The lithium (Li)‐metal anode offers a promising solution for high‐energy‐density lithium‐metal batteries (LMBs). However, the significant volume expansion of the Li metal during charging results in ...poor cycling stability as a result of the dendritic deposition and broken solid electrolyte interphase. Herein, a facile one‐step roll‐to‐roll fabrication of a zero‐volume‐expansion Li‐metal‐composite anode (zeroVE‐Li) is proposed to realize high‐energy‐density LMBs with outstanding electrochemical and mechanical stability. The zeroVE‐Li possesses a sandwich‐like trilayer structure, which consists of an upper electron‐insulating layer and a bottom lithiophilic layer that synergistically guides the Li deposition from the bottom up, and a middle porous layer that eliminates volume expansion. This sandwich structure eliminates dendrite formation, prevents volume change during cycling, and provides outstanding flexibility to the Li‐metal anode even at a practical areal capacity over 3.0 mAh cm−2. Pairing zeroVE‐Li with a commercial NMC811 or LCO cathode, flexible LMBs that offer a record‐breaking figure of merit (FOM, 45.6), large whole‐cell energy density (375 Wh L−1, based on the volume of the anode, separator, cathode, and package), high‐capacity retention (> 99.8% per cycle), and remarkable mechanical robustness under practical conditions are demonstrated.
A novel design and scalable fabrication of zero‐volume‐expansion lithium‐composite anodes with high electrochemical and mechanical stability through simple roll‐to‐roll manufacturing processes is proposed. The sandwich‐like trilayer structure of zero‐volume‐expansion lithium‐composite anodes can simultaneously suppress dendrite formation, eliminate volume change during cycling, and provides excellent mechanical robustness.
A duty-cycled and pulse-based embedded radar system without a quartz crystal unit is presented for cardiorespiratory monitoring. A reference clock source with features of high accuracy and ...temperature independence is directly gained from ac electric power grids. The 50/60 Hz power-line interference is further utilized and converted to a reliable clock source as a substitute for the conventional crystal that can be fed into the radar system. The theoretical analysis of the clock source conversion circuit and the experimental instantaneous frequency deviation from the wall outlet will be described to investigate frequency stability and uncertainty based on statistical evidence and significance. In addition, a pulse control unit (PCU) with a duty-cycle mechanism is implemented to convert the initial clock into a duplet-pulse sequence with a tunable phase delay for simultaneously performing the probing and demodulated pulses. A fully customized embedded radar system driven from a 60 Hz ac source is proposed for real-time physiological detection.
Data for elucidating post-kidney transplantation (KT) acute pancreatitis (AP) risk are limited and no large-scale cohort study has investigated the impact of AP after KT.
Data from Taiwan National ...Health Insurance (NHI) Research Database (NHIRD) were calculated through the method of propensity score matching to compare the pancreatitis risk in patients with and without KT.
The overall pancreatitis incidence rates were 1.71 and 0.61 per 1,000 person-years in the KT and non-KT groups, respectively and corresponding adjusted HR (aHR 95% CI) for pancreatitis was 2.48 (1.51-4.09) in the KT group. In the multivariable model, AP risk was higher in transplant patients with alcohol-related illnesses (aHR: 3.78, 95% CI: 1.32-10.8), gall stone disease (aHR: 3.53, 95% CI: 1.48-8.44), or past history of pancreatitis (aHR: 10.3, 95% CI: 5.08-20.8). Of note, recurrent AP risk was significantly higher in the KT group (aHR: 8.19, 95% CI: 2.89-23.2). Patients with post-KT AP demonstrated shorter patient and allograft survival than did those without (both P < 0.001, respectively).
In conclusion, KT recipients are very likely to be associated with AP. Moreover, their inferior outcomes are strongly associated with post-KT AP.
Polymer/ceramic‐based composite solid electrolytes (CSE) are promising candidates for all‐solid‐state lithium metal batteries (SLBs), benefiting from the combined mechanical robustness of polymeric ...electrolytes and the high ionic conductivity of ceramic electrolytes. However, the interfacial instability and poorly understood interphases of CSE hinder their application in high‐voltage SLBs. Herein, a simple but effective CSE that stabilizes high‐voltage SLBs by forming multiple intermolecular coordination interactions between polyester and ceramic electrolytes is discovered. The multiple coordination between the carbonyl groups in poly(ε‐caprolactone) and the fluorosulfonyl groups in anions with Li6.5La3Zr1.5Ta0.5O12 nanoparticles is directly visualized by cryogenic transmission electron microscopy and further confirmed by theoretical calculation. Importantly, the multiple coordination in CSE not only prevents the continuous decomposition of polymer skeleton by shielding the vulnerable carbonyl sites but also establishes stable inorganic‐rich interphases through preferential decomposition of anions. The stable CSE and its inorganic‐rich interphases enable Li||Li symmetric cells with an exceptional lifespan of over 4800 h without dendritic shorting at 0.1 mA cm−2. Moreover, the high‐voltage SLB with LiNi0.5Co0.2Mn0.3O2 cathode displays excellent cycling stability over 1100 cycles at a 1C charge/discharge rate. This work reveals the underlying mechanism behind the excellent stability of coordinating composite electrolytes and interfaces in high‐voltage SLBs.
