MRI-based radiomics model to preoperatively predict mesenchymal transition subtype in high-grade serous ovarian cancer

AIM

To develop a magnetic resonance imaging (MRI)-based radiomics model for the preoperative identification of mesenchymal transition (MT) subtype in high-grade serous ovarian cancer (HGSOC).

MATERIALS AND METHODS

One hundred and eighty-nine patients with histopathologically confirmed HGSOC were enrolled retrospectively. Among the included patients, 55 patients were determined as the MT subtype and the remaining 134 were non-MT subtype. After extracting a total of 204 features from T2-weighted imaging (T2WI) and contrast-enhanced (CE)-T1WI images, the Mann-Whitney U-test, Spearman correlation test, and Boruta algorithm were adopted to select the optimal feature set. Three classifiers, including logistic regression (LR), support vector machine (SVM), and random forest (RF), were trained to develop radiomics models. The performance of established models was evaluated from three aspects: discrimination, calibration, and clinical utility.

RESULTS

Seven radiomics features relevant to MT subtypes were selected to build the radiomics models. The model based on the RF algorithm showed the best performance in predicting MT subtype, with areas under the curves (AUCs) of 0.866 (95 % confidence interval [CI]: 0.797-0.936) and 0.852 (95 % CI: 0.736-0.967) in the training and testing cohorts, respectively. The calibration curves, supported with Brier scores, indicated very good consistency between observation and prediction. Decision curve analysis (DCA) showed that the RF-based model could provide more net benefit, which suggested favorable utility in clinical application.

CONCLUSION

The RF-based radiomics model provided accurate identification of MT from the non-MT subtype and may help facilitate personalised management of HGSOC.

A silicon photoanode protected with TiO2/stainless steel bilayer stack for solar seawater splitting

Photoelectrochemical seawater splitting is a promising route for direct utilization of solar energy and abundant seawater resources for H2 production. However, the complex salinity composition in seawater results in intractable challenges for photoelectrodes. This paper describes the fabrication of a bilayer stack consisting of stainless steel and TiO2 as a cocatalyst and protective layer for Si photoanode. The chromium-incorporated NiFe (oxy)hydroxide converted from stainless steel film serves as a protective cocatalyst for efficient oxygen evolution and retarding the adsorption of corrosive ions from seawater, while the TiO2 is capable of avoiding the plasma damage of the surface layer of Si photoanode during the sputtering of stainless steel catalysts. By implementing this approach, the TiO2 layer effectively shields the vulnerable semiconductor photoelectrode from the harsh plasma sputtering conditions in stainless steel coating, preventing surface damages. Finally, the Si photoanode with the bilayer stack inhibits the adsorption of chloride and realizes 167 h stability in chloride-containing alkaline electrolytes. Furthermore, this photoanode also demonstrates stable performance under alkaline natural seawater for over 50 h with an applied bias photon-to-current efficiency of 2.62%.

Electronic structure modification of SnO2 to accelerate CO2 reduction towards formate

A systematic theoretical study probing the catalytic potential of metal-doped SnO2(110) was conducted. The incorporation of metals such as Zr, Ti, W, V, Hf, and Ge is shown to drive electron transfer to Sn. The increased charge of Sn is injected into anti-bonding orbitals, finely tuning the catalytic activity and reducing the overpotential to -0.34 V. AIMD simulations show the stability of the modified structures. This work sheds light on the rational design of low-cost metal oxides with a high catalytic performance for CO2ER to formate.

Metastable gallium hydride mediates propane dehydrogenation on H2 co-feeding

In heterogeneous catalysis, the catalytic dehydrogenation reactions of hydrocarbons often exhibit a negative pressure dependence on hydrogen due to the competitive chemisorption of hydrocarbons and hydrogen. However, some catalysts show a positive pressure dependence for propane dehydrogenation, an important reaction for propylene production. Here we show that the positive activity dependence on H2 partial pressure of gallium oxide-based catalysts arises from metastable hydride mediation. Through in situ spectroscopic, kinetic and computational analyses, we demonstrate that under reaction conditions with H2 co-feeding, the dissociative adsorption of H2 on a partially reduced gallium oxide surface produces H atoms chemically bonded to coordinatively unsaturated Ga atoms. These metastable gallium hydride species promote C-H bond activation while inhibiting deep dehydrogenation. We found that the surface coverage of gallium hydride determines the catalytic performance. Accordingly, benefiting from proper H2 co-feeding, the alumina-supported, trace additive-modified gallium oxide catalyst GaOx-Ir-K/Al2O3 exhibited high activity and selectivity at high propane concentrations.

Structured Catalysts and Catalytic Processes: Transport and Reaction Perspectives

The structure of catalysts determines the performance of catalytic processes. Intrinsically, the electronic and geometric structures influence the interaction between active species and the surface of the catalyst, which subsequently regulates the adsorption, reaction, and desorption behaviors. In recent decades, the development of catalysts with complex structures, including bulk, interfacial, encapsulated, and atomically dispersed structures, can potentially affect the electronic and geometric structures of catalysts and lead to further control of the transport and reaction of molecules. This review describes comprehensive understandings on the influence of electronic and geometric properties and complex catalyst structures on the performance of relevant heterogeneous catalytic processes, especially for the transport and reaction over structured catalysts for the conversions of light alkanes and small molecules. The recent research progress of the electronic and geometric properties over the active sites, specifically for theoretical descriptors developed in the recent decades, is discussed at the atomic level. The designs and properties of catalysts with specific structures are summarized. The transport phenomena and reactions over structured catalysts for the conversions of light alkanes and small molecules are analyzed. At the end of this review, we present our perspectives on the challenges for the further development of structured catalysts and heterogeneous catalytic processes.

Confinement of ionomer for electrocatalytic CO2 reduction reaction via efficient mass transfer pathways

Gas diffusion electrodes (GDEs) mediate the transport of reactants, products and electrons for the electrocatalytic CO2 reduction reaction (CO2RR) in membrane electrode assemblies. The random distribution of ionomer, added by the traditional physical mixing method, in the catalyst layer of GDEs affects the transport of ions and CO2. Such a phenomenon results in elevated cell voltage and decaying selectivity at high current densities. This paper describes a pre-confinement method to construct GDEs with homogeneously distributed ionomer, which enhances mass transfer locally at the active centers. The optimized GDE exhibited comparatively low cell voltages and high CO Faradaic efficiencies (FE > 90%) at a wide range of current densities. It can also operate stably for over 220 h with the cell voltage staying almost unchanged. This good performance can be preserved even with diluted CO2 feeds, which is essential for pursuing a high single-pass conversion rate. This study provides a new approach to building efficient mass transfer pathways for ions and reactants in GDEs to promote the electrocatalytic CO2RR for practical applications.

