Highly Crystalline Iridium-Nickel Nanocages with Subnanopores for Acidic Bifunctional Water Splitting Electrolysis

Developing efficient bifunctional materials is highly desirable for overall proton membrane water splitting. However, the design of iridium materials with high overall acidic water splitting activity and durability, as well as an in-depth understanding of the catalytic mechanism, is challenging. Herein, we successfully developed subnanoporous Ir3Ni ultrathin nanocages with high crystallinity as bifunctional materials for acidic water splitting. The subnanoporous shell enables Ir3Ni NCs optimized exposure of active sites. Importantly, the nickel incorporation contributes to the favorable thermodynamics of the electrocatalysis of the OER after surface reconstruction and optimized hydrogen adsorption free energy in HER electrocatalysis, which induce enhanced intrinsic activity of the acidic oxygen evolution reaction (OER) and hydrogen evolution reaction (HER). Together, the Ir3Ni nanocages achieve 3.72 A/mgIr(η=350 mV) and 4.47 A/mgIr(η=40 mV) OER and HER mass activity, which are 18.8 times and 3.3 times higher than that of commercial IrO2 and Pt, respectively. In addition, their highly crystalline identity ensures a robust nanostructure, enabling good catalytic durability during the oxygen evolution reaction after surface oxidation. This work provides a new revenue toward the structural design and insightful understanding of metal alloy catalytic mechanisms for the bifunctional acidic water splitting electrocatalysis.

Symmetry-Induced Regulation of Pt Strain Derived from Pt3 Ga Intermetallic for Boosting Oxygen Reduction Reaction

Pt-based fuel cell catalysts with excellent activity and stability for proton-exchange membrane fuel cells (PEMFCs) have been developed through strain regulation in recent years. Herein, this work demonstrates that symmetry-induced strain regulation of Pt surface of PtGa intermetallic compounds can greatly enhance the catalytic performance of the oxygen reduction reaction (ORR). With the strain environment varies derived from the lattice mismatch of analogous PtGa core but different symmetry, the Pt surface of the PtGa alloy and the Pt3 Ga (Pm3 ¯ $\bar{3}$ m) precisely realize 0.58% and 2.7% compressive strain compared to the Pt3 Ga (P4/mmm). Experimental and theoretical results reveal that when the compressive stress of the Pt lattice increases, the desorption process of O* intermediates becomes accelerated, which is conducive to oxygen reduction. The Pt3 Ga (Pm3 ¯ $\bar{3}$ m) with high symmetry and compressive Pt surface exhibit the highest mass and specific activities of 2.18 A mgPt -1 and 5.36 mA cm-2 , respectively, which are more than one order of magnitude higher than those of commercial Pt/C catalysts. This work demonstrates that material symmetry can be used to precisely modulate Pt surface stress to enhance the ORR, as well as provide a distinct platform to investigate the relationship between Pt compressibility and catalytic activity.

Radiotherapy for Liver Cancer: An International Multi-Centre Pooled Analysis of 925 Cases

PURPOSE/OBJECTIVE(S)

Primary and secondary liver cancer incidence is growing and has a poor prognosis. The standard use of radiation has been hampered by studies with a wide range of patients, different management protocols and varied outcomes. To overcome this heterogeneity in the literature, larger and higher-level trials are warranted, but, so far, have been difficult to implement. Therefore, pooled analyses may offer the best way to determine the benefit of radiation, identify treatment parameters needed to optimize treatment techniques, and identify patient factors that allow for better patient selection.

MATERIALS/METHODS

Patients with liver cancer treated by radiotherapy at centers in Canada, United States and Australia was pooled. Patient and treatment characteristics were noted, as well as the clinical outcomes of local control within 1 year, recurrence and mortality. Stepwise Cox proportional hazards models were used to identify significant predictors for recurrence and mortality. Patients were stratified by center, and primary versus metastatic disease.

RESULTS

A total of 925 patients were included in this study. Mean age was 67 years, and 45% had a primary diagnosis of hepatocellular carcinoma. 1-year local control rate was 80%. Median survival was 1.8 years (1.9 years for primary liver cancer, and 1.4 years for metastatic liver cancer). Higher total dose and BED was associated with better survival. Median time to recurrence was 1.5 years. Higher total dose was associated with lower risk of recurrence CONCLUSION: As one of the largest pooled analyses in hepatic cancer, this international multi-center study provides pragmatic data on clinical outcomes of patients receiving radiotherapy for liver cancer. This database may assist in better selection of patients for future studies and answer questions such as what is the optimal dose and which patients benefit from treatment.

5-Year Renal Function Outcomes after SABR for Primary Renal Cell Carcinoma: A Report from the International Radiosurgery Oncology Consortium of the Kidney (IROCK)

PURPOSE/OBJECTIVE(S)

Renal cell carcinoma (RCC) presents uncommonly in patients with a congenital solitary kidney or prior contralateral nephrectomy. The objective of this study was to compare renal function outcomes of stereotactic ablative body radiotherapy (SABR) in patients with solitary vs. bilateral kidneys.

MATERIALS/METHODS

Patients with primary RCC with ≥2 years of follow-up at 12 participating International Radiosurgery Consortium for Kidney (IROCK) institutions were included. Patients with upper tract urothelial carcinoma or metastatic disease were excluded. Renal function was measured by estimated glomerular filtration rate (eGFR). For patients where eGFR was not recorded, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate eGFR based on known creatinine. Baseline characteristics and renal function outcomes were compared between solitary vs. bilateral kidneys. Multivariable logistic regression was used to identify factors predictive of eGFR decline ≥ 15 mL/min and any eGFR increase evaluated at 1-year post-SABR.

