Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Background

Delirium following cardiac surgery is common, morbid, and costly, but may be prevented with risk stratification and targeted intervention. Preoperative protein signatures may identify patients at increased risk for worse postoperative outcomes, including delirium. In this study, we aimed to identify plasma protein biomarkers and develop a predictive model for postoperative delirium in older patients undergoing cardiac surgery, while also uncovering possible pathophysiological mechanisms.

Methods

SOMAscan analysis of 1,305 proteins in the plasma from 57 older adults undergoing cardiac surgery requiring cardiopulmonary bypass was conducted to define delirium-specific protein signatures at baseline (PREOP) and postoperative day 2 (POD2). Selected proteins were validated in 115 patients using the ELLA multiplex immunoassay platform. Proteins were combined with clinical and demographic variables to build multivariable models that estimate the risk of postoperative delirium and bring light to the underlying pathophysiology.

Results

A total of 115 and 85 proteins from SOMAscan analyses were found altered in delirious patients at PREOP and POD2, respectively (p<0.05). Using four criteria including associations with surgery, delirium, and biological plausibility, 12 biomarker candidates (Tukey's fold change (|tFC|)>1.4, Benjamini-Hochberg (BH)-p<0.01) were selected for ELLA multiplex validation. Eight proteins were significantly altered at PREOP, and seven proteins at POD2 (p<0.05), in patients who developed postoperative delirium compared to non-delirious patients. Statistical analyses of model fit resulted in the selection of a combination of age, sex, and three proteins (angiopoietin-2 (ANGPT2); C-C motif chemokine 5 (CCL5); and metalloproteinase inhibitor 1 (TIMP1); AUC=0.829) as the best performing predictive model for delirium at PREOP. The delirium-associated proteins identified as biomarker candidates are involved with inflammation, glial dysfunction, vascularization, and hemostasis, highlighting the multifactorial pathophysiology of delirium.

Conclusion

Our study proposes a model of postoperative delirium that includes a combination of older age, female sex, and altered levels of three proteins. Our results support the identification of patients at higher risk of developing postoperative delirium after cardiac surgery and provide insights on the underlying pathophysiology. ClinicalTrials.gov ( NCT02546765 ).

Development of reference material for quality control of uranium analysis in marine sediments

Environmental radioactivity monitoring is strengthening due to public concerns over radioactive contamination since the Fukushima nuclear power plant accident. Therefore, various research laboratories, institutes, and universities have been conducting environmental radioactivity surveys around nuclear power plants (NPPs). However, the reliability of the results continues to trigger controversy in society. This study was conducted to develop reference material (RM) for the quality control of 238U and 234U analyses in marine sediments. The RM was prepared according to ISO Guides 31, 34, and 35. A homogeneity test of the marine sediment RM was implemented by analyzing two batch samples from ten bottles using multiple acid digestion and alkali fusion, respectively. We found that the 238U and 234U reference values of the RM were 43.0 ± 1.7 Bq kg-1(k=1) and 41.5 ± 1.9 Bq kg-1(k=1), respectively. This marine sediment RM will be useful for the quality control of analytical methods for similar samples and proficiency tests.

Development of metal radioactive liquid reference material for proficiency test

This study developed liquid reference materials containing various metals, to be used for quality assurance of radiation measurements of the most common metallic wastes generated during the operation or decommissioning of nuclear power plants. The liquid reference materials were prepared by assuming the dissolution of stainless-steel using acid and melting of the major metals present in the stainless steel, namely Fe, Ni, Cr, and Mn, along with the standard sources (134Cs, 137Cs, 60Co, 90Sr). The theoretical massic activity of the standard sources added to the samples and the measured reference values of the gamma and beta emitters in the samples were compared, and they showed good agreement within a one-sigma confidence interval (k = 1). Using the developed reference materials, a proficiency test was conducted on three domestic labs, and the results were evaluated using Z-score. While the evaluation results showed good agreement between the reference values and the reported values for 137Cs and 60Co, all participating labs reported lower values than the reference value for 134Cs. For 90Sr, two out of the three labs reported significantly higher values than the reference value. Based on the results of this study, the developed metal radioactive liquid reference material is expected to be registered as certified reference material (CRM) in the future. They will be used as the CRM for measuring and ensuring the quality of radioactive metal waste.

