Evaluating the relationship between the nutrient intake of lactating women and their breast milk nutritional profile: a systematic review and narrative synthesis

Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle-Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α-linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets.

Direct Visualization of Supramolecular Binding and Separation of Light Hydrocarbons in MFM-300(In)

The purification of light olefins is one of the most important chemical separations globally and consumes large amounts of energy. Porous materials have the capability to improve the efficiency of this process by acting as solid, regenerable adsorbents. However, to develop translational systems, the underlying mechanisms of adsorption in porous materials must be fully understood. Herein, we report the adsorption and dynamic separation of C₂ and C₃ hydrocarbons in the metal-organic framework MFM-300(In), which exhibits excellent performance in the separation of mixtures of ethane/ethylene and propyne/propylene. Unusually selective adsorption of ethane over ethylene at low pressure is observed, resulting in selective retention of ethane from a mixture of ethylene/ethane, thus demonstrating its potential for a one-step purification of ethylene (purity > 99.9%). In situ neutron powder diffraction and inelastic neutron scattering reveal the preferred adsorption domains and host-guest binding dynamics of adsorption of C₂ and C₃ hydrocarbons in MFM-300(In).

Porous Metal-Organic Polyhedra: Morphology, Porosity, and Guest Binding

Designing porous materials which can selectively adsorb CO₂ or CH₄ is an important environmental and industrial goal which requires an understanding of the host–guest interactions involved at the atomic scale. Metal–organic polyhedra (MOPs) showing permanent porosity upon desolvation are rarely observed. We report a family of MOPs (Cu-1a, Cu-1b, Cu-2), which derive their permanent porosity from cavities between packed cages rather than from within the polyhedra. Thus, for Cu-1a, the void fraction outside the cages totals 56% with only 2% within. The relative stabilities of these MOP structures are rationalized by considering their weak nondirectional packing interactions using Hirshfeld surface analyses. The exceptional stability of Cu-1a enables a detailed structural investigation into the adsorption of CO₂ and CH₄ using in situ X-ray and neutron diffraction, coupled with DFT calculations. The primary binding sites for adsorbed CO₂ and CH₄ in Cu-1a are found to be the open metal sites and pockets defined by the faces of phenyl rings. More importantly, the structural analysis of a hydrated sample of Cu-1a reveals a strong hydrogen bond between the adsorbed CO₂ molecule and the Cu(II)-bound water molecule, shedding light on previous empirical and theoretical observations that partial hydration of metal−organic framework (MOF) materials containing open metal sites increases their uptake of CO₂. The results of the crystallographic study on MOP–gas binding have been rationalized using DFT calculations, yielding individual binding energies for the various pore environments of Cu-1a.

We report a family of metal−organic polyhedra (MOP), which derive their permanent porosity from cavities between packed cages rather than from within the polyhedra. The relative stabilities of these MOP structures are rationalized by considering their weak nondirectional packing interactions using Hirshfeld surface analysis. A detailed structural investigation into the adsorption of CO₂ and CH₄ is reported using in situ X-ray and neutron diffraction, coupled with DFT calculations.

The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI

Background

Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.

Purpose

We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.

Methods

A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).

Results

A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p<0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).

Conclusions

The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.

Figure 1

Funding Acknowledgement

Type of funding source: None

Tripyrrin-armed isosmaragdyrins: synthesis, heterodinuclear coordination, and protonation-triggered helical inversion

Oxidative ring closure of linear oligopyrroles is one of the synthetic approaches to novel porphyrinoids with dinuclear coordination sites and helical chirality. The spatial arrangement of the pyrrolic groups of octapyrrole (P8) affected the position of the intramolecular oxidative coupling of the pyrrolic units; tripyrrin-armed isosmaragdyrin analogue (1) containing a β,β-linked bipyrrole moiety was synthesized regioselectively in a high yield by using FeCl₃. Ni^II-coordination at the armed tripyrrin site of 1 allowed the formation of diastereomeric helical twisted complexes (2A and 2B) and succeeding Cu^II-coordination at the macrocyclic core afforded heterodinuclear Ni^II/Cu^II-complexes (3A and 3B). Each of them comprised a pair of separable enantiomers, exhibiting P- and M-helices, respectively. Notably, diastereomeric interconversion from 2A to 2B was quantitatively achieved as a consequence of helical transformation under acidic conditions.