RESULTS

One hundred and ninety patients with solitary (n = 56) or bilateral kidneys (n = 134) underwent SABR and were followed for a median of 5.0 years (IQR: 3.4-6.8). Pre-SABR eGFR (mean ± SD) was similar in patients with solitary (61.1 ± 23.2 mL/min) vs. bilateral kidneys (58.0 ± 22.3 mL/min, p = 0.324). Mean tumor size was 3.70 ± 1.40 cm in solitary and 4.35 ± 2.50 cm in bilateral kidneys (p = 0.026). After SABR, an initial compensatory increase in eGFR was observed in both cohorts (22.7% solitary and 17.7% bilateral at 1 year). This compensatory increase persisted in patients with bilateral but not a solitary kidney (10.3% vs. 0% at 3-years and 21.1% vs. 0% at 5-years, respectively). At 5-years post-SABR, eGFR decreased by -14.5 ± 7.6 in solitary and -13.3 ± 15.9 mL/min in bilateral kidneys (p = 0.665). At all timepoints assessed, there were no significant differences in eGFR decline between solitary vs. bilateral cohorts (all p > 0.05). There were also no significant differences in post-SABR end-stage renal disease (7.1% vs. 6.7%) or dialysis (3.6% vs. 3.7%) in solitary vs. bilateral, respectively. Multivariable analysis demonstrated that increasing tumor size (OR per 1 cm: 1.57; 95% CI: 1.14-2.16, p = 0.006) and baseline eGFR (OR per 10 mL/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) was more likely to be associated with eGFR decline ≥ 15 mL/min. There was no significant association between solitary vs. bilateral kidney and eGFR decline (OR: 1.22; 95% CI: 0.45-3.34, p = 0.693).

CONCLUSION

There was no observed difference between renal function outcomes in patients with a solitary vs. bilateral kidneys. While larger tumor size may increase the risk of eGFR decline post-SABR, treatment of a solitary kidney does not appear to increase the risk of renal dysfunction long-term.

Real-World Experience of Intensity Modulated Radiation Therapy and Concurrent Chemotherapy for Anal Cancer with Long-Term Follow up and Clinical Outcomes

PURPOSE/OBJECTIVE(S)

The standard treatment for epidermoid anal cancer (AC) is concurrent chemoradiation (CRT). Here we present real world evidence of the safety and outcomes of AC patients managed by IMRT and concurrent chemotherapy at a single academic cancer center.

MATERIALS/METHODS

We retrospectively reviewed the outcomes of 180 AC patients treated with definitive CRT between 2011 and 2018. Patients were managed according to a prospectively designed protocol of IMRT with radiation dose escalated according to tumor stage: 50.4, 55.8 and 63 Gy for T1, T2 and T3/T4 disease respectively, and 36 Gy for elective nodal RT. Involved nodes were given the same dose based on T category. Concurrent chemotherapy consisted of two cycles of mitomycin C (MMC, 12 mg/m2) and 5-fluorouracil (5FU, 1000 mg/m2/day x 4 days) given on week 1 and 5. There was no planned treatment break. Univariate and multivariate analysis for outcomes were performed using Cox proportional hazard method and likelihood ratio statistics. Overall survival (OS) disease free (DFS), colostomy-free survival (CFS) and local failure rates (LFR) were described by Kaplan-Meier methods.

RESULTS

There were 128 female and 52 male patients with a median age of 64 (IQR 55-74). The median size of the primary was 4.0 cm (0.6-11.0 cm). There were 18 T1, 91 T2, 38 T3 and 33 T4 lesions; 50.6% (91/180) of the patients had N0 disease. Thirteen (7.2%) did not receive concurrent chemotherapy, and 16 (8.9%) failed to complete treatment as planned. Forty-three (23.9%) patients had a treatment gap >5 (6-33) days. Eighteen of 147 (12%) with T1-3 disease failed locally, LF was observed in 13/33 (39%) T4 lesions (P = 0.0002). The 5-year OS, DFS, CFS and LFR were 85.1%, 75.6%, 87.6% and 15.5% respectively. On multivariate analysis, increasing age and N+ disease were significant for worse OS, and increasing size of the primary tumor was the only significant factor for worse DFS, CFS and LFR. Grade ≥3 acute toxicities were observed in 42.8% of patients, with grade ≥3 neutropenia and febrile neutropenia observed in 18.9% and 13.9% of patients respectively. Six patients (3.3%) died of acute toxicities. Thirteen (7%) patients experienced grade ≥3 late toxicities.

CONCLUSION

Size of the primary appears to be the most important determinant of outcome following standard CRT using IMRT for AC. Despite IMRT, almost 1 in 4 patients required a treatment break, and over 40% experienced grade ≥3 acute toxicities including neutropenia and febrile neutropenia. Future studies with RT dose escalation or de-escalation, stratifying patients based on tumor size, HPV status and molecular markers are necessary to improve outcomes and decrease treatment related toxicity.

Dosimetric Parameters Predictive of Treatment-Related Toxicity in High Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer

PURPOSE/OBJECTIVE(S)

High dose-rate (HDR) brachytherapy as monotherapy is an effective treatment for patients with low- and intermediate-risk prostate cancer and is increasingly being offered as a 2-fraction protocol. There is a lack of consensus on the optimal dosimetric planning parameters to use, or whether there is any benefit summating dosimetric parameters from more than one implant. Our goal is to determine planning parameters associated with disease control, toxicity and health-related quality of life (HRQOL).

MATERIALS/METHODS

Data were collected on 83 patients with low- and intermediate-risk prostate cancer who received 2 fractions of 13.5 Gy HDR brachytherapy without androgen-deprivation therapy as part of a randomized phase II clinical trial. An in-house deformable, registration algorithm was used to co-register and dose-summate the plans from both implants for each patient. Acute and late GU and GI toxicities were measured using CTCAE 4.0 and HRQOL was measured in urinary, bowel, sexual and hormonal domains using the EPIC scores. Treatment efficacy was assessed through PSA measurement and imaging with or without biopsy where indicated. Covariates included baseline clinical factors, disease characteristics and treatment dosimetric parameters. Cox proportional hazards was performed to evaluate covariates impact on treatment toxicity and efficacy, and logistic regression analysis evaluated covariates impact on HRQOL.

RESULTS

Among the 83 patients, median prostate volume was 46.7cm3. Median summated planning target volume receiving 100% prescription dose (PTV V100%) was 97.4%, median PTV V150% 42.4% and median PTV V200% 15.5%. Median highest dose to the 1cm3 rectum (D1cc) was 66.9% of the prescription dose and median rectum V80% was 0.008cm3. Median urethral D1cc was 99.0% of the prescription dose, median urethral Dmax 121.7% and median urethral D10% 116.2%. Grade ≥2 GI toxicity was uncommon (3.7% acute and 8.5% late), but grade ≥2 GU toxicity was reported in 73.2% (acute) and 46.3% (late) patients. Rectum D1cc and V80% were found to be significantly associated with grade 2 or higher acute GI toxicity, while use of a-blocker at baseline was associated with grade ≥2 acute GU toxicity. Similarly, use of a-blocker was associated with late grade ≥2 GU toxicity, but with no dosimetric associations. No other variables were associated with treatment-related toxicities. Only rectum D1cc was significantly associated with changes in bowel EPIC scores. Estimated 5-year biochemical disease-free survival was 93.9% and 5-year cumulative incidence of local failure was 3.8%.

