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Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged over 60 years from the 1999–2014 National Health and Nutrition Examination Survey (NHANES). All included participants were followed up until the date of death or 31 December 2015. Restricted cubic spline analyses were used to explore the associations of PP with cardiovascular mortality and all-cause mortality. The population was categorized into two groups according to the optimal cut-off of PP for all-cause mortality by X-tile software. Propensity matching score analysis was further performed to reduce confounding bias. The Kaplan–Meier curves and Cox proportional hazard models were applied to estimate the associations of widening PP cardiovascular mortality and all-cause mortality. Subgroup analyses were also conducted. Results: A total of 6309 participants were included (52.9% men and median age 69 (63, 75) years). The median follow-up duration was 74 (42, 114) months. The restricted cubic spline analyses revealed that continuous PP was linearly related to cardiovascular mortality (p for linearity < 0.001; p for nonlinearity = 0.284) and nonlinearly related to all-cause mortality (p for nonlinearity = 0.001). After propensity score matching, 1855 subjects with widening PP and 1855 matched counterparts were included (50.2% men and average age 72 (66, 78) years, 50.9% men and average age 72 (66, 78) years, respectively), of which 966 (26.0%) died during a median follow-up duration of 71 (39, 105) months. In the Cox proportional hazards model, widening PP was associated with increased cardiovascular mortality Hazard Ratio (HR) 1.47; 95% Confidence Interval (CI) 1.07–2.00, p < 0.05] and all-cause mortality (HR 1.15; 95% CI 1.01–1.31, p < 0.05). After adjusting for other traditional risk factors, the association of widening PP with cardiovascular mortality (HR 1.44; 95%CI 1.05–1.98, p < 0.05) remained, and the association of widening PP with all-cause mortality was not statistically significant (p > 0.05). Conclusion: In the normotensive elder population, a low-risk population without traditional coronary risk factors, PP is an independent risk factor for cardiovascular mortality.

Objective Many researches have demonstrated the effects of the extreme cold ambient temperature on the risk of out-of-hospital cardiac arrest (OHCA); yet, the results have been inconsistent. We performed a meta-analysis to evaluate whether extreme cold ambient temperature is related to OHCA. Methods We searched for time-series studies reporting associations between extreme cold ambient temperature and OHCA in PubMed, web of science and Cochrane database. Results Six studies involving 2 337 403 cases of OHCA were qualified for our meta-analysis. The odds ratio (OR) of OHCA was significantly increased in extreme cold weather (defined as the 1st or 5th centile temperature year-round) compared to reference temperature (as the 25th centile temperatures or daily mean temperature with minimum risk of OHCA) (OR=1.49, 95% CI 1.18–1.88). The subgroup analysis for the elderly and the female failed to detect the influence of extreme cold weather on OHCA, the ORs are 1.25 (95% CI 0.89–1.75) and 1.19 (95% CI 0.87–1.64), respectively. Conclusion The risk of OHCA is significantly higher in extreme cold ambient temperatures than in reference temperature, according to a relative temperature scale with percentiles of the region-specific temperature distribution.

The association of anion gap (AG) with short-term mortality in the critically ill patients with cardiac diseases is still not well understood.To evaluate the association of AG with short-term mortality, and the predictive ability of AG for short-term mortality in critically ill patients with cardiac diseases.This retrospective cohort study enrolled 9104 critically ill patients with cardiac diseases from the Medical Information Mart for Intensive Care III (MIMIC III) database. The restricted cubic spline models were used to evaluate the nonlinear relationship between AG and short-term mortality. Cox proportional hazards regression models and subgroup analysis were applied to assess the association of AG with short-term mortality.The data were divided into three groups by AG tertiles: tertile I (AG12, n = 2095), tertile II (12 ≤ AG15, n = 3195), and tertile III (15 ≤ AG, n = 3814). The restricted cubic spline models revealed continuous AG was non-linearly related to short-term mortality. The elevated AG tertiles were strongly associated with higher in-hospital, 30-day and 90-day mortality (all P for trend 0.001). After adding AG to traditional severity scores, the area under curves (AUCs) elevated significantly compared to severity scores alone (all DeLong's test: P 0.001). Subgroup analysis did not indicate significant interaction in most diverse subgroups.AG was an independent risk factor for short-term all-cause mortality in critically ill patients with cardiac diseases. AG improved significantly the mortality predictive abilities of traditional severity scores when AG was added to these scores.

