Photo-enhanced oxidation of arsenite by biochar: The effect of pH, kinetics and mechanisms

The persistent and photo-induced free radicals of biochar play significant roles in the transformation or degradation of inorganic and organic pollutants. However, the redox capacity of biochar for arsenite (As(III)) photochemistry under different pH conditions remains unclear. In this study, we discovered that solar radiation primarily expedited the oxidation of As(III) by biochar by augmenting the production of reactive oxygen species (ROS). Biochar demonstrated a strong pH reliance on the photooxidation of As(III). Under acidic and neutral conditions, solar radiation amplified the generation of •OH (hydroxyl radicals) by BC-P (phenolic -OH of biochar) and semiquinone-type BC-PFRs (persistent free radicals of biochar) by 4.9 and 2.0 times, respectively, resulting in enhanced As(III) oxidation. Under alkaline conditions, BC-P and BC-Q (quinoid CO of biochar) facilitated the production of H2O2 (hydrogen peroxide) by 2.1 times through the spontaneous formation of semiquinone-type BC-PFRs via an anti-disproportionation reaction, promoting approximately 88.2% of As(III) photooxidation. Furthermore, solar radiation elevated around 11.8% As(III) oxidation driven by BC-Q and semiquinone-type BC-PFRs. This study provides a crucial theoretical foundation for using biochar to treat arsenic pollution in aquatic systems and understanding the migration and transformation of arsenic in different environments.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

[Survival analysis of malignant tumors in cancer registration areas of Hubei province in China, 2013 to 2015]

Objective: To analyze the survival of newly diagnosed malignant tumors in cancer registration areas of Hubei Province from 2013 to 2015. Methods: From January 1, 2013 to December 31, 2015, all newly diagnosed malignant tumors were collected from cancer registration areas in Hubei Province, and patients were followed up using a combination of active and passive methods. Cancer survival was analyzed using the strs package in Stata software. Observed and expected survival were calculated using the life table and Ederer Ⅱ methods, and the difference in survival rate of patients with different sex, age, urban and rural areas and different cancer species was compared. Results: From 2013 to 2015, 83 987 new malignant tumors were diagnosed in cancer registration areas in Hubei Province, including 45 742 males (54.46%) and 38245 females (45.54%). The overall 5-year relative survival rate was 41.46%, 34.43% for men and 49.63% for women. With the increase of age, the observed survival rate and relative survival rate of patients of different genders showed a decreasing trend. The 5-year relative survival rate of patients with malignant tumors was 47.58% in urban areas and 26.58% in rural areas. The observed survival rate and relative survival rate in rural areas were significantly lower than those in urban areas. The overall 5-year relative survival rates for common malignancies were 20.61% for lung cancer, 15.36% for liver cancer, 22.89% for esophageal cancer, 34.92% for gastric cancer, and 54.87% for colorectal cancer. In addition, the 5-year relative survival rates of common malignant tumors in women were 78.65% for breast cancer and 52.55% for cervical cancer. Conclusions: In Hubei Province, the survival rate of malignant tumors is different among different genders, regions, age groups and cancer species. Prevention and treatment and health education should be strengthened for malignant tumor patients in rural areas and those with high incidence and low survival rate such as liver cancer and lung cancer, and relevant strategies should be formulated according to the gender and age distribution characteristics of different cancer species.

High performance polymeric aluminum silicate sulfate (PASS) flocculant from abandoned molecular sieve

PASS is an innovative inorganic polymer flocculant (IPF), which possesses the advantages of a polysilicate/aluminum sulfate-based flocculant. Recently, solid wastes rich in Si and Al, such as kaolinite, rice husks, and abandoned molecular sieves (AMS) have been recognized as promising raw materials for the synthesis of flocculants. The present study involved the synthesis of PASS flocculant derived from AMS. The efficacy of the as-prepared PASS was evaluated through the flocculation of wastewater containing ultramarine blue (UB) pigment. The optimal flocculation performance of PASS was observed at a Si/Al molar ratio of 1.62 and a polymerization time of 9 h. Furthermore, we investigated the impact of PASS dosage, stirring/settling time, and pH on the flocculation process while also exploring potential mechanisms. The PASS flocculant prepared in this study exhibited superior performance compared to the commercially available polyaluminum sulfate (PAS). The results demonstrated the viability of preparing PASS flocculants from waste resources.

Nano-sized aggregate Ti3C2-TiO2 supported on the surface of Ag2NCN as a Z-scheme catalyst with enhanced visible light photocatalytic performance

Exposing the photocatalyst's highly active facets and hybridizing the photocatalyst with suitable cocatalysts in the proper spot have been recognized as strong methods for high-performance photocatalysts. Herein, Ag2NCN/TiO2-Ti3C2 composites were synthesized by applying simple calcination and physically weak interaction deposition processes to obtain an excellent photocatalyst for Rhodamine B (Rh B) degradation when exposed to visible light. The findings from the experiments reveal that the Ag2NCN/TiO2-Ti3C2400 composite exhibited an outstanding photocatalytic rate in 80 min, with the highest Rh B degradation rate (k = 0.03889 min-1), which was 16 times higher than that of pure Ag2NCN (k = 0.00235 min-1) and 2.2 times higher than that of TiO2-Ti3C2400 (k = 0.01761 min-1). The results from the following factors: (i) the powerful interfacial contact created by the in situ formation of TiO2, and the superior electrical conductivity of Ti3C2 that makes carrier separation possible; (ii) TiO2 with electron-rich (101) facets are deposited on the surface of Ag2NCN, significantly reducing charge carrier recombination by trapping photoelectrons; (iii) a Z-type heterojunction is constructed between nanosize aggregate Ti3C2-TiO2 and Ag2NCN with non-metal Ti3C2 as the solid medium, improving the transfer and separation of photogenerated charges and inhibiting the recombination of electrons and holes. Additionally, the redox ability of the composite photocatalyst is enhanced. Furthermore, the analyses of active species showed that photogenerated superoxide radicals and holes were the principal active agents inside the photodegradation of Rh B. Moreover, the composite exhibited outstanding photo-stability.

Ag2NCN anchored on Ti3C2Tx MXene as a Schottky heterojunction: enhanced visible light photocatalytic efficiency of rhodamine B degradation

The quick charge recombination of light-generated electrons and holes severely restricts the photocatalytic applications of single semiconductors. Here, a straightforward electrostatically driven self-assembly technique was used to construct an Ag₂NCN/Ti₃C₂T_x Schottky heterojunction, which was then used to degrade Rhodamine B (RhB) in the illumination of visible light. The findings from the experiments revealed that as a cocatalyst, Ti₃C₂T_x significantly suppresses the recombination rate and broadens visible absorptivity to improve Ag₂NCN photocatalytic efficiency. The optimized Ag₂NCN/Ti₃C₂T_x (AT2) composite exhibited an outstanding photocatalytic rate in 96 min, with the highest RhB degradation rate (k = 0.029 min^-1), which was around fifteen times that of pure Ag₂NCN (k = 0.002 min^-1). Furthermore, the trapping-agent experiment showed photogenerated superoxide radicals and holes were the principal active agents inside the photodegradation of RhB. Compared with Ag-based semiconductors, the composite exhibited outstanding photostability, highlighting its excellent potential for application in visible-light photocatalysis.

