Improvement of Photovoltaic Performance of Perovskite Solar Cells by Synergistic Modulation of SnO2 and Perovskite via Interfacial Modification.

In the past decade, perovskite solar cell (PSC) photoelectric conversion efficiency has advanced significantly, and tin dioxide (SnO2) has been extensively used as the electron transport layer (ETL). Due to its high electron mobility, strong chemical stability, energy level matching with perovskite, and easy low-temperature fabrication, SnO2 is one of the most effective ETL materials. However, the SnO2 material as an ETL has its limitations. For example, SnO2 films prepared by low-temperature spin-coating contain a large number of oxygen vacancies, resulting in energy loss and high open-circuit voltage (VOC) loss. In addition, the crystal quality of perovskites is closely related to the substrate, and the disordered crystal orientation will lead to ion migration, resulting in a large number of uncoordinated Pb2+ defects. Therefore, interface optimization is essential to improve the efficiency and stability of the PSC. In this work, 2-(5-chloro-2-benzotriazolyl)-6-tert-butyl-p-cresol (CBTBC) was introduced for ETL modification. On the one hand, the hydroxyl group of CBTBC forms a Lewis mixture with the Sn atom, which reduces the oxygen vacancy defect and prevents nonradiative recombination. On the other hand, the SnO2/CBTBC interface can effectively improve the crystal orientation of perovskite by influencing the crystallization kinetics of perovskite, and the nitrogen element in CBTBC can effectively passivate the uncoordinated Pb2+ defects at the SnO2/perovskite interface. Finally, the prevailing PCE of PSC (1.68 eV) modified by CBTBC was 20.34% (VOC = 1.214 V, JSC = 20.49 mA/cm2, FF = 82.49%).

Handgrip strength and risks of diabetic vascular complications: Evidence from Guangzhou Diabetic Eye Study and UK cohorts.

PURPOSE: The purpose is to investigate the association between handgrip strength (HGS) and the risk of future diabetic complications in multicountry cohorts. METHODS: The association between HGS and diabetic complications was evaluated using cox models among 84 453 patients with pre-diabetes and diabetes from the UK Biobank with a 12-year follow-up. The association between HGS and longitudinal microcirculatory damage rates was assessed among 819 patients with diabetes from the Guangzhou Diabetic Eye Study (GDES) with a 3-year follow-up. Participants were divided into three age groups (<56, 56-65 and ≥65 years), and each group was further subdivided into three HGS tertiles. RESULTS: A 5 kg reduction in HGS was associated with increased risk for all-cause mortality (women, HR=1.10, 95% CI: 1.05 to 1.14; p<0.001; men, HR=1.13, 95% CI: 1.11 to 1.15; p<0.001). Women and men in the lowest HGS group exhibited 1.6-times and 1.3-1.5-times higher risk of myocardial infarction and stroke compared with the highest HGS group. In men, there was a higher risk of developing end-stage renal disease (HR=1.83, 95% CI: 1.30 to 2.57; p=0.001), while this was not observed in women. Both sexes in the lowest HGS group had a 1.3-times higher risk of diabetic retinopathy compared with the highest HGS group. In the GDES group, individuals with the lowest HGS showed accelerated microcirculatory damage in retina (all p<0.05). CONCLUSIONS: Reduced HGS is significantly associated with a higher risk of diabetic complications and accelerated microvascular damage. HGS could serve as a practical indicator of vascular health in patients with pre-diabetes and diabetes.

Laser forward and backward scattering characteristics and experimental study of bubbles in ship wake.

The detection and tracking of ships can be realized by using the laser forward and backward scattering characteristics of ship wake bubbles. In this paper, the detection ability of two kinds of scattering to wake bubbles is studied. Based on the distribution characteristics of ship wake and bubble targets, typical bubble targets are selected to study from both micro and macro aspects. The light scattering model of water is established from the microscopic aspect, and the forward and backward scattering light intensity equations of water are derived. The circumferential scattering characteristics of a single bubble are analyzed based on the Mie scattering theory. According to the transmission characteristics of light in wake bubbles, the secondary scattering model of wake bubbles is established, and the forward and backward scattering light intensity equations are derived. In the macroscopic aspect, the laser scattering simulation model of wake bubbles is established by Monte Carlo, and the forward and backward scattering characteristics of wake bubble clusters with different radii, densities, and thicknesses are analyzed emphatically. A laser forward scattering and backscattering detection system under typical bubble characteristics was built, and the composite scattering characteristics of wake bubbles with different parameter characteristics were experimentally analyzed. The theoretical and experimental results show that with the increase of bubble radius, density, and thickness, the amplitude of laser forward scattering signal of bubble groups decreases gradually, the amplitude of backward scattering signal increases gradually, the change rate of forward and backward scattering amplitude increases, and the change rate of backscattering is obviously larger than that of forward scattering. The detection of wake bubbles by backscattering has more characteristic changes than that by forward scattering, and the detection success rate is higher. The research results can provide theoretical and experimental support for the design of a ship wake laser detection system.

