Efficient Ternary Organic Solar Cells with Suppressed Nonradiative Recombination and Fine-Tuned Morphology via IT-4F as Guest Acceptor

The large open circuit voltage (VOC) loss is currently one of the main obstacles to achieving efficient organic solar cells (OSCs). In this study, the ternary OSCs comprising PM6:BTP-eC9:IT-4F demonstrate a superior efficiency of 18.2 %. Notably, the utilization of the medium bandgap acceptor IT-4F as the third component results in an exceptionally low nonradiative recombination energy loss of 0.28 V. The desirable energy level cascade is formed among PM6, BTP-eC9, and IT-4F due to the low-lying HOMO and LUMO energy levels of IT-4F. More importantly, the VOC of PM6:BTP-eC9:IT-4F OSCs can reach as high as 0.86 V, which is higher than both binary OSCs without sacrificing JSC and FF. Besides, this strategy proved that IT-4F can not only broaden the absorption range but also work as a morphology modifier in PM6:BTP-eC9:IT-4F OSCs, and there also exists efficient energy transfer between BTP-eC9 and IT-4F. This result provides a promising way to suppress the nonradiative recombination energy loss and realize higher VOC than the two binary OSCs in ternary OSCs to obtain high power conversion efficiencies.

Reducing Interfacial Losses in Solution-Processed Integrated Perovskite-Organic Solar Cells

Low bandgap organic semiconductors have been widely employed to broaden the light response range to utilize much more photons in the inverted perovskite solar cells (PSCs). However, the serious charge recombination at the heterointerface contact between perovskite and organic semiconductors usually leads to large energy loss and limits the device performance. In this work, a titanium chelate, bis(2,4-pentanedionato) titanium(IV) oxide (C10H14O5Ti), was directly used as an interlayer between the perovskite layer and organic bulk heterojunction layer for the first time. Impressively, it was found that C10H14O5Ti can not only increase the surface potential of perovskite films but also show a positive passivation effect toward the perovskite film surface. Drawing from the above function, a smoother perovskite active layer with a higher work function was realized upon the use of C10H14O5Ti. As a result, the C10H14O5Ti-modified integrated devices show lower interfacial loss and obtain the best power conversion efficiency (PCE) of up to 20.91% with a high voltage of 1.15 V. The research offers a promising strategy to minimize the interfacial loss for the preparation of high-performance perovskite solar cells.

Achieved 18.9% Efficiency by Fine-Tuning Non-Fullerene Acceptor Content to Simultaneously Increase the Short-Circuit Current and Fill Factor of Organic Solar Cells

In this study, using PM6:L8-BO as the main system and non-fullerene acceptor IDIC as the third component, a series of ternary organic solar cells (TOSCs) are fabricated. The results reveal that IDIC plays a significant role in enhancing the performance of TOSCs by optimizing the morphology of blended films and forming interpenetrating nanostructure. The improved film morphology facilitates exciton dissociation and collection in TOSCs, which causes an increase in the short-circuit current density (JSC ) and fill factor (FF). Further, by optimizing the IDIC content, the power conversion efficiency (PCE) of TOSCs reaches 18.9%. Besides, the prepared TOSCs exhibit a JSC of 27.51 mA cm-2 and FF of 76.64%, which are much higher than those of PM6:L8-BO-based organic solar cells (OSCs). Furthermore, the addition of IDIC improves the long-term stability of the OSCs. Meanwhile, TOSCs with a large effective area of 1.00 cm2 have been prepared, which exhibit a PCE of 12.4%. These findings suggest that modifying the amount of the third component can be a useful strategy to construct hight-efficiency TOSCs with practical application potential.

Target Therapy for Buried Interface Enables Stable Perovskite Solar Cells with 25.05% Efficiency

The buried interface in perovskite solar cells (PSCs) is pivotal for achieving high efficiency and stability. However, it is challenging to study and optimize the buried interface due to its non-exposed feature. Here, a facile and effective strategy is developed to modify the SnO2 /perovskite buried interface by passivating the buried defects in perovskite and modulating carrier dynamics via incorporating formamidine oxalate (FOA) in SnO2 nanoparticles. Both formamidinium and oxalate ions show a longitudinal gradient distribution in the SnO2 layer, mainly accumulating at the SnO2 /perovskite buried interface, which enables high-quality upper perovskite films, minimized defects, superior interface contacts, and matched energy levels between perovskite and SnO2 . Significantly, FOA can simultaneously reduce the oxygen vacancies and tin interstitial defects on the SnO2 surface and the FA+ /Pb2+ associated defects at the perovskite buried interface. Consequently, the FOA treatment significantly improves the efficiency of the PSCs from 22.40% to 25.05% and their storage- and photo-stability. This method provides an effective target therapy of buried interface in PSCs to achieve very high efficiency and stability.

Solid Additive Enables Organic Solar Cells with Efficiency up to 18.6

Additive strategies play a critical role in improving the performance of organic solar cells (OSCs). There are only a few reports on the application of solid additives for OSCs, which leaves a large space for further improvement of solid additives and further study on the relationship between material structure and property. PM6:BTP-eC9-based organic solar cells (OSCs) were prepared by using a small molecule BTA3 as a solid additive, and a high energy conversion efficiency of 18.65% is achieved. BTA3 has good compatibility with the acceptor component (BTP-eC9) and optimizes the morphology of the thin films. Moreover, the introduction of a small amount of BTA3 (5 wt %) effectively promotes exciton dissociation and charge transfer and suppresses charge recombination, and the relationship between the BTA3 content and the device parameter is deeply revealed. The use of BTA3 in the active layers is an attractive and effective strategy for high-performance OSCs.