CONCLUSION

HDR monotherapy with 27 Gy delivered in 2 fractions in treatment of prostate cancer is well tolerated with high rates of disease control and minimal toxicity. Dose summation between 2 fractions of HDR brachytherapy is feasible, with rectal dose predicting acute GI toxicity. The lack of association between dose metrics and urinary toxicity raises the potential for further dose escalation.

Dosimetric Predictors of Toxicities and Quality of Life Following Two-Fraction Stereotactic Body Radiotherapy for Prostate Cancer

PURPOSE/OBJECTIVE(S)

There is emerging interest in two-fraction stereotactic body radiotherapy (2#SBRT) for localized prostate cancer. However, there is limited data to guide organs at risk (OAR) dose constraints in 2#SBRT. We aim to identify dosimetric predictors of toxicities and quality of life (QoL) using real life patient data from two prospective 2#SBRT trials.

MATERIALS/METHODS

We included 60 patients who had 2#SBRT in the 2STAR (NCT02031328) and 2SMART (NCT03588819) phase 2 trials. The prescribed dose was 26Gy to the prostate +/- focal boost of 32Gy to the dominant intraprostatic lesions. Toxicities and QoL data were prospectively collected using CTCAEv4 and EPIC26 questionnaires. For QoL, we reported the minimal clinical important changes (MCIC), defined as changes in QoL score of >0.5 standard deviation from baseline QoL score. We evaluated the bladder, urethra, rectum, and penile bulb dosimetry (urethra dosimetry only available in 30 patients in 2SMART trial). Some of the dosimetric parameters were log-transformed to normalize the distribution. Cox regression was used to identify dosimetric predictors for acute and late grade ≥2 GU toxicities. Logistic regression was used to identify dosimetric predictors for late MCIC in urinary, bowel and sexual QoL domains. Backward stepwise selection was used to identify significant dosimetric parameters. For GU toxicities and urinary QoL, three additional clinical factors (age, prostate volume and IPSS) were included in the final model as confounding factors. Receiver operating characteristics curve was used to identify cut-off for significant dosimetric parameters.

RESULTS

The median follow-up for the cohort was 56 months (range: 39-78 months). The cumulative acute and late grade ³2 GU toxicities were 62% (37/60) and 57% (34/60) respectively. No bladder or urethra dosimetric parameter was associated with acute grade ≥2 GU toxicities. Bladder D0.5cc was significant predictor of late grade ≥2 GU toxicities in univariate model (P = 0.05), but not in multivariate model. Baseline IPSS score was the single strongest predictor for late grade ≥2 GU toxicities (HR = 1.9; 95% CI = 1.1-3.4; P = 0.03). For late QoL outcomes, there were 36% (21/58), 28% (16/58), and 29% (17/58) of patients with MCIC in urinary, bowel and sexual QoL domains respectively. Bladder V10Gy was associated with late urinary MCIC in multivariate model after adjusting for clinical confounders (HR = 2.6, 95% CI = 1.1-6.6; P = 0.04). 48% (14/29) and 24% (7/29) of patients with bladder V10Gy>13.9% and V10Gy≤13.9% respectively had late urinary MCIC. No rectum and penile bulb dosimetry parameters was identified to be associated with late bowel or sexual QoL.

CONCLUSION

Using real life patient data from prospective clinical trials with medium term follow-up, we identified statistically significant bladder dosimetry parameter predictive of late urinary QoL. This finding could be useful to guide OAR dose constraints in prostate 2#SBRT trials.

Layered Inorganic Silicate Aerogel Pillared by Nanoclusters for High Temperature Thermal Insulation

Layered inorganic material, with large-area interlayer surface and interface, provides an essential material platform for constructing new configuration of functional materials. Herein, a layered material pillared with nanoclusters realizing high temperature thermal insulation performance is demonstrated for the first time. Specifically, systematic synchrotron radiation spectroscopy and finite element calculation analysis show that ZrOx nanoclusters served as "pillars" to effectively produce porous structures with enough boundary defect while maintaining the layered structure, thereby significantly reducing solid state thermal conductivity (≈0.32 W m-1  K-1 , 298-573 K). Moreover, the layered inorganic silicate material assembled aerogel also exhibits superior thermal insulation performance from room temperature (0.034 W m-1  K-1 , 298 K, air conditions) to high temperature (0.187 W m-1  K-1 , 1073 K, air conditions) and largely enhanced compressive strength (42 kPa at 80% compression), which is the best layered material-based aerogel that has achieved synergistic improvement in thermal and mechanical performance so far. Layered inorganic silicate aerogel pillared by nanoclusters will pave a new avenue for the design of advanced thermal insulation materials under extreme conditions.

Toward Highly Selective Heteroatom Dopants in Hard Carbon with Superior Lithium Storage Performance

Hard carbons (HCs) have gained much attention for next-generation high energy density lithium-ion battery (LIB) anode candidates. However, voltage hysteresis, low rate capability, and large initial irreversible capacity severely affect their booming application. Herein, a general strategy is reported to fabricate heterogeneous atom (N/S/P/Se)-doped HC anodes with superb rate capability and cyclic stability based on a three-dimensional (3D) framework and a hierarchical porous structure. The obtained N-doped hard carbon (NHC) exhibits an excellent rate capability of 315 mA h g^-1 at 10.0 A g^-1 and a long-term cyclic stability of 90.3% capacity retention after 1000 cycles at 3 A g^-1. Moreover, the as-constructed pouch cell delivers a high energy density of 483.8 W h kg^-1 and fast charging capability. The underlying mechanisms of lithium storage are illustrated by electrochemical kinetic analysis and theoretical calculations. It is demonstrated that heteroatom doping imposes significant effects on adsorption and diffusion for Li⁺. The versatile strategy in this work opens an avenue for rational design of advanced carbonaceous materials with high performance for LIB applications.