Unraveling the rate-determining step of C2+ products during electrochemical CO reduction

The electrochemical reduction of CO has drawn a large amount of attention due to its potential to produce sustainable fuels and chemicals by using renewable energy. However, the reaction's mechanism is not yet well understood. A major debate is whether the rate-determining step for the generation of multi-carbon products is C-C coupling or CO hydrogenation. This paper conducts an experimental analysis of the rate-determining step, exploring pH dependency, kinetic isotope effects, and the impact of CO partial pressure on multi-carbon product activity. Results reveal constant multi-carbon product activity with pH or electrolyte deuteration changes, and CO partial pressure data aligns with the theoretical formula derived from *CO-*CO coupling as the rate-determining step. These findings establish the dimerization of two *CO as the rate-determining step for multi-carbon product formation. Extending the study to commercial copper nanoparticles and oxide-derived copper catalysts shows their rate-determining step also involves *CO-*CO coupling. This investigation provides vital kinetic data and a theoretical foundation for enhancing multi-carbon product production.

Highly selective photoelectrochemical CO2 reduction by crystal phase-modulated nanocrystals without parasitic absorption

Photoelectrochemical (PEC) carbon dioxide (CO2) reduction (CO2R) holds the potential to reduce the costs of solar fuel production by integrating CO2 utilization and light harvesting within one integrated device. However, the CO2R selectivity on the photocathode is limited by the lack of catalytic active sites and competition with the hydrogen evolution reaction. On the other hand, serious parasitic light absorption occurs on the front-side-illuminated photocathode due to the poor light transmittance of CO2R cocatalyst films, resulting in extremely low photocurrent density at the CO2R equilibrium potential. This paper describes the design and fabrication of a photocathode consisting of crystal phase-modulated Ag nanocrystal cocatalysts integrated on illumination-reaction decoupled heterojunction silicon (Si) substrate for the selective and efficient conversion of CO2. Ag nanocrystals containing unconventional hexagonal close-packed phases accelerate the charge transfer process in CO2R reaction, exhibiting excellent catalytic performance. Heterojunction Si substrate decouples light absorption from the CO2R catalyst layer, preventing the parasitic light absorption. The obtained photocathode exhibits a carbon monoxide (CO) Faradaic efficiency (FE) higher than 90% in a wide potential range, with the maximum FE reaching up to 97.4% at -0.2 V vs. reversible hydrogen electrode. At the CO2/CO equilibrium potential, a CO partial photocurrent density of -2.7 mA cm-2 with a CO FE of 96.5% is achieved in 0.1 M KHCO3 electrolyte on this photocathode, surpassing the expensive benchmark Au-based PEC CO2R system.

Alkaline-earth ion stabilized sub-nano-platinum tin clusters for propane dehydrogenation

The strong promotion effects of alkali/alkaline earth metals are frequently reported for heterogeneous catalytic processes such as propane dehydrogenation (PDH), but their functioning principles remain elusive. This paper describes the effect of the addition of calcium (Ca) on reducing the deactivation rate of platinum-tin (Pt-Sn) catalyzed PDH from 0.04 h-1 to 0.0098 h-1 at 873 K under a WHSV of 16.5 h-1 of propane. The Pt-Sn-Ca catalyst shows a high propylene selectivity of >96% with a propylene production rate of 41 molC3H6 (gPt h)-1 and ∼1% activity loss after regeneration. The combination of characterization and DFT simulations reveals that Ca acts as a structural promoter favoring the transition of Snn+ in the parent catalyst to Sn0 during reduction, and the latter is an electron donor that increases the electron density of Pt. This greatly suppresses coke formation from deep dehydrogenation. Moreover, it was found that Ca promotes the formation of a highly reactive and sintering-resistant sub-nano Pt-Sn alloy with a diameter of approximately 0.8 nm. These lead to high activity and selectivity for the Pt-Sn-Ca catalyst for PDH.

[Analysis of public health risks associated with pathogenic fungi in China]

At present, the public health risks caused by pathogenic fungi are greater in China and have attracted great attention from disease control departments. Due to the difficulty in diagnosing fungal infections, the public health risk of pathogenic fungi is currently hidden in the unexplained pneumonia/encephalitis/fever syndrome and is not effectively appreciated. From the public health perspective, the mainly focused fungal pathogens include highly pathogenic fungi (including dimorphic fungi and dematiaceous fungi), pathogenic fungi that cause regional aggregation infections, and drug-resistant pathogenic fungi. However, due to the lack of systematic monitoring data, the disease burden related to pathogenic fungi cannot be accurately quantified and evaluated. Therefore, to effectively reduce the serious harm of fungal infections to the public, systematic monitoring of pathogenic fungi should be carried out nationally.

Reversed Electron Transfer in Dual Single Atom Catalyst for Boosted Photoreduction of CO2

Photogenerated charge localization on material surfaces significantly affects photocatalytic performance, especially for multi-electron CO2 reduction. Dual single atom (DSA) catalysts with flexibly designed reactive sites have received significant research attention for CO2 photoreduction. However, the charge transfer mechanism in DSA catalysts remains poorly understood. Here, for the first time, a reversed electron transfer mechanism on Au and Co DSA catalysts is reported. In situ characterizations confirm that for CdS nanoparticles (NPs) loaded with Co or Au single atoms, photogenerated electrons are localized around the single atom of Co or Au. In DSA catalysts, however, electrons are delocalized from Au and accumulate around Co atoms. Importantly, combined advanced spectroscopic findings and theoretical computation evidence that this reversed electron transfer in Au/Co DSA boosts charge redistribution and activation of CO2 molecules, leading to highly significantly increased photocatalytic CO2 reduction, for example, Au/Co DSA loaded CdS exhibits, respectively, ≈2800% and 700% greater yields for CO and CH4 compared with that for CdS alone. Reversed electron transfer in DSA can be used for practical design for charge redistribution and to boost photoreduction of CO2 . Findings will be of benefit to researchers and manufacturers in DSA-loaded catalysts for the generation of solar fuels.

Temporal Structures in Positron Spectra and Charge-Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic positron fluxes in the rigidity range from 1.00 to 41.9 GV based on 3.4×10^{6} positrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The positron fluxes show distinctly different time variations from the electron fluxes at short and long timescales. A hysteresis between the electron fluxes and the positron fluxes is observed with a significance greater than 5σ at rigidities below 8.5 GV. On the contrary, the positron fluxes and the proton fluxes show similar time variation. Remarkably, we found that positron fluxes are modulated more than proton fluxes with a significance greater than 5σ for rigidities below 7 GV. These continuous daily positron fluxes, together with AMS daily electron, proton, and helium fluxes over an 11-year solar cycle, provide unique input to the understanding of both the charge-sign and mass dependencies of cosmic rays in the heliosphere.