A randomized controlled clinical evaluation of desensitization efficacy of a newly developed toothpaste with highly stabilized SnF₂

PURPOSE

To assess the relief of dentin hypersensitivity of the new toothpaste with stabilized stannous fluoride (SnF₂) versus a marketed standard fluoride toothpaste as a negative control and a marketed anhydrous SnF₂ toothpaste as a positive control.

METHODS

This was a single-centered, randomized, controlled, double blind, clinical trial. 96 participants with hypersensitivity were enrolled in this 4-week clinical study. Electrical stimulation and evaporative air tests were performed to evaluate the desensitization efficacy. Clinical assessments were made at baseline, and after 3 days, 1 week, 2 weeks and 4 weeks of twice-daily brushing. Additionally, the influence of Sn² ⁺ species on desensitization was evaluated using bovine dentin specimens treated with toothpaste.

RESULTS

All 96 enrolled participants were randomized. 96 participants completed all evaluations. Participants had an average age (SD) of 47.0 (10.5) years; 45% of participants were female. Both SnF₂ toothpastes showed superior desensitization efficacy compared to the negative control toothpaste, the conventional sodium monofluorophosphate (SMFP) toothpaste, after a week. The new stabilized SnF₂ toothpaste demonstrated improved electrical stimulation benefits compared to the negative control toothpaste, with increases of 15.1% after 3 days, 34.2% after 1 week, 66.3% after 2 weeks, and 111.6% after 4 weeks. Additionally, it showed relative verbal evaluation scale (VES) benefits of 14.2% after 3 days, 37.6% after 1 week, 28.9% after 2 weeks, and 37.4% after 4 weeks. The stabilized SnF₂ toothpaste exhibited desensitization properties comparable to those of a commercial anhydrous SnF₂ toothpaste, which typically produces undesirable side effects in the mouth. Toothpastes containing 0.454 % SnF₂ exhibited perfect occlusion of dentin tubules.

CLINICAL SIGNIFICANCE

The stabilized 0.454% SnF₂ toothpaste exhibited significantly greater dentin hypersensitivity relief within only a week and comparable property to commercial anhydrous SnF₂ toothpaste.

Development of concrete reference material for quality assurance/quality control of gamma radioactivity measurement for nuclear power plant decommissioning waste

The Korea Research Institute of Standards and Science has developed a new concrete reference material (RM) for measuring gamma-emitting radionuclides, such as 134Cs, 137Cs, 65Zn, 241Am, and 60Co, to improve and maintain the quality assurance and quality control of the radioactivity measurement in radioactive waste generated during the decommissioning of nuclear power plants. In this study, cement, SiO2, and bentonite, which are the main components of concrete, were mixed in an appropriate ratio with radionuclides. For certification and homogeneity assessment, 10 bottles were randomly selected, two sub-samples were collected from each bottle, and radionuclides were measured via HPGe gamma spectrometry. The results of the homogeneity tests using a one-way analysis of variance on 241Am, 134Cs, 137Cs, 65Zn, and 60Co in the concrete RM fulfilled the requirements of ISO Guide 35. Coincidence summing and self-absorption correction were performed on measurement results by introducing the Monte Carlo efficiency transfer code and Monte Carlo N-Particle transport code. The reference values for five radionuclides (60Co, 65Zn, 241Am, 134Cs, and 137Cs) in the RM were in the range of 15-40 Bq/kg, and the expanded uncertainty was within 10% (k = 2). To the best of our knowledge, this was the first study to develop concrete RM for measuring gamma-emitting radionuclides.