Ultrafast Super-filling Construction of Metal Artificial Interface for Long-term Stable Zinc Anode

Zinc (Zn) metal anodes are promising candidates for large-scale, highly safe energy storage systems. However, their cycling life is associated with instability issues such as dendritic growth, corrosion, and hydrogen evolution. Introducing an artificial metal interface is expected to help overcome this challenge owing to the optimisation of the absorption, nucleation, and growth of Zn²⁺ . In this study, w e developed an ultrafast, universal, and cost-effective super-filling approach to construct a metal-artificial interface-decorated Zn anode in situ. Most zincophilic metals, including Sn, Cu, and Ag, can be used to construct a homogenous interface without any restrictions on the size, morphology, or curvature of the substrates. With Sn as a proof-of-concept demonstration, the as-obtained Sn@Zn anode is conducive for the homogenous Zn nuclei and two-dimensional (2D) diffusion of Zn²⁺ ions. Symmetric cells with Sn@Zn electrodes could be operated for over 900 h at different current densities. This superior performance contributed to the attractive electrochemical characteristics of both coin and scaled-up Sn@Zn//β-MnO₂ cells. Given the facile and cost-effective fabrication and recyclability of the cells, o ur work enables the efficient design and exploration of Zn anodes for research, industrialisation, and commercialisation purposes. This article is protected by copyright. All rights reserved.

Ultrasmall Co3O4 nanoparticles as a long-lived high-rate lithium-ion battery anode

Herein, ultrasmall nanostructured Co₃O₄ particles have been prepared by a facile two-step synthetic method and furthermore applied to lithium-ion batteries. Benefitting from an increased specific surface area and improved tolerance for volume expansion, they deliver an extremely high specific capacity of 1432.7 mA h g^-1 at 0.1 A g^-1 and an outstandingly long cycle life with about 511.2 mA h g^-1 at 10 A g^-1 after 2000 cycles. This work will pave a new way to engineer advanced electrode materials for long-lived high-rate lithium-ion batteries.

Crystalline Order Propagates Across Thick Layers of Water in Solutions of Supramolecular Nanotubes

3D crystalline order with 1 nm resolution is observed in aqueous solutions of supramolecular nanotubes containing 94% water, at concentrations as low as 6 wt%. 50 of star-like organic ions arrange into supramolecular rings which, in turn, stack on top of each other to form long hollow tubes with 15 nm outer diameter. Cryo-TEM and X-ray diffraction show that the parallel nanotubes arrange on a perfect hexagonal lattice. Unexpectedly, fiber diffraction on sheared solutions revealed numerous hkl Bragg reflections on several layer lines indicating longitudinal interlock between the tubes and 3D crystalline order with molecular-scale details transferred across 10 nm thick layers of water. The observed high 3D order is attributed to long-range attraction between like-charged tubes and amplified charge modulation by the extremely high intra-tube correlation length.

Stereotactic Body Radiotherapy for Renal Cell Carcinoma: Oncological and Renal Function Outcomes

AIMS

To evaluate oncological and renal function outcomes of stereotactic body radiotherapy (SBRT) for medically inoperable patients with localised renal cell carcinoma.

MATERIALS AND METHODS

Consecutive patients treated with curative intent SBRT (30-45 Gy in five fractions or 42 Gy in three fractions) were included. Data on local control (Response Evaluation Criteria in Solid Tumors [RECIST] v1.1), distant metastasis, impact on estimated glomerular filtration rate (eGFR) and proportional ipsilateral and contralateral renal functions (measured through renal scans) were collected. Univariate and multivariable analyses were conducted to determine association of variables with oncological and renal function outcomes.

RESULTS

Seventy-four patients were analysed. The median follow-up was 27.8 months (interquartile range 17.6-41.7). Fifty-seven per cent had tumours ≥ T1b. One-, 2- and 4-year cumulative incidence of local failure was 5.85, 7.77 and 7.77%, respectively. The cumulative incidence of distant metastasis at 2 years was 4.24%. On multivariable analysis, a lower planning target volume (PTV) mean dose (P = 0.019) and a larger PTV (P = 0.005) were significantly associated with the risk of developing local failure. A lower PTV maximum dose (P = 0.039) was significantly associated with the risk of developing distant metastasis. The median change in global eGFR (ml/min) from pre-SBRT levels was -7.0 (interquartile range -14.5 to -1.0) at 1 year and -11.5 (interquartile range -19.5 to -4.0) at 2 years. The proportion of ipsilateral (differential) renal function decreased over time from 47% of overall renal function pre-SBRT to 36% at 2 years, whereas the proportion of contralateral renal function correspondingly improved. On multivariable analysis, a higher volume of uninvolved renal cortex (P < 0.0001) was significantly associated with a smaller decrease in eGFR over time.

CONCLUSION

In this large institutional cohort, oncological outcomes of renal cell carcinoma treated with SBRT were favourable and a longitudinal decline in renal function in the ipsilateral kidney and compensatory increase in the contralateral kidney were observed. Clinical and dosimetric factors were significantly associated with oncological and renal function outcomes.

[Retrospective analysis for 424 330 first-line screening results of non-invasive prenatal testing in Hebei province]

Objective: To evaluate the effect of noninvasive prenatal testing (NIPT) as first-line screening in fetal chromosome aneuploidy screening practice, and to provide evidence for the prevention and control strategy of birth defects. Methods: Since July 2019, Hebei province had carried out the NIPT project providing first-line screening for eligible pregnant women in the area (except for those who were not applicable). Pregnant women with high risk received genetic counseling, prenatal diagnosis and intervention guidance. Low risk and false-positive ones received continuous detection and moved to prenatal diagnosis center for counseling and diagnosis if abnormities were discovered. All pregnant women were followed up to learn about pregnancy outcomes and newborn health status. Detection results and clinical data of pregnant women participating the NIPT project from July 2019 to July 2020 were collected. The detection results and effect of NIPT were analyzed. Results: (1) Basic information of the screened population: A total of 424 330 pregnant women were screened, and 423 596 were successfully detected, with a success rate of 99.83% (423 596/424 330). The age of pregnant women was (28.8±4.5) years old; the gestational age of screening was (16.6±2.3) weeks; the proportion of advanced-age pregnant women (≥35 years old) was 10.18% (43 132/423 596); in vitro fertilization-embryo transfer (IVF-ET) rate was 1.58% (6 713/423 596); the twin rate was 1.38% (5 849/423 596); the proportion of primipara was 34.23% (144 977/423 596). (2) Screening results and detection performance: totally, 325, 73 and 20 pregnant women were diagnosed with trisomy 21, 18 and 13; the sensitivity were 99.39%, 100.00% and 100.00%; the specificity were 99.98%, 99.99% and 99.98%; the positive predictive value were 75.76%, 68.87% and 21.51%, respectively. Besides, 249 190 pregnant women were received supplementary reports as well, and 255, 10 and 9 were confirmed for sex chromosome aneuploidy, other autosomal aneuploidy and deletion/duplication syndrome; the positive predictive value were 37.78%, 6.06% and 32.14%, respectively. The sensitivity of NIPT for target trisomy (trisomy 21, 18 and 13) screening in advanced-age, IVF-ET and twin pregnant women were 99.29%, 100.00% and 90.00%, respectively; the specificity were 99.93% for all; the positive predictive value were 82.25%, 61.54% and 69.23%, respectively. Conclusions: NIPT has a significant effect and good performance in the first-line screening of fetal chromosome aneuploidy in the whole population, which might provide reference for the improvement of birth defect prevention and control strategy.

