Hydride-doped coinage metal superatoms and their catalytic applications

Superatomic constructs have been identified as a critical component of future technologies. The isolation of coinage metal superatoms relies on partially reducing metallic frameworks to accommodate the mixed valent state required to generate a superatom. Controlling this reduction requires careful consideration in reducing the agent, temperature, and the ligand that directs the self-assembly process. Hydride-based reducing agents dominate the synthetic wet chemical routes to coinage metal clusters. However, within this category, a unique subset of superatoms that retain a hydride/s within the nanocluster post-reduction have emerged. These stable constructs have only recently been characterized in the solid state and have highly unique structural features and properties. The difficulty in identifying the position of hydrides in electron-rich metallic constructs requires the combination and correlation of several analytical methods, including ESI-MS, NMR, SCXRD, and DFT. This text highlights the importance of NMR in detecting hydride environments in these superatomic systems. Added to the complexity of these systems is the dual nature of the hydride, which can act as metallic hydrogen in some cases, resulting in entirely different physical properties. This review includes all hydride-doped superatomic nanoclusters emphasizing synthesis, structure, and catalytic potential.

Doping effect on a two-electron silver nanocluster

This study investigates the effects of metal addition and doping of a 2-electron silver superatom, [Ag10{S2P(OiPr)2}8] (Ag10). When Ag+ is added to Ag10 in THF solution, [Ag11{S2P(OiPr)2}8(OTf)] (Ag11) is rapidly formed almost quantitatively. When the same method is used with Cu+, a mixture of alloys, [CuxAg11-x{S2P(OiPr)2}8]+ (x = 1-3, CuxAg11-x), is obtained. In contrast, introducing Au+ to Ag10 leads to decomposition. The structural and compositional analysis of Ag11 was characterized by single-crystal X-ray diffraction (SCXRD), ESI-MS, NMR spectroscopy, and DFT calculations. While no crystal structure was obtained for CuxAg11-x, DFT calculations provide insights into potential sites for copper location. The absorption spectrum exhibits a notable blue shift in the low-energy band after copper doping, contrasting with that of the slight shift observed in 8-electron Cu-doped Ag nanoclusters. Ag11 and CuxAg11-x are strongly emissive at room temperature, and solvatochromism across different organic solvents is highlighted. This study underscores the profound influence of metal addition and doping on the structural and optical properties of silver nanoclusters, providing important contributions to understanding the nanoclusters and their photophysical behaviors.

[Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery]

Objective: To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications (MC) following long-segment spinal correction surgery in female patients with degenerative scoliosis (DS). Methods: The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed. According to whether restoring the ideal Roussouly classification after surgery, the patients were divided into R group(recovery group) (n=51) and N group(non-recovery group) (n=21). According to whether mechanical complications occurred after operation within two years, the patients were divided into MC (mechanical complications)group (n=24) and NMC(non-mechanical complications) group (n=48). The RM group (n=14) experienced mechanical complications in the R group, while the RN group (n=37) did not. The NM group (n=10) experienced mechanical complications in the N group, while the NN group (n=11) did not.Radiographic assessment included Sagittal parameters of spine and pelvis, standardized cross-sectional area (SCSA) and fat infiltration rate (FI%) of paraspinal muscle at each lumbar disc level. Results: The age of DS patients in this study was (61.4±6.2) years.The incidence of MC was 33.33%(n=24)in all patients. The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10) in group N. The correction amount of pelvic tilt angle (PT) (-11.62°±10.06° vs -7.04°±8.45°, P=0.046) and T1 pelvic angle(TPA)(-12.88°±11.23° vs -7.31°±9.55°, P=0.031)during surgery were significantly higher in MC group compared to the NMC group. In group R, the FI% of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC (P<0.05). In the R and N groups, there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level (all P>0.05). Multivariate logistic regression analysis showed that the average FI% of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI% of lumbar PSM≥22.63% was a risk factors for MC after spinal fusion (P=0.010,OR=1.088, 95%CI:1.020-1.160). Conclusions: Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications. For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.

A Silver Nanocluster Assembled by a Superatomic Building Unit

A unique assembly of a two-electron superatom, [Ag10{S2P(OiPr)2}8], as a primary building unit in the construction of a supramolecule [Ag10{S2P(OiPr)2}8]2(μ-4,4'-bpy) through a 4,4'-bipyridine (4,4'-bpy) linker is reported. This approach is facilitated by an open site in the structure that allows for effective pairing. The assembled structure demonstrates a minimal solvatochromic shift across organic solvents with variable polarities, highlighting the influence of self-assembly on the photophysical properties of silver nanoclusters.

[Effect of different observations on evaluation of cosmetic shoulder balance in adolescent idiopathic scoliosis patients with thoracic curve]