P3611The effect of concomitant AF on in-hospital clinical outcomes of NSTE-ACS related hospitalizations in the United States: an analysis of rates, trends and predictors from 2004 to 2014

Background

Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS).

Purpose

We sought to examine the rates, trends, and clinical outcomes of non-ST Elevation acute coronary syndrome (NSTE-ACS) related hospitalisations in the United States in patients with AF compared to those with sinus rhythm (SR).

Methods

We analysed the Nationwide Inpatient Sample (NIS) database from 2004 to 2014 for patients with a primary discharge diagnosis of NSTEMI or UA, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to identify the association between AF and MACCE (composite of mortality, stroke and cardiac complications), mortality, stroke, and bleeding.

Results

A total of 4,668,737 NSTE-ACS admissions were included in our analysis. The proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% in 2004 to 19.3% in 2014 (p<0.001). The AF group was at a greater risk of adverse outcomes with higher overall rates and adjusted relative risk of MACCE (12.9% vs. 5.3%; RR: 1.74 [1.72, 1.75]), mortality (6.5% vs. 3.3%. RR: 1.12 [1.11, 1.13]), stroke (2.7% vs. 1.5%; RR: 1.32 [1.30, 1.34]) and bleeding (14.7% vs. 8.8%; RR: 1.42 [1.41, 1.43]). The AF group was less likely to receive coronary angiography (47.1% vs. 58%) and PCI (18.7% vs. 32.6%) and more likely to undergo CABG (13.9% vs. 7.6%) in comparison to SR.

Figure 1. Crude rates of adverse events

Conclusion

The prevalence of concomitant Atrial Fibrillation amongst patients presenting with NSTE-ACS has increased over a decade. However, this high-risk group remains less likely to receive invasive coronary management for NSTE-ACS than patients with sinus rhythm, independent of their comorbidities, and are associated with worse clinical outcomes.

P6510Frailty and in-hospital outcomes in percutaneous coronary interventions

Background

Frailty may be an important marker for poor outcomes in percutaneous coronary intervention (PCI) and there is limited literature on outcomes based on frailty from national cohorts.

Purpose

This study evaluates the prevalence of frailty, changes in frailty over time and outcomes associated with frailty in a national American cohort of patients who underwent PCI.

Methods

The study included adults who underwent PCI in the National Inpatients Sample between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5–15 and >15 corresponding to low, intermediate and high HFRS.

Results

There were 7,306,007 PCI admissions in this cohort. A total of 94.58%, 5.39% and 0.03% of admissions were for low HFRS, intermediate HFRS and high HFRS, respectively. The proportion of intermediate or high frailty risk patients increased over time from 1.9% in 2004 to 11.7% in 2014. In-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS and average length of stay increased from 2.9±3.3 days to 17.1±15.5 days from low to high HFRS. Greater frailty risk was associated with greater average inpatient cost which was $17,743±11,059, $38,824±34,809 and $56,119±49,772 for low, intermediate and high HFRS, respectively. There were increased adverse outcomes with high frailty including greater in-hospital death (OR 9.91 95% CI 7.17–13.71), in-hospital bleeding complications (OR 4.99 95% CI 3.82–6.51), in-hospital vascular complications (OR 3.96 95% CI 3.00–5.23) and in-hospital stroke (OR 10.49 95% CI 8.28–13.29) comparing high to low HFRS.

Conclusions

More than 1 in 20 patients who undergo PCI have intermediate or high risk of frailty which has significantly increased over time. There are poor outcomes and increased inpatient costs associated with greater frailty. Improvements in education of healthcare workers and increased awareness of frailty could facilitate frailty-tailored care to minimise risk of adverse outcomes and its associated costs.