Clinical-Radiomics Nomogram for Risk Prediction of Esophageal Fistula in Patients with Esophageal Squamous Cell Carcinoma Treated by IMRT or VMAT

PURPOSE/OBJECTIVE(S)

This study aimed to analyze the predictive factors of esophageal fistula (EF) in patients with esophageal squamous cell carcinoma (ESCC) receiving intensity-modulated radiotherapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT), and to establish a prediction model for risk prediction of EF.

MATERIALS/METHODS

A total of 479 patients with ESCC treated with IMRT or VMAT from 2013 to 2020 in Xijing hospital were retrospectively analyzed. A total of 43 patients with EF and 129 patients without EF were included in the analysis by 1:3 propensity score matching (time of diagnosis, gender). The clinical risk factors associated with EF were obtained based on univariate logistic regression analysis. Radiomic features were extracted and selected from pre-treatment contrast-enhance computed tomography (CT) to construct radiomic signature. The clinical-radiomics nomogram was constructed based on multivariate stepwise logistic regression. The classification performance of the model was evaluated based on 100 times of 5-fold cross validation.

RESULTS

The median OS of the 172 patients included in the analysis was 27.8 months (range 1.3-104.9m), and the median OS of EF patients was lower than that of non-EF patients with 13.1 months (range 1.3-65.3m) vs 49.4 months (range 4.0-104.9m, p<0.001). A total of 1158 radiomics features were extracted and 8 radiomics features were finally selected. The area under the receiver operating characteristic curve (AUC) value of radiomic signature calculated by selected features for predicting EF was 0.794, and it also had the prognostic ability of OS risk stratification (median OS:17.6vs 46.6m, p<0.001). Multivariate analysis showed that the tumor length, tumor volume, T stage, lymphocyte rate and grade 4 esophagus stenosis were related to EF, and the AUC value of clinical nomogram for predicting EF was 0.849. The clinical-radiomics nomogram had the best performance in predicting EF with an AUC value of 0.896.

CONCLUSION

The clinical-radiomics nomogram can predict the risk of EF in ESCC patients, and be helpful for individualized treatment of esophageal cancer.

Association of Parental Status and Gender with Burden of Multidisciplinary Tumor Boards

PURPOSE/OBJECTIVE(S)

Tumor boards are an integral part of the management of patients with cancer. However, there is limited data investigating the burden of tumor boards on physicians. Our objective was to determine what physician-related, and tumor board-related factors associate with higher burden.

MATERIALS/METHODS

Tumor board start times were collected by email from 22 National Cancer Institute-designated cancer centers and/or U.S. World and News Report Top 40 hospitals for cancer. Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3, 2022, and April 3, 2022. Tumor board burden was measured on a 4-point scale (1, not at all; 2, slightly; 3, moderately; 4, very burdensome). Univariable and multivariable analyses were performed using a probabilistic index model.

RESULTS

The timing of 392 tumor boards was collected from 22 institutions. The most common tumor board start time was at or before 0730 (24.6%). Surveys were completed by 111 physicians, of which 52.3% identified as women and 42.3% as men. Reported specialties were radiation oncology (39.6%), medical oncology (18.0%), surgery (15.3%), radiology (12.6%), and pathology (9.9%). On average, 41.4% attended ≥3 hours/week total of tumor boards and 1-2 hours/week of early/late tumor boards (defined as starting before 0800 or 1700 or after). Overall, 37.8% reported tumor boards were at least moderately burdensome. On multivariable analysis, radiology/pathology specialty (probability 0.68; 95% confidence interval [CI], 0.54-0.79; p = 0.015), attending ≥3 hours/week of tumor boards (probability 0.68; 95% CI, 0.58-0.76; p<.001), and having ≥2 children (probability 0.65; 95% CI, 0.52-0.77; p = 0.029), were associated with higher burden. Early/late tumor boards were frequently considered burdensome (20.7% moderately, 29.7% very burdensome). On multivariable analysis, identifying as a woman (probability 0.69; 95% CI, 0.57-0.78; p = 0.003) and having children (probability 0.75; 95% CI, 0.62-0.84; p<.001) remained associated with a higher level of burden from early/late tumor boards. Further, parents frequently reported that early/late tumor boards negatively affected childcare (55.8%), feeding and/or sleep logistics (33.8%), and overall family dynamics (63.7%).

CONCLUSION

Identifying as a woman and having children were associated with a higher level of burden from early/late tumor boards. The negative impact of early/late tumor boards on overall family dynamics, including children feeding, sleeping, and childcare logistics, was commonly reported by parents. Having ≥2 children, attending ≥3 hours/week of tumor boards, and radiology/pathology specialty were associated with a higher level of burden overall. Future strategies should aim to decrease burden, particularly the disparate impact on parents and women.

4D-MRI Guided Stereotactic Body Radiation Therapy for Unresectable Colorectal Liver Metastases

PURPOSE/OBJECTIVE(S)

This study evaluated the feasibilities and outcomes following four-dimensional magnetic resonance imaging (4D-MRI) guided stereotactic body radiation therapy (SBRT) for unresectable colorectal liver metastases (CRLM).

MATERIALS/METHODS

From March 2018 to January 2022, we identified 76 unresectable CRLM patients with 123 lesions who received 4D-MRI guided SBRT in our institution. 4D-MRI simulation with or without abdominal compression was conducted for all patients. The prescription dose was 50-65 Gy in 5-12 fractions. The image quality of computed tomography (CT) and MRI were compared using the Clarity Score. Clinical outcomes and toxicity profiles were evaluated.

RESULTS

The 4D-MRI significantly improved the image quality compared with CT images (mean Clarity Score: 1.67 vs 2.88, P < 0.001). The abdominal compression significantly reduced motions in cranial-caudal direction (P = 0.03) with 2 phase T2 weighted images assessing tumor motion. The median follow-up time was 12.5 months. For 98 lesions assessed for best response, the complete response, partial response and stable disease rate were 57.1 %, 30.6 % and 12.2 %, respectively. The local control (LC) rate at 2 year was 97.3%. 46.1% of patients experienced grade 1-2 toxicities and only 2.6% patients experienced grade 3 hematologic toxicities.

CONCLUSION

The 4D-MRI technique allowed precise target delineation and motion tracking in unresectable CRLM patients. High LC rate and mild toxicities were achieved. This study provided evidence for using 4D-MRI guided SBRT as an alternative treatment in unresectable CRLM.