Multiaperture g-C3N4@SiO2 to activate peroxydisulfate via visible light for efficient Rhodamine B removal

The sulfate radical-based advanced oxidation process (SR-AOPs) has been verified as a promising method to handle the persistent organic compounds in water using peroxydisulfate (PDS) as oxidant. A Fenton-like process was constructed and showed great potential to remove organic pollutants using visible-light-assisted PDS activation. The g-C₃N₄@SiO₂ was synthesized via thermo-polymerization, and characterized using powder X-ray diffraction (XRD), scanning electron microscope equipped with an energy-dispersive X-ray (SEM-EDX), X-ray photoelectron spectroscopy (XPS), N₂ adsorption-desorption, Brunauer-Emmett-Teller (BET) and Barrett-Joyner-Halenda (BJH) method, photoluminescence (PL), transient photocurrent, and electrochemical impedance. Photocatalytic performance was demonstrated using the removal rate of Rhodamine B (RhB), and 96.08% RhB was removed from the solution within 50 min (10 mg/L in 200 mL, g-C₃N₄@SiO₂ = 0.25 g/L, pH = 6.3, PDS = 1 mmol/L). The free radical capture experiment proved that HO^•, h⁺, [Formula: see text] and [Formula: see text] were generated and removed RhB. The cyclic stability of g-C₃N₄@SiO₂ has also been studied, and the result shows no noticeable difference in the six cycles. The system of visible-light-assisted PDS activation might provide a novel strategy for wastewater treatment and must be an environment-friendly catalyst.

[Clinical and genetics characteristics of adult-onset cerebrotendinous xanthomatosis: analysis of a Chinese pedigree]

Objective: Clinical manifestations, imaging findings, pathologic features, and genetic mutations of Chinese adult patients with cerebrotendinous xanthomatosis (CTX) were analyzed in order to achieve a greater understanding of CTX that can improve early detection, diagnosis, and treatment. Methods: Clinical data including medical history, neurologic and auxiliary examinations, imaging findings, and genetic profile were collected for an adult patient with CTX admitted to the Sixth Medical Center of Chinese People's Liberation Army General Hospital in August 2020. Additionally, a systematic review of genetically diagnosed Chinese adult CTX cases reported in major databases in China and other countries was performed and age of onset, first symptoms, common signs and symptoms, pathologic findings, imaging changes, and gene mutations were analyzed. Results: The proband was a 39-year-old female with extensive, early-onset nervous system manifestations including cognitive dysfunction and ataxia. Systemic lesions included juvenile cataract and a tendon mass. Cranial magnetic resonance imaging revealed cerebral atrophy, symmetric white matter changes predominantly in the pyramidal tract, and lesions in the cerebellar dentate nucleus. A novel homozygous mutation in the sterol-27-hydroxylase (CYP27A1) gene (c.1477-2A>C) was identified. There were no family members with similar clinical presentation although some were carriers of the c.1477-2A>C mutation. The patient showed a good response to deoxycholic acid treatment. Totally there were 56 cases of adult CTX patients in China, mostly in East China (31/56, 55.4%), at a male-to-female ratio of 1.8 to 1. Multiple organs and tissues including nervous system, tendon, lens, lung, and skeletal muscle were affected in these cases. The most common neurologic manifestations were cognitive dysfunction (44/52, 84.6%) and ataxia (44/51, 86.3%). The cases were characterized by early onset, chronic progressive damage of multiple systems, long disease course, and delayed diagnosis, making the disease difficult to manage clinically and resulting in poor prognosis. The 2 most common genetic mutations in Chinese adult CTX patients were c.1263+1G>A and c.379C>T. Exon 2 of the CYP27A1 gene was identified as a mutation hot spot. Conclusions: Chinese adult patients with CTX have complex clinical characteristics, a long diagnostic cycle, and various CYP27A1 gene mutations. Early diagnosis and intervention can improve the prognosis of these patients.

Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study

PURPOSE

Growth hormone-secreting pituitary adenomas (GH-PAs) with a low Knosp grade are typically associated with a good postoperative biochemical remission (BR) rate. However, a proportion of patients do not achieve remission. In this study, we aimed to investigate predictive factors of postoperative remission for lower Knosp GH-PAs.

METHODS

In this retrospective study, we enrolled 140 patients who were diagnosed with lower Knosp (0-2) GH-PAs and received trans-sphenoidal surgery between December 2016 and June 2021 from the largest pituitary tumor surgery center in southern China. The univariate, binary Logistic regression, and receiver operating characteristic curve (ROC) analyses were employed to determine independent predictors and cutoff values of remission. The postoperative outcome was defined as remission using the 2010 consensus criteria of acromegaly.

RESULTS

One hundred and thirty six patients (97.1%) achieved gross total resection. The postoperative long-term BR was 68.6%. Empty sella, tumor maximum diameter and postoperative GH levels were independent factors predicting remission. ROC revealed that postoperative 24 h GH ≤ 1.3 ng/mL and  ≤ 1.23 ng/mL were valuable predictors for 3-month and long-term remission respectively, and that postoperative 3-month GH ≤ 1.6 ng/mL and tumor maximum diameter  ≤ 17 mm were predictors for delayed remission.

CONCLUSION

Early postoperative GH levels can be used as predictors of remission. However, BR was not associated with preoperative somatostatin analogs therapy or Knosp grade (0-2). For patients without residual tumor or recurrence and whose GH levels are slightly elevated within 1 year after surgery, adjuvant treatments may not be necessary.

Effects of different dietary protein levels on intestinal aquaporins in weaned piglets

This study was conducted to investigate the relationship between changes in intestinal aquaporins (AQPs) in piglets fed diets with different protein levels and nutritional diarrhoea in piglets. Briefly, 96 weaned piglets were randomly divided into four groups fed diets with crude protein (CP) levels of 18%, 20%, 22% and 24%. The small intestines and colons of the weaned piglets were collected, and several experiments were conducted. In the small intestine, AQP4 protein expression was higher in weaned piglets fed the higher-CP diets (22% and 24% CP) than in those fed the 20% CP diet except at 72 h (p < 0.01). At 72 h, the AQP4 protein expression in the small intestine was lower in the 18% group than in the other three groups (p < 0.01). Under 20% CP feeding, AQP2, AQP4 and AQP9 protein expression in the colons of piglets peaked at certain time points. The AQP2 and AQP4 mRNA levels in the colon and the AQP4 and AQP4 mRNA levels in the distal colon were approximately consistent with the protein expression levels. However, the AQP9 mRNA content in the colon was highest in the 18% group, and the AQP2 mRNA content in the distal colon was significantly higher in the 24% group than in the 20% group. AQP2 and AQP4 were expressed mainly around columnar cells in the upper part of the smooth colonic intestinal villi, and AQP9 was expressed mainly on columnar cells and goblet cells in the colonic mucosa. In conclusion, 20% CP is beneficial to the normal expression of AQP4 in the small intestine, AQP2, AQP4 and AQP9 in the colon of weaned piglets, which in turn maintains the balance of intestinal water absorption and secretion in piglets.