Thermally Crosslinked Hole Conductor Enables Stable Inverted Perovskite Solar Cells with 23.9% Efficiency

Poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine] (PTAA) represents the state-of-the-art hole transport material (HTM) in inverted perovskite solar cells (PSCs). However, unsatisfied surface properties of PTAA and high energy disorder in the bulk film hinder the further enhancement of device performance. Herein, a simple small molecule 10-(4-(3,6-dimethoxy-9H-carbazol-9-yl)phenyl)-3,7-bis(4-vinylphenyl)-10H-phenoxazine (MCz-VPOZ) is strategically developed for in situ fabrication of polymer hole conductor (CL-MCz) via a facile and low-temperature cross-linking technology. The resulting polymer CL-MCz offers high energy ordering and improved electrical conductivity, as well as appropriate energy-level alignment, enabling efficient charge carrier collection in the devices. Meanwhile, CL-MCz synchronously provides satisfied surface wettability and interfacial functionalization, facilitating the formation of high-quality perovskite films with fewer bulk iodine vacancies and suppressed carrier recombination. Significantly, the device with CL-MCz yields a champion efficiency of 23.9% along with an extremely low energy loss down to 0.41 eV, which represents the highest reported efficiency for non-PTAA-based polymer HTMs in inverted PSCs. Furthermore, the corresponding unencapsulated devices exhibit competitive shelf-life stability under various operational stressors up to 2500 h, reflecting high promises of CL-MCz in the scalable PSC application. This work underscores the promising potential of the cross-linking approach in preparing low-cost, stable, and efficient polymer HTMs toward reliable PSCs.

Efficient and stable organic solar cells enabled by multicomponent photoactive layer based on one-pot polymerization

Degradation of the kinetically trapped bulk heterojunction film morphology in organic solar cells (OSCs) remains a grand challenge for their practical application. Herein, we demonstrate highly thermally stable OSCs using multicomponent photoactive layer synthesized via a facile one-pot polymerization, which show the advantages of low synthetic cost and simplified device fabrication. The OSCs based on multicomponent photoactive layer deliver a high power conversion efficiency of 11.8% and exhibit excellent device stability for over 1000 h (>80% of their initial efficiency retention), realizing a balance between device efficiency and operational lifetime for OSCs. In-depth opto-electrical and morphological properties characterizations revealed that the dominant PM6-b-L15 block polymers with backbone entanglement and the small fraction of PM6 and L15 polymers synergistically contribute to the frozen fine-tuned film morphology and maintain well-balanced charge transport under long-time operation. These findings pave the way towards the development of low-cost and long-term stable OSCs.

Terminal Cyano-Functionalized Fused Bithiophene Imide Dimer-Based n-Type Small Molecular Semiconductors: Synthesis, Structure-Property Correlations, and Thermoelectric Performances

n-Doped small molecular organic thermoelectric materials (OTMs) hold advantages of high Seebeck coefficient and better performance reproducibility over their polymeric analogues; however, high-performance n-type small molecular OTMs are severely lacking. We report here a class of small molecular OTMs based on terminal cyanation of a bithiophene imide-based ladder-type heteroarene BTI2. It was found that the cyanation could effectively lower the lowest unoccupied molecular orbital (LUMO) level from -2.90 eV (BTI2) to -4.14 eV (BTI2-4CN) and thus lead to significantly improved n-doping efficiency. Additionally, terminal cyano-functionalization can maintain the close packing and efficient intermolecular charge transfer between these cyanated molecules, thus yielding high electron mobilities of up to 0.40 cm2 V-1 s-1. Benefiting from its low LUMO-enabled efficient n-doping and high electron mobility, an encouraging n-type electrical conductivity of 0.43 S cm-1 and power factor (PF) of 6.34 μW m-1 K-2 were achieved for tetracyanated BTI2-4CN, significantly outperforming those of its noncynated BTI2 (<10-7 S cm-1, PF undetectable) and dicyanated BTI2-2CN (0.24 S cm-1, 1.78 μW m-1 K-2). These results suggest the great potential of the terminal cyanation strategy of ladder-type heteroarenes for developing high-performance small molecular OTMs.

Green-Solvent-Processable Low-Cost Fluorinated Hole Contacts with Optimized Buried Interface for Highly Efficient Perovskite Solar Cells

Solution-processed hole contact materials, as an indispensable component in perovskite solar cells (PSCs), have been widely studied with consistent progress achieved. One bottleneck for the commercialization of PSCs is the lack of hole contact materials with high performance, cost-effective preparation, and green-solvent processability. Therefore, the development of versatile hole contact materials is of great significance. Herein, we report two novel donor-acceptor (D-A)-type hole contact molecules (FMPA-BT-CA and 2FMPA-BT-CA) with low cost and alcohol-based processability by utilizing a fluorination strategy. We showed that the fluorine atoms lead to the lowered highest occupied molecular orbital (HOMO) energy levels and larger dipole moments for FMPA-BT-CA and 2FMPA-BT-CA. Moreover, fluorination also improves the buried interfacial interaction between hole contacts and perovskite. As a result, a remarkable power conversion efficiency (PCE) of 22.37% along with good light stability could be achieved for green-solvent-processed FMPA-BT-CA-based inverted PSC devices, demonstrating the great potential of environmentally compatible hole contacts for highly efficient PSCs.