New Limits on Exotic Spin-Dependent Interactions at Astronomical Distances

Exotic spin-dependent interactions involving new light particles address key questions in modern physics. Interactions between polarized neutrons (n) and unpolarized nucleons (N) occur in three forms: g_{S}^{N}g_{P}^{n}σ·r, g_{V}^{N}g_{A}^{n}σ·v, and g_{A}^{N}g_{A}^{n}σ·v×r, where σ is the spin and g's are the corresponding coupling constants for scalar, pseudoscalar, vector, and axial-vector vertexes. If such interactions exist, the Sun and Moon could induce sidereal variations of effective fields in laboratories. By analyzing existing data from laboratory measurements on Lorentz and CPT violation, we derive new experimental upper limits on these exotic spin-dependent interactions at astronomical ranges. Our limits on g_{S}^{N}g_{P}^{n} surpass the previous combined astrophysical-laboratory limits, setting the most stringent experimental constraints to date. We also report new constraints on vector-axial-vector and axial-axial-vector interactions at astronomical scales, with vector-axial-vector limits improved by ∼12 orders of magnitude. We extend our analysis to Hari Dass interactions and obtain new constraints.

Tandem propane dehydrogenation and surface oxidation catalysts for selective propylene synthesis

Direct propane dehydrogenation (PDH) to propylene is a desirable commercial reaction but is highly endothermic and severely limited by thermodynamic equilibrium. Routes that oxidatively remove hydrogen as water have safety and cost challenges. We coupled chemical looping-selective hydrogen (H2) combustion and PDH with multifunctional ferric vanadate-vanadium oxide (FeVO4-VOx) redox catalysts. Well-dispersed VOx supported on aluminum oxide (Al2O3) provides dehydrogenation sites, and adjacent nanoscale FeVO4 acts as an oxygen carrier for subsequent H2 combustion. We achieved an integral performance of 81.3% propylene selectivity at 42.7% propane conversion at 550°C for 200 chemical looping cycles for the reoxidization of FeVO4. Based on catalytic experiments, spectroscopic characterization, and theory calculations, we propose a hydrogen spillover-mediated coupling mechanism. The hydrogen species generated at the VOx sites migrated to adjacent FeVO4 for combustion, which shifted PDH toward propylene. This mechanism is favored by the proximity between the dehydrogenation and combustion sites.

Accessing complex reconstructed material structures with hybrid global optimization accelerated via on-the-fly machine learning

The complex reconstructed structure of materials can be revealed by global optimization. This paper describes a hybrid evolutionary algorithm (HEA) that combines differential evolution and genetic algorithms with a multi-tribe framework. An on-the-fly machine learning calculator is adopted to expedite the identification of low-lying structures. With a superior performance to other well-established methods, we further demonstrate its efficacy by optimizing the complex oxidized surface of Pt/Pd/Cu with different facets under (4 × 4) periodicity. The obtained structures are consistent with experimental results and are energetically lower than the previously presented model.

Highly selective NH3 synthesis from N2 on electron-rich Bi0 in a pressurized electrolyzer

Electrochemical conversion of N2 into ammonia presents a sustainable pathway to produce hydrogen storage carrier but yet requires further advancement in electrocatalyst design and electrolyzer integration. This technology suffers from low selectivity and yield owing to the extremely strong N≡N bond and the exceptionally low solubility of N2 in aqueous systems. A high NH3 synthesis performance is restricted by the high activation energy of N≡N bond and the supply insufficiency of N2 to active sites. This paper describes the introduction of electron-rich Bi0 sites into Ag catalysts with a high-pressure electrolyzer that enables a dramatically enhanced Faradaic efficiency of 44.0% and yield of 28.43 μg cm-2 h-1 at 4.0 MPa. Combined with density functional theory results, in situ attenuated total reflectance surface-enhanced infrared absorption spectroscopy demonstrates that N2 reduction reaction follows an associative mechanism, in which a high coverage of N-N bond and -NH2 intermediates suggest electron-rich Bi0 boosts sound activation of N2 molecules and low hydrogenation barrier. The proposed strategy of engineering electrochemical catalysts and devices provides powerful guidelines for achieving industrial-level green ammonia production.

Fast-Response Nickel-Promoted Indium Oxide Catalysts for Carbon Dioxide Hydrogenation from Intermittent Solar Hydrogen

Construction of a "net-zero-emission" system through CO2 hydrogenation to methanol with solar energy is an eco-friendly way to mitigate the greenhouse effect. Traditional CO2 hydrogenation demands centralized mass production for cost reduction with mass water electrolysis for hydrogen supply. To achieve continuous reaction with intermittent and fluctuating flow of H2 on a small-scale for distributed application scenarios, modulating the catalyst interface environment and chemical adsorption capacity to adapt fluctuating reaction conditions is highly desired. This paper describes a distributed clean CO2 utilization system in which the surface structure of catalysts is carefully regulated. The Ni catalyst with unsaturated electrons loaded on In2 O3 can reduce the dissociation energy of H2 to overcome the slow response of intermittent H2 supply, exhibiting a faster response (12 min) than bare oxide catalysts (42 min). Moreover, the introduction of Ni enhances the sensitivity of the catalyst to hydrogen, yielding a Ni/In2 O3 catalyst with a good performance at lower H2 concentrations with a 15 times adaptability for wider hydrogen fluctuation range than In2 O3 , greatly reducing the negative impact of unstable H2 supplies derived from renewable energies.

Guiding catalytic CO2 reduction to ethanol with copper grain boundaries

The grain boundaries (GBs) in copper (Cu) electrocatalysts have been suggested as active sites for CO₂ electroreduction to ethanol. Nevertheless, the mechanisms are still elusive. Herein, we describe how GBs tune the activity and selectivity for ethanol on two representative Cu-GB models, namely Cu∑3/(111) GB and Cu∑5/(100) GB, using joint first-principles calculations and experiments. The unique geometric structures on the GBs facilitate the adsorption of bidentate intermediates, *COOH and *CHO, which are crucial for CO₂ activation and CO protonation. The decreased CO-CHO coupling barriers on the GBs can be rationalized via kinetics analysis. Furthermore, when introducing GBs into Cu (100), the product is selectively switched from ethylene to ethanol, due to the stabilization effect for *CH₃CHO and inapposite geometric structure for *O adsorption, which are validated by experimental trends. An overall 12.5 A current and a single-pass conversion of 5.18% for ethanol can be achieved over the synthesized Cu-GB catalyst by scaling up the electrode into a 25 cm² membrane electrode assembly system.

