Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Hydrogenation of cyclohexene over single-atom Pt or Pd incorporated porous ceria nanoparticles under solvent-free conditions.

In order to maximize the utilization of noble metals in catalysis, single atom of palladium (Pd) and platinum (Pt) were incorporated individually in the framework of porous ceria (CeO2) by using a one-step flash combustion method. Samples with different Pd and Pt loading (0.5, 1, 2.5, and 5 wt%) were prepared and examined by using different analysis techniques such as XRD, ICP, N2 sorption measurements, SEM, HR-TEM, and XPS. The characterization data confirms the formation of zero-state single-atom Pt and Pd (with possible formation of Pd nanoparticles with a size less than 5 nm) incorporated onto the three-dimensional porous ceria structure. The catalytic activity of the synthesized materials was studied in the cyclohexene reduction to cyclohexane at 393 K and 3 atm of pure hydrogen (H2) gas as a model reaction. The obtained results demonstrated that the conversion percentage of cyclohexene is increasing with Pd or Pt loading. The best cyclohexene conversion, 21% and 29%, was achieved over the sample that contains 5 wt% of Pt and Pd, respectively. The collected catalytic data fit the zero-order reaction model, and the rate constant of each catalyst was determined. The catalytic experiments of the most-performed catalysts were repeated five times and the obtained loss in activity was insignificant.

Renal Transplant in Elderly End-Stage Renal Disease Patients: Impact of Comorbidities and Posttransplant Adverse Events on Outcomes.

OBJECTIVES: Elderly renal transplant continues to be debated because of age-related factors affecting transplant success and long-term prognosis. We investigated the effects ofrecipient age and predictors of renal transplant outcomes in elderly renal transplant recipients. MATERIALS AND METHODS: We retrospectively analyzed 506 patients who had a first renal transplant between January 2010 and December 2020; there were 165 recipients aged ≥60 years (elderly) and 341 recipients aged <60 years (young).We collected recipient, donor, and transplant characteristics and assessed 1-, 3-, and 5-year overall patient and death-censored graft survival and risk factors influencing outcomes ofrenal transplant in elderly recipients. RESULTS: Elderly recipients showed significantly lower 1-, 3-, and 5-year patient survival rates (96.3%, 89.8%, 80.9%) than young recipients (98.8%, 98.5%, 97.8%; P < .001). However, death-censored graft survival rates were not significantly different (P = .459) between elderly (96.3%, 94.3%, 93.2%) and young recipients (97.7%, 97.0%, 93.9%). Advanced recipient age was identified as an independent risk factor for patient survival, irrespective of donor age. In elderly recipients, male gender (hazard ratio 2.013; 95% CI, 1.110-3.649), pretransplant cardiovascular disease (hazard ratio 1.774; 95% CI, 1.030-3.553), and posttransplant chestinfection (hazard ratio 2.421; 95% CI, 1.439-4.076) were significant predictors of inferior patient survival. Proteinuria at 1 month (hazard ratio 1.006; 95% CI, 1.000-1.011) and low estimated glomerular filtration rate at 3 months (hazard ratio 0.943; 95% CI, 0.899-0.988) posttransplant were early predictors of worse death-censored graft survival. CONCLUSIONS: Elderly renaltransplantrecipients showed promising 5-year patient and death-censored graft survival, exceeding 80%, despite higher mortality risk compared with young recipients. Optimizing outcomes of elderly renal transplant necessitates a multifaceted approach encompassing meticulous pretransplant cardiovascular disease assessment, rigorous posttransplant chest infection prevention and management, and proactive monitoring for early posttransplant kidney dysfunction, to permit timely intervention.

Endoscopic thyroidectomy using the axillo-breast approach in patients with lactating and/or large ptotic breasts.