[Evaluation of clinical safety and diagnostic efficacy of domestic liver-specific magnetic resonance contrast agent (gadoxetate disodium)]

Objective: To evaluate the clinical safety and diagnostic efficacy of domestic gadoxetate disodium (GdEOBDTPA). Methods: The imaging data from patients with space-occupying liver lesions who underwent GdEOBDTPA enhanced magnetic resonance examination at West China Hospital of Sichuan University between January 2020 and September 2020 were analyzed retrospectively. Clinical indicators were evaluated by the incidental condition of transient severe respiratory motion artifacts (TSM) in the arterial phase to assess the safety profile.The differences in quantitative and qualitative indicators for the risk factors of TSM in the arterial phase between the TSM group and the non-TSM group were compared by t-test and χ2 test. Observational indicators of the accuracy of diagnostic procedures: The 2018 version of the Liver Imaging Reporting and Data System (LI-RADS) was used to evaluate the main signs, auxiliary signs, and LR grades of lesions. Postoperative pathological findings were used as the gold standard for evaluating and diagnosing hepatocellular carcinoma (HCC). Simultaneously, the relative enhancement degree of the liver, the contrast between the lesion and the liver, and the cholangiography in the hepatobiliary phase were evaluated. The McNemar test was used to compare the differences in the diagnostic efficiency of physician 1 and physician 2 in the diagnosis of hepatocellular carcinoma according to the 2018 version of LI-RADS. Results: A total of 114 cases were included in this study. The incidence rate of TSM was 9.6% (11/114). Age [(53.8 ± 11.3) years vs. (55.4 ± 15.4) years, t = 0.465, P = 0.497], body weight [(65.8 ± 11.1) kg vs. (60.8 ± 7.6) kg, t = 1.468, P = 0.228], body mass index [(23.9 ± 3.1) kg/m(2) vs. (23.4 ± 3.0) kg/m(2), t = 0.171, P = 0.680], liver cirrhosis ratio (39 cases vs. 4 cases, χ (2) =1.776, P = 0.183), proportion of mild to moderate pleural effusion (32 cases vs. 4 cases, χ (2) = 0.000, P = 0.986), and proportion of mild to moderate ascites (47 cases vs. 5 cases χ (2) = 0.000, P = 0.991) had no statistically significant difference between the groups of non-TSM and TSM patients. According to the 2018 version of LI-RADS for the LR5 category, there was no statistically significant difference between the two physicians' HCC diagnoses in terms of sensitivity (91.4% vs.86.4%, χ (2) = 1.500, P = 0.219), specificity (72.7 % vs. 69.7%, χ (2) = 0.000, P = 1.000), positive predictive value (89.2% vs. 87.5%, χ (2) = 2.250, P = 0.125), negative predictive value (77.4% vs. 67.6%, χ (2) = 2.250, P = 0.125), and accuracy (86.0% vs. 81.6%, χ (2) = 0.131, P = 0.125). According to physicians 1 and 2 film review results, 91.2% (104/114) and 89.5% (102/114) of the contrast agent were discharged into the common bile duct or duodenum, respectively. In addition, 86.0% (98/114) of the patients had good liver enhancement, and 91.2% (104/114) of the lesions showed low signals relative to the liver background. Conclusion: Domestic gadoxetate disodium has a good clinical safety profile and diagnostic efficacy.

Photocatalysis coupled with adsorption of AC@Ni0.5Cu0.5Fe2O4 in peroxydisulfate assisted system efficiently enhance ciprofloxacin removal

Nickle-copper ferrite (Ni_0.5Cu_0.5Fe₂O₄) supported on activated carbon (AC) (AC@Ni_0.5Cu_0.5Fe₂O₄) was synthesized and used as adsorbent, photocatalyst, and activator of peroxydisulfate (PDS) to realize the removal of ciprofloxacin (CIP). AC@Ni_0.5Cu_0.5Fe₂O₄ properties were characterized by scanning electron microscope equipped with energy-dispersive X-ray (SEM-EDX), X-ray diffraction (XRD), N₂ adsorption-desorption isotherm plot of Brunauer-Emmett-Teller (BET) and Barrett-Joyner-Halenda (BJH), vibrating sample magnetometer (VSM). A rapid removal rate (94.30%) of CIP was achieved on AC@Ni_0.5Cu_0.5Fe₂O₄/PDS/UV system with the condition of catalyst dosage 0.30 g/L, initial pH 7.3, PDS addition 0.20 mM, CIP concentration 10 mg/L (200 mL), UV 28 W, in 30 min. Free radical quenching experiments indicate that reactive species of superoxide (·O₂^-), holes (h⁺), sulfate radicals (SO₄^-·) and hydroxyl radicals (·OH) were produced and all worked. The reusability test demonstrated that AC@Ni_0.5Cu_0.5Fe₂O₄ could be recycled five times with minimal performance reduction for the removal of CIP. The XRD and SEM of the after used AC@Ni_0.5Cu_0.5Fe₂O₄ did not change significantly, which further showed its stability and recyclability. This work might provide new insight into the application of AC@Ni_0.5Cu_0.5Fe₂O₄ in photocatalysis coupled with adsorption in peroxydisulfate assisted system and has high potential in CIP removal.

Saturn Anomalous Myriametric Radiation, a New Type of Saturn Radio Emission Revealed by Cassini

A new radio component namely Saturn Anomalous Myriametric Radiation (SAM) is reported. A total of 193 SAM events have been identified by using all the Cassini Saturn orbital data. SAM emissions are L-O mode radio emission and occasionally accompanied by a first harmonic in R-X mode. SAM's intensities decrease with increasing distance from Saturn, suggesting a source near Saturn. SAM has a typical central frequency near 13 kHz, a bandwidth greater than 8 kHz and usually drifts in frequency over time. SAM's duration can extend to near 11 hr and even longer. These features distinguish SAM from the regular narrowband emissions observed in the nearby frequency range, hence the name anomalous. The high occurrence rate of SAM after low frequency extensions of Saturn Kilometric Radiation and the SAM cases observed during compressions of Saturn's magnetosphere suggest a special connection to solar wind dynamics and magnetospheric conditions at Saturn.

Toripalimab (anti-PD-1) versus High-Dose Interferon-α2b as Adjuvant Therapy in Resected Mucosal Melanoma: A Phase II Randomized Trial

BACKGROUND

No standard of care for mucosal melanoma (MM) in the adjuvant setting has been established. Meanwhile, relapse-free survival (RFS) is only about five months after surgery alone. This phase II trial aimed to compare toripalimab vs. high-dose interferon-α2b (HDI) as an adjuvant therapy for resected MM.