Directional Manipulation of Electron Transfer by Energy Level Engineering for Efficient Cathodic Oxygen Reduction

Electron transfer plays an important role in determining the energy conversion efficiency of energy devices. Nitrogen-coordinated single metal sites (M-N₄) materials as electrocatalysts have exhibited great potential in devices. However, there are still great difficulties in how to directionally manipulate electron transfer in M-N₄ catalysts for higher efficiency. Herein, we demonstrated the mechanism of electron transfer being affected by energy level structure based on classical iron phthalocyanine (FePc) molecule/carbon models and proposed an energy level engineering strategy to manipulate electron transfer, preparing high-performance ORR catalysts. Engineering molecular energy level via modulating FePc molecular structure with nitro induces a strong interfacial electronic coupling and efficient charge transfer from carbon to FePc-β-NO₂ molecule. Consequently, the assembled zinc-air battery exhibits ultrahigh performance which is superior to most of M-N₄ catalysts. Energy level engineering provides a universal approach for directionally manipulating electron transfer, bringing a new concept to design efficient and stable M-N₄ electrocatalyst.

N-Doped hollow Fe0.4Co0.6S2@NC nanoboxes derived from a Prussian blue analogue as a sodium ion anode

Herein, a bimetallic sulfide Fe_0.4Co_0.6S₂@NC nanobox was prepared via a simple two-step synthetic route. The N-doped carbon coated hollow nanobox was derived from a Prussian blue analogue (PBA) and applied for an SIB anode. As expected, it exhibits a high capacity (486.6 mA h g^-1 at 0.1 A g^-1) and displays an excellent cycling stability (230 mA h g^-1 at 10 A g^-1 after 900 cycles).

Epitaxial Growth of Ultrathin Highly Crystalline Pt-Ni Nanostructure on a Metal Carbide Template for Efficient Oxygen Reduction Reaction

Structure engineering strategies such as core-shell and hollow nanostructures are effective pathways to improve the utilization of noble metals for catalysis. However, nowadays materials design based on these strategies still largely rely on precious metal templates. Herein, the epitaxial growth of highly crystalline Pt₃ Ni overlayer on earth-abundant nickel carbide is reported, forming Ni₃ C@Pt₃ Ni core-shell nanoparticles with a well-defined interface through a new lattice-match-directed synthetic strategy. Derived from such core-shell nanostructures, ultrathin highly crystalline Pt₃ Ni nanocages have an advantageous configuration of oxygen reduction reaction (ORR)-favored facets and inherently high active surface area for the ORR, bringing high mass activity and specific activity as much as 4.71 A mg_Pt ^-1 and 5.14 mA cm^-2 , which are 26 and 20 times to that of commercial Pt/C, respectively. This novel epitaxial growth of platinum opens up new avenues to rationally design highly active and economical electrocatalysts.

In Situ Architecting Endogenous Heterojunction of MoS2 Coupling with Mo2 CTx MXenes for Optimized Li+ Storage

Endogenous heterojunction of 2D MXenes with unique structure shows inspiring potential in energy applications, which is impeded by complex synthesis method and finite MAX materials. Herein, an in situ hydrothermal strategy is implemented to successfully synthesize unique endogenous hetero-MXenes of amorphous MoS₂ coupling with fluoride-free Mo₂ CT_x (hetero-Mo₂ C) directly from Mo₂ Ga₂ C MAX. The distinctive morphology and heterojunction structure caused by the introduction of MoS₂ endow the hetero-MXenes with extraordinary structural stability and optimized Li⁺ storage mechanism with improved charge transport and lithium ion adsorption capabilities. As a result, hetero-Mo₂ C exhibits excellent electrochemical performance with a high discharge specific capacity of 1242 mAh g^-1 at 0.1 A g^-1 and long cycle stability of 683.9 mAh g^-1 after 1200 cycling. This work provides new insights into rational design of novel MXenes heterojunctions, practically important for the development of MXenes and their applications in high-performance energy storage systems.

Structural Transformation of Heterogeneous Materials for Electrocatalytic Oxygen Evolution Reaction

Electrochemical water splitting for hydrogen generation is a promising pathway for renewable energy conversion and storage. One of the most important issues for efficient water splitting is to develop cost-effective and highly efficient electrocatalysts to drive sluggish oxygen-evolution reaction (OER) at the anode side. Notably, structural transformation such as surface oxidation of metals or metal nonoxide compounds and surface amorphization of some metal oxides during OER have attracted growing attention in recent years. The investigation of structural transformation in OER will contribute to the in-depth understanding of accurate catalytic mechanisms and will finally benefit the rational design of catalytic materials with high activity. In this Review, we provide an overview of heterogeneous materials with obvious structural transformation during OER electrocatalysis. To gain insight into the essence of structural transformation, we summarize the driving forces and critical factors that affect the transformation process. In addition, advanced techniques that are used to probe chemical states and atomic structures of transformed surfaces are also introduced. We then discuss the structure of active species and the relationship between catalytic performance and structural properties of transformed materials. Finally, the challenges and prospects of heterogeneous OER electrocatalysis are presented.

