High-Energy-Density Lithium Metal Batteries with Impressive Li+ Transport Dynamic and Wide-Temperature Performance from -60 to 60 °C.

High-energy-density Li metal batteries (LMBs) with Nickel (Ni)-rich cathode and Li-metal anode have attracted extensive attention in recent years. However, commercial carbonate electrolytes bring severe challenges including poor cycling stability, severe Li dendrite growth and cathode cracks, and narrow operating temperature window, especially hardly work at below -40 °C. In this work, a 2.4 m lithium difluoro(oxalato)borate (LiDFOB) in ethyl acetate (EA) solvent with 20 wt% fluorocarbonate (FEC) (named 2.4m-DEF) is designed to solve Li+ transport dynamic at low temperature and improve interfacial stability between electrolyte with Li anode or Ni-rich cathode. Beneficial lower freezing point, lower viscosity, and higher dielectric constant of EA solvent, the electrolyte exhibits excellent Li+ transport dynamic. Relying on the unique Li+ solvation structure, more DFOB- anions and FEC solvents are decomposed to establish a stable solid electrolyte interface at electrolyte/electrode. Therefore, LiNi0.9 Co0.05 Mn0.05 O2 (NCM90)/Li LMB with 2.4m-DEF enables excellent rate capability (184 mA h g-1 at 30 C) and stable cycling performance with ≈93.7% of capacity retention after 200 cycles at 20 C and room temperature. Moreover, the NCM90/Li LMB with 2.4m-DEF exhibits surprising ultra-low-temperature performance, showing 173 mA h g-1 at -40 °C and 152 mA h g-1 at -60 °C, respectively.

The impact of communication training on the clinical care of hypertension in general practice: a cluster randomized controlled trial in China.

BACKGROUND: Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management. METHODS: A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes. RESULTS: After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up. CONCLUSION: Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs. TRIAL REGISTRATION: The trial was registered on Chinese Clinical Trials Registry on 2019-04-03. (ChiCTR1900022278).

Factors influencing the quality of acupuncture clinical trials: a qualitative interview of stakeholders.

OBJECTIVE: To investigate the influencing factors on the quality of acupuncture clinical trials from the stakeholders, and to provide references for improving the quality of acupuncture clinical trials. METHODS: A qualitative study based on semi-structured interviews was performed. Experts, acupuncturists, editors, and patients were interviewed. The interview results were thematically analyzed from transcribed audio recordings. RESULTS: A total of 38 stakeholders were interviewed, including 12 experts, 14 acupuncturists, 2 editors, and 10 patients. There were 25 tree nodes and 106 sub-nodes, with 1141 reference points. The key factors influencing the quality of acupuncture clinical trials could be divided into five core theme frameworks: a) trial design, b) trial conduction, c) research results reporting and publication, d) research evidence dissemination, and e) research evidence transformation and application. CONCLUSIONS: The results reveal that to improve the quality of acupuncture trials, it should consider each step of trial design, trial conduction, research results reporting and publication, research evidence dissemination, and research evidence transformation and application. A guideline for quality control of the whole process of acupuncture clinical trials is needed.

Long-Life Lithium-Ion Sulfur Pouch Battery Enabled by Regulating Solvent Molecules and Using Lithiated Graphite Anode.

The development of lithium-sulfur (Li-S) batteries is severely limited by the shuttle effect and instability of Li-metal anode. Constructing Li-ion S batteries (LISBs), by using more stable commercial graphite (Gr) anode instead of Li-metal, is an effective way to realize long-cycle-life Li-S batteries. However, Gr electrode is usually incompatible with the ether-based electrolytes commonly used for Li-S batteries due to the Li+ -ether complex co-intercalation into Gr interlayers. Herein, a solvent molecule structure regulation strategy is provided to weaken the Li+ -solvent binding by increasing steric hindrance and electronegativity, to accelerate Li+ de-solvation process and prevent Li+ -ether complex co-intercalation into Gr anode. Meanwhile, the weakly solvating power of solvent can suppress the shuttle effect of lithium polysulfides and makes more anions participate in Li+ solvation structure to generate a stable anion-derived solid electrolyte interface on Gr surface. Therefore, a LISB coin-cell consisting of lithiated graphite anode and S@C cathode displays a stable capacity of ≈770 mAh g-1 within 200 cycles. Furthermore, an unprecedented practical LISB pouch-cell with a high Gr loading (≈10.5 mg cm-2 ) also delivers a high initial capacity of 802.3 mAh g-1 and releases a stable capacity of 499.1 mAh g-1 with a high Coulombic efficiency (≈95.9%) after 120 cycles.

Co-Intercalation-Free Ether-Based Weakly Solvating Electrolytes Enable Fast-Charging and Wide-Temperature Lithium-Ion Batteries.