PATIENTS AND METHODS

From July 2017 to May 2019, 145 patients with resected MM were randomized (1:1) to receive HDI (N = 72) or toripalimab (N = 73) for one year until disease relapse/distant metastasis, unacceptable toxicity, or withdrawal of consent. The primary endpoint was RFS. The secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), and safety.

RESULTS

After a median follow-up of 26.3 months, the numbers of RFS, OS, and DMFS events were 51 vs. 46, 33 vs. 29, and 49 vs. 44 in the toripalimab arm and the HDI arm, respectively. The median RFS were 13.6 (95%CI: 8.31-19.02) months and 13.9 (95%CI: 8.28-19.61) months in the toripalimab arm and HDI arm, respectively. The DMFS was not significantly different between the two arms (HR: 1.00, 95%CI: 0.65-1.54). The median OS was 35.1 months (95%CI: 27.93-NR) in the toripalimab arm, with no significant difference in all-cause death (HR: 1.11, 95% CI: 0.66-1.84) for the two arms. The median sums of the patients' actual infusion doses were 3672 mg and 1054.5 MIU in the toripalimab arm and HDI arm, respectively. The incidence of treatment-emergent adverse events with a grade ≥ 3 was much higher in the HDI arm than in the toripalimab arm (87.5% vs. 27.4%).

CONCLUSION

Toripalimab showed a similar RFS and a more favorable safety profile than HDI, both better than historical data, suggesting that toripalimab might be the better treatment option. However, additional translational studies and better treatment regimens are still warranted to improve the clinical outcome of MM.

[Morvan syndrome with positive anti LGI1/CASPR2 antibodies in serum/cerebrospinal fluid:a case report and literature review]

To report a typical case of Morvan syndrome with positive anti-leucine rich glioma-inactivated 1(LGI1) and contactin-associated protein 2 (CASPR2) antibodies in serum and cerebrospinal fluid. A 39-years-old female initially presented weakness of extremeties. The main symptoms included paroxysmal limb pain, wheezing, itching, muscle twitching, epilepsy, hypomnesia, dysphoria, apathy, intractable insomnia, salivation and sweating. Tests of electrolytes found hypokalemia (2.7-3.1 mmol/L) and hyponatremia (130-136 mmol/L). Arterial blood gas analysis showed hypoxemia (oxygen saturation 50%-70%). Total thyroxine (TT4) was elevated to 207 nmol/L with positive thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab). LGI1and CASPR2 antibodies (CBA method) were positive in both serum and cerebrospinal fluid, and the remaining antibodies related to autoimmune encephalitis and paraneoplastic syndrome were negative. Head MRI was almost normal, while mild abnormalities were found in electroencephalogram. Electromyography showed slightly increased voltage of left quadriceps motor unit potential. After treated with corticosteroids, IVIG and mycophenolate mofetil, the patient completely improved. Cognitive function scores recovered from MoCA/MMSE (16/24) to MoCA/MMSE (26/29). Positivity of LGI1/CASPR2 antibodies both in serum/cerebrospinal fluid are rarely seen in patients with Morvan syndrome. Steroids and immunosuppressants are suggested for treatment as early as possible.

A novel method for in situ stabilization of calcium arsenic residues via yukonite formation

Stabilizing the hazardous calcium arsenic residues (CAR) and monitoring the subsequent fate of arsenic (As) are critical to reduce its risk to the environment. In this work, a novel in situ method has been proposed to stabilize CAR by adding Fe^III solution and subsequent formation of the secondary mineral (yukonite). The experiments were conducted at pH 6-9 with different Fe/As molar ratios (0.28-0.66) and the solid phases were characterized by using X-ray diffraction and scanning/transmission electron microscopy. Results showed that the stability of the CAR was significantly increased after the addition of Fe^III solution, indicating good fixation effectiveness. The dissolved As concentration in the treated CAR samples continuously decreased to <5 mg/L after 490 days of treatment at Fe/As molar ratio ≥ 0.54 and pH ≥ 8, with the leached As concentration lower than 5 mg/L (US EPA standard) for most of the treated CAR in the TCLP and HVM tests. The formation of yukonite under different experimental conditions is closely related to the enhanced stability of the treated CAR. This work provides a novel in situ method to treat CAR which might have potential for future industrial applications.

Effects of dietary protein level on small intestinal morphology, occludin protein, and bacterial diversity in weaned piglets

Due to the physiological characteristics of piglets, the morphological structure and function of the small intestinal mucosa change after weaning, which easily leads to diarrhea in piglets. The aim of this study was to investigate effects of crude protein (CP) levels on small intestinal morphology, occludin protein expression, and intestinal bacteria diversity in weaned piglets. Ninety‐six weaned piglets (25 days of age) were randomly divided into four groups and fed diets containing 18%, 20%, 22%, and 24% protein. At 6, 24, 48, 72, and 96 h, changes in mucosal morphological structure, occludin mRNA, and protein expression and in the localization of occludin in jejunal and ileal tissues were evaluated. At 6, 24, and 72 h, changes in bacterial diversity and number of the ileal and colonic contents were analyzed. Results showed that structures of the jejunum and the ileum of piglets in the 20% CP group were intact. The expression of occludin mRNA and protein in the small intestine of piglets in the 20% CP group were significantly higher than those in the other groups. As the CP level increased, the number of pathogens, such as Clostridium difficile and Escherichia coli, in the intestine increased, while the number of beneficial bacteria, such as Lactobacillus, Bifidobacterium, and Roseburia, decreased. It is concluded that maintaining the CP level at 20% is beneficial to maintaining the small intestinal mucosal barrier and its absorption function, reducing the occurrence of diarrhea, and facilitating the growth and development of piglets.

Enhanced photothermoelectric detection in Co:BiCuSeO crystals with tunable Seebeck effect

BiCuSeO is a widely-used thermoelectric material recently proved to be an appealing candidate for broadband photothermoelectric (PTE) detection. Developing a simple and scalable route for advancing PTE properties is therefore essential to explore the full potential of BiCuSeO. Here we systematically demonstrated that Co³⁺ atomic doping strategies in BiCuSeO single crystals (Co concentration of 1%, 2% and 4%) could modulate the Seebeck coefficient and thus strongly improve the performance of BiCuSeO PTE photodetectors across visible to infrared spectral regions. Benefiting from these strategies, a large enhancement on photovoltage responsivity is achieved and the response time of a 4% Co:BiCuSeO PTE photodetector is one order of magnitude faster than those in most of PTE photodetectors. Also, Co:BiCuSeO PTE photodetectors show good stability with changeless photoresponse after being exposed to air for three months. Therefore, the controllable atomic doping of BiCuSeO with tunable PTE properties as well as fast and broadband photodetection provides the feasibility for facilitating ongoing research toward PTE devices.