As a promising component for next-generation high energy lithium-ion batteries, silicon based electrode has attracted increasing attention by virtue of ultrahigh theoretical specific capacities. Nevertheless, fast capacity fade posed by tremendous volume changes during the lithiation and delithiation process remains a huge challenge before large-scale applications. Inspired by spidroin, we herein develop a tenacious hierarchical structure binder for tolerating huge volume change of silicon-based anode, which is prepared through simply mixing aqueous poly(acrylic acid) solution, and oily N-methyl pyrrolidone solution containing a tetrazole groups based copolymer (PPB) of polyacrylonitrile and poly(ethylene glycol) bisazide. Such an aqueous-oil binary solution based blend (AOB) binder exhibits a spidroin-like hierarchical structure. In the AOB binder, hydrophobic PPB polymer condensates in the mixture solution to form crystalline region within submicron-sized irregular spherical domains as the rigid node of the molecular chain segment similar to β-sheet of spidroin; while water-souble, amorphous poly(acrylic acid) mimicks the α-helix structure of spidroin, and builds up a network structure by linking with PPB via ionic bonding similar to the interactions between repetitive amino acid sequence segment in the primary structure of spidroin. Benefited by these, AOB binder enables both high tensile strength and elasticity, and superior adhesion of electrodes, therefore apparently stabilizing silicon-based anode structure and rendering prolonged electrode cycle life. This work marks a milestone in developing state-of-the-art silicon-based electrodes towards high energy density lithium battery applications.

Background The long-term outcomes for patients after coronary artery bypass grafting (CABG) have been received more and more concern. The existing prediction models are mostly focused on in-hospital operative mortality after CABG, but there is still little research on long-term mortality prediction model for patients after CABG. Objective To develop and validate a novel nomogram for predicting 3-year mortality in critically ill patients after CABG. Methods Data for developing novel predictive model were extracted from Medical Information Mart for Intensive cart III (MIMIC-III), of which 2929 critically ill patients who underwent CABG at the first admission were enrolled. Results A novel prognostic nomogram for 3-year mortality was constructed with the seven independent prognostic factors, including age, congestive heart failure, white blood cell, creatinine, SpO2, anion gap, and continuous renal replacement treatment derived from the multivariable logistic regression. The nomogram indicated accurate discrimination in primary (AUC: 0.81) and validation cohort (AUC: 0.802), which were better than traditional severity scores. And good consistency between the predictive and observed outcome was showed by the calibration curve for 3-year mortality. The decision curve analysis also showed higher clinical net benefit than traditional severity scores. Conclusion The novel nomogram had well performance to predict 3-year mortality in critically ill patients after CABG. The prediction model provided valuable information for treatment strategy and postdischarge management, which may be helpful in improving the long-term prognosis in critically ill patients after CABG.

For layered transition metal oxides cathode-based lithium batteries, the chemical degradation of electrolytes leads to fast battery capacity decay, severely challenging their practical applications. This kind of chemical degradation of electrolytes is caused by the oxidation of reactive oxygen (e.g., singlet oxygen) and the attack of free radicals during cycling. To address this, we first report a biologically inspired antiaging strategy of developing the photostabilizer with singlet oxygen- and free radicals-scavenging abilities as a cathode binder additive. It is fully evidenced that this binder system consisting of the binder additive and a commercially available polyvinylidene difluoride can scavenge singlet oxygen and free radicals generated during high-voltage cycling, thus significantly restraining electrolyte decomposition. As a result, high-voltage layered transition metal oxides-based lithium batteries with reproducibly superior electrochemical performance, even under elevated temperatures, can be achieved. This bioinspired strategy to scavenge reactive oxygen and free radicals heralds a new paradigm for manipulating the cathode/electrolyte interphase chemistry of various rechargeable batteries involving layered transition metal oxides-based cathodes.