INTRODUCTION: The purpose of this study is to evaluate the outcomes of endoscopic hemithyroidectomy (EH) performed via the modified unilateral axillo-breast approach (UABA) in patients with lactating and/or large ptotic breasts. METHODS: Between 2019 and 2021, we studied the records of twenty-three eligible female patients with lactating and/or large ptotic breasts who were presented with benign unilateral thyroid nodule (s) and who were treated by EH using modified UABA at Mansoura University Oncology Center or Meet Ghamr oncology center. The demographic data, clinicopathological parameters, operative and the esthetic outcomes were collected and analyzed. RESULTS: Nine patients (39%) were lactating. All patients were obese (the mean BMI was 37.82 ± 4.37). All patients were having large breasts, cup C and D sizes (34% of patients & 56% of patients respectively), except for only two lactating female patients who had Cup B breasts. All patients were having ptotic breasts. The thyroid nodules greatest dimension ranged from 2.1-6 cm. All procedures were completed successfully endoscopically without any perioperative adverse events except for one case with temporary hoarseness of voice and three cases with axillary port sites cellulitis. The mean operative time was 83.26 ± 7.92 min. The patient satisfaction scores were high. CONCLUSION: EH via modified UABA in patients with lactating and/or large ptotic breasts is safe, feasible and effective procedure without adverse events. It should be offered to this group of patients as an alternative to conventional open thyroidectomy if there is no other contraindication.

Boosting Alkaline Seawater Oxidation of CoFe-layered Double Hydroxide Nanosheet Array by Cr Doping.

The pursuit of stable and efficient electrocatalysts toward seawater oxidation is of great interest, yet it poses considerable challenges. Herein, the utilization of Cr-doped CoFe-layered double hydroxide nanosheet array is reported on nickel-foam (Cr-CoFe-LDH/NF) as an efficient electrocatalyst for oxygen evolution reaction in alkaline seawater. The Cr-CoFe-LDH/NF catalyst can achieve current densities of 500 and 1000 mA cm -2 with remarkably low overpotentials of only 334 and 369 mV, respectively. Furthermore, it maintains at least 100 h stability when operated at 500 mA cm-2.

A brush-like Cu2O-CoO core-shell nanoarray: an efficient bifunctional electrocatalyst for overall seawater splitting.

Herein, a brush-like Cu2O-CoO core-shell nanoarray on copper foam (Cu2O-CoO/CF) can achieve efficient oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) performance in alkaline seawater electrolyte. This Cu2O-CoO/CF shows overpotentials as low as 315 and 295 mV at 100 mA cm-2 for the OER and HER, respectively. Moreover, it could also be operated at 1.82 V with 100 mA cm-2 in a two-electrode electrolyzer and exhibits strong stability for at least 50 hours of electrolysis. The excellent performance and hierarchical structure advantages of Cu2O-CoO/CF provide new ideas for designing efficient seawater splitting electrocatalysts.

A Hierarchical CuO Nanowire@CoFe-Layered Double Hydroxide Nanosheet Array as a High-Efficiency Seawater Oxidation Electrocatalyst.

Seawater electrolysis has great potential to generate clean hydrogen energy, but it is a formidable challenge. In this study, we report CoFe-LDH nanosheet uniformly decorated on a CuO nanowire array on Cu foam (CuO@CoFe-LDH/CF) for seawater oxidation. Such CuO@CoFe-LDH/CF exhibits high oxygen evolution reaction electrocatalytic activity, demanding only an overpotential of 336 mV to generate a current density of 100 mA cm-2 in alkaline seawater. Moreover, it can operate continuously for at least 50 h without obvious activity attenuation.

High-efficiency electrocatalytic nitrite reduction toward ammonia synthesis on CoP@TiO2 nanoribbon array.

Electrochemical reduction of nitrite (NO2-) can satisfy the necessity for NO2- contaminant removal and deliver a sustainable pathway for ammonia (NH3) generation. Its practical application yet requires highly efficient electrocatalysts to boost NH3 yield and Faradaic efficiency (FE). In this study, CoP nanoparticle-decorated TiO2 nanoribbon array on Ti plate (CoP@TiO2/TP) is verified as a high-efficiency electrocatalyst for the selective reduction of NO2- to NH3. When measured in 0.1 M NaOH with NO2-, the freestanding CoP@TiO2/TP electrode delivers a large NH3 yield of 849.57 µmol h-1 cm-2 and a high FE of 97.01% with good stability. Remarkably, the subsequently fabricated Zn-NO2- battery achieves a high power density of 1.24 mW cm-2 while delivering a NH3 yield of 714.40 µg h-1 cm-2.

