"Primer shot" fractionation with an early treatment break is theoretically superior to consecutive weekday fractionation schemes for early-stage non-small cell lung cancer

PURPOSE

Radiotherapy is traditionally given in equally spaced weekday fractions. We hypothesize that heterogeneous interfraction intervals can increase radiosensitivity via reoxygenation. Through modeling, we investigate whether this minimizes local failures and toxicity for early-stage non-small cell lung cancer (NSCLC).

METHODS

Previously, a tumor dose-response model based on resource competition and cell-cycle-dependent radiosensitivity accurately predicted local failure rates for early-stage NSCLC cohorts. Here, the model mathematically determined non-uniform inter-fraction intervals minimizing local failures at similar normal tissue toxicity risk, i.e., iso-BED3 (iso-NTCP) for fractionation schemes 18Gyx3, 12Gyx4, 10Gyx5, 7.5Gyx8, 5Gyx12, 4Gyx15. Next, we used these optimized schedules to reduce toxicity risk (BED3) while maintaining stable local failures (TCP).

RESULTS

Optimal schedules consistently favored a "primer shot" fraction followed by a 2-week break, allowing tumor reoxygenation. Increasing or decreasing the assumed baseline hypoxia extended or shortened this optimal break by up to one week. Fraction sizes of 7.5 Gy and up required a single primer shot, while smaller fractions needed one or two extra fractions for full reoxygenation. The optimized schedules, versus consecutive weekday fractionation, predicted absolute LF reductions of 4.6%-7.4%, except for the already optimal LF rate seen for 18Gyx3. Primer shot schedules could also reduce BED3 at iso-TCP with the biggest improvements for the shortest schedules (94.6Gy reduction for 18Gyx3).

CONCLUSION

A validated simulation model clearly supports non-standard "primer shot" fractionation, reducing the impact of hypoxia-induced radioresistance. A limitation of this study is that primer-shot fractionation is outside prior clinical experience and therefore will require clinical studies for definitive testing.

Precursor Induced Assembly of Si Nanoparticles Encapsulated in Graphene/Carbon Matrices and the Influence of Al2 O3 Coating on their Properties as Anode for Lithium-Ion Batteries

The theoretical capacity of pristine silicon as anodes for lithium-ion batteries (LIBs) can reach up to 4200 mAh g-1 , however, the low electrical conductivity and the huge volume expansion limit their practical application. To address this challenge, a precursor strategy has been explored to induce the curling of graphene oxide (GO) flakes and the enclosing of Si nanoparticles by selecting protonated chitosan as both assembly inducer and carbon precursor. The Si nanoparticles are dispersed first in a slurry of GO by ball milling, then the resulting dispersion is dried by a spray drying process to achieve instantaneous solution evaporation and compact encapsulation of silicon particles with GO. An Al2 O3 layer is constructed on the surface of Si@rGO@C-SD composites by the atomic layer deposition method to modify the solid electrolyte interface. This strategy enhances obviously the electrochemical performance of the Si as anode for LIBs, including excellent long-cycle stability of 930 mAh g-1 after 1000 cycles at 1000 mA g-1 , satisfied initial Coulomb efficiency of 76.7%, and high rate ability of 806 mAh g-1 at 5000 mA g-1 . This work shows a potential solution to the shortcomings of Si-based anodes and provides meaningful insights for constructing high-energy anodes for LIBs.

Carbon Nanofibers Decorated by MoS2 Nanosheets with Tunable Quantity as Self-Supporting Anode for High-Performance Lithium Ion Batteries

Two-dimensional molybdenum disulfide (MoS2) is considered as a highly promising anode material for lithium-ion batteries (LIBs) due to its unique layer structure, large plane spacing, and high theoretical specific capacity; however, the overlap of MoS2 nanosheets and inherently low electrical conductivity lead to rapid capacity decay, resulting in poor cycling stability and low multiplicative performance. This severely limits its practical application in LIBs. To overcome the above problems, composite fibers with a core//sheath structure have been designed and fabricated. The sheath moiety of MoS2 nanosheets is uniformly anchored by the hydrothermal treatment of the axial of carbon nanofibers derived from an electrospinning method (CNFs//MoS2). The quantity of the MoS2 nanosheets on the CNFs substrates can be tuned by controlling the amount of utilized thiourea precursor. The influence of the MoS2 nanosheets on the electrochemical properties of the composite fibers has been investigated. The synergistic effect between MoS2 and carbon nanofibers can enhance their electrical conductivity and ionic reversibility as an anode for LIBs. The composite fibers deliver a high reversible capacity of 866.5 mA h g-1 after 200 cycles at a current density of 0.5 A g-1 and maintain a capacity of 703.3 mA h g-1 after a long cycle of 500 charge-discharge processes at 1 A g-1.