Acknowledgement/Funding

Research and Development Department at the Royal Stoke Hospital, Keele University and Biosensors International

Ammonia Storage by Reversible Host-Guest Site Exchange in a Robust Metal-Organic Framework

MFM-300(Al) shows reversible uptake of NH3 (15.7 mmol g-1 at 273 K and 1.0 bar) over 50 cycles with an exceptional packing density of 0.62 g cm-3 at 293 K. In situ neutron powder diffraction and synchrotron FTIR micro-spectroscopy on ND3 @MFM-300(Al) confirms reversible H/D site exchange between the adsorbent and adsorbate, representing a new type of adsorption interaction.

Direct observation of supramolecular binding of light hydrocarbons in vanadium(iii) and (iv) metal-organic framework materials

Binding of C₂H₂ in MFM-300(V^III) showing interactions to O–H, carboxylate O-centres and intermolecular packing.

Fine tuning of host–guest supramolecular interactions in porous systems enables direct control over the properties of functional materials. We report here a modification of hydrogen bonding and its effect on guest binding in a pair of redox-active metal–organic frameworks (MOFs). Oxidation of MFM-300(V^III) {[VIII2(OH)₂(L)], LH₄ = biphenyl-3,3′,5,5′-tetracarboxylic acid} is accompanied by deprotonation of the bridging hydroxyl groups to afford isostructural MFM-300(V^IV), [VIV2O₂(L)]. The precise role of the hydroxyl groups, O-carboxylate centres and π–π interactions in the supramolecular binding of C₂ hydrocarbons in these materials has been determined using neutron diffraction and inelastic neutron scattering, coupled with DFT modelling. The hydroxyl protons are observed to bind to adsorbed unsaturated hydrocarbons preferentially in MFM-300(V^III), particularly to C₂H₂, which is in a sharp contrast to MFM-300(V^IV) where interactions with O-carboxylate centres and π–π interactions predominate. This variation in structure and redox leads to notably higher separation selectivity for C₂H₂/CH₄ and C₂H₄/CH₄ in MFM-300(V^III) than in MFM-300(V^IV). Significantly, owing to the specific host–guest interactions, MFM-300(V^III) shows a record packing density for adsorbed C₂H₂ at 303 K and 1 bar, demonstrating its potential for use in portable acetylene stores.

Locating the binding domains in a highly selective mixed matrix membrane via synchrotron IR microspectroscopy

The location of binding domains in a new CO₂ selective mixed matrix membrane has been established via in situ synchrotron IR microspectroscopy.

Modulating supramolecular binding of carbon dioxide in a redox-active porous metal-organic framework

Hydrogen bonds dominate many chemical and biological processes, and chemical modification enables control and modulation of host–guest systems. Here we report a targeted modification of hydrogen bonding and its effect on guest binding in redox-active materials. MFM-300(V^III) {[V^III₂(OH)₂(L)], LH₄=biphenyl-3,3′,5,5′-tetracarboxylic acid} can be oxidized to isostructural MFM-300(V^IV), [V^IV₂O₂(L)], in which deprotonation of the bridging hydroxyl groups occurs. MFM-300(V^III) shows the second highest CO₂ uptake capacity in metal-organic framework materials at 298 K and 1 bar (6.0 mmol g⁻¹) and involves hydrogen bonding between the OH group of the host and the O-donor of CO₂, which binds in an end-on manner, =1.863(1) Å. In contrast, CO₂-loaded MFM-300(V^IV) shows CO₂ bound side-on to the oxy group and sandwiched between two phenyl groups involving a unique ···c.g._phenyl interaction [3.069(2), 3.146(3) Å]. The macroscopic packing of CO₂ in the pores is directly influenced by these primary binding sites.

Gaining molecular-level insight into host–guest binding interactions is fundamentally important, but experimentally challenging. Here, Schröder and co-workers study CO₂–host hydrogen bonding interactions in a pair of isostructural redox-active V^III/V^IV MOFs using neutron scattering and diffraction techniques.