Treatment Outcomes of Stereotactic Body Radiation Therapy for Pulmonary Metastasis from Sarcoma: A Multicenter, Retrospective Study

PURPOSE/OBJECTIVE(S)

The aim of this study was to evaluate the treatment outcomes and potential dose-response relationship of stereotactic body radiation therapy (SBRT) for pulmonary metastasis of sarcoma.

MATERIALS/METHODS

A retrospective review of 39 patients and 71 lesions treated with SBRT from two institutions was performed. The patients had oligometastatic or oligoprogressive disease, or were receiving palliation. Doses of 20-60 Gy were delivered in 1-5 fractions. The local control per tumor (LCpT) was evaluated according to the biologically effective dose with an α/β ratio of 10 (BED10) of the prescribed dose (BED10 ≥ 100 Gy vs. BED10 < 100 Gy). Clinical outcomes per patient, including local control per patient (LCpP), pulmonary progression-free rate (PPFR), any progression-free rate (APFR), and overall survival (OS) were investigated.

RESULTS

The median follow-up period was 27.2 months. The 1-, 2-, and 3-year LCpT rates for the entire cohort were 100.0%, 88.3%, and 73.6%, respectively. There was no observed difference in LCpT between the two BED10 groups (p = 0.180). The 3-year LCpP, PPFR, APFR, and OS rates were 78.1%, 22.7%, 12.9%, and 83.7%, respectively. Five (12.8%) patients with oligometastasis had long-term disease-free intervals, with a median survival period of 40.7 months. Factors that were associated with a worse prognosis were oligoprogression (vs. oligometastasis), multiple pulmonary metastases, and simultaneous extrathoracic metastasis.

CONCLUSION

SBRT for pulmonary metastasis of sarcoma is effective. Some selected patients may achieve durable response. Considerations of SBRT indication and disease extent may be needed as they may influence the prognosis.

The Early and Late Effects of High-Dose Irradiation on Cardiac Injury in a Rat Model

PURPOSE/OBJECTIVE(S)

Radiation-induced heart disease is a critical concern after radiotherapy (RT) for thoracic and chest wall tumors; however, the biological effects and mechanisms are still unknown. In this study, we investigated dose-responsive functional and pathological changes in rat hearts at 1, 3, and 5 months after high-dose irradiation. Then, we sought to elucidate the underlying mechanisms of myocardial changes induced by high-dose irradiation.

MATERIALS/METHODS

Whole hearts of rats (N = 72) were irradiated with a single fraction of 0 (control), 10, 20, or 30 Gy and allocated into three groups according to the follow-up period after RT: baseline, one, three, and five months. During follow-up periods, rats underwent functional evaluation by electrocardiogram and echocardiography at 4-week intervals. If a rat's body weight decreased by 20% or more, it was considered premature death, and the heart was explanted immediately. Otherwise, all hearts were explanted when each group's follow-up period was completed. Pathological changes of cardiac structures were evaluated using a light microscope after staining with hematoxylin-eosin, Masson's trichrome, α-smooth muscle actin, desmin, and connexin-43.

RESULTS

All rats irradiated with 0 or 10 Gy completed their follow-up periods with continuously increasing body weight. However, among rats irradiated with 20 or 30 Gy, half of the rats died prematurely at 8-10 weeks after RT, and the remainder survived until 20 weeks. In echocardiography, increased wall thickness and E/E' ratio, and decreased end-diastolic volume were observed in 20-30 Gy groups compared to 0-10 Gy groups from 8 weeks after RT. Ejection fraction was preserved in all groups. In pathological review, 20-30 Gy groups demonstrated diffuse inflammation and vacuolization at 4 weeks. Then, at 8 weeks, prominent fibrotic changes and intercalated disc disruptions were observed. Notably, fibrotic changes were somewhat resolved at 20 weeks, but intercalated disc disruptions were not repaired until 20 weeks. The 0 and 10 Gy groups showed no significant changes in both functional and pathological analyses.

CONCLUSION

Rats irradiated with 20 or 30 Gy showed diastolic dysfunction in functional analysis and time-dependent myocardial changes in pathological analysis. Radiation-induced fibrosis might be a "reactive" fibrosis, which could proceed to either a profibrotic course (progressive fibrosis) or an anti-fibrotic course (recovery phase). Further studies are needed to identify whether high-dose irradiation-induced cardiac fibrosis could be reversible.