Comparison of bihemispheric and unihemispheric M1 transcranial direct current stimulations during physical therapy in subacute stroke patients: A randomized controlled trial.

BACKGROUND: Despite the central origin of stroke affecting the primary motor cortex M1, most physical and occupational rehabilitation programs focus on peripheral treatments rather than addressing the central origin of the problem. This highlights the urgent need for effective protocols to improve neurological rehabilitation and achieve better long-term functional outcomes. OBJECTIVES: Our hypothesis was that the bihemispheric delivery of transcranial direct current stimulation (tDCS) is superior to unihemispheric in enhancing motor function after stroke, in both the upper and lower extremities. METHODS: 35 sub-acute ischemic stroke survivors were randomly divided into three groups: bihemispheric and unihemispheric treatment groups, or sham groups. Each participant received a 20-minute session of tDCS with an intensity of 2 mA during physical therapy sessions, three days a week, for four weeks. The outcomes were measured using Fugl-Meyer assessment scale, modified Ashworth scale, Berg balance scale, and serum brain-derived neurotrophic factor (BDNF) levels. RESULTS: One-way ANOVA test indicated a significant effect of both treatment protocols on the upper extremity (p = < 0.001) and lower extremity (p = .034) for motor measures, but there was no difference between the two (p = .939). Kruskal Wallis test for spasticity showed a significant improvement in both treatment groups for elbow (p = .036) and wrist flexors (p = .025), compared to the sham group. However, there was no statistically significant difference in spasticity between uni- and bihemispheric stimulation for elbow (p = .731) or wrist flexors (p = .910). CONCLUSION: There is no statistically significant difference in efficacy between bihemispheric and unihemispheric tDCS in patients presenting with acute ischemic stroke. .

Pd-Doped Co3 O4 Nanoarray for Efficient Eight-Electron Nitrate Electrocatalytic Reduction to Ammonia Synthesis.

Ammonia (NH3 ) is an indispensable feedstock for fertilizer production and one of the most ideal green hydrogen rich fuel. Electrochemical nitrate (NO3 - ) reduction reaction (NO3 - RR) is being explored as a promising strategy for green to synthesize industrial-scale NH3 , which has nonetheless involved complex multi-reaction process. This work presents a Pd-doped Co3 O4 nanoarray on titanium mesh (Pd-Co3 O4 /TM) electrode for highly efficient and selective electrocatalytic NO3 - RR to NH3 at low onset potential. The well-designed Pd-Co3 O4 /TM delivers a large NH3 yield of 745.6 µmol h-1 cm-2 and an extremely high Faradaic efficiency (FE) of 98.7% at -0.3 V with strong stability. These calculations further indicate that the doping Co3 O4 with Pd improves the adsorption characteristic of Pd-Co3 O4 and optimizes the free energies for intermediates, thereby facilitating the kinetics of the reaction. Furthermore, assembling this catalyst in a Zn-NO3 - battery realizes a power density of 3.9 mW cm-2 and an excellent FE of 98.8% for NH3 .

Multiscale (microscopic to remote sensing) preliminary exploration of auriferous-uraniferous marbles: A case study from the Egyptian Nubian Shield.

