Addressing Health Equity in the Context of Carbon Capture, Utilization, and Sequestration Technologies

PURPOSE OF REVIEW

To describe the role of health equity in the context of carbon capture, utilization, and sequestration (CCUS) technologies.

RECENT FINDINGS

CCUS technologies have the potential to both improve and worsen health equity. They could help reduce greenhouse gas emissions, a major contributor to climate change, but they could also have negative health impacts like air and noise pollution. More research is needed to fully understand the health equity implications of CCUS technologies. CCUS technologies have both health equity risks and benefits. Implementing misguided CCUS projects in vulnerable communities could exacerbate environmental injustice and health disparities and have the potential to increase carbon emissions. However, well-conceived projects could benefit communities through economic development. Governments, industry, and society should prioritize and expedite the reduction of CO2 emissions before considering carbon reductions via CCUS. Furthermore, CCUS projects must be thoroughly evaluated and should only proceed if they have demonstrated a net reduction in CO2 emissions and provide more benefits than risks to local communities. This underscores the importance of prioritizing health equity in the planning of CCUS projects.

Cancer patients with clonal hematopoiesis die from primary malignancy or comorbidities despite higher rates of transformation to myeloid neoplasms

BACKGROUND

The occurrence of somatic mutations in patients with no evidence of hematological disorders is called clonal hematopoiesis (CH). CH, whose subtypes include CH of indeterminate potential and clonal cytopenia of undetermined significance, has been associated with both hematologic cancers and systemic comorbidities. However, CH's effect on patients, especially those with concomitant malignancies, is not fully understood.

METHODS

We performed a retrospective evaluation of all patients with CH at a tertiary cancer center. Patient characteristics, mutational data, and outcomes were collected and analyzed.

RESULTS

Of 78 individuals included, 59 (76%) had a history of cancer and 60 (77%) had moderate to severe comorbidity burdens. DNMT3A, TET2, TP53, and ASXL1 were the most common mutations. For the entire cohort, the 2-year overall survival rate was 79% (95% CI: 70, 90), while the median survival was not reached. Of 20 observed deaths, most were related to primary malignancies (n = 7, 35%), comorbidities (n = 4, 20%), or myeloid neoplasms (n = 4, 20%). Twelve patients (15%) experienced transformation to a myeloid neoplasm. According to the clonal hematopoiesis risk score, the 3-year transformation rate was 0% in low-risk, 15% in intermediate-risk (p = 0.098), and 28% in high-risk (p = 0.05) patients. By multivariate analysis, transformation was associated with variant allele frequency ≥0.2 and hemoglobin <10 g/dL.

CONCLUSIONS

In a population including mostly cancer patients, CH was associated with comorbidities and myeloid transformation in patients with higher mutational burdens and anemia. Nevertheless, such patients were less likely to die of their myeloid neoplasm than of primary malignancy or comorbidities.

Atmospheric CO2 Sequestration in Seawater Enhanced by Molluscan Shell Powders

Carbon capture, utilization, and storage (CCUS) are widely recognized as a promising technology for mitigating climate change. CO2 mineralization using Ca-rich fluids and high-concentration CO2 gas has been studied extensively. However, few studies have reported CO2 mineralization with atmospheric CO2, owing to the difficulty associated with its low concentration. In seawater, the biomineralization process promotes Ca accumulation and CaCO3 precipitation, assisted by specific organic matter. In this study, we examined the conversion of atmospheric CO2 into CaCO3 in seawater using shell powders (Pinctada fucata, Haliotis discus, Crassostrea gigas, Mizuhopecten yessoensis, Turbo sazae, and Saxidomus purpurata). Among the six species, the shell powder of S. purpurata showed the highest rate of CaCO3 formation and recovery of CaCO3. NaClO treatment test revealed that the organic matter in the shells enhanced the CO2 mineralization. All materials used in this study, including atmospheric CO2, seawater, and shells, are economically feasible for large-scale applications. Using shell powder for CO2 mineralization in seawater embodies an innovative technological advancement to address climate change.

Public perceived risks and benefits of carbon capture, utilization, and storage (CCUS): Scale development and validation

As a critical technology to mitigate climate change, the large-scale implementation of carbon capture, utilization, and storage (CCUS) depends on both technological advancement and public acceptance, which is significantly influenced by the perceived risks and benefits. Existing studies, however, have yet to reach a consensus regarding the measurement of CCUS in these two aspects. To fill this gap, this paper develops and validates new scales based on four studies. Specifically, Study 1 generates the initial item pool based on a literature review and semi-structured interviews, and then invites experts to examine the content validity of these items; Study 2 identifies the dimensions and assesses the reliability and validity of the measures through an exploratory and confirmatory factor analysis; Study 3 conducts a one-way ANOVA to test known-group validity; and Study 4 employed structural equation modeling to evaluate the nomological validity. The results demonstrate the internal consistency, reliability, and construct validity of the new scales developed to measure CCUS. This study provides a valuable tool for investigating public perceptions of CCUS and can help policymakers develop future publicity strategies.

ProGraME: A novel flow cytometry algorithm for the diagnosis of low-risk myelodysplastic syndromes in patients with cytopenia

OBJECTIVES

Flow cytometry (FC) is, together with morphology, genetics, and cytogenetics, used in the diagnostic assessment of cytopenia, as its value in evaluating bone marrow dysplasia been highlighted by several studies. However, despite the development of algorithms and guidelines, there is still a lack of standardization of the FC assessment of bone marrow dysplasia.

METHODS

By combining FC, together with morphological analysis and cytogenetic/molecular assessment in a training cohort of 209 patients, we created a novel score, ProGraME, which includes four parameters, each from a different cell lineage (Progenitor cells, Granulocytes, Monocytes, Erythroid precursors), solely based on relevant population gating. Points for ProGraME were attained for: lymphoid precursors ≤5% of all CD34+ cells (1.5 point); a granulocyte-to-lymphocyte side-scatter ratio ≤6 (1 point); a monocyte CD33-CV% ≥ 63 (2 points), and an erythroid precursor CD36-CV% ≥ 65 (2 points).

RESULTS

Using a cutoff of ≥2 as suggestive of dysplasia, ProGraME showed a sensitivity of 91% and a specificity of 81% in the training cohort and 95% and 75%, respectively, in an independent validation cohort of 159 patients. In addition, ProGraME had a very high negative predictive value of 97.1% and 97.8% in the training and validation cohorts, respectively, offering a useful tool for excluding bone marrow dysplasia. Finally, among the 23 CCUS patients that scored positive for dysplasia with ProGraME in the training cohort, 16 of them (69%) carried high-risk mutations, suggesting that FC might help identify early changes of dysplasia.

