A P2/P3 Biphasic Layered Oxide Composite as a High-Energy and Long-Cycle-Life Cathode for Potassium-Ion Batteries

Layered transition metal oxides are extensively considered as appealing cathode candidates for potassium-ion batteries (PIBs) due to their abundant raw materials and low cost, but their further implementations are limited by slow dynamics and impoverished structural stability. Herein, a layered composite having a P2 and P3 symbiotic structure is designed and synthesized to realize PIBs with large energy density and long-term cycling stability. The unique intergrowth of P2 and P3 phases in the obtained layered oxide is plainly characterized by X-ray diffraction refinement, high-angle annular dark field and annular bright field-scanning transmission electron microscopy at atomic resolution, and Fourier transformation images. The synergistic effect of the two phases of this layered P2/P3 composite is well demonstrated in K+ intercalation/extraction process. The as-prepared layered composite can present a large discharge capacity with the remarkable energy density of 321 Wh kg-1 and also manifest excellent capacity preservation after 600 cycles of K+ uptake/removal.

Atomic-Resolution In Situ Exploration of the Phase Transition Triggered Failure in a Single-Crystalline Ni-Rich Cathode

Single-crystalline cathode materials LiNixCoyMn1-y-zO2 (x ≥ 0.6) are important candidates for obtaining better cyclic stability and achieving high energy densities of Li-ion batteries. However, it is liable to initiate phase transitions inside the grains during electrochemical cycling, and the processes and regions of these phase transitions have remained unknown. In this research, we conducted an intrinsic study, investigating the chemicals and microstructural evolution of single-crystalline LiNi0.83Co0.11Mn0.06O2 using in situ biasing transmission electron microscopy at an atomic scale. We observed that the layered structure on the surface of the single-crystalline material was degraded during the charging process, resulting in continuous phase transitions and the formation of surface oxygen vacancies, which can reduce both the structural and thermal stability of the material. Uneven delithiation led to the formation of high-density defects and discontinuous inactive electrochemical phases, such as local antiphase boundaries and the rock salt phase, in the bulk of the material. The non-uniformity of the structure and the coexistence of active and inactive phases introduce significant tensile stress, which can lead to intragranular cracks inside the grains. As the number of cycles increases, the structural degradation caused by the intragranular phase transition will further increase, ultimately affecting the cycling capacity and stability of the battery. This work has broad implications for creating lithium-ion batteries that are effective and long-lasting.

Molecular Engineering toward Robust Solid Electrolyte Interphase for Lithium Metal Batteries

Lithium-metal batteries (LMBs) with high energy density are becoming increasingly important in global sustainability initiatives. However, uncontrollable dendrite seeds, inscrutable interfacial chemistry, and repetitively formed solid electrolyte interphase (SEI) have severely hindered the advancement of LMBs. Organic molecules have been ingeniously engineered to construct targeted SEI and effectively minimize the above issues. In this review, multiple organic molecules, including polymer, fluorinated molecules, and organosulfur, are comprehensively summarized and insights into how to construct the corresponding elastic, fluorine-rich, and organosulfur-containing SEIs are provided. A variety of meticulously selected cases are analyzed in depth to support the arguments of molecular design in SEI. Specifically, the evolution of organic molecules-derived SEI is discussed and corresponding design principles are proposed, which are beneficial in guiding researchers to understand and architect SEI based on organic molecules. This review provides a design guideline for constructing organic molecule-derived SEI and will inspire more researchers to concentrate on the exploitation of LMBs.

Universal Design Strategy for Air-Stable Layered Na-Ion Cathodes toward Sustainable Energy Storage

Na-ion batteries (NIBs) are sustainable alternatives to Li-ion technologies due to the abundant and widely-distributed resources. However, the most promising cathode materials of NIBs so far, O3 layered oxides, suffer from serious air instability issues, which significantly increases the manufactural cost and carbon footprint because of the long-term use of dry rooms. While some feasible strategies are proposed via case studies, universal design strategies for air-stable cathodes are yet to be established. Herein, the air degradation mechanisms of O3 cathodes are investigated via combined first-principles and experimental approaches, with bond dissociation energy proposed as an effective descriptor for predicting air stability. Experimental validations in various unary, binary, and ternary O3 cathodes confirm that the air stability can indeed be effectively improved via simple compositional design. Guided by the predictive model, the designed material can sustain 30-day air-storage without structural or electrochemical degradation. It is calculated that such air-stable cathodes can significantly reduce both energy consumption (≈4 100 000 kWh) and carbon footprint (≈2200-ton CO2) annually for a 2 GWh NIBs manufactory. Therefore, the fundamental understandings and universal design strategy presented open an avenue for rational materials design of NIBs toward both elemental and manufactural sustainability.

Study of the Properties and Modification Mechanism of SBS-Modified Asphalt by Dry Process

SBS (styrene-butadiene-styrene block copolymer) is a thermoplastic elastomer with properties most similar to rubber. SBS asphalt modifier is mainly composed of a styrene-butadiene-styrene block copolymer with a certain amount of additives and stabilizers. SBS-modified asphalt binder has always been the most commonly used pavement material both domestically and internationally. However, conventional wet-process SBS-modified asphalt binder requires manufacturers to produce it in advance and transport it to a mixing plant for blending. This has provided an opportunity for unscrupulous businesses to reduce the amount of SBS by adding other substances, allowing inferior asphalt binder to pass inspections undetected. At the same time, conventional wet-process SBS-modified asphalt tends to undergo phase separation and experience a decline in performance as the storage time increases. However, dry-process SBS-modified asphalt can be directly added at the mixing plant, effectively addressing the issues associated with conventional wet-process SBS-modified asphalt. It also helps to reduce environmental pollution to a certain extent. This study investigates the extraction process of dry-process SBS-modified asphalt binder. It clarifies the performance and modification mechanisms of two types of dry-process SBS-modified asphalt binder at different dosages through various testing methods, including basic indicators, rheological properties, infrared spectroscopy, and fluorescence microscopy. The results indicate that due to the incorporation of oil, crosslinker, solubilizer, and other substances into dry-process SBS modifier, there is a small amount of chemical reaction with asphalt in the melting process. The high- and low-temperature properties and fatigue properties of the two dry-process SBS-modified asphalt binders at a 7% dosage are close to wet SBS-modified asphalt binder at a 5% dosage.