Interfacial Passivation Engineering for Highly Efficient Perovskite Solar Cells with a Fill Factor over 83

Charge carrier nonradiative recombination (NRR) caused by interface defects and nonoptimal energy level alignment is the primary factor restricting the performance improvement of perovskite solar cells (PSCs). Interfacial modification is a vital strategy to restrain NRR and enable high-performance PSCs. We report here two interfacial materials, PhI-TPA and BTZI-TPA, consisting of phthalimide and a 2,1,3-benzothiadiazole-5,6-dicarboxylicimide core, respectively. The difunctionalized BTZI-TPA with imide and thiadiazole shows higher hole mobility, better aligned energy levels, and stronger interaction with uncoordinated Pb²⁺ on the perovskite surface, suppressing NRR and carrier accumulation at the interface of perovskite/spiro-OMeTAD and yielding enhanced open-circuit voltage and fill factor. Consequently, the PSC based on BTZI-TPA delivers a high efficiency of 24.06% with an excellent fill factor of 83.10%, superior to that (21.47%) of the reference cell without an interfacial layer, and 21.45% efficiency for the device with a scaled-up area (1.00 cm²). These results underscore the potential of imide and thiadiazole groups in developing interfacial layers with strong passivation capability, effective charge transport property, and fine-tuned energetics for stable and efficient PSCs.

[Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index]

Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

[Update on the medical management of parathyroid carcinoma]

Parathyroid carcinoma is a rare endocrine malignancy with an increasing rate of incidence. Most parathyroid carcinoma patients will develop local recurrence or metastases leading to poor prognosis. Medical management is the mainstay of treatment for patients with unresectable parathyroid carcinoma. However, the therapeutic outcome of medical management remains unsatisfactory restricted by limited options and efficacy. With the deepening of research, several novel drugs have been reported to be applied in the treatment of parathyroid carcinoma. Calcimimetics and receptor activator for nuclear factor-κB ligand inhibitors aiming to control hypercalcemia have been applied in the endocrine therapy of parathyroid carcinoma. Besides, preliminary studies have shown the therapeutic effects of targeted therapy and immunotherapy on parathyroid carcinoma. These new drugs have shed light on this clinical dilemma; however, their clinical efficacy remains to be determined. In this article, the recent progress in the medical management of parathyroid carcinoma is updated.

[Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis]

Objective: To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis (TBM). Methods: The clinical data (basic information, clinical symptoms and laboratory test results) of 112 patients with TBM, who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed. The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale. The variables of basic information, clinical symptoms and laboratory test measurements etc. were compared between the two groups by using Student t test, Rank sum test or Chi-square test. Multivariate Logistic regression analysis were used to analyze nutritional risk factors. Results: Among 112 patient with TBM, 55 were males and 57 females. There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group. The proportion of cases with nutritional risk was 55.4% (62/112). Patients in the nutritional risk who lived in rural areas, had symptoms of brain nerve damage, convulsions, emaciation and anorexia, with a diagnosis time of ≥21 days, and the level of cerebrospinal fluid (CSF) protein were all higher than those in the non-nutritional risk group ((50 cases (80.6%) vs. 32 cases (64.0%), 20 cases (32.3%) vs.8 cases (16.0%), 33 cases (53.2%) vs. 15 cases (30.0%), 30 cases (48.4%) vs. 2 cases (4.0%), 59 cases (95.2%) vs. 1 case (2.0%),41 cases (66.1%) vs.18 cases (36.0%), 1 406 (1 079, 2 068) vs. 929 (683, 1 208) mg/L, χ²=3.91, 3.90, 6.10, 26.72, 98.58, 10.08, Z=4.35, all P<0.05). The levels of serum albumin,hemoglobin,lymphocyte count, white blood cell count, and CSF glucose were significantly lower in patients with nutritional risk ((36±5) vs. (41±4) g/L, (110±17) vs. (122±14) g/L, 1.4 (1.0, 2.0)vs. 2.3 (1.6, 3.8)×10⁹/L, 7.8 (6.3, 10.0)×10⁹ vs. 10.0 (8.3, 12.8)×10⁹/L, 1.0 (0.8, 1.6) vs. 2.1 (1.3, 2.5) mmol/L, t=-6.15, -4.22, Z=-4.86, -3.92, -4.16, all P<0.05).Increased levels of serum albumin (OR=0.812, 95%CI:0.705-0.935, P=0.004) and lymphocyte count (OR=0.609, 95%CI:0.383-0.970, P=0.037) may reduce the nutritional risk of children with TBM; while convulsions (OR=3.853, 95%CI:1.116-13.308, P=0.033) and increased level of CSF protein (OR=1.001,95%CI:1.000-1.002, P=0.015) may increase the nutritional risk of children with TBM. Similarly, the rate of complications and drug-induced liver injury was higher in the nutritional risk group (47 cases (75.8%) vs. 15 cases(30.0%), 31 cases (50.0%) vs.8 cases (16.0%), χ²=23.50, 14.10, all P<0.05). Moreover, the length of hospital stay was also longer in the nutritional risk group ((27±13) vs. (18±7) d, t=4.38, P<0.05). Conclusions: Children with TBM have a high incidence of nutritional risk. Convulsive, the level of serum albumin, the level of lymphocyte count and CSF protein may affect the nutritional risk of children with TBM. The nutritional risk group has a high incidence of complications and heavy economic burden.It is necessary to carry out nutritional screening and nutritional support for children with TBM as early as possible.

396 Rotator Cuff Assessment Following Traumatic Anterior Shoulder Dislocation

Aim

Glenohumeral joint dislocation is the most common traumatic joint dislocation with a high recurrence rate correlating with age at first dislocation. There is an associated increased incidence in concurrent rotator cuff tears with increasing age affecting 40% aged 40–60. Patient care was assessed against BESS/BOA standard: These patients should have rotator cuff assessment and those aged 40–60 should undergo routine MRI/Ultrasound imaging.

Method

All patients admitted to the emergency departments of the 3 Lanarkshire hospitals undergoing first time traumatic anterior dislocation of the shoulder in February 2021 were included. This was the third cycle of this audit. Previous interventions were presentation at a CPD meeting after cycle one and an NHS Lanarkshire regional meeting after cycle two.