Skin-like cryogel electronics from suppressed-freezing tuned polymer amorphization

The sole situation of semi-crystalline structure induced single performance remarkably limits the green cryogels in the application of soft devices due to uncontrolled freezing field. Here, a facile strategy for achieving multifunctionality of cryogels is proposed using total amorphization of polymer. Through precisely lowering the freezing point of precursor solutions with an antifreezing salt, the suppressed growth of ice is achieved, creating an unusually weak and homogenous aggregation of polymer chains upon freezing, thereby realizing the tunable amorphization of polymer and the coexistence of free and hydrogen bonding hydroxyl groups. Such multi-scale microstructures trigger the integrated properties of tissue-like ultrasoftness (Young's modulus <10 kPa) yet stretchability, high transparency (~92%), self-adhesion, and instantaneous self-healing (<0.3 s) for cryogels, along with superior ionic-conductivity, antifreezing (-58 °C) and water-retention abilities, pushing the development of skin-like cryogel electronics. These concepts open an attractive branch for cryogels that adopt regulated crystallization behavior for on-demand functionalities.

Electrochemical Activation of Nitromethane to Construct Isoxazoline Aldoximes

Activating the nitromethane to endow new reactivity is an intersesting and meaningful but challenging topic. Herein, we report an electrochemical activation of nitromethane to serve as both heterocyclic skeleton and oxime sources for the construction of isoxazoline aldoximes. The isoxazoline aldoximes that prepared by four steps with reported strategy are synthesized in a single step from low-cost and readily available nitromethane and olefins with moderate to excellent yields under our electrochemical conditions. The reaction also takes advantages of high atom-economy and E-selectivity. Moreover, the mechanism is studied by control experiments, kinetic isotope effect (KIE) study, cyclic voltammograms (CVs) experiments, and density functional theory (DFT) calculations. The mechanistic results reveal that nitromethane may be activated under electrochemical conditions to deliver 1,2,5-oxadiazole 2-oxide intermediate, which undergoes [3 + 2] cycloaddition with olefins to yield isoxazoline aldoximes.

Pd-Enriched-Core/Pt-Enriched-Shell High-Entropy Alloys Nanoparticles with a Face-Centred Cubic Structure for C1 and C2 Alcohol Oxidation

Recently, high-entropy alloy nanoparticles (HEA NPs) have aroused great interest globally with their unique electrochemical, catalytic, and mechanical properties, as well as diverse activity and multielement tunability for multi-step reactions. Herein, a facile low-temperature synthesis method at atmospheric pressure is employed to synthesize Pd-enriched-HEA-core and Pt-enriched-HEA-shell NPs with a single phase of face-centred cubic structure for promoting the oxidation of C1 and C2 alcohols. Interestingly, the lattice of both Pd-enriched-HEA-core and Pt-enriched-HEA-shell enlarge during the formation process of HEA, with tensile strains included in the core and shell of HEA. Strikingly, the as-made PdAgSn/PtBi HEA NPs show excellent electrocatalytic activity and durability for methanol oxidation reaction (MOR) and ethanol oxidation reaction (EOR). Especially, the specific (mass) activity of PdAgSn/PtBi HEA NPs for MOR is 4.7 mA/cm2 (2874 mA mg(Pd+Pt)-1), about 1.7 (5.9) and 1.5 (4.8) times higher than that of commercial Pd/C and Pt/C catalysts, respectively. Combined with high-entropy effect, Pt sites and Pd sites on the interface of the HEA act synergistically to facilitate the multi-step process towards EOR. This study offers a promising way to find a feasible route for scalable HEA manufacturing with promising applications.

Proton-mediated reversible switching of metastable ferroelectric phases with low operation voltages

The exploration of ferroelectric phase transitions enables an in-depth understanding of ferroelectric switching and promising applications in information storage. However, controllably tuning the dynamics of ferroelectric phase transitions remains challenging owing to inaccessible hidden phases. Here, using protonic gating technology, we create a series of metastable ferroelectric phases and demonstrate their reversible transitions in layered ferroelectric α-In₂Se₃ transistors. By varying the gate bias, protons can be incrementally injected or extracted, achieving controllable tuning of the ferroelectric α-In₂Se₃ protonic dynamics across the channel and obtaining numerous intermediate phases. We unexpectedly discover that the gate tuning of α-In₂Se₃ protonation is volatile and the created phases remain polar. Their origin, revealed by first-principles calculations, is related to the formation of metastable hydrogen-stabilized α-In₂Se₃ phases. Furthermore, our approach enables ultralow gate voltage switching of different phases (below 0.4 volts). This work provides a possible avenue for accessing hidden phases in ferroelectric switching.