Observation of surface precipitation of ferric molybdate on ferrihydrite: Implication for the mobility and fate of molybdate in natural and hydrometallurgical environments

Adsorption of molybdate (Mo(VI)) on the surfaces of ferrihydrite is one of the most critical processes that control its mobility and fate in the environment. However, the sorption mechanism and the effect of pH on the speciation of Mo(VI) on ferrihydrite surfaces are not well understood. In this study, X-ray diffraction (XRD), Raman, Fourier transform infrared (FTIR), and Mo K-edge and L₃-edge X-ray absorption spectroscopy (XAS) have been utilized to characterize the Mo(VI) species sorbed on ferrihydrite under various pH conditions. XRD, Raman, and FTIR results show that at acidic pH, surface precipitation of poorly crystalline ferric molybdate (PCFM) occurs under apparently undersaturated conditions (theoretical log IAP < log K_sp) and is enhanced by the aging process, whereas Mo(VI) is mainly present as surface adsorbed species at circum-neutral pH. The Mo K-edge and L₃-edge X-ray absorption near edge structure (XANES) analyses show that a mixture of tetrahedrally and octahedrally coordinated Mo(VI) simultaneously exists at pH 3-7 and the octahedral Mo(VI) species decreases with increasing pH. The Mo-Fe interatomic distances (3.52-3.56 Å) derived from EXAFS fittings suggest the corner-sharing complexation of both MoO₄ and MoO₆ with FeO₆ octahedra. As the pH decreases from 7 to 3, the coordination number of the Mo-Fe shell (CN_Mo-Fe) increases from 0.6(3) to 1.9(3), possibly due to the gradual transformation of surface adsorbed Mo(VI) to PCFM. These findings on the observation of Mo(VI) complexation, surface precipitation, and their marked pH dependence during the Mo(VI) adsorption on ferrihydrite have important implications for both understanding the mobility and fate of Mo(VI) in natural and hydrometallurgical industry impacted environments and developing optimal applications for the remediation of Mo contamination in aqueous environments.

Insight into the performance and mechanism of magnetic Ni0.5Cu0.5Fe2O4 in activating peroxydisulfate for ciprofloxacin degradation

Magnetic nickel-copper ferrite (Ni_xCu_yFe₂O₄) nano-catalyst was synthesized by co-precipitation method, and it exhibited excellent ability for activating peroxydisulfate (PDS) in the degradation of ciprofloxacin (CIP). As-prepared Ni_0.5Cu_0.5Fe₂O₄ properties were characterized by Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscope equipped with an energy-dispersive X-ray (SEM-EDX), transmissions electron microscopy (TEM), N₂ adsorption-desorption isotherm plot of Brunauer-Emmett-Teller (BET) and Barrett-Joyner-Halenda (BJH), vibrating sample magnetometer (VSM). The maximum degradation efficiency is 80.2% by using 0.500 g/L of Ni_0.5Cu_0.5Fe₂O₄ for activating 5.00 mmol/L of PDS to degrade CIP (20.0 mg/L) at 25 ± 2 °C for 50 min (pH = 6.00). The presence of interfering ions Cl^-, NO₃^-, and HCO₃^- inhibited the reaction by producing reactive species with low oxidation potential, inducing the degradation efficiency down to 60.0%, 58.1% and 21.5% respectively. Ni_0.5Cu_0.5Fe₂O₄ displayed great magnetic separation characteristic for the satisfactory magnetization; saturation value is ∼8.6 emu/g. The degradation efficiency of recycled samples has no significant difference after using three times, which is about 60%, indicating that Ni_0.5Cu_0.5Fe₂O₄ is a reusability catalyst in activating PDS for CIP degradation. This work might provide an efficient and promising approach to construct recyclable magnetic materials that can be used for wastewater treatment.

Partitioning and transformation behavior of arsenic during Fe(III)-As(III)-As(V)-SO42- coprecipitation and subsequent aging process in acidic solutions: Implication for arsenic mobility and fixation

The coprecipitation and subsequent aging of Fe(III)-As(III)-As(V)-SO₄^2- play an important role in controlling As behavior in acidic systems, such as acid mine drainage and hydrometallurgical acid waste. In this study, we investigated the redistribution and transformation of As in the Fe(III)-As(III)-As(V)-SO₄^2- system (As(III)/As(V) ≈ 1) at different Fe/As molar ratios (i.e., 0.25, 0.5, and 1) and pH (1.2 and 1.8) at 60 °C. The results showed that As(III) and SO₄^2- can be incorporated into the amorphous ferric arsenate and scorodite host phases by forming a Fe(AsO₄)_x(AsO₃)_y(SO₄)_z solid solution. As(III) contents in the freshly coprecipitated solids increased with pH and initial As(III) concentrations. During aging process, As(III) contents in the solid products with Fe/As molar ratios of 0.5 and 1 increased with aging time at pH 1.8. In contrast, As(III) was gradually expelled from aging products with aging time at pH 1.2, regardless of Fe/As molar ratio. X-ray diffraction (XRD), scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), and Raman spectroscopy characterization results showed that an As(III)-SO₄^2--doped scorodite was formed at Fe/As molar ratio ≤0.5 during the aging process. It was also found that As(III) had an inhibitory effect on the transformation of poorly crystalline ferric arsenate to scorodite. The present study may have important implications for understanding the geochemical cycle of As, Fe, and SO₄^2- in acidic solutions and give further understanding on the mechanisms involved in As removal and fixation in hydrometallurgical unit operations.

Complexation of arsenate to humic acid with different molecular weight fractions in aqueous solution

Natural organic matter (NOM) has been considered a critical substance in the transport and transformation of arsenic. NOM is a complex mixture of multifunctional organic components with a wide molecular weight (MW) distribution, and it is necessary to understand the complexation of arsenic with MW-dependent NOM fractions. In this study, humic acid (HA) was chosen as the representative fraction of NOM to investigate the complexation mechanism with arsenic. The bulk HA sample was fractionated to five fractions by ultrafiltration technology, and the complexing property of HA fractions with arsenic was analyzed by the dialysis method. We observed that the acidic and neutral conditions favor the complexation of HA fractions with arsenate (As(V)). The HA fractions with molecular weight > 100 kDa, 1-10 kDa, and <1 kDa have the stronger complexing capacity of As(V) than the other HA fractions. The bound As(V) percentage was positively associated with carboxyl content, phenolic content, and especially total acidity. A two-site ligand-binding model can describe the complexing capacity of arsenic onto HA fractions. The results can provide some fundamental information about the complexation of arsenic with MW-dependent HA fractions quantitatively.

Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation

Background

Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established.

Objective

The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA.

Methods

250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations.

Results

During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p&lt;0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF.

Conclusion

This study revealed that mitral L wave predicts late recurrence of AF after RFCA.

Funding Acknowledgement

Type of funding sources: None.

Notoginsenoside R1 protects hypoxia-reoxygenation deprivation-induced injury by upregulation of miR-132 in H9c2 cells

BACKGROUND

Myocardial ischemia/reperfusion injury (IRI) is a common perioperative complication of heart and great vessels surgery, aggravating the original myocardial damage and seriously affecting the postoperative recovery of cardiac function. The aim of this study was to reveal the functional effects and potential mechanisms of notoginsenoside R1 (NG-R1) in myocardial cells injured by hypoxia-reoxygenation (H/R).