Surface Modification of ZnO with Sn(IV)-Porphyrin for Enhanced Visible Light Photocatalytic Degradation of Amaranth Dye

Two hybrid composite photocatalysts, denoted as SnP/AA@ZnO and SnP@ZnO, were fabricated by a reaction of trans-dihydroxo[5,10,15,20-tetrakis(4-pyridyl)porphyrinato]tin(IV) (SnP) and ZnO with and without pretreatment of adipic acid (AA), respectively. In SnP@ZnO, SnP and ZnO are likely held together by a coordinative interaction between the pyridyl N atoms of SnP and the Zn atoms on the surface of ZnO. In the case of SnP/AA@ZnO, the SnP centers were robustly coupled with ZnO nanoparticles through the AA anchors. SnP/AA@ZnO exhibited largely enhanced photocatalytic activities for the degradation of anionic amaranth (AM) dye under a visible light irradiation, compared to SnP, ZnO, and SnP@ZnO. The degradation efficiency of AM by SnP/AA@ZnO was 95% within 60 min at a rate constant of 0.048 min-1. The remarkable photocatalytic oxidation performance of SnP/AA@ZnO was mainly attributed to the synergistic effect between SnP and ZnO. This study is valuable for the development of highly effective composite photocatalytic systems in advanced oxidation processes and is of importance for the treatment of wastewater containing dyes.

Fabrication and properties of Sn(iv) porphyrin-linked porous organic polymer for environmental applications

A robust porous organic polymer cross-linked by Sn(iv) porphyrin (SnPOP) was fabricated by reacting trans-dihydroxo-[5,15,10,20-tetrakis(phenyl)porphyrinato]tin(iv) (SnP) with fluorinated polyimide (FPI) via sol-gel formation, followed by supercritical CO2 drying. The structural and porous properties of SnPOP were characterized using FT-IR, UV-vis, and fluorescence spectroscopies, along with field-emission scanning electron microscopy and gas sorption experiments. The reaction between the SnP's oxophilic Sn(iv) center and FPI's carboxylic acid moiety resulted in a controllable cross-linked porous texture. This material features the desirable physical properties of porphyrin and exhibits mesoporous structures with a relatively high surface area. SnPOP is thermally stable at temperatures up to 600 °C and highly resistant to boiling water, strong acids, and bases, owing to its assembly via formation of covalent bonds instead of typically weaker hydrogen bonds. The modified chemical and morphological structures of SnPOP showed an impressive CO2 uptake capacity of 58.48 mg g-1 at 273 K, with a preference for CO2 over N2. SnPOP showed significant efficiency in removing pollutant dyes, such as methylene blue and methyl orange, from dye-contaminated water. Additionally, SnPOP was a photocatalyst for fabricating silver nanoparticles of regular shape and size. All these properties make SnPOP a potential candidate for environmental applications like pollutant removal, gas storage, and separation.

A162 RARE PRESENTATION OF EXTRANODAL NK/T-CELL LYMPHOMA INVOLVING STOMACH AND EYE: CASE REPORT AND LITERATURE REVIEW

Background

Extranodal NK/T-cell lymphoma (ENKTL) is a rare and aggressive form of non-Hodgkin lymphoma. ENKTL are predominantly localized to nasal and upper aerodigestive sites, but extranasal involvement including gastrointestinal tract are rarely seen. Small and large intestines are primary sites of gastrointestinal ENKTL. Gastric involvements are exceedingly rare accounting for less than 5% of all gastrointestinal ENKTL.

Purpose

We present a literature review on gastrointestinal ENKTL and a case report of gastrointestinal bleed secondary to ENKTL involving stomach and left orbit.

Method

Case report and literature review.

Result(s)

33-year-old female was admitted to a tertiary hospital with 3-week history of epigastric pain and left periorbital swelling. Abdominal CT showed edema and thickening of gastric folds. Head CT showed grossly enlarged left lateral rectus muscle and periorbital soft tissue swelling suggestive of left orbital pseudotumor. Esophagogastroduodenoscopy revealed multifocal Forrest classification II-C ulcerations throughout her stomach and duodenum. Biopsies from stomach showed gastric mucosa with extensive infiltration by an atypical lymphoid cell population. Immunohistochemistry demonstrated high grade lymphoid cells with uniform expression of CD2, CD3, CD30, CD56, TIA1, perforin and granzyme B. EBV-encoded small RNA in-situ hybridization (EBER ISH) was strongly positive. Findings were consistent with gastric ENKTL. Left orbital biopsy revealed similar morphology and phenotypic features consistent with concurrent ENKTL involvement of her orbit. Patient was initiated on intravenous corticosteroids, but unfortunately developed hemorrhagic shock secondary to gastrointestinal bleeding from gastric ulcer and passed away.

