance performance of filters above 1.6 keV.

Shear Wave Elastography-Assisted Ultrasound Breast Image Analysis and Identification of Abnormal Data.

In this paper, shear wave elastography was used to study and analyze the images of the breast in-depth and identify the abnormal image data. Sixty breast lesions were evaluated, and quantitative metrics were reproducible in the static and dynamic modes of shear wave elastography with a higher interobserver agreement in dynamic qualitative metrics than in the static mode. There were no statistically significant differences between the two modes of imaging in quantitative metrics, and quantitative metrics were more effective than qualitative metrics. Postoperative immunohistochemical expression of ER, PR, HER-2, Ki-67, molecular typing, pathological type, histological grading, and axillary lymph node status of breast cancer was obtained based on pathological results. The correlation between mass size, patient age, and WiMAX values of breast cancer masses was analyzed using Pearson correlation, and the differences in SWVmax values of breast cancer masses between different expressions of immunohistochemical parameters ER, PR, HER-2, Ki-67, and axillary lymph node status were compared using tests. The variables with correlations and differences were included in the multiple linear regression analysis to assess the factors influencing the SWVmax values. The performance of TDPM, SPM, and TSPM was compared using PVA body models with different freeze-thaw cycles. The results showed that TSPM performed better than SPM in general, and TDPM showed excellent performance because of high temporal resolution and low random error, especially when the number of freeze-thaw cycles increased and the hardness of the PVA body mold increased. Measurements at different depths of inhomogeneous body models also showed that the TDPM method was less affected by depth, and the results were more stable. Finally, the reliability of the shear wave velocity (SWS) measured by the TDPM and SPM methods was investigated using porcine ligament tissue, and the results showed that the mean values of SWS goodness of fit for TDPM and SPM were 0.94 and 0.87, respectively, and the estimated elastic modulus of TDPM was very close to the mechanical test results.

Plasmonic Chiral Metasurface-Induced Upconverted Circularly Polarized Luminescence from Achiral Upconversion Nanoparticles.

Chirality induction, transfer, and manipulation have aroused great interest in achiral nanomaterials. Here, we demonstrate strong upconverted circularly polarized luminescence from achiral core-shell upconversion nanoparticles (UCNPs) via a plasmonic chiral metasurface-induced optical chirality transfer. The Yb3+-sensitized core-shell UCNPs with good dispersity exhibit intense upconversion luminescence of Tm3+ and Nd3+ through the energy transfer process. By spin-coating the core-shell UCNPs on this chiral metasurface, strong enhancement and circular polarization modulation of upconversion luminescence can be achieved due to resonant coupling between surface plasmons and upconversion nanoparticles. In the UCNPs-on-metasurface composite, a significant upconversion luminescence enhancement can be achieved with a maximum enhancement factor of 32.63 at 878 nm and an overall enhancement factor of 11.61. The luminescence dissymmetry factor of the induced upconverted circularly polarized luminescence can reach 0.95 at the emission wavelength of 895 nm. The UCNPs-on-metasurface composite yields efficient modulation for the emission intensity and polarization of UCNPs, paving new pathways to many potential applications in imaging, sensing, and anticounterfeiting fields.

Cholesteric liquid crystal-enabled electrically programmable metasurfaces for simultaneous near- and far-field displays.

Metasurfaces can enable polarization multiplexing of light so as to carry more information. Specific polarized light necessitates bulk polarizers and waveplates, which significantly increases the form size of metasurface devices. We propose an electrically programmable metasurface enabled by dual-frequency cholesteric liquid crystals (DF-CLCs) for simultaneous near- and far-field displays. Moreover, the integrated device can be electrically programmed to demonstrate 6 different optical images by engineering the DF-CLCs with frequency-modulated voltage pulses. Such programmable metasurfaces are potentially useful for many applications including information storage, displays, anti-counterfeiting, and so on.

Ultrathin Suspended Chiral Metasurfaces for Enantiodiscrimination.

Chiral metasurfaces can exhibit a strong circular dichroism, but it is limited by the complicated fabrication procedure and alignment errors. Here, a new type of self-aligned suspended chiral bilayer metasurface with only one-step electron beam lithography exposure is demonstrated. A significant optical chirality of 221° µm-1 can be realized using suspended metasurfaces with a thickness of 100 nm. Furthermore, this study experimentally demonstrates that such a structure is capable of label-free discrimination of the chiral molecules at zeptomole level, exhibiting a much higher sensitivity (orders of magnitude) compared to the conventional circular dichroism spectroscopy. The fundamental principles for chiral sensing using molecules-metasurfaces interactions are explored. Benefiting from the giant chiroptical response, the proposed metadevice may offer promising applications for ultrathin circular polarizers, chiral molecular detectors, and asymmetry information processing.