Results

Cycle one (2018)-14 patients. 3/14 underwent rotator cuff assessment. 5/14 aged 40–60. 1/5 underwent rotator cuff imaging.

Cycle two (2020)-11 patients. 0/9 underwent rotator cuff assessment (Two excluded as managed operatively). 4/11 aged 40–60. 0/4 underwent rotator cuff imaging.

Cycle three (2021)-13 patients. 3/11 underwent rotator cuff assessment (Two excluded as managed operatively). 3/13 aged 40–60. 0/3 underwent rotator cuff imaging.

Conclusions

Although a slight improvement has been made over the 3 cycles with rotator cuff assessment the BOA standard is not being met. There has been no improvement in the additional imaging required in traumatic anterior shoulder dislocations in those aged 40–60 over the 3 cycles. These patients may develop pain, reduced function, and rotator cuff arthropathy. There is now an aim to introduce a pathway for these patients across the health board.

Repurposing Ivermectin to augment chemotherapy's efficacy in osteosarcoma

BACKGROUND

Osteosarcoma is the most frequent malignant bone malignancy and the current treatments are ineffective. Ivermectin, an anti-protozoal drug, has been shown to have anti-cancer activity. This work investigated the potential of repurposing ivermectin to augment chemotherapy's efficacy in osteosarcoma.

METHODS

Proliferation, migration and apoptosis assays were performed in ivermectin-treated osteosarcoma cells. Combination studies were performed. Osteosarcoma xenograft mouse model was established to investigate the in vivo efficacy of ivermectin. Intracellular reactive oxygen species (ROS) and mitochondrial superoxide, membrane potential, ATP, 8-OHdG level, protein carbonylation and lipid peroxidation were determined after ivermectin treatment.

RESULTS

Ivermectin was effective and acted synergistically with doxorubicin in osteosarcoma cells regardless of cellular origin and genetic profiling. This was achieved through suppressing inhibiting growth and migration, and inducing caspase-dependent apoptosis. Ivermectin also significantly inhibited osteosarcoma growth in vivo and its combination with doxorubicin resulted in much greater efficacy than doxorubicin alone. Importantly, the effective dose of ivermectin was clinically feasible and did not cause significant toxicity in mice. Mechanistical analysis showed that ivermectin induced oxidative stress and damage, and mitochondrial dysfunction.

CONCLUSIONS

Our findings indicate that ivermectin has utility in treating patients with osteosarcoma, especially those resistant to chemotherapy.

A prospective study on vulvovaginal candidiasis: multicentre molecular epidemiology of pathogenic yeasts in China

BACKGROUND

Vulvovaginal candidiasis (VVC) is frequent in women of reproductive age, but very limited data are available on the epidemiology in cases of VVC in China.

OBJECTIVES

The current study has been conducted to reveal the prevalence, species distribution of yeast causing VVC and molecular genetics of Candida albicans in China.

METHODS

Vaginal swabs were collected from 543 VVC outpatients recruited in 12 hospitals in China between September 2017 and March 2018. They were preliminarily incubated on Sabouraud dextrose agar and then positive subjects of which were then transmitted to our institute for further identification. CHROMagar™ was used to isolate Candida species, and all isolates were finally identified by DNA sequencing. Multilocus sequence typing (MLST) was used to analyse phylogenetic relationships of the various C. albicans isolates.

RESULTS

Eleven different yeast species were identified in 543 isolates, among which C. albicans (84.7%) was the most frequent, followed by C. glabrata (8.7%). We obtained 117 unique diploid sequence types from 451 clinical C. albicans isolates and 92 isolates (20.4%) belonged to a New Clade. All the strains appearing in the New Clade were from northern China and they were isolated from non-recurrent VVC.

CONCLUSIONS

Our findings suggest that C. albicans are still the main cause of VVC in China and the majority of C. albicans isolates belongs to Clade 1 with DST 79 and DST 45 being two most common. Moreover, the New Clade revealed in our study seems to be specific to northern China.

Intramolecular Noncovalent Interaction-Enabled Dopant-Free Hole-Transporting Materials for High-Performance Inverted Perovskite Solar Cells

Intramolecular noncovalent interactions (INIs) have served as a powerful strategy for accessing organic semiconductors with enhanced charge transport properties. Herein, we apply the INI strategy for developing dopant-free hole-transporting materials (HTMs) by constructing two small-molecular HTMs featuring an INI-integrated backbone for high-performance perovskite solar cells (PVSCs). Upon incorporating noncovalent S⋅⋅⋅O interaction into their simple-structured backbones, the resulting HTMs, BTORA and BTORCNA, showed self-planarized backbones, tuned energy levels, enhanced thermal properties, appropriate film morphology, and effective defect passivation. More importantly, the high film crystallinity enables the materials with substantial hole mobilities, thus rendering them as promising dopant-free HTMs. Consequently, the BTORCNA-based inverted PVSCs delivered a power conversion efficiency of 21.10 % with encouraging long-term device stability, outperforming the devices based on BTRA without S⋅⋅⋅O interaction (18.40 %). This work offers a practical approach to designing charge transporting layers with high intrinsic mobilities for high-performance PVSCs.

349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma

Introduction

Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016.

Method

Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis.

Results

Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%).

Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients.

Conclusions

Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P &lt; 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.

