Regulating Hydrogen/Oxygen Species Adsorption via Built-in Electric Field -Driven Electron Transfer Behavior at the Heterointerface for Efficient Water Splitting

Alkaline water electrolysis (AWE) plays a crucial role in the realization of a hydrogen economy. The design and development of efficient and stable bifunctional catalysts for both the hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) are pivotal to achieving high-efficiency AWE. Herein, WC1-x/Mo2C nanoparticle-embedded carbon nanofiber (WC1-x/Mo2C@CNF) with abundant interfaces is successfully designed and synthesized. Benefiting from the electron transfer behavior from Mo2C to WC1-x, the electrocatalysts of WC1-x/Mo2C@CNF exhibit superior HER and OER performance. Furthermore, when employed as anode and cathode in membrane electrode assembly devices, the WC1-x/Mo2C@CNF catalyst exhibits enhanced catalytic activity and remarkable stability for 100 hours at a high current density of 200 mA cm-2 towards overall water splitting. The experimental characterizations and theoretical simulation reveal that modulation of the d-band center for WC1-x/Mo2C@CNF, achieved through the asymmetric charge distribution resulting from the built-in electric field induced by work function, enables optimization of adsorption strength for hydrogen/oxygen intermediates, thereby promoting the catalytic kinetics for overall water splitting. This work provides promising strategies for designing highly active catalysts in energy conversion fields.

γ-MnO2 as an Electron Reservoir for RuO2 Oxygen Evolution Catalyst in Acidic Media

Developing highly active and durable catalysts in acid conditions remains an urgent issue due to the sluggish kinetics of oxygen evolution reaction (OER). Although RuO2 has been a state-of-the-art commercial catalyst for OER, it encounters poor stability and high cost. In this study, the electronic reservoir regulation strategy is proposed to promote the performance of acidic water oxidation via constructing a RuO2/MnO2 heterostructure supported on carbon cloth (CC) (abbreviated as RuO2/MnO2/CC). Theoretical and experimental results reveal that MnO2 acts as an electron reservoir for RuO2. It facilitates electron transfer from RuO2, enhancing its activity prior to OER, and donates electrons to RuO2, improving its stability after OER. Consequently, RuO2/MnO2/CC exhibits better performance compared to commercial RuO2, with an ultrasmall overpotential of 189 mV at 10 mA cm-2 and no signs of deactivation even after 800 h of electrolysis in 0.5 m H2SO4 at 10 mA cm-2. When applied as the anode in a proton exchange membrane water electrolyzer, the cost-efficient RuO2/MnO2/CC catalyst only requires a cell voltage of 1.661 V to achieve the water-splitting current of 1 A cm-2, and the noble metal cost is as low as US$ 0.00962 cm-2, indicating potential for practical applications.

Toward the High-Voltage Stability of Layered Oxide Cathodes for Sodium-Ion Batteries: Challenges, Progress, and Perspectives

Sodium-ion batteries (SIBs) have garnered significant attention as ideal candidates for large-scale energy storage due to their notable advantages in terms of resource availability and cost-effectiveness. However, there remains a substantial energy density gap between SIBs and commercially available lithium-ion batteries (LIBs), posing challenges to meeting the requirements of practical applications. The fabrication of high-energy cathodes has emerged as an efficient approach to enhancing the energy density of SIBs, which commonly requires cathodes operating in high-voltage regions. Layered oxide cathodes (LOCs), with low cost, facile synthesis, and high theoretical specific capacity, have emerged as one of the most promising candidates for commercial applications. However, LOCs encounter significant challenges when operated in high-voltage regions such as irreversible phase transitions, migration and dissolution of metal cations, loss of reactive oxygen, and the occurrence of serious interfacial parasitic reactions. These issues ultimately result in severe degradation in battery performance. This review aims to shed light on the key challenges and failure mechanisms encountered by LOCs when operated in high-voltage regions. Additionally, the corresponding strategies for improving the high-voltage stability of LOCs are comprehensively summarized. By providing fundamental insights and valuable perspectives, this review aims to contribute to the advancement of high-energy SIBs.

Computational chemistry for water-splitting electrocatalysis

Electrocatalytic water splitting driven by renewable electricity has attracted great interest in recent years for producing hydrogen with high-purity. However, the practical applications of this technology are limited by the development of electrocatalysts with high activity, low cost, and long durability. In the search for new electrocatalysts, computational chemistry has made outstanding contributions by providing fundamental laws that govern the electron behavior and enabling predictions of electrocatalyst performance. This review delves into theoretical studies on electrochemical water-splitting processes. Firstly, we introduce the fundamentals of electrochemical water electrolysis and subsequently discuss the current advancements in computational methods and models for electrocatalytic water splitting. Additionally, a comprehensive overview of benchmark descriptors is provided to aid in understanding intrinsic catalytic performance for water-splitting electrocatalysts. Finally, we critically evaluate the remaining challenges within this field.

Unraveling the "Gap-Filling" Mechanism of Multiple Charge Carriers in Aqueous Zn-MoS2 Batteries

The utilization rate of active sites in cathode materials for Zn-based batteries is a key factor determining the reversible capacities. However, a long-neglected issue of the strong electrostatic repulsions among divalent Zn2+ in hosts inevitably causes the squander of some active sites (i.e., gap sites). Herein, we address this conundrum by unraveling the "gap-filling" mechanism of multiple charge carriers in aqueous Zn-MoS2 batteries. The tailored MoS2 /(reduced graphene quantum dots) hybrid features an ultra-large interlayer spacing (2.34 nm), superior electrical conductivity/hydrophilicity, and robust layered structure, demonstrating highly reversible NH4 + /Zn2+ /H+ co-insertion/extraction chemistry in the 1 M ZnSO4 +0.5 M (NH4 )2 SO4 aqueous electrolyte. The NH4 + and H+ ions can act as gap fillers to fully utilize the active sites and screen electrostatic interactions to accelerate the Zn2+ diffusion. Thus, unprecedentedly high rate capability (439.5 and 104.3 mAh g-1 at 0.1 and 30 A g-1 , respectively) and ultra-long cycling life (8000 cycles) are achieved.