Since their recent first record within the Egyptian Nubian Shield, auriferous and uraniferous marbles (Au = 0.98-2.76 g/t; U = 133-640 g/t) have rarely been addressed, despite not only their probable economic importance but also the fact that it is a new genetic style of gold and uranium mineralization in the Nubian Shield rocks. This is mainly attributed to the inadequate localization of these marbles within harsh terrains, as well as the cost and time spent with conventional fieldwork for their identification compared to the main lithological components of the Nubian Shield. On the contrary, remote sensing and machine learning techniques save time and effort while introducing reliable feature identification with reasonable accuracy. Consequently, the current research is an attempt to apply the well-known machine learning algorithm (Support vector Machine-SVM) over Sentinel 2 remote sensing data (with a spatial resolution of up to 10 m) to delineate the distribution of auriferous-uraniferous marbles in the Barramiya-Daghbagh district (Eastern Desert of Egypt), as a case study from the Nubian Shield. Towards better results, marbles were accurately distinguished utilizing ALOS PRISM (2.5 m) pan-sharpened Sentinel 2 data and well-known exposures during fieldwork. With an overall accuracy of more than 90%, a thematic map for auriferous-uraniferous marbles and the major rock units in the Barramiya-Daghbagh district was produced. Marbles are spatially related to ophiolitic serpentinite rocks, as consistent with their genesis within the Neoproterozoic oceanic lithosphere. Field and petrographic investigations have confirmed the newly detected Au and U-bearing zones (impure calcitic to impure dolomitic marbles in Wadi Al Barramiya and Wadi Daghbagh areas and impure calcitic marble in Gebel El-Rukham area). Additionally, X-ray diffraction (XRD), back-scattered electron images (BSEIs), and Energy Dispersive X-ray spectroscopy (EDX) results were integrated to verify our remote sensing results and petrographic investigations. Different times of mineralization are indicated, ranging from syn-metamorphism (gold in Wadi Al Barramiya and Gebel El-Rukham) to post-metamorphism (gold in Wadi Daghbagh and uranium in all locations). Based on the application of geological, mineralogical, machine learning and remote sensing results for the construction of a preliminary exploration model of the auriferous-uraniferous marble in the Egyptian Nubian Shield, we recommend a detailed exploration of Au and U-bearing zones in Barramiya-Dghbagh district and applying the adopted approach to other districts of similar geological environments.

High-Efficiency Electroreduction of Nitrite to Ammonia on Ni Nanoparticles Strutted 3D Honeycomb-Like Porous Carbon Framework.

Electroreduction of nitrite (NO2 - ) to ammonia (NH3 ) provides a sustainable approach to yield NH3 , whilst eliminating NO2 - contaminants. In this study, Ni nanoparticles strutted 3D honeycomb-like porous carbon framework (Ni@HPCF) is fabricated as a high-efficiency electrocatalyst for selective reduction of NO2 - to NH3 . In 0.1 M NaOH with NO2 - , such Ni@HPCF electrode obtains a significant NH3 yield of 12.04 mg h-1 mgcat. -1 and a Faradaic efficiency of 95.1 %. Furthermore, it exhibits good long-term electrolysis stability.

Ruthenium doping: An effective strategy for boosting nitrite electroreduction to ammonia over titanium dioxide nanoribbon array.

Electrochemical reduction of nitrite (NO2-) not only removes NO2- contaminant but also produces high-added value ammonia (NH3). This process, however, needs efficient and selective catalysts for NO2--to-NH3 conversion. In this study, Ruthenium doped titanium dioxide nanoribbon array supported on Ti plate (Ru-TiO2/TP) is proposed as an efficient electrocatalyst for the reduction of NO2- to NH3. When operated in 0.1 M NaOH containing NO2-, such Ru-TiO2/TP achieves an ultra-large NH3 yield of 1.56 mmol h-1 cm-2 and a super-high Faradaic efficiency of 98.9%, superior to its TiO2/TP counterpart (0.46 mmol h-1 cm-2, 74.1%). Furthermore, the reaction mechanism is studied by theoretical calculation.

Improved Alkaline Seawater Splitting of NiS Nanosheets by Iron Doping.

Seawater electrolysis driven by renewable electricity is deemed a promising and sustainable strategy for green hydrogen production, but it is still formidably challenging. Here, we report an iron-doped NiS nanosheet array on Ni foam (Fe-NiS/NF) as a high-performance and stable seawater splitting electrocatalyst. Such Fe-NiS/NF catalyst needs overpotentials of only 420 and 270 mV at 1000 mA cm-2 for the oxygen evolution reaction and hydrogen evolution reaction in alkaline seawater, respectively. Furthermore, its two-electrode electrolyzer needs a cell voltage of 1.88 V for 1000 mA cm-2 with 50 h of long-term electrochemical durability in alkaline seawater. Additionally, in situ electrochemical Raman and infrared spectroscopy were employed to detect the reconstitution process of NiOOH and the generation of oxygen intermediates under reaction conditions.