In this work, a simple and effective composite solid electrolyte with multiple coordination to stabilize high‐voltage lithium metal batteries is discovered, and the interface formation mechanism is visualized using cryogenic transmission electron microscopy. The multiple coordination prevents the continuous decomposition of the polymer skeleton by shielding the vulnerable carbonyl sites and establishing stable inorganic‐rich interphases through the preferential decomposition of anions, thereby ensuring the long‐term cycling stability of high‐voltage solid‐state lithium metal batteries.
We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography ...(ERCP) complications.
A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson's classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.
A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.
Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
Abstract Electrolytes with high stability against both Li anode and high‐voltage cathode are critical for high‐energy and long‐cycling lithium metal batteries (LMBs). However, the free active ...solvents in common electrolytes are susceptible to decomposition at both Li anode and high‐voltage cathode. Although recently developed locally high‐concentration electrolytes (LHCEs) have largely restricted active solvents via Li + coordination, the free molecules are still released upon the desolvation of Li + at the surface of electrodes, causing continuous decomposition during long‐cycling processes. Here, a molecule competitive solvation electrolyte (MCE) is shown to stabilize high‐voltage LMBs by introducing a well‐designed and newly synthetic bipolar solvent molecule with one ion‐dissociative polar head and the other highly fluorinated nonpolar tail. The bipolar molecules competitively dissociate Li + via weak coordination interactions, drastically reducing the ratio of active solvents in electrolytes and the detrimental decomposition at electrodes during the desolvation processes. Consequently, the MCE enables a 1.4‐Ah Li metal pouch cell with a stack energy density of 450 Wh kg −1 along with exceptional operation stability over 400 cycles (retention: 81%). Furthermore, the MCE also maintains the stable operation of a 2.5‐Ah Li‐S pouch cell with an excellent energy density of 417 Wh kg −1 for 70 cycles under practical conditions.
To compare the efficacy and safety of ultrasound (US) and computed tomography (CT) in the guidance of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
We retrospectively analyzed ...consecutive treatment-naïve patients who received curative RFA for HCC from January 2008 to July 2013. Patients were divided into the US group or the CT group according to their RFA guidance instruments. Patients who were only suitable for US- or CT-guided RFA were excluded. Cumulative incidences of and hazard ratios for HCC recurrence were analyzed after adjusting for competing mortality risk.
We recruited a total of 101 patients in the US group and 51 patients in the CT group. The baseline demographic characteristics were not significantly different in both groups. Initial response rates were similar between the two groups (US vs. CT: 89.1% vs. 92.2%, p = 0.54), and complete tumor ablation was finally achieved for all patients. However, more ablations per session were performed in US group (median 2.0 1.0-3.0 vs. 1.0 1.0-2.0; p<0.01). The 1-, 2- and 3-year local tumor recurrence rates (US vs. CT: 13.0%, 20.9%, and 29.2% vs. 11.2%, 29.8% and 29.8%, respectively) and overall mortality rates (US vs. CT: 5.2%, 9.6% and 16.5% vs. 0%, 3.1% and 23.8%, respectively) were not significantly different. In multivariate analysis, tumor characteristics and underlying liver function, but not US or CT guidance, were independent prognostic factors. The complication rates were similar between the two groups (US vs. CT: 10.9% vs. 9.8%; p = 0.71), and there was no procedure-related mortality.
With comparable major outcomes, either US or CT can be used in the guidance of RFA in experience hands.