Development of high-energy non-aqueous lithium-sulfur batteries via redox-active interlayer strategy

Lithium-sulfur batteries have theoretical specific energy higher than state-of-the-art lithium-ion batteries. However, from a practical perspective, these batteries exhibit poor cycle life and low energy content owing to the polysulfides shuttling during cycling. To tackle these issues, researchers proposed the use of redox-inactive protective layers between the sulfur-containing cathode and lithium metal anode. However, these interlayers provide additional weight to the cell, thus, decreasing the practical specific energy. Here, we report the development and testing of redox-active interlayers consisting of sulfur-impregnated polar ordered mesoporous silica. Differently from redox-inactive interlayers, these redox-active interlayers enable the electrochemical reactivation of the soluble polysulfides, protect the lithium metal electrode from detrimental reactions via silica-polysulfide polar-polar interactions and increase the cell capacity. Indeed, when tested in a non-aqueous Li-S coin cell configuration, the use of the interlayer enables an initial discharge capacity of about 8.5 mAh cm⁻² (for a total sulfur mass loading of 10 mg cm⁻²) and a discharge capacity retention of about 64 % after 700 cycles at 335 mA g⁻¹ and 25 °C.

Lithium-sulfur batteries promise high energy density, but polysulfide shuttling acts as a major stumbling block toward practical development. Here, a redox-active interlayer is proposed to confine polysulfides, increase the cell capacity and improve cell cycle life.

POS1060 CHANGES IN DISEASE ACTIVITY AND PATIENT-REPORTED OUTCOMES IN PSORIATIC ARTHRITIS PATIENTS TREATED WITH IXEKIZUMAB IN A REAL-WORLD US COHORT

Background

Ixekizumab (IXE), an IL-17A inhibitor, has demonstrated efficacy in clinical trials1-3 but real-world effectiveness (RWE) data are limited.4

Objectives

To describe changes in disease activity and patient-reported outcomes (PROs) at 6 and 12 months follow-up among psoriatic arthritis (PsA) patients initiating IXE in a routine clinical setting.

Methods

This retrospective cohort study included patients from the OM1 PsA Registry (OM1, Boston, MA), a linked electronic medical record and administrative claims dataset with over 50,000 patients. Eligible patients had ≥1 prescription for IXE (first = index), were ≥18 years old at index, had ≥1 diagnosis code for PsA in the 12 months before or on index, and had ≥12 months of baseline and ≥6 months of follow-up data as of June 2021. For patients with baseline and follow-up measures available, changes in Clinical Disease Activity Index (CDAI), PROs, and other clinical outcomes from baseline to 6 and 12 months were described. For patients on IXE monotherapy, change in CDAI score from baseline to 6 and 12 months was assessed using mixed effects linear models adjusted for age, sex, and baseline CDAI score.

Results

The study population included 1,812 patients with a mean age of 53.7 years (Table 1). Psoriasis was present in 82% and enthesitis in 28%. Over 60% of patients were obese, and the mean Charlson Comorbidity Index was 1.3. Most patients (84%) had prior treatment with a biologic disease-modifying antirheumatic drug (bDMARD) and 40% with a targeted synthetic DMARD (tsDMARD). The mean number of bDMARDs and tsDMARDs used during all available prior history was 2.3 and 1.1, respectively. The most common prior bDMARDs were secukinumab (n=428, 24%) and adalimumab (n=245, 14%).

Table 1.

Demographic and Clinical Characteristics by Therapy Status

All Patients(N=1,812)Monotherapy(N=1,485)Combination Therapy(N=327)Age (years)Mean (s.d.)53.7 (12.2)53.9 (12.3)52.9 (11.7)Median (Q1-Q3)55 (46-62)55 (46-62)54 (45-61)SexFemale1,108 (61.1%)909 (61.2%)199 (60.9%)Male704 (38.9%)576 (38.8%)128 (39.1%)Charlson Comorbidity IndexMean (s.d.)1.3 (1.6)1.3 (1.6)1.5 (1.7)Median (Q1-Q3)1 (0-2)1 (0-2)1 (0-2)BMIUnderweight: <18.510 (0.6%)10 (0.7%)0 (0.0%)Normal weight: 18.5-24.9210 (12.2%)172 (12.2%)38 (12.1%)Overweight: 25-29.9455 (26.5%)379 (27.0%)76 (24.2%)Obese: >= 301,045 (60.8%)845 (60.1%)200 (63.7%)Missing927913Domains of PsA: PsoriasisYes1,490 (82.2%)1,222 (82.3%)268 (82.0%)No322 (17.8%)263 (17.7%)59 (18.0%)Domains of PsA: EnthesitisYes510 (28.1%)409 (27.5%)101 (30.9%)No1,302 (71.9%)1,076 (72.5%)226 (69.1%)