Strain Regulation of Mixed-Halide Perovskites Enables High-Performance Wide-Bandgap Photovoltaics.

Wide-bandgap mixed-halogen perovskite materials are widely used as top cells in tandem solar cells. However, serious open-circuit voltage (Voc) loss restricts the power conversion efficiency (PCE) of wide-bandgap perovskite solar cells (PSCs). Herein, it is shown that the resulting methylammonium vacancies induce lattice distortion in methylammonium chloride-assisted perovskite film, resulting in an inhomogeneous halogen distribution and low Voc. Thus, a lattice strain regulation strategy is reported to fabricate high-performance wide-bandgap PSCs. Rubidium (Rb) cations are introduced to fill the A-site vacancy caused by the methylammonium volatilization, which alleviates shrinkage strain of the perovskite crystal. The reduced lattice distortion and increased halide ion migration barrier result in a homogeneous mixed-halide perovskite film. Due to improved carrier transport and suppressed nonradiative recombination, the Rb-treated wide-bandgap PSC (1.68 eV) achieves an excellent PCE of 21.72%, accompanied by a high Voc of 1.22 V. The resulting device maintains more than 90% of its initial PCE after 1500 h under 1-sun illumination conditions.

Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect.

Importance: Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS. Objective: To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC). Design, Setting, and Participants: This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up. Results: The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 µm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 µm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 µm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model's performance. Conclusions and Relevance: This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 µm and light-room ARA at 750 µm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.

Degradation of bisphenol A by persulfate activation of MoS2 composite iron tailings.

In this paper, molybdenum disulfide was grown on the surface of iron-containing tailings by hydrothermal method, and a series of highly efficient activated persulfate (PMS) iron-based catalysts were successfully prepared. The results show that in the CTM 1-200/PMS system, the additional ratio of tailings and the hydrothermal temperature have important effects on the catalyst. The catalyst prepared under the conditions of CT:MoS2 (molar ratio 1:1) and hydrothermal temperature of 200 °C (CTM 1-200) had the best degradation effect on BPA, and the degradation effect was increased by four times. The reason for the improvement of degradation efficiency is that the introduction of MoS2 accelerates the REDOX cycle between Fe(II)/Fe(III), and the reduction of Fe(III) is mainly related to Mo(IV), while the reduction capacity of S is relatively weak. Molybdenum disulfide/iron tailing composite material provides a way for tailings to solve the problem of water pollution.

Metabolic fingerprinting on retinal pigment epithelium thickness for individualized risk stratification of type 2 diabetes mellitus.

The retina is an important target organ of diabetes mellitus, with increasing evidence from patients and animal models suggesting that retinal pigment epithelium (RPE) may serve as an early marker for diabetes-related damages. However, their longitudinal relationship and the biological underpinnings remain less well understood. Here, we demonstrate that reduced in vivo measurements of RPE thickness (RPET) represents a significant risk factor for future type 2 diabetes mellitus (T2DM) and its microvascular phenotypes. After performing systematic analyses of circulating plasma metabolites using two complementary approaches, we identify a wide range of RPET metabolic fingerprints that are independently associated with reduced RPET. These fingerprints hold their potential to improve predictability and clinical utility for stratifying future T2DM and related microvascular phenotypes beyond traditional clinical indicators, providing insights into the promising role of retinas as a window to systemic health.

Heteropolymer improves p-i junction in perovskite solar cells.