Tunable CO2 electroreduction to ethanol and ethylene with controllable interfacial wettability

The mechanism of how interfacial wettability impacts the CO₂ electroreduction pathways to ethylene and ethanol remains unclear. This paper describes the design and realization of controllable equilibrium of kinetic-controlled *CO and *H via modifying alkanethiols with different alkyl chain lengths to reveal its contribution to ethylene and ethanol pathways. Characterization and simulation reveal that the mass transport of CO₂ and H₂O is related with interfacial wettability, which may result in the variation of kinetic-controlled *CO and *H ratio, which affects ethylene and ethanol pathways. Through modulating the hydrophilic interface to superhydrophobic interface, the reaction limitation shifts from insufficient supply of kinetic-controlled *CO to that of *H. The ethanol to ethylene ratio can be continuously tailored in a wide range from 0.9 to 1.92, with remarkable Faradaic efficiencies toward ethanol and multi-carbon (C₂₊) products up to 53.7% and 86.1%, respectively. A C₂₊ Faradaic efficiency of 80.3% can be achieved with a high C₂₊ partial current density of 321 mA cm^-2, which is among the highest selectivity at such current densities.

Tandem cells for unbiased photoelectrochemical water splitting

Hydrogen is an essential energy carrier which will address the challenges posed by the energy crisis and climate change. Photoelectrochemical water splitting (PEC) is an important method for producing solar-powered hydrogen. The PEC tandem configuration harnesses sunlight as the exclusive energy source to drive both the hydrogen (HER) and oxygen evolution reactions (OER), simultaneously. Therefore, PEC tandem cells have been developed and gained tremendous interest in recent decades. This review describes the current status of the development of tandem cells for unbiased photoelectrochemical water splitting. The basic principles and prerequisites for constructing PEC tandem cells are introduced first. We then review various single photoelectrodes for use in water reduction or oxidation, and highlight the current state-of-the-art discoveries. Second, a close look into recent developments of PEC tandem cells in water splitting is provided. Finally, a perspective on the key challenges and prospects for the development of tandem cells for unbiased PEC water splitting are given.

Tracking C-H bond activation for propane dehydrogenation over transition metal catalysts: work function shines

The activation of the C-H bond in heterogeneous catalysis plays a privileged role in converting light alkanes into commodity chemicals with a higher value. In contrast to traditional trial-and-error approaches, developing predictive descriptors via theoretical calculations can accelerate the process of catalyst design. Using density functional theory (DFT) calculations, this work describes tracking C-H bond activation of propane over transition metal catalysts, which is highly dependent on the electronic environment of catalytic sites. Furthermore, we reveal that the occupancy of the antibonding state for metal-adsorbate interaction is the key factor in determining the ability to activate the C-H bond. Among 10 frequently used electronic features, the work function (W) exhibits a strong negative correlation with C-H activation energies. We demonstrate that e^-W can effectively quantify the ability of C-H bond activation, surpassing the predictive capacity of the d-band center. The C-H activation temperatures of the synthesized catalysts also confirm the effectiveness of this descriptor. Apart from propane, e^-W applies to other reactants like methane.

Designing single-site alloy catalysts using a degree-of-isolation descriptor

Geometrically isolated metal atoms in alloy catalysts can target efficient and selective catalysis. However, the geometric and electronic disturbance between the active atom and its neighbouring atoms, that is, diverse microenvironments, makes the active site ambiguous. Herein, we demonstrate a methodology to describe the microenvironment and determine the effectiveness of active sites in single-site alloys. A simple descriptor, degree-of-isolation, is proposed, considering both electronic regulation and geometric modulation within a PtM ensemble (M = transition metal). The catalytic performance of PtM single-site alloy is examined thoroughly using this descriptor for an industrially important reaction, propane dehydrogenation. The volcano-shaped isolation-selectivity plot reveals a Sabatier-type principle for designing selective single-site alloys. Specifically, for a single-site alloy with a high degree-of-isolation, alternation of the active centre has a great impact on tuning selectivity, validated by the outstanding consistency between experimental propylene selectivity and the computational descriptor.

Confinement of an alkaline environment for electrocatalytic CO2 reduction in acidic electrolytes

Acidic electrochemical CO₂ reduction reaction (CO₂RR) can minimize carbonate formation and eliminate CO₂ crossover, thereby improving long-term stability and enhancing single-pass carbon efficiency (SPCE). However, the kinetically favored hydrogen evolution reaction (HER) is generally predominant under acidic conditions. This paper describes the confinement of a local alkaline environment for efficient CO₂RR in a strongly acidic electrolyte through the manipulation of mass transfer processes in well-designed hollow-structured Ag@C electrocatalysts. A high faradaic efficiency of over 95% at a current density of 300 mA cm^-2 and an SPCE of 46.2% at a CO₂ flow rate of 2 standard cubic centimeters per minute are achieved in the acidic electrolyte, with enhanced stability compared to that under alkaline conditions. Computational modeling results reveal that the unique structure of Ag@C could regulate the diffusion process of OH^- and H⁺, confining a high-pH local reaction environment for the promoted activity. This work presents a promising route to engineer the microenvironment through the regulation of mass transport that permits the CO₂RR in acidic electrolytes with high performance.

Properties of Cosmic-Ray Sulfur and Determination of the Composition of Primary Cosmic-Ray Carbon, Neon, Magnesium, and Sulfur: Ten-Year Results from the Alpha Magnetic Spectrometer

We report the properties of primary cosmic-ray sulfur (S) in the rigidity range 2.15 GV to 3.0 TV based on 0.38×10^{6} sulfur nuclei collected by the Alpha Magnetic Spectrometer experiment (AMS). We observed that above 90 GV the rigidity dependence of the S flux is identical to the rigidity dependence of Ne-Mg-Si fluxes, which is different from the rigidity dependence of the He-C-O-Fe fluxes. We found that, similar to N, Na, and Al cosmic rays, over the entire rigidity range, the traditional primary cosmic rays S, Ne, Mg, and C all have sizeable secondary components, and the S, Ne, and Mg fluxes are well described by the weighted sum of the primary silicon flux and the secondary fluorine flux, and the C flux is well described by the weighted sum of the primary oxygen flux and the secondary boron flux. The primary and secondary contributions of the traditional primary cosmic-ray fluxes of C, Ne, Mg, and S (even Z elements) are distinctly different from the primary and secondary contributions of the N, Na, and Al (odd Z elements) fluxes. The abundance ratio at the source for S/Si is 0.167±0.006, for Ne/Si is 0.833±0.025, for Mg/Si is 0.994±0.029, and for C/O is 0.836±0.025. These values are determined independent of cosmic-ray propagation.