Objective: To investigate the correlations between cosmetic and radiographic parameters of shoulder balance, as well as the variations in cosmetic shoulder balance observed from different perspectives, among patients with adolescent idiopathic scoliosis (AIS) characterized by thoracic curves. Methods: A total of 43 patients with thoracic curves treated from July to October in 2022 in Nanjing Drum Tower Hospital were recruited in this study. There were 9 males and 34 females with a mean age of (14.3±1.5) years. All participants underwent comprehensive radiographic assessments and were photographed both from posterior and anterior views, focusing on the shoulder region as well as a higher level (maintaining a consistent vertical distance of 180 cm from the ground). Six cosmetic parameters were measured on the photographs: shoulder angle(α1), axilla angle(α2), shoulder area index 1(SAI1), shoulder area index 2 (SAI2), inner shoulder height (SHi) and outer shoulder height (SHo). Eight radiographic parameters were measured on the radiographs: radiographic shoulder height difference (RSHD), first rib angle (FRA), clavicle-rib cage intersection (CRCI), coracoid process height (CPH), T1 tilt, clavicle angle(CA), clavicle chest cage angle difference (CCAD) and Cobb angle. Differences among bilateral cosmetic indicators from different perspectives were analyzed and compared, and their correlation with bilateral radiographic indicators was studied. Results: There was no significant differences between anterior cosmetic parameters and posterior cosmetic parameters at the same level of observation(all P>0.05). However, when observing SHi, SHo, α1, and α2 at the shoulder level, it became evident that they exhibited significantly higher values compared to the corresponding higher level on the same side of the patients' bodies. This contrast was observed in both the dorsal [SHo: (0.11±1.20) cm vs (-0.44±1.39) cm, P=0.005; SHi: (0.64±0.86) cm vs (0.32±0.56) cm, P=0.003; α1:-0.47°±2.27° vs -0.77°±2.49°, P=0.014; α2:-3.06°±3.23° vs -2.21°±3.03°, P=0.034] and ventral [SHo: (0.12±1.29) cm vs (-0.48±1.35) cm, P=0.007; SHi: (0.61±0.88) cm vs (0.30±0.59) cm, P=0.006; α1:-0.46°±2.18° vs -0.69°±2.35°, P=0.018; α2:-3.26°±3.12° vs -2.05°±2.97°, P=0.029] aspects of the patients. SHi and SHo were more sensitive to this difference of height. The correlation coefficients between radiographic parameters and cosmetic aspects at the shoulder level varied from 0.374 to 0.767. Similarly, the correlation coefficients between radiographic parameters and cosmetic factors at the higher level ranged from 0.273 to 0.579 (all P<0.05). Conclusions: The cosmetic parameters had significant difference between different perspective of observation, the cosmetic parameters are needed to be observed at the shoulder level in the evaluation of patients' shoulder balance.

Hydride-Containing Pt-doped Cu-rich Nanoclusters: Synthesis, Structure, and Electrocatalytic Hydrogen Evolution

A structurally precise hydride-containing Pt-doped Cu-rich nanocluster [PtH2 Cu14 {S2 P(Oi Pr)2 }6 (CCPh)6 ] (1) has been synthesized. It consists of a bicapped icosahedral Cu14 cage that encapsulates a linear PtH2 unit. Upon the addition of two equivalents of CF3 COOH to 1, two hydrido clusters are isolated. These clusters are [PtHCu11 {S2 P(Oi Pr)2 }6 (CCPh)4 ] (2), which is a vertex-missing Cu11 cuboctahedron encaging a PtH moiety, and [PtH2 Cu11 {S2 P(Oi Pr)2 }6 (CCPh)3 ] (3), a distorted 3,3,4,4,4-pentacapped trigonal prismatic Cu11 cage enclosing a PtH2 unit. The electronic structure of 2, analyzed by Density Functional Theory, is a 2e superatom. The electrocatalytic activities of 1-3 for hydrogen evolution reaction (HER) were compared. Notably, Cluster 2 exhibited an exceptionally excellent HER activity within metal nanoclusters, with an onset potential of -0.03 V (at 10 mA cm-2 ), a Tafel slope of 39 mV dec-1 , and consistent HER activity throughout 3000 cycles in 0.5 M H2 SO4 . Our study suggests that the accessible central Pt site plays a crucial role in the remarkable HER activity and may provide valuable insights for establishing correlations between catalyst structure and HER activity.

The Effect of the Knowledge, Skills, and Attitudes from Nurse Training Using In Situ Simulation in an Intensive Care Unit

BACKGROUND

In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients.

METHODS

This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect.

RESULTS

The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care.

CONCLUSIONS

In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field.

Spin independence of the strongly enhanced effective mass in ultra-clean SiGe/Si/SiGe two-dimensional electron system

The effective mass at the Fermi level is measured in the strongly interacting two-dimensional (2D) electron system in ultra-clean SiGe/Si/SiGe quantum wells in the low-temperature limit in tilted magnetic fields. At low electron densities, the effective mass is found to be strongly enhanced and independent of the degree of spin polarization, which indicates that the mass enhancement is not related to the electrons' spins. The observed effect turns out to be universal for silicon-based 2D electron systems, regardless of random potential, and cannot be explained by existing theories.

The Interplay Effect and Mitigations with Cyclotron and Linac Proton Beam Scanning for Lung SBRT

PURPOSE/OBJECTIVE(S)

To evaluate the impact of different types of pencil beam scanning proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for lung cancer patients treated with SBRT.

MATERIALS/METHODS

Twenty lung cancer patients (ten peripheral and ten central tumors) treated in our institution with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes for this retrospective study. The respiratory motion amplitude ranged from 0.1 to 1.0 cm with compression. For each patient, plans were created using: 1) cyclotron-generated proton beams (CPB) (σ: 2.7-7.0 mm); 2) linear accelerator proton beams (LPB) (σ: 2.9-5.5 mm); and 3) linear accelerator proton minibeams (LPMB) (σ: 0.9-3.9 mm). Plans were robustly optimized on the GTV using each individual 4DCT phase. Single-filed optimization (SFO) plans were the first attempt, and if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparison. For each patient, all plans were normalized to have the same dose to 99% of the GTV. Interplay effects were evaluated for ten scenarios of treatment delivery starting in ten breathing phases using machine generic time models and a constant breathing period of 4 seconds. Volumetric repainting (VR) was performed 2-6 times for each plan. To assess plan quality in the nominal scenario, we compared the conformity index (CI), R50, and the percentage of lung volume receiving 20 Gy (RBE) (V20Gy). CI is defined as the ratio of the 100% isodose volume to the GTV. R50 is defined as the 50% isodose volume divided by the GTV. Dmax and V18Gy of the proximal bronchial tree (PBT) were evaluated for central tumors.