The p-i heterojunction imbedded underneath the perovskite layer plays a vital role in determining the efficiency and stability of inverted perovskite solar cells (PSCs). We found that poly[bis(4-phenyl) (2,4,6-trimethylphenyl) amine] (PTAA) suffers from the severely chain entanglement resulting in poor contact with perovskite. In this work, PTAA layer was treated by poly[(2,6-(4,8-bis(5-(2-ethylhexylthio)-4-fluorothiophen-2-yl)-benzo[1,2-b:4,5-b'] dithiophene))-alt-(5,5-(1',3'-di-2-thienyl-5',7'-bis(2-ethylhexyl) benzo[1',2'-c:4',5'-c'] dithiophene-4,8-dione)] (PBDB-T-SF) diluted solution in chlorobenzene. PBDB-T-SF, which contains dual carbonyl groups in its backbones and suitable electronic levels, can spontaneously fill the voids in chlorobenzene-washed PTAA (nano-PTAA). This not only promotes the work function of the substrate but also strengthens the coherence between perovskite and the substrate. Blade coated PSC (0.09 cm2) containing PBDB-T-SF (s-PSCs) realized a power conversion efficiency (PCE) of 21.83 %. After aging for more than 2000 h, s-PSCs maintains 88 % of the initial efficiency which is only 59 % for the control devices.

Lattice Strain Regulation Enables High-Performance Formamidinium Perovskite Photovoltaics.

Formamidinium lead iodide (FAPbI3 ) perovskite possesses an ideal optical bandgap and is a potential material for fabricating the most efficient single-junction perovskite solar cells (PSCs). Nevertheless, large formamidinium (FA) cations result in residual lattice strain, which reduces the power conversion efficiency (PCE) and operational stability of PSCs. Herein, the modulation of lattice strain in FAPbI3 crystals via a π-conjugated organic amine, i.e., 4-pyrene oxy butylamine (PYBA), is proposed. PYBA pairs at the grain boundary serve as a template for the crystallization of FAPbI3 perovskite, thereby inducing a highly oriented crystal and a pure α-phase film. The PYBA pairs with strong π-π interactions provide a solid fulcrum for external compression strain, thus compensating for the inherent tension strain of FAPbI3 crystals. The strain release elevates the valence band of the perovskite crystals, thereby decreasing the bandgap and trap density. Consequently, the PYBA-regulated FAPbI3 PSC achieves an excellent PCE of 24.76%. Moreover, the resulting device exhibits improves operational stability and maintains over 80% of its initial PCE after 1500 h under maximum power point tracking conditions.

Single Crystalline Transparent Conducting F, Al, and Ga Co-Doped ZnO Thin Films with High Photoelectrical Performance.

Transparent conductive film (TCF) is a material that integrates electrical conductivity and optical transparency. It is widely used as an electrode material in thin-film solar cells. However, considerable progress is needed to facilitate its high performance and low-cost preparation. In this study, a preparation scheme for AlF3 and GaF3 co-doped ZnO (FAGZO) thin films was designed and implemented by magnetron sputtering (MS). The mutual restraint between the electrical properties and the wide-spectrum transmission performance of ZnO films was resolved. First-principles calculations showed that the doped ZnO system had n-type conductivity and that the most stable structure was the FO-AlZn-GaZn system. The experimental results verified the theoretical predictions. Single crystalline ZnO transparent conducting films (ZnO-TCFs) of high quality were achieved by MS. After rapid thermal annealing (RTA) treatment, the mobility reached 49.6 cm2/V s, and the resistivity decreased to 3.82 × 10-4 Ω cm. The AT was 90% between 380 and 1200 nm. Furthermore, the application of the prepared FAGZO film in perovskite solar cells (PSCs) has been verified. Compared to the reference indium tin oxide film, the PSCs using the FAGZO film showed higher JSC and power conversion efficiency. These results demonstrate that MS combined with anion and cation co-doping provides an effective means of exploring high-quality and high-performance ZnO-TCFs.

Analysis of Plasma Metabolic Profile on Ganglion Cell-Inner Plexiform Layer Thickness With Mortality and Common Diseases.