Electrolyte leakage is a severe safety concern in lithium batteries. With highly volatile 1,2-dimethoxyethane as solvent, the leakage related hazards are more pronounced in lithium-sulfur (Li-S) batteries. To address this concern, a leakage-proof electrolyte is delicately designed through functionalizing the commercial electrolyte by Li6 PS5 Cl-grafted poly(ethyl cyanoacrylate), which can interact readily with the aluminum-plastic packing through hydrogen bond to immobilize the electrolyte. The moisture from ambient can also catalyze a further polymerization of the macromolecules to seal the leaking points and thereby to solve the leakage issue, endowing Li-S batteries superior safety even in an artificial cut pouch cell. With a bare S loading of 4.9 mg cm-2 , the battery can deliver good endurance owing to the suppressed polysulfide shuttle by its polar groups. This work enlightens the design of leakage-proof electrolyte and makes a milestone for high performance Li-S batteries.

Research on the chemistry of high-energy-density transition metal oxide cathodes (TMOCs) is at the forefront in the pursuit of lithium-ion batteries with increased energy density. As a critical component of these cathodes, binders not only glue cathode active material particles and conducting carbons together and to current collectors but also play pivotal roles in building multiscale compatible interphases between electrolytes and cathodes. In this review, we outline several vital design considerations of high-voltage binders, several of which are already present in traditional binder design that need to be highlighted, and systematically reveal the chemistry and mechanisms underpinning such binders for in-depth understanding. Further optimization of the design of polymer binders to improve battery performance is also discussed. Finally, perspectives regarding the future rational design and promising research opportunities of state-of-the-art binders for high-voltage TMOCs are presented.

A series of copolymers of thiazoloisoindigo (TzII) with different chalcogenophene trimers were synthesized to systematically investigate the chalcogen effect on their charge transport properties. When only the middle thiophene ring of terthiphene (T-T-T) is replaced by heavier chalcogenophenes, a preference (expressed by the ratio of μe/μh) towards electron transport was observed descending from T-T-T to T-Se-T then to T-Te-T (Se and Te stand for selenophene and tellurophene, respectively). On the other hand, with the increased number of heavier chalcogenophenes, a preference toward hole transport was observed descending from Se-T-Se to Se-Se-Se then to Se-Te-Se. This phenomenon is well-explained by the balance between the aromatic resonance energy of the chalcogenophenes and the electronegativity of the chalcogens. Specifically, P(TzII-T-Se-T) displayed relatively balanced ambipolar property (μhmax and μemax of 3.77 and 1.59 cm2·V−1·s−1 with a μe/μh of 0.42), while P(Tzll-Se-Te-Se) exhibited the best preference to hole transfer with a μe/μh of 0.09. P(Tzll-T-Te-T) exhibited the best preference to electron transfer with a μe/μh, of 16 and the μemax of 0.64 cm2·V−1·s−1 which is the highest electron mobility among the known conjugated polymers containing tellurophenes.

By virtue of environmental friendliness, low cost, and the high theoretical capacity of sulfur (1675 mAh/g), metal–sulfur batteries (MSBs), as promising next-generation rechargeable cells, have att...

Background. To evaluate the prognostic value of preoperative activated partial thromboplastin time (APTT) in patients who underwent coronary artery bypass grafting (CABG). Methods. All data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The study population was divided to two groups according to the optimal cut-off value of APTT calculated by X-tile software, and Cox proportional hazard model was used to define independent effect of APTT on 4-year mortality. Survival curves were estimated by the Kaplan-Meier method, and the area under the receiver-operating characteristic curve (AUC) was calculated to compare APTT with other severity scores. Propensity score matching (PSM) analysis were applied to ensure the robustness of this study. Results. A total of 2,706 patients were included. The optimal cut-off value of APTT for 4-year mortality was 44 seconds. The Cox proportional hazard model showed that patients with APTT ≥ 44 had a significantly higher risk of all-cause death than those with APTT < 44 both before (HR (95% CI), 1.42 (1.16-1.74), P < 0.001 ) and after PSM (HR (95% CI), 1.47 (1.14-1.89), P = 0.003 ). The survival curves showed that patients with longer APTT had a significantly lower 1-year and 4-year cumulative survival probability. The ROC of APTT combined with other severity scores significantly increased predictive ability for 1-year and 4-year mortality. Conclusions. A longer APTT (≥44) was associated with a higher risk of mortality and can serve as a prognostic predictor in CABG patients.

