Mechanism of carbonized humic acid and magnesium aluminum-layered double hydroxide promoting biohydrogen generation.

Dark fermentation (DF) is prone to low hydrogen (H2) yield. In this work, magnesium aluminum-layered double hydroxide and carbonized humic acid (MgAl-LDH/CHA) was synthesized by co-precipitation to reveal the mechanism in rising bioH2 generation. The results indicated that MgAl-LDH released Mg and Al ions slowly in DF system, improving the activity of H2-producing microbes (HPM) for more H2. The H2 yield increased from 169.3 mL/g glucose to 244.9 mL/g glucose, which was 44.7 % higher than that for the control yield. MgAl-LDH/CHA increased Proteobacteria content from 30.9 % to 43.7 %, making it form a complex microbial community and participate in DF metabolism with Firmicutes and other microbes together. Besides, MgAl-LDH/CHA could serve as an electron shuttle that likely effectively promotes electron transfer in DF, significantly reduced the energy requirements of HPM, thus raising metabolic activity. It provides direction for the multi-element composite applied in DF system.

Synthesis, crystal structure and Hirshfeld surface analysis of 1-[(1-octyl-1H-1,2,3-triazol-4-yl)methyl]-3-phenyl-1,2-di-hydro-quinoxalin-2(1H)-one.

In the title mol-ecule, C25H29N5O, the di-hydro-quinoxaline unit is not quite planar (r.m.s. deviation = 0.030 Å) as there is a dihedral angle of 2.69 (3)° between the mean planes of the constituent rings and the mol-ecule adopts a hairpin conformation. In the crystal, the polar portions of the mol-ecules are associated through C-H⋯O and C-H⋯N hydrogen bonds and C-H⋯π(ring) and C=O⋯π(ring) inter-actions, forming thick layers parallel to the bc plane and with the n-octyl groups on the outside surfaces.

Crystal structure, Hirshfeld surface analysis, DFT and the mol-ecular docking studies of 3-(2-chloro-acet-yl)-2,4,6,8-tetra-phenyl-3,7-di-azabicyclo-[3.3.1]nonan-9-one.

In the title compound, C33H29ClN2O2, the two piperidine rings of the di-aza-bicyclo moiety adopt distorted-chair conformations. Inter-molecular C-H⋯π inter-actions are mainly responsible for the crystal packing. The inter-molecular inter-actions were qu-anti-fied and analysed using Hirshfeld surface analysis, revealing that H⋯H inter-actions contribute most to the crystal packing (52.3%). The mol-ecular structure was further optimized by density functional theory (DFT) at the B3LYP/6-31 G(d,p) level and is compared with the experimentally determined mol-ecular structure in the solid state.

Synthesis and crystal structure of 1,3-bis-(acet-oxymeth-yl)-5-{[(4,6-di-methyl-pyridin-2-yl)amino]-methyl}-2,4,6-tri-ethyl-benzene.

In the crystal structure of the title compound, C26H36N2O4, the tripodal mol-ecule exists in a conformation in which the substituents attached to the central arene ring are arranged in an alternating order above and below the ring plane. The heterocyclic unit is inclined at an angle of 79.6 (1)° with respect to the plane of the benzene ring. In the crystal, the mol-ecules are connected via N-H⋯O bonds, forming infinite supra-molecular strands. Inter-strand association involves weak C-H⋯O and C-H⋯π inter-actions, with the pyridine ring acting as an acceptor in the latter case.

Comparative analysis of recurrence predictors and outcomes for atrial tachyarrhythmia following atrial fibrillation ablation: high-power short-duration vs. conventional pulmonary vein isolation.