Microspheres of Si@Carbon-CNTs composites with a stable 3D interpenetrating structure applied in high-performance lithium-ion battery

The huge volumetric expansion (>300 %) of Si that occurs during the charge-discharge process makes it to have poor cycling ability and weak stable structure. These factors are considered as critical obstacles to the further development of Si as anode for lithium-ion batteries (LIBs). Herein, novel 3D interpenetrating microspheres, i.e., Si@C-CNTs, which consist of silicon nanoparticles interpenetrated with carbon nanotubes (CNTs) and stuck with amorphous carbon (C) have been designed and prepared via a spray-drying assisted approach. As anode of LIBs, Si@C-CNTs microspheres can achieve high silicon loadings of around 86 % and a high initial coulomb efficiency of 80.8 %. The electrodes maintain a reversible specific capacity of 1585.9mAh/g at 500 mA g-1 after 200 cycles, and deliver an excellent rate capability of 756.4 mAh/g at 5 A g-1. The outstanding performance of Si@C-CNTs can be due to their 3D interpenetrating structure and the synergy effect between the CNTs network and amorphous carbon therein. They synergistically act as conductive matrices which significantly improve the conductivity of the composite; they also act binders and reinforcing skeleton which help the composite spheres to have stable structure. Especially, the latter (reinforcing skeleton) alleviates the volumetric effect induced by the expansion and shrinkage of silicon particles during lithiation. The unique architecture provides an ideal model that can be used to design Si-based composite anode for advanced LIBs.

Unveiling the Synergistic Effects of Monodisperse Sea Urchin-like PdPb Alloy Nanodendrites as Stable Electrocatalysts for Ethylene Glycol and Glycerol Oxidation Reactions

In recent times, the fabrication of noble metal-based catalysts with controllable morphologies has become a research hotspot. Electrocatalytic devices with excellent catalytic performance and enhanced durability for the ethylene glycol oxidation reaction (EGOR) and the glycerol oxidation reaction (GOR) are significant for commercial direct fuel cells. Herein, a series of PdPb sea urchin-like nanodendrite (ND) structures with controllable molar ratios were synthesized as EGOR and GOR electrocatalysts of high efficiency. The optimized structurally regular Pd₃Pb NDs exhibit the best electrocatalytic activity and outstanding stability compared to other samples and commercial Pt/C. In addition, the integrated Pb on Pd₃Pb NDs can mitigate the bond energy the intermediates generate and further boost the electrooxidation of the intermediates by supplying enough active sites without considering its intrinsic structure, which is beneficial to the enhanced EGOR and GOR activity and stability. With the assistance of electrochemical measurement, the mechanism of the enhanced alloy was further investigated. This paper presents a promising strategy to fabricate catalysts with stable structures, which will elucidate a very promising approach for developing Pd-based catalysts for further applications in fuel cells.

Effects of WeChat platform-based nursing intervention on disease severity and maternal and infant outcomes of patients with gestational diabetes mellitus

OBJECTIVE

To determine the effects of WeChat platform-based nursing intervention on the disease control and pregnancy outcomes of patients with gestational diabetes mellitus (GDM).

METHODS

A total of 112 patients with GDM treated in our hospital from December 2018 to December 2020 were enrolled, and their clinical data were retrospectively analysed. Among them, 61 pregnant women were given routine nursing as the control group (Con group), and the other 51 were given WeChat platform-based interactive continuous nursing intervention as the observation group (Obs group). The blood glucose (BG) of the two groups before and after nursing was compared, and their self-management level and nursing satisfaction were evaluated. The maternal and infant outcomes of the two groups were also compared.