Sub-2 nm Ultrasmall High-Entropy Alloy Nanoparticles for Extremely Superior Electrocatalytic Hydrogen Evolution

The development of sufficiently effective catalysts with extremely superior performance for electrocatalytic hydrogen production still remains a formidable challenge, especially in acidic media. Here, we report ultrasmall high-entropy alloy (us-HEA) nanoparticles (NPs) with the best-level performance for hydrogen evolution reaction (HER). The us-HEA (NiCoFePtRh) NPs show an average diameter of 1.68 nm, which is the smallest size in the reported HEAs. The atomic structure, coordinational structure, and electronic structure of the us-HEAs were comprehensively clarified. The us-HEA/C achieves an ultrahigh mass activity of 28.3 A mg^-1_{noble metals} at -0.05 V (vs the reversible hydrogen electrode, RHE) for HER in 0.5 M H₂SO₄ solution, which is 40.4 and 74.5 times higher than those of the commercial Pt/C and Rh/C catalysts, respectively. Moreover, the us-HEA/C demonstrates an ultrahigh turnover frequency of 30.1 s^-1 at 50 mV overpotential (41.8 times higher than that of the Pt/C catalyst) and excellent stability with no decay after 10 000 cycles. Operando X-ray absorption spectroscopy and theoretical calculations reveal the actual active sites, tunable electronic structures, and a synergistic effect among five elements, which endow significantly enhanced HER activity. This work not only engineers a general and scalable strategy for synthesizing us-HEA NPs and elucidates the complex structural information and catalytic mechanisms of multielement HEA system in depth, but also highlights HEAs as sufficiently advanced catalysts and accelerates the research of HEAs in energy-related applications.

Metformin with neoadjuvant chemoradiation to improve pathologic response in rectal cancer: A pilot phase I/II trial

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A prospective pilot phase I/II study on metformin given concurrently with neoadjuvant chemoradiation (CRT) in non-diabetic rectal cancer patients.

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Three patients had a clinical complete response (cCR) and did not have surgical resection.

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Of the 12 patients who underwent surgery, there were two pCRs. For the combined pCR/cCR rate of 33% (95% CI 19–47%), a total of 85 patients will be required to yield a 95% CI with a 10% margin of error.

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These pilot results are encouraging, and will serve to refine the design and conduct of a future phase 2 trial to determine whether adding metformin to CRT improves pCR/cCR rates.

Purpose

Neoadjuvant radiotherapy with or without chemotherapy decreases the risk of local recurrence after surgery for rectal cancer. Emerging data suggest that diabetic patients on metformin may have improved cancer outcome after radiotherapy. A single institutional pilot study was performed to determine if metformin given concurrently with long course chemoradiation (CRT) may improve pathologic complete response (pCR) in non-diabetic rectal cancer patients. The study was designed to construct a confidence interval (CI) for the pCR rate to determine the sample size for a phase 2 trial.

Methods

Non-diabetic patients with biopsy confirmed rectal cancer deemed candidates for long course neoadjuvant CRT were invited to participate. Radiation consisted of 50.4 Gy in 28 daily fractions with concurrent daily capecitabine (825 mg/m² twice daily). Participants self-administered metformin (500 mg of twice daily) 2 weeks prior to, during and for 4 weeks after CRT.

Results

A total of 16 patients were accrued. One patient withdrew from the study. Only grade 1 or 2 adverse events were observed. Three patients had a clinical complete response (cCR) and did not undergo surgery. Of the 12 patients who underwent surgery, there were two pCRs. For the combined pCR/cCR rate of 33% (95% CI 19–47%), a total of 85 patients will be required to yield a 95% CI with a 10% margin of error.

Conclusions

Adding metformin to neoadjuvant CRT for rectal cancer does not appear to enhance toxicities. These results will be used to refine the design and conduct of a future phase 2 trial to determine whether adding metformin to CRT improves pCR/cCR rates.

Intrinsic Room-Temperature Ferromagnetism in V2C MXene Nanosheets

Two-dimensional (2D) materials with intrinsic magnetic properties are intensively explored due to their potential applications in low-power-consumption electronics and spintronics. To date, only a handful of intrinsic magnetic 2D materials have been reported. Here, we report a realization of intrinsic ferromagnetic behavior in 2D V₂C MXene nanosheets through layer mismatch engineering. The V₂C MXene nanosheets with a small-angle twisting show a robust intrinsic ferromagnetic response with a saturation magnetic moment of 0.013 emu/g at room temperature. An in-depth study has been performed by X-ray absorption spectroscopy as well as electron paramagnetic resonance (EPR) and photoelectron spectroscopy analyses. It has been revealed that the symmetry-broken interlayer twisting reduced the degeneracy of V 3d states and the van Hove singularity. This led to a redistribution of the density of electronic states near the Fermi level and consequently activated the Stoner ferromagnetism with improved density of itinerant d electrons. This work highlights V₂C MXene as a promising intrinsic room-temperature ferromagnetic material with potential applications in spintronics or spin-based electronics.

Patient-reported Quality of Life following Stereotactic Body Radiation Therapy for Primary Kidney Cancer - Results from a Prospective Cohort Study

AIMS

We report on the first prospective series of patient-reported quality of life (QoL) following stereotactic body radiation therapy (SBRT) for primary kidney cancer.

MATERIALS AND METHODS

Patients were treated on a multi-institutional prospective cohort study with 30-42 Gy SBRT in three or five fractions. QoL assessments were carried out using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-15 Palliative (EORTC-QLQ-C15-PAL), the Functional Assessment of Cancer Therapy-Kidney Symptom Index-19 (FACT FKSI-19) and the EuroQol-5D-3L tools at baseline, 1 week, and 1, 3 and 6 months post-treatment. QoL over time was analysed using linear mixed modelling, pairwise and anchor-based analyses.

RESULTS

Twenty-eight patients were included. No significant reduction in any QoL metric was observed on repeated measures. However, a trend to reduced EORTC global QoL and fatigue was observed at 1 week, with improvement over time in other symptom scores such as pain, appetite and nausea. On pairwise analysis, there were statistically significant reductions in global QoL at 1 week (with subsequent recovery) and dyspnoea at 6 months post-SBRT. Trends to improved pain, appetite and nausea were observed following SBRT. Less than half of patients reported stable or better EORTC global QoL at 1 week. For all other QoL and symptom scales, most patients had reported stable or better scores at all times, with a slight proportional improvement in emotional functioning, nausea, fatigue, pain and appetite, and a slight worsening of physical functioning and dyspnoea over time.