Concerted oxygen diffusion across heterogeneous oxide interfaces for intensified propane dehydrogenation

Propane dehydrogenation (PDH) is an industrial technology for direct propylene production which has received extensive attention in recent years. Nevertheless, existing non-oxidative dehydrogenation technologies still suffer from the thermodynamic equilibrium limitations and severe coking. Here, we develop the intensified propane dehydrogenation to propylene by the chemical looping engineering on nanoscale core-shell redox catalysts. The core-shell redox catalyst combines dehydrogenation catalyst and solid oxygen carrier at one particle, preferably compose of two to three atomic layer-type vanadia coating ceria nanodomains. The highest 93.5% propylene selectivity is obtained, sustaining 43.6% propylene yield under 300 long-term dehydrogenation-oxidation cycles, which outperforms an analog of industrially relevant K-CrO_x/Al₂O₃ catalysts and exhibits 45% energy savings in the scale-up of chemical looping scheme. Combining in situ spectroscopies, kinetics, and theoretical calculation, an intrinsically dynamic lattice oxygen "donator-acceptor" process is proposed that O^2- generated from the ceria oxygen carrier is boosted to diffuse and transfer to vanadia dehydrogenation sites via a concerted hopping pathway at the interface, stabilizing surface vanadia with moderate oxygen coverage at pseudo steady state for selective dehydrogenation without significant overoxidation or cracking.

Temporal Structures in Electron Spectra and Charge Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic electron fluxes in the rigidity interval from 1.00 to 41.9 GV based on 2.0×10^{8} electrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The electron fluxes exhibit variations on multiple timescales. Recurrent electron flux variations with periods of 27 days, 13.5 days, and 9 days are observed. We find that the electron fluxes show distinctly different time variations from the proton fluxes. Remarkably, a hysteresis between the electron flux and the proton flux is observed with a significance of greater than 6σ at rigidities below 8.5 GV. Furthermore, significant structures in the electron-proton hysteresis are observed corresponding to sharp structures in both fluxes. This continuous daily electron data provide unique input to the understanding of the charge sign dependence of cosmic rays over an 11-year solar cycle.

A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease

BACKGROUND & AIMS

Ischemia-reperfusion injury (IRI) has thus far been considered as an inevitable component of organ transplantation, compromising outcomes, and limiting organ availability. Ischemia-free organ transplantation is a novel approach designed to avoid IRI, with the potential to improve outcomes.

METHODS

In this randomized, controlled clinical trial, recipients of livers from donors after brain death were randomly assigned to receive either an ischemia-free or a 'conventional' transplant. Primary end point was the incidence of early allograft dysfunction. Secondary end points included complications related to graft IRI.

RESULTS

65 out of 68 randomized patients underwent transplants and were included in the analysis. 32 patients received ischemia-free liver transplantation (IFLT), and 33 received conventional liver transplantation (CLT). Early allograft dysfunction occurred in 2 (6%) randomized to IFLT and in 8 (24%) randomized to CLT (difference, -18%; 95% CI, -35% to -1%; P=.044). Post-reperfusion syndrome occurred in 3 (9%) randomized to IFLT and in 21 (64%) randomized to CLT (difference, -54%; 95% CI, -74% to -35%; P < .001). Non-anastomotic biliary strictures diagnosed with protocol magnetic resonance cholangiopancreatography at 12 months were observed in 2 recipients (8%) randomized to IFLT and in 9 recipients (36%) randomized to CLT (difference, -28%; 95% CI, -50% to -7%; P = .014). The comprehensive complication index at one year after transplantation was 30.48 (95% CI, 23.25-37.71) in the IFLT group vs 42.14 (95% CI, 35.01-49.26) in the CLT group (difference, -11.66; 95% CI, -21.81 to -1.51; P = .025).

CONCLUSIONS

Among patients with end-stage liver disease, IFLT, compared with conventional approach, significantly reduced complications related to ischemia reperfusion injury.

CLINICAL TRIAL REGISTRATION

Chictr.org. ChiCTR1900021158 IMPACT AND IMPLICATIONS: Ischemia reperfusion injury has thus far been considered as an inevitable event in organ transplantation, compromising outcomes and limiting organ availability. Ischemia-free liver transplantation is a novel approach of transplanting donor livers without interruption of blood supply. We showed that in patients with end-stage liver disease, ischemia-free liver transplantation, compared with conventional approach led to reduced complications related to ischemia reperfusion injury in this randomized trial. This new approach is expected to change the current practice in organ transplantation improving transplant outcomes, increasing organ utilization, while providing a clinical model to delineate the impact of organ injury on alloimmunity.

Coupling acid catalysis and selective oxidation over MoO3-Fe2O3 for chemical looping oxidative dehydrogenation of propane

Redox catalysts play a vital role in chemical looping oxidative dehydrogenation processes, which have recently been considered to be a promising prospect for propylene production. This work describes the coupling of surface acid catalysis and selective oxidation from lattice oxygen over MoO₃-Fe₂O₃ redox catalysts for promoted propylene production. Atomically dispersed Mo species over γ-Fe₂O₃ introduce effective acid sites for the promotion of propane conversion. In addition, Mo could also regulate the lattice oxygen activity, which makes the oxygen species from the reduction of γ-Fe₂O₃ to Fe₃O₄ contribute to selectively oxidative dehydrogenation instead of over-oxidation in pristine γ-Fe₂O₃. The enhanced surface acidity, coupled with proper lattice oxygen activity, leads to a higher surface reaction rate and moderate oxygen diffusion rate. Consequently, this coupling strategy achieves a robust performance with 49% of propane conversion and 90% of propylene selectivity for at least 300 redox cycles and ultimately demonstrates a potential design strategy for more advanced redox catalysts.

Gas-Dependent Active Sites on Cu/ZnO Clusters for CH3OH Synthesis

This study describes an instantaneously gas-induced dynamic transition of an industrial Cu/ZnO/Al₂O₃ catalyst. Cu/ZnO clusters become "alive" and lead to a promotion in reaction rate by almost one magnitude, in response to the variation of the reactant components. The promotional changes are functions of either CO₂-to-CO or H₂O-to-H₂ ratio which determines the oxygen chemical potential thus drives Cu/ZnO clusters to undergo reconstruction and allows the maximum formation of Cu-Zn²⁺ sites for CH₃OH synthesis.

Modulation of *CHxO Adsorption to Facilitate Electrocatalytic Reduction of CO2 to CH4 over Cu-Based Catalysts

Copper (Cu) can efficiently catalyze the electrochemical CO₂ reduction reaction (CO₂RR) to produce value-added fuels and chemicals, among which methane (CH₄) has drawn attention due to its high mass energy density. However, the linear scaling relationship between the adsorption energies of *CO and *CH_xO on Cu restricts the selectivity toward CH₄. Alloying a secondary metal in Cu provides a new freedom to break the linear scaling relationship, thus regulating the product distribution. This paper describes a controllable electrodeposition approach to alloying Cu with oxophilic metal (M) to steer the reaction pathway toward CH₄. The optimized La₅Cu₉₅ electrocatalyst exhibits a CH₄ Faradaic efficiency of 64.5%, with the partial current density of 193.5 mA cm^-2. The introduction of oxophilic La could lower the energy barrier for *CO hydrogenation to *CH_xO by strengthening the M-O bond, which would also promote the breakage of the C-O bond in *CH₃O for the formation of CH₄. This work provides a new avenue for the design of Cu-based electrocatalysts to achieve high selectivity in CO₂RR through the modulation of the adsorption behaviors of key intermediates.