RESULTS

Before nursing, BG and glycosylated hemoglobin (HbA1c) levels in the two groups were comparatively high, without notable difference between the two groups (P>0.05); after nursing, the levels of fasting blood glucose, 2 hour postprandial blood glucose (2h-PG), and HbA1c in the Obs group decreased significantly, and were significantly lower than those in the Con group (P<0.05). Additionally, the two groups were similar in self-management level scores before nursing (P>0.05), while after nursing, the scores of diet management, exercise management, BG monitoring management and foot care management in the Obs group increased and were significantly higher than those in the Con group (P<0.05). The Obs group expressed significantly higher nursing satisfaction than the Con group (χ²=6.078, P<0.05). The total incidence of adverse pregnancy outcome in Obs group was lower than that in Con group (χ²-5.566, P<0.05). According to the analysis of risk factors, older age, pre-pregnancy BMI ≥24 kg/m², and history of diabetes mellitus were independent risk factors for adverse pregnancy outcomes of pregnant women, while WeChat platform-based interactive continuous nursing was a protective factor against adverse pregnancy outcome (P<0.05).

CONCLUSION

WeChat platform-based interactive continuous nursing intervention can help patients master comprehensive self-management skills to achieve good control of GDM, improve their satisfaction toward nursing and lower the risk of adverse outcome.

Assembly of Alloyed PdCu Nanosheets and Their Electrocatalytic Oxidation of Ethanol

Two-dimensional (2D) nanostructured catalysts have attracted great attention in many important fields, including energy applications and chemical industry. In this study, PdCu nanosheet assemblies (NSAs) have been synthesized and investigated as electrocatalysts for direct ethanol fuel cells in an alkaline medium. A great number of active sites on the nanosheets of PdCu NSAs for ethanol electro-oxidation are exposed, where the electron structures are optimized combined with the second element copper. Electrochemical measurements show that PdCu NSA1 exhibits excellent catalytic activity (2536 mA mg^-1) and cyclic stability compared to PdCu NSA2 (1700 mA mg^-1) and PdCu NSA3 (1436 mA mg^-1), much higher than commercial Pd/C. Kinetics studies on the electrolysis of ethanol suggest that PdCu NSAs should be more favorable at higher catalytic temperatures, higher concentrations of ethanol, and low pH value environments. The unique composition and structures PdCu NSA1 would result in the lowest energy barrier in the rate-controlling step of the ethanol oxidation reaction (EOR), confirmed by density functional theory (DFT). The formation mechanism of PdCu NSAs and their excellent electrocatalytic activity toward EOR have been discussed and analyzed.

Alloyed Palladium-Lead Nanosheet Assemblies for Electrocatalytic Ethanol Oxidation

Synthesizing alloyed bimetallic electrocatalysts with a three-dimensional (3D) structure assembly have arouse great interests in electrocatalysis. We synthesized a class of alloyed Pd₃Pb/Pd nanosheet assemblies (NSAs) composed of a two-dimensional (2D) sheet structure with adjustable compositions via an oil bath approach at a low temperature. Both the scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images reveal the successful formation of the nanosheet structure, where the morphology of Pd₃Pb/Pd NSAs can be regulated by adjusting the atomic mole ratio of Pb and Pb metal precursors. The power X-ray diffraction (XRD) pattern shows that Pd₃Pb/Pd NSA catalysts are homogeneously alloyed. Electrochemical analysis and the density functional theory (DFT) method demonstrate that the electrocatalytic activity of the alloyed Pd₃Pb/Pd NSAs can be improved by the doping of the Pb element. As a result of the addition of element Pb and change of the electron structure, the electrocatalytic activity toward ethanol oxidation of alloyed Pd₃Pb/Pd-15 NSA can reach up to 2886 mA mg^-1, which is approximately 2.8 times that of the pure Pd NSA counterpart (1020 mA mg^-1). The Pd₃Pb/Pd NSAs are favorable in a high catalytic temperature, high KOH concentration, and high ethanol concentration.

Outcomes of patients with high bleeding risks characteristics presenting with acute coronary syndrome undergoing percutaneous coronary intervention

Background

Patients with high bleeding risk characteristics (HBR) presenting with acute coronary syndrome (ACS) pose a clinical challenge to balance risk for recurrent ischemic events versus incurring bleeding with dual antiplatelet therapy.

Purpose

We seek to determine the incidence and predictors of short and long term ischemic and bleeding outcomes in patients with HBR factors presenting with ACS after percutaneous coronary intervention (PCI).

Method

Consecutive patients over a 1-year period, who underwent PCI for ACS were categorized as having HBR based on: age ≥75, anemia (hemoglobin&lt;110g/L), thrombocytopenia (platelet&lt;100x109/L), renal failure (eGFR&lt;30umol/L) or concurrent use of oral anticoagulation. Primary outcome was major adverse cardiovascular event (MACE) defined as composite of cardiovascular death, myocardial infarction, and stroke at 1 year. Key secondary outcomes include significant bleeding defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, and net adverse cardiovascular event (NACE), as a composite of MACE and significant bleeding.