CONCLUSIONS

SBRT results in well-preserved QoL in the weeks to months following treatment for primary kidney cancer.

57 Physical Activity Improvement in Elderly Hospitalised Patients at the Royal London: Exercise as Part of A Multimodal Intervention

Introduction

Approximately 65% of elderly patients admitted to hospital experience some level of deconditioning during their stay. This can lead to longer length of stays, premature admissions to care homes and loss of function whilst in hospital (British Geriatrics Society). There is evidence that exercise can be safe and effective in reversing functional decline in this population. However, there is limited evidence into the effectiveness and feasibility of running a multi modal exercise intervention (eg. Dance and Exercise) on a busy elderly care ward in the UK.

Method

An 8-week inpatient programme consisting of a 60-minute exercise classes once a week and/or 60-minute dance class once a week started on the Older Person’s Wards at the Royal London. Primary outcome measures included: 5 x Sit To Stands (5xSTS) and Falls Efficacy Scale International (FES-I). Secondary measures; Rockwood score, Barthel Index, Elderly Mobility Score (EMS), Mood, 4AT and handgrip strength. Patient satisfaction scores were also recorded.

Results

23 patients were included in the analysis, 3 patients attended the dance class, 14 attended the exercise class and 5 attended both. In total 37 sessions were completed. The average score for all outcome measures improved except one after 8 weeks. The 5xSTS times improved by an average of 7.7 seconds and the FES-I score dropped by 3.9. The Barthel score increased by 5 points. Handgrip strength increased by 2.3 kg and 57% improved on their EMS. Mood improved from 5.4/10 to 6.0/10 and 4AT from 2.7 to 1.7. Overall, 70% of participants reported enjoying the classes and 90% said they would re-attend.

Conclusion

A multifactorial intervention including seated dance and exercise sessions showed significant improvements in mobility, fear of falling, cognition and functional tasks. Further work will look into the impact on length of stay and readmissions inpatient to hospital.

Rational design of hierarchical FeSe2 encapsulated with bifunctional carbon cuboids as an advanced anode for sodium-ion batteries

Earth-abundant transition-metal selenides (TMSs) have aroused great interest towards their application in sodium-ion batteries (SIBs). Herein, we present Fe-based Prussian blue analogs (PBA) modified by graphene oxide as precursors to synthesize FeSe2 nanoparticles within a nitrogen-doped carbon (NC) matrix and graphene layer (FeSe2/NC@G). The bifunctional carbon wrapped FeSe2/NC@G shows excellent sodium-storage performance with a large reversible capacity of 331 mA h g-1 at 5.0 A g-1 and a high cyclability of 323 mA h g-1 at the current density of 2.0 A g-1 after 1000 cycles (82% capacity retention). Furthermore, full SIBs are also fabricated and exhibit superior capacities and stabilities. The remarkable electrochemical properties result from the formation of an Fe-O-C chemical bond in the composite with enhanced electronic/ionic diffusion kinetics and structural integrity. This study paves the way for the successful synthesis of novel nanostructural TMSs which can be utilized in energy storage system application.

Nanopore Confinement of Electrocatalysts Optimizing Triple Transport for an Ultrahigh-Power-Density Zinc-Air Fuel Cell with Robust Stability

Metal-air fuel cells with high energy density, eco-friendliness, and low cost bring significantly high security to future power systems. However, the impending challenges of low power density and high-current-density stability limit their widespread applications. In this study, an ultrahigh-power-density Zn-air fuel cell with robust stability is highlighted. Benefiting from the water-resistance effect of the confined nanopores, the highly active cobalt cluster electrocatalysts reside in specific nanopores and possess stable triple-phase reaction areas, leading to the synergistic optimization of electron conduction, oxygen gas diffusion, and ion transport for electrocatalysis. As a result, the as-established Zn-air fuel cell shows the best stability under high-current-density discharging (>90 h at 100 mA cm^-2 ) and superior power density (peak power density: >300 mW cm^-2 , specific power: 500 Wg_cat ^-1 ) compared to most reported non-noble-metal electrocatalysts. The findings will provide new insights in the rational design of electrocatalysts for advanced metal-air fuel cell systems.

Inhibition of oxygen dimerization by local symmetry tuning in Li-rich layered oxides for improved stability

Li-rich layered oxide cathode materials show high capacities in lithium-ion batteries owing to the contribution of the oxygen redox reaction. However, structural accommodation of this reaction usually results in O–O dimerization, leading to oxygen release and poor electrochemical performance. In this study, we propose a new structural response mechanism inhibiting O–O dimerization for the oxygen redox reaction by tuning the local symmetry around the oxygen ions. Compared with regular Li₂RuO₃, the structural response of the as-prepared local-symmetry-tuned Li₂RuO₃ to the oxygen redox reaction involves the telescopic O–Ru–O configuration rather than O–O dimerization, which inhibits oxygen release, enabling significantly enhanced cycling stability and negligible voltage decay. This discovery of the new structural response mechanism for the oxygen redox reaction will provide a new scope for the strategy of enhancing the anionic redox stability, paving unexplored pathways toward further development of high capacity Li-rich layered oxides.

Li-rich layered oxide cathodes show high capacities in Li-ion batteries but suffer from structural degradation via O–O dimerization. Here, the authors present local-symmetry-tuned Li₂RuO₃ with oxygen redox involving a telescopic O–Ru–O configuration avoiding O₂ release, enhancing cycling stability.

Retrospective analysis of the clinical effects of endoscopic mucosal dissection on treatment of early esophagogastric precancerous lesions

INTRODUCTION

The purpose of this study was to conduct a retrospective study about the clinical effects of endoscopic mucosal dissection on the treatment of early esophagogastric precancerous lesions.

METHODS

A total of 132 patients with early esophagogastric precancerous lesions who were diagnosed and treated with concurrent surgery in our hospital from January 2018 to December 2019 were included in this retrospective study. Patients were divided into endoscopic mucosal resection (EMR) group (n = 58) and endoscopic submucosal dissection (ESD) group (n = 74) according to different surgical methods. The data in the two groups were compared and analyzed in terms of surgical indicators, treatment status and incidence of postoperative complications.