Importance: The neural retina is considered a unique window to systemic health, but its biological link with systemic health remains unknown. Objective: To investigate the independent associations of retinal ganglion cell-inner plexiform layer thickness (GCIPLT) metabolic profiles with rates of mortality and morbidity of common diseases. Design, Setting, and Participants: This cohort study evaluated UK Biobank participants enrolled between 2006 and 2010, and prospectively followed them up for multidisease diagnosis and mortality. Additional participants from the Guangzhou Diabetes Eye Study (GDES) underwent optical coherence tomography scanning and metabolomic profiling and were included for validation. Main Outcomes and Measures: Systematic analysis of circulating plasma metabolites to identify GCIPLT metabolic profiles; prospective associations of these profiles with mortality and morbidity of 6 common diseases with their incremental discriminative value and clinical utility. Results: Among 93 838 community-based participants (51 182 [54.5%] women), the mean (SD) age was 56.7 (8.1) years and mean (SD) follow-up was 12.3 (0.8) years. Of 249 metabolic metrics, 37 were independently associated with GCIPLT, including 8 positive and 29 negative associations, and most were associated with the rates of future mortality and common diseases. These metabolic profiles significantly improved the models for discriminating type 2 diabetes over clinical indicators (C statistic: 0.862; 95% CI, 0.852-0.872 vs clinical indicators only, 0.803; 95% CI, 0.792-0.814; P < .001), myocardial infarction (0.792; 95% CI, 0.775-0.808 vs 0.768; 95% CI, 0.751-0.786; P < .001), heart failure (0.803; 95% CI, 0.786-0.820 vs 0.790; 95% CI, 0.773-0.807; P < .001), stroke (0.739; 95% CI, 0.714-0.764 vs 0.719; 95% CI, 0.693-0.745; P < .001), all-cause mortality (0.747; 95% CI, 0.734-0.760 vs 0.724; 95% CI, 0.711-0.738; P < .001), and cardiovascular disease mortality (0.790; 95% CI, 0.767-0.812 vs 0.763; 95% CI, 0.739-0.788; P < .001). Additionally, the potential of GCIPLT metabolic profiles for risk stratification of cardiovascular diseases were further confirmed in the GDES cohort using a different metabolomic approach. Conclusions and Relevance: In this prospective study of multinational participants, GCIPLT-associated metabolites demonstrated the potential to inform mortality and morbidity risks. Incorporating information on these profiles may facilitate individualized risk stratification for these health outcomes.

Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial.

PURPOSE: This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC). DESIGN: Extended follow-up of the Zhongshan Angle-Closure Prevention Study. PARTICIPANTS: Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS. METHODS: Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit. MAIN OUTCOME MEASURES: Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC. RESULTS: During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI. CONCLUIONS: Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Consumption of Coffee and Tea Is Associated with Macular Retinal Nerve Fiber Layer Thickness: Results from the UK Biobank.

Coffee and tea drinking are thought to be protective for the development and progression of neurodegenerative disorders. This study aims to investigate associations between coffee and tea consumption with macular retinal nerve fiber layer (mRNFL) thickness, a marker of neurodegeneration. After quality control and eligibility screening, 35,557 out of 67,321 United Kingdom (UK) Biobank participants from six assessment centers were included in this cross-sectional study. In the touchscreen questionnaire, participants were asked how many cups of coffee and tea were consumed daily on average over the last year. Self-reported coffee and tea consumption were divided into four categories including 0 cup/day, 0.5-1 cups/day, 2-3 cups/day, and ≥4 cups/day, respectively. The mRNFL thickness was measured by the optical coherence tomography (Topcon 3D OCT-1000 Mark II) and automatically analyzed by segmentation algorithms. After adjusting for covariates, coffee consumption was significantly associated with an increased mRNFL thickness (ß = 0.13, 95% CI = 0.01~0.25), which was more prominent in those who drank 2~3 cups coffee per day (ß = 0.16, 95% CI = 0.03~0.30). The mRNFL thickness was also significantly increased in tea drinkers (ß = 0.13, 95% CI = 0.01~0.26), especially for those who drank more than 4 cups of tea per day (ß = 0.15, 95% CI = 0.01~0.29). The positive associations with mRNFL thickness, indicating that both coffee and tea consumptions had likely neuroprotective potentials. Causal links and underlying mechanisms for these associations should be explored further.

Relationship between Cholesterol-Related Lipids and Severe Acute Pancreatitis: From Bench to Bedside.

It is well known that hypercholesterolemia in the body has pro-inflammatory effects through the formation of inflammasomes and augmentation of TLR (Toll-like receptor) signaling, which gives rise to cardiovascular disease and neurodegenerative diseases. However, the interaction between cholesterol-related lipids and acute pancreatitis (AP) has not yet been summarized before. This hinders the consensus on the existence and clinical importance of cholesterol-associated AP. This review focuses on the possible interaction between AP and cholesterol-related lipids, which include total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein (Apo) A1, from the bench to the bedside. With a higher serum level of total cholesterol, LDL-C is associated with the severity of AP, while the persistent inflammation of AP is allied with a decrease in serum levels of cholesterol-related lipids. Therefore, an interaction between cholesterol-related lipids and AP is postulated. Cholesterol-related lipids should be recommended as risk factors and early predictors for measuring the severity of AP. Cholesterol-lowering drugs may play a role in the treatment and prevention of AP with hypercholesterolemia.