Impact of changing PI-RADS cutoff on prostate cancer detection by MRI cognitive fusion biopsy in biopsy-naïve patients.

BACKGROUND: Multi-parametric magnetic resonance imaging may improve the detection of prostate cancer. The aim of this work is to compare between PI-RADS 3-5 and PI-RADS 4-5 as a threshold for targeted prostatic biopsy. METHODS: This is a prospective clinical study that included 40 biopsy-naïve patients referred for prostate biopsy. Patients underwent prebiopsy multi-parametric (mp-MRI), followed by 12-core transrectal ultrasound-guided systematic biopsy and cognitive MRI/TRUS fusion targeted biopsy from each detected lesion. The primary endpoint was to assess the diagnostic accuracy of the PI-RAD 3-4 versus PI-RADS 4-5 lesion by mpMRI for prostate cancer detection in biopsy-naive men. RESULTS: The overall prostate cancer detection rate and the clinically significant cancer detection rate were 42.5% and 35%, respectively. Targeted biopsies from PI-RADS 3-5 lesions showed a sensitivity of 100%, specificity of 44%, positive predictive value of 51.7%, and negative predictive value of 100%. Restricting targeted biopsies to PI-RADS 4-5 lesions resulted in a decrease in sensitivity and negative predictive value to 73.3% and 86.2%, respectively, while specificity and positive predictive value were increased to 100% for both parameters which was statistically significant (P value < 0.0001 and P value = 0.004, respectively). CONCLUSIONS: Limiting the TBs to PI-RADS 4-5 lesions improves the performance of mp-MRI in the detection of prostate cancer especially aggressive tumors.

Lateral Route Endoscopic Thyroidectomy with gas Insufflation: Proposed Critical View of Safety.

BACKGROUND: The extra-cervical lateral route endoscopic thyroidectomy (LRET) approaches such as the trans-axillary, breast and axillo-breast approaches are proved to be safe, feasible, esthetic, highly effective. The inherent difficulty and long learning curve of these techniques prevents its widespread application. METHODS: Benefiting from the experience of more than 5 years in LRET approaches with CO2 insufflation, the authors developed ten surgical key steps and a critical view of safety (CVS) for performing thyroid lobectomy via LRET approaches. A detailed description and a video of the surgical technique is provided. RESULTS: Application of these structured key steps and CVS was feasible and effective in achieving thyroid lobectomy in all selected cases with unilateral goiter up to 8 cm, even in cases with thyroiditis or controlled toxic adenoma, without any adverse events and with shorter operative time than the non-structured surgical technique. CONCLUSION: The described ten key steps and CVS are conclusive, applicable, easy to learn. Our video could act as a guide for promoting the standardized, safe, and wide application of LRET techniques.

Highly efficient activation of peroxymonosulfate by biomass juncus derived carbon decorated with cobalt nanoparticles for the degradation of ofloxacin.

The cobalt nanoparticles decorated biomass Juncus derived carbon (Co@JDC) was prepared by facile calcination strategy and applied to activate peroxymonosulfate (PMS) for eliminating ofloxacin (OFX) in the water environment. The results of catalytic experiments show that 97% of OFX degradation efficiency and 70.4% of chemical oxygen demand removal rate are obtained within 24 min at 0.1 g L-1 Co@JDC, 0.2 g L-1 PMS, 20 mg L-1 OFX (100 mL), and pH = 7, which indicates that Co@JDC/PMS system exhibits excellent performance. Meanwhile, the experimental results of affect factor show that Co@JDC/PMS system can operate in a wider pH range (3-9) and Cl-1, NO3-1, and SO42- have an ignorable effect on OFX degradation. The radical identification experiments confirm that SO4˙-, ·OH, O2˙-, and 1O2 are involved in the process of PMS activation, especially SO4˙- and 1O2 are the main contributors. Furthermore, a possible PMS activation mechanism by Co@JDC was proposed and the degradation pathways of OFX were deduced. Finally, the stable catalytic activity, negligible leaching of Co2+, and the outstanding degradation efficiency for other antibiotics prove that Co@JDC possesses good stability and universality.