Gastrointestinal ENKTL is a rare presentation of a rare disease. Gastric involvement is especially rare and described only in few case reports. Gastrointestinal ENKTL are often initially asymptomatic but can progress to abdominal pain, bleeding and even bowel perforation. Due its nonspecific clinical features and rarity, diagnosis can be difficult and requires careful examination by an experienced pathologist. This aggressive lymphoma is characterized by positive CD2, CD3, CD30, CD56, TIA, granzyme B, perforin and EBER ISH. Optimal treatment approach remains unclear due to lack of prospective clinical studies. Currently, treatment modalities used for other lymphomas including radiotherapy and non-anthracycline-based chemotherapy are used. Despite treatment, prognosis is grim with median overall survival period of 7-8 months.

Image

Conclusion(s)

We present a case of gastric and orbital ENKTL with gastric ulcer bleeding. Gastric ENKTL disease is a rare presentation of a rare disease. Due to non-specific clinical features, diagnosis is often difficult and relies on careful pathology examination by experienced pathologist. Prognosis is poor without optimal treatment approach due to rarity of disease and lack of validated data.

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INFLAMMATORY BOWEL DISEASES

MECHANISMS AND TREATMENTS

A135 ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC ADENOMAS AND EARLY CARCINOMAS

Background

Management of gastric adenoma and early gastric cancer requires endoscopic resection. This can often be achieved with endoscopic mucosal resection (EMR), which has been shown to be effective with a good safety profile. One disadvantage of EMR is that it is often completed piecemeal, leading to indeterminant margins and higher rates of recurrences that require additional intervention. Endoscopic submucosal dissection (ESD) is a more advanced endoscopic resection technique that has been shown to be more effective than EMR at en-bloc resection. ESD requires high technical proficiency but it is becoming more widely available in western countries.

Purpose

The purpose of this study is to report on the outcomes and rates of complications of gastric ESD completed in a tertiary centre in British Columbia.

Method

All gastric ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all gastric ESD procedures done in St. Paul’s Hospital from May 7th, 2015, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a gastric lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications.

Result(s)

A total of 49 ESD procedures were completed. The mean size of the resected lesions was 25.3 mm (range: 5 – 100 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 48/49 procedures (98.0%). En bloc resection was achieved in 42/48 (87.5%) completed ESD. The rate of R0 resection was also 42/48 (87.5%). Curative resection, defined as technically successful ESD with an R0 margin and no lymphovascular invasion, was achieved in 41/49 (83.7%) of the cases. In our cohort, 8 patients had adenocarcinoma, 5 of which had a curative resection with no evidence of recurrence. None of the ESD resulted in any intra-procedural or delayed perforation. 5/49 (10.2%) patients had clinically significant post-endoscopic resection bleeding. Out of 37 patients that completed follow-up, 3 (8.1%) had recurrence, and all of them were managed endoscopically. 4/49 (8.2%) of patients required surgery post-ESD.

Conclusion(s)

In our cohort, ESD is an effective endoscopic resection modality for gastric lesions with a high rate of technical success and curative resection. Despite a deeper plane of resection versus other endoscopic resection modalities, its complication rate remains low. Although ESD requires high technical proficiency, its favorable outcomes along with low rates of complication make ESD highly feasible for the resection of gastric lesions. Further research will be needed to study the implementation and outcomes of

ESD in a western setting.

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A131 ENDOSCOPIC SUBMUCOSAL DISSECTION OF COLORECTAL ADENOMAS AND EARLY ADENOCARCINOMAS: OUTCOMES FROM BRITISH COLUMBIA

Background

Endoscopic resection is the standard of care for the management of colorectal polyps. Larger and more complex polyps require endoscopic mucosal resection (EMR). While complications have been low, EMR is often piecemeal, resulting in indeterminant margins and often a higher recurrence rate. Endoscopic submucosal dissection (ESD) is an advanced endoscopic resection technique with a higher rate of en bloc resection. While more data exist for the resection of gastric lesions with ESD, ESD is becoming more widely used in western countries for the resection of colorectal lesions.

Purpose

The purpose of this study is to report on the outcomes and rates of complications for colorectal ESD completed in a tertiary centre in British Columbia.

Method

All colorectal ESD was completed by a senior therapeutic endoscopist who has previously received training in Japan. Retrospective data were collected on all colorectal ESD procedures done in St. Paul’s Hospital from July 11th, 2016, when the procedure first became available, to Aug 30th, 2022. Inclusion criteria were all adults who have undergone ESD for resection of a colorectal lesion. Exclusion criteria were patients younger than 18. Data collected included demographic variables, polyp characteristics, procedural outcomes, and complications.