Atrial fibrillation (AF) is a common cardiac arrhythmia, with structural and electrical remodeling being significant risk factors for recurrence post-catheter ablation. The advent of high-power short-duration pulmonary vein isolation (HPSD-PVI) presents a novel approach, potentially enhancing procedural success rates through the creation of transmural lesions without overheating. This study investigates the predictors of atrial tachyarrhythmia (ATA) recurrence and compares outcomes between HPSD-PVI and conventional PVI techniques. A total of 1005 patients undergoing radiofrequency catheter ablation (RFA) for AF were retrospectively analyzed in this study. The cohort was divided based on the ablation strategy: conventional PVI from February 2013 to September 2018, and HPSD-PVI from October 2018 onwards. The primary objective was to compare the predictors of ATA recurrence and the outcome between the two groups. Among 969 patients analyzed after exclusions, independent predictors of recurrence differed between groups; higher CHADS2/CHA2DS2-VASc scores and lower left ventricular ejection fraction (LVEF) were significant in the HPSD-PVI group, while non-paroxysmal AF, larger left atrial volume index (LAVI), and longer AF history were predictors in the conventional PVI group. The HPSD-PVI group showed a trend toward lower ATA recurrence rates compared to the conventional PVI group in the propensity-score-matched (PSM) cohort (log-rank test, p = 0.06). Higher CHADS2/CHA2DS2-VASc scores and lower LVEF were also independent predictors of ATA recurrence in the PSM cohort.

CHA2DS2-VASc predicts readmission, outcomes and resource utilization in patients undergoing coronary artery bypass grafting: A 7-year National Readmission Database study.

BACKGROUND: CHA2DS2-VASc score is used to assess thromboembolic risk in patients with atrial fibrillation (AF)/atrial flutter (AFL), however its utilization to predict outcomes and readmission at following discharge in patients undergoing coronary artery bypass grafting (CABG) regardless of AF/AFL presence is understudied. We sought to assess its utility in predicting outcomes, length of hospital stay (LOS), and healthcare-associated costs (HAC) in these patients. METHOD: The National Readmission Database (NRD) was queried from 2010 to 2017 for patients with/without AF/AFL undergoing CABG using the International Classification of Diseases, Ninth and Tenth editions (ICD-9-&-10). Multiple regression analysis and multivariate analysis using Cox-Hazard analysis were used to evaluate outcomes up to 90-day readmission from discharge, LOS, and HAC against CHA2DS2-VASc score (cut-off-score:6) were abstracted from the database. RESULTS: Of the 420,458 patients that underwent CABG, 76,859 (18.3 %) were re-admitted to hospital within 90-days from discharge. Statistically significant increase in 90-day all-cause readmissions were demonstrated with increasing CHA2DS2-VASc score [No AF/AFL vs AF/AFL: score-0 (2.4 % vs1.4 %), score-6 (3.1 % vs 4.5 %, p-value<0.0001]. Similar trends were seen in re-admissions for TIA/Stroke and heart failure. The survival rate for all events were lower with incremental increase in CHA2DS2-VASc score (score-0 = 100 %; score-6 = 73 %, p-value<0.0001). Greater LOS and HAC was associated with increasing higher CHA2DS2-VASc score (standardized-beta[ß]; no AF/AFL vs AF/AFL: LOS = score-1: 0.08 vs 0.06, score-6: 0.12 vs 0.13. HAC = score-1: 0.02 vs 0.009, score-6: 0.02 vs 0.01, p-value <0.001). CONCLUSION: CHA2DS2-VASc score is an easy-to-use tool that predicts poorer outcomes, higher readmission, longer LOS, higher HAC, not just in patients with AF/AFL undergoing CABG, but also in those without AF/AFL.

Resonance energy transfer-based electrochemiluminescence aptasensor for serotonin detection.

Serotonin is an essential neurotransmitter that regulates many physiological processes and is related to a variety of diseases. Herein, a novel electrochemiluminescence-resonance energy transfer (ECL-RET) aptasensor for serotonin detection was developed, with zinc-based metal-organic frameworks (Zn-MOFs) as an ECL donor and Pt@Cu2O cubic nanocrystals (CNs) as an acceptor. In the presence of target, numerous Pt@Cu2O CNs were brought to electrode surface through the catalytic hairpin assembly (CHA)-driven DNA walker, resulting in a significant inhibition of ECL signal. The efficient ECL-RET device exhibited a wide linear range for monitoring serotonin (10-12 to 10-6 M) and a low detection limit of 0.5 pM. Furthermore, satisfactory recoveries were obtained by using the aptasensor to monitor serotonin levels in serum and urine samples. The broadband absorption feature of Pt@Cu2O CNs, along with the extraordinary amplification effect of catalytic hairpin assembly (CHA)-driven DNA walking machine, provided a new route for the construction of efficient ECL-RET systems.