Results

Of 1351 patients presented with ACS, 389 (28.8%) had at least one HBR criteria. At 1 year, patients with HBR, compared to those without, had increased MACE (11.1% vs 4.2%, p&lt;0.001) and cardiovascular death (5.7% vs 1.7%, p&lt;0.001). Patients with HBR had increased significant bleeding (3.6% vs 2.3%, p=0.011) and NACE (14.4% vs 5.4%, p&lt;0.001). Multivariate analysis showed the presence of HBR and prior history of myocardial infarction were predictors for 1-year MACE (OR 2.67, CI [1.62–4.42], p&lt;0.001 and OR 2.18, CI [1.29–3.70], p=0.004, respectively), whereas the use of second-generation antiplatelet agent was not. Increased MACE and NACE were observed in HBR patients beyond 1 month of DAPT.

Conclusion

Among patients with ACS undergoing PCI, those with HBR had higher risk for both ischemic and bleeding complications. Novel strategies need to be considered for this high-risk group. Current guidelines, recommending 1 year of DAPT for patients with ACS, should be re-evaluated among patients with HBR.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier curve for 1 year MACEKaplan-Meier curve for 1 year death

Scalable Superior Chemical Sensing Performance of Stretchable Ionotronic Skin via a π-Hole Receptor Effect

Skin-attachable gas sensors provide a next-generation wearable platform for real-time protection of human health by monitoring environmental and physiological chemicals. However, the creation of skin-like wearable gas sensors, possessing high sensitivity, selectivity, stability, and scalability (4S) simultaneously, has been a big challenge. Here, an ionotronic gas-sensing sticker (IGS) is demonstrated, implemented with free-standing polymer electrolyte (ionic thermoplastic polyurethane, i-TPU) as a sensing channel and inkjet-printed stretchable carbon nanotube electrodes, which enables the IGS to exhibit high sensitivity, selectivity, stability (against mechanical stress, humidity, and temperature), and scalable fabrication, simultaneously. The IGS demonstrates reliable sensing capability against nitrogen dioxide molecules under not only harsh mechanical stress (cyclic bending with the radius of curvature of 1 mm and cyclic straining at 50%), but also environmental conditions (thermal aging from -45 to 125 °C for 1000 cycles and humidity aging for 24 h at 85% relative humidity). Further, through systematic experiments and theoretical calculations, a π-hole receptor mechanism is proposed, which can effectively elucidate the origin of the high sensitivity (up to parts per billion level) and selectivity of the ionotronic sensing system. Consequently, this work provides a guideline for the design of ionotronic materials for the achievement of high-performance and skin-attachable gas-sensor platforms.

Comparing clinical outcomes following 1 year of dual antiplatelet therapy in patients risk stratified by the PRECISE-DAPT and DAPT scores

Background

Dual antiplatelet therapy (DAPT) is the standard of care following PCI. DAPT reduces ischemic events but increases bleeding risk. Duration of DAPT following PCI remains controversial. Current guidelines recommend duration be individualized based on risk of ischemia and bleeding. Although multiple strategies exist to risk stratify patients, including application of the PRECISE-DAPT and DAPT scores, there is currently no standardized risk assessment protocol.

Purpose

To determine if the PRECISE-DAPT and DAPT scores can identify patients at increased risk of ischemia or bleeding in a cohort prescribed 12 months of DAPT following PCI.

Methods

We calculated the PRECISE-DAPT and DAPT scores for 469 consecutive patients at baseline after PCI. Patients were grouped based on score treatment recommendation; PRECISE-DAPT prolonged or shortened (PRECISE DAPT &lt;25 vs. ≥25) and DAPT prolonged or shortened (DAPT ≥2 vs &lt;2). End points included 1-year rates of major adverse cardiovascular events (MACE) and TIMI major or minor bleeding.

Results

Among 469 patients, mean age was 64.4 (SD 12.2); 102 (21.7%) were women. Index presentation consisted of a STEMI in 207 (44.1%), NSTEMI in 99 (21.1%), and UA in 60 (12.8%). At presentation, 174 (37.1%) were current smokers, 115 (24.5%) had a prior MI, 118 (25.2%) had diabetes, 249 (53.1%) had dyslipidemia and 281 (60.0%) were previously diagnosed as hypertensive. Overall, there was an increase in bleeding and no difference in MACE for patients with a PRECISE-DAPT score ≥25 (13.3% vs. 4.1% P&lt;0.001). No difference in bleeding or MACE was present in patients stratified by the DAPT score.