A Dual-Functional Conjugated Polymer as an Efficient Hole-Transporting Layer for High-Performance Inverted Perovskite Solar Cells

Conductive polyelectrolytes such as P3CT-Na have been widely used as efficient hole-transporting layers (HTLs) in inverted perovskite solar cells (PSCs) due to their high hole mobility. However, the acid-base neutralization reaction is indispensable for preparing such polyelectrolytes and the varied content of cations usually leads to poor reproducibility of the device performance in PSCs. In this work, a commercially available polymer poly[3-(4-carboxybutyl)thiophene-2,5-diyl] (P3CT) was directly applied as an HTL in PSCs for the first time. Encouragingly, it was found that due to the dual functionality of carboxyl groups on side chains, a thin layer of P3CT can not only strongly anchor on ITO electrode and optimize its work function but also show an effective passivation effect toward perovskite active layer. Benefiting from such dual functionality, a uniform perovskite film with better quality was obtained on P3CT. As a result, the P3CT-based PSCs show much lower nonradiative recombination and achieve a champion power conversion efficiency (PCE) of 21.33% with a high fill factor (FF) of 83.6%. Impressively, as the device area is increased to 0.80 cm², a PCE of 19.65% can still be obtained for the PSCs based on P3CT HTL. Our work provides important strategy for developing HTLs for high-performance PSCs.

Malnutrition Prolongs the Hospitalization of Patients with COVID-19 Infection: A Clinical Epidemiological Analysis

OBJECTIVES

During the 2019 coronavirus disease (COVID-19) outbreak, malnutrition may contribute to COVID-19 adverse outcomes. We conducted a clinical epidemiological analysis to investigate the association of malnutrition with hospitalized duration in patients with COVID-19.

DESIGN

Retrospective survey study.

SETTING

Taikang Tongji (Wuhan) hospital in Wuhan, China.

PARTICIPANTS

139 patients with COVID-19.

METHODS

In total, 139 patients with COVID-19 from patients in the Infection Department of Taikang Tongji (Wuhan) hospital from February 2020 to April 2020 were analyzed retrospectively. We used the "Global leadership Initiative on Malnutrition(GLIM)" assessment standard published in 2019 to assess nutritional status. Prolonged hospitalization was lasting more than the median value of the hospitalized days (17 days) in this population.

RESULTS

According to the assessment results of GLIM nutrition assessment, the patients were divided into malnutrition group and normal nutrition group. Compared with the patients in the normal nutrition group, the hospitalization time was longer(15.67±6.26 days versus 27.48±5.04 days, P = 0.001). Kaplan-Meier analysis showed patients with malnutrition were more likely to be hospitalized longer compared with those normal nutrition (mean with 95% confidence interval [CI]: 28.91[27.52-30.30] versus 22.78[21.76-23.79], P = 0.001). COX regression analysis showed that malnutrition (hazard ratio [HR] = 3.773, P for trend = 0.001) was proportional associated with being discharged from hospital delayed.

CONCLUSION AND IMPLICATIONS

Present findings suggested that malnutrition contributed to predicting a probability of prolonged hospitalization in patients with COVID-19 infection, to whom extra attentions and precautions should be paid during clinical treatments. Based on the existing results, it is recommended that inpatients with nutritional risk or malnutrition start nutritional support treatment as soon as possible.

A Narrow-Bandgap n-Type Polymer with an Acceptor-Acceptor Backbone Enabling Efficient All-Polymer Solar Cells

Narrow-bandgap polymer semiconductors are essential for advancing the development of organic solar cells. Here, a new narrow-bandgap polymer acceptor L14, featuring an acceptor-acceptor (A-A) type backbone, is synthesized by copolymerizing a dibrominated fused-ring electron acceptor (FREA) with distannylated bithiophene imide. Combining the advantages of both the FREA and the A-A polymer, L14 not only shows a narrow bandgap and high absorption coefficient, but also low-lying frontier molecular orbital (FMO) levels. Such FMO levels yield improved electron transfer character, but unexpectedly, without sacrificing open-circuit voltage (V_oc ), which is attributed to a small nonradiative recombination loss (E_loss,nr ) of 0.22 eV. Benefiting from the improved photocurrent along with the high fill factor and V_oc , an excellent efficiency of 14.3% is achieved, which is among the highest values for all-polymer solar cells (all-PSCs). The results demonstrate the superiority of narrow-bandgap A-A type polymers for improving all-PSC performance and pave a way toward developing high-performance polymer acceptors for all-PSCs.

Immunocyte density in parathyroid carcinoma is correlated with disease relapse

PURPOSE

Parathyroid carcinoma (PC) is an endocrine malignancy with a poor prognosis. The tumour immune microenvironment is a critical factor influencing the outcomes of multiple cancer types. However, knowledge of the immune microenvironment in PC remains limited.

METHODS

The intratumoural density of immunocytes and the Ki-67 index were evaluated immunohistochemically in 51 PC patient samples and were compared with clinicopathological features and parafibromin staining results. The Kaplan-Meier method and Cox proportional hazards analysis were used to estimate the effects of these variables on clinical outcomes.

RESULTS

Intratumoural immunocyte density was not correlated with age, gender, urolithiasis, or palpation of a neck mass. The Ki-67 index was correlated with the intratumoural density of CD3⁺ cells (P = 0.022) and CD8⁺ cells (P = 0.021) and serum calcium levels (P = 0.022). In the intratumoural area of primary foci, Kaplan-Meier method showed that the risk factors associated with recurrence/metastasis were a low density of CD3⁺ (P = 0.017), CD8⁺ (P = 0.019) and CD45⁺ cells (P = 0.047), a high density of CD163⁺ cells (P = 0.003) and a high Ki-67 index (P = 0.004). Cox regression multivariate analysis revealed that CD163⁺ cell density (hazard ratio (HR) 16.19, 95% confidence interval (CI) 1.99-131.66; P = 0.009) and CD8⁺ cell density (HR 0.13, 95% CI 0.02-0.76, P = 0.024) were independent factors associated with PC relapse.