The development of gel polymer electrolytes (GPEs) is considered to be an effective strategy to drive practical applications of high-voltage lithium metal batteries (HLMBs). However, rare GPEs that can satisfy the demands of HLMBs have been developed because of the limited compatibility with lithium anodes and high-voltage cathodes simultaneously. Herein, a novel strategy for constructing polymer matrixes with a customized frontier orbital energy for GPEs is proposed. The as-investigated polymer matrix (P(CUMA-NPF6))-based GPE (P(CUMA-NPF6)-GPE) obtained via in situ random polymerization delivers a wide voltage window (0-5.6 V vs Li+/Li), large lithium-ion transference number (tLi+, 0.61), and superior electrode/electrolyte interface compatibility. It is to be noted that such a tLi+ of P(CUMA-NPF6)-GPE, which is one of the largest tLi+ among high-voltage GPEs in a fair comparison, results from the high dissociation of lithium salts and effective anion immobilization abilities of P(CUMA-NPF6). Ultimately, the as-assembled HLMB delivers more enhanced cycle performance than its counterpart of commercial liquid electrolytes. It is also demonstrated that P(CUMA-NPF6) can scavenge the active PF5 intermediate generated in the electrolyte at the anode side, thus suppressing the PF5-mediated decomposition reaction of carbonates. This work will enlighten the rational structure design of GPEs for HLMBs.

Great efforts have been devoted to the development of high-energy-density lithium-ion batteries (LIBs) to meet the requirements of emerging technologies such as electric cars, large-scale energy storage, and portable electronic devices. To this end, silicon-based electrodes have been increasingly regarded as promising electrode materials by virtue of their high theoretical capacity, low costs, environmental friendliness, and high natural abundance. It has been noted that during repeated cycling, severe challenges such as huge volume change remain to be solved prior to practical application, which boosts the development of advanced cross-linked binders via chemical bonds (CBCBs) beyond traditional PVDF binder. This is because CBCBs can effectively fix the electrode particles, inhibit the volume expansion of Si particles, and stabilize the solid electrolyte interface and thus can enable good cycling stability of silicon anode-based batteries. In light of these merits, CBCBs hence arouse much attention from both industry and academia. In this review, we present chemical/mechanical characteristics of CBCBs and systematically discuss the recent advancements of cross-linked binders via chemical bonding for silicon-based electrodes. Focus is placed on the cross-linking chemistries, construction methods and structure-performance relationships of CBCBs. Finally, the future development and performance optimization of CBCBs are proposed. This discussion will provide good insight into the structural design of CBCBs for silicon-based electrodes.

In situ polymerization system can provide a compact and compatible interface with minimum polymer electrolyte, which is imperative to address the bottleneck of notorious solid–solid interface issue...

Summary The studies of perovskite film in the perovskite solar cells (PSCs) mainly focus on their crystallization and growth, but the reactions that happen in the precursor solutions are still not very clear, which is leading to the bad reproducibility for high-efficient devices. We demonstrated that, in the methylammonium- and formamidinium-mixed organic cation perovskite solution, the methylamine molecule could be first generated from the deprotonation of methylammonium iodide, and then condensate with formamidinium iodide to form N-methyl formamidinium iodide and N, N′-dimethyl formamidinium iodide. The triethyl borate was carried out as a stabilizer to restrain the deprotonation of methylammonium iodide in the precursor solutions, resulting in the elimination of the impurity phase in perovskite films. We think that the introduction of stabilizer in the perovskite precursor solution will become a common strategy for mixed-organic-cation PSCs in the future to improve the reproducibility and efficiency.

High voltage spinel manganese oxide LiNi0.5Mn1.5O4 (LNMO) cathodes are promising for practical applications owing to several strengths including high working voltages, excellent operating safety, low costs, and so on. However, LNMO-based lithium-ion batteries (LIBs) fade rapidly mainly owing to unqualified electrolytes, hence becoming a big obstacle toward practical applications. To tackle this roadblock, substantial progress has been made thus far, and yet challenges still remain, while rare reviews have systematically discussed the status quo and future development of electrolyte optimization coupling with LNMO cathodes. Here, we discuss cycling degradation mechanisms at the cathode/electrolyte interface and ideal requirements of electrolytes for LNMO cathode-equipped LIBs, as well as review the recent advance of electrolyte optimization for LNMO cathode-equipped LIBs in detail. And then, the perspectives regarding the future research opportunities in developing state-of-the-art electrolytes are also presented. The authors hope to shed light on the rational optimization of advanced organic electrolytes in order to boost the large-scale practical applications of high voltage LNMO cathode-based LIBs.