RESULTS

Twelve of 20 plans can be optimized sufficiently with SFO. In interplay effect evaluation, the mean V100%RX values of the GTV were 99.42±0.6%, 97.52±3.9%, and 94.49±7.3%for CPB, LPB, and LPMB plans respectively. After VR 2/3/5 times, the V100%RX values were improved (on average) by 0.13%/1.84%/4.63% for CPB/LPB/LPMB plans. The delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 minute longer than CPB plans. VR showed no effect on lung V20Gy, Dmax and V18Gy of the PBT. SFO plans were more robust against the interplay effect compared with MFO plans for LPB and LPMB. Average CIs of 1.88±0.4, 1.79±0.4, and 1.75±0.4; average R50s of 7.99±4.0, 6.68±3.0, and 5.70±2.6; and average lung V20Gy values of 2.81±1.5, 2.26±1.3, and 1.85±1.1 were obtained for CPB, LPB, and LPMB plans, respectively. Dmax and V18Gy of the PBT decreased with decreasing spot sizes.

CONCLUSION

LPMB, with the smallest spot size, produced superior plan quality. In the absence of VR, proton machines with large spot sizes generated more robust plans against interplay effects. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.

Investigation of the Relationship between Aperture Use for Treating Small and Shallow Brain Lesions in Proton Therapy with Different Spot Size Variations in Three Proton Therapy Systems

PURPOSE/OBJECTIVE(S)

To compare plan quality among standard vs. aperture-based Intensity-Modulated Proton Therapy (IMPT) using cyclotron-generated proton beams (CPB), linear accelerator proton beams (LPB), and linear accelerator proton minibeams (LPMB) for multiple brain metastases.

MATERIALS/METHODS

Fifty-five brain lesions from twenty patients were planned with three different spot size ranges using CPBs (σ: 2.7-7.0 mm) and compared against LPBs (σ: 2.9-5.5 mm), and LPMBs (σ: 0.9-3.9 mm). Apertures with a diameter of 0.3 cm were applied to beams irradiating all tumors < 1 cm3 in volume and any tumor < 2.5 cm depth in the patient and compared against the same patient plans containing no apertures. All plans were optimized with the multi-field optimization (MFO) technique using the Monte Carlo algorithm. Dose coverage to each lesion for each proton plan was set to 99% of the GTV receiving the prescription (Rx) dose for all plans. Robustness with ±2 mm setup uncertainty and ±2% range uncertainty was included in robust evaluation using V100%Rx > 95% of the GTV. Conformity index (CI) and gradient index (GI) were used to analyze the effect of apertures vs. no apertures (standard) for each IMPT plan type. CI was defined as the volume of the 100% isodose line divided by the volume of the GTV + 2 mm expansion to account for robust planning. The Wilcoxon signed rank test was utilized to determine the statistical significance of dosimetric results compared between aperture-based and standard IMPT plans.

RESULTS

When apertures were implemented in the treatment planning for all shallow and small brain lesions, shallow brain tumors showed the most prominent improvement in conformity and gradient index. A 6.7% difference in average conformity was calculated for standard vs. aperture-based plans for LPMBs, followed by a 5.3% improvement for CPBs. Improvement in gradient index for standard vs. aperture-based plans was significant for both shallow and deeper tumors for CPB and LPB plan types, as shown in Table 1 below. CPB and LPB plan gradient indices were statistically significant for comparing aperture-based vs. standard IMPT plans.

CONCLUSION

We successfully quantified plan quality and evaluated results for aperture- vs. standard IMPT plans using CPBs, LPBs, and LPMBs for brain metastases. Plan quality improves the greatest with apertures applied to beams irradiating shallow tumors. Apertures may not be necessary for small, deeper tumors with IMPT.

The effectiveness of facilitator-led remote interactive intervention for loneliness, quality of life, and social support among seniors in communities during the COVID-19 pandemic: a randomized controlled experiment

OBJECTIVE

This study investigated the impact of a 12-week remote interaction intervention on loneliness, quality of life, and social support for seniors living in a community during the COVID-19 pandemic.

METHODS

This study adopted a randomized controlled trial design. Participants in the intervention group received a 12-week bidirectional remote interaction intervention, while participants in the control group received a 12-week unidirectional remote interaction intervention. The study's primary assessment tools were the UCLA Loneliness Scale (UCLA) and the World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF).

RESULTS

The main findings indicate that the intervention group scored significantly higher than the control group on the WHOQOL-BREF in the physical health and social relationships domains after the intervention. In addition, intervention group participants with low loneliness scored significantly higher than their control group counterparts in the physical health and social relationships domains of the WHOQOL-BREF. Similarly, intervention group participants with high loneliness scored significantly higher than their control group counterparts in the social relationships domain of the WHOQOL-BREF. However, there was no significant difference in loneliness scores between the intervention and control groups.

CONCLUSIONS

This result confirms that providing intensive bidirectional interaction benefits seniors' quality of life during the COVID-19 pandemic.