From Oxygen Redox to Sulfur Redox: A Paradigm for Li-Rich Layered Cathodes

The utilization of anionic redox chemistry provides an opportunity to further improve the energy density of Li-ion batteries, particularly for Li-rich layered oxides. However, oxygen-based hosts still suffer from unfavorable structural rearrangement, including the oxygen release and transition metal (TM)-ion migration, in association with the tenuous framework rooted in the ionicity of the TM-O bonding. An intrinsic solution, by using a sulfur-based host with strong TM-S covalency, is proposed here to buffer the lattice distortion upon the highly activating sulfur redox process, and it achieves howling success in stabilizing the host frameworks. Experimental results demonstrate the prolonged preservation of the layered sulfur lattice, especially the honeycomb superlattice, during the Li+ extraction/insertion process in contrast to the large structural degeneration in Li-rich oxides. Moreover, the Li-rich sulfide cathodes exhibited a negligible overpotential of 0.08 V and a voltage drop of 0.13 mV/cycle, while maintaining a substantial reversible capacity upon cycling. These superior electrochemical performances can be unambiguously ascribed to the much shorter trajectories of sulfur in comparison to those of oxygen revealed by molecular dynamics simulations at a large scale (∼30 nm) and a long time scale (∼300 ps) via high-dimensional neural network potentials during the delithiation process. Our findings highlight the importance of stabilizing host frameworks and establish general guidance for designing Li-rich cathodes with durable anionic redox chemistry.

Dual-ion conductors: from liquid to solid

The traditional working principle within lithium-ion batteries relies on Li+ shuttling between the cathode and anode, namely the rocking-chair mechanism. A single working ion constrains the possibilities for battery design and the selection of electrode materials, while realizing multiple working ions offers the potential to break through the fundamental principles of traditional battery construction. Accordingly, it is necessary to develop dual-ion conductors to enable the migration of multiple working ions. This focus article starts by introducing traditional dual-ion batteries based on liquid electrolytes and their pros and cons. Then, solidifying liquid dual-ion conductors is expected to overcome these drawbacks, so the development of solid dual-ion conductors is discussed in detail. Specifically, basic design principles of solid dual-ion conductors are briefly proposed, including constructing continuous ion transport channels and choosing appropriately sized ion carriers. The potential applications of solid dual-ion conductors are also summarized, such as stabilizing the electrode/electrolyte interface and activating additional redox couples. The goal of this article is to inspire researchers in the development of dual-ion conductors and to contribute to the advancement of all-solid-state batteries.

Molecular Engineering Enabling High Initial Coulombic Efficiency and Rubost Solid Electrolyte Interphase for Hard Carbon in Sodium-Ion Batteries

Hard carbon (HC) as a potential candidate anode for sodium-ion batteries (SIBs) suffers from unstable solid electrolyte interphase (SEI) and low initial Coulombic efficiency (ICE), which limits its commercial applications and urgently requires the emergence of a new strategy. Herein, an organic molecule with two sodium ions, disodium phthalate (DP), was successfully engineered on the HC surface (DP-HC) to replenish the sodium loss from solid electrolyte interphase (SEI) formation. A stabilized and ultrathin (≈7.4 nm) SEI was constructed on the DP-HC surface, which proved to be simultaneously suitable in both ester and ether electrolytes. Compared to pure HC (60.8 %), the as-designed DP-HC exhibited a high ICE of >96.3 % in NaPF6 in diglyme (G2) electrolyte, and is capable of servicing consistently for >1600 cycles at 0.5 A g-1 . The Na3 V2 (PO4 )3 (NVP)|DP-HC full-cell with a 98.3 % exceptional ICE can be cycled stably for 450 cycles, demonstrating the tremendous practical application potential of DP-HC. This work provides a molecular design strategy to improve the ICE of HC, which will inspire more researchers to concentrate on the commercialization progress of HC.

Efficacy of preventive interventions against ventilator-associated pneumonia in critically ill patients: an umbrella review of meta-analyses

Many meta-analyses have assessed the efficacy of preventive interventions against ventilator-associated pneumonia (VAP) in critically ill patients. However, there has been no comprehensive analysis of the strength and quality of evidence to date. Systematic reviews of randomized and quasi-randomized controlled trials, which evaluated the effect of preventive strategies on the incidence of VAP in critically ill patients receiving mechanical ventilation for at least 48 h, were included in this article. We identified a total of 34 interventions derived from 31 studies. Among these interventions, 19 resulted in a significantly reduced incidence of VAP. Among numerous strategies, only selective decontamination of the digestive tract (SDD) was supported by highly suggestive (Class II) evidence (risk ratio (RR)=0.439, 95% CI: 0.362-0.532). Based on data from the sensitivity analysis, the evidence for the efficacy of non-invasive ventilation in weaning from mechanical ventilation (NIV) was upgraded from weak (Class IV) to highly suggestive (Class II) (RR=0.32, 95% CI: 0.22-0.46). All preventive interventions were not supported by robust evidence for reducing mortality. Early mobilization exhibited suggestive (Class III) evidence in shortening both intensive length of stay (LOS) in the intensive care unit (ICU) (mean difference (MD)=-0.85, 95% CI: -1.21 to -0.49) and duration of mechanical ventilation (MD=-1.02, 95% CI: -1.41 to -0.63). In conclusion, SDD and NIV are supported by robust evidence for prevention against VAP, while early mobilization has been shown to significantly shorten the LOS in the ICU and the duration of mechanical ventilation. These three strategies are recommendable for inclusion in the ventilator bundle to lower the risk of VAP and improve the prognosis of critically ill patients.

Comprehensive Multiomics Analyses Establish the Optimal Prognostic Model for Resectable Gastric Cancer : Prognosis Prediction for Resectable GC

BACKGROUND

Prognostic models based on multiomics data may provide better predictive capability than those established at the single-omics level. Here we aimed to establish a prognostic model for resectable gastric cancer (GC) with multiomics information involving mutational, copy number, transcriptional, methylation, and clinicopathological alterations.

PATIENTS AND METHODS

The mutational, copy number, transcriptional, methylation data of 268, 265, 226, and 252 patients with stages I-III GC were downloaded from the TCGA database, respectively. Alterations from all omics were characterized, and prognostic models were established at the individual omics level and optimized at the multiomics level. All models were validated with a cohort of 99 patients with stages I-III GC.