Result(s)

A total of 39 ESD procedures were completed. The mean size of the resected lesion was 30.4 mm (range: 5 – 60 mm). Technical success, defined as successful resection of all polypoid tissue, was achieved in 35/39 procedures (89.7%). En-bloc resection was achieved in 27/35 (77.1%) of the completed ESD. The rate of R0 resection was 22/35 (62.9%). Curative resection, defined as technically successful ESD with R0 margin and no lymphovascular invasion, was achieved in 23/39 (59.0%) of the cases and the majority of the patients with non-curative resection that underwent endoscopic surveillance had no recurrence on follow-up. In our cohort, 3/39 (7.7%) patients had adenocarcinoma. None of the ESD resulted in any intra-procedural or delayed perforation. 3/39 (7.7%) patients had clinically significant post-endoscopic resection bleeding. Out of 24 patients that completed follow-up, 4 (16.7%) had recurrence at the resection site that was managed endoscopically. 4/39 (10.3%) of patients required surgery post-ESD.

Conclusion(s)

In our cohort, ESD is an effective endoscopic resection modality for the management of colorectal adenomas and early adenocarcinoma with a high rate of technical success and low rates of complications. Although the rate of curative resection was low, most were the result of R1 or Rx resection and a majority of the follow-ups in this subgroup demonstrated no further recurrence. The rate of en bloc resection is high, especially given the average size of adenomas in this cohort. Although ESD requires high technical proficiency, its favorable outcomes and low complication rates make ESD highly feasible for the resection of colorectal lesions.

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Risk factors for delirium among patients with advanced cancer in palliative care: a multicenter, patient-based registry cohort in South Korea

OBJECTIVE

Previous studies have comprehensively investigated the prevalence and various potential risk factors for delirium among patients with advanced cancer admitted to the acute palliative care unit (APCU). Our objective was to evaluate the comprehensive association between delirium and various risk factors among patients with advanced cancer in an acute palliative care setting using a patient-based multicenter registry cohort.

PATIENTS AND METHODS

We performed a multicenter, patient-based registry cohort study collected in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified using a medical record review based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

RESULTS

In total, 2,124 eligible patients with advanced cancer in the APCU met the inclusion criteria. There were 127 out of 2,124 patients (prevalence, 6.0%; 95% CI, 5.0 to 7.1) with delirium during admission. Delirium in patients with advanced cancer was associated with age >70 years (OR, 1.793; 95% CI, 1.246 to 2.581), male sex (OR, 1.675; 95% CI, 1.131 to 2.479), no chemotherapy during hospitalization (OR, 2.019; 95% CI, 1.236 to 3.298), hearing impairment (OR, 3.566; 95% CI, 1.176 to 10.810), underweight (OR, 1.826; 95% CI, 1.067 to 3.124), current use of opioid medication (OR, 1.942; 95% CI, 1.264 to 2.982), previous history of delirium (OR, 12.497; 95% CI, 6.920 to 22.568), and mental illness (OR, 2.333; 95% CI, 1.251 to 4.352).

CONCLUSIONS

In a large-scale multicenter patient-based registry cohort, delirium was associated with old age, male sex, no chemotherapy during hospitalization, hearing impairment, underweight, current use of opioid medication, and a history of delirium and mental illness. Our findings suggest physicians should pay attention to delirium in patients with advanced cancer admitted to the APCU with the above risk factors.

Hybrid Composite of Sn(IV)-Porphyrin and Mesoporous Structure for Enhanced Visible Light Photocatalytic Degradation of Organic Dyes

Two hybrid composites (SnP@MCM-41 and SnP@SiO₂) were fabricated by chemical adsorption of (trans-dihydroxo)(5,10,15,20-tetraphenylporphyrinato)tin(IV) (SnP) on mesoporous structured Mobil Composition of Matter No. 41 (MCM-41) and SiO₂ nanoparticles. These materials were characterized by Fourier-transform infrared spectroscopy, ultraviolet-visible spectroscopy, fluorescence spectroscopy, transmission electron microscopy, and field-emission scanning electron microscopy techniques. The incorporation of SnP into MCM-41 and SiO₂ supports efficient photocatalytic degradation of the anionic erioglaucine, cationic rhodamine B, and neutral m-cresol purple dyes under visible light irradiation in an aqueous solution. The performances of degradation of these dyes by these photocatalysts under visible light irradiation varied from 87 to 95%. The pseudo-first-order degradation rate constant of organic dyes for SnP@MCM-41 was higher than those of SnP@SiO₂ and SnP. These visible light photocatalysts showed remarkable stability and reliable reusability.

A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death

Funding Acknowledgements

Type of funding sources: None.

Background

Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy.