Of patients with a baseline CDAI score, 61% had moderate or severe disease activity. For all patients, CDAI scores improved (decreased) by an average of 3.4 and 3.7 points at 6 and 12 months, respectively, from a baseline mean of 15.4. All disease activity measures and PROs improved from baseline to 6 and 12 months (Figure 1). In patients persistent with IXE, 35.3% and 33.7% were in CDAI remission or low disease activity at 6 and 12 months after initiation, respectively. For IXE monotherapy users (82% of patients), at baseline, patients had a mean CDAI of 14.3 (n=131) and 15.1 (n=105) for the 6 and 12 month analyses, respectively. Adjusted mean changes in CDAI from baseline to 6 months (-3.6 points, p < 0.0001) and 12 months (-4.9 points, p < 0.0001) were statistically significant.

Conclusion

In this cohort of PsA patients with multiple prior b/tsDMARD failures, improvements in disease activity and PROs were observed at 6 and 12 months after initiating treatment with IXE. Improvements were observed in patients overall and in the monotherapy subgroup. More real-world research on IXE and other bDMARDs are important to understand the effect of treatment choices on clinical and PROs in both bDMARD-naive and experienced PsA patients.

References

[1]Mease PJ. Ann. Rheum. Dis. 2017;76(1):79-87

[2]Nash P. Lancet. 2017;389(10086):2317-2327

[3]Mease PJ. Ann. Rheum. Dis. 2020;79(1):123-131

[4]Berman J. Biologics. 2021 Nov 18;15:463-470

Disclosure of Interests

Julie Birt Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, William Tillett Speakers bureau: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis,, Pfizer, UCB, Consultant of: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Amgen, Celgene, Eli-Lilly, Janssen, UCB, Cristi Cavanaugh: None declared, Yoojin Jung: None declared, Aisha Vadhariya Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Sarah Ross Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Jess Paulus: None declared, Aubrey Trevelin Sprabery Shareholder of: Shareholder of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Ennio Lubrano: None declared

High spatial-density, cladding-pumped 6-mode 7-core fiber amplifier for C-band operation

We present a C-band 6-mode 7-core fiber amplifier in an all-fiberized cladding-pumped configuration for space division multiplexed transmission supporting a record 42 spatial channels. With optimized fiber components (e.g. passively cooled pump laser diode, pump coupler, pump stripper), high power multimode pump light is coupled to the active fiber without any noticeable thermal degradation and an average gain of 18 dB and noise figure of 5.4 dB are obtained with an average differential modal gain of 3.4 dB.

Preparation and Electrochemical Analysis of Ni-Based Metal Organic Frameworks Containing Binary Ligands for Capacitor Electrodes

As one of the energy storage systems, supercapacitors have quite long charge-discharge cycle life. Among many kinds of electrode materials, metal organic frameworks (MOFs) have unique properties such as high specific surface areas and large pore volume as supercapacitor electrode materials. Nickel-MOFs consist of binary ligand such as 1,3,5-Trimesic acid (H₃BTC) and terephthalic acid (TPA) were used as working electrode materials in three electrode cell for capacitor system. When synthesizing MOFs, it is possible to prepare uniform crystals using hydrothermal synthesis. The morphology of composites was analyzed by field emission scanning electron microscopy (FE-SEM). Electrochemical properties were measured by cyclic voltammetry (CV), galvanostatic charge-discharge (GCD) in 6M KOH electrolyte.