CONCLUSIONS

ProGraME can potentially optimize the FC diagnosis of low-risk myelodysplasia without minimal requirements of flow analysis other than accurate population gating.

Development and Applications of CO2-Responsive Gels in CO2 Flooding and Geological Storage

Gel systems are widely used as plugging materials in the oil and gas industry. Gas channeling can be mitigated by reducing the heterogeneity of the formation and the mobility ratio of CO2 to crude oil. Cracks and other CO2 leaking pathways can be plugged during the geological storage of CO2 to increase the storage stability. By adding CO2-responsive groups to the classic polymer gel's molecular chain, CO2 responsive gel is able to seal and recognize CO2 in the formation while maintaining the superior performance of traditional polymer gel. The application of CO2 responsive gels in oil and gas production is still in the stage of laboratory testing on the whole. To actually achieve the commercial application of CO2 responsive gels in the oil and gas industry, it is imperative to thoroughly understand the CO2 responsive mechanisms of the various types of CO2 responsive gels, as well as the advantages and drawbacks of the gels and the direction of future development prospects. This work provides an overview of the research progress and response mechanisms of various types of CO2 responsive groups and CO2 responsive gels. Studies of the CO2 responsive gel development, injectivity, and plugging performance are comprehensively reviewed and summarized. The shortcomings of the existing CO2 responsive gels system are discussed and the paths for future CO2 responsive gel development are suggested.

Clinical Flow Cytometry Analysis in the Setting of Chronic Myeloid Neoplasms and Clonal Hematopoiesis

The utility of flow cytometry analysis in the evaluation of chronic myeloid neoplasms, such as myelodysplastic neoplasms and chronic myeloproliferative neoplasms, continues to be emphasized and explored. Recently flow cytometry analysis has been also proven to be able to distinguish persistent clonal hematopoiesis from measurable residual disease in patients with acute myeloid leukemia (AML), a finding with potential critical treatment impact in the management of patients with AML.

Lesson learned from the assessment of planned converted CO2 injection well integrity in Indonesia - CCUS project

The risk of CO2 leakage from carbon capture, utilization, and storage (CCUS) wells and geological storage sites must be properly assessed before the implementation of CO2 injection. According to ISO 27914 and ISO/FDIS 27916, the design and construction of an injection well needs to guarantee safety and ability to contain the stored CO2 over a long-term period. However, these standards alone were inadequate to evaluate the well integrity due to the need to specify criteria, duration of measurement, and range of measurement parameters of the available tools according to industries' best practices. The methodology used in the study adapted applicable and readily-available international standards, field experiences, and lessons learned that could be used to support the construction of new and/or the conversion of existing oil and gas wells into CO2 injection wells. This study focused on Jepon-1 in Gundih field, Indonesia, an abandoned oil and gas well. Its actual conditions, well integrity, capabilities of the equipment used in the workover and logging operations, and its limitations in checking the conditions of various crucial aspects of integrity, were evaluated. The results showed that the application of the international standards could not fulfill all the detailed requirements of integrity evaluation of the JPN-1 well due to its particular condition and situation. Other field experiences needed to be adapted, improved, and incorporated in the integrity evaluation of this well. Additionally, longer duration of measurement and more accurate and sensitive logging evaluation tools, combined with temperature logging tools, are required to detect leakage that could not be identified by the commercial tools used in this well. The result of this well integrity study will be used as a fundamental basis for constructing CCUS well regulations by the Government and stakeholders.

Amine-Assisted Simultaneous CO2 Absorption and Mineral Carbonation: Effect of Different Categories of Amines

The hybrid technology of CO₂ capture-mineral carbonation (CCMC) using alkaline streams has emerged in recent years. However, thus far, there has been no comprehensive study revealing the mechanisms of the simultaneous CCMC process regarding the choice of amine types and sensitivity of parameters. Combining with the analysis of multistep reaction mechanisms for different amines, we investigated a representative from each category in CCMC using calcium chloride to simulate the alkaline resource after leaching, i.e., primary (ethanolamine, MEA), secondary (diisopropanolamine, DIPA), tertiary (diethylethanolamine, DEAE), and triamine (diethylenetriamine, DETA), respectively. In the adsorption step, increasing the amine concentration beyond 2 mol/L reduced the absorption efficiency of DEAE due to the hydration mechanism, motivating a rational choice of concentration. In CCMC sections, when the amine concentration increased, only DEAE exhibited an increased carbonation efficiency of up to 100%, while DETA showed the lowest conversion. The carbonation of DEAE demonstrated the least sensitivity to temperature. The crystal transformation experiments suggested that over time, the produced vaterite could completely transform to calcite or aragonite, except those from DETA. Thus, with rationally chosen conditions, DEAE was demonstrated ideal for CCMC. These findings obtained in this work provided a theoretical foundation for designing future CCMC processes.

Review of clonal hematopoiesis, subtypes and its role in neoplasia and different morbidities

Clonal hematopoiesis (CH) is the development of a certain cell lineage which is the cornerstone of hematologic malignancy especially myeloid neoplasms, however, can also be found in old age (6th-7th decade). CH is caused by many different somatic mutations most commonly in DNMT3A, TET2, ASXL1, SF3B1 and TP53. It is detected by different sequencing methods, the most commonly used ones are next generation sequencing (NGS) which can be whole exome, whole genome sequencing or a panel for certain genes. CH is divided into multiple categories depending on the clinical picture associated with it into: clonal monocytosis of undetermined significance (CMUS), clonal hematopoiesis of indeterminate significance (CHIP), clonal cytopenia and monocytosis of undetermined significance (CCMUS) and clonal cytopenia of undetermined significance (CCUS). In order to diagose CH, first other hematologic malignancies must be ruled out CH is also associated with many different entities including lung cancer and some studies have shown that COVID-19 infections are affected by CH. Certain traits and infections are associated with CH including smoking, obesity, and cardiovascular disease. A minority of patients with CH progress to a malignant process (between 0.5 %-2 %) which do not require treatment, however, any patient with CH should be kept under surveillance in order to detect any malignancy early and be treated accordingly. SIMPLE SUMMARY: Clonal hematopoiesis (CH) is considered to be the predisposing factor for development of different hematologic neoplasms. With the help of NGS, patients with CH can be monitored more closely. Several studies have shown that these patients might develop hematologic neoplasms in their lifetime. It has been subdivided into multiple groups according to the clinical picture and/or blood counts.