RESULTS

TTN, TP53, and MUC16 were among the genes with the highest mutational frequency, while UBR5, ZFHX4, PREX2, and ARID1A exhibited the most prominent copy number variations (CNVs). Upregulated COL10A1, CST1, and HOXC10 and downregulated GAST represented the biggest transcriptional alterations. Aberrant methylation of some well-known genes was revealed, including CLDN18, NDRG4, and SDC2. Many alterations were found to predict the patient prognosis by univariate analysis, while four mutant genes, two CNVs, five transcriptionally altered genes, and seven aberrantly methylated genes were identified as independent risk factors in multivariate analysis. Prognostic models at the single-omics level were established with these alterations, and optimized combination of selected alterations with clinicopathological factors was used to establish a final multiomics model. All single-omics models and the final multiomics model were validated by an independent cohort. The optimal area under the curve (AUC) was 0.73, 0.71, 0.71, and 0.85 for mutational, CNV, transcriptional, and methylation models, respectively. The final multiomics model significantly increased the AUC to 0.92 (P < 0.05).

CONCLUSIONS

Multiomics model exhibited significantly better capability in predicting the prognosis of resectable GC than single-omics models.

China's prevention and control experience of echinococcosis: A 19-year retrospective

Echinococcosis poses a significant threat to public health. The Chinese government has implemented prevention and control measures to mitigate the impact of the disease. By analyzing data from the Chinese Center for Disease Control and Prevention and the State Council of the People's Republic of China, we found that implementation of these measures has reduced the infection rate by nearly 50% between 2004 to 2022 (from 0.3975 to 0.1944 per 100,000 person-years). Nonetheless, some regions still bear a significant disease burden, and lack of detailed information limites further evaluation of the effects on both alveolar and cystic echinococcosis. Our analysis supports the continuing implementation of these measures and suggests that enhanced wildlife management, case-based strategies, and surveillance systems will facilitate disease control.

High Entropy-Induced Kinetics Improvement and Phase Transition Suppression in K-Ion Battery Layered Cathodes

Layered oxides are widely accepted to be promising cathode candidate materials for K-ion batteries (KIBs) in terms of their rich raw materials and low price, while their further applications are restricted by sluggish kinetics and poor structural stability. Here, the high-entropy design concept is introduced into layered KIB cathodes to address the above issues, and an example of high-entropy layered K0.45Mn0.60Ni0.075Fe0.075Co0.075Ti0.10Cu0.05Mg0.025O2 (HE-KMO) is successfully prepared. Benefiting from the high-entropy oxide with multielement doping, the developed HE-KMO exhibits half-metallic oxide features with a narrow bandgap of 0.19 eV. Increased entropy can also reduce the surface energy of the {010} active facets, resulting in about 2.6 times more exposure of the {010} active facets of HE-KMO than the low-entropy K0.45MnO2 (KMO). Both can effectively improve the kinetics in terms of electron conduction and K+ diffusion. Furthermore, high entropy can inhibit space charge ordering during K+ (de)insertion, and the transition metal-oxygen covalent interaction of HE-KMO is also enhanced, leading to suppressed phase transition of HE-KMO in 1.5-4.2 V and better electrochemical stability of HE-KMO (average capacity drop of 0.20%, 200 cycles) than the low-entropy KMO (average capacity drop of 0.41%, 200 cycles) in the wide voltage window.

A Flexible and Stretchable MXene/Waterborne Polyurethane Composite-Coated Fiber Strain Sensor for Wearable Motion and Healthcare Monitoring

Fiber-based flexible sensors have promising application potential in human motion and healthcare monitoring, owing to their merits of being lightweight, flexible, and easy to process. Now, high-performance elastic fiber-based strain sensors with high sensitivity, a large working range, and excellent durability are in great demand. Herein, we have easily and quickly prepared a highly sensitive and durable fiber-based strain sensor by dip coating a highly stretchable polyurethane (PU) elastic fiber in an MXene/waterborne polyurethane (WPU) dispersion solution. Benefiting from the electrostatic repulsion force between the negatively charged WPU and MXene sheets in the mixed solution, very homogeneous and stable MXene/WPU dispersion was successfully obtained, and the interconnected conducting networks were correspondingly formed in a coated MXene/WPU shell layer, which makes the as-prepared strain sensor exhibit a gauge factor of over 960, a large sensing range of over 90%, and a detection limit as low as 0.5% strain. As elastic fiber and mixed solution have the same polymer constitute, and tight bonding of the MXene/WPU conductive composite on PU fibers was achieved, enabling the as-prepared strain sensor to endure over 2500 stretching-releasing cycles and thus show good durability. Full-scale human motion detection was also performed by the strain sensor, and a body posture monitoring, analysis, and correction prototype system were developed via embedding the fiber-based strain sensors into sweaters, strongly indicating great application prospects in exercise, sports, and healthcare.

Integrative analysis reveals the recurrent genetic etiologies in idiopathic pulmonary fibrosis

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) is increasingly recognized as a chronic, progressive and fatal lung disease with an unknown etiology. Current studies focus on revealing the genetic factors in the risk of IPF, making the integrative analysis of genetic variations and transcriptomic alterations of substantial value.

AIM

This study aimed to improve the understanding of the molecular basis of IPF through an integrative analysis of whole-exome sequencing (WES), bulk RNA sequencing (RNA-seq) and single-cell RNA sequencing (scRNA-seq) data.

METHODS

WES is a powerful tool for studying the genetic basis of IPF, allowing for the identification of genetic variants that may be associated with the development of the disease. RNA-seq data provide a comprehensive view of the transcriptional changes in IPF patients, while scRNA-seq data offer a more granule view of cell-type-specific alterations.

RESULTS

In this study, we identified a comprehensive mutational landscape of recurrent genomic and transcriptomic variations, including single-nucleotide polymorphisms, CNVs and differentially expressed genes, in IPF populations, which may play a significant role in the development and progression of IPF.

CONCLUSIONS

Our study provided valuable insights into the genetic and transcriptomic variations associated with IPF, revealing changes in gene expression that may contribute to disease development and progression. These findings highlight the importance of an integrative approach to understanding the molecular mechanisms underlying IPF and may pave the way for identifying potential therapeutic targets.

