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Microbial electrosynthesis is a promising technology that recovers energy from wastewater while converting CO 2 into CH 4 . Constructing a biocathode with both strong H 2 -mediated and direct electron transfer capacities is crucial for efficient startup and long-term stable CH 4 production. This study found that introducing carboxyl groups onto the cathode effectively enhanced both electron transfer pathways, improving the reduction rate and coulombic efficiency of CH 4 production and increasing the CH 4 yield by 2-3 times. Carboxyl groups decreased the overpotential for H 2 evolution and increased current density, thereby enhancing H 2 -mediated electron transfer. Additionally, carboxyl groups increased the relative abundance of Methanosaeta by 3%-10%, doubled the protein content in extracellular polymeric substances, and boosted the expression of cytochrome c-related genes, thereby enhancing direct electron transfer capacity. These findings present a novel and efficient approach for constructing a stable, high-performance biocathode, contributing to energy recovery and CO 2 fixation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Patients with clinically significant portal hypertension (CSPH) are recommended to be treated with non-selective beta-blockers (ie, carvedilol) to prevent the first hepatic decompensation event by the renewing Baveno VII consensus. CSPH is defined by hepatic venous pressure gradient (HVPG)≥10 mm Hg; however, the HVPG measurement is not widely adopted due to its invasiveness. Liver stiffness (LS)≥25 kPa can be used as a surrogate of HVPG≥10 mm Hg to rule in CSPH with 90% of the positive predicting value in majority aetiologies of patients. A compelling argument is existing for using LS≥25 kPa to diagnose CSPH and then to initiate carvedilol in patients with compensated cirrhosis, and about 5%-6% of patients under this diagnosis criteria may not be benefited from carvedilol and are at risk of lower heart rate and mean arterial pressure. Randomised controlled trial on the use of carvedilol to prevent liver decompensation in CSPH diagnosed by LS remains to elucidate. Therefore, we aimed to investigate if compensated cirrhosis patients with LS≥25 kPa may benefit from carvedilol therapy., Methods and Analysis: This study is a randomised, double-blind, placebo-controlled, multicentre trial. We will randomly assign 446 adult compensated cirrhosis patients with LS≥25 kPa and without any previous decompensated event and without high-risk gastro-oesophageal varices. Patients are randomly divided into two groups, with 223 subjects in group A and 223 subjects in group B. Group A is a carvedilol intervention group, while group B is a placebo group. All patients in both groups will receive aetiology therapies and are followed up at an interval of 6 months. The 3-year incidences of decompensated events of cirrhosis-related and liver-related death are the primary outcome. The secondary outcomes include development of each complication of portal hypertension individually (ascites, variceal bleeding or overt hepatic encephalopathy), development of spontaneous bacterial peritonitis and other bacterial infections, development of new varices, growth of small varices to large varices, delta changes in LS and spleen stiffness, change in hepatic dysfunction assessed by Child-Pugh and model for end-stage liver disease score, change in platelet count, development of hepatocellular carcinoma, development of portal vein thrombosis and adverse events with a 3-year follow-up. A predefined interim analysis will be performed to ensure that the calculation is reasonable., Ethics and Dissemination: The study protocol has been approved by the ethics committees of the Sixth People's Hospital of Shenyang (2023-05-003-01) and independent ethics committee for clinical research of Zhongda Hospital, affiliated to Southeast University (2023ZDSYLL433-P01). The results from this trial will be submitted for publication in peer-reviewed journals and will be presented at international conferences., Trial Registration Number: ChiCTR2300073864., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Diabetes is one of the major burdens in health care, but could be controlled if the relevant data are well-managed. Referring to current successful cases, we designed a framework for the interoperability and integration of medical data in compliance with both archetype and reference information model specification. The clinical data model (CDM) was designed on the basis of OpenEHR archetypes and self-made patient generated health data (PGHD). Integrating healthcare enterprise (IHE) protocol was taken into integrating different modality data. After terminology mapping, the personal health record could be transferred and shared in different clinical information vendors complying with HL7 standards. Many fragment data such as blood glucose and gene data were also integrated to system. Those patients suspected of higher risk of diabetic retinopathy (DR) were grouped as case and other patients could be filtered as control cohort. Furthermore, the framework could be further developed for precision medicine.