Improving predictions of shale wettability using advanced machine learning techniques and nature-inspired methods: Implications for carbon capture utilization and storage

The utilization of carbon capture utilization and storage (CCUS) in unconventional formations is a promising way for improving hydrocarbon production and combating climate change. Shale wettability plays a crucial factor for successful CCUS projects. In this study, multiple machine learning (ML) techniques, including multilayer perceptron (MLP) and radial basis function neural networks (RBFNN), were used to evaluate shale wettability based on five key features, including formation pressure, temperature, salinity, total organic carbon (TOC), and theta zero. The data were collected from 229 datasets of contact angle in three states of shale/oil/brine, shale/CO₂/brine, and shale/CH₄/brine systems. Five algorithms were used to tune MLP, while three optimization algorithms were used to optimize the RBFNN computing framework. The results indicate that the RBFNN-MVO model achieved the best predictive accuracy, with a root mean square error (RMSE) value of 0.113 and an R² of 0.999993. The sensitivity analysis showed that theta zero, TOC, pressure, temperature, and salinity were the most sensitive features. This research demonstrates the effectiveness of RBFNN-MVO model in evaluating shale wettability for CCUS initiatives and cleaner production.

Research progress and perspectives on carbon capture, utilization, and storage (CCUS) technologies in China and the USA: a bibliometric analysis

Carbon dioxide capture, utilization, and storage (CCUS) technology is an emerging technology with large-scale emission reduction potential and an essential component of the global response to climate change to achieve net-zero goals. As the two most important countries in global climate governance, it is necessary to review and examine the current status and trends of research in the field of CCUS in China and the USA. This paper uses bibliometric tools to review and analyze peer-reviewed articles in the Web of Science from both countries during 2000-2022. The results show a significant increase in research interest among scholars from both countries. The number of publications in the CCUS field in China and the USA was 1196 and 1302, respectively, showing an increasing trend. China and the USA have become the most influential countries in CCUS. And the USA has a more significant academic influence on a global scale. Furthermore, the research hotspots in the field of CCUS are diverse and differentiated. That is, China and the USA pay attention to different research hotspots or have different focuses in different periods. This paper also finds that new capture materials and technology development, geological storage monitoring and early warning, CO₂ utilization and new energy development, sustainable business models, incentive policies and measures, and public awareness are critical directions for future research in the field of CCUS, to provide a comprehensive review and comparison of CCUS technology development in China and the USA. It helps to gain insight into the research differences and linkages between the two countries in the field of CCUS and identify the research gaps between them. And place some consensus that policymakers can use.

LEP promoter methylation in the initiation and progression of clonal cytopenia of undetermined significance and myelodysplastic syndrome

BACKGROUND

Idiopathic non-clonal cytopenia (ICUS) and clonal cytopenia (CCUS) are common in the elderly population. While these entities have similar clinical presentations with peripheral blood cytopenia and less than 10% bone marrow dysplasia, their malignant potential is different and the biological relationship between these disorders and myeloid neoplasms such as myelodysplastic syndrome (MDS) is not fully understood. Aberrant DNA methylation has previously been described to play a vital role in MDS and acute myeloid leukemia (AML) pathogenesis. In addition, obesity confers a poorer prognosis in MDS with inferior overall survival and a higher rate of AML transformation. In this study, we measured DNA methylation of the promoter for the obesity-regulated gene LEP, encoding leptin, in hematopoietic cells from ICUS, CCUS and MDS patients and healthy controls. We investigated whether LEP promoter methylation is an early event in the development of myeloid neoplasms and whether it is associated with clinical outcome.

RESULTS

We found that blood cells of patients with ICUS, CCUS and MDS all have a significantly hypermethylated LEP promoter compared to healthy controls and that LEP hypermethylation is associated with anemia, increased bone marrow blast percentage, and lower plasma leptin levels. MDS patients with a high LEP promoter methylation have a higher risk of progression, shorter progression-free survival, and inferior overall survival. Furthermore, LEP promoter methylation was an independent risk factor for the progression of MDS in a multivariate Cox regression analysis.

CONCLUSION

In conclusion, hypermethylation of the LEP promoter is an early and frequent event in myeloid neoplasms and is associated with a worse prognosis.

Clonal Hematopoiesis: Origins and determinants of evolution

The accrual of somatic mutations is a byproduct of aging. When a clone bearing a somatic genetic alteration, conferring comparative competitive advantage, displays sufficient outgrowth to become detectable amongst an otherwise polyclonal background in the hematopoietic system, this is called clonal hematopoiesis (CH). Somatic genetic alterations observed in CH include point mutations in cancer related genes, mosaic chromosomal alterations or a combination of these. Interestingly, clonal hematopoiesis (CH) can also occur with somatic variants in genes without a known role in cancer and in the absence of a somatic genetic alteration through a process that has been described as 'genetic drift'. Clonal hematopoiesis of indeterminate significance (CHIP), is age-related and defined by the presence of somatic point mutations in cancer related genes, in the absence of cytopenias or a diagnosis of hematologic neoplasm, with a variant allele fraction ≥ 2 %. Remarkably, the increased mortality associated with CHIP is largely due to cardiovascular disease. Subsequently, CHIP has been associated with a myriad of age-related conditions such as Alzheimer's Disease, osteoporosis, CVA and COPD. CHIP is associated with an increased risk of hematologic malignancies, particularly myeloid neoplasms, with the risk rising with increasing clone size and clonal complexity. Mechanisms regulating clonal evolution and progression to hematologic malignancies remain to be defined. However, observations on context specific CH arising in the setting of bone marrow failure states, or on exposure to chemotherapy and radiation therapy, suggest that CH reflects context specific selection pressures and constraint-escape mechanisms.