Hydride Doping Effects on the Structure and Properties of Eight-Electron Rh/Ag Superatoms: The [RhHx@Ag21-x{S2P(OnPr)2}12] (x = 0-2) Series

Three hitherto unknown eight-electron rhodium/silver alloy nanoclusters, [RhAg₂₁{S₂P(OⁿPr)₂}₁₂] (1), [RhHAg₂₀{S₂P(OⁿPr)₂}₁₂] (2), and [RhH₂Ag₁₉{S₂P(OⁿPr)₂}₁₂] (3), have been isolated and fully characterized. Cluster 1 contains a regular Rh@Ag₁₂ icosahedral core, whereas 2 and 3 exhibit distorted RhH@Ag₁₂ and RhH₂@Ag₁₂ icosahedral cores. The single-crystal neutron structure of 2 located the encapsulated hydride at the center of an enlarged RhAg₃ tetrahedron. A similar position was found by neutron diffraction for one of the hydrides in 3, whereas the other hydride is trigonally coordinated to Rh and an elongated Ag-Ag edge. The solid-state structures of 1-3 possess C₁ symmetry due to the asymmetric arrangement of the surrounding capping Ag atoms. Our investigation shows that the insertion of one hydride dopant provokes the elimination of one capping silver atom on the cluster surface, resulting in the general formula [RhH_x@Ag_21-x{S₂P(OⁿPr)₂}₁₂] (x = 0-2), which maintains the same number of cluster electrons as well as neutral charge. Clusters 1-3 exhibit an intense emission band in the NIR region. Contrarily to their PdAg₂₁ and PdHAg₂₀ relatives, the 4d orbitals of the encapsulated heterometal are somewhat involved in the optical processes.

A heteroleptic fused bi-cuboctahedral Cu21S2 cluster

A new dicationic cluster, [Cu₂₁S₂{S₂CNⁿBu₂}₉(C₂Ph)₆]²⁺, where the Cu21S2 kernel consists of two S@Cu₁₂ cuboctahedra sharing a triangular Cu₃ face is reported. Its waist part is bridged by three dithiocarbamate ligands, each in a hexaconnective, hexametallic (μ₃, μ₃) coordination pattern, an unprecedented feature in Cu nanocluster chemistry.

Recent progress in dichalcophosphate coinage metal clusters and superatoms

Atomically precise clusters of group 11 metals (Cu, Ag, and Au) attract considerable attention owing to their remarkable structure and fascinating properties. One of the unique subclasses of these clusters is based on dichalcophosphate ligands of [(RO)₂PE₂]^- type (E = S or Se, and R = alkyl). These ligands successfully stabilise the most diverse Cu, Ag, and Au clusters and superatoms, spanning from simple ones to amazing assemblies featuring unusual structural and bonding patterns. It is noteworthy that such complicated clusters are assembled directly from cheap and simple reagents, metal(I) salts and dichalcophosphate anions. This reaction, when performed in the presence of a hydride or other anion sources, or foreign metal ions, results in hydrido- or anion-templated homo- or heteronuclear structures. In this feature article, we survey the recent advances in this exciting field, highlighting the powerful synthetic capabilities of the system "a metal(I) salt - [(RO)₂PX₂]^- ligands - a templating anion or borohydride" as an inexhaustible platform for the creation of new atomically precise clusters, superatoms, and nanoalloys.

Long-acting injectable in situ gel of rasagiline: a patented product development

Rasagiline has a certain potential in neuroprotection and delaying the progression of Parkinson's disease (PD). However, the poor pharmacokinetics (PK) characteristics of conventional oral tablets and poor medication compliance limit the optimal efficacy of rasagiline. Based on this, we designed and optimized a sustained-release rasagiline in situ gel based on in vitro release and in vivo PK results. Among them, we found for the first time that aluminum hydroxide can effectively shorten the lag phase and promote early and late release, making the daily release more uniform. After subcutaneous administration of the optimized gel formulation at a monthly dose, the C_max (64 ng/ml) was lower than that of free rasagiline (494 ng/ml) administered subcutaneously at a daily dose and comparable to that of oral administration of Azilect^® (59.1 ng/ml) at a daily dose. In the meantime, the plasma concentration of rasagiline was mainly maintained at 5-10 ng/ml for about 1 month, and the active metabolite 1-aminoindane in plasma was also able to maintain a steady state. The rasagiline in situ gel has suitable viscosity and injectability, good repeatability of subcutaneous injection, and controllable impurities and can achieve sustained release in vivo with small burst release, which may have the clinical application advantages of maximizing the disease-modifying effect of rasagiline and improving medication compliance. The rasagiline in situ gel was optimized through the feedback of in vitro release and in vivo pharmacokinetics (PK), in which the addition of aluminum hydroxide had a modulating effect on uniform release. The gel has low burst release and maintains steady-state blood drug concentration for about 1 month.

Galvanic replacement-induced introduction of a heteroligand into bimetallic and trimetallic nanoclusters

Heteroleptic 8-electron silver-rich alloy nanoclusters, [Au@Au₄Ag₁₂(dtp)₇(PPh₃)₄]²⁺ (1) and [Pt@Au₄Ag₁₁(dtp)₇(PPh₃)₄] (2), were successfully synthesized via a galvanic replacement reaction of 1,1-dithiolate-protected M@Ag₂₀ (M = Au and Pt) nanoclusters with Au(I)-phosphine salts, leading to the alteration of the cluster nuclearity and geometry of shell skeletons but retaining the same 8-electron count.

Superatom Pruning by Diphosphine Ligands as a Chemical Scissor

A two-electron silver superatom, [Ag₆{S₂P(OⁱPr)₂}₄(dppm)₂] (1), was synthesized by adding dppm (bis(diphenylphosphino)methane) into [Ag₂₀{S₂P(OⁱPr)₂}₁₂] (8e). It was characterized by single-crystal crystallography, multinuclear NMR spectroscopy, electrospray ionization-mass spectrometry, density functional theory (DFT), and time-dependent DFT calculations. The added dppm ligands, which carry out the nanocluster-to-nanocluster transformation, act as a chemical scissor to prune the nanocluster geometrically from an icosahedron-based Ag₂₀ nanocluster (NC) to an octahedral Ag₆ NC and electronically from eight-electron to two-electron. Eventually, dppm was involved in the protective shell to form a new heteroleptic NC. The temperature-dependent NMR spectroscopy confirms its fluxional behavior, showing the fast atomic movement at ambient temperature. Compound 1 exhibits a bright yellow emission under UV irradiation at ambient temperature with a quantum yield of 16.3%. This work demonstrates a new methodology to achieve nanocluster-to-nanocluster transformation via stepwise synthesis.