METHODS

The rat cardiomyocyte line H9c2 was subjected to H/R with or without NG-R1 treatment. The levels of miR-132 and HBEGF in the cell were altered by microRNA or short-hairpin RNA transfection. Cell viability, apoptosis, lactate dehydrogenase (LDH) and malondialdehyde (MDA) were monitored. Dual luciferin was used to detect the relationship between miR-132 and HBEGF.

RESULTS

NG-R1 (20 μM) had no impact on H9c2 cells, but cell viability was significantly reduced at 80 μM. NG-R1 (20 μM) protected H9c2 cells against H/R-induced cell damage, accompanied by increased cell viability, reduced cell apoptosis, and downregulation of LDH and MDA. Furthermore, the level of miR-132 was decreased in response to H/R exposure but then increased after NG-R1 treatment. When miR-132 was overexpressed, H/R-induced cell damage could be recovered. Downregulation of miR-132 limited the protective effect of NG-R1 on H/R damage. We also found that HBEGF was a direct target of miR-132. The expression of HBEGF was increased upon H/R damage, and this increase was reversed after NG-R1 treatment.

CONCLUSIONS

This study demonstrated that NG-R1 markedly protected H9c2 cells against H/R-induced damage via upregulation of miR-132 and downregulation of its target protein HBEGF.

Antidiuretic hormone inhibits osteogenic differentiation of dental follicle stem cells via V1a receptors and the PLC-IP3 pathway

OBJECTIVE

The aim of this study was to elucidate the molecular mechanism by which antidiuretic hormone (ADH) inhibited osteogenesis in dental follicle stem cells.

DESIGN

Rat dental follicle stem cells were cultured in osteogenic differentiation medium supplemented with ADH. Alkaline phosphatase enzyme activity, Alizarin Red S staining, MTT assay and RT-qPCR was used to examine ADH's impact on cell mineralization, viability, and osteogenic gene expression. Real-time calcium imaging analysis was performed to identify the ADH receptor and its mechanism of action.

RESULTS

ADH supplementation to the osteogenic differentiation medium inhibited cell mineralization without compromising cell viability and downregulated the expression of key osteogenic genes: DCN (Decorin), RUNX2 (Runt-related transcription factor 2) and BSP (Bone sialoprotein). Real-time calcium imaging analysis revealed that ADH (1-1000 nM) increased intracellular calcium in a concentration-dependent manner. Pretreatment of cells with V2255, a V1a receptor blocker, inhibited the calcium signals, but not with the V1b (Nelivaptan) or V2 (Tolvaptan). V2255 also reversed the inhibitory effect of ADH on osteogenesis. Furthermore, U73122, a Phospholipase C (PLC) inhibitor, 2-APB, an Inositol Triphosphate (IP₃) receptor blocker, and depletion of endoplasmic reticulum calcium stores abolished the calcium signals by ADH.

CONCLUSIONS

Our results demonstrated that ADH activates V1a receptors and the PLC-IP₃ pathway to stimulate intracellular calcium signals, which inhibits cell mineralization and osteogenic gene expression. These findings uncovered a novel function for ADH as a negative regulator of osteogenesis in dental follicle stem cells. The role of ADH in the pathogenesis of bone diseases remains to be determined.

Gas explosion-induced acute blast lung injury assessment and biomarker identification by a LC-MS-based serum metabolomics analysis

The objective of this study was to evaluate the histopathological effect of gas explosion on rats, and to explore the metabolic alterations associated with gas explosion-induced acute blast lung injury (ABLI) in real roadway environment using metabolomics analyses. All rats were exposed to the gas explosion source at different distance points (160 m and 240 m) except the control group. Respiratory function indexes were monitored and lung tissue analysis was performed to correlate histopathological effect to serum metabolomics. Their sera samples were collected to measure the metabolic alterations by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). HE staining in lung showed that the gas explosion caused obvious inflammatory pulmonary injury, which was consistent with respiratory function monitoring results and the serum metabolomics analysis results. The metabolomics identified 9 significantly metabolites different between the control- and ABLI rats. 2-aminoadipic acid, L-methionine, L-alanine, L-lysine, L-threonine, cholic acid and L-histidine were significantly increased in the exposed groups. Citric acid and aconitic acid were significantly decreased after exposure. Pathway analyses identified 8 perturbed metabolic pathways, which provided novel potential mechanisms for the gas explosion-induced ABLI. Therefore, metabolomics analysis identified both known and unknown alterations in circulating biomarkers, adding an integral mechanistic insight into the gas explosion-induced ABLI in real roadway environment.

The Effect of Gypsum on the Fixation of Selenium in the Iron/Calcium-Selenium Coprecipitation Process

The coprecipitation of selenium^(IV) (Se) with iron^(III) (Fe) is a widely practiced method for the removal of Se from mineral processing effluents, but the effect of gypsum as a major secondary mineral on the iron-selenium coprecipitation process is still of concern. In our work we first investigated the effects of pH, Fe/Se molar ratio and the neutralizing agent on the removal efficiency of Se by iron-selenium coprecipitation method. The developed two-step Fe-Se coprecipitation method (Fe/Se molar ratio of 4) was superior to the one-step Fe-Se coprecipitation method at pH 4 using CaO as base in terms of the stability of the generated Fe-Se coprecipitates. Raman experimental results indicated the iron-selenium coprecipitates had the by-product of calcium selenite. We then investigated the effect of incorporation of Se into gypsum on the coprecipitation process at different pHs. The fourier transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), and scanning electron microscopy (SEM) of the calcium-selenium coprecipitates showed that the Se incorporated into the structure of gypsum at pH 8-10. Therefore, this work has important implications for the development of new technologies for efficient Se removal.

Uric Acid Variability and All-Cause Mortality: A Prospective Cohort Study in Northern China

OBJECTIVES

Uric acid(UA) is related with cardiovascular disease, but the association of UA variability with all-cause mortality is rarely known. This study aimed to investigate the relationship between UA variability and all-cause mortality in Kailuan cohort study in northern China.

DESIGN

Cohort study.

SETTING

Kailuan community hospitals in Tangshan, Hebei province, Northern China.

PARTICIPANTS

A total of 55717 participants from Kailuan Study were enrolled, and our study followed up biennially from 2006 to 2010.

MEASUREMENTS

Clinical records of the participants enrolled were analyzed. UA variation independent of mean (UAVIM) values were calculated and all the participants were quartile grouped into four groups as: Q1(UAVIM<0.68), Q2(0.68≤UAVIM<1.10), Q3(1.10≤UAVIM<1.67) and Q4(UAVIM≥1.67). The endpoint event was all-cause death. Cox regression model was performed to evaluate the hazard ratios(HRs) of all-cause mortality based on UAVIM groups.