Economic feasibility and policy incentive analysis of Carbon Capture, Utilization, and Storage (CCUS) in coal-fired power plants based on system dynamics

Carbon Capture, Utilization, and Storage (CCUS) is an important potential technical way for coal power plants to achieve near-zero carbon emissions with the current energy structure in China being dominated by coal. However, CCUS is still at the early demonstration stage, and there are many uncertainties in the business model and policy incentives that the traditional method can no longer handle. At the same time, few studies have analyzed these issues. Taking coal-fired power plants as the research object, we adopt the system dynamics method (SD) to compare the economic feasibility, stability, and CO₂ emission reduction effect of the CCUS in the vertical integration model and the CCUS operator model. Furthermore, this paper also studies the effect of different incentive policies on CCUS. Results show the following: (1) Both models are economically viable. From the stability perspective, the CCUS operator model is superior to the vertical integration model. (2) In terms of the effect of individual policies, the government's preference for subsidies to the coal-fired power plant can significantly reduce CO₂ emissions. Increasing the additional government subsidy and carbon tax can accelerate the CCUS system into a relatively stable state, but beyond a certain range, the marginal CO₂ capture rate, marginal CO₂ emission reduction rate, and marginal profit rate of each department will be significantly reduced. The storage enterprise highly depends on the government subsidy. Low government subsidy allocation, low additional government subsidy, and a low carbon tax will lead to continuous negative profits for the storage enterprise, making the CCUS system unsustainable. (3) The impact of combination policies on CCUS is not simply the sum of the effects of individual policies. Each policy has a counteracting or reinforcing effect on the other.

CHIPing away the progression potential of CHIP: A new reality in the making

Over the past few years, we have gained a deeper understanding of clonal hematopoiesis of indeterminate potential (CHIP), especially with regard to the epidemiology, clinical sequelae, and mechanical aspects. However, interventional strategies to prevent or delay the potential negative consequences of CHIP remain underdeveloped. In this review, we highlight the latest updates on clonal hematopoiesis research, including molecular mechanisms and clinical implications, with a particular focus on the evolving strategies for the interventions that are being evaluated in ongoing observational and interventional trials. There remains an urgent need to formulate standardized and evidence-based recommendations and guidelines for evaluating and managing individuals with clonal hematopoiesis. In addition, patient-centric endpoints must be defined for clinical trials, which will enable us to continue the robust development of effective preventive strategies and improve clinical outcomes.

A Lower Frequency of Spliceosome Mutations Distinguishes Clonal Cytopenias of Undetermined Significance From Low-Risk Myelodysplastic Syndromes, Despite Inherent Similarities in Genomic, Laboratory, and Clinical Features

Clonal cytopenias of undetermined significance (CCUS) are associated with an increased risk of developing a myelodysplastic syndrome (MDS); however, the mechanism and factors associated with evolution remain unclear. We propose that next-generation sequencing (NGS) of cytopenic cases with equivocal morphologic dysplasia will improve patient clinical care and that serial sequencing of such equivocal cases could identify the factors that predict evolution to MDS. We performed targeted NGS of samples from 193 individuals with confirmed or suspected MDS or MDS/myeloproliferative neoplasm, including sequential investigation for 28 individuals at the time of diagnosis and during follow-up. NGS facilitated the diagnosis of all suspicious cases as myeloid neoplasm (21%), CCUS (34%), or idiopathic cytopenias of undetermined significance (45%) when no variants were detected. We found that there was no significant difference in most measured clinical features or clonal phenotypes, such as cell counts, number of variants, variant allele frequencies, and overall survival, between CCUS and International Prognostic Scoring System-Revised-defined low-risk MDS. However, there was a significant difference in the types of variants between CCUS and low-risk MDS, with a significantly lower number of splicing factor mutations in CCUS cases (P < .001). Moreover, we observed an increased probability of evolution to MDS of individuals with CCUS compared with that in those with idiopathic cytopenias of undetermined significance over the first 5 years (P = .045). Our analyses revealed no conclusive pattern associating clonal expansion or the number of variants with the evolution of CCUS to MDS, perhaps further supporting the similarity of these diseases and the clinical importance of recognizing and formally defining CCUS as a category of precursor myeloid disease state in the next revision of the World Health Organization guidelines.

Tuning Ionic Liquid-Based Catalysts for CO(2) Conversion into Quinazoline-2,4(1H,3H)-diones

Carbon capture and storage (CCS) and carbon capture and utilization (CCU) are two kinds of strategies to reduce the CO₂ concentration in the atmosphere, which is emitted from the burning of fossil fuels and leads to the greenhouse effect. With the unique properties of ionic liquids (ILs), such as low vapor pressures, tunable structures, high solubilities, and high thermal and chemical stabilities, they could be used as solvents and catalysts for CO₂ capture and conversion into value-added chemicals. In this critical review, we mainly focus our attention on the tuning IL-based catalysts for CO₂ conversion into quinazoline-2,4(1H,3H)-diones from o-aminobenzonitriles during this decade (2012~2022). Due to the importance of basicity and nucleophilicity of catalysts, kinds of ILs with basic anions such as [OH], carboxylates, aprotic heterocyclic anions, etc., for conversion CO₂ and o-aminobenzonitriles into quinazoline-2,4(1H,3H)-diones via different catalytic mechanisms, including amino preferential activation, CO₂ preferential activation, and simultaneous amino and CO₂ activation, are investigated systematically. Finally, future directions and prospects for CO₂ conversion by IL-based catalysts are outlined. This review is benefit for academic researchers to obtain an overall understanding of the synthesis of quinazoline-2,4(1H,3H)-diones from CO₂ and o-aminobenzonitriles by IL-based catalysts. This work will also open a door to develop novel IL-based catalysts for the conversion of other acid gases such as SO₂ and H₂S.

Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole

Canine chronic ulcerative stomatitis (CCUS) is a spontaneously occurring, painful, and often debilitating condition of the oral cavity, with a suspected immune-mediated component. The response to pharmacological treatment is generally poor, thus the need to identify more effective medical therapies for this condition. This article describes a prospective clinical trial that was designed to evaluate the efficiency of a combination of cyclosporine and metronidazole in managing CCUS. The hypothesis was that a combination of cyclosporine and metronidazole would effectively minimize clinical signs associated with CCUS. Ten client-owned dogs with a biopsy-confirmed diagnosis consistent with CCUS were prescribed cyclosporine (5 mg/kg) for 1 week, followed by the addition of metronidazole (15-20 mg/kg), both administered orally once daily. The cyclosporine dosage interval was lengthened over time. Dogs were observed for a 6-month period and evaluated using a 32-point Canine Ulcerative Stomatitis Disease Activity Index (CUSDAI). Regular cyclosporine therapeutic drug monitoring was also conducted by the measurement of whole blood cyclosporine levels and the pharmacodynamic assessment of the T-cell expression of IL-2. The results demonstrated that a combination of cyclosporine and metronidazole was effective in minimizing the clinical signs of CCUS and in reducing CUSDAI scores. Neither blood cyclosporine levels nor the T-cell expression of IL-2 predicted improvement in clinical signs and CUSDAI scores, although there was a correlation between blood drug concentrations and the suppression of T-cell IL-2 expression. The evaluation of clinical signs and CUSDAI scores appears to be the most effective means of assessing response to therapy, and therapeutic drug level monitoring does not appear to be routinely indicated.