Risk factors for the delayed diagnosis of extrapulmonary TB

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

MULTIPHYSICS MODELING OF PRECURSORS IN MOLTEN SALT FAST REACTORS USING PROTEUS AND Nek5000

The goal of this work was to calculate the impact of the delayed neutron precursor drift in fast spectrum Molten Salt Reactors (MSRs) using coupled solutions from the neutronics code PROTEUS and the computational fluid dynamics code Nek5000. Specifically, using a multiphysics approach to solve the effective delayed neutron fraction (βeff) or delayed neutron precursor distribution for reactors with flowing fuel salts would provide valuable information for transient simulations and safety assessments. Given the multiple options for the flux solution and geometric resolution/fidelity in PROTEUS, two approaches were developed and applied to various test cases: PROTEUS-NODAL/Nek5000 and PROTEUS-SN/Nek5000. For the former, the precursors are tracked in the built-in precursor drift model in PROTEUS-NODAL, whereas in the latter, Nek5000 directly tracks the precursors. Both approaches were used to solve a single test channel problem and showed excellent agreement in the calculated βeff. Separately, a 3D hourglass-shaped core was modeled using the PROTEUS-SN/Nek5000 approach. This problem was designed to demonstrate the capability of the discrete ordinates (SN) solver and Nek5000 to model complex core designs with axially varying geometries and the ability for Nek5000 to track the precursors and calculate the resulting βeff. In addition, the Nek5000 calculations revealed the presence of recirculation zones in the hourglass design, which could lead to significant temperatures in the fuel salt and surrounding materials. These first coupled solutions show why these approaches may be necessary for not only predicting the precursor drift effect in fast MSRs but also for reactor design and performance assessments.

Advances in Mechanical Thrombectomy for Acute Ischemic Stroke Due to Large Vessel Occlusion

Acute ischemic stroke (AIS) is a significant cause of global morbidity and mortality, with functional implications for quality of life and long-term disability. The limitations of intravenous thrombolytic therapy for the treatment of AIS, especially for emergent large vessel occlusion (ELVO), have paved the way for alternative therapies and the rapidly evolving landscape of endovascular therapy (EVT). Here, we summarize the major landmark trials that have advanced the field largely due to ongoing biomedical engineering device development that have translated into significantly improved clinical outcomes. Our review describes the clinical success of EVT, and current and future trends.

Oxytocin receptor expression in stallion testes and epididymides

Endocrine, paracrine, and autocrine factors orchestrate the development and physiology of the stallion reproductive system. Oxytocin (OXT) is one of the critical endocrine, paracrine, and autocrine factors for the male reproductive system. Previous studies have investigated OXT receptor (OXTR) expression in testes and epididymides, including humans, marmosets, macaques, swine, and sheep. This study aimed to explore (1) OXTR localization in the testes and epididymides and (2) the seasonal modification of OXTR expression in the testes. Adult stallion testis and epididymis samples were prepared using routine castration procedures. Reverse-transcription PCR was performed to detect the presence of OXTR messenger RNA (mRNA) in the testes. Western blot procedure was performed to confirm the cross-reactivity of OXTR antibody to horse OXTR. Immunohistochemistry was performed to detect OXTR protein expression in the testes and epididymides. Oxytocin receptor mRNA was detected in the stallion testes. The OXTR protein band was observed at 55 kDa. Interestingly, the relative intensity of the OXTR protein band varied between nonbreeding and breeding season. The OXTR protein level in the testes collected during the breeding season was higher than that during the nonbreeding season. Oxytocin receptor localization was observed in the cytoplasm of Type A spermatogonia and spermatid. Oxytocin receptor protein expression was also observed in the cytoplasmic area of Leydig cells and the membrane of the seminiferous tubules. The cytoplasm of principal and basal cells in the caput, corpus, and cauda was also immunolabeled with OXTR antibody. In conclusion, based on the expression of OXTR in tissues of testes and epididymides, OXT-OXTR system may be a critical factor for stallion testicular and epididymal function. In addition, according to the seasonal alteration of intensity, the OXT-OXTR system may be associated with seasonal changes in the reproductive system in stallions.

Free-Standing Sulfur-Carbon Nanotube Electrode with a Deposited Sulfur Layer for High-Energy Lithium-Sulfur Batteries

To obtain a high S-loading cathode for a Li-S battery, we propose a free-standing carbon nanotube (CNT)-based S cathode, which consists of two layers: a pure S deposition layer with a thickness of 20 μm, and a S-containing CNT film (S-CNT). Based on scanning electron microscopic (SEM) studies, it was observed that the S layer completely vanished when the cell with the S/S-CNT cathode was discharged to 2.1 V after cell assembly, indicating that the thick sulfur film dissolved in the form of polysulfide intermediates during discharge. The proposed S/S-CNT cathode delivered double the areal capacity with good capacity retention of 83% after 100 cycles, compared with that of the control cathode (S-CNT). Thus, we believe that our new cathode design will be useful in developing stable, high-energy Li-S batteries.