Purpose

In this study, we derived and validated a novel scoring system to predict hypoxic-ischaemic brain injury (HIBI) and in-hospital death (IHD).

Methods

We retrospectively analysed Korean Hypothermia Network prospective registry data collected from in Korea between 2015 and 2018. Patients without neuroprognostication data were excluded, and the remaining patients were randomly divided into derivation and validation cohorts. HIBI was defined when at least one prognostication predicted a poor outcome. IHD meant all deaths regardless of cause. In the derivation cohort, stepwise multivariate logistic regression was conducted for HIBI and IHD scores, and model performance was assessed. We then classified patients into four categories and analysed associations between the categories and cerebral performance categories (CPCs) at hospital discharge. Finally, we validated our models in the internal validation cohort.

Results

Among 1373 patients, 240 were excluded, and 1133 were randomised into derivation (n=754) and validation cohorts (n=379). In the derivation cohort, 7 and 8 predictors were selected for HIBI (0–8) and IHD scores (0–11), respectively, and the area under the curve (AUC) was 0.85 (95% CI 0.82–0.87) and 0.80 (95% CI 0.77–0.82), respectively. Applying optimum cutoff values of ≥6 points for HIBI and ≥7 points for IHD, patients were classified as follows: HIBI (-)/IHD (-), Category 1 (n=424); HIBI (-)/IHD (+), Category 2 (n=100); HIBI (+)/IHD (-), Category 3 (n=21); and HIBI (+)/IHD (+), Category 4 (n=209). CPCs at discharge were significantly different in each category (p&lt;0.001). In the validation cohort, the model showed moderate discrimination (AUC 0.83, 95% CI 0.79–0.87 for HIBI and AUC 0.77, 95% CI 0.72–0.81 for IHD) with good calibration. Each category of the validation cohort showed a significant difference in discharge outcomes (p&lt;0.001) and a similar trend to the derivation cohort.

Conclusions

We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.

Association between Fiber Intake and Risk of Incident Chronic Kidney Disease: The UK Biobank Study

OBJECTIVES

Dietary fiber intake is associated with a lower risk of diabetes, cardiovascular disease, and cancer. However, it is unknown whether dietary fiber has a beneficial effect on preventing the development of chronic kidney disease (CKD).

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Using the UK Biobank prospective cohort, 110,412 participants who completed at least one dietary questionnaire and had an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, urinary albumin-to-creatinine ratio <30 mg/g, and no history of CKD were included. The primary exposure was total dietary fiber density, calculated by dividing the absolute amount of daily total fiber intake by total energy intake (g/1,000 kcal). We separately examined soluble and insoluble fiber densities as additional predictors. The primary outcome was incident CKD based on diagnosis codes.

RESULTS

A total of 3,507 (3.2%) participants developed incident CKD during a median follow-up of 9.9 years. In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for incident CKD were 0.85 (0.77-0.94), 0.78 (0.70-0.86), and 0.76 (0.68-0.86), respectively, for the second, third, and highest quartiles of dietary fiber density (reference: lowest quartile). In a continuous model, the aHR for each +∆1.0g/1,000 kcal increase in dietary fiber density was 0.97 (95% CI, 0.95-0.99). This pattern of associations was similar for both soluble and insoluble fiber densities and did not differ across subgroups of sex, age, body mass index, hypertension, diabetes, smoking, and inflammation.

CONCLUSION

Increased fiber intake was associated with a lower risk of CKD in this large well-characterized cohort.

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Sn(IV)-Porphyrin-Based Nanostructures Featuring Pd(II)-Mediated Supramolecular Arrays and Their Photocatalytic Degradation of Acid Orange 7 Dye

Two robust Sn(IV)-porphyrin-based supramolecular arrays (1 and 2) were synthesized via the reaction of trans-Pd(PhCN)2Cl2 with two precursor building blocks (SnP1 and SnP2). The structural patterns in these architectures vary from 2D to 3D depending on the axial ligation of Sn(IV)-porphyrin units. A discrete 2D tetrameric supramolecule (1) was constructed by coordination of {(trans-dihydroxo)[5,10-bis(4-pyridyl)-15,20-bis(phenyl) porphyrinato]}tin(IV) (SnP1) with trans-PdCl2 units. In contrast, the coordination between the {(trans-diisonicotinato)[5,10-bis(4-pyridyl)-15,20-bis(phenyl)porphyrinato]}tin(IV) (SnP2) and trans-PdCl2 units formed a divergent 3D array (2). Axial ligation of the Sn(IV)-porphyrin building blocks not only alters the supramolecular arrays but also significantly modifies the nanostructures, including porosity, surface area, stability, and morphology. These structural changes consequently affected the photocatalytic degradation efficiency under visible-light irradiation towards acid orange 7 (AO) dye in an aqueous solution. The degradation efficiency of the AO dye in the aqueous solution was observed to be between 86% to 91% within 90 min by these photocatalysts.