Hydride-containing 2-Electron Pd/Cu Superatoms as Catalysts for Efficient Electrochemical Hydrogen Evolution

The first hydride-containing 2-electron palladium/copper alloys, [PdHCu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₄ ] (PdHCu₁₁ ) and [PdHCu₁₂ {S₂ P(Oⁱ Pr)₂ }₅ {S₂ PO(Oⁱ Pr)} (C≡CPh)₄ ] (PdHCu₁₂ ), are synthesized from the reaction of [PdH₂ Cu₁₄ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₆ ] (PdH₂ Cu₁₄ ) with trifluoroacetic acid (TFA). X-ray diffraction reveals that the PdHCu₁₁ and PdHCu₁₂ kernels consist of a central PdH unit encapsulated within a vertex-missing Cu₁₁ cuboctahedron and complete Cu₁₂ cuboctahedron, respectively. DFT calculations indicate that both PdHCu₁₁ and PdHCu₁₂ can be considered as axially-distorted 2-electron superatoms. PdHCu₁₁ shows excellent HER activity, unprecedented within metal nanoclusters, with an onset potential of -0.05 V (at 10 mA cm^-2 ), a Tafel slope of 40 mV dec^-1 , and consistent HER activity during 1000 cycles in 0.5 M H₂ SO₄ . Our study suggests that the accessible central Pd site is the key to HER activity and may provide guidelines for correlating catalyst structures and HER activity.

Unusual core engineering on a copper hydride nanoball

A neutral polyhydrido copper cluster, [Cu₂₇H₁₅{S₂CNⁿBu₂}₁₂] (abbreviated as [Cu₂₇H₁₅]), was prepared by the reaction of dithiocarbamates (dtc), Cu(I) salts and NaBH₄. The isolated cluster provides insights into core engineering, demonstrating its novel ability to reversibly add or remove one copper atom from the cluster core. Single-crystal X-ray analysis reveals that the new core-shell structure exhibits a Cu₂₄ rhombicuboctahedral outer cage and an inner Cu₃ triangular kernel. The two core-shell clusters, [Cu₂₇H₁₅{S₂CNⁿBu₂}₁₂] and previously published [Cu₂₈H₁₅(S₂CNⁿBu₂)₁₂]⁺ (abbreviated as [Cu₂₈H₁₅]⁺), are only differentiated by one copper atom in their inner core. Importantly, we demonstrate core engineering with the controllable reversible transition between an irregular Cu₄ tetrahedron and a Cu₃ triangle, whilst maintaining their outer Cu₂₄ shell intact. The 15 hydride atoms in [Cu₂₇H₁₅], coordinated in three different modes, are co-incident with the hydride positions in [Cu₂₈H₁₅]⁺. The degradation of [Cu₂₇H₁₅] in solution or the addition of one eq. of Cu(I) ions leads to the conversion of [Cu₂₇H₁₅] into [Cu₂₈H₁₅]⁺, while the reverse transformation can be achieved by the addition of either formic acid or a reducing agent to [Cu₂₈H₁₅]⁺. A dicationic species was observed in the ESI mass spectrum, and the composition is formulated as [Cu₅₆H₃₀(S₂CNⁿBu₂)₂₄]²⁺, a dimer of [Cu₂₇H₁₅(S₂CNⁿBu₂)₁₂ + Cu⁺]₂²⁺. The dimeric species was further explored by DFT calculations, suggesting that the lowest energy structure consists of a [Cu₂₈H₁₅]⁺ and a [Cu₂₇H₁₅] cluster connected through one Cu⁺ atom bridge. As a result, [Cu₂₇H₁₅] is considered an intermediate species in the formation of the more stable [Cu₂₈H₁₅]⁺ nanoball.

Poor prognostic implications of myelodysplasia-related mutations in both older and younger patients with de novo AML

A set of myelodysplasia-related (MDS-R) gene mutations are incorporated into the 2022 European LeukemiaNet risk classification as adverse genetic factors for acute myeloid leukemia (AML) based on their poor prognostic impact on older patients. The impact of these mutations on younger patients (age < 60 years) remains elusive. In the study of 1213 patients with de novo non-M3 AML, we identified MDS-R mutations in 32.7% of the total cohort, 44.9% of older patients and 23.4% of younger patients. The patients with MDS-R mutations had a significantly lower complete remission rate in both younger and older age groups. With a median follow-up of 9.2 years, the MDS-R group experienced shorter overall survival (P = 0.034 for older and 0.035 for younger patients) and event-free survival (P = 0.004 for older and 0.042 for younger patients). Furthermore, patients with MDS-R mutations more frequently harbored measurable residual disease that was detectable using next generation sequencing at morphological CR than those without MDS-R mutations. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) might ameliorate the negative impact of MDS-R mutations. In summary, AML patients with MDS-R mutations have significantly poorer outcomes regardless of age. More intensive treatment, such as allo-HSCT and/or novel therapies, is warranted for AML patients with MDS-R mutations.