CONCLUSION

The immune microenvironment is an important factor influencing the relapse of PC. The intratumoural density of CD3⁺, CD8⁺, CD45⁺, and CD163⁺ immunocytes was correlated with disease-free survival (DFS) in patients with PC. Immunotherapy based on T lymphocytes or tumour-associated macrophages may be a promising treatment strategy.

Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease

OBJECTIVES

Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010-2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China.

METHODS

We used a static model parameterized with the national HFMD surveillance data during 2010-2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010-2013 and caregiver survey data of costs and health quality of life during 2012-2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy.

RESULTS

In the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2-5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively.

CONCLUSIONS

Bivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.

Narrow bandgap difluorobenzochalcogenadiazole-based polymers for high-performance organic thin-film transistors and polymer solar cells

A series of difluorobenzochalcogenadiazole-bithiophene copolymers are developed for high-performance organic semiconductors.

Isomerization enabling near-infrared electron acceptors

An isomerization method was utilized to yield a novel near-infrared nonfullerene acceptor DTA-IC-M. By simply changing the linking fashion between the anthracene and neighboring thiophenes, a remarkable redshift (∼170 nm) of absorption was observed from DTA-IC-S to its isomer DTA-IC-M which shows a maximum absorption peak over 800 nm with a narrow bandgap of 1.35 eV. Due to the enhanced photo-to-current response in the near-infrared region, an improved short-circuit current of 12.96 mA cm^-2 was achieved for the DTA-IC-M based OSCs.

A New Wide Bandgap Donor Polymer for Efficient Nonfullerene Organic Solar Cells with a Large Open-Circuit Voltage

Significant progress has been made in nonfullerene small molecule acceptors (NF-SMAs) that leads to a consistent increase of power conversion efficiency (PCE) of nonfullerene organic solar cells (NF-OSCs). To achieve better compatibility with high-performance NF-SMAs, the direction of molecular design for donor polymers is toward wide bandgap (WBG), tailored properties, and preferentially ecofriendly processability for device fabrication. Here, a weak acceptor unit, methyl 2,5-dibromo-4-fluorothiophene-3-carboxylate (FE-T), is synthesized and copolymerized with benzo[1,2-b:4,5-b']dithiophene (BDT) to afford a series of nonhalogenated solvent processable WBG polymers P1-P3 with a distinct side chain on FE-T. The incorporation of FE-T leads to polymers with a deep highest occupied molecular orbital (HOMO) level of -5.60-5.70 eV, a complementary absorption to NF-SMAs, and a planar molecular conformation. When combined with the narrow bandgap acceptor ITIC-Th, the solar cell based on P1 with the shortest methyl chain on FE-T achieves a PCE of 11.39% with a large V oc of 1.01 V and a J sc of 17.89 mA cm-2. Moreover, a PCE of 12.11% is attained for ternary cells based on WBG P1, narrow bandgap PTB7-Th, and acceptor IEICO-4F. These results demonstrate that the new FE-T is a highly promising acceptor unit to construct WBG polymers for efficient NF-OSCs.

A Narrow-Bandgap n-Type Polymer Semiconductor Enabling Efficient All-Polymer Solar Cells

Currently, n-type acceptors in high-performance all-polymer solar cells (all-PSCs) are dominated by imide-functionalized polymers, which typically show medium bandgap. Herein, a novel narrow-bandgap polymer, poly(5,6-dicyano-2,1,3-benzothiadiazole-alt-indacenodithiophene) (DCNBT-IDT), based on dicyanobenzothiadiazole without an imide group is reported. The strong electron-withdrawing cyano functionality enables DCNBT-IDT with n-type character and, more importantly, alleviates the steric hindrance associated with typical imide groups. Compared to the benchmark poly(naphthalene diimide-alt-bithiophene) (N2200), DCNBT-IDT shows a narrower bandgap (1.43 eV) with a much higher absorption coefficient (6.15 × 10⁴ cm^-1 ). Such properties are elusive for polymer acceptors to date, eradicating the drawbacks inherited in N2200 and other high-performance polymer acceptors. When blended with a wide-bandgap polymer donor, the DCNBT-IDT-based all-PSCs achieve a remarkable power conversion efficiency of 8.32% with a small energy loss of 0.53 eV and a photoresponse of up to 870 nm. Such efficiency greatly outperforms those of N2200 (6.13%) and the naphthalene diimide (NDI)-based analog NDI-IDT (2.19%). This work breaks the long-standing bottlenecks limiting materials innovation of n-type polymers, which paves a new avenue for developing polymer acceptors with improved optoelectronic properties and heralds a brighter future of all-PSCs.

[Epidemiological analysis of the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015]

Objective: To analyze the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015, in order to understand the epidemiological characteristics and to further reduce the mortality rate in Liangshan Prefecture. Methods: The relevant information was collected through the Management Database of Antiretroviral Treatment from the National AIDS Comprehensive Prevention Information System. Results: From 2005 to 2015, a total of 14 219 adult HIV/AIDS patients received antiretroviral treatment and 1 425 death cases were reported during the treatment. The cause of death was mainly AIDS-related diseases (58.9%), and the cumulative mortality rate was 10.02%. Gender, age, the way of infection, duration of antiretroviral therapy, clinical stage when received antiretroviral therapy, and CD(4)(+) T lymphocyte levels were factors for the mortality rate (P<0.001). The mortality increased with older age, higher initiation clinical stage and lower level of CD(4)(+) T lymphocyte. Among the death cases, 82.6% were male, 1 182 (82.9%) were married or cohabited, most aged between 30-39 years old (48.6%). At the initial point of receiving antiretroviral therapy, 49.7% of the cases with CD(4)(+)T lymphocytes levels< 200/μl, 61.2% of the deaths cases were>1 000 copies/ml during the last viral load test, and 16.2% of deaths were ≥500/μl in the last CD(4)(+)T lymphocyte test; 44.5% of deaths were received antiretroviral treatment within one year. Conclusion: Early and timely antiretroviral therapy should be carried out. It is necessary to strengthen the propaganda of antiretroviral therapy and to improve the management quality of follow-up information of antiretroviral therapy case files, and to improve the medication compliance of patients.