Prognostic impact of plasma glucose on cardiogenic shock patients with or without diabetes ellitus: smart rescue trial

Background

Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population

Purpose

Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients

Method

A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L).

Results

The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p&lt;0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1: 45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients

Conclusion

In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital

Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study

Background

In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.

Methods and results

1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI &gt;25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.

Conclusions

Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.

Funding Acknowledgement

Type of funding sources: None.

Preparation and Characterization of Low-Cost Ceramic Membrane Coated with Chitosan: Application to the Ultrafine Filtration of Cr(VI)

In this work, low-cost ceramic membranes (CMs) were prepared from ultrafine starting powders such as kaolin, clay, and starch by a dry compaction method. The ceramic membranes were sintered at different temperatures and times and were characterized by XRD, XRF, TG-DTA, SEM-EDS, N₂-BET, water absorption, compressive strength, and pure water flux. The optimal membrane, sintered at 1000 °C for 3 h, possessed water absorption of 27.27%, a compressive strength of 31.05 MPa, and pure water flux of 20.74 L/h m². Furthermore, chitosan crosslinked with glutaraldehyde was coated on the surface of the ceramic membrane by the dip coating method, and the pore size of the chitosan-coated ceramic membrane (CCCM) was 16.24 nm. Eventually, the separation performance of this membrane was assessed for the removal of chromium(VI) from aqueous solution. The ultrafine filtration of Cr(VI) was studied in the pH range of 2-7. The maximum removal of Cr(VI) was observed to be 71.25% with a pH of 3. The prepared CCCM showed good membrane properties such as mechanical stability and ultrafine structure, which have important applications for the treatment of wastewater including such heavy metals.

Photocatalytic Hydrogen Production by the Sensitization of Sn(IV)-Porphyrin Embedded in a Nafion Matrix Coated on TiO2

Efficient utilization of visible light for photocatalytic hydrogen production is one of the most important issues to address. This report describes a facile approach to immobilize visible-light sensitizers on TiO₂ surfaces. To effectively utilize the sensitization of Sn(IV) porphyrin species for photocatalytic hydrogen production, perfluorosulfonate polymer (Nafion) matrix coated-TiO₂ was fabricated. Nafion coated-TiO₂ readily adsorbed trans-diaqua[meso-tetrakis(4-pyridinium)porphyrinato]tin(IV) cation [(TPy^HP)Sn(OH₂)₂]⁶⁺ via an ion-exchange process. The uptake of [(TPy^HP)Sn(OH₂)₂]⁶⁺ in an aqueous solution completed within 30 min, as determined by UV-vis spectroscopy. The existence of Sn(IV) porphyrin species embedded in the Nafion matrix coated on TiO₂ was confirmed by zeta potential measurements, UV-vis absorption spectroscopy, TEM combined with energy dispersive X-ray spectroscopy, and thermogravimetric analysis. Sn(IV)-porphyrin cationic species embedded in the Nafion matrix were successfully used as visible-light sensitizer for photochemical hydrogen generation. This photocatalytic system performed 45% better than the uncoated TiO₂ system. In addition, the performance at pH 7 was superior to that at pH 3 or 9. This work revealed that Nafion matrix coated-TiO₂ can efficiently produce hydrogen with a consistent performance by utilizing a freshly supplied cationic Sn(IV)-porphyrin sensitizer in a neutral solution.

Selective Homocysteine Assay with Cucurbit[7]uril by pH Regulation

We report the effect of pH on the supramolecular complexation of two biothiols, viz., homocysteine (Hcy) and cysteine (Cys), with cucurbit[7]uril (CB[7]). Under basic pH conditions, Cys did not complex with CB[7], whereas Hcy efficiently complexed with CB[7], as confirmed by ¹H NMR spectroscopy and Ellman's reagent (5,5'-dithio-bis(2-nitrobenzoic acid), DTNB) assay. ¹H NMR and Raman spectroscopic studies revealed that, in the absence of CB[7], Hcy auto-oxidized slowly (~36 h) to homocystine (HSSH) under basic pH conditions. However, the rate of Hcy oxidation increased by up to 150 fold in the presence of CB[7], as suggested by the DTNB assay. Thus, supramolecular complexation under basic pH conditions led to the formation of a HSSH-CB[7] complex, and not Hcy-CB[7]. The results indicate that Hcy is rapidly oxidized to HSSH under the catalysis of CB[7], which acts as a reaction chamber, in basic pH conditions. Our studies suggest that Hcy concentration, a risk factor for cardiovascular disease, can be selectively and more easily quantified by supramolecular complexation with CB [7].