Dual-ion batteries (DIBs) have grand prospects for use in electric vehicles owing to their high voltage and low cost. However, the electrochemically catalyzed electrolyte decomposition arises from incompatible cathode/electrolyte interfaces at high voltages, which can hinder their extensive applications. The adoption of polymer electrolytes provides a feasible strategy to address such a critical issue. Herein, an interfacially self-reinforced polymer electrolyte of polyvinylidene fluoride/polyvinyl acetate (PVDF/PVAc) is proposed to enhance the electrochemical performance of DIBs. It is found that PVAc can trap poisonous POF3, forming PVAc derivatives with superior oxidation resistance and mitigating the autocatalytic electrolyte decomposition. Meanwhile, these derivatives along with PVDF construct an F-rich cathode/electrolyte interface, which remarkably restrains carbonate decomposition. By virtue of this self-reinforcement strategy, the polymer electrolyte DIB (PDIB) exhibits improved average coulombic efficiency of 96% even under a high cut-off voltage of 5.35 V vs. Li/Li+ and achieves outstanding cyclability with 92% capacity retention after 2000 cycles. Moreover, PDIB is applicable in a wide temperature range between −10 °C and 60 °C. This polymer chemistry reinforcement strategy will boost the development of low-cost DIBs and enlighten other related high-voltage batteries.

Solid polymer electrolytes (SPEs) have been considered as an effective approach to eliminate most of the potential safety issues encountered in conventional liquid electrolytes for lithium batteries. Substantial research efforts have been devoted to exploiting better comprehensive performance SPE systems, including poly(ethylene oxide), polycarbonates, polymeric siloxanes (PSs), polyphosphazenes and plastic crystals-based SPEs. Among them, PSs-based SPEs have been increasingly regarded as good candidates for SPEs due to low glass transition temperatures (Tg), excellent thermal and chemical stabilities, and facile chemical modifications. Despite great efforts in this field, however, PSs-based electrolytes still suffer from several challenges and can hardly meet the requirements of practical applications. In addition, to the best of our knowledge, separate and detailed reviews on the progress of PSs-based SPEs, especially in the recent progress after 2009 for lithium batteries are rare. In this review, we comprehensively summarize the progress in PSs for solid state lithium batteries (SLBs), including polysiloxanes, silsesquioxanes and oligosiloxanes based electrolytes from perspectives of the ionic conductivity, electrochemical properties and modification strategies, as well as their potential applications in SLBs. In addition, several possible research directions and strategic designs are also suggested to further improve comprehensive performance of siloxane-based polymer electrolytes. Our review will provide clear guidance in exploring high performance siloxane-based polymer electrolytes for SLBs.

Graphitic carbon that allows reversible anion (de)intercalation is a promising cathode material for cost-efficient and high-voltage dual-ion batteries (DIBs). However, one notorious but overlooked issue is the incomplete interfacial anion desolvation, which not only reduces the oxidative stability of electrolytes, but also results in solvent co-intercalation into graphite layers. Here, an "anion-permselective" polymer electrolyte with abundant cationic quaternary ammonium motif is developed to weaken the PF

High-voltage spinel manganese oxide LiNi0.5Mn1.5O4 (LNMO) that possesses high energy densities, high thermal and electrochemical stabilities, good operating safeties, low costs, and good rate perfo...

A novel polymeric sodium tartaric acid borate is synthesized and blended with poly(vinylene carbonate) to prepare a single-ion conducting gel polymer electrolyte (PSP-GPE). The PSP-GPE possesses a superior ionic conductivity of 1 × 10−4 S cm−1 at ambient temperature and a high sodium ion transference number of 0.88. Compared to the NaClO4 based liquid electrolyte, the Na3V2(PO4)3/Na battery assembled with the PSP-GPE exhibits improved cycling performance, especially at elevated temperatures, and effective suppression of sodium dendrites. This work demonstrates a promising method to design single-ion conducting gel polymer electrolytes for elevated-temperature sodium metal batteries.