Positive interventions (PIs) that are based on the theory of positive psychology have proven to be effective in improving well-being and alleviating depression. However, little research has explored ...the effect of dosing intervals on experimental effects. As such, this study designed strength-based PIs using cognitive reframing theory and compared flexible and fixed dosing intervals to find out which one could more effectively reduce depression with equal total amounts of dosing. The 8-item Center for Epidemiological Studies Depression Scale (8-item CES-D) and the Positive reframing scale (PRS) were adopted as research instruments. A total of 193 Taiwanese college students were recruited as the research sample and they were randomly assigned to experimental Group A (fixed dosing intervals), experimental Group B (flexible dosing intervals), and the Control Group. The research participants received 17-day interventions with follow-up tests administered in the seventh week of the experiment. Ultimately, 157 participants completed the experiment. According to the ANCOVA results, participants in experimental Group A showed significantly lower degrees of depression than those in the Control Group in both post-test and follow-up stages and displayed greater effect size in the follow-up stage than in the post-test stage. The results indicated that the design of fixed dosing intervals enabled the participants to effectively integrate reflections on reframing learned during PIs into their life. On the contrary, participants in experimental Group B exhibited no significant difference in the degree of depression from those in the Control Group during either the post-test or follow-up stage and manifested poorer effects in the follow-up stage than in the post-test stage. These results demonstrated that fixed dosing intervals achieved better effects than flexible dosing intervals. Participants receiving fixed dosing intervals could more effectively execute cognitive reframing and showed longer-lasting experimental effects, whereas participants using the design of flexible dosing intervals were more prone to forget to implement PIs and attain less positive effects as a result.
Asymptomatic erosive esophagitis (AEE) is commonly found in men, and might be a risk factor of developing esophageal adenocarcinoma. We aimed to determine if specific dietary habits increase the risk ...of AEE in asymptomatic Taiwanese men.
We recruited male adults undergoing upper gastrointestinal endoscopy for health check. We excluded subjects with reflux symptoms, or taking anti-reflux medications or drugs that potentially impair lower esophageal sphincter function or cause mucosal injury. The frequency of consuming reflux-provoking diets including alcohol, tea, coffee, tomato/citric juice, chocolate, sweet food, and spicy food was assessed. The erosive esophagitis was diagnosed based on the Los Angeles Classification after endoscopy. Frequent consumption of a specific diet was defined as ≥4 days/week of consuming that diet.
A total of 1256 participants were recruited. After excluding 424 ineligible subjects, AEE was identified in 180 (22%) among 832 asymptomatic subjects. The risk of AEE increased with the number of days per week of consuming alcohol or tea: nondrinkers (19%, 17%), occasional drinkers (<1 day/week; 19%, 15%), regular drinkers (1-3 days/week; 26%, 21%), frequent drinkers (4-6 days/week; 32%, 22%), and daily drinkers (42%, 28%), respectively (trend test P < 0.001 for both). Multivariate analysis showed that hiatus hernia (adjusted odds ratio (aOR) 5.0, 95% confidence interval (CI) 2.6-9.6), drinking alcohol ≥4 days/week (aOR 2.3, 95% CI 1.3-4.0), and drinking tea ≥4 days/week (aOR 1.6, 95% CI 1.1-2.3) are independent risk factors of AEE. The risk of AEE was 3.8 times greater for those drinking both alcohol and tea ≥4 days/week than the non-drinkers.
Frequent alcohol and tea consumption increased the risk of AEE in Taiwanese men.
Previous deep learning studies on optical coherence tomography (OCT) mainly focused on diabetic retinopathy and age-related macular degeneration. We proposed a deep learning model that can identify ...epiretinal membrane (ERM) in OCT with ophthalmologist-level performance.
Cross-sectional study.
A total of 3,618 central fovea cross section OCT images from 1,475 eyes of 964 patients.
We retrospectively collected 7,652 OCT images from 1,197 patients. From these images, 2,171 were normal and 1,447 were ERM OCT. A total of 3,141 OCT images was used as training dataset and 477 images as testing dataset. DL algorithm was used to train the interpretation model. Diagnostic results by four board-certified non-retinal specialized ophthalmologists on the testing dataset were compared with those generated by the DL model.
We calculated for the derived DL model the following characteristics: sensitivity, specificity, F1 score and area under curve (AUC) of the receiver operating characteristic (ROC) curve. These were calculated according to the gold standard results which were parallel diagnoses of the retinal specialist. Performance of the DL model was finally compared with that of non-retinal specialized ophthalmologists.
Regarding the diagnosis of ERM in OCT images, the trained DL model had the following characteristics in performance: sensitivity: 98.7%, specificity: 98.0%, and F1 score: 0.945. The accuracy on the training dataset was 99.7% (95% CI: 99.4 - 99.9%), and for the testing dataset, diagnostic accuracy was 98.1% (95% CI: 96.5 - 99.1%). AUC of the ROC curve was 0.999. The DL model slightly outperformed the average non-retinal specialized ophthalmologists.
An ophthalmologist-level DL model was built here to accurately identify ERM in OCT images. The performance of the model was slightly better than the average non-retinal specialized ophthalmologists. The derived model may play a role to assist clinicians to promote the efficiency and safety of healthcare in the future.
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