Oxocarbon Anions Templated in Silver Clusters

Three types of oxocarbon anions as templates were used to synthesize high-nuclear silver clusters, [Ag₁₆(C₂O₄){S₂P(OEt)₂}₁₂]₂(PF₆)₄ (1), [Ag₁₆(C₄O₄){S₂P(OEt)₂}₁₂]₂(PF₆)₄ (2), and [Ag₃₂(S)₂(C₅O₅)₂{S₂P(OEt)₂}₂₂](PF₆)₂ (3), and characterized by multi-NMR spectroscopy and X-ray crystallography. As the template size increases, the shape and size of the clusters change accordingly. The template effect in high-nuclear silver clusters has been investigated in this work.

Hydride-Containing Eight-Electron Pt/Ag Superatoms: Structure, Bonding, and Multi-NMR Studies

Recent reports on hydride-doped noble metal nanoclusters strongly suggest that the encapsulated hydride is a part of the superatom core, but no accurate location of the hydride could be experimentally proved, so far. We report herein a hydride-doped eight-electron platinum/silver alloy nanocluster in which the position of four-coordinated hydride was determined by neutron diffraction for the first time. X-ray structures of [PtHAg₁₉(dtp/desp)₁₂] (dtp = S₂P(OⁿPr)₂, 1; dsep = Se₂P(OⁱPr)₂, 2) describe a central platinum hydride (PtH) unit encapsulated within a distorted Ag₁₂ icosahedron, the resulting (PtH)@Ag₁₂ core being stabilized by an outer sphere made up of 7 capping silver atoms and 12 dichalcogenolates. Solid-state structures of 1 and 2 differ somewhat in the spatial configuration of their outer spheres, resulting in overall different symmetries, C₁ and C₃, respectively. Whereas the multi-NMR spectra of 2 in solution at 173 K reveal that the structure of C₃ symmetry is the predominant one, ¹H and ¹⁹⁵Pt NMR spectra of 1 at the same temperature disclose the presence of isomers of both C₁ and C₃ symmetry. DFT calculations found both isomers to be very close in energy, supporting the fact that they co-exist in solution. They also show that the [PtH@Ag₁₂]⁵⁺ kernel can be viewed as a closed-shell superatomic core, the μ₄-hydride electron contributing to its eight-electron count. On the other hand, the 1s(H) orbital contributes only moderately to the superatomic orbitals, being mainly involved in the building of a Pt-H bonding electron pair with the 5d_z²(Pt) orbital.

Homoleptic Silver-Rich Trimetallic M20 Nanocluster

Two silver-rich M₂₀ alloy nanoclusters (NCs), [Cu_3.5Ag_16.5{S₂P(OⁿPr)₂}₁₂] (1) and [Cu_2.5AuAg_16.5{S₂P(OⁿPr)₂}₁₂] (2), were synthesized and fully characterized by electrospray ionization mass spectrometry, NMR spectroscopy, and X-ray crystallography. Cluster 2, the first structurally characterized trimetallic M₂₀ NC, was produced by doping one Au atom into a bimetallic M₂₀ NC. Structural analyses showed the preferred positions of Group 11 metals in the yielded M₂₀ NCs. Their antioxidation ability has been investigated, and the time-dependent UV-vis spectrum shows that the presence of Cu^I atoms in structures 1 and 2 can improve the antioxidant ability.

Investigations on the Wound Healing Potential of Tilapia Piscidin (TP)2-5 and TP2-6

Wound healing is a highly orchestrated process involving many cell types, such as keratinocytes, fibroblasts and endothelial cells. This study aimed to evaluate the potential application of synthetic peptides derived from tilapia piscidin (TP)2, TP2-5 and TP2-6 in skin wound healing. The treatment of HaCaT keratinocytes with TP2-5 and TP2-6 did not cause cytotoxicity, but did enhance cell proliferation and migration, which could be attributed to the activation of epidermal growth factor receptor signaling. In CCD-966SK fibroblasts, although TP2-5 (31.25 μg/mL) and TP2-6 (125 μg/mL) showed cytotoxic effects, we observed the significant promotion of cell proliferation and migration at low concentrations. In addition, collagen I, collagen III, and keratinocyte growth factor were upregulated by the peptides. We further found that TP2-5 and TP2-6 showed pro-angiogenic properties, including the enhancement of human umbilical vein endothelial cell (HUVEC) migration and the promotion of neovascularization. In a murine model, wounds treated topically with TP2-5 and TP2-6 were reduced by day 2 post-injury and healed significantly faster than untreated wounds. Taken together, these findings demonstrate that both TP2-5 and TP2-6 have multifaceted effects when used as topical agents for accelerating wound healing.

Distinct clinico-biological features in AML patients with low allelic ratio FLT3-ITD: role of allogeneic stem cell transplantation in first remission

The mutant burden of FLT3-ITD modulates its prognostic impact on patients with acute myeloid leukemia (AML). However, for patients with low allelic ratio (AR) FLT3-ITD (FLT3-ITD^low, AR < 0.5), clinical features, as well as genomic and transcriptomic profiles remain unclear, and evidence supporting allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) remains controversial. This study aimed to elucidate the genomic features, prognosis, and transplantation outcome of FLT3-ITD^Iow in AML patients with intermediate-risk cytogenetics. FLT3-ITD^low was associated with a negative enrichment of the leukemic stem cell signature, a marked enrichment of the RAS pathway, and with higher frequencies of RAS pathway mutations, different from those with FLT3-ITD^high. Concurrent CEBPA double mutations were favorable prognostic factors, whereas MLL-PTD, and mutations in splicing factors were unfavorable prognostic factors in FLT3-ITD^low patients. Patients with FLT3-ITD^low had a shorter overall survival (OS) and event-free survival (EFS) than those with FLT3^wt. Allo-HSCT in CR1 was associated with a significantly longer OS and EFS compared with postremission chemotherapy in patients with FLT3-ITD^low. In conclusion, FLT3-ITD^low is associated with different mutational and transcriptomic profiles compared with FLT3-ITD^high. The presence of concomitant poor-risk mutations exert negative prognostic impacts in patients with FLT3-ITD^low, who markedly benefit from allo-HSCT in CR1.