High-Throughput Screening of Electrocatalysts for Nitrogen Reduction Reactions Accelerated by Interpretable Intrinsic Descriptor

Numerous activity descriptors have been developed to rationally design single-atom catalysts (SACs), such as energy-based or electronic descriptors. However, their computationally costly and experimentally unobtainable properties limit the understanding of the structure-activity relationship to a case-by-case basis. This paper describes a simple and interpretable descriptor directly related to activity, which can be not only easily obtained from the atomic databases, but also experimentally verified by X-ray absorption spectroscopy. The defined descriptor proves to accelerate high-throughput screening of more than 700 graphene-based SAC models without computations, universal for 3-5d transition metals and C/N/P/B/O-based coordination environments. Meanwhile, the analytical formula of this descriptor reveals the intrinsic relations of various crucial features in the complicated metal-ligand interaction, thus the structure-activity relationship is clarified at the molecular orbital level. Using electrochemical nitrogen reduction as an example, this descriptor's guidance role has been experimentally validated by 13 previous reports as well as our synthesized 4 SACs. Several other new advanced catalysts are also identified. Orderly combining machine learning with physical insights, this work provides a new generalized strategy for crossing the chasm between low-cost high-throughput screening and a comprehensive understanding of the structure-mechanism-activity relationship.

Nature of Catalytic Behavior of Cobalt Oxides for CO2 Hydrogenation

Cobalt oxide (CoO _x ) catalysts are widely applied in CO₂ hydrogenation but suffer from structural evolution during the reaction. This paper describes the complicated structure-performance relationship under reaction conditions. An iterative approach was employed to simulate the reduction process with the help of neural network potential-accelerated molecular dynamics. Based on the reduced models of catalysts, a combined theoretical and experimental study has discovered that CoO(111) provides active sites to break C-O bonds for CH₄ production. The analysis of the reaction mechanism indicated that the C-O bond scission of *CH₂O species plays a key role in producing CH₄. The nature of dissociating C-O bonds is attributed to the stabilization of *O atoms after C-O bond cleavage and the weakening of C-O bond strength by surface-transferred electrons. This work may offer a paradigm to explore the origin of performance over metal oxides in heterogeneous catalysis.

An integrated n-Si/BiVO4 photoelectrode with an interfacial bi-layer for unassisted solar water splitting

Integrated n-Si/BiVO4 is one of the most promising candidates for unbiased photoelectrochemical water splitting. However, a direct connection between n-Si and BiVO4 will not attain overall water splitting due to the small band offset as well as the interfacial defects at the n-Si/BiVO4 interface that severely impede carrier separation and transport, limiting the photovoltage generation. This paper describes the design and fabrication of an integrated n-Si/BiVO4 device with enhanced photovoltage extracted from the interfacial bi-layer for unassisted water splitting. An Al2O3/indium tin oxide (ITO) interfacial bi-layer was inserted at the n-Si/BiVO4 interface, which promotes the interfacial carrier transport by enlarging the band offset while healing interfacial defects. When coupled to a separate cathode for hydrogen evolution, spontaneous water splitting could be realized with this n-Si/Al2O3/ITO/BiVO4 tandem anode, with an average solar-to-hydrogen (STH) efficiency of 0.62% for over 1000 hours.

Scaling-Up of Thin-Film Photoelectrodes for Solar Water Splitting Based on Atomic Layer Deposition

Atomic layer deposition (ALD) is an established method to prepare protective layers for Si-based photoelectrodes for photoelectrochemical (PEC) water splitting. Although ALD has been widely used in microelectronics and photovoltaics, it remains a great challenge to design simple and effective ALD systems to deposit large and uniform protective films for Si-based photoelectrodes with industrial sizes. This paper describes the design and realization of a simple ALD chamber configuration for photoelectrodes with large sizes, in which the influence of a gas redistributor over the gas flow and heat transfer during film growth was revealed by computational fluid dynamics simulations and experimental investigations. A simple circular baffle-type redistributor was proposed to establish a uniform gas flow field throughout the ALD reactor, resulting in a uniform temperature profile. With this simple baffle redistributor, the large-area Al₂O₃ monitor film (46 nm thickness) reached a good nonuniformity (Nu %) of 0.88% over a large area of 256 cm². This design enables the fabrication of large-scale photocathodes from standard industrial-grade 166 mm Si(100) wafers (276 cm²) by depositing 50 nm TiO₂ protective films with Nu % less than 5%. The obtained photocathode achieves a saturation current of 6.45 A with a hydrogen production rate of 43.2 mL/min under outdoor illumination. This work elucidates how flow pattern and heat transfer may influence the deposition of protective layers over large photoelectrodes, providing guidance for future industrial applications of PEC water splitting.

Neural Network Accelerated Investigation of the Dynamic Structure-Performance Relations of Electrochemical CO2 Reduction over SnO x Surfaces

Heterogeneous catalysts, especially metal oxides, play a curial role in improving energy conversion efficiency and production of valuable chemicals. However, the surface structure at the atomic level and the nature of active sites are still ambiguous due to the dynamism of surface structure and difficulty in structure characterization under electrochemical conditions. This paper describes a strategy of the multiscale simulation to investigate the SnO _x reduction process and to build a structure-performance relation of SnO _x for CO₂ electroreduction. Employing high-dimensional neural network potential accelerated molecular dynamics and stochastic surface walking global optimization, coupled with density functional theory calculations, we propose that SnO₂ reduction is accompanied by surface reconstruction and charge density redistribution of active sites. A regulatory factor, the net charge, is identified to predict the adsorption capability for key intermediates on active sites. Systematic electronic analyses reveal the origin of the interaction between the adsorbates and the active sites. These findings uncover the quantitative correlation between electronic structure properties and the catalytic performance of SnO _x so that Sn sites with moderate charge could achieve the optimally catalytic performance of the CO₂ electroreduction to formate.