Conclusion

A PRECISE-DAPT score ≥25 was associated with an increased rate of bleeding and no difference in MACE in patients prescribed 12 months of DAPT. This supports the use of the PRECISE-DAPT as a prospective tool in clinical practice.

Funding Acknowledgement

Type of funding source: None

Bidirectional heterostructures consisting of graphene and lateral MoS2/WS2 composites: a first-principles study

First-principles calculations have been performed to explore the structural and electronic properties of bidirectional heterostructures composed of graphene and (MoS₂) _X /(WS₂)_4-X (X = 1, 2, 3) lateral composites and compare them with those of heterobilayers formed by graphene and pristine MS₂ (M = Mo, W). The band gaps of the lateral heterostructures lie between those of pristine MoS₂ and WS₂. The weak coupling between the two layers can induce a tiny band-gap opening of graphene and formation of an n-type Schottky contact at the G-(MoS₂) _X /(WS₂)_4-X interface. Moreover, the combination ratio of MoS₂/WS₂ can control the electronic properties of G-(MoS₂) _X /(WS₂)_4-X . By applying external electric fields, the band gaps of (MoS₂) _X /(WS₂)_4-X (X = 0, 1, 2, 3, 4) monolayers undergo a direct-indirect transition, and semiconductor-metal transitions can be found in WS₂. External electric fields can also be used effectively to tune the binding energies, charge transfers, and band structures (the types of Schottky and Ohmic contacts) of G-(MoS₂) _X /(WS₂)_4-X heterostructures. These findings suggest that G-(MoS₂) _X /(WS₂)_4-X heterostructures can serve as high-performance nano-electronic devices.

P1933Comparing treatment recommendations for the DAPT and PRECISE-DAPT scores after percutaneous coronary intervention

Background

Dual antiplatelet therapy (DAPT), with aspirin and a P2Y12 inhibitor, is the standard therapy for patients following PCI. Duration of treatment with DAPT has been controversial despite large studies. Current guidelines recommend treatment duration be individualized based on risk of ischemia and bleeding. To facilitate treatment decisions, risk assessment tools, including the DAPT and PRECISE-DAPT scores, have been developed.

Purpose

As components of these scores differ, the variability of recommendation remains unknown. We set to evaluate inter-tool concordance in treatment recommendation in a cohort of patients after PCI.

Methods

Using data from our local PCI registry, we calculated the PRECISE-DAPT at baseline following PCI and the DAPT after 1 year of treatment for 311 consecutive patients with complete data for both scores to be calculated. Based on their DAPT and PRECISE-DAPT scores, patients were grouped into concordant for long-term treatment (DAPT ≥2 and PRECISE-DAPT <25) or concordant for shortened treatment (DAPT <2 and PRECISE- DAPT ≥25). All other patients were considered discordant. We then performed a concordance analysis using Cohen's kappa to measure degree of agreement.

Results

Among the 311 patients, mean age was 63.4 (SD 11.6); 245 (79%) were men, 93 (29.9%) had history of a prior MI, 130 (41.8%) were current smokers, 32 (10.3%) had a history of CHF or LVEF <30%, 82 (26.3%) had diabetes and 196 (63.0%) were previously diagnosed with hypertension. Index event consisted of a STEMI in 101 (32.4%), NSTEMI in 93 (29.9%), unstable angina in 27 (8.7%), stable angina in 67 (21.5%) and the remaining 23 (7.4%) had other indications for PCI. Mean DAPT score was 1.52 (SD 1.37). Mean PRECISE-DAPT was 17.65 (SD 12.73). The DAPT recommended long-term treatment for 162 (52.1%) and shortened treatment for 149 (47.9%). The PRECISE-DAPT recommended long-term treatment for 245 (78.9%) and shortened treatment for 66 (21.2%). The overall proportion of agreement between the two risk scores was 56.6% with a Cohen's kappa index of 0.110 (95% CI, 0.017 to 0.204). See Table.

Concordance Analysis PRECISE-DAPT Score Recommendation Long Term (N=245) Shortened (N=66) DAPT Score Recommendation Long Term (N=162) 136 (43.7%) 26 (8.4%) Concordant for Long Term Treatment Shortened (N=149) 109 (35%) 40 (12.8%) Concordant for Shortened Treatment

Conclusion

Comparison of the DAPT score and the PRECISE-DAPT score showed concordance in treatment recommendation in only 56.6% of patients. Given the poor agreement between these tools, prospective concurrent evaluations and correlation to outcomes will be required in future studies.