Carbon Nanotube-Based Sulfur Cathode with a Mesoporous Carbon-Silica Composite for Long Cycle Life Li-S Batteries

The use of carbon nanotube (CNT) films as a sulfur host is a promising approach to improve the sulfur loading and energy density of Li-S batteries. However, the inability to durably incorporate polysulfides within the cathode structure results in a limited cycle life. Herein, we propose a CNTbased sulfur cathode with carbon-coated ordered mesoporous silica (c-OMS) to overcome the cycle performance issue. Scanning electron microscopy and X-ray diffraction studies on the c-OMS prepared in this work revealed that the wall surface of OMS was evenly coated with an extremely thin carbon layer. The sulfur-CNT cathode with c-OMS retained a remarkably improved capacity (942 mAh g^-1) with excellent cycling stability (91%) after 100 cycles as well as significantly high sulfur utilization in the first cycle compared with the sulfur-CNT cathode with OMS. This result may stem from the surface property of c-OMS with high chemical affinity towards electrolyte solvents.

Three-Layer Sulfur Cathode with a Conductive Material-Free Middle Layer

An ingenious design for a three-layer sulfur cathode is demonstrated, in which the pure sulfur layer is sandwiched between carbon nanotube (CNT) films. The unique feature of this particular model is that the sulfur layer does not contain any conductive materials, and therefore, the top CNT film of the prepared three-layer CNT/S/CNT electrode is electrically isolated from the bottom CNT film. Scanning electron microscopy studies revealed that the three-layer cathode was transformed into a single CNT cathode, with proximate contact between the two CNT films in the upper plateau of the first discharge. The lithium-sulfur cells employing a CNT/S/CNT cathode exhibited remarkably enhanced performance in terms of the specific capacity, rate property, and cycling stability compared to the cells with a sulfur-coated CNT cathode. This can mainly be attributed to the top CNT film, which serves not only as an interlayer to trap the migrating polysulfides, but also as an electrode to facilitate the redox reaction of active materials. Such an innovative approach is promising as it may promote the rational design of high-performance sulfur cathodes.

A Sulfur-Infused Separator for Boosting Areal Capacity of Li-S Batteries

This study presents a new approach for enabling the development of high-performance lithium-sulfur (Li-S) cells by simply inserting a sulfur-infused separator (SIS) between a common S cathode and a Li metal anode. All solid sulfur electrically isolated from the cathode is electrochemically reduced to polysulfides during the first discharge. Notably, scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS) studies have demonstrated that the S in the separator disappears completely even when the cell is discharged to 2.1 V in the first cycle. The combination of a SIS with a typical S cathode results in the doubling of the areal capacity with superior cycling stability upon comparison with the control cell. This result demonstrates that the introduction of additional active materials, such as elemental sulfur, to a separator is a highly effective method for the fabrication of Li-S cells with a high areal capacity.

Synthesis of Bi-Metallic Organic Frameworks and Their Capacitive Behaviors According to Metal Mixing Ratio

Metallic organic frameworks (MOFs) with mixed metals has attracted attention as electrochemical energy storage material because it has high specific surface area, synergy of two metals, and a new crystal structure different from that of conventional MOF. In this study, we synthesized MOFs, including nickel and zinc, by hydrothermal method at a time. We investigated the effect of two metal ratios on the capacitive behavior. Through the structure and morphology analysis, it was found that Ni-Zn-MOF forms a completely different crystal structure from MOF using one metal, and found that it is a porous material. As a result of electrochemical measurements with cyclic voltammetry (CV) and galvanostatic charge-discharge (GCD), the specific capacitance of Ni-Zn-MOF 2:1 with a nickel to zinc ratio of 2:1 was 616 F g^-1 at a current density was 1 A g^-1.