Hydrogen sulfide protects against ischemic heart failure by inhibiting RIP1/RIP3/MLKL-mediated necroptosis

The aim of the present study was to explore whether hydrogen sulfide (H2S) protects against ischemic heart failure (HF) by inhibiting the necroptosis pathway. Mice were randomized into Sham, myocardial infarction (MI), MI + propargylglycine (PAG) and MI + sodium hydrosulfide (NaHS) group, respectively. The MI model was induced by ligating the left anterior descending coronary artery. PAG was intraperitoneally administered at a dose of 50 mg/kg/day for 4 weeks, and NaHS at a dose of 4mg/kg/day for the same period. At 4 weeks after MI, the following were observed: A significant decrease in the cardiac function, as evidenced by a decline in ejection fraction (EF) and fractional shortening (FS); an increase in plasma myocardial injury markers, such as creatine kinase-MB (CK-MB) and cardiac troponin I (cTNI); an increase in myocardial collagen content in the heart tissues; and a decrease of H2S level in plasma and heart tissues. Furthermore, the expression levels of necroptosis-related markers such as receptor interacting protein kinase 1 (RIP1), RIP3 and mixed lineage kinase domain-like protein (MLKL) were upregulated after MI. NaHS treatment increased H2S levels in plasma and heart tissues, preserving the cardiac function by increasing EF and FS, decreasing plasma CK-MB and cTNI and reducing collagen content. Additionally, NaHS treatment significantly downregulated the RIP1/RIP3/MLKL pathway. While, PAG treatment aggravated cardiac function by activated the RIP1/RIP3/MLKL pathway. Overall, the present study concluded that H2S protected against ischemic HF by inhibiting RIP1/RIP3/MLKL-mediated necroptosis which could be a potential target treatment for ischemic HF.

Revealing the Mechanism of sp-N Doping in Graphdiyne for Developing Site-Defined Metal-Free Catalysts

Due to the limited reserves of metals, scientists are devoted to exploring high-performance metal-free catalysts based on carbon materials to solve environment-related issues. Doping would build up inhomogeneous charge distribution on surface, which is an efficient approach for boosting the catalytic performance. However, doping sites are difficult to control in traditional carbon materials, thus hindering their development. Taking the advantage of unique sp-C in graphdiyne (GDY), a new N doping configuration of sp-hybridized nitrogen (sp-N), bringing a Pt-comparable catalytic activity in oxygen reduction reaction is site-defined introduced. However, the reaction intermediate of this process is never captured, hindering the understanding of the mechanism and the precise synthesis of metal-free catalysts. After the four-year study, the fabrication of intermediate-like molecule is realized, and finally sp-N doped GDY via the pericyclic reaction is obtained. Compared with GDY doped with other N configurations, the designed sp-N GDY shows much higher catalytic activity in electroreduction of CO₂ toward CH₄ production, owing to the unique electronic structure introduced by sp-N, which is more favorable in stabilizing the intermediate. Thus, besides opening the black-box for the site-defined doping, this work reveals the relationship between doping configuration and products of CO₂ reduction.

Association between immune checkpoint inhibitors and vascular endothelial growth factor targeted therapy with cardiovascular events

Background

The use of immune checkpoint inhibitors (ICI) has been associated with a 3-fold higher risk for cardiovascular events as compared to cancer patients who did not receive ICI. Therapies targeting vascular endothelial growth factor (VEGF) have also been associated with a wide range of cardiovascular events. The combination use of ICIs and VEGF inhibitors is currently approved as a treatment for patients with renal-cell carcinoma, hepatocellular carcinoma, non-small cell lung cancer, and endometrial cancer. Data are lacking whether the combination of ICIs and VEGF-targeted therapy is associated with an additional increase in cardiovascular events.

Purpose

To evaluate whether the combination use of ICI and VEGF targeted therapies are associated with a higher risk of cardiovascular events as compared to ICI therapy alone, we performed a retrospective matched case-control study.

Methods

Cases received both ICI and VEGF-targeted therapy (n=157), and control patients (n=157) only received ICI therapy. The primary outcome was a composite of cardiovascular events (myocardial infarction, coronary revascularization, ischemic stroke, deep venous thrombosis, and pulmonary embolism). Patients were censored at time of first event or at last date of follow up. Cox proportional hazard regression analysis was performed to calculate hazard ratio (HR) with 95% confidence interval (CI), counting only the first cardiovascular event.

Results

Baseline characteristics for the cases and controls are shown in Table 1. Overall cases (combination ICI and VEGF inhibitor) and controls (ICI alone) were not different with respect to age, type of cancer, and a prior history of any cardiovascular event. Cases received more ICI cycles as compared to controls (median of 7 [4–17] cycles vs. 4 [2–10] cycles, P&lt;0.001). Cases also had a longer follow-up time (334 [127–663] days vs. 201 [60–564] days, P=0.008) as compared to the control group. As compared to ICI alone, a similar risk for a composite cardiovascular event was observed in those who received both ICI and VEGF-targeted therapy (HR, 0.70 [95% CI, 0.39–1.25]; P=0.23, Table 1). In total, 21/157 patients had a composite cardiovascular event among the cases, who received the combination of ICI and VEGF inhibitor (9 DVT, one MI, 9 PE, two ischemic strokes) as compared to 25/157 among the controls, who received ICI alone (14 DVT, 3 MI, 7 PE, one ischemic stroke). The median time to event was not different between the two groups (126 [98–260] days vs. 145 [28–205] days, P=0.47).

Conclusion

We found that among 157 patients who received a combination of ICI and VEGF-targeted therapy and 157 matched control patients who only received ICI therapy, the risk for cardiovascular events was not different between the two groups.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding.

Trajectory of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction and association with cardiac structure and function

Background

The PARADISE-MI trial examined the efficacy of sacubitril/valsartan in patients with acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. Little is known about the trajectory and echocardiographic correlates of pulmonary congestion in this population.

Purpose

We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a subset of patients enrolled in PARADISE- MI.

Methods

Participants underwent 8-zone LUS at baseline and 8 months. B-lines were quantified offline, blinded to treatment group, clinical findings, timepoint and outcomes by a core laboratory. Paired t-tests, chi-squared tests, and linear regression analyses were conducted.

Results

Among 152 patients (median age 65 years, 32% women, 35% obese, mean LVEF 41%), any B-lines were detectable in 87%, the median sum of B-lines in 8 zones was 4 [IQR 2–8], and 67% had ≥3 B-lines indicative of congestion. Greater number of B-lines at baseline was associated with larger left atrial (LA) size, higher E/e' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular (RV) systolic function, and higher tricuspid regurgitation velocity (P trend &lt;0.05 for all) (Figure 1). Among 115 patients with 8-month LUS data, there was a significant decline in number of B-lines from baseline (mean ± SD: −1.6±7.3; p=0.018). Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in a patient who experienced an intercurrent heart failure (HF) event than a non-HF patient (p=0.001). Among 75 patients with ≥3 B-lines at baseline, a decrease in B-lines to &lt;3, indicating decongestion, occurred in 37% and was similar in the sacubitril/valsartan and ramipril groups (36% vs. 39%, p=0.83).

Conclusions

In this post-AMI cohort, sonographic B-lines, indicating pulmonary congestion, were common at baseline and were significantly higher at follow-up in those who developed HF. Worse pulmonary congestion at baseline was associated with prognostically important echocardiographic markers of LV filling pressure, pulmonary pressure, and RV function.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Novartis