Impact of stress hyperglycemia ratio, derived from glycated albumin or hemoglobin A1c, on mortality among ST-segment elevation myocardial infarction patients.

BACKGROUND: Stress hyperglycemia ratio (SHR), associated with adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI), has several definitions. This study aims to assess the prognostic value of SHR, derived from hemoglobin A1c (HbA1c) or glycated albumin (GA), to mortality. METHODS: The study comprised 1,643 STEMI patients who underwent percutaneous coronary intervention (PCI) in two centers. SHR1 was calculated using fasting blood glucose (FBG)/GA, while SHR2 was calculated using the formula FBG/(1.59*HbA1c-2.59). The primary endpoints were in-hospital death and all-cause mortality, with a median follow-up duration of 1.56 years. RESULTS: Higher SHR1 and SHR2 values are associated with increased risks of in-hospital death and all-cause mortality. Each standard deviation increase in SHR1 corresponded to a 39% and 22% escalation in in-hospital death and all-cause mortality, respectively. The respective increases for SHR2 were 51% and 26%. Further examinations validated these relationships as linear. Additionally, the areas under the curve (AUC) for in-hospital death were not significantly different between SHR1 and SHR2 (p > 0.05). Incorporating SHR1 or SHR2 into the base model significantly improved the discrimination and risk reclassification for in-hospital and all-cause mortality. A subgroup analysis revealed that the effects of SHR1 and SHR2 were more pronounced in patients with hypercholesteremia. CONCLUSION: SHR1 and SHR2 have emerged as robust and independent prognostic markers for STEMI patients undergoing PCI. The SHR calculation based on either HbA1c or GA can provide additional predictive value for mortality beyond traditional risk factors, helping to identify high-risk STEMI patients.

Physiological Traits and Adherence to Sleep Apnea Therapy in Individuals with Coronary Artery Disease.

Rationale: Untreated obstructive sleep apnea (OSA) is associated with adverse outcomes in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is the most common treatment, but despite interventions addressing established adherence determinants, CPAP use remains poor. Objectives: To determine whether physiological traits that cause OSA are associated with long-term CPAP adherence in patients with CAD. Methods: Participants in the RICCADSA (Randomized Intervention with CPAP in CAD and OSA) trial with objective CPAP adherence (h/night) over 2 years and analyzable raw polysomnography data were included (N = 249). The physiological traits-loop gain, arousal threshold (ArTH), pharyngeal collapsibility (Vpassive), and pharyngeal muscle compensation (Vcomp)-were measured by using polysomnography. Linear mixed models were used to assess the relationship between the traits and adherence. We also compared actual CPAP adherence between those with physiologically predicted "poor" adherence (lowest quartile of predicted adherence) and those with physiologically predicted "good" adherence (all others). Measurements and Main Results: The median (interquartile range) CPAP use declined from 3.2 (1.0-5.8) h/night to 3.0 (0.0-5.6) h/night over 24 months (P < 0.001). In analyses adjusted for demographics, anthropometrics, OSA characteristics, and clinical comorbidities, a lower ArTH was associated with worse CPAP adherence (0.7 h/SD of the ArTH; P = 0.021). Both high and low Vcomp were associated with lower adherence (P = 0.008). Those with predicted poor adherence exhibited markedly lower CPAP use than those with predicted good adherence for up to 2 years of follow-up (group differences of 2.0-3.2 h/night; P < 0.003 for all). Conclusions: A low ArTH, as well as a very low and high Vcomp, are associated with worse long-term CPAP adherence in patients with CAD and OSA. Physiological traits-alongside established determinants-may help predict and improve CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT00519597).

Modulation of the morphotropic phase boundary for high-performance ductile thermoelectric materials.

The flexible thermoelectric technique, which can convert heat from the human body to electricity via the Seebeck effect, is expected to provide a peerless solution for the power supply of wearables. The recent discovery of ductile semiconductors has opened a new avenue for flexible thermoelectric technology, but their power factor and figure-of-merit values are still much lower than those of classic thermoelectric materials. Herein, we demonstrate the presence of morphotropic phase boundary in Ag2Se-Ag2S pseudobinary compounds. The morphotropic phase boundary can be freely tuned by adjusting the material thermal treatment processes. High-performance ductile thermoelectric materials with excellent power factor (22 µWcm-1 K-2) and figure-of-merit (0.61) values are realized near the morphotropic phase boundary at 300 K. These materials perform better than all existing ductile inorganic semiconductors and organic materials. Furthermore, the in-plane flexible thermoelectric device based on these high-performance thermoelectric materials demonstrates a normalized maximum power density reaching 0.26 Wm-1 under a temperature gradient of 20 K, which is at least two orders of magnitude higher than those of flexible organic thermoelectric devices. This work can greatly accelerate the development of flexible thermoelectric technology.