Three Isomeric Zn(II)-Sn(IV)-Zn(II) Porphyrin-Triad-Based Supramolecular Nanoarchitectures for the Morphology-Dependent Photocatalytic Degradation of Methyl Orange

Three isomeric Zn(II)-Sn(IV)-Zn(II) porphyrin-based triads (T2, T3, and T4) were synthesized by the reaction of common Zn(II) porphyrins (ZnL) with different Sn(IV) porphyrins (SnP n ). The Sn(IV) porphyrin precursors differ with respect to the position of the pyridyl-N atoms. All compounds were characterized by 1H NMR, UV-vis, fluorescence spectroscopy, electrospray ionization-mass spectrometry, and field-emission scanning electron microscopy measurements. In these structures, the intramolecular cooperative metal-ligand coordination of the 3-pyridyl nitrogen in SnP 3 with axial ZnL and the π-π interactions between the adjacent porphyrin triad are the determining factors affecting the nanostructures of T3. Owing to the geometrical constraints of the SnP 2 center, this type of interaction is not possible for T2. Therefore, only the π-π interactions affect the self-assembly process. In the case of SnP 4 , intermolecular coordinative interactions and then π-π interactions are responsible for the nanostructure of T4. The morphology-dependent photocatalytic degradation of methyl orange (MO) dye in aqueous solution under visible light irradiation was observed for these photocatalysts, and the degradation ratio of MO varied from 76 to 94% within 100 min. Nanorod-shaped T3 exhibited higher performance compared to nanosphere T2 and nanoflake T4.

Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study

BACKGROUND

Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care.

METHODS

300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies.

RESULTS

Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists.

CONCLUSIONS

Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.

Morphology-controlled self-assembled nanostructures of complementary metalloporphyrin triads obtained through tuning their intermolecular coordination and their photocatalytic degradation of Orange II dye

Tuning the intermolecular metal–ligand coordination mode in a series of (Zn–Sn–Zn) porphyrin triads resulted in the formation of specific nanostructured photocatalysts for the visible light photodegradation of Orange II dye.

Supramolecular squares of Sn(IV)porphyrins with Re(I)-corners for the fabrication of self-assembled nanostructures performing photocatalytic degradation of Eriochrome Black T dye

Two Sn(IV)porphyrin-based supramolecular squares (1 and 2) were synthesized via the reaction of Re(CO)5Cl with two [trans-bis(4-pyridyl)(porphyrinato)]Sn(IV) complexes (SnP1 and SnP2). Although the structural framework of these architectures was fixed...

Coordination framework materials fabricated by the self-assembly of Sn(IV) porphyrins with Ag(I) ions for the photocatalytic degradation of organic dyes in wastewater

Two porphyrin-based coordination frameworks, [Ag2(TPyP)Sn(OH)2](NO3)2●(solv)x (1) and [Ag2(TPyP)Sn(INA)2](OTf)2●(CH3CN)2 (2) (INA = isonicotinato anion, OTf = CF3SO3-), were constructed by the self-assembly of hexacoordinated (meso-tetra-(4-pyridyl)porphyrinato)Sn(IV) building blocks with Ag(I) ions. They...

Associations between changing patterns of ST-T waves morphologies in rest electrocardiography and cardiovascular risk in an asymptomatic low risk population: a report from Ansan-Ansung cohort study

Background

While clinical significance of ST-T wave abnormalities (STA) in rest electrocardiography (ECG) on long-term cardiovascular outcomes has been on debate, few studies have been reported on the association between the changes in ST-T waves in rest ECG and cardiovascular outcomes in low risk populations. We investigate the changing patterns of STA in rest ECG and the predictive value of the changes in ST-T wave in rest ECG for cardiovascular events in an asymptomatic general population.

Methods

A longitudinal community-based cohort study was conducted for 12 years. Koreans aged 40–69 years were followed biennially through scheduled revisit for comprehensive assessments. Among 10,030 participants, 6,648 participants who did not have any cardiovascular diseases, angina-related symptoms or pathologic Q waves in rest ECG at baseline were included for analysis. Changes in STAs were defined using the changes between ECG at baseline and that at the first revisit. A major adverse cardiovascular events was defined as a composite of cardiac death, myocardial infarction, clinical diagnosis of coronary artery disease and stroke.