Molecular characteristics, oncogenic roles, and relevant immune and pharmacogenomic features of NEK2 in gastric cancer.

Gastric cancer (GC) is the most common form of gastrointestinal cancer, with a high mortality rate and limited treatment options. High levels of NEK2 are associated with malignant progression and a poor prognosis in several tumors; however, the role of NEK2 in GC remains unclear. We aimed to explore the potential role of NEK2 in the oncogenesis of GC and in the shaping of the tumor microenvironment (TME). The expression levels of NEK2 were analyzed using immunohistochemistry and real-time quantitative polymerase chain reaction. We found that NEK2 expression was upregulated in GC and was a predictor of a poor prognosis. Based on Kyoto Encyclopedia of Genes and Genomes pathway enrichment and gene set enrichment analyses, multiple tumor pathways were hyperactivated in patients with high NEK2 mRNA expression. Immunological characteristics indicated that NEK2 upregulation might lead to decreased immune cell infiltration and weakened immune activity in the cancer immunity cycle. Additionally, higher frequencies of amplifications and deletions were observed in the high NEK2 expression subpopulation. Based on the TME classification, patients with high expression of NEK2 were more susceptible to targeted therapy with drugs targeting the cell cycle and DNA replication. Following verification, a NEK2-derived genomic model reliably predicted the patient prognosis; A nomogram (radiation therapy, tumor/node/metastasis staging, and the NEK2-derived risk score) was used to better estimate an individual's survival probability. In summary, our findings indicate that NEK2 plays a vital role in the tumorigenesis of GC.

Near-Stoichiometric and Homogenized Perovskite Films for Solar Cells with Minimized Performance Variation.

Mixed-cation, small band-gap perovskites via rationally alloying formamidinium (FA) and methylammonium (MA) together have been widely employed for blade-coated perovskite solar cells with satisfied efficiencies. One of the stringent challenges lies in difficult control of the nucleation and crystallization kinetics of the perovskites with mixed ingredients. Herein, a pre-seeding strategy by mixing FAPbI3 solution with pre-synthesized MAPbI3 microcrystals has been developed to smartly decouple the nucleation and crystallization process. As a result, the time window of initialized crystallization has been greatly extended by 3 folds (i.e. from 5 s to 20 s), which enables the formation of uniform and homogeneous alloyed-FAMA perovskite films with designated stoichiometric ratios. The resultant blade-coated solar cells achieved a champion efficiency of 24.31 % accompanied by outstanding reproducibility with more than 87 % of the devices showing efficiencies higher than 23 %.

Retinal nerve fiber layer thinning as a novel fingerprint for cardiovascular events: results from the prospective cohorts in UK and China.

BACKGROUND: Retinal structural abnormalities have been found to serve as biomarkers for cardiovascular disease (CVD). However, the association between retinal nerve fiber layer (RNFL) thickness and the incidence of CVD events remains inconclusive, and relevant longitudinal studies are lacking. Therefore, we aimed to examine this link in two prospective cohort studies. METHODS: A total of 25,563 participants from UK Biobank who were initially free of CVD were included in the current study. Another 635 participants without retinopathy at baseline from the Chinese Guangzhou Diabetes Eye Study (GDES) were adopted as the validation set. Measurements of RNFL thickness in the macular (UK Biobank) and peripapillary (GDES) regions were obtained from optical coherence tomography (OCT). Adjusted hazard ratios (HRs), odd ratios (ORs), and 95% confidence intervals (CI) were calculated to quantify CVD risk. RESULTS: Over a median follow-up period of 7.67 years, 1281 (5.01%) participants in UK Biobank developed CVD events. Each 5-µm decrease in macular RNFL thickness was associated with an 8% increase in incident CVD risk (HR = 1.08, 95% CI: 1.01-1.17, p = 0.033). Compared with participants in the highest tertile of RNFL thickness, the risk of incident CVD was significantly increased in participants in the lowest thickness tertile (HR = 1.18, 95% CI: 1.01-1.38, p = 0.036). In GDES, 29 (4.57%) patients developed CVD events within 3 years. Lower average peripapillary RNFL thickness was also associated with a higher CVD risk (OR = 1.35, 95% CI: 1.11-1.65, p = 0.003). The additive net reclassification improvement (NRI) was 21.8%, and the absolute NRI was 2.0% by addition of RNFL thickness over the Framingham risk score. Of 29 patients with incident CVD, 7 were correctly reclassified to a higher risk category while 1 was reclassified to a lower category, and 21 high risk patients were not reclassified. CONCLUSIONS: RNFL thinning was independently associated with increased incident cardiovascular risk and improved reclassification capability, indicating RNFL thickness derived from the non-invasive OCT as a potential retinal fingerprint for CVD event across ethnicities and health conditions. TRIAL REGISTRATION: ISRCTN 15853192.