RESULTS

During a median follow-up of 6.83 years, 2926 deaths occurred. The accumulated mortality rates were 4.6%, 4.8%, 5.4% and 6.1% in group Q1, Q2, Q3 and Q4 respectively. When adjusted potential confounders, the highest risk for all-cause mortality was in group Q4 and the adjusted HRs and 95% confidence intervals(CIs) of group Q2-Q4 for all-cause death were 1.044(0.937, 1.164), 1.182(1.064, 1.314) and 1.353(1.220, 1.501) compared with group Q1, respectively. Further analysis showed that the risk for all-cause death increased as UAVIM value increased. Sensitive analysis still showed the similar results when excluding participants with hyperuricemia or severe chronic kidney diseases. Sub-group analysis by age, gender, BMI or hypertension history also indicated analogous results.

CONCLUSION

Elevated UAVIM was related with increased all-cause mortality and UAVIM was an independent risk factor for all-cause mortality in the community cohort study.

Electrocardiographic evaluation of depolarization and repolarization abnormalities in breast cancer patients with HER2-inhibitor related cardiac dysfunction

Background

The arrhythmic substrates of the myocardium such as depolarization and repolarization abnormalities are thought to reflect cardiac dysfunction prior to the morphologic left ventricular dysfunction. Activation time (AT), recovery time (RT) and T wave peek-end interval dispersion (Tpe-dispersion) are useful indicators of the arrhythmic substrate. We examined the appearance of depolarization and repolarization abnormalities in patients with cancer therapeutics-related cardiac dysfunction (CTRCD) using AT, RT and Tpe-dispersion.

Methods

We conducted a standardized case-control study of CTRCD with 40 patients who developed breast cancer and treated with trastuzumab (13 cases and 27 controls). We assessed the relation between electrocardiographic indexes, including AT, RT and corrected Tpe-dispersion, and CTRCD. QT intervals were measured by Fridericia method, and QT observer 3 software were used for the measurement of all electrocardiographic indexes.

Results

LVEF in case and control group were 45.7±8% and 69.2±6%, respectively. AT in aVR lead was significantly higher in case group compared with control (28.8±7ms vs 22.8±5ms, P=0.02). corrected Tpe-dispersion tended to be higher in case group than that of control group (43.2±19ms vs 31.9±10ms, P=0.06). QT dispersion and RT dispersion were not different between case and control group.

Conclusions

Our study demonstrated that AT in aVR may predict cardiac dysfunction in breast cancer patients with HER2-inhibitor related cardiac dysfunction. More detailed studies using other modalities which can detect depolarization and repolarization abnormalities, including ventricular late potentials and T wave alternans, are needed.

Funding Acknowledgement

Type of funding source: None

Predicting non-elective hospital readmission or death using a composite assessment of cognitive impairment and frailty in elderly inpatients with cardiovascular diseases

Background

Cardiovascular disease (CVD) and related complications are significant healthcare problems in the growing elderly population. Metabolic factors are the predominant risk factors for CVD, sedentary behaviour and physical inactivity are major modifiable risk factors for CVD. Age-associated cognitive decline and impairment are associated with an increased mortality. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for CVD. There is a clinical need to identify more practical screens that can assist us to definite cognitive impairment and physical frailty, then to determine which patients with CVD are at high risk of adverse outcomes, early management of these high-risk patients can reduce readmission rates, healthcare spending, and improve quality of care.

Purpose

We aimed to assess the utility of a combination developed using the mini-mental state examination + clock drawing test and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD.

Methods

A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death.

Results

A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]: 1.73, 95% confidence intervals [CI]: 1.06–2.82, P=0.028) and impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke.

Conclusions

The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time.

Kaplan-Meier survival curves

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Beijing Municipal Science & Technology Commission, Chinese Academy of Medical Sciences

Detoxification and reclamation of hydrometallurgical arsenic- and trace metals-bearing gypsum via hydrothermal recrystallization in acid solution

Arsenic- and trace metals-bearing gypsum (As-gypsum) is one of the major hazardous solid wastes produced from metallurgical industry that poses a serious threat to the environment. However, the method for effective extraction of As and trace metals from As-gypsum is still lacking. In this study, simultaneous extraction of As and trace metals from a hydrometallurgical As-gypsum via hydrothermal recrystallization in acid solution was investigated. The effects of the type (H₂SO₄ vs HCl) and concentration of acid, and temperature on extraction efficiency were assessed. The results showed that 99% As, >92% Cu and >96% Zn could be extracted from the As-gypsum during hydrothermal treatment in 6 mol L^-1 H₂SO₄ at 90 and 120 °C, but Pb and Cd could not be extracted efficiently. The results of hydrothermal treatment in HCl solutions demonstrated that higher HCl concentration and temperature significantly enhanced the extraction efficiency and 100% As, Cu²⁺, Zn²⁺, Pb²⁺ and >90% Cd were removed from the As-gypsum after treatment in 6 mol L^-1 HCl, at 120 °C, for 12 h. X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and Raman spectroscopy results revealed that dissolution-recrystallization of gypsum is the key process for the removal of the incorporated As and trace metals. Thermodynamic modelling indicated that the released HAsO₄^2-/Me²⁺ transformed into H₃AsO₄/MeCl_n^(2-n) (1 ≤ n ≤ 4) species in HCl solution, hence inhibiting their reincorporation into the recrystallization products via isomorphic substitution for SO₄^2-/Ca²⁺. This work provides a simple and effective method for detoxification and reclamation of As-gypsum.

Simultaneous oxidation and removal of Sb(III) from water by using synthesized CTAB/MnFe2O4/MnO2 composite

Low levels of antimony (Sb) can be effectively removed from water by adsorption onto various materials, and searching for low-cost and high-efficiency new adsorbents has been a hot topic in recent years. In the present study, the performance of cetyltrimethylammonium bromide (CTAB) modified MnFe₂O₄/MnO₂ composites (CTAB/MnFe₂O₄/MnO₂) as an adsorbent for Sb(III) removal from aqueous solution was investigated. Kinetic study revealed that adsorption of Sb(III) by CTAB/MnFe₂O₄/MnO₂ was fast in the first 430 min and the equilibrium was achieved within 1440 min. The adsorption kinetic data were well fitted with pseudo-second-order model. The maximum adsorption capacity of the synthesized adsorbent for Sb(III) at pH 7 calculated from Langmuir adsorption isotherms in batch experiments was 321.03 mg g^-1. During the adsorption process, Sb(III) can be simultaneously oxidized to Sb(V) and the average oxidation percentage reached 95.43% within 1440 min. The adsorption capacity did not significantly vary with pH. Common metal cations (Ca²⁺ and Mg²⁺) slightly enhanced Sb(III) adsorption at pH 7. In comparison, the effect of anions (Cl^-, NO₃^-, and PO₄^3-) on Sb(III) adsorption was not obvious. The results suggest that CTAB/MnFe₂O₄/MnO₂ is a potential cost-effective adsorbent for Sb(III) removal in water treatment.