The impact of total factor mobility on rural-urban symbiosis: Evidence from 27 Chinese provinces

The rational flow and optimal allocation of urban and rural factors is the key to solving the problem of unbalanced and insufficient urban and rural development. This study draws on the theory of ecological symbiosis to examine the mechanism of factor flow and urban-rural symbiosis. It analyzes panel data from 27 Chinese provinces and autonomous regions between 2010 and 2020 to empirically demonstrate the influence of labor, capital, technology, and land mobility on urban-rural symbiosis. The study found that: (1) The relationship between the total factor flow and urban-rural symbiosis is U-shaped nonlinear, and the time when cities feed the development of rural areas has come; (2) The impact of labor factor flow on urban-rural symbiosis exhibits an inverted U-shaped relationship, the impact of capital factor flow displays a positive U-shaped relationship, the impact of land factor flow shows an inverted U-shaped relationship, and the impact of technical factor flow on urban-rural symbiotic development is not significant. (3) The factor flow exerts a region-oriented impact on the level of urban-rural symbiosis. In developed areas, total factor flow does not affect urban-rural symbiosis, but the level of labor flow and the urban-rural symbiosis demonstrates an inverted U-shaped relationship, the flow of technological factors has a U-shaped impact on the urban-rural symbiosis level, the flow of land factors and the urban-rural symbiosis show an inverted U-shaped relationship, and the flow of capital factors has no impact on the urban-rural symbiosis relationship. In underdeveloped areas, the impact of the total factor flow on urban-rural symbiosis shows a significantly positive U-shaped characteristic, the labor mobility level and urban-rural symbiosis show an inverted U-shaped relationship, the flow of capital factors has a U-shaped impact on the urban-rural symbiosis level, and the flow of lands and technology does not have a remarkable impact on urban-rural symbiosis in underdeveloped areas.

Impact of automatic acquisition of key clinical information on the accuracy of electrocardiogram interpretation: a cross-sectional study

BACKGROUND

The accuracy of electrocardiogram (ECG) interpretation by doctors are affected by the available clinical information. However, having a complete set of clinical details before making a diagnosis is very difficult in the clinical setting especially in the early stages of the admission process. Therefore, we developed an artificial intelligence-assisted ECG diagnostic system (AI-ECG) using natural language processing to provide screened key clinical information during ECG interpretation.

METHODS

Doctors with varying levels of training were asked to make diagnoses from 50 ECGs using a common ECG diagnosis system that does not contain clinical information. After a two-week-blanking period, the same set of ECGs was reinterpreted by the same doctors with AI-ECG containing clinical information. Two cardiologists independently provided diagnostic criteria for 50 ECGs, and discrepancies were resolved by consensus or, if necessary, by a third cardiologist. The accuracy of ECG interpretation was assessed, with each response scored as correct/partially correct = 1 or incorrect = 0.

RESULTS

The mean accuracy of ECG interpretation was 30.2% and 36.2% with the common ECG system and AI-ECG system, respectively. Compared to the unaided ECG system, the accuracy of interpretation was significantly improved with the AI-ECG system (P for paired t-test = 0.002). For senior doctors, no improvement was found in ECG interpretation accuracy, while an AI-ECG system was associated with 27% higher mean scores (24.3 ± 9.4% vs. 30.9 ± 10.6%, P = 0.005) for junior doctors.

CONCLUSION

Intelligently screened key clinical information could improve the accuracy of ECG interpretation by doctors, especially for junior doctors.

[Molluscicidal effect of spraying 5% niclosamide ethanolamine salt granules with drones against Oncomelania hupensis in hilly regions]

OBJECTIVE

To establish a snail control approach for spraying chemicals with drones against Oncomelania hupensis in complex snail habitats in hilly regions, and to evaluate its molluscicidal effect.

METHODS

The protocol for evaluating the activity of spraying chemical molluscicides with drones against O. hupensis snails was formulated based on expert consultation and literature review. In August 2022, a pretest was conducted in a hillside field environment (12 000 m2) north of Dafengji Village, Dacang Township, Weishan County, Yunnan Province, which was assigned into four groups, of no less than 3 000 m2 in each group. In Group A, environmental cleaning was not conducted and 5% niclosamide ethanolamine salt granules were sprayed with drones at a dose of 40 g/m2, and in Group B, environmental cleaning was performed, followed by 5% niclosamide ethanolamine salt granules sprayed with drones at a dose of 40 g/m2, while in Group C, environmental cleaning was not conducted and 5% niclosamide ethanolamine salt granules were sprayed with knapsack sprayers at a dose of 40 g/m2, and in Group D, environmental cleaning was performed, followed by 5% niclosamide ethanolamine salt granules sprayed with knapsack sprayers at a dose of 40 g/m2. Then, each group was equally divided into six sections according to land area, with Section 1 for baseline surveys and sections 2 to 6 for snail surveys after chemical treatment. Snail surveys were conducted prior to chemical treatment and 1, 3, 5, 7 days post-treatment, and the mortality and corrected mortality of snails, density of living snails and costs of molluscicidal treatment were calculated in each group.

RESULTS

The mortality and corrected mortality of snails were 69.49%, 69.09%, 53.57% and 83.48%, and 68.58%, 68.17%, 52.19% and 82.99% in groups A, B, C and D 14 days post-treatment, and the density of living snails reduced by 58.40%, 63.94%, 68.91% and 83.25% 14 days post-treatment relative to pre-treatment in four groups, respectively. The median concentrations of chemical molluscicides were 37.08, 35.42, 42.50 g/m2 and 56.25 g/m2 in groups A, B, C and D, and the gross costs of chemical treatment were 0.93, 1.50, 0.46 Yuan per m2 and 1.03 Yuan per m2 in groups A, B, C and D, respectively.

CONCLUSIONS

The molluscicidal effect of spraying 5% niclosamide ethanolamine salt granules with drones against O. hupensis snails is superior to manual chemical treatment without environmental cleaning, and chemical treatment with drones and manual chemical treatment show comparable molluscicidal effects following environmental cleaning in hilly regions. The cost of chemical treatment with drones is slightly higher than manual chemical treatment regardless of environmental cleaning. Spraying 5% niclosamide ethanolamine salt granules with drones is recommended in complex settings with difficulty in environmental cleaning to improve the molluscicidal activity and efficiency against O. hupensis snails.