Monitoring Injected CO2 Using Earthquake Waves Measured by Downhole Fibre-Optic Sensors: CO2CRC Otway Stage 3 Case Study

Monitoring changes of formation properties along the well bore associated with the presence of carbon dioxide can be important for both tracking the plume inside of the primary containment and detecting leakage into the zone located above the reservoir. This can be achieved with time lapse wireline logging, but this approach requires well intervention and is not always possible. If the well is permanently instrumented with an optical fibre, it can be used as a distributed seismic receiver array to detect gas behind the casing by monitoring changes in amplitude of the seismic waves generated by active or passive seismic sources. Previous research showed the efficacy of this technique using continuous seismic sources. The Stage 3 Otway Project presented an opportunity to test this technique using passive seismic recording, as downhole fibre-optic arrays recorded numerous regional earthquakes over the period of nearly 2 years before, during, and after CO₂ injection. Analysis of P-wave amplitudes extracted from these downhole gathers shows a consistent amplitude anomaly at the injection level, visible in all events that occurred after the start of injection. This indicates that the anomaly is caused by changes in elastic properties in the reservoir caused by CO₂ saturation. However, extracted amplitudes show significant variability between earthquakes even without subsurface changes; thus, multiple events are required to distinguish the time-lapse anomaly from time-lapse noise. Ubiquity of these events even in a tectonically quiet region (such as Australia) makes this technique a viable and cost-effective option for downhole monitoring.

Covalent Organic Frameworks with Ionic Liquid-Moieties (ILCOFs): Structures, Synthesis, and CO2 Conversion

CO₂, an acidic gas, is usually emitted from the combustion of fossil fuels and leads to the formation of acid rain and greenhouse effects. CO₂ can be used to produce kinds of value-added chemicals from a viewpoint based on carbon capture, utilization, and storage (CCUS). With the combination of unique structures and properties of ionic liquids (ILs) and covalent organic frameworks (COFs), covalent organic frameworks with ionic liquid-moieties (ILCOFs) have been developed as a kind of novel and efficient sorbent, catalyst, and electrolyte since 2016. In this critical review, we first focus on the structures and synthesis of different kinds of ILCOFs materials, including ILCOFs with IL moieties located on the main linkers, on the nodes, and on the side chains. We then discuss the ILCOFs for CO₂ capture and conversion, including the reduction and cycloaddition of CO₂. Finally, future directions and prospects for ILCOFs are outlined. This review is beneficial for academic researchers in obtaining an overall understanding of ILCOFs and their application of CO₂ conversion. This work will open a door to develop novel ILCOFs materials for the capture, separation, and utilization of other typical acid, basic, or neutral gases such as SO₂, H₂S, NOx, NH₃, and so on.

Abnormal CD13/HLA-DR Expression Pattern on Myeloblasts Predicts Development of Myeloid Neoplasia in Patients With Clonal Cytopenia of Undetermined Significance

OBJECTIVES

Patients with clonal cytopenia of undetermined significance (CCUS) are at increased risk of developing myeloid neoplasia (MN). We evaluated whether a simple flow cytometry immunophenotyping (FCIP) assay could differentiate the risk of development of MN in patients with CCUS.

METHODS

Bone marrow aspirates were assessed by FCIP panel in a cohort of 80 patients identified as having CCUS based on next-generation sequencing or cytogenetics from March 2015 to May 2020, with available samples. Flow cytometric assay included CD13/HLA-DR expression pattern on CD34-positive myeloblasts; CD13/CD16 pattern on maturing granulocytic precursors; and aberrant expression of CD2, CD7, or CD56 on CD34-positive myeloblasts. Relevant demographic, comorbidity, and clinical and laboratory data, including the type and extent of genetic abnormalities, were extracted from the electronic health record.

RESULTS

In total, 17 (21%) patients with CCUS developed MN over the follow-up period (median survival follow-up, 28 months [95% confidence interval, 19-31]). Flow cytometry immunophenotyping abnormalities, including the aberrant pattern of CD13/HLA-DR expression, as detected at the time of the diagnosis of CCUS, were significantly associated with risk of developing MN (hazard ratio, 2.97; P = .006). Additional FCIP parameters associated with the development of MN included abnormal expression of CD7 on myeloblasts and the presence vs absence of any FCIP abnormality.

CONCLUSIONS

A simple FCIP approach that includes assessment of CD13/HLA-DR pattern on CD34-positive myeloblasts can be useful in identifying patients with CCUS at higher risk of developing MN.

Potential matching of carbon capture storage and utilization (CCSU) as enhanced oil recovery in perspective to Indian oil refineries

Carbon capture storage and utilization is not a new technology, but its application to reduce CO2 emissions from the refinery sector is just now emerging as promising mitigation. This study will look closely at opportunities to match CO2 sources with potential sinks by matching carbon-capturing projects at Indian oil refineries with Enhanced Oil Recovery (EOR) operations at nearby oil fields in India. This study has identified four such pairings of source-sink matching along with the challenges the first of the kind implementation of CCSU technology in specific projects. The study concludes with a discussion on the way forward and policy implications for the commercial use of the CCSU in India.

GRAPHICAL ABSTRACT

CCS Carbon Capture Storage; CCU Carbon Capture Utilization, EOR . Source: Authors' design.

Carbonic anhydrase to boost CO2 sequestration: Improving carbon capture utilization and storage (CCUS)

CO₂ Capture Utilization and Storage (CCUS) is a fundamental strategy to mitigate climate change, and carbon sequestration, through absorption, can be one of the solutions to achieving this goal. In nature, carbonic anhydrase (CA) catalyzes the CO₂ hydration to bicarbonates. Targeting the development of novel biotechnological routes which can compete with traditional CO₂ absorption methods, CA utilization has presented a potential to expand as a promising catalyst for CCUS applications. Driven by this feature, the search for novel CAs as biocatalysts and the utilization of enzyme improvement techniques, such as protein engineering and immobilization methods, has resulted in suitable variants able to catalyze CO₂ absorption at relevant industrial conditions. Limitations related to enzyme recovery and recyclability are still a concern in the field, affecting cost efficiency. Under different absorption approaches, CA enhances both kinetics and CO₂ absorption yields, besides reduced energy consumption. However, efforts directed to process optimization and demonstrative plants are still limited. A recent topic with great potential for development is the CA utilization in accelerated weathering, where industrial residues could be re-purposed towards becoming carbon sequestrating agents. Furthermore, research of new solvents has identified potential candidates for integration with CA in CO₂ capture, and through techno-economic assessments, CA can be a path to increase the competitiveness of alternative CO₂ absorption systems, offering lower environmental costs. This review provides a favorable scenario combining the enzyme and CO₂ capture, with possibilities in reaching an industrial-like stage in the future.