Full-Inorganic Flexible Ag2S Memristor with Interface Resistance-Switching for Energy-Efficient Computing.

Flexible memristor-based neural network hardware is capable of implementing parallel computation within the memory units, thus holding great promise for fast and energy-efficient neuromorphic computing in flexible electronics. However, the current flexible memristor (FM) is mostly operated with a filamentary mechanism, which demands large energy consumption in both setting and computing. Herein, we report an Ag2S-based FM working with distinct interface resistance-switching (RS) mechanism. In direct contrast to conventional filamentary memristors, RS in this Ag2S device is facilitated by the space charge-induced Schottky barrier modification at the Ag/Ag2S interface, which can be achieved with the setting voltage below the threshold voltage required for filament formation. The memristor based on interface RS exhibits 105 endurance cycles and 104 s retention under bending condition, and multiple level conductive states with exceptional tunability and stability. Since interface RS does not require the formation of a continuous Ag filament via Ag+ ion reduction, it can achieve an ultralow switching energy of ∼0.2 fJ. Furthermore, a hardware-based image processing with a software-comparable computing accuracy is demonstrated using the flexible Ag2S memristor array. And the image processing with interface RS indeed consumes 2 orders of magnitude lower power than that with filamentary RS on the same hardware. This study demonstrates a new resistance-switching mechanism for energy-efficient flexible neural network hardware.

High Performance Full-Inorganic Flexible Memristor with Combined Resistance-Switching.

Flexible memristors hold great promise for flexible electronics applications but are still lacking of good electrical performance together with mechanical flexibility. Herein, we demonstrate a full-inorganic nanoscale flexible memristor by using free-standing ductile α-Ag2S films as both a flexible substrate and a functional electrolyte. The device accesses dense multiple-level nonvolatile states with a record high 106 ON/OFF ratio. This exceptional memristor performance is induced by sequential processes of Schottky barrier modification at the contact interface and filament formation inside the electrolyte. In addition, it is crucial to ensure that the cathode junction, where Ag+ is reduced to Ag, dominates the total resistance and takes the most of setting bias before the filament formation. Our study provides a comprehensive insight into the resistance-switching mechanism in conductive-bridging memristors and offers a new strategy toward high performance flexible memristors.

Ductile Ag20 S7 Te3 with Excellent Shape-Conformability and High Thermoelectric Performance.

Hetero-shaped thermoelectric (TE) generators (TEGs) can power the sensors used in safety monitoring systems of undersea oil pipelines, but their development is greatly limited by the lack of materials with both good shape-conformable ability and high TE performance. In this work, a new ductile inorganic TE material, Ag20 S7 Te3 , with high TE performance is reported. At 300-600 K, Ag20 S7 Te3 crystallizes in a body-centered cubic structure, in which S and Te atoms randomly occupy the (0, 0, 1) site. Due to the smaller generalized stacking fault energy in the ( 10 1 ¯ )[010] slip system, Ag20 S7 Te3 shows better ductility than Ag2 S, yielding excellent shape-conformability. The high carrier mobility and low lattice thermal conductivity observed in Ag20 S7 Te3 result in a maximum dimensionless figure of merit (zT) of 0.80 at 600 K, which is comparable with the best commercial Bi2 Te3 -based alloys. The prototype TEG consisting of 10 Ag20 S7 Te3 strips displays an open-circuit voltage of 69.2 mV and a maximum power output of 17.1 µW under the temperature difference of 70 K. This study creates a new route toward hetero-shaped TEG.

Investigation on Low-Temperature Thermoelectric Properties of Ag2Se Polycrystal Fabricated by Using Zone-Melting Method.

Silver selenide, Ag2Se, is a promising low-temperature thermoelectric material which can be used to harvest the low-quality waste heat for electrical power generation or cool the microelectronics. Currently, the investigation on Ag2Se and its derivatives has become a hot topic in the thermoelectric community, but the thermoelectric properties of Ag2Se below 300 K have been rarely investigated. In this study, we prepared Ag2Se by using the zone-melting method. The electrical and thermal transport properties of zone-melted Ag2Se from 5 to 380 K were systematically investigated and compared with the previously reported data of Ag2Se and other typical low-temperature thermoelectric materials, such as Mg3Bi2, Bi2Te3, and BiSb. Ag2Se shows intrinsic semiconductor features, ultrahigh carrier mobility, small density-of-state effective mass, and ultralow lattice thermal conductivity. At 300 K, the zT of zone-melted Ag2Se is 0.75. This study will shed light on the further investigation of Ag2Se.

Crystalline Structure-Dependent Mechanical and Thermoelectric Performance in Ag2Se1-x S x System.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-x S x (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-x S x system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-x S x samples are brittle while the monoclinic Ag2Se1-x S x samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-x S x samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.