Single-atom catalysts (SACs) have recently emerged as the ultimate solution for overcoming the limitations of traditional catalysts by bridging the gap between homogeneous and heterogeneous catalysts. Atomically dispersed identical active sites enable a maximal atom utilization efficiency, high activity, and selectivity toward the wide range of electrochemical reactions, superior structural robustness, and stability over nanoparticles due to strong atomic covalent bonding with supports. Mononuclear active sites of SACs can be further adjusted by engineering with multicomponent elements, such as introducing dual-metal active sites or additional neighbor atoms, and SACs can be regarded as multicomponent SACs if the surroundings of the active sites or the active sites themselves consist of multiple atomic elements. Multicomponent engineering offers an increased combinational diversity in SACs and unprecedented routes to exceed the theoretical catalytic performance limitations imposed by single-component scaling relationships for adsorption and transition state energies of reactions. The precisely designed structures of multicomponent SACs are expected to be responsible for the synergistic optimization of the overall electrocatalytic performance by beneficially modulating the electronic structure, the nature of orbital filling, the binding energy of reaction intermediates, the reaction pathways, and the local structural transformations. This Review demonstrates these synergistic effects of multicomponent SACs by highlighting representative breakthroughs on electrochemical conversion reactions, which might mitigate the global energy crisis of high dependency on fossil fuels. General synthesis methods and characterization techniques for SACs are also introduced. Then, the perspective on challenges and future directions in the research of SACs is briefly summarized. We believe that careful tailoring of multicomponent active sites is one of the most promising approaches to unleash the full potential of SACs and reach the superior catalytic activity, selectivity, and stability at the same time, which makes SACs promising candidates for electrocatalysts in various energy conversion reactions.

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Background and purposeAnti-titin antibodies are antistriational antibodies associated with thymoma-associated myasthenia gravis (MG). We evaluated whether the patients with anti-titin antibody are more frequently hospitalized to manage thymoma-associated MG than those patients without anti-titin antibody.MethodsPatients with thymoma-associated MG who conducted the serological test for anti-titin antibody were retrospectively included. Disease severity, treatments, MG-related annual hospitalization rate, and MG-related emergency room (ER) visit rate were compared between the patients with anti-titin antibody and those patients without anti-titin antibody. Multivariate analysis was conducted to analyze the association between anti-titin antibody serostatus and multiple admissions (hospitalization or ER visit of ≥2 times).ResultsOf the 64 included patients, 31 (48.4%) patients were positive for anti-titin antibody (titin+ group) and 33 (51.6%) patients were negative for anti-titin antibody (titin– group). Both the annual rate of MG-related hospitalization and ER visit were significantly higher in the titin+ group [0.2 (0.1–0.6) and 0.1 (0–0.2) per year, respectively] than those in the titin– group [0 (0–0.2) and 0 (0–0) per year, p = 0.004 and p = 0.006, respectively]. In multivariate analysis, positive anti-titin antibody was still significantly associated with multiple admissions [odds ratio (OR) 4.11, 95% CI 1.05–16.03] compared to the titin– group as a reference after adjusting for sex, follow-up duration, age at onset, systemic chemotherapy, and the Masaoka staging.ConclusionThe presence of anti-titin antibody is associated with more frequent hospital utilization. Personalized explanation and careful monitoring strategy could be required in patients with thymoma-associated MG with anti-titin antibody for the timely detection of relapses.

Introduction: Encephalopathy is a rare disease caused by adverse effects of antibiotic drugs such as metronidazole. The incidence of metronidazole-induced encephalopathy is unknown, although several previous studies have addressed metronidazole neurotoxicity. Here, we report the case of a patient with reversible cerebellar dysfunction on magnetic resonance imaging, induced by prolonged administration of metronidazole for the treatment of infectious colitis. Case presentation: A 71-year-old Asian man, admitted to our hospital with hematochezia, underwent Hartmann's operation for the treatment of colorectal cancer three years ago. He was diagnosed with an infectious colitis by colonoscopy. After taking metronidazole, he showed drowsiness and slow response to verbal commands. Brain magnetic resonance imaging showed obvious bilateral symmetric hyperintensities within his dentate nucleus, tectal region of the cerebellum, and splenium of corpus callosum in T2-weighted images and fluid attenuated inversion recovery images. Our patient's clinical presentation and magnetic resonance images were thought to be most consistent with metronidazole toxicity. Therefore, we discontinued metronidazole, and his cerebellar syndrome resolved. Follow-up magnetic resonance imaging examinations showed complete resolution of previously noted signal changes. Conclusion: Metronidazole may produce neurologic side effects such as cerebellar syndrome, and encephalopathy in rare cases. We show that metronidazole-induced encephalopathy can be reversed after cessation of the drug. Consequently, careful consideration should be given to patients presenting with complaints of neurologic disorder after the initiation of metronidazole therapy.

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