A systematic study of the synthesis conditions of blue and green ultramarine pigments via the reclamation of the industrial zeolite wastes and agricultural rice husks

Discarded industrial zeolite waste and agricultural rice husks have caused a waste of resources. To achieve resource reuse, we proposed an economical method for the preparation of ultramarine pigments via the reclamation of industrial zeolite waste (ZW) and agricultural rice husks (RHs) or previously bio-charred rice husks (BRHs). The optimal blue and green pigments were synthesized by solid state reaction of mixtures of BRH/ZW/Na₂CO₃/S with mass ratios of 1:2:1:1.5 and 2:2:7:3, respectively, and using a two-step calcination process with a first stage at 500 and a second stage at 800 °C. Furthermore, the blue and green pigments were also obtained using directly RH (instead of BRH) as raw material, but this time with RH/ZW/Na₂CO₃/S mass ratios of 1:2:2:3 and 1:2:7:3.5 and with first-stage and second-stage calcination temperatures of 400 and 800 °C. This was done to reduce additional chemical reactions (e.g., BRH derived from the pyrolysis of RH). The XRD, FT-IR, Raman, and SEM results suggest that the synthetic blue and green pigments have the sodalite structure containing S₃^- and S₂^- radicals. The synthetic green pigment using RH as raw material had the best acid resistance. Additionally, the synthesis of blue and green ultramarine pigments via the reclamation of the industrial zeolite wastes and agricultural rice husks can reduce the costs of the production process.

Genetic Variants of Homocysteine Metabolism, Homocysteine, and Frailty - Rugao Longevity and Ageing Study

OBJECTIVES

Recently, elevated homocysteine was reported to be associated with frailty in cross-sectional studies. However, whether homocysteine is causally associated with frailty is unknown. Here, we explore the inter-relationships between five non-synonymous genetic variants of homocysteine metabolic four genes, plasma homocysteine levels, and frailty.

METHOD

Data of 1480 individuals aged 70-87 years from the ageing arm of Rugao Longevity and Ageing Study were used. Five variants of the four homocysteine metabolic enzyme genes were genotyped. Frailty was defined using Fried's phenotype criteria.

RESULTS

The percentage of high homocysteine (>15μmol/L) is 33.3%. Two functional variants that decrease methylenetetrahydrofolate reductase (MTHFR) activities, C677T (Ala222Val, rs1801133) and A1298C (Glu429Ala, rs1801131), were significantly associated with increased homocysteine levels (β=-1.16, p=0.01; and β=1.46, p<0.001, respectively). In addition, homocysteine increase gradually from CC-CC, CC-AC, CT-AC, CT-AA, CC-AA, to TT-AA genotypes of the C677T-A1298C combinations. The five polymorphisms in the homocysteine metabolic gene was not associated with frailty. However, homocysteine was significantly associated with frailty with an OR of 2.27 (95% 1.36-3.78) for high homocysteine after adjusting for multiple confounding factors.

CONCLUSION

Elevated homocysteine is not a causal factor but a biomarker that manifests greater possibility of frailty in high risk elderly individuals for prevention.

P93 The usefulness of dual cardiac autonomic nervous modulation assessment for prediction of mortality in patients with relatively preserved left ventricular ejection fraction

Background

Recent guidelines have stated that reduced left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. Although reduced LVEF identifies patients at an increased risk of cardiac arrest, sudden cardiac deaths (SCDs) occur considerably more often in patients with relatively preserved LVEF. Current guidelines on SCDs risk stratification do not adequately cover this general population pool. Heart rate variability (HRV) and heart rate turbulence (HRT) are non-invasive electrocardiography (ECG)-based techniques capable of providing relevant information on the cardiac autonomic nervous modulation. Although a large body of evidence about autonomic nervous modulation markers has been reported, the usefulness of HRV and HRT parameters for risk stratification in such patients with relatively preserved LVEF has not yet been elucidated.

Purpose

This study aimed to evaluate HRV and HRT parameters for predicting cardiac mortality in patients with structural heart disease (SHD), including ischemic heart disease, dilated cardiomyopathy and valvular heart disease, who have mid-range left ventricular dysfunction (LVD).

Methods

We prospectively enrolled 229 patients (187 men, age 63 ± 13 years) with SHD who have mid-range LVD (LVEF &gt; 40%). HRV and HRT parameters based on 24-hour ambulatory ECG recordings (Fukuda Denshi Co., Ltd., Tokyo, Japan) were evaluated as follows; SDNN, triangular index, high and low frequency HRV, turbulence onset and slope. The primary endpoint was all-cause mortality. Univariate and multivariate Cox regression analysis were used to assess the association between these cardiac autonomic nervous modulation and mortality.

Results

During a mean follow-up of 21 ± 11 months, all-cause mortality was seen in 11 (4.8%) patients. Univariate Cox regression analysis showed that reduced SDNN (&lt;50ms), reduced triangular index (&lt;20ms) and HRT category 2 were significantly associated with the primary endpoint (P &lt; 0.05). When HRT category 2 combined with reduced SDNN, Multivariate Cox regression analysis revealed that this combination more strongly associates with the primary endpoint (hazard ratio =7.91, 95%CI, 1.82-34.2; P = 0.006).

Conclusion

Dual cardiac autonomic nervous modulation assessment which combined HRT and HRV could be a superior technique to predict mortality in patients with relatively preserved LVEF.

Associations of TNF-α -308 G>A and TNF-β 252 A>G with Physical Function and BNP-Rugao Longevity and Ageing Study

OBJECTIVES

To explore the associations of TNF-α -308 G>A (rs1800629) and TNF-β 252 A>G (rs909253) with physical function and plasma B-type natriuretic peptide (BNP).

METHODS

Data of 1747 community-dwelling elders from the ageing arm of the Rugao Longevity and Ageing Study was used. Physical function was measured by handgrip strength, Timed Up and Go (TUG) test and 5-meter walking test (5MWT).

RESULTS

AA genotype of the TNF-α -308 G>A was associated with higher mean time of TUG test and 5MWT (multivariable adjusted β=5.75 and 5.70, respectively, p<0.05), compared with GG genotype. For the TNF-β 252 A>G polymorphism, GG genotype was associated with higher mean time of TUG test and 5MWT (multivariable adjusted β=1.55 and 0.83, respectively, p<0.05) and lower handgrip strength (multivariable adjusted β=-0.69, p<0.05), compared with AA genotype. Further, GG was associated with greater odds of low handgrip strength (OR=1.47, 95% CI=1.06-2.04), low speed of TUG test (OR=1.87, 95% CI=1.20-2.01) and elevated BNP (OR=1.30, 95% CI=1.08-1.84). GG also interacted with elevated BNP to be associated with greater odds of low handgrip strength and 5MWT.

CONCLUSIONS

TNF-β 252 A>G was associated with physical function measurements, plasma BNP level, and odds of elevated BNP in an elderly population. TNF-β 252 A>G also interacted with elevated BNP to be associated with greater odds of physical function measurements.