One-Pot Decoration of Graphene with SnO₂ Nanocrystals by an Elevated Hydrothermal Process and Their Application as Anode Materials for Lithium Ion Batteries

Tin dioxide (SnO₂), with a high theoretical storage capacity of 782 mAhg^-1, is a potential alternative anode for rechargeable lithium ion batteries (LIBs). However, its low electronic conductivity and poor stability during cycling (due to a change in volume) hinder its practical applications for energy storage. Composite materials of SnO₂-nanocrystal-decorated graphene, which show excellent electrochemical characteristics, were prepared using a one-pot elevated hydrothermal method at 250 °C without subsequent carbonization treatment. The effects of graphene, solvent composition, and temperature on the morphology, structure, and electrochemical properties of the SnO₂/graphene composites were investigated using XRD, SEM, TEM, and N₂ adsorption-desorption techniques. The as-prepared SnO₂/graphene composites deliver a high initial discharge capacity of 1734.1 mAh g^-1 at 200 mA g^-1 and exhibit a high reversible capacity of 814.7 mAh g^-1 even after 70 cycles at a current density of 200 mA g^-1. The composites also exhibit a high rate capability of 596 mAh g^-1 at 2000 mAg^-1, indicating a long cycle life and promising capability when used as anode materials for lithium ion batteries and suggesting that SnO₂/graphene composites have wide application prospects in LIBs.

Electroic and optical properties of germanene/MoS2 heterobilayers: first principles study

First principles calculations have been performed to investigate the structural, electronic, and optical properties of germanene/MoS₂ heterostructures. The results show that a weak van der Waals coupling between germanene and MoS₂ layers can lead to a considerable band-gap opening (53 meV) as well as the preserved Dirac cone with a linear band dispersion of germanene. The applied external electric filed can not only enhance the interaction strength between two layers, but also linearly control the charge transfer between germanene and MoS₂ layers, and consequently lead to a tunable band gap. Furthermore, the reduction in the optical absorption intensity of the heterostructures with respect to the separated monolayers has been predicted. These findings suggest that the Ge/MoS₂ hybrid can be designed as the device where both finite band gap and high carrier mobility are required.

Carbon Wrapped Ni₃S₂ Nanocrystals Anchored on Graphene Sheets as Anode Materials for Lithium-Ion Battery and the Study on Their Capacity Evolution

Ni₃S₂ nanocrystals wrapped by thin carbon layer and anchored on the sheets of reduced graphene oxide (Ni₃S₂@C/RGO) have been synthesized by a spray-coagulation assisted hydrothermal method and combined with a calcination process. Cellulose, dissolved in Thiourea/NaOH aqueous solution is chosen as carbon sources and mixed with graphene oxide via a spray-coagulation method using graphene suspension as coagulation bath. The resulted cellulose/graphene suspension is utilized as solvent for dissolving of Ni(NO₃)₂ and then used as raw materials for hydrothermal preparation of the Ni₃S₂@C/RGO composites. The structure of the composites has been investigated and their electrochemical properties are evaluated as anode material for lithium-ion batteries. The Ni₃S₂@C/RGO sample exhibits increasing reversible capacities upon cycles and shows a superior rate performance as well. Such kinds of promising performance have been ascribed to the wrapping effect of carbon layer which confines the dislocation of the polycrystals formed upon cycles and the enhanced conductivity as the integration of RGO conductive substrate. Discharge capacities up to 850 and 630 mAh·g⁻¹ at current densities of 200 and 5000 mA·g⁻¹, respectively, are obtained. The evolution of electrochemical performance of the composites with structure variation of the encapsulated Ni₃S₂ nanocrystals has been revealed by ex-situ TEM and XRD measurements.

Spray-Drying-Induced Assembly of Skeleton-Structured SnO2/Graphene Composite Spheres as Superior Anode Materials for High-Performance Lithium-Ion Batteries