[Clinicopathologic features of secretory breast carcinoma]

Objective: Investigate the clinicopathological features for secretory carcinoma of breast (SCB). Methods: The clinical data of 3 SCB cases were collected, immunohistochemical staining was performed by the streptavidin-peroxidase (SP) method to test the expression of the antibodies: ER, PR, HER-2, Ki-67, S100, CK5/6, p63, SMA, calponin, GCDFP-15, and EGFR. Fluorescence in situ hybridization (FISH) was used to detect the ETV6-NTRK3 gene fusion. Results: ER was focal weakly positive in case 1 and case 2 (about 5%) , and negative in case 3. PR was focal weakly positive in case 1 (about 5%) and completely negative in case 2 and case 3. Three cases showed that HER-2, SMA, calponin, GCDFP-15 were negative, while S100, CK5/6, EGFR were diffuse strongly positive. The proliferation index was nearly 15% in case 1 and case 2, and 10% in case 3. p63 was negative in mostly tumor cells of case 1, and focal positive expression in the nucleus and cytoplasm. In case 2, p63 was completely negative. However, p63 was observed positive in the cytoplasm as well as some secretory material in case 3. ETV6-NTRK3 gene fusion detection by FISH was positive in all cases. Conclusions: SCB is a rare low grade triple-negative breast cancer with the unique pathomorphologic features, while its recurrent t (12; 15) (p13; q25) translocation resulting in ETV6 -NTRK3 gene fusion. It has the indolent clinical behavior and good prognosis.

Boosting Efficiency and Stability of Organic Solar Cells Using Ultralow-Cost BiOCl Nanoplates as Hole Transporting Layers

A novel nanomaterial, bismuth oxychloride nanoplates (BiOCl NPs), was first applied in organic solar cells (OSCs) as hole transporting layers (HTLs). It is worth noting that the BiOCl NPs can be facilely synthesized at ∼1/200 of the cost of the commercial PEDOT:PSS and well dissolved in green solvents. Different from the PEDOT:PSS interlayer, the deposition of BiOCl HTL is free of post-treatment at elevated temperature, which reduces device fabrication complexity. To demonstrate the universality of BiOCl in improving photovoltaic performance, OSCs containing various representative active layers were investigated. The power conversion efficiencies (PCEs) of the P3HT:PC₆₁BM, PTB7-Th:PC₇₁BM, and PM6:Y6-based OSCs with the BiOCl HTL boosted from 3.62, 8.78, and 15.63 to 4.24, 9.92, and 16.11%, respectively, compared to the PEDOT:PSS-based ones. It was found that the superior performances of the BiOCl-based OSCs are mainly attributed to the sufficient oxygen vacancies and improved interfacial contact. Moreover, the BiOCl-based OSCs show a much better stability than the cells with the PEDOT:PSS interfacial layer.

Backbone Coplanarity Tuning of 1,4-Di(3-alkoxy-2-thienyl)-2,5-difluorophenylene-Based Wide Bandgap Polymers for Efficient Organic Solar Cells Processed from Nonhalogenated Solvent

Halogenated solvents are prevailingly used in the fabrication of nonfullerene organic solar cells (NF-OSCs) at the current stage, imposing significant restraints on their practical applications. By copolymerizing phthalimide or thieno[3,4-c]pyrrole-4,6-dione (TPD) with 1,4-di(3-alkoxy-2-thienyl)-2,5-difluorophenylene (DOTFP), which features intramolecular noncovalent interactions, the backbone planarity of the resulting DOTFP-based polymers can be effectively tuned, yielding distinct solubilities, aggregation characters, and chain packing properties. Polymer DOTFP-PhI with a more twisted backbone showed a lower degree of aggregation in solution but an increased film crystallinity than polymer DOTFP-TPD. An organic thin-film transistor and NF-OSC based on DOTFP-PhI, processed with a nonhalogenated solvent, exhibited a high hole mobility up to 1.20 cm² V^-1 s^-1 and a promising power conversion efficiency up to 10.65%, respectively. The results demonstrate that DOTFP is a promising building block for constructing wide bandgap polymers and backbone coplanarity tuning is an effective strategy to develop high-performance organic semiconductors processable with a nonhalogenated solvent.

[Data analysis on HIV/AIDS sentinel surveillance programs targeting community population in Liangshan Yi Autonomous Prefecture, 2010-2015]

Objective: To investigate the epidemiologic and behavioral characteristics of HIV among community population in Liangshan prefecture. Methods: We collected social demographic, behavioral and serological information by means of the monitoring questionnaire and serological tests. Data was analyzed by using the chi-square test and logistic regression. Results: From April to June of 2010 to 2015, 14 092 cases of community population were selected as the study objects, with 267 cases diagnosed as HIV positive patients. The HIV positive rates were 3.24%, 3.07%, 1.17%, 1.38%,1.42% and 1.25%, respectively. We observed that when community population having the following characteristics as: living in Butuo country (OR=3.83), being males (OR=1.77), being Yi nationality (OR=4.40) being widowed (OR=28.57), with history of drug abuse (OR=3.71) or injecting drug use (PWID) (OR=4.92), or history of needle sharing among PWID (OR=8.53), were under higher risks for HIV infection. With histories as: having had secondary or above levels of schooling (OR=0.59), having protected sex with regular partners (OR=0.21) and with non-regular partners (OR=0.46), they seemed to be somehow protected for getting HIV infection. Conclusion: The positive HIV rates of HIV among community population in Dechang, Ningnan and Butuo varied from 0.10% to 8.77% while the HIV transmission among general population remained challenging.