Layered transition metal oxides such as LiNixMnyCo1−x−yO2 and LiNixCoyAl1−x−yO2 (NCA) (referred to as ternary cathode material, TCM) are widely recognized to be promising candidates for lithium batteries (LBs) due to superior reversible capacities, high operating voltages and low production costs. However, despite recent progress toward practical application, commercial TCM-based lithium ion batteries (LIBs) suffer from severe issues such as the use of flammable and hazardous electrolytes, with one high profile example being the ignition of NCA-based LIBs used in Tesla Model S vehicles after accidents, which jeopardizes the future development of TCM-based LBs. Here, the need for TCM and flammable liquid electrolytes in TCM-based LBs is a major obstacle that needs to be overcome, in which conflicting requirements for energy density and safety in practical application need to be resolved. To address this, polymer electrolytes have been demonstrated to be a promising solution and thus far, many polymer electrolytes have been developed for high-performance TCM-based LBs. However, comprehensive performances, especially long-term cycling capabilities, are still insufficient to meet market demands for electric vehicles, and moreover, comprehensive reviews into polymer electrolytes for TCM-based LBs are rare. Therefore, this review will comprehensively summarize the ideal requirements, intrinsic advantages and research progress of polymer electrolytes for TCM-based LBs. In addition, perspectives and challenges of polymer electrolytes for advanced TCM-based LBs are provided to guide the development of TCM-based power batteries.

Spinel LiNi0.5Mn1.5O4 (LNMO) is one of the most promising cathode materials for high-energy density lithium batteries owing to its high reversible capacity and high operating voltage. However, LNMO-based lithium batteries have poor cycling performance due to the decomposition of liquid electrolytes and dissolution of transition metal (e.g. Mn and Ni) ions at high operating voltages. Herein, poly(methyl vinyl ether-alt-lithium maleic acid) (P(MVE-LMA)) is presented as an excellent aqueous binder for the first time to tackle the abovementioned issues, in which the lithium carboxylic motifs of P(MVE-LMA) deliver superior adhesion and cohesion capabilities and interact with transition metal cations to inhibit their dissolution from cathodes, whereas its ether motifs can adsorb on the carbon particle surface to render excellent distribution of carbon black. As a result, a 5 V-class LNMO/Li battery fabricated employing the P(MVE-LMA) binder exhibited better electrochemical performance (e.g., cycling life, cell impedance and rate capability) when compared with the battery with the traditional polyvinylidene fluoride (PVDF) binder. A more thorough investigation clearly elucidated that the enhanced battery performance of the P(MVE-LMA) binder could be attributed to the generation of a favorable cathode electrolyte interphase (CEI) layer, in turn favorably suppressing the oxidative decomposition of electrolytes and stabilizing the lattice structure of LNMO upon cycling.

Despite their attractive properties such as high operating voltages and considerable rate capabilities, the commercialization of LiNi0.5Mn1.5O4 cathodes is plagued by rapid capacity fading that stems from the severe parasitic side reactions with conventional liquid carbonate based electrolytes at a high voltage exceeding 4.5 V (vs. Li+/Li). In this work, a poly(vinylene carbonate-acrylonitrile) based gel polymer electrolyte (PVN-GPE) is intricately designed by copolymerizing acrylonitrile with vinylene carbonate. The intricately designed PVN-GPE can exhibit superior compatibility with LiNi0.5Mn1.5O4 cathodes, in order to address the above-mentioned severe parasitic side reactions. When evaluating the electrochemical properties of LiNi0.5Mn1.5O4/graphite full cells assembled with the PVN-GPE, an outstanding cycling stability (with a capacity retention of 93.2% after 200 cycles) has been achieved, which is far more superior to that of conventional liquid electrolytes. It is noted that the introduction of vinylene carbonate endows the PVN-GPE with improved interfacial compatibility towards lithium anodes, which can efficiently suppress the formation of lithium dendrites and enables excellent cycling performance (with a capacity retention of 90% after 200 cycles) of LiNi0.5Mn1.5O4/Li metal batteries. Our work presents an intriguing 5 V class high-voltage polymer electrolyte with superior performance and will boost the development of high-energy-density lithium batteries.