CHA2DS2-VASc Score as Predictor of New-Onset Atrial Fibrillation and Mortality in Critical COVID-19 Patients.

BACKGROUND: Pre-existing and new-onset atrial fibrillation (NOAF) is a common arrhythmia in COVID-19 patients and is related to increased mortality. CHA2DS2-VASc score was initially developed to evaluate thromboembolic risk in patients with AF. Moreover, it predicted adverse outcomes in other clinical conditions, including SARS-CoV-2 infection. We aimed to evaluate the association of CHA2DS2-VASc with NOAF, ICU length of stay (LOS) and mortality in critically ill COVID-19 patients. We also examined the relationship of NOAF with mortality. We reviewed the literature to describe the link between cardiovascular risk factors and inflammatory response of severe COVID-19. METHODS AND RESULTS: We retrospectively studied 163 COVID-19 patients admitted to a level 3 general ICU from March 2020 to April 2022. Patients were of advanced age (median 64 years, IQR 56.5-71) and the majority of them were male (67.5%). Regarding NOAF, we excluded 12 patients with AF history. In this group, CHA2DS2VASc score was significantly elevated (3 IQR (1-4) versus 1 IQR (1-2.75), p = 0.003). Specifically, three components of CHA2DS2VASc were notably increased: age (p < 0.001), arterial hypertension (p = 0.042) and stroke (p = 0.047). ICU mortality was raised in the NOAF group [75.8% versus 34.8%, p < 0.001 OR 5.87, 95% CI (2.43, 14.17)]. This was significant even after adjusting for ICU clinical scores (APACHE II and SOFA). About mortality in the entire sample, survivors were younger (p = 0.001). Non-survivors had greater APACHE II (p = 0.04) and SOFA (p = 0.033) scores. CHA2DS2VASc score was positively associated with mortality [p = 0.031, OR 1.28, 95% CI (1.03, 1.6)]. ICU length of stay was associated with mortality (p = 0.016) but not with CHA2DS2VASc score (p = 0.842). CONCLUSIONS: NOAF and CHA2DS2VASc score were associated with higher mortality in COVID-19 ICU patients. CHA2DS2VASc score was also associated with NOAF but not with ICU LOS.

Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial.

BACKGROUND: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear. METHODS AND RESULTS: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients). CONCLUSIONS: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.

Clinical outcomes, management, healthcare resource utilization, and cost according to the CHA2DS2-VASc scores in Asian patients with nonvalvular atrial fibrillation.

BACKGROUND: The prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA2DS2-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients. METHODS AND RESULTS: This retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022. Patients were stratified into 3 cohorts by CHA2DS2-VASc scores: low-risk, intermediate-risk, and high-risk. One-year incidence rates and cumulative incidence of clinical outcomes (including ischemic stroke [IS], transient ischemic attack [TIA], arterial embolism [AE], and major bleeding [MB]) were calculated. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1 % female), 16,541 (3.9 %) were classified as low-risk, 38,494 (9.2 %) as intermediate-risk, and 364,455 (86.9 %) as high-risk. The one-year incidence rates for IS, TIA, AE, and MB were 12.4 (95 % CI, 12.3-12.5), 1.1 (95 % CI, 1.0-1.1), 0.5 (95 % CI, 0.5-0.5), and 3.1 per 100 person-years (95 % CI, 3.1-3.2), with an increasing trend from the low-risk to the high-risk group, respectively. During follow-up, 16.4 % and 11.1 % of patients in the low-risk and high-risk cohorts received oral anticoagulants (OACs), respectively. In addition, significant differences in HCRU and cost were observed in these three cohorts. CONCLUSION: This study demonstrates that contemporary Asian NVAF patients with higher CHA2DS2-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. Additionally, suboptimal management was present across all CHA2DS2-VASc score groups.