A prototype of dual-ion conductor for all-solid-state lithium batteries

All-solid-state batteries (ASSBs) represent a promising battery strategy to achieve high energy density with great safety. However, inadequate kinetic property and poor interfacial compatibility remain great challenges, which impede their practical application. A prototype of dual-ion conductor of Li+ synchronized with Cu+ unlocks a four-electron redox reaction with high reversibility and fast kinetics. As a result, the constructed ASSB exhibited a high reversible capacity of 603.0 mA·hour g-1 and an excellent cycling retention of 93.2% over 1500 cycles. Moreover, because of the ion highway connecting active materials and catholytes constructed by dual-ion conductor, remarkable temperature tolerance (-60°C) and excellent rate performance (231.6 mA·hour g-1 at 20 mA cm-2) were achieved. The superior electrochemical performance can be ascribed to the migration pathway with small energy barrier and low tortuosity once the Cu+ introduced into Li6PS5Cl. This work creates a unique perspective of ASSBs with dual-ion conducting strategy, thus inspiring a potential developing strategy of state-of-the-art ASSBs.

Sabatier Relations in Electrocatalysts Based on High-entropy Alloys with Wide-distributed d-band Centers for Li-O2 Batteries

Li-O2 battery (LOB) is a promising "beyond Li-ion" technology with ultrahigh theoretical energy density (3457 Wh kg-1 ), while currently impeded by the sluggish cathodic kinetics of the reversible gas-solid reaction between O2 and Li2 O2 . Despite many catalysts are developed for accelerating the conversion process, the lack of design guidance for achieving high performance makes catalysts exploring aleatory. The Sabatier principle is an acknowledged theory connecting the scaling relationship with heterogeneous catalytic activity, providing a tradeoff strategy for the topmost performance. Herein, a series of catalysts with wide-distributed d-band centers (i.e., wide range of adsorption strength) are elaborately constructed via high-entropy strategy, enabling an in-depth study of the Sabatier relations in electrocatalysts for LOBs. A volcano-type correlation of d-band center and catalytic activity emerges. Both theoretical and experimental results indicate that a moderate d-band center with appropriate adsorption strength propels the catalysts up to the top. As a demonstration of concept, the LOB using FeCoNiMnPtIr as catalyst provides an exceptional energy conversion efficiency of over 80 %, and works steadily for 2000 h with a high fixed specific capacity of 4000 mAh g-1 . This work certifies the applicability of Sabatier principle as a guidance for designing advanced heterogeneous catalysts assembled in LOBs.

A Bio-Inspired Trehalose Additive for Reversible Zinc Anodes with Improved Stability and Kinetics

The moderate reversibility of Zn anodes, as a long-standing challenge in aqueous zinc-ion batteries, promotes the exploration of suitable electrolyte additives continuously. It is crucial to establish the absolute predominance of smooth deposition within multiple interfacial reactions for stable zinc anodes, including suppressing side parasitic reactions and facilitating Zn plating process. Trehalose catches our attention due to the reported mechanisms in sustaining biological stabilization. In this work, the inter-disciplinary application of trehalose is reported in the electrolyte modification for the first time. The pivotal roles of trehalose in suppressed hydrogen evolution and accelerated Zn deposition have been investigated based on the principles of thermodynamics as well as reaction kinetics. The electrodeposit changes from random accumulation of flakes to dense bulk with (002)-plane exposure due to the unlocked crystal-face oriented deposition with trehalose addition. As a result, the highly reversible Zn anode is obtained, exhibiting a high average CE of 99.8 % in the Zn/Cu cell and stable cycling over 1500 h under 9.0 % depth of discharge in the Zn symmetric cell. The designing principles and mechanism analysis in this study could serve as a source of inspiration in exploring novel additives for advanced Zn anodes.

[Research progress of optical coherence tomography and optical coherence tomography angiography in noninfectious uveitis: a review]

Non-infectious uveitis (NIU) is a challenging type of intraocular inflammatory disease that tends to recur and can be resistant to treatment. It can cause both transient and permanent pathological changes in the retina and choroid. Accurate diagnosis and monitoring of these changes rely heavily on ophthalmic imaging methods. In recent years, the enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT), swept-source optical coherence tomography (SS-OCT), and swept-source optical coherence tomography angiography (SS-OCTA) have emerged as rapidly evolving ophthalmic imaging techniques that offer significant advantages in evaluating choroidal thickness, displaying the whole choroid, and monitoring choroidal blood flow. This review provides an overview of the current research status of EDI-OCT, SS-OCT, and SS-OCTA in evaluating intraocular inflammation and other choroid-related complications in noninfectious intermediate uveitis, posterior uveitis, and panuveitis, and also highlights their future prospects.

Toward High Performance Anodes for Sodium-Ion Batteries: From Hard Carbons to Anode-Free Systems

Sodium-ion batteries (SIBs) have been deemed to be a promising energy storage technology in terms of cost-effectiveness and sustainability. However, the electrodes often operate at potentials beyond their thermodynamic equilibrium, thus requiring the formation of interphases for kinetic stabilization. The interfaces of the anode such as typical hard carbons and sodium metals are particularly unstable because of its much lower chemical potential than the electrolyte. This creates more severe challenges for both anode and cathode interfaces when building anode-free cells to achieve higher energy densities. Manipulating the desolvation process through the nanoconfining strategy has been emphasized as an effective strategy to stabilize the interface and has attracted widespread attention. This Outlook provides a comprehensive understanding about the nanopore-based solvation structure regulation strategy and its role in building practical SIBs and anode-free batteries. Finally, guidelines for the design of better electrolytes and suggestions for constructing stable interphases are proposed from the perspective of desolvation or predesolvation.