Distal hypospadias repair: Comparative study between snodgrass and transverse preputial onlay flap.

INTRODUCTION: Distal hypospadias repair has several operative strategies such as tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Mathieu Procedure. The aim of our work is to compare between TIP and TPOF techniques in the outcome. MATERIAL AND METHOD: We conducted this comparative study on 66 patients with different types of distal hypospadias divided in two groups A and B for TIP and TPOF respectively. We reported outcome and complications for both TIP and TPOF repair. Our results revealed mean operative time was significantly higher in group B (123.1 ± 6.8 min) than in group A (93.73 ± 3.9 min, P value < 0.001). Postoperative urinary fistula was reported in group A (15.2%) while no fistula in group B (p value = 0.05). The vertical slit appearance of meatus was better in group A (54.5%) than in group B (24.2%, P value 0.023). As regard to hypospadias objective scoring evaluation (HOSE) (Summary Figure) the meatal shape score was higher in group A (1.55 ± 0.51) than in group B (1.24 ± 0.44, p value = 0.0 l), the urinary stream score was significantly higher in group A (1.82 ± 0.39) than in group B (1.97 ± 0.17, p value = 0.04) and the urinary fistula score was significantly higher in group A (3.79 ± 0.60) than in group B (4 ± 0, p value = 0.04). DISCUSSION: Complications are more common after TIP than in TPOF. As regard the meatus shape, the naturally looking vertical slit like meatus was achieved more in the TIP than in TPOF. We advocate further studies with a large number of patients with a long follow up period. CONCLUSION: TPOF is a great option to consider in cases of distal hypospadias because it is an effective technique for primary distal hypospadias repair with a good cosmetic outcome and a low associated complication.

Impact of Morbid Obesity on the Outcomes of Type II Endometrial Cancer: a Cohort Study.

Obesity has long been associated with endometrial cancer. However, there is a paucity of studies addressing the impact of morbid obesity in type II endometrial cancer on oncologic and surgical outcomes. In this study, the author retrospectively compared morbid to non-morbid obese in clinico-epidemiologic, surgical, and oncologic outcomes. Both groups were comparable as regards all clinico-epidemiologic parameters. Vaginal involvement, survival, and recurrence were also comparable between the 2 groups. Para-aortic adenopathy and treatment with preoperative therapy were the only significant predictors of DFS. Surgery is feasible with equivalent complications and oncologic outcomes in morbidly obese patients with type II endometrial cancer.

High-Efficiency Ammonia Electrosynthesis on Anatase TiO2-x Nanobelt Arrays with Oxygen Vacancies by Selective Reduction of Nitrite.

Electrocatalytic reduction of nitrite to NH3 provides a new route for the treatment of nitrite in wastewater, as well as an attractive alternative to NH3 synthesis. Here, we report that an oxygen vacancy-rich TiO2-x nanoarray with different crystal structures self-supported on the Ti plate can be prepared by hydrothermal synthesis and by subsequently annealing it in an Ar/H2 atmosphere. Anatase TiO2-x (A-TiO2-x) can be a superb catalyst for the efficient conversion of NO2- to NH3; a high NH3 yield of 12,230.1 ± 406.9 µg h-1 cm-2 along with a Faradaic efficiency of 91.1 ± 5.5% can be achieved in a 0.1 M NaOH solution containing 0.1 M NaNO2 at -0.8 V, which also exhibits preferable durability with almost no decay of catalytic performances after cycling tests and long-term electrolysis. Furthermore, a Zn-NO2- battery with such A-TiO2-x as a cathode delivers a power density of 2.38 mW cm-2 as well as a NH3 yield of 885 µg h-1 cm-2.