Ether-based electrolytes are competitive choices to meet the growing requirements for fast-charging and low-temperature lithium-ion batteries (LIBs) due to the low viscosity and low melting point of ether solvents. Unfortunately, the graphite (Gr) electrode is incompatible with commonly used ether solvents due to their irreversible co-intercalation into Gr interlayers. Here, we propose cyclopentyl methyl ether (CPME) as a co-intercalation-free ether solvent, which contains a cyclopentane group with large steric hindrance to obtain weakly solvating power with Li+ and a wide liquid-phase temperature range (-140 to +106 °C). A weakly solvating electrolyte (WSE) based on CPME and fluoroethylene carbonate (FEC) cosolvents can simultaneously achieve fast desolvation ability and high ionic conductivity, which also induces a LiF-rich solid electrolyte interphase (SEI) on the Gr anode. Therefore, the Gr/Li half-cell with this WSE can deliver outstanding rate capability, stable cycling performance, and high specific capacity (319 mAh g-1) at an ultralow temperature of -60 °C. Furthermore, a practical LiFePO4 (loading ≈25 mg cm-2)/Gr (loading ≈12 mg cm-2) pouch cell with this WSE also reveals outstanding rate capability and stable long-term cycling performance above 1000 cycles with a high Coulombic efficiency (≈99.9%) and achieves an impressive low-temperature application potential at -60 °C.

Observational studies of traditional Chinese medicine may provide evidence nearly consistent with the randomized controlled trials: A meta-epidemiological study.

Background: In traditional Chinese medicine (TCM) field, the benefits of observational studies was more significant. Whether the evidence from observational studies agreed with RCTs in the field of TCM was still unclear. Methods: A meta-epidemiological study was conducted. Meta-analyses and systematic reviews including cohort studies and case-control studies of TCM were included. Ratio of odds ratio (ROR) of randomized controlled trials and observational studies were calculated individually and intercomparisons were conducted by pool analysis. Results: A total of 11 studies and 30 outcome pairs were included in the pool analysis. Using results from the observational studies as the reference group, the polled ROR comparing randomized controlled trials with observational studies was 1.23 (95% confidence interval 1.05 to 1.44, and 95% prediction interval 0.90 to 1.68). The ROR by subgroup analysis were 1.15 (95% confidence interval 0.96 to 1.38; 95% prediction interval 0.95 to 1.39) and 1.12 (95% confidence interval 0.86 to 1.46; 95% prediction interval 0.51 to 2.47) for cohort studies and case-control studies, respectively. Conclusions: There is difference in pooled results between randomized controlled studies and observational studies on TCM. However, the prediction interval shows the difference is small, which suggests observational studies of TCM can be included in data analysis to provide evidence for TCM. Future studies are needed to verify the above conclusion.

Clinical Application of Traditional Chinese Medicine Therapy for Type 2 Diabetes Mellitus: An Evidence Map.

Type 2 diabetes mellitus (T2DM), a common disease with a complex etiology in the world, is an important risk factor for severe cardiovascular and cerebrovascular diseases. However, treatments of T2DM are mainly based on Western medicine, whose severe side effects make traditional Chinese medicine (TCM) therapy more appealing to patients and clinicians. The overall clinical evidence for different TCM therapies in the treatment of T2DM is still unclear. This study aimed to adopt the evidence-mapping method and integrate the evidence from various researches on this topic, to depict the whole picture of TCM therapies for T2DM. This review included searches of PubMed, Embase, Web of Science, and three major Chinese literature databases (CNKI, VIP, and Wanfang) from inception to November 18, 2021. Two independent reviewers screened the literature, extracted information, and evaluated the quality of all included studies. A systematic review was subsequently performed. In total, 47 studies were reviewed, of which 46 studies (97.9%) were from China and 1 (2.1%) was from Canada. The evidence map was conducted according to different TCM therapies, including herbs or herbal extracts, compounds, powders, decoctions, pills, external treatment, basic theories and treatment principles of TCM, proprietary Chinese medicines, and unspecified TCM integrated therapies. According to the AMSTAR-2 scoring results, 4 papers were rated as high quality, 11 were low quality, and 32 were very low quality. Outcome indicators mainly focused on FBG, HbA1c, 2-h PBG, TC, TG, LDL-C, etc. The results showed that different types of TCM treatment had different improvement effects on the outcome indicators of T2DM. More consistent benefits were observed in the improvement of FBG, HbA1c, and 2-h PBG with treatment regimens based on basic theories and treatment principles of TCM, decoctions and pills, and unspecified TCM integrated therapies. Among herbs, ginger and Coptis root showed more improvement in all outcomes. Compounds, powders, and external treatment showed relatively consistent beneficial effects on the improvement of FBG. No serious adverse events were reported. Overall, the current evidence map provided an intuitive overview of the beneficial effects of TCM therapies in the treatment of type 2 diabetes. This study can be used as a reference for the clinical application of traditional Chinese medicine in T2DM, but due to the low-quality level of the included studies, it should be treated with caution in clinical practices.