[Progress of schistosomiasis control in People's Republic of China in 2022]

This report presented the endemic status of schistosomiasis and analyzed the data collected from the national schistosomiasis prevention and control system and national schistosomiasis surveillance program in the People's Republic of China in 2022. Among the 12 provinces (municipality and autonomous region) endemic for schistosomiasis, Shanghai Municipality, Zhejiang Province, Fujian Province, Guangdong Province and Guangxi Zhuang Autonomous Region continued to maintain the achievements of schistosomiasis elimination, and Sichuan and Jiangsu provinces maintained the criteria of transmission interruption, while Yunnan, Hubei, Anhui, Jiangxi and Hunan provinces maintained the criteria of transmission control by the end of 2022. A total of 452 counties (cites, districts) were found to be endemic for schistosomiasis in China in 2022, with 27 434 endemic villages covering 73 424 400 people at risk of infections. Among the 452 endemic counties (cities, districts), 75.89% (343/452), 23.45% (106/452) and 0.66% (3/452) achieved the criteria of elimination, transmission interruption and transmission control of schistosomiasis, respectively. In 2022, 4 317 356 individuals received serological tests for schistosomiasis, and 62 228 were sero-positive. A total of 208 646 individuals received stool examinations for schistosomiasis, with one positive and another two cases positive for urine microscopy, and these three 3 cases were imported schistosomiasis patients from Africa. There were 28 565 cases with advanced schistosomiasis documented in China by the end of 2022. Oncomelania hupensis snail survey was performed in 18 891 endemic villages in China in 2022 and O. hupensis snails were found in 6 917 villages (36.62% of all surveyed villages), with 8 villages identified with emerging snail habitats. Snail survey was performed at an area of 655 703.01 hm² and 183 888.60 hm² snail habitats were found, including 110.58 hm² emerging snail habitats and 844.35 hm² re-emerging snail habitats. There were 477 200 bovines raised in the schistosomiasis endemic areas of China in 2022, and 113 946 bovines received serological examinations for schistosomiasis, with 204 sero-positives detected. Among the 131 715 bovines received stool examinations, no positives were identified. In 2022, there were 19 726 schistosomiasis patients receiving praziquantel chemotherapy, and expanded chemotherapy was performed in 714 465 person-time for humans and 234 737 herd-time for bovines in China. In 2022, snail control with chemical treatment was performed at an area of 119 134.07 hm², and the actual area of chemical treatment was 65 825.27 hm², while environmental improvements were performed at an area of 1 163.96 hm². Data from the national schistosomiasis surveillance program of China showed that the mean prevalence of Schistosoma japonicum infections was both zero in humans and bovines in 2022, and no S. japonicum infection was detected in O. hupensis snails. These data demonstrated that the endemic status of schistosomiasis continued to decline in China in 2022, with 3 confirmed schistosomiasis patients that had a foreign nationality and all imported from Africa, and the areas of snail habitats remained high. Further improvements in the construction of the schistosomaisis surveillance and forecast system, and reinforcement of O. hupensis survey and control are required to prevent the re-emerging schistosomiasis.

Recent Progress on Honeycomb Layered Oxides as a Durable Cathode Material for Sodium-Ion Batteries

Sodium-ion batteries (SIBs) are becoming promising candidates for energy storage devices due to the low cost, abundant reserves, and excellent electrochemical performance. As the most important unit, layered cathodes attract much attention, where honeycomb-layered-oxides (HLOs) manifest outstanding structural stability, high redox potential, and long-life electrochemistry. Here, recent progress on HLOs as well as Na₃ Ni₂ SbO₆ and Na₃ Ni₂ BiO₆ as two representative materials are introduced, and the crystal and electronic structure, electrochemical performance, and modification strategies are summarized. The advanced high nickel HLOs are highlighted toward development of state-of-the-art sodium-ion batteries. This review would deepen the understanding of superstructure in layered oxides, as well as structure-property relationship, and inspire more interest in high output voltage, long lifespan sodium-ion batteries.

Occupancy of orbitals and the quadrupole collectivity in 45Sc nucleus

In the present work, the Doppler Shift Attenuation method (DSAM) was used to analyze the observed lineshapes of transitions from excited states in ⁴⁵Sc, populated in the reaction ³⁶Ar + ¹²C at a beam energy of 145 MeV. The interpretation and comparison of the experimental results have been performed with large-scale shell model calculations, involving different interactions like: GX1A, GX1J, FPD6, KB3 and ZBM2. KB3 and FPD6 (present work) interactions in the negative parity states, and in positive parity states ZBM2 are most pre-eminent in reproducing the results, due to the large configuration space describing strong collective effects. Furthermore, the present work also looks at the details of the shell model helping in improving the understanding for the occupancy of orbitals. The present investigation suggests the observation of stronger collectivity for positive parity states over negative parity states with predicted enhanced collectivity of states in ⁴⁵Sc nucleus.

[Activation of GABAergic neurons in the zona incerta accelerates anesthesia induction with sevoflurane and propofol without affecting anesthesia maintenance or awakening in mice]

OBJECTIVE

To explore the regulatory effects of GABAergic neurons in the zona incerta (ZI) on sevoflurane and propofol anesthesia.

METHODS

Forty-eight male C57BL/6J mice divided into 8 groups (n=6) were used in this study. In the study of sevoflurane anesthesia, chemogenetic experiment was performed in 2 groups of mice with injection of either adeno-associated virus carrying hM3Dq (hM3Dq group) or a virus carrying only mCherry (mCherry group). The optogenetic experiment was performed in another two groups of mice injected with an adeno-associated virus carrying ChR2 (ChR2 group) or GFP only (GFP group). The same experiments were also performed in mice for studying propofol anesthesia. Chemogenetics or optogenetics were used to induce the activation of GABAergic neurons in the ZI, and their regulatory effects on anesthesia induction and arousal with sevoflurane and propofol were observed; EEG monitoring was used to observe the changes in sevoflurane anesthesia maintenance after activation of the GABAergic neurons.

RESULTS

In sevoflurane anesthesia, the induction time of anesthesia was significantly shorter in hM3Dq group than in mCherry group (P < 0.05), and also shorter in ChR2 group than in GFP group (P < 0.01), but no significant difference was found in the awakening time between the two groups in either chemogenetic or optogenetic tests. Similar results were observed in chemogenetic and optogenetic experiments with propofol (P < 0.05 or 0.01). Photogenetic activation of the GABAergic neurons in the ZI did not cause significant changes in EEG spectrum during sevoflurane anesthesia maintenance.

CONCLUSION

Activation of the GABAergic neurons in the ZI promotes anesthesia induction of sevoflurane and propofol but does not affect anesthesia maintenance or awakening.

Detection of haemodynamic obstruction in hypertrophic cardiomyopathy using the sub-aortic complex: a cardiac MRI and Doppler study

AIM

To investigate the "sub-aortic complex (SAC)", a new cardiac magnetic resonance imaging (CMRI)-derived parameter, for the evaluation of left ventricular (LV) outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy (HCM), compared with conventional CMRI parameters and Doppler echocardiography.

MATERIALS AND METHODS

A total of 157 consecutive patients with HCM were recruited retrospectively. The patients were divided into two groups, 87 with LVOT obstruction and 70 without obstruction. The SAC was defined as a specific anatomical SAC affecting the LVOT, which were measured on the LV three-chamber steady-state free precession (SSFP) cine image at the end-systolic phase. The relations between the existence and severity of obstruction and SAC index (SACi) were evaluated using Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and logistic regression.

RESULTS

The SACs were significantly different between the obstructive and non-obstructive groups. The ROC curves indicated that the SACi was able to discriminate obstructive and non-obstructive patients with the best predictive accuracy (AUC = 0.949, p<0.001). The SACi was an independent predictor of LVOT obstruction and there was a significant negative correlation between resting LVOT pressure gradient and SACi (r=0.72 p<0.001). In the subgroup of patients with or without severe basal septal hypertrophy, the SACi was still able to predict LVOT obstruction with excellent diagnostic accuracy (AUC = 0.944 and 0.948, p<0.001, respectively).

CONCLUSION

The SAC is a reliable and straightforward CMRI marker for assessing LVOT obstruction. It is more effective than CMRI two-dimensional flow in diagnosing the severity of obstruction in patients with HCM.

Revealing the Origin of Transition-Metal Migration in Layered Sodium-Ion Battery Cathodes: Random Na Extraction and Na-Free Layer Formation

Cation migration often occurs in layered oxide cathodes of lithium-ion batteries due to the similar ion radius of Li and transition metals (TMs). Although Na and TM show a big difference of ion radius, TMs in layered cathodes of sodium-ion batteries (SIBs) can still migrate to Na layer, leading to serious electrochemical degeneration. To elucidate the origin of TM migration in layered SIB cathodes, we choose NaCrO₂ , a typical layered cathode suffering from serious TM migration, as a model material and find that the TM migration is derived from the random desodiation and subsequent formation of Na-free layer at high charge potential. A Ru/Ti co-doping strategy is developed to address the issue, where the doped active Ru is first oxidized to create a selective desodiation and the doped inactive Ti can function as a pillar to avoid complete desodiation in Ru-contained TM layers, leading to the suppression of the Na-free layer formation and subsequent enhanced electrochemical performance.

Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer

BACKGROUND

The incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumors. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients.

METHODS

We retrieved the clinical materials and follow-up data on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits.

RESULTS

A total of 111 patients were screened for the study, including 55 in the robotic group and 56 in the laparoscopic group. The demographic details were generally similar between the two groups. No statistically significant difference in the number of removed lymph nodes was observed between the two approaches, with a median of 15 versus 14 (P = 0.053). The intraoperative blood loss was significantly reduced by robotic technique when compared to the laparoscopic approach, with a mean of 76.9 ml versus 161.6 ml (P = 0.025). There were no significant differences in operation time, conversion, postoperative complications and recovery, and long-term outcomes between the two groups.

CONCLUSION

Robotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or hematological conditions.

[Prevalence and related factors of visual disability, hearing disability and comorbidity of visual and hearing disability among the elderly in China]

Objective: To estimate the prevalence of visual disability, hearing disability and comorbidity of visual and hearing disability among the elderly in China, and explore the related factors of comorbidity of visual and hearing disability in the elderly. Methods: This was a cross-sectional study. Based on the Second China National Sample Survey on Disability in 2006, the data of the elderly with visual and hearing disability were extracted and combined for descriptive analysis. Meanwhile, multivariate logistic regression model was used to analyze the related factors of comorbidity of visual and hearing disability among the elderly. Results: A total of 250 752 cases were in the final analysis (119 120 males and 131 632 females), and there were 164 003, 74 156 and 12 593 cases with the age of 65-<75, 75-<85 and ≥ 85 years, respectively. The prevalence of visual disability and hearing disability of the elderly in China was 8.10% (95%CI: 8.00%-8.21%), 13.41% (95%CI: 13.29%-13.54%), respectively, while the prevalence of comorbidity of visual and hearing disability was 1.97% (95%CI: 1.92%-2.02%). The severity of disability of the elderly with comorbidity of visual and hearing disability was higher, and the percentage of mild disabilities (18.31%, 966/5 277) was lower than those with visual (53.06%, 11 208/21 123) or hearing disabilities (32.96%, 11 536/34 995). Moreover, 19.40% (1 024/5 277) of visual or hearing disability occurred in the same year. Multivariate logistic regression analysis showed that education level below primary school (OR=0.65, 95%CI: 0.61-0.70, P<0.001), having a spouse (OR=0.68, 95%CI: 0.64-0.72, P<0.001), living in an urban area (OR=0.77, 95%CI: 0.71-0.82, P<0.001) and having a per capita household income higher than the national average (OR=0.73, 95%CI: 0.68-0.78, P<0.001) were protective factors for comorbidity of visual and hearing disability among the elderly. Conclusions: Visual disability is correlated with hearing disability in the elderly. Attention should be paid to the prevention and control of associated disabilities such as visual and hearing co-disabilities in the elderly population, with emphasis on strengthening publicity and education on prevention and control of visual and hearing disabilities for the elderly who are economically disadvantaged, have no spouse and live in remote areas.

Metal-air batteries: progress and perspective

The metal-air batteries with the largest theoretical energy densities have been paid much more attention. However, metal-air batteries including Li-air/O₂, Li-CO₂, Na-air/O_2, and Zn-air/O₂ batteries, are complex systems that have their respective scientific problems, such as metal dendrite forming/deforming, the kinetics of redox mediators for oxygen reduction/evolution reactions, high overpotentials, desolution of CO₂, H₂O, etc. from the air and related side reactions on both anode and cathode. It should be the main direction to address these shortages to improve performance. Here, we summarized recently research progress in these metal-air/O₂ batteries. Some perspectives are also provided for these research fields.

A Case of ALECT2 Renal Amyloidosis Associated with IgG4 Related Kidney Disease, Membranous Nephropathy and Early Diabetic Kidney Injury

Introduction/Objective

ALECT-2 amyloidosis is a rare type of amyloidosis that mostly involves kidneys with other organs rarely affected. It has a high prevalence among patients of Hispanic descent. Membranous nephropathy is one of the most common causes of proteinuria in adults. IgG4-related disease is a systemic disease, which commonly involves the pancreas, but occasionally affects the kidney and manifests as chronic renal insufficiency. Here we describe a very unusual case of concurrence of membranous nephropathy, IgG4 disease involving the kidney, ALECT2 amyloidosis, and early diabetic kidney injury.

Methods/Case Report

A 49-year-old Hispanic male patient with a history of diabetes and IgG4-related autoimmune pancreatitis and primary sclerosing cholangitis presented with abrupt onset of proteinuria and hypoalbuminemia. A kidney biopsy was performed and showed severe interstitial plasma cell-rich inflammatory infiltrates and interstitial fibrosis which had a storiform pattern. The glomerular basement membranes (GBM) showed focal pinpoint holes but no spikes by silver stain. Immunofluorescence microscopy (IF) showed diffuse and finely granular capillary loop staining for IgG, with Kappa and lambda light chains of equal intensity. IF for Anti-phospholipase A2 receptor (PLA2R) was negative. Immunohistochemical (IHC) stain showed IgG4 positivity in about 60% of IgG-positive plasma cells. Congo red was positive for birefringent deposits predominantly in the interstitium and arteriolar walls with focal deposits in the glomerular mesangium and capillary wall. IHC stain for Amyloid AA and DNAJB9 were negative. Electron microscopy showed scattered subepithelial immune complex-type electron dense deposits consistent with membranous nephropathy, randomly oriented fibrils in interstitium, mesangium and GBM, consistent with amyloidosis, and thickening of GBM (average 559 nm), consistent with early diabetic kidney change. The tissue was sent for mass spectrometry which showed a peptide profile consistent with ALECT-2 (Leukocyte chemotactic factor 2) type amyloidosis.

Results (if a Case Study enter NA)

NA

Conclusion

In up to a third of cases reported in the literature, a concomitant renal pathology was present. Diabetic nephropathy was the most common concurrent pathology, to be followed by IgA nephropathy and membranous nephropathy. However, the concurrence of membranous nephropathy, IgG4 disease involving the kidney, ALECT2 amyloidosis, and early diabetic kidney injury has never been described before.

Association between fluid balance and mortality for heart failure and sepsis: a propensity score-matching analysis

BACKGROUND

Fluid resuscitation is necessary to correct the sepsis-induced hypoperfusion, which is contradictory to the treatment of heart failure. This study explored the association between fluid balance (FB) of the first 24 h after ICU admission and mortality in critically ill patients with heart failure and sepsis.

METHODS

Data were extracted from the Medical Information Mart for Intensive Care database. The locally weighted scatterplot smoothing (Lowess) method was used to demonstrate the relationship between FB and in-hospital mortality. Groups were divided into high FB (≥ 55.85 ml/kg) and low FB (< 55.85 ml/kg) according to the cut-off value of FB using Receiver operating characteristic analysis and Youden index method. The primary outcome was in-hospital mortality. Subgroup analyses, multivariable logistic regression analyses, and Kaplan-Meier curves were used to detect the association and survival difference between groups. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) were performed to minimize the bias of confounding factors and facilitate the comparability between groups.

RESULTS

A total of 936 patients were included. The Lowess curve showed an approximate positive linear relationship for FB and in-hospital mortality. In the multivariable logistic regression adjusted model, high FB showed strong associations with in-hospital mortality (OR 2.53, 95% CI 1.60-3.99, p < 0.001) as compared to the low FB group. In IPTW and PSM models, high FB consistently showed higher in-hospital mortality (IPTW model: OR 1.94, 95% CI 1.52-2.49, p < 0.001; PSM model: OR 2.93, 95% CI 1.75-4.90, p < 0.001) and 30-day mortality (IPTW model: OR 1.65, 95% CI 1.29-2.10, p < 0.001; PSM model: OR 2.50, 95% CI 1.51-4.15, p < 0.001), compared with the low FB group.

CONCLUSION

For critically ill patients with heart failure and sepsis, high FB within the first 24 h after ICU admission could serve as an independent risk factor for in-hospital mortality and 30-day mortality. The avoidance of fluid overload exerts important effects on reducing mortality in such patients.

A new Li-rich layered cathode with low lattice strain for lithium-ion batteries

A new layered C2/m oxide, Li₂Ni_0.2Mn_0.4Ru_0.4O₃ (LNMR), is introduced as a cathode for lithium-ion batteries, which undergoes a low volume variation of 1.5% in the voltage window of 2.0-4.6 V studied via in situ X-ray diffraction. Compared with the contrast sample Li₂MnO₃, LNMR displays superior capacity, a more stable capacity retention rate, and higher energy density and average discharge voltage.

Retinal Microvascular Abnormalities Predict Clinical Outcomes in Patients with Heart Failure

Background: Narrower retinal arterioles and wider retinal venules have been associated with the incidence of heart failure (HF). However, whether they are predictive of the prognosis of heart failure (HF) is unclear. We aimed to explore the role of retinal vessel calibers in predicting long-term clinical outcomes of HF. Methods: This is a prospective, single-center, observational study that surveyed patients in a tertiary referral hospital for the treatment of HF. Retinal vessel caliber was graded using retinal photography. The primary endpoint was the composite endpoint of HF rehospitalization and mortality at 12 months. Results: There were 55 patients with chronic HF included in the final analysis. At 12 months, the cumulative incidence of the primary endpoint, HF rehospitalization, and mortality tended to be higher with the widening of the central retinal venular equivalent (CRVE) (p for non-linearity = 0.059) and was significantly increased when CRVE reached a cut-off value (283 μm) (p = 0.011) following adjustment for age, sex, etiology of HF, and diabetes. No association between the central retinal arteriolar equivalent (CRAE) and arteriolar-to-venular caliber ratio (AVR) was found with the clinical outcome in both univariable and multivariable Cox regression. CRAE, CRVE, and AVR had no relationship with the concentration of the N-terminal pro-B-type natriuretic peptide. In addition, CRVE was not associated with cardiac diastolic and systolic function. Conclusions: When the retinal venular caliber widens to a certain point, the composite incidence of HF rehospitalization and mortality significantly increase, suggesting retinal vessel caliber imaging may provide insight into the development of HF.