A state-of-the-art review of CO2 enhanced oil recovery as a promising technology to achieve carbon neutrality in China

Although there are some review papers on carbon capture, utilization and storage (CCUS), hardly any of these reviews are focused on the role of CO₂ enhanced oil recovery (EOR) in accelerating carbon neutrality in China. In this review, strategies to achieve carbon neutrality is briefly but critically discussed, followed by a review of CO₂-EOR as a promising technology. Especially, data analysis, including the number of publications on China's carbon neutrality, per capita CO₂ emissions, China's power generation, and the crude oil production of China's large oilfields, is carried out to make the discussion more comprehensive. Given the large amount of coal consumed in China, the high percent of electricity generated with coal, and the slow penetration of renewables already observed, it seems unlikely that 2060 targets will be met without CCUS. In order to achieve carbon neutrality, both reduction in carbon emissions and increase in carbon sequestration are inevitable. Furthermore, it is concluded that CO₂ storage through EOR is likely to have a bright future. However, there are some critical issues to be solved, including the technical issues, leakage and safety issues, cost issues, policy issues, etc. In order to turn CO₂-EOR into a reliable and more favorable technology, more research and efforts are needed to solve these issues, including advancing carbon capture technologies, improving storage technologies, developing effective monitoring technologies, deploying government support and incentive policies, etc.

Techno-Economic Assessment and Life Cycle Assessment of CO2-EOR

CO₂-enhanced oil recovery (EOR) can have less GHG emissions compared to conventional oil production methods. The economy of CO₂-EOR can significantly benefit from the recent rise of carbon prices in carbon markets due to its greenhouse gas (GHG) emission savings. This study conducted a life cycle assessment (LCA) of CO₂-EOR in major hydrocarbon provinces of the world. Estimated net GHG emissions of CO₂-EOR were compared with GHG emissions of average produced oil in the given country. When sourcing CO₂ from coal-fired power plants, Kazakhstan and China have net GHG emissions of CO₂-EOR of 276 and 380 kg CO₂ eq/bbl, respectively, which are lower than the GHG emission factor of average oil produced in each of them. Significantly lower GHG emissions of CO₂-EOR are observed in other hydrocarbon provinces (Iraq, Saudi Arabia, Kuwait, etc.), where CO₂ could be delivered from Natural Gas Combined Cycle (NGCC) power plants. However, the cost of CO₂ capture is higher at NGCC power plants than at coal-fired power plants. Further, we developed a techno-economic assessment (TEA) model of the CO₂-EOR and integrated it with LCA to thoroughly consider carbon credits in its economy. The model was built based upon previous investigations and used statistics from a large industrial data set of CO₂-EOR to produce accurate estimates of the CO₂-EOR economy. The technical model iteratively estimated the balance of three fluids (crude oil, CO₂, and water) in the CO₂-EOR system with a 25 year operational lifespan and obtained actual data for the LCA and TEA models. The model was simulated for the Kazakhstan case with its oil market conditions for a demonstration purpose. TEA results showed that, with the available low-cost CO₂ capture source or high CO₂ cost in carbon trading, CO₂-EOR can compete with current upstream projects in Kazakhstan by simultaneously increasing oil production and reducing GHG emissions.

Excellent Prognosis of Low-Risk Myelodysplastic Syndromes (MDS) Without Detectable Myeloid-Related Mutations

BACKGROUND

Unexplained cytopenia (UC) and low-risk myelodysplastic syndrome (MDS) are distinguished mainly by morphologic dysplasia, which sometimes shows inter-observer discrepancy. We hypothesized that gene mutations are strong prognostic factors for these low-risk patients.

MATERIALS AND METHODS

We enrolled patients from 4 medical centers with unexplained cytopenia of at least 1 lineage. Diagnosis of low-risk MDS was made according to WHO 2016 classification and a revised international prognostic scoring system (R-IPSS) score of ≤ 3.5. DNA was extracted from bone marrow or blood and sequenced by targeted next generation sequencing (NGS).

RESULTS

One hundred twenty-one patients were recruited: 25% with UC and 75% with low-risk MDS. Complete blood counts were similar, but low-risk MDS patients carried higher numbers of mutations (1 vs. 0; P = .04) than UC patients. Overall, the most frequent mutated genes were TET2 (14.6%), SF3B1 (12.2%), and ASXL1 (9.7%). Survival rates of low-risk MDS patients versus UC patients were not significantly different. UC patients and low-risk MDS patients without genetic abnormalities showed superior 5-year progression free survival compared to MDS patients with mutations (100% vs. 76.0%; P = .005). Overall, ASXL1 mutations were associated with decreased 4-year overall survival compared to wild-type (59% vs. 31%; P = .01). In a multivariate analysis, ASXL1 and DNMT3A mutations in low-risk MDS patients were associated with a higher risk of disease progression with hazard ratios of 7.88 (95% CI 1.76-35.32, P = .01) and 7.45 (95% CI 1.61-34.46, P = .01), respectively.

CONCLUSION

Mutation detection is important for proper risk stratification of patients presenting with idiopathic cytopenia.

Morphologic, immunophenotypic, and molecular genetic comparison study in patients with clonal cytopenia of undetermined significance, myelodysplastic syndrome, and acute myeloid leukemia with myelodysplasia-related changes: A single institution experience

INTRODUCTION

Next-generation sequencing (NGS) analysis showed clonal cytopenia of undetermined significance (CCUS) as an immediate precursor to myelodysplastic syndrome (MDS).

METHODS

We evaluated and compared morphologic, multiparametric flow cytometry (MFC), and molecular genetic findings in patients with CCUS (n = 37), MDS (n = 75), and acute myeloid leukemia with myelodysplasia-related changes (AML-MRC, n = 24).