A Mesoporous Chelating Polymer-Carbon Composite for the Hyper-Efficient Separation of Heavy Metal Ions

The removal of heavy-metal ions from wastewater is an important objective from a public-health perspective, and chelating agents can be used to achieve this aim. Herein, we report the synthesis of mesoporous carbon as a chelating polymer host using nanoarchitectonics approach. Carboxymethylated polyethyleneimine, a chelating polymer, was incorporated into the mesopore walls of mesoporous carbon to create a polymer-mesoporous-carbon composite. Nitrogen adsorption- desorption experiments and scanning electron microscopy (SEM) were used to illustrate the structural advantages of the composite. Co²⁺ adsorption by the composite material was examined using cobalt nitrate solutions at pH 3. The study revealed that the Co²⁺-absorption data are most closely modeled by the Langmuir isotherm. The maximum adsorption capacity, calculated by linear regression, was determined to be about 40 mg-Co/g-composite at pH 3. The composite exhibited about a six-times higher adsorption capacity toward a dilute Co solution (12.5 ppm) than that of the pristine mesoporous carbon. In addition, the composite showed a substantially higher distribution coefficient (K_d = 1.54×10⁵) compared to that (K_d = 2.05×10²) of the mesoporous carbon. Overall, we expect that the mesoporous composite, with its large mesopores (~20 nm), will be in high demand for adsorption applications.

Electrochemical Study of Bimetal Organic Frameworks with Graphene Oxide for Lithium-Sulfur Cells as Nanoarchitectonics

We studied that hybrid material of metal organic framework, using two different metals (bimetal organic frameworks), containing graphene oxide (GO) as a sulfur immobilizing host was successfully synthesized by hydrothermal reaction. Composites were prepared using ligands of varying ratios to observe the structure properties depending on the amount of ligand used. Field emission scanning electron microscopy (FE-SEM), Fourier Transform Infra-Red Spectroscopy (FT-IR), and X-ray diffraction (XRD) were conducted to determine the morphology and micro-structure of the composite. Electrochemical properties were characterized by cyclic voltammetry (CV) and galvanostatic charge-discharge tests. Based on these study, bimetal organic frameworks showed different morphology by ligand amounts and the enhanced performance for Li-S battery cathode.

Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet

BACKGROUND AND PURPOSE

Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks.

MATERIALS AND METHODS

Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients.

RESULTS

At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks.

CONCLUSIONS

This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.

High-Energy-Density Li-S Batteries with Additional Elemental Sulfur Coated on a Thin-Film Separator

For the development of high-areal-capacity Li-S batteries, sulfur-coated separators were utilized between the cathode and anode. It was found that (1) the additional sulfur on the separator participated at the electrode reaction occurring in the cathode region, contributing to the improvement of the areal capacity of Li-S batteries, and (2) the areal capacity significantly increased with the mass ratio of sulfur on the separator (S_sep) to sulfur in cathode (S₊). At the high S_sep/S₊ mass ratio of 5.0, the Li-S cell delivered fourfold higher areal capacity of 4.28 mAh/cm² than that of the control cell, along with excellent capacity retention of 90% after 50 cycles, demonstrating that the new concept for Li-S cells could be highly advantageous in boosting the Li-S battery cell performance. The new approach can be widely applied to increase the areal capacity and volumetric energy density of Li-S batteries.

Facile and Low-Cost Fabrication of Cathode Protection Thin Layer for Durable Li-S Batteries

A new and cost-efficient way of confining the diffusing polysulfides within the sulfur cathode is presented on the basis of employing a porous diatomite that is highly abundant in nature. The sulfur cathode coated with diatomite layer exhibited a significantly reduced capacity fade during the first two cycles, implying that the loss of active materials due to the migration of polysulfides can be mitigated by the protective layer. The diatomite-layered cathode demonstrated excellent cycling stability as high as 85% after 100 cycles. These results clearly indicate that the polysulfide diffusion is effectively blocked and the dissolved polysulfides are well confined within the protected cathode region.