Detection and analysis of laser driven proton beams by calibrated Gafchromic HD-V2 and MD-V3 radiochromic films

The radiochromic film (RCF) is a high-dose, high-dynamic range dosimetry detection medium. A stack of RCFs can be used to detect both spatial and energetic distribution of laser driven ion beams with a large divergence angle and continuous energy spectrum. Two types of RCFs (HD-V2 and MD-V3, from Radiation Products Design, Inc.) have been calibrated using MeV energy protons and carbon ions produced by using a 2 × 6 MV tandem electrostatic accelerator. The proportional relationship is obtained between the optical density and the irradiation dose. For protons, the responses are consistent at all energies with a variation of about 15%. For carbon ions, the responses are energy related, which should be noted for heavy ion detection. Based on the calibration, the broad energy spectrum and charge distribution of laser accelerated proton beam with energy from 3 to 8 MeV and pC charge were detected and reconstructed at the Compact LAser Plasma Accelerator at Peking University.

Phthalimide-Based High Mobility Polymer Semiconductors for Efficient Nonfullerene Solar Cells with Power Conversion Efficiencies over 13

Highly efficient nonfullerene polymer solar cells (PSCs) are developed based on two new phthalimide-based polymers phthalimide-difluorobenzothiadiazole (PhI-ffBT) and fluorinated phthalimide-ffBT (ffPhI-ffBT). Compared to all high-performance polymers reported, which are exclusively based on benzo[1,2-b:4,5-b']dithiophene (BDT), both PhI-ffBT and ffPhI-ffBT are BDT-free and feature a D-A1-D-A2 type backbone. Incorporating a second acceptor unit difluorobenzothiadiazole leads to polymers with low-lying highest occupied molecular orbital levels (≈-5.6 eV) and a complementary absorption with the narrow bandgap nonfullerene acceptor IT-4F. Moreover, these BDT-free polymers show substantially higher hole mobilities than BDT-based polymers, which are beneficial to charge transport and extraction in solar cells. The PSCs containing difluorinated phthalimide-based polymer ffPhI-ffBT achieve a substantial PCE of 12.74% and a large V oc of 0.94 V, and the PSCs containing phthalimide-based polymer PhI-ffBT show a further increased PCE of 13.31% with a higher J sc of 19.41 mA cm-2 and a larger fill factor of 0.76. The 13.31% PCE is the highest value except the widely studied BDT-based polymers and is also the highest among all benzothiadiazole-based polymers. The results demonstrate that phthalimides are excellent building blocks for enabling donor polymers with the state-of-the-art performance in nonfullerene PSCs and the BDT is not necessary for constructing such donor polymers.

Laser Acceleration of Highly Energetic Carbon Ions Using a Double-Layer Target Composed of Slightly Underdense Plasma and Ultrathin Foil

We report the experimental generation of highly energetic carbon ions up to 48 MeV per nucleon by shooting double-layer targets composed of well-controlled slightly underdense plasma and ultrathin foils with ultraintense femtosecond laser pulses. Particle-in-cell simulations reveal that carbon ions are ejected from the ultrathin foils due to radiation pressure and then accelerated in an enhanced sheath field established by the superponderomotive electron flow. Such a cascaded acceleration is especially suited for heavy ion acceleration with femtosecond laser pulses. The breakthrough of heavy ion energy up to many tens of MeV/u at a high repetition rate would be able to trigger significant advances in nuclear physics, high energy density physics, and medical physics.

Incidence of hepatitis B virus infection in young Chinese blood donors born after mandatory implementation of neonatal hepatitis B vaccination nationwide

This study was carried out to determine the incidence of hepatitis B virus (HBV) infection in the young generation born after mandatory implementation of hepatitis B vaccination since 1992. Repeat blood donors born between 1992 and 1997 were enrolled, who gave blood at least twice during the past 3 years. Donors were tested for HBV infection markers of HBsAg, anti-HBc, anti-HBs and viral DNA by immunoassays (EIAs) and nucleic acid tests (NAT). A total of 14 937 pre-donation screening qualified young repeat donors aged 18-23 years were tested with 9 (0.06%) being HBsAg by EIA and 10 (1:1494) HBV DNA positive by Ultrio NAT (10.4 IU/mL), respectively. HBV DNA was further detected in 1:192 (9/1732) anti-HBc+ repeat donors with Ultrio Plus NAT (3.4 IU/mL). Most cases were identified as occult HBV infection (OBI). Of 14 937 repeat donors, 20.9% were anti-HBc+ positive, while approximately 50% of 12 024 repeat donors were anti-HBs negative or had levels <100 IU/L. HBsAg+ or OBI strains were classified as wild type of genotype B or genotype C. Incident HBV infection in repeat donors was approximately 1:18.5 person-years (1.1%/year) but significantly less frequent in donors with confirmed HBV vaccination (2.4%-3.3%) than those unsure of vaccination status (10.5%; P = .0023). Hepatitis B virus vaccination appears largely protective of HBV infection, but incidence of infections increases in young adults with mostly undetectable or low anti-HBs or occasionally high anti-HBs. A boost of hepatitis B vaccine for adolescents prior to age 18 years may reduce HBV infection, and implementation of more sensitive NAT in blood donation screening may improve HBV safety in blood transfusion.