Results

Among 5,924 participants without STA at baseline, only 187 participants (3.2%) developed new STA. Among 724 patients (10.9%) with STA at baseline, 274 patients (37.8%) persistently showed STA at the first revisit. MACEs occurred more frequently in the participants persistently with STA and those with newly-developed STA than in the participants persistently without STA (Figure 1). Multivariate Cox-proportional hazard models showed that a higher risk of MACE was only associated with the persisted STA (HR 1.69; 95% CI 1.10–2.63). In participants with baseline STA, persisted T-wave flattening was associated with a higher risk of MACE, whereas T-wave inversion, either persisted or fluctuated was not associated with a higher risk of MACE, compared with persistent absence of STA (Figure 2). In the participants without baseline STAs, multivariate Cox-proportional hazard model showed that newly-developed T-wave flattening (HR 1.85; 95% CI 0.20–2.84), not T-wave inversion (HR 1.50; 95% CI 0.85–2.65) was associated with a higher risk of MACE. Survival receiver operating curve analysis showed that the changes in STAs had a C-index of 0.538 (95% CI 0.511–0.558), a sensitivity of 13.0% and a specificity of 92.5% and add only a small value to the predictive power of 10-year atherosclerotic cardiovascular diseases risk estimator (C-index without STA changes 0.708 [0.681–0.736] vs. C-index with STA changes 0.721 [0.694–0.748]).

Conclusions

STAs uncommonly developed while frequently disappeared spontaneously in the asymptomatic general population. Persisted STA and newly developed STA in rest ECG were predictive of future cardiovascular events in the asymptomatic general population. However, the changes in STAs did not significantly improve the predictive value of the conventional risk estimator, when added.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea Figure 1Figure 2

Simulation and validation for count-based binary decision of target blood pressure achievement in home blood pressure monitoring data analysis for clinical practice

Introduction

Home blood pressure monitoring (HBPM) is a useful tool to identify hypertension and to decide whether a patient's blood pressure (BP) is controlled. The use of automatized oscillometric BP measurement devices has become increasingly popular with help of information technology and internet of things to the devices. However, applying HBPM to daily clinical practices is still challenging, because most patients with hypertension are in age groups not familiar to digital devices and internet and high BP criteria using average home BP values are often useless in outpatient clinics without easily accessible average BP calculation tools. Therefore, we developed a simple and straightforward method to interpret HBPM through counts of BP ≥135/85 mmHg.

Methods

We simulated 400 cases of HBPM using a random number generator function in statistical software. The simulated average home systolic BP (SBP) and its standard deviation (SD) were 125±15 mmHg and 12±5 mmHg and the number of HBP readings was 24 times. The simulated diastolic BP (DBP) was randomly selected to 50–75% of the SBP. The validation of the binary interpretation method was conducted using actual HBPM data from 386 subjects in a rural area of South Korea. Receiver operating characteristics curve analysis was conducted, and linear regression and logarithmic models were fitted between the numbers of home BP ≥135/85 mmHg and mean BP. Hypertension was defined with average home BP ≥135/85 mmHg.

Results

In the simulated cohort, hypertension was presented in 197 cases (49.3%). The C-index of the numbers of BP readings ≥135/85 mmHg was 0.994 (95% confidence interval [CI] 0.990–0.998), and ≥12 of 24 BP readings ≥135/85 mmHg showed a sensitivity of 95.4%, a specificity of 95.1% and an accuracy of 95.3% for the diagnosis of hypertension. In validation cohort, the numbers of home BP measurements varied from 8 to 81 times. The validation cohort similarly showed that the C-index of the ratio between the number of high BP readings (≥135/85 mmHg) to the number of BP measurements (R-NHBP/NBP) was 0.985 (95% CI, 0.976–0.994) and the best accuracy was shown at R-NHBP/NBP of ≥0.45. R-NHBP/NBP of ≥0.5 showed a sensitivity of 0.957, a specificity of 0.907 and an accuracy of 0.927. The accuracy of the R-NHBP/NBP of ≥0.5 decreased as SD and the range of SBP increased, whereas it did not change with the number of measurements (Figure 1). R-NHBP/NBP &lt;0.2 predicted normotension and R-NHBP/NBP &gt;0.8 predicted hypertension in 95% confidence. Mean widths of the 95 prediction intervals for the average SBP and DBP were 18.2 mmHg and 12.6 mmHg, respectively (Figure 2).

Conclusion

Counting the number of BP ≥135/85 mmHg can provide accurate assessments for the BP levels. R-NHBP/NBP of ≥0.5 is a simple and accurate marker of high BP in HBPM, and R-NHBP/NBP could be a useful tool to assess BP levels in patients practicing HBPM.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2