RESULTS

CCUS patients showed variable MFC abnormalities including >2% CD34+ myeloblasts (5.8%), altered antigen expression on myeloblasts, monocytes, and granulocytes (1.2, 1.5, and 0.2/case), abnormal maturation of myeloblasts (45.8%), decreased hematogones (17.6%), and decreased side scatter (SSC) of granulocytes (11.4%). CCUS patients with high-risk mutations showed significantly more MFC abnormalities. However, CCUS patients with >20% variant allelic fraction (VAF) did not show more MFC aberrations than the rest of the group. MDS patients showed significantly more MFC abnormalities compared with CCUS patients (p = 7.8E-05-0.047). Low-grade MDS patients showed significantly fewer MFC abnormalities compared with high-grade MDS or AML-MRC patients (p = 1.89E-05-0.04). AML-MRC patients showed significantly elevated blast counts, more antigen aberrations, decreased hematogones, and decreased SSC of granulocytes compared with CCUS patients (p = 2.0E-05-0.01). CCUS patients carried predominantly TET2/DNMT3A/ASXL1 mutations. They harbored fewer mutations in gene coding splicing factors compared with MDS patients (p = .0001-.02) and fewer mutations in tumor suppressor and transcription factor genes compared with AML-MRC patients (p = .0006-.02).

CONCLUSIONS

CCUS is an immediate precursor to low-grade MDS. The progression from CCUS to MDS to AML-MRC is a stepwise process that requires acquisition of mutations in splicing, transcription factor, and tumor suppressor genes with accumulations of additional MFC abnormalities.

Flow Cytometric Findings in Clonal Cytopenia of Undetermined Significance

OBJECTIVES

To examine flow cytometric (FCM) findings in clonal cytopenia of undetermined significance (CCUS) in relation to variant allele fraction (VAF) and mutation risk.

METHODS

Nine FCM parameters, including 5 FCM metrics (Meyerson-Alayed scoring scheme [MASS] parameters) we previously used to identify myelodysplastic syndromes (MDS), were compared among 96 CCUS samples, 100 low-grade MDS samples and 100 samples from patients without somatic alterations (controls).

RESULTS

FCM findings did not differ between CCUS samples with less than 20% VAF and controls. CCUS samples with more than 20% VAF (CCUS >20% VAF) demonstrated more than 1 abnormal FCM parameter at a frequency between MDS and controls. Abnormalities in CCUS with high-risk alterations (CCUS(hi)) were similar to MDS, with no statistical difference in the percentage of cases with more than 1 FCM abnormality or a positive MASS score. The positive predictive value (PPV) for clinically significant myeloid processes; MDS, CCUS(hi), and CCUS >20% VAF compared with other CCUS samples and controls was 94.8%, with 96.5% specificity and 61% sensitivity using a modified MASS score. A subset of MDS (43%) was distinguished from CCUS(hi) and CCUS >20% VAF using 3 parameters, with a 93.5% PPV and 83.3% specificity.

CONCLUSIONS

FCM abnormalities can distinguish high-risk CCUS based on VAF or alteration type from low-risk CCUS and MDS in many cases. The findings are of potential utility in the evaluation of patients with cytopenias.

Clonal Cytopenia of Undetermined Significance in a Patient with Congenital Wilms' Tumor 1 and Acquired DNMT3A Gene Mutations

Congenital mutations of the Wilms' tumor 1 (WT1) gene can lead to various abnormalities, including renal/gonadal developmental disorders and cardiac malformations. Although there have been many reports of somatic WT1 mutations in patients with acute myeloid leukemia and myelodysplastic syndrome, congenital WT1 mutations have not been reported in hematological disorders. We herein report a patient with early-onset clonal cytopenia of undetermined significance that was associated with a congenital mutation of WT1 and an acquired mutation of DNMT3A [encoding DNA (cytosine-5)-methyltransferase 3A].

Assessing Representative CCUS Layouts for China's Power Sector toward Carbon Neutrality

China's carbon neutrality target is building momentum for carbon capture, utilization, and storage (CCUS), by which the power sector may attain faster decarbonization in the short term. However, an overall CCUS pipeline network blueprint remains poorly understood. This study, for the first time, links the China TIMES model and ChinaCCUS Decision Support System 2.0 to assess representative CCUS layouts for the power sector toward carbon neutrality, with the level of deployment and the maximum transportation distance from emission sources to storage sites considered. The total length of the proposed layouts under the low, medium, and high levels of deployment are about 5100, 18,000, and 37,000 km, with the annum CO2 captures of 0.4, 1.1, and 1.7 Gt, respectively, whereas pipes of medium diameters (12, 16, and 20 in) account for the majority in all three plans. As the deployment rate increases, the layouts generally spread from Northeast, North, and Northwest China to East, South Central, and Southwest China. However, some local exceptions take place considering terrain areas that the pipeline passes through. In addition to engineering guidance, this assessment also illuminates the opportunity for improving the efficiency of CCUS based on carbon pricing.

Polymer-Ceramic Composite Membranes for Water Removal in Membrane Reactors

Methanol can be obtained through CO₂ hydrogenation in a membrane reactor with higher yield or lower pressure than in a conventional packed bed reactor. In this study, we explore a new kind of membrane with the potential suitability for such membrane reactors. Silicone–ceramic composite membranes are synthetized and characterized for their capability to selectively remove water from a mixture containing hydrogen, CO₂, and water at temperatures typical for methanol synthesis. We show that this membrane can achieve selective permeation of water under such harsh conditions, and thus is an alternative candidate for use in membrane reactors for processes where water is one of the products and the yield is limited by thermodynamic equilibrium.

Mutations in myelodysplastic syndromes: Core abnormalities and CHIPping away at the edges

The myelodysplastic syndromes (MDS) are a heterogeneous constellation of hematologic malignancies characterized by aberrant differentiation and clonal expansion of abnormal myeloid cells that initially manifest with ineffective hematopoiesis and consequent cytopenias. The prognosis of MDS is variable and depends on clinical and hematologic parameters, cytogenetic and molecular findings, as well as comorbidities. Gene sequencing studies have uncovered remarkable genomic complexity within MDS, based on the presence of recurrent and sometimes co-operating mutations in genes encoding proteins that play a role in numerous biologic pathways. Although the treatment of MDS is currently limited to the use of hypomethylating, immunomodulatory, or erythropoiesis-stimulating agents, improved understanding of the molecular underpinnings of its pathophysiology has led to the development of multiple targeted treatments that are poised to be added to the therapeutic armamentarium. This review will focus on the role of mutations in the pathogenesis, diagnosis, and prognosis of MDS and how the discovery of clonal hematopoiesis of indeterminate potential (CHIP) might impact the utility of detecting mutations in the diagnosis of MDS.