Choriocapillaris flow deficit and the risk of referable diabetic retinopathy: a longitudinal SS-OCTA study.

AIMS: To investigate the association between the choriocapillaris flow deficit percentage (CC FD%) and the 1-year incidence of referable diabetic retinopathy (RDR) in participants with type 2 diabetes mellitus (DM). METHODS: This prospective cohort study included participants with type 2 DM. The DR status was graded based on the ETDRS-7 photography. The CC FD% in the central 1 mm area, inner circle (1.5 mm to 2.5 mm), outer circle (2.5 mm to 5.0 mm) and the entire area in the macular region were measured using swept-source optical coherence tomography angiography (SS-OCTA). Logistic regression analysis was used to examine the association between baseline CC FD% and 1-year incident RDR. RESULTS: A total of 1222 patients (1222 eyes, mean age: 65.1±7.4 years) with complete baseline and 1-year follow-up data were included. Each 1% increase in baseline CC FD% was significantly associated with a 1.69 times (relative risk 2.69; 95% CI 1.53 to 4.71; p=0.001) higher odds for development of RDR after 1-year follow-up, after adjusting for other confounding factors. CONCLUSIONS: A greater baseline CC FD% detected by SS-OCTA reliably predicted higher risks of RDR in participants with type 2 DM. Thus, CC FD% may act as a novel biomarker for predicting the onset and progression of DR.

Factors associated with non-lifting of colorectal mucosal lesions.

BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective treatment for colorectal tumors. However, lesions that cannot be lifted after submucosal injection are not indication for ESD. This is because the procedure is difficult, and the lesions are often considered as tumor invasion or submucosal fibrosis. The aims of this study are to evaluate the efficacy and safety of ESD for non-lifting lesions and to analyze the causes of non-lifting phenomenon. METHODS: This retrospective study included 29 patients with non-lifting colon lesions resected by ESD from February 2018 to September 2021. Cases were observed for demographics, endoscopic findings, treatment outcomes, adverse events and endoscopic follow-up. We studied the pathological features of lesions to explore the reasons for non-lifting. RESULTS: Among 29 cases of non-lifting lesions, 20 lesions (69.0%) were 30 mm in diameter or larger. Most of lesions (96.6%) were non-lifting in center, and only one lesions (3.4%) had non-lifting of one side. The en bloc and curative resection rates of ESD were 100 and 86.2%, respectively. There was one (3.4%) delayed bleeding, no perforations and other complications. No tumor recurrence occurred during the follow-up period. For pathological features, 16 (55.2%) non-lifting lesions had submucosal fibrosis and only 4 cases (13.8%) had deep submucosal invasion. There were 9 cases (31.0%) of non-lifting lesions due to musculo-fibrous of muscularis propria anomaly (MMPA). CONCLUSION: MMPA is another reason for non-lifting signs besides invasive carcinomas and submucosal fibrosis. ESD should be considered in patients with large non-lifting adenoma instead of surgery.

Genome-wide DNA methylation analysis of extreme phenotypes in the identification of novel epigenetic modifications in diabetic retinopathy.

BACKGROUND: Aberrant epigenetic modifications such as DNA methylation may contribute to the pathogenesis of DR. We aimed at elucidating the role of novel DNA methylation modifications in diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) using an extreme phenotypic design. METHODS/RESULTS: Two consecutive studies were conducted. A cross-sectional study using an extreme phenotypic design was conducted to identify rare methylation modifications that might contribute to DR pathogenesis. A 2-year longitudinal nested case-control study was conducted to validate the results and assess whether these novel methylation modifications could be used as biomarkers for predicting DR onset. A large number of differentially methylated CpG sites were identified in the cross-sectional study, and two (cg12869254 and cg04026387) corresponding to known genes were replicated in the longitudinal study. Higher methylation of cg12869254 significantly correlated with macular RNFL thinning in the superior and nasal subregions, and that of cg04026387 correlated with reduced deep capillary plexus VD in the superior and inferior subregions after adjusting for covariates. CONCLUSIONS: Cg12869254 and cg04026387 hypermethylation may complement the known risk factors that contribute to the pathogenesis of DR and as novel biomarkers for disease prediction.