RESULTS

There were statistically significant differences between the two groups in the whole block cutting rate, fractional cutting rate and complete cutting rate (P < 0.05). The mean operation time of ESD group was significantly longer than that of EMR group (P < 0.05). There were no significant differences in the intraoperative bleeding rate, blood loss, average specimen area, length of hospital stay and treatment cost between the two groups (P > 0.05). The incidence and recurrence of postoperative complications, including bleeding, perforation and stenosis in the two groups, were observed within 1 year of postoperative follow-up. The incidence of complications in ESD group was slightly higher than that in EMR group, and the local recurrence rate in ESD group was lower than that in EMR group (P > 0.05).

CONCLUSION

ESD is an alternative surgical treatment for patients with early esophagogastric precancerous lesions.

Surface Nitrogen-Injection Engineering for High Formation Rate of CO2 Reduction to Formate

In this study, we highlight that surface nitrogen-injection engineering brings a high formation rate for CO₂ reduction to formate, which is high level among the reported electrocatalysts. Surface nitrogen-injection engineering can increase the amounts of active sites and optimize the electronic structure simultaneously. Taking an example of SnS₂ precursors, the final-obtained surface N-enriched Sn(S) nanosheets (denoted as N-Sn(S) nanosheets) exhibit a 5-fold of current density and 2.45-fold of Faradaic efficiency than pristine SnS₂ derived Sn(S) nanosheets (denoted as Sn(S) nanosheets). On account of high activity and selectivity, the formation rate of formate is 14 times than that of pristine samples and reaches up to 1358 μmol h^-1 cm^-2. Moreover, this strategy is proven to be general to other metal sulfides, such as CuS and In₂S₃. We anticipate that surface nitrogen-injection engineering offers new avenues to rational design of advanced electrocatalysts for CO₂ reduction reaction.

Ultrafine Co3 O4 Nanoparticles within Nitrogen-Doped Carbon Matrix Derived from Metal-Organic Complex for Boosting Lithium Storage and Oxygen Evolution Reaction

Transition metal oxides have recently received great attention for application in advanced lithium-ion batteries (LIBs) and oxygen evolution reaction (OER). Herein, the ethylenediaminetetraacetic cobalt complex as a precursor to synthesize ultrafine Co₃ O₄ nanoparticles encapsulated into a nitrogen-doped carbon matrix (NC) composites is presented. The as-prepared Co₃ O₄ /NC-350 obtained by pyrolysis at 350 °C demonstrates superior rate performance (372 mAh g^-1 at 5.0 A g^-1 ) and high cycling stability (92% capacity retention after 300 cycles at 1.0 A g^-1 ) as anode for LIBs. When evaluated as an electrocatalyst for OER, the Co₃ O₄ /NC-350 achieves an overpotential of 298 mV at a current density of 10 mA cm^-2 . The NC-encapsualted porous hierarchical structure assures fast and continuous electron transportation, high activity sites, and strong structural integrity. This works offers novel complex precursors for synthesizing transition metal-based electrodes for boosting electrochemical energy conversion and storage.

Results of 15 Gy HDR-BT boost plus EBRT in intermediate-risk prostate cancer: Analysis of over 500 patients

PURPOSE/OBJECTIVE

To report biochemical control associated with single fraction 15 Gy high-dose-rate brachytherapy (HDR-BT) boost followed by external beam radiation (EBRT) in patients with intermediate-risk prostate cancer.

MATERIALS AND METHODS

A retrospective chart review of all patients with intermediate-risk disease treated with a real-time ultrasound-based 15 Gy HDR-BT boost followed by EBRT between 2009 and 2016 at a single quaternary cancer center was performed. Freedom from biochemical failure (FFBF), cumulative incidence of androgen deprivation therapy use for biochemical or clinical failure post-treatment (CI of ADT) and metastasis-free survival (MFS) outcomes were measured.

RESULTS

518 patients met the inclusion criteria for this study. Median age at HDR-BT was 67 years (IQR 61-72). 506 (98%) had complete pathologic information available. Of these, 146 (28%) had favorable (FIR) and 360 (69%) had unfavorable (UIR) intermediate-risk disease. 83 (16%) received short course hormones with EBRT + HDR. Median overall follow-up was 5.2 years. FFBF was 91 (88-94)% at 5 years. Five-year FFBF was 94 (89-99)% and 89 (85-94)% in FIR and UIR patients, respectively (p = 0.045). CI of ADT was 4 (2-6)% at 5 years. Five-year CI of ADT was 1 (0-3)% and 5 (2-8)% in FIR and UIR patients, respectively (p = 0.085). MFS was 97 (95-98)% at 5 years. Five-year MFS was 100 (N/A-100)% and 95 (92-98)% in FIR and UIR patients, respectively (p = 0.020).

CONCLUSION

In this large cohort of intermediate-risk prostate cancer patients, 15 Gy HDR-BT boost plus EBRT results in durable biochemical control and low rates of ADT use for biochemical failure.

Reduced Local Symmetry in Lithium Compound Li2SrSiO4 Distinguished by an Eu3+ Spectroscopy Probe

Research on lithium compounds has attracted much attention nowadays. However, to elucidate the precise structure of lithium compounds is a challenge, especially when considering the small ions that may be transferred between the interstitial voids. Here, the discovery of reduced local symmetry (symmetry breaking) in small domains of Li2SrSiO4 is reported by employing Eu3+ as a spectroscopic probe, for which X-ray, neutron, and electron diffraction have confirmed the average long-range structure with the space group P3121. However, luminescence shows a lower local symmetry, as confirmed by the extended X-ray absorption fine structure. By considering the reduced symmetry of the local structure, this work opens the door to a new class of understanding of the properties of materials.

Freestanding Cubic ZrN Single-Crystalline Films with Two-Dimensional Superconductivity

The successful fabrication of freestanding two-dimensional (2D) crystals that exhibit unprecedented high crystal quality and macroscopic continuity renovates the conventional cognition that 2D long-range crystalline order cannot stably exist at finite temperatures. Current progresses are primarily limited to van der Waals (vdW) layered materials, while studies on how to obtain 2D materials from nonlayered bulk crystals remain sparse. Herein, we report the experimental realization of vdW-like cubic ZrN single crystal and emphasize the significant role of confined electrons in stabilizing the atomic structure at the 2D limit. Furthermore, the exfoliated ZrN single-crystal films with a few nanometers thick exhibit dimensional crossover effect of emerging 2D superconductivity with the unconventional upper critical field beyond Pauli paramagnetic limit, which suggests a dimensional effect in the pairing mechanism of dimensionally confined superconductors.