Comparison of SF3B1/DNMT3A Comutations With DNMT3A or SF3B1 Mutation Alone in Myelodysplastic Syndrome and Clonal Cytopenia of Undetermined Significance

OBJECTIVES

To compare the clinical significance of SF3B1/DNMT3A Comutations with SF3B1 or DNMT3A mutation alone in myelodysplastic syndrome (MDS) and clonal cytopenia of undetermined significance (CCUS).

METHODS

We identified and compared 31 patients with only DNMT3A mutation, 48 patients with only SF3B1 mutation, and 16 patients with only SF3B1/DNMT3A comutations.

RESULTS

SF3B1/DNMT3A comutations were found to be more common in MDS, whereas DNMT3A mutation alone was more common in CCUS. The patients with SF3B1/DNMT3A comutations were less likely to have poor cytogenetics than patients with DNMT3A mutation alone. Patients with SF3B1/DNMT3A comutations showed significantly longer median survival time and better overall survival than patients with DNMT3A mutation alone.

CONCLUSIONS

Patients with SF3B1/DNMT3A comutations appear to have better clinical outcomes than patients with isolated DNMT3A mutation. These findings suggest that the favorable prognosis of SF3B1 mutation in is not abrogated by the concurrent presence of a DNMT3A mutation.

Could congressionally mandated incentives lead to deployment of large-scale CO2 capture, facilities for enhanced oil recovery CO2 markets and geologic CO2 storage?

In passing the Bipartisan Budget Act of 2018, Congress reformed and strengthened a section of the tax code, 45Q, which provides tax credits of up to $35/ton CO₂ for the capture and utilization of CO₂ in qualifying applications such as enhanced oil recovery (EOR) and up to $50/ton CO₂ for CO₂ that is captured and permanently stored in a geologic repository. Earlier versions of the tax credit with lower credit values generated limited interest. This change to the tax code could potentially alter U.S. energy systems. This paper examines the effect of the increased 45Q credits on CO₂ capture, utilization and storage (CCUS) deployment in the United States and on petroleum and power production. A range of potential outcomes is explored using five modeling tools. The paper goes on to explore the potential impact of possible modifications of the current tax credit including extension of its availability in time, the period over which 45Q tax credits can be utilized for any given asset and increases in the value of the credit as well as interactions with technology availability and carbon taxation. The paper concludes that 45Q tax credits could stimulate additional CCUS beyond that which is already underway.

Premalignant Clonal Hematopoietic Proliferations

OBJECTIVES

The 2017 Workshop of the Society for Hematopathology/European Association for Hematopathology aimed to review premalignant clonal hematopoietic proliferations.

METHODS

The workshop panel reviewed 27 cases of clonal proliferations of indeterminate significance or potential (18 myeloid, nine lymphoid) and rendered consensus diagnoses.

RESULTS

Immunophenotyping and genetic studies on peripheral blood, bone marrow, and lymph node samples have led to the incidental detection of small clonal populations in asymptomatic individuals. These premalignant clonal myeloid and lymphoid proliferations include monoclonal gammopathy of uncertain significance, monoclonal B-cell lymphocytosis, in situ follicular neoplasia, in situ mantle cell neoplasia, clonal hematopoiesis of indeterminate potential, and clonal cytopenia of undetermined significance.

CONCLUSIONS

Current diagnostic criteria for the diagnoses of premalignant clonal hematopoietic proliferations are reviewed and discussed in the context of the cases presented at the workshop.

Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU)

Over the past decades, ultrasound (US) has gained its place in the armamentarium of monitoring tools in the intensive care unit (ICU). Critical care ultrasonography (CCUS) is the combination of general CCUS (lung and pleural, abdominal, vascular) and CC echocardiography, allowing prompt assessment and diagnosis in combination with vascular access and therapeutic intervention. This review summarises the findings, challenges lessons from the 3rd Course on Acute Care Ultrasound (CACU) held in November 2015, Antwerp, Belgium. It covers the different modalities of CCUS; touching on the various aspects of training, clinical benefits and potential benefits. Despite the benefits of CCUS, numerous challenges remain, including the delivery of CCUS training to future intensivists. Some of these are discussed along with potential solutions from a number of national European professional societies. There is a need for an international agreed consensus on what modalities are necessary and how best to deliver training in CCUS.

Lung ultrasound in the critically ill (LUCI): A translational discipline

In the early days of ultrasound, it was not a translational discipline. The heart was claimed by cardiologists, with others, such as gynaecologists, urologists and vascular surgeons claiming their part while the rest was given to radiologists. Only recently, ultrasound transgressed and crossed the usual borders between the different disciplines, such as emergency and critical care medicine. The advent of portable machines in the early 1980s, allowed the critical care physician to perform bedside ultrasound, and the development of whole body critical care ultrasound (CCUS) was born. It may sound cynical that radiologists were the first to state that diagnostic sonography was truly the next stethoscope: poorly utilized by many but understood by few. Exactly the same radiologists then abandoned the use of ultrasound outside the radiology department, leaving a vast domain to other disciplines eager to welcome the modern stethoscope. In this review, we list the possibilities of lung ultrasound as a translational holistic discipline.

ICUS/CCUS/CHIP: basics & beyond

INTRODUCTION

Patients presenting with idiopathic cytopenia with non-diagnostic marrow morphology and a normal karyotype pose a diagnostic and therapeutic challenge. Additional diagnostic information from mutation analysis could provide important clinical insights. However, one has to be cautious during such diagnostic interpretations in view of the recent documentation of clonal somatic mutations in healthy elder individuals. Whether to regard clonality synonymous with malignant proliferation or a manifestation of ageing process is to be judged carefully. Areas covered: The review covers defining criteria and diagnostic work up for Idiopathic cytopenia of undetermined significance (ICUS), Clonal cytopenia of undetermined significance (CCUS), Clonal hematopoiesis of indeterminate potential (CHIP). It also presents the results from previous reports on this subject. In addition the evolution and potential impact of these entities is discussed. Expert commentary: Current evidence does not support the use of somatic mutations as presumptive evidence of myelodysplastic syndrome (MDS). Including CCUS under the category of MDS requires further insight on natural disease course. Longitudinal follow up study on ICUS, CCUS, CHIP may eventually identify the pathological significance of the clonal mutations. An absence of mutation however may still be useful as good predictor of not having MDS.