[Emulation pulmonary nodules localization model:a novel non-invasive localization technique in resection of pulmonary nodules]

Objective: To explore the accuracy and efficiency of a novel 3D-printed emulation localization model of small pulmonary nodules in lung surgery. Methods: From April 2020 to April 2021, a total of 66 patients were selected in the study, who underwent localization and resection of pulmonary nodules with video-assisted thoracoscopic surgery (VATS) guided by the 3D-printed emulation localization model at Department of Thoracic Surgery, West China Hospital of Sichuan University. There were 13 males and 53 females, aged from 25 to 79 (52.7±11.4) years. Of all patients, 24 (36.4%) had single pulmonary nodule, and 42 (63.6%) had synchronous multiple pulmonary nodules. The chest high-resolution CT image data were utilized for digital reconstruction and 3D printing to make a tailored life-size emulation pulmonary nodules localization model, which was used to navigate real-time intraoperative localization of nodules. Clinical data including operative parameters, localization information, resection types and pathological findings of nodules were analyzed. The pulmonary nodules that doctors planned to resect were categorized into two categories:major nodules and additional nodules, according to their presence of invasion and radiological risk factors. The accuracy of localization and resection efficiency of nodules were evaluated in accordance with the categories of the nodules respectively. Results: On the basis of preoperative evaluation, there were 71 major nodules with median maximal diameter of 0.9 (0.6-1.3) cm, and 77 additional nodules with median maximal diameter of 0.5 (0.4-0.7) cm. All patients underwent VATS surgery, 52 of them (78.8%) were treated with uniportal VATS and 14 (21.2%) with triportal VATS. Among the patients with single nodule, 18 segmentectomies and 6 wedge resections were performed; whereas among the patients with multiple nodules, 5 segmentectomies, 14 wedge resections, and 23 combined pulmonary resections (including 2 cases of lobectomy+segmentectomy, 7 cases of lobectomy+wedge resections, and 14 cases of segmentectomy+wedge resections) were achieved. The median operative time was 93 (45-240) min, and the median resection time for all nodules was 51.4 (6.7-147.0) min. All major nodules were successfully resected and visibly dissected after removal, and all additional nodules were successfully resected with 85.7%(66/77) nodules visibly dissected. The accuracy rate of localization of both types of nodules was 100%. All major nodules were malignant, and the malignancy rate of additional nodules was 21.2%(14/66). Conclusion: This novel 3D-printed emulation localization model of small pulmonary nodules proved to be a non-invasive, accurate and efficient technique. Not only that, it has a unique advantage in localization of synchronous multiple pulmonary nodules.

Alloying dichalcogenolate-protected Ag21 eight-electron nanoclusters: a DFT investigation

The isoelectronic doping of dichalcogenolato nanoclusters of the type [Ag₂₁{E₂P(OR)₂}₁₂]⁺ (E = S, Se) by any heteroatom belonging to groups 9-12 was systematically investigated using DFT calculations. Although they can differ in their global structure, all of these species have the same M@M₁₂-centered icosahedral core. In any case, the different structure types are all very close in energy. In all of them, three different alloying sites can be identified (central, icosahedral, peripheral) and calculations allowed the trends in heteroatom site occupation preference across the group 9-12 family to be revealed. These trends are supported by complementary experimental results. They were rationalized on the basis of electronegativity, potential involvement in the bonding of valence d-orbitals and atom size. TD-DFT calculations showed that the effect of doping on optical properties is sizable and this should stimulate research on the modulation of luminescence properties in the dithiolato and diseleno families of complexes.

Tilapia Piscidin 4 (TP4) Reprograms M1 Macrophages to M2 Phenotypes in Cell Models of Gardnerella vaginalis-Induced Vaginosis

Gardnerella vaginalis is associated with bacterial vaginosis (BV). The virulence factors produced by G. vaginalis are known to stimulate vaginal mucosal immune response, which is largely driven by activated macrophages. While Tilapia piscidin 4 (TP4), an antimicrobial peptide isolated from Nile tilapia, is known to display a broad range of antibacterial functions, it is unclear whether TP4 can affect macrophage polarization in the context of BV. In this study, we used the culture supernatants from G. vaginalis to stimulate differentiation of THP-1 and RAW264.7 cells to an M1 phenotype. The treatment activated the NF-κB/STAT1 signaling pathway, induced reactive nitrogen and oxygen species, and upregulated inflammatory mediators. We then treated the induced M1 macrophages directly with a non-toxic dose of TP4 or co-cultured the M1 macrophages with TP4-treated vaginal epithelial VK2 cells. The results showed that TP4 could not only decrease pro-inflammatory mediators in the M1 macrophages, but it also enriched markers of M2 macrophages. Further, we found that direct treatment with TP4 switched M1 macrophages toward a resolving M2c phenotype via the MAPK/ERK pathway and IL-10-STAT3 signaling. Conversely, tissue repair M2a macrophages were induced by TP4-treated VK2 cells; TP4 upregulated TSG-6 in VK2 cells, which subsequently activated STAT6 and M2a-related gene expression in the macrophages. In conclusion, our results imply that TP4 may be able to attenuate the virulence of G. vaginalis by inducing resolving M2c and tissue repair M2a macrophage polarizations, suggesting a novel strategy for BV therapy.