Platinum Supported Nitrogen-Doped Carbon Nanotubes/ZIF-8 Derived Carbon Composite Electrodes for a Methanol Oxidation

Pt-supported on ZIF-8 derived porous carbon (CZIF8) and nitrogen-doped multi-walled carbon nanotubes (NCNT) composites was prepared by pyrolysis process and chemical reduction. The electrochemical characterization and morphological analysis of composites was measured by cyclic voltammetry (CV), chronoamperometry, transmission electron microscope (TEM), and fourier transform infrared spectroscopy (FT-IR). These results indicate that the Pt-NCNT@CZIF8 nanocomposite showed electrochemically superior properties to methanol oxidation reaction and the higher electrochemical surface area (ECSA). Also, ZIF-8 derived carbon and modified the CNTs was thought to enhance the effective area of the platinum deposition site.

CXCR3 ligands in pleural fluid as markers for the diagnosis of tuberculous pleural effusion

SETTING

A tertiary care academic medical centre.

OBJECTIVE

To evaluate the clinical usefulness of C-X-C motif chemokine receptor 3 (CXCR3) ligands in tuberculous pleural effusion (TPE).

DESIGN

We recruited 336 patients with pleural effusion due to various causes. Concentrations of interferon-gamma (IFN-γ) and the CXCR3 ligands CXCL9 and CXCL11 were determined using enzyme immunoassays; adenosine deaminase (ADA) activity was measured in pleural fluid and serum.

RESULTS

TPE was diagnosed in 106 patients. Non-TB conditions included lung cancer (n = 95), para-pneumonic effusion (n = 52), non-lung malignancy (n = 30), other exudate (n = 24) and transudate (n = 29) disorders. All marker levels in serum samples and pleural fluid were significantly higher in the TPE group. Analyses of receiver operating characteristic curves for differentiating TPE from non-TB effusions produced the following results for the area under the curve (AUC) for CXCL9, CXCL11, IFN-γ and ADA, respectively: 0.982, 0.952, 0.982, and 0.952. Marker AUCs in lymphocytic exudates were also high. Combining the levels of CXCL9, IFN-γ and ADA in pleural fluid improved the diagnostic performance. Serum levels of CXCL9 had the highest AUC (0.848) for diagnosing TPE.

CONCLUSION

Levels of CXR3 ligands in pleural effusion are useful for diagnosing TPE.

Colloidal Silica Templated Mesoporous Carbons from a Maltose Solution for Use in Supercapacitor Electrodes

A series of disordered mesoporous carbons (DMC) are synthesized via the colloidal silica template method by varying the mass ratio of silica to maltose from 0.4 to 1.4. A gradual improvement in the surface area and porosity of the DMC is apparent with an increase in the ratio of silica to maltose. The capacitance of the DMCs tends to increase linearly with their surface area. In particular, the DMC synthesized at a mass ratio of 1.4 exhibits the largest surface area of 1,152 m2/g and the highest capacitance of 175.4 F/g, comparable to the capacitance of other porous carbons with large surface areas (>2,000 m2/g). This feature may be attributed to its unique structural properties, such as the high pore interconnectivity allowing for easy access of the electrolyte ions. We believe that a higher capacitive performance can be achieved through further optimization studies (e.g., searching for better carbon precursors and adjusting the mass ratio of silica to carbon precursor).

Effect of Reducing Agent on Preparation and Electroactivity of MnO₂/Graphene Composite Electrode for Capacitors

Supercapacitor electrodes materials with improved electrochemical properties were prepared by synthesizing manganese dioxide (MnO2) in an aqueous solution of graphene having a wide specific surface area and high electrical conductivity. MnO2/graphene composites were synthesized by reducing potassium permanganate with three kinds of reducing agent (ethanol, ethylene glycol, DMF). TEM-image confirmed that the MnO2/graphene composite which was reduced by ethanol had a small average particle size. Electrochemical properties were characterized by cyclic voltammetry (CV) and galvanostatic charge-discharge test in 1 M Na2SO4 aqueous electrolyte solution. The MnO2/graphene composite reduced by ethanol showed higher specific capacitance than the MnO2/graphene composite reduced by ethylene glycol or DMF. It was concluded that the manganese dioxide reduced by ethanol having a small average particle size, resulting in a large specific surface area and low impedance characteristics.