Three-dimensional skeleton-structured assemblies of graphene sheets decorated with SnO₂ nanocrystals are fabricated via a facile and large-scalable spray-drying-induced assembly process with commercial graphene oxide and SnO₂ sol as precursors. The influences of different parameters on the morphology, composition, structure, and electrochemical performances of the skeleton-structured SnO₂/graphene composite spheres are studied by XRD, TGA, SEM, TEM, Raman spectroscopy, and N₂ adsorption-desorption techniques. Electrochemical properties of the composite spheres as the anode electrode for lithium-ion batteries are evaluated. After 120 cycles under a current density of 100 mA g^-1, the skeleton-structured SnO₂/graphene spheres still display a specific discharge capacity of 1140 mAh g^-1. It is roughly 9.5 times larger than that of bare SnO₂ clusters. It could still retain a stable specific capacity of 775 mAh g^-1 after 50 cycles under a high current density of 2000 mA g^-1, exhibiting extraordinary rate ability. The superconductivity of the graphene skeleton provides the pathway for electron transportation. The large pore volume deduced from the skeleton structure of the SnO₂/graphene composite spheres increases the penetration of electrolyte and the diffusion of lithium ions and also significantly enhances the structural integrity by acting as a mechanical buffer.

Synthesis and Characterization of N-Doped Porous TiO₂ Hollow Spheres and Their Photocatalytic and Optical Properties

Three kinds of N-doped mesoporous TiO₂ hollow spheres with different N-doping contents, surface area, and pore size distributions were prepared based on a sol–gel synthesis and combined with a calcination process. Melamine formaldehyde (MF) microspheres have been used as sacrificial template and cetyltrimethyl ammonium bromide (CTAB) or polyvinylpyrrolidone (PVP) was selected as pore-directing agent. Core–shell intermediate spheres of titania-coated MF with diameters of 1.2–1.6 μm were fabricated by varying the volume concentration of TiO₂ precursor from 1 to 3 vol %. By calcining the core–shell composite spheres at 500 °C for 3 h in air, an in situ N-doping process occurred upon the decomposition of the MF template and CTAB or PVP pore-directing surfactant. N-doped mesoporous TiO₂ hollow spheres with sizes in the range of 0.4–1.2 μm and shell thickness from 40 to 110 nm were obtained. The composition and N-doping content, thermal stability, morphology, surface area and pore size distribution, wall thickness, photocatalytic activities, and optical properties of the mesoporous TiO₂ hollow spheres derived from different conditions were investigated and compared based on Fourier-transformation infrared (FTIR), SEM, TEM, thermogravimetric analysis (TGA), nitrogen adsorption–desorption, and UV–vis spectrophotoscopy techniques. The influences of particle size, N-doping, porous, and hollow characteristics of the TiO₂ hollow spheres on their photocatalytic activities and optical properties have been studied and discussed based on the composition analysis, structure characterization, and optical property investigation of these hollow spherical TiO₂ matrices.

The Plastid Terminal Oxidase is a Key Factor Balancing the Redox State of Thylakoid Membrane

Mitochondria possess oxygen-consuming respiratory electron transfer chains (RETCs), and the oxygen-evolving photosynthetic electron transfer chain (PETC) resides in chloroplasts. Evolutionarily mitochondria and chloroplasts are derived from ancient α-proteobacteria and cyanobacteria, respectively. However, cyanobacteria harbor both RETC and PETC on their thylakoid membranes. It is proposed that chloroplasts could possess a RETC on the thylakoid membrane, in addition to PETC. Identification of a plastid terminal oxidase (PTOX) in the chloroplast from the Arabidopsis variegation mutant immutans (im) demonstrated the presence of a RETC in chloroplasts, and the PTOX is the committed oxidase. PTOX is distantly related to the mitochondrial alternative oxidase (AOX), which is responsible for the CN-insensitive alternative RETC. Similar to AOX, an ubiquinol (UQH2) oxidase, PTOX is a plastoquinol (PQH2) oxidase on the chloroplast thylakoid membrane. Lack of PTOX, Arabidopsis im showed a light-dependent variegation phenotype; and mutant plants will not survive the mediocre light intensity during its early development stage. PTOX is very important for carotenoid biosynthesis, since the phytoene desaturation, a key step in the carotenoid biosynthesis, is blocked in the white sectors of Arabidopsis im mutant. PTOX is found to be a stress-related protein in numerous research instances. It is generally believed that PTOX can protect plants from various environmental stresses, especially high light stress. PTOX also plays significant roles in chloroplast development and plant morphogenesis. Global physiological roles played by PTOX could be a direct or indirect consequence of its PQH2 oxidase activity to maintain the PQ pool redox state on the thylakoid membrane. The PTOX-dependent chloroplast RETC (so-called chlororespiration) does not contribute significantly when chloroplast PETC is normally developed and functions well. However, PTOX-mediated RETC could be the major force to regulate the PQ pool redox balance in the darkness, under conditions of stress, in nonphotosynthetic plastids, especially in the early development from proplastids to chloroplasts.