Reactivities of Interstitial Hydrides in a Cu11 Template: En Route to Bimetallic Clusters

In sharp contrast to surface hydrides, reactivities of interstitial hydrides are difficult to explore. When treated with a metal ion (Cu⁺ , Ag⁺ , and Au⁺ ), the stable Cu^I dihydride template [Cu₁₁ H₂ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ ] (H₂ Cu₁₁ ) generates surprisingly three very different compounds, namely [CuH₂ Cu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ ]⁺ (1), [AgH₂ Cu₁₄ {S₂ P(Oⁱ Pr)₂ }₆ ((C≡CPh)₆ ]⁺ (2), and [AuCu₁₁ {S₂ P(Oⁱ Pr)₂ }₆ (C≡CPh)₃ Cl] (3). Compounds 1 and 2 are both M^I species and maintain the same number of hydride ligands as their H₂ Cu₁₁ precursor. Neutron diffraction revealed the first time a trigonal-pyramidal hydride coordination mode in the AgCu₃ environment of 2. 3 has no hydride and exhibits a mixed-valent [AuCu₁₁ ]¹⁰⁺ metal core, making it a two-electron superatom.

Low-dose rivaroxaban associated with lower incidence of all-cause mortality and bleeding complications in older patients with non-valvular atrial fibrillation

Background

Low-dose rivaroxaban 10mg daily was used in the J-ROCKET AF trial, and it demonstrated the safety in Asian population. It remains unclear whether low-dose rivaroxaban vs. standard dose 20mg daily is associated with efficacy, safety, and net-clinical outcomes in older Asian patients with non-valvular atrial fibrillation.

Purpose

To evaluate the effects of low-dose rivaroxaban on efficacies and safeties in the old patients age more than 85 years.

Methods

We retrospectively enrolled the patients from medical records between Oct 2012 and Nov 2016. We used 2x2 factorial design by age of 85 years and use of low-dose rivaroxaban. The study outcomes were one-year all-cause mortality and bleeding complications.

Results

The study cohort consisted of 2,386 patients with the mean age 76.6 years (SD 10.5), 51.8% male, CHA2DS2Vsc 4.4 (SD 1.7) and HASBLED 1.6 (SD 1.0). In the age ≥85 group (n=593), low vs. standard dose rivaroxaban had a lower incidence of all-cause mortality (5.3% vs. 10.6%, P=0.021), whereas the incidence of all-cause mortality was greater in the low dose rivaroxaban compared with the standard dose in the age &lt;85 group (3.7% vs. 1.8%, P=0.012). No significant differences of bleeding complication rates were found between the low- and standard-dose rivaroxaban regarding age &lt;85 or ≥85 years. After adjusting for potential confounders, low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the age ≥85 group (adjusted HR: 0.400 95% CI: 0.215–0.743, P=0.004), but the significant association was not found in the age &lt;85 group (adjusted HR: 1.101 95% CI: 0.557–2.174, P=0.782).

Conclusion

Low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the patients with non-valvular atrial fibrillation and age ≥85 years.

Funding Acknowledgement

Type of funding sources: None.

Percutaneous transluminal angioplasty associated with a comparable risk of mortality in old patients with severe lower extremities arterial disease

Background

Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients.

Purpose

We investigated the effect of age ≥85 vs &lt;85 years on prognoses in LEAD patients.

Methods

We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs).

Results

The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005).

Conclusion

Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different.

Funding Acknowledgement

Type of funding sources: None. Study outcomes in LEAD patients

[Treatment strategies and research progress of acute ilio-femoral deep vein thrombosis]

In the past,treatment of acute ilio-femoral deep vein thrombosis (IFDVT) was mainly based on anticoagulation alone,but 30%-50% of patients will develop post-thrombotic syndrome,causing a serious medical burden.Thrombus removal technology such as catheter-directed thrombolysis and percutaneous mechanical thrombectomy can effectively remove blood clots and compensate for the deficiencies of simple anticoagulation,which is expected to improve the prognosis of such disease,but the current evidence is insufficient,and other treatments such as filter implantation and compression therapy are also controversial.This article summarizes the treatment strategies and the latest progress of acute IFDVT,hoping to help the treatment of this type of disease.

All-selenolate-protected eight-electron platinum/silver nanoclusters

The first atomically and structurally precise platinum/silver superatoms protected by Se-donor ligands were synthesized in high yield by adopting ligand replacements on [PtAg₂₀{S₂P(OⁿPr)₂}₁₂] (3) with 12 equiv. of di-alkyl diselenophosph(in)ates. Structures of [PtAg₂₀{Se₂P(OR)₂}₁₂] (R = ⁿPr (1a), ⁱPr (1b)) and [PtAg₂₀{Se₂P(CH₂CH₂Ph)₂}₁₂] (2) were accurately determined by single-crystal X-ray diffraction to reveal an eight-electron [Pt@Ag₁₂]⁴⁺ icosahedral core embedded within a cube of eight silver(i) atoms and wrapped into a shell of 12 diselenophosph(in)ates. While the lowest energy absorption band of the Se derivatives is red-shifted to longer wavelengths in comparison with the S analogue, it is blue-shifted in the emission spectra. Density functional theory (DFT) and TD-DFT calculations rationalize the electronic structures as those of eight-electron superatoms, with their HOMO and LUMO being the 1P and 1D levels, respectively. The two UV-visible lowest bands are associated with 1P → 1D metal to metal charge transfer (MMCT) transitions. The blue shift observed for the S analogue results from a larger HOMO-LUMO gap in the case of dithiolate ligands.

Doping effect on the structure and properties of eight-electron silver nanoclusters

The bimetallic M₂₀ and M₂₁ compounds, {[Cu₃Ag₁₇{S₂P(OⁱPr)₂}₁₂]_0.5 [Cu₄Ag₁₆{S₂P(OⁱPr)₂}₁₂]_0.5} ({[1a]_0.5[1b]_0.5}