Thioacetamide Additive Homogenizing Zn Deposition Revealed by In Situ Digital Holography for Advanced Zn Ion Batteries

Zinc ion batteries are considered as potential energy storage devices due to their advantages of low-cost, high-safety, and high theoretical capacity. However, dendrite growth and chemical corrosion occurring on Zn anode limit their commercialization. These problems can be tackled through the optimization of the electrolyte. However, the screening of electrolyte additives using normal electrochemical methods is time-consuming and labor-intensive. Herein, a fast and simple method based on the digital holography is developed. It can realize the in situ monitoring of electrode/electrolyte interface and provide direct information concerning ion concentration evolution of the diffusion layer. It is effective and time-saving in estimating the homogeneity of the deposition layer and predicting the tendency of dendrite growth, thus able to value the applicability of electrolyte additives. The feasibility of this method is further validated by the forecast and evaluation of thioacetamide additive. Based on systematic characterization, it is proved that the introduction of thioacetamide can not only regulate the interficial ion flux to induce dendrite-free Zn deposition, but also construct adsorption molecule layers to inhibit side reactions of Zn anode. Being easy to operate, capable of in situ observation, and able to endure harsh conditions, digital holography method will be a promising approach for the interfacial investigation of other battery systems.

Asthma and clinical outcomes of COVID-19 in a community setting

OBJECTIVES

The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19.

STUDY DESIGN

A case-control study based on a surveillance cohort in Harris County, Texas.

METHODS

Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing.

RESULTS

In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease.

CONCLUSIONS

The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.

Composite Quasi-Solid-State Electrolytes with Organic-Inorganic Interface Engineering for Fast Ion Transport in Dendrite-Free Sodium Metal Batteries

Quasi-solid-state electrolytes (QSSE) are a promising candidate for addressing the limitations of liquid and solid electrolytes. However, different ion transport capacities between liquid solvents and polymers can cause localized heterogeneous distribution of Na+ fluxes. In addition, the continuous side reactions occurring at the interface between QSSE and sodium anode lead to uncontrollable dendrites growth. Herein, a novel strategy is designed to integrate the composite electrospun membrane of Na3 Zr2 Si2 PO12 and poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) into QSSE, aiming to introduce new fast ion conducting channels at the organic-inorganic interface. The efficient ion transfer pathways can effectively promote the homogenization of ion migration, enabling composite QSSE to achieve an ultrahigh ionic conductivity of 4.1 mS cm-1 at room temperature, with a Na+ transference number as high as 0.54. Moreover, the PVDF-HFP is preferentially reduced upon contact with the sodium anode to form a "NaF-rich" solid electrolyte interphase, which effectively suppresses the growth of dendrites. The synergistic combination of multiple strategies can realize exceptional long-term cycling stability in both sodium symmetric batteries (≈700 h) and full batteries (2100 cycles). This study provides a new insight for constructing high performance and dendrite-free solid-state sodium metal batteries.

Inorganic-Organic Hybrid Multifunctional Solid Electrolyte Interphase Layers for Dendrite-Free Sodium Metal Anodes

Constructing a stable and robust solid electrolyte interphase (SEI) is crucial for achieving dendrite-free sodium metal anodes and high-performance sodium batteries. However, maintaining the integrity of SEI during prolonged cycle life under high current densities poses a significant challenge. In this study, we propose an integrated multifunctional SEI layer with inorganic/organic hybrid construction (IOHL-Na) to enhance the durability of sodium metal anode during reduplicative plating/stripping processes. The inorganic components with high mechanical strength and strong sodiophilicity demonstrate optimized ionic conduction efficiency and dendrite inhibition ability. Simultaneously, the organic component contributes to the formation of a dense and elastic membrane structure, preventing fracture and delamination issues during volume fluctuations. The symmetrical batteries of IOHL-Na achieve stable cycling over 2000 hours with an extremely low voltage hysteresis of around 15.8 mV at a high current density of 4 mA cm-2 . Moreover, the Na-O2 batteries sustain exceptional long-term stability and impressive capacity retention, exploiting a promising approach for constructing durable SEI and dendrite-free sodium metal anodes.

[Analysis of clinical characteristics and treatment status of atopic dermatitis in a children's hospital in Beijing from 2015 to 2019]

To analyze the clinical characteristics and treatment status of atopic dermatitis (AD) in children in the outpatient department of a children's hospital in Beijing from 2015 to 2019. This study used a cross-sectional study method to retrospectively analyze the data of AD patients who visited the Dermatology outpatient department of Beijing Children's Hospital, Capital Medical University, from April 2015 to April 2019. A total of 1 926 AD patients aged 0-17.5 years old living in Beijing and its surrounding areas were included, and the general situation, severity and distribution of AD disease, clinical characteristics and severity of AD, relevant influencing factors of AD onset, AD disease prognosis and treatment status were recorded. SAS 9.4, SPSS19.0, and R software were used for data processing, and descriptive statistical analysis, Chi-square test, Analysis of Variance, and correspondence analysis were used for statistical analysis. The results showed that the male to female ratio of AD patients in children included in this study was 1.4∶1; 79.0% (1 522/1 926), 86.1%(1 658/1 926), 91.3%(1 758/1 926), and 97.3%(1 907/1 926) of AD onset at the age of 6 months, 1 year, 2 years, and 5 years, respectively; mild of AD patients accounted for 13.2% (255/1 926)(SCORAD score 0-24), moderate of AD patients accounted for 50.1%(965/1 926) (SCORAD score 25-50), and severe of AD patients accounted for 36.7% (706/1 926)(SCORAD score>50).The age of severe AD patients were younger than mild and moderate AD patients. The face, head, trunk, and lower limbs were common areas of onset for moderate to severe AD, while the hands, feet, and ears were common areas of onset for severe AD patients. Temperature changes, hot water factors, mental and emotional states, and spring and winter were the main aggravation factors of AD;35.2% (678/1 926) aggravated and 61.8% (1 191/1 926) persistent. The more frequent bathing, the less severity of AD disease (χ2=29.791,P<0.001); 28.0% (520/1 856) of AD patients have no moisturizing habits, which were correlated with the severity of AD disease (χ2=15.908, P<0.05); the proportion of combined treatment medications in children with moderate to severe AD was significantly higher than mild AD patients. In conclusion, the patients with AD who went to specialist clinics were mainly moderate to severe patients and developed disease before the age of 5 years from 2015 to 2019.The severity of AD were mainly moderate to severe, and most of these patients had poor disease control. Traditional treatment plans had limitations. Identifying the clinical characteristics and treatment status of childhood AD would help us to carry out more targeted prevention and management work.

Boosting the Reversibility and Kinetics of Anionic Redox Chemistry in Sodium-Ion Oxide Cathodes via Reductive Coupling Mechanism

Activating anionic redox chemistry in layered oxide cathodes is a paradigmatic approach to devise high-energy sodium-ion batteries. Unfortunately, excessive oxygen redox usually induces irreversible lattice oxygen loss and cation migration, resulting in rapid capacity and voltage fading and sluggish reaction kinetics. Herein, the reductive coupling mechanism (RCM) of uncommon electron transfer from oxygen to copper ions is unraveled in a novel P2-Na0.8Cu0.22Li0.08Mn0.67O2 cathode for boosting the reversibility and kinetics of anionic redox reactions. The resultant strong covalent Cu-(O-O) bonding can efficaciously suppress excessive oxygen oxidation and irreversible cation migration. Consequently, the P2-Na0.8Cu0.22Li0.08Mn0.67O2 cathode delivers a marvelous rate capability (134.1 and 63.2 mAh g-1 at 0.1C and 100C, respectively) and outstanding long-term cycling stability (82% capacity retention after 500 cycles at 10C). The intrinsic functioning mechanisms of RCM are fully understood through systematic in situ/ex situ characterizations and theoretical computations. This study opens a new avenue toward enhancing the stability and dynamics of oxygen redox chemistry.

Constructing CoO/Mo2 C Heterostructures with Interfacial Electron Redistribution Induced by Work Functions for Boosting Overall Water Splitting

Space charge transfer of heterostructures driven by the work-function-induced built-in field can regulate the electronic structure of catalysts and boost the catalytic activity. Herein, an epitaxial heterojunction catalyst of CoO/Mo2 C with interfacial electron redistribution induced by work functions (WFs) is constructed for overall water splitting via a novel top-down strategy. Theoretical simulations and experimental results unveil that the WFs-induced built-in field facilitates the electron transfer from CoO to Mo2 C through the formed "Co─C─Mo" bond at the interface of CoO/Mo2 C, achieving interfacial electron redistribution, further optimizing the Gibbs free energy of primitive reaction step and then accelerating kinetics of hydrogen evolution reaction (HER). As expected, the CoO/Mo2 C with interfacial effects exhibits excellent HER catalytic activity with only needing the overpotential of 107 mV to achieve 10 mA cm-2 and stability for a 60-h continuous catalyzing. Besides, the assembled CoO/Mo2 C behaves the outstanding performance toward overall water splitting (1.58 V for 10 mA cm-2 ). This work provides a novel possibility of designing materials based on interfacial effects arising from the built-in field for application in other fields.

Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis

BACKGROUND AND PURPOSE

There is no clear association between plaque distribution and postoperative complications in patients with basilar artery atherosclerotic stenosis. The aim of this study was to determine whether plaque distribution and postoperative complications after endovascular treatment for basilar artery stenosis are related.

MATERIALS AND METHODS

Our study enrolled patients with severe basilar artery stenosis who were scanned with high-resolution MR imaging and followed by DSA before the intervention. According to high-resolution MR imaging, plaques can be classified as ventral, lateral, dorsal, or involved in 2 quadrants. Plaques affecting the proximal, distal, or junctional segments of the basilar artery were classified according to DSA. An experienced independent team assessed ischemic events after the intervention using MR imaging. Further analysis was conducted to determine the relationship between plaque distribution and postoperative complications.

RESULTS

A total of 140 eligible patients were included in the study, with a postoperative complication rate of 11.4%. These patients were an average age of 61.9 (SD, 7.7) years. Dorsal wall plaques accounted for 34.3% of all plaques, and plaques distal to the anterior-inferior cerebellar artery accounted for 60.7%. Postoperative complications of endovascular treatment were associated with plaques located at the lateral wall (OR = 4.00; 95% CI, 1.21-13.23; P = .023), junctional segment (OR = 8.75; 95% CI, 1.16-66.22; P = .036), and plaque burden (OR = 1.03; 95% CI, 1.01-1.06; P = .042).

CONCLUSIONS

Plaques with a large burden located at the junctional segment and lateral wall of the basilar artery may increase the likelihood of postoperative complications following endovascular therapy. A larger sample size is needed for future studies.

Annealing in Argon Universally Upgrades the Na-Storage Performance of Mn-Based Layered Oxide Cathodes by Creating Bulk Oxygen Vacancies

Manganese-rich layered oxide cathodes of sodium-ion batteries (SIBs) are extremely promising for large-scale energy storage owing to their high capacities and cost effectiveness, while the Jahn-Teller (J-T) distortion and low operating potential of Mn redox largely hinder their practical applications. Herein, we reveal that annealing in argon rather than conventional air is a universal strategy to comprehensively upgrade the Na-storage performance of Mn-based oxide cathodes. Bulk oxygen vacancies are introduced via this method, leading to reduced Mn valence, lowered Mn 3d-orbital energy level, and formation of the new-concept Mn domains. As a result, the energy density of the model P2-Na_0.75 Mg_0.25 Mn_0.75 O₂ cathode increases by ≈50 % benefiting from the improved specific capacity and operating potential of Mn redox. The Mn domains can disrupt the cooperative J-T distortion, greatly promoting the cycling stability. This exciting finding opens a new avenue towards high-performance Mn-based oxide cathodes for SIBs.

Fluorine Substitution Promotes Air-Stability of P'2-Type Layered Cathodes for Sodium-Ion Batteries

As one of the most promising cathode materials in sodium-ion batteries, manganese-based layered oxides have aroused wide attention due to their high specific capacity and plentiful reserves. However, they are plagued by poor air stability rooting in water/Na⁺ exchange and adverse structural reconstruction, hindering their practical applications. Herein, it is demonstrated that utilizing fluorine to substitute oxygen atoms can narrow the interlayer spacing of novel P'2-Na_0.67 MnO_1.97 F_0.03 (NMOF) cathode material, which resists the attack of water molecules, significantly prolonging exposure time in air. Density functional theory (DFT) calculation results indicate that fluorine substitution alleviates the insertion of water molecules and spontaneous extraction of Na⁺ effectively. Benefiting from the structural modulation, NMOF can deliver a high specific capacity of 227.1 mAh g^-1 at 20 mA g^-1 and a promising capacity retention of 84.0% after 100 cycles at 200 mA g^-1 . This facile and available strategy provides a feasible way to strengthen the air-stability and expands the scope of practical applications of layered oxide cathodes.

Progress in Hydrogen Production Coupled with Electrochemical Oxidation of Small Molecules

The electrochemical oxidation of small molecules to generate value-added products has gained enormous interest in recent years because of the advantages of benign operation conditions, high conversion efficiency and selectivity, the absence of external oxidizing agents, and eco-friendliness. Coupling the electrochemical oxidation of small molecules to replace oxygen evolution reaction (OER) at the anode and the hydrogen evolution reaction (HER) at the cathode in an electrolyzer would simultaneously realize the generation of high-value chemicals or pollutant degradation and the highly efficient production of hydrogen. This Minireview presents an introduction on small-molecule choice and design strategies of electrocatalysts as well as recent breakthroughs achieved in the highly efficient production of hydrogen. Finally, challenges and future orientations are highlighted.

Thrombectomy Using the EmboTrap Clot-Retrieving Device for the Treatment of Acute Ischemic Stroke: A Glimpse of Clinical Evidence

BACKGROUND

The EmboTrap Recanalization Device is a novel stent retriever for thrombectomy in the setting of acute ischemic stroke due to large-vessel occlusion.

PURPOSE

Our aim was to summarize the safety and efficacy of the EmboTrap Recanalization Device in acute ischemic stroke-large-vessel occlusion through a systematic review and meta-analysis.

DATA SOURCES

Medline, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were searched up to April 2022.

STUDY SELECTION

Nine observational studies using the EmboTrap Recanalization Device were selected.

DATA ANALYSIS

We adapted effect size with 95% CIs for dichotomous data. P value <.05 was statistically significant.

DATA SYNTHESIS

The estimated rate of successful recanalization (modified TICI 2b-3) was 90% (95% CI, 86%-95%; I ² = 82.4%); 90-day favorable outcome (mRS 0-2), 53% (95% CI, 42%-63%; I ² = 88.6%); modified first-pass effect, 43% (95% CI, 35%-51%; I ² = 63.7%); and first-pass effect, 36% (95% CI, 29%-46%; I ² = 10.7%). The rate of any intracerebral hemorrhage was 19% (95% CI, 16%-22%; I ² = 0.0%); symptomatic intracerebral hemorrhage, 5% (95% CI, 1%-8%; I ² = 84.6%); and 90-day mortality, 14% (95% CI, 9%-19%; I ² = 79.3%). Subgroup analysis showed higher rates of complete recanalization for EmboTrap II than for the EmboTrap System.

LIMITATIONS

The included studies are single-arm without direct comparison with other stent retrievers. Some of the studies recruited had a small sample size and were limited by the retrospective study design. In addition, the uncertain heterogeneity among studies was high.

CONCLUSIONS

The EmboTrap Recanalization Device is safe and efficient in treating acute ischemic stroke due to large-vessel occlusion.

442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy

Aim

Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP.

Method

We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality.

Results

Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (&gt; 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group.

Conclusions

According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.

Stabilized Multi-Electron Reactions in a High-Energy Na4 Mn0.9 CrMg0.1 (PO4 )3 Sodium-Storage Cathode Enabled by the Pinning Effect

Na superionic conductor (NASICON)-type Na₄ MnCr(PO₄ )₃ has attracted extensive attention among the phosphate sodium-storage cathodes due to its ultra-high energy density originating from three-electron reactions but it suffers from severe structural degradation upon repeated sodiation/desodiation processes. Herein, Mg is used for partial substitution of Mn in Na₄ MnCr(PO₄ )₃ to alleviate Jahn-Teller distortions and to prolong the cathode cycling life by virtue of the pinning effect induced by implanting inert MgO₆ octahedra into the NASICON framework. The as-prepared Na₄ Mn_0.9 CrMg_0.1 (PO₄ )₃ /C cathode delivers high capacity retention of 92.7% after 500 cycles at 5 C and fascinating rate capability of 154.6 and 70.4 mAh g^-1 at 0.1 and 15 C, respectively. Meanwhile, it can provide an admirable energy density of ≈558.48 Wh kg^-1 based on ≈2.8-electron reactions of Mn²⁺ /Mn³⁺ , Mn³⁺ /Mn⁴⁺ , and Cr³⁺ /Cr⁴⁺ redox couples. In situ X-ray diffraction reveals the highly reversible single-phase and bi-phase structural evolution of such cathode materials with a volume change of only 6.3% during the whole electrochemical reaction. The galvanostatic intermittent titration technique and density functional theory computations jointly demonstrate the superior electrode process kinetics and enhanced electronic conductivity after Mg doping. This work offers a new route to improve the cycling stability of the high-energy NASICON-cathodes for sodium-ion batteries.

Tailoring the surface chemistry of hard carbon towards high-efficiency sodium ion storage

Hard carbon (HC) is most likely to be a commercialized anode material for sodium-ion batteries (SIBs). However, its low initial coulombic efficiency (ICE) impedes its further large-scale industrialization. Since the ICE is greatly related to the side reactions of the electrolyte on the HC surface, herein, we focus on tailoring the surface chemistry of HC via a facile low-temperature oxygen plasma (LTOP) treatment technique. The modified HC after a suitable treatment time possesses a highly ordered and low defect surface without a negligible change in layer spacing, thus facilitating Na⁺ deinsertion/insertion and reducing the HC/electrolyte side reactions. Moreover, LTOP treatment also brings oxygen functional groups (CO) to the HC surface to enrich Na⁺ storage active sites. Consequently, the modified HC reveals a higher ICE of 80.9% compared to 60.6% in the bare HC. Also, the modified HC delivers an ultrahigh specific capacity of 331.0 mA h g^-1 at 0.1 A g^-1 and exhibits superior rate performance with a high specific capacity of 211.0 mA h g^-1 at 5 A g^-1. This work provides a feasible strategy to tailor the surface chemistry of HC for high-efficiency Na-storage and provides a novel avenue to construct high-efficiency SIBs.

Synergistic Effect of 3D Flexible Framework with Sodiophilic Mesoporous SnO2 Nanosheet Arrays on Dendrite-Free Sodium Metal Batteries

Although tremendous efforts have been dedicated to promote the electrochemical stability of sodium metal batteries (SMBs), the uncontrollable dendrites growth and inevitable side reactions at the sodium (Na) anode/electrolyte interface have not been effectively resolved. In this work, a flexible and functionalized 3D framework with mesoporous SnO₂ nanosheet arrays (SnO₂@CC-12) is fabricated to serve as a sodiophilic matrix toward dendrite-free Na metal anode. The mesoporous SnO₂ nanosheet arrays provide abundant sodiophilic sites and sufficient internal voids, which can not only accelerate electron transport to reduce the local current density of Na anode surface but also manipulate the Na⁺ flux deposition to suppress the growth of Na dendrites. Therefore, the SnO₂@CC-12-Na symmetric cell exhibits an ultralow overpotential of 9 mV and superior Na plating/stripping stability over 2200 h at 1.0 mA cm^-2. Moreover, the full cells using Na₃V₂(PO₄)₃ cathode show favorable high-rate performance and impressive long cycling stability with 95.1% capacity retention over 1000 cycles at 500 mA g^-1. This work may provide a new insight into the design of functionalized interface layer with high sodiophilicity toward dendrite-free SMBs.

Inorganic Electrolyte for Low-Temperature Aqueous Sodium Ion Batteries

Aqueous sodium ion batteries have received widespread attention due to their great application potential and high safety. However, the serious capacity fading under low temperature dramatically restricts their practical application. Compared to flammable and toxic organic antifreezing additives, addition of common cheap inorganic inert additives to improve low-temperature performance is of interest scientifically. Herein, low-cost calcium chloride is served as antifreezing additive in 1 m NaClO₄ aqueous electrolyte due to its strong interaction with water molecules. The freezing point of the optimized electrolyte is significantly reduced to below -50 °C with an ultrahigh ionic conductivity (7.13 mS cm^-1 ) at -50 °C. All pure inorganic composition of the full battery delivers a high capacity of 74.5 mAh g^-1 under 1 C (1 C = 150 mA g^-1 ) at -30 °C. More importantly, when tested under 10 C at -30 °C, the battery can achieve an ultralong cycling stability of 6000 cycles with no obvious capacity decay, indicating fast Na⁺ transport under low temperature. Significantly, this work provides an easy-to-operate strategy by adding cheap inorganic salt to develop high-performance low-temperature aqueous batteries.

Cardiovascular benefits outweigh risks in patients with atrial fibrillation in REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial)

Background/Introduction

REDUCE-IT, a multinational, double-blind trial, randomized 8179 statin-treated patients with controlled low density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 grams/day or placebo. IPE reduced the primary (CV death, myocardial infarction [MI], stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, MI, stroke) endpoints 25% and 26%, respectively (each p&lt;0.0001), and individual components including stroke (28%), MI (31%), cardiac arrest (48%), and sudden cardiac death (31%) (all p≤0.01). With IPE, bleeding was greater (11.8% vs 9.9%; p=0.006), serious bleeding trended higher (2.7% vs 2.1%; p=0.06), and atrial fibrillation/flutter (AF/F) hospitalization endpoints increased (3.1% vs 2.1%; p=0.004).

Purpose

To evaluate the effects of IPE on the risk of CV events and safety measures in patients by either history of AF/F or in-study occurrence of positively adjudicated AF/F hospitalization.

Methods

Conduct post hoc efficacy and safety subgroup analyses of patients with or without either baseline history of AF/F or in-study adjudicated AF/F hospitalization, including hospitalization for ≥24 hours; AF/F not meeting endpoint criteria were reported as adverse events.

Results

Patients with (n=751; 9.2%) AF/F history at baseline (vs without; n=7428; 90.8%) (Figure 1), or those with (n=211; 2.6%) positively adjudicated in-study AF/F hospitalization endpoints (vs without; n=7968; 97.4%) (Figure 2), had higher event rates of primary, key secondary, and fatal or nonfatal stroke endpoints, but relative risk reductions with IPE were not significantly different (all interaction p-values [pint]=ns). Similar reductions were observed with IPE across the prespecified endpoint testing hierarchy in patients with or without AF/F history or in-study hospitalization endpoints. Patients with baseline AF/F history had similar relative risk for in-study occurrence of AF/F hospitalization with IPE versus placebo (pint=0.21) but had greater absolute risk (12.5% vs 6.3%, IPE vs placebo) vs patients without baseline AF/F history (2.2% vs 1.6%, IPE vs placebo); i.e., recurrent AF/F in those with a prior history of AF/F was more prevalent than de novo AF/F. Serious bleeding trended higher regardless of AF/F history or in-study AF/F hospitalization endpoints (all pint=ns); absolute risk of serious bleeding was greater in patients with AF/F history at baseline (7.3% vs 6.0%) vs those without a baseline history of AF/F (2.3% vs 1.7%), and serious bleeding also trended higher in patients with in-study AF/F hospitalization (8.7% vs 6.0%) vs without (2.5% vs 2.0%) [all IPE vs placebo].

Conclusion

REDUCE-IT patients with AF/F history or in-study AF/F hospitalization endpoints had greater CV risk, but similar relative risk reduction in primary, key secondary, and fatal or nonfatal stroke endpoints with IPE.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amarin Pharma, Inc.

P-Block Atomically Dispersed Antimony Catalyst for Highly Efficient Oxygen Reduction Reaction

Main-group (s- and p-block) metals are generally regarded as catalytically inactive due to the delocalized s/p-band. Herein, we successfully synthesized a p-block antimony single-atom catalyst (Sb SAC) with the Sb-N₄ configuration for efficient catalysis of the oxygen reduction reaction (ORR). The obtained Sb SAC exhibits superior ORR activity with a half-wave potential of 0.86 V and excellent stability, which outperforms most transition-metal (TM, d-block) based SACs and commercial Pt/C. In addition, it presents an excellent power density of 184.6 mW cm^-2 and a high specific capacity (803.5 mAh g^-1 ) in Zn-air battery. Both experiment and theoretical calculation manifest that the active catalytic sites are positively charged Sb-N₄ single-metal sites, which have closed d shells. Density of states (DOS) results unveil the p orbital of the atomically dispersed Sb cation in Sb SAC can easily interact with O₂ -p orbital to form hybrid states, facilitating the charge transfer and generating appropriate adsorption strength for oxygen intermediates, lowering the energy barrier and modulating the rate-determining step. This work sheds light on the atomic-level preparing p-block Sb metal catalyst for highly active ORR, and further provides valuable guidelines for the rational design of other main-group-metal SACs.

Molecular Engineering on MoS2 Enables Large Interlayers and Unlocked Basal Planes for High-Performance Aqueous Zn-Ion Storage

Aqueous Zn-storage behaviors of MoS₂ -based cathodes mainly rely on the ion-(de)intercalation at edge sites but are limited by the inactive basal plane. Herein, an in-situ molecular engineering strategy in terms of structure defects manufacturing and O-doping is proposed for MoS₂ (designated as D-MoS₂ -O) to unlock the inert basal plane, expand the interlayer spacing (from 6.2 to 9.6 Å), and produce abundant 1T-phase. The tailored D-MoS₂ -O with excellent hydrophilicity and high conductivity allows the 3D Zn²⁺ transport along both the ab plane and c-axis, thus achieving the exceptional high rate capability. Zn²⁺ diffusion through the basal plane is verified by DFT computations. As a proof of concept, the wearable quasi-solid-state rechargeable Zn battery employing the D-MoS₂ -O cathode operates stably even under severe bending conditions, showing great application prospects. This work opens a new window for designing high-performance layered cathode materials for aqueous Zn-ion batteries.

Metallic S-CoTe with Surface Reconstruction Activated by Electrochemical Oxidation for Oxygen Evolution Catalysis

Developing highly active electrocatalysts toward oxygen evolution reaction (OER) is critical for the application of water splitting for hydrogen production and can further alleviate the energy crisis problem, but still remaining challenging. Especially, unlocking the catalytic site, in turn, helps design the available catalysts. Herein, the nanorod cobalt telluride with sulfur incorporation grown on a carbon cloth (S-CoTe/CC) as catalysts for OER, which displays extraordinary catalytic activity, is reported. Significantly, the in situ formed CoOOH species on the surface of S-CoTe merited from the structure evolution during the OER process serves as the active species. Furthermore, density functional theory calculations demonstrate that sulfur incorporation can tailor the electronic structure of active species and substantially optimize the free energy, accelerating the OER kinetics. This work provides an in-depth understanding of enhanced OER mechanism through foreign elements incorporating into precatalysts and is beneficial for the guiding design of more efficient catalysts.

MOFs-Derived Carbon-Based Metal Catalysts for Energy-Related Electrocatalysis

Electrochemical devices, as renewable and clean energy systems, display a great potential to meet the sustainable development in the future. However, well-designed and highly efficient electrocatalysts are the technological dilemmas that retard their practical applications. Metal-organic frameworks (MOFs) derived electrocatalysts exhibit tunable structure and intriguing activity and have received intensive investigation in recent years. In this review, the recent progress of MOFs-derived carbon-based single atoms (SAs) and metal nanoparticles (NPs) catalysts for energy-related electrocatalysis is summarized. The effects of synthesis strategy, coordination environment, morphology, and composition on the catalytic activity are highlighted. Furthermore, these SAs and metal NPs catalysts for the applications of electrocatalysis (hydrogen evolution reaction, oxygen evolution reaction, oxygen reduction reaction, carbon dioxide reduction reaction, and nitrogen reduction reaction) are overviewed. Finally, some current challenges and foresighted ideas for MOFs-derived carbon-based metal electrocatalysts are presented.

High-Energy Aqueous Sodium-Ion Batteries

Water-in-salt electrolytes (WISE) have largely widened the electrochemical stability window (ESW) of aqueous electrolytes by formation of passivating solid electrolyte interphase (SEI) on anode and also absorption of the hydrophobic anion-rich double layer on cathode. However, the cathodic limiting potential of WISE is still too high for most high-capacity anodes in aqueous sodium-ion batteries (ASIBs), and the cost of WISE is also too high for practical application. Herein, a low-cost 19 m (m: mol kg^-1 ) bi-salts WISE with a wide ESW of 2.8 V was designed, where the low-cost 17 m NaClO₄ extends the anodic limiting potential to 4.4 V, while the fluorine-containing salt (2 m NaOTF) extends the cathodic limiting potential to 1.6 V by forming the NaF-Na₂ O-NaOH SEI on anode. The 19 m NaClO₄ -NaOTF-H₂ O electrolyte enables a 1.75 V Na₃ V₂ (PO₄ )₃ ∥Na₃ V₂ (PO₄ )₃ full cell to deliver an appreciable energy density of 70 Wh kg^-1 at 1 C with a capacity retention of 87.5 % after 100 cycles.

Stimulating the Reversibility of Sb2 S3 Anode for High-Performance Potassium-Ion Batteries

Conversion-alloy sulfide materials for potassium-ion batteries (KIBs) have attracted considerable attention because of their high capacities and suitable working potentials. However, the sluggish kinetics and sulfur loss result in their rapid capacity degeneration as well as inferior rate capability. Herein, a strategy that uses the confinement and catalyzed effect of Nb₂ O₅ layers to restrict the sulfur species and facilitate them to form sulfides reversibly is proposed. Taking Sb₂ S₃ anode as an example, Sb₂ S₃ and Nb₂ O₅ are dispersed in the core and shell layers of carbon nanofibers (C NFs), respectively, constructing core@shell structure Sb₂ S₃ -C@Nb₂ O₅ -C NFs. Benefiting from the bi-functional Nb₂ O₅ layers, the electrochemical reversibility of Sb₂ S₃ is stimulated. As a result, the Sb₂ S₃ -C@Nb₂ O₅ -C NFs electrode delivers the rapidest K-ion diffusion coefficient, longest cycling stability, and most excellent rate capability among the controlled electrodes (347.5 mAh g^-1 is kept at 0.1 A g^-1 after 100 cycles, and a negligible capacity degradation (0.03% per cycle) at 2.0 A g^-1 for 2200 cycles is delivered). The enhanced K-ion storage properties are also found in SnS₂ -C@Nb₂ O₅ -C NFs electrode. Encouraged by the stimulated reversibility of Sb₂ S₃ and SnS₂ anodes, other sulfides with high electrochemical performance also could be developed for KIBs.

Sandwich-Like Heterostructures of MoS2 /Graphene with Enlarged Interlayer Spacing and Enhanced Hydrophilicity as High-Performance Cathodes for Aqueous Zinc-Ion Batteries

Layered materials have great potential as cathodes for aqueous zinc-ion batteries (AZIBs) because of their facile 2D Zn²⁺ transport channels; however, either low capacity or poor cycling stability limits their practical applications. Herein, two classical layered materials are innovatively combined by intercalating graphene into MoS₂ gallery, which results in significantly enlarged MoS₂ interlayers (from 0.62 to 1.16 nm) and enhanced hydrophilicity. The sandwich-structured MoS₂ /graphene nanosheets self-assemble into a flower-like architecture that facilitates Zn-ion diffusion, promotes electrolyte infiltration, and ensures high structural stability. Therefore, this novel MoS₂ /graphene nanocomposite exhibits exceptional high-rate capability (285.4 mA h g^-1 at 0.05 A g^-1 with 141.6 mA h g^-1 at 5 A g^-1 ) and long-term cycling stability (88.2% capacity retention after 1800 cycles). The superior Zn²⁺ migration kinetics and desirable pseudocapacitive behaviors are confirmed by electrochemical measurements and density functional theory computations. The energy storage mechanism regarding the highly reversible phase transition between 2H- and 1T-MoS₂ upon Zn-ion insertion/extraction is elucidated through ex situ investigations. As a proof of concept, a flexible quasi-solid-state zinc-ion battery employing the MoS₂ /graphene cathode demonstrates great stability under different bending conditions. This study paves a new direction for the design and on-going development of 2D materials as high-performance cathodes for AZIBs.

REDUCE-IT: outcomes by baseline statin type

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) randomized 8,179 statin-treated patients with elevated triglycerides and increased cardiovascular (CV) risk to either icosapent ethyl (IPE), a pure, stable prescription form of eicosapentaenoic acid, 4g/day or placebo. IPE significantly reduced time to first occurrence of the primary composite endpoint of major adverse CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) (HR 0.75, CI 0.68–0.83) and key secondary endpoint events (composite of CV death, nonfatal MI, or nonfatal stroke) (HR 0.74, CI 0.65–0.83) versus placebo (all p&lt;0.0001). A modest reduction in placebo-corrected LDL-C was observed (−6.6%; p&lt;0.0001). The mechanisms for the CV benefit of icosapent ethyl are not fully understood.

Purpose

Explore the impact of statin type and lipophilic/lipophobic category on outcomes, and on LDL-C, to further consider the possible relevance of LDL-C pathways to the observed CV benefit of icosapent ethyl.

Methods

Primary and key secondary endpoint analyses and LDL-C changes from baseline were explored by individual statin type (atorvastatin, simvastatin, rosuvastatin, or pravastatin) at baseline, and then by categorizing these statins into lipophilic (i.e., hydrophobic: atorvastatin, simvastatin) and lipophobic (i.e., hydrophilic: rosuvastatin, pravastatin) statin groups; 96.1% of patients fell within these individual statin groups.

Results

CV outcomes were similar across statin types (interaction p=0.61) and lipophilic/lipophobic categories (interaction p=0.51) (Figure). Statin type and category had a similar lack of meaningful impact on the modest placebo-corrected median LDL-C changes from baseline to one year, which ranged from −5.8 to −8.4% (all p≤0.0003).

Conclusion

No meaningful treatment differences in the primary or key secondary endpoints across statin type or lipophilic/lipophobic category were observed. A similar lack of treatment difference was observed in LDL-C changes from baseline to one year. Therefore, the LDL-C changes and CV risk reduction in REDUCE-IT appear independent of the type of concomitant statin therapy. These data provide clinicians with additional insight regarding concomitant statin therapy considerations when prescribing icosapent ethyl and suggest there are important mechanisms of action for the substantial CV risk reduction observed with icosapent ethyl that are distinct from the LDL receptor pathway.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: accumulation of data across prespecified interim analyses to final results

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), an event-driven trial, randomized 8,179 statin-treated patients with elevated triglycerides (TGs) and increased cardiovascular (CV) risk to icosapent ethyl (IPE); pure, stable prescription eicosapentaenoic acid, 4g/day or placebo. 1,612 primary endpoint events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) projected 90% power to detect 15% relative risk reduction (5% 2-sided alpha). The key secondary composite endpoint was CV death, nonfatal MI, or nonfatal stroke. An independent data and safety monitoring committee (DMC) performed prespecified interim analyses (IAs) at ∼60% (IA1 31 May 2016 data cutoff; 2.9 y median primary endpoint follow-up) and ∼80% (IA2 01 May 2017; 3.7 y) of events; final analysis included 1,606 events (06 Sep 2018; 4.9 y median study follow-up).

Purpose

Explore REDUCE-IT efficacy and safety across prespecified IAs for insight into progression of robustness and consistency of conclusions.

Methods

The interim statistical analysis plan guided study continuation decisions by a prespecified decision-making process, including assessment of safety, treatment arm performance, primary composite endpoint formal analyses, and informal robustness analyses, with no futility or efficacy stopping requirements. Prior to DMC IA study continuation decisions, the need for a mature dataset to support the robustness of final efficacy and safety findings was discussed. Sponsor, Steering Committee, and Clinical Endpoint Committee were blinded throughout.

Results

Primary and key secondary endpoints achieved statistical significance at IA1 and IA2 that persisted at final analyses (p-value below final adjusted 2-sided alpha of 0.0437); hazard ratios also remained consistent and similar robustness was observed across individual endpoint components; clarity of findings across endpoints and subgroups improved with more events. Stopping for overwhelming efficacy was discussed at each IA; prior to IA study continuation recommendations, the DMC considered historical examples of failed CV outcome studies for TG-lowering and mixed omega-3 therapies, reflected on the potential for overestimating final demonstrated benefit using incomplete data, and weighed societal impacts of fuller datasets relative to patient therapy access.

Conclusions

Consistent, potent efficacy emerged early and persisted across the two prespecified interim and final analyses. The mature dataset demonstrated highly statistically significant reductions in the primary (25%; p=0.00000001) and key secondary (26%; p=0.0000006) endpoints and allowed robust analyses to support overall efficacy and safety conclusions. Allowing the REDUCE-IT dataset to fully mature provided clinicians with robust, consistent, and reliable data upon which to base clinical decisions for IPE in CV risk reduction.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: total ischemic events reduced across the full range of baseline LDL cholesterol and other key subgroups

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a study of 8,179 randomized statin-treated patients with elevated triglycerides (TG) and increased cardiovascular (CV) risk followed for a median of 4.9 years, demonstrated robust results. Icosapent ethyl (IPE), a pure and stable prescription form of eicosapentaenoic acid, 4g/day reduced both time-to-first and total primary endpoint ischemic events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) by 25% (HR 0.75; 95% CI 0.68–0.83; p&lt;0.0001) and 30% (rate ratio 0.70; 95% CI 0.62–0.78; p&lt;0.0001), respectively. Similar substantial reductions in first and total key secondary endpoint ischemic events (composite of CV death, nonfatal MI, or nonfatal stroke) were also observed. Demographic and baseline disease characteristics were generally balanced across treatment groups. Time-to-first event analyses showed robust and generally consistent benefit across subgroups. Previous total event analyses by baseline TG demonstrated large, consistent, statistically significant reductions across tertiles, suggesting the CV benefit of IPE is tied primarily to non-TG factors.

Purpose

Further explore the extent to which IPE reduced total primary and key secondary events across prespecified baseline demographic, disease, treatment, and lipid/lipoprotein/inflammatory biomarker subgroups.

Methods

Total events across subgroups were assessed with the prespecified negative binomial regression method. Main outcomes were total (first and subsequent) primary and key secondary composite endpoint events.

Results

Median baseline LDL-C levels in ascending tertiles were 58, 76, and 96 mg/dL; there were large, significant relative reductions in total primary endpoint events with IPE across tertiles (35%, 28%, and 27%, respectively; interaction p=0.62), with parallel substantial absolute risk reductions. Similar, significant relative reductions of 33%, 28%, and 24% in total key secondary endpoint events were observed, along with substantial absolute risk reductions. Total events analyses of prespecified subgroups also demonstrated robust and generally consistent findings for the primary and key secondary composite endpoints.

Conclusion

REDUCE-IT demonstrated substantial reductions in first and total primary and key secondary endpoint ischemic events, with robust and generally consistent results across baseline TG and LDL-C levels, as well as other prespecified baseline biomarker, demographic, disease, and treatment subgroups. These analyses provide useful insights for clinicians considering the range of patients who may benefit from IPE therapy and suggest that mechanisms beyond the lipid/lipoprotein/inflammatory pathways tested, including mechanisms beyond the LDL receptor pathways, may contribute to the observed substantial reductions in total ischemic burden with IPE therapy.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

1009 Sleep Apnea and Colorectal Adenoma in the Veteran Population: A Case-Control Study

Introduction

Colorectal cancer is the third most common cancer in the United States, with over half of colorectal cancers estimated to be the result of modifiable risk factors. Studies relating sleep apnea (SA) and colorectal adenoma (CRA) are limited and the findings are equivocal. The objective of this study was to examine the association between SA and risk of CRA.

Methods

This was a retrospective cross-sectional case-control study of data collected from 460 veterans, ages 50-79, seen in the colonoscopy clinic at the Michael E. DeBakey VA Medical Center between 2014 and 2018. Information on demographics, sleep history, and co-morbidities were obtained through lifestyle questionnaire. Self-reported SA was diagnosed by a prior sleep study. Cases consisted of 297 participants had pathologically confirmed adenoma (including 117 participants having advanced CRA with villous component or diameter of polyp &gt; 1 cm). Controls consisted of 173 polyp-free participants. The distribution of demographics and lifestyle factors were compared between CRA and non-CRA using the Student’s t or chi-square tests. Odds ratios (OR) and 95% confidence intervals (CI) of CRA in association with CRA were calculated using univariate and multivariate unconditional logistic regression models. The confounding factors included age, sex, ethnicity, obesity, smoking status, alcohol use, hypertension, and sleep duration.

Results

Compared with non-SA, the multivariable OR (95% CI) for CRA was 0.92 (0.58-1.48); for non-advanced CRA was 1.14 (0.68-1.91), and for advanced CRA was 0.61 (0.32-1.17) in SA participants. Adjustment of sleep duration in the model did not change the risk estimates.

Conclusion

Sleep-study diagnosed SA was not associated with development of CRA in this veteran population. Further studies are needed to confirm this observation and incorporate the severity and treatment of SA, and undiagnosed SA in risk assessment.

Support

This research is supported in part by the Gillson Longenbaugh Foundation, and Golfers Against Cancer organization (to LJ), the Cancer Prevention Research Institute of Texas (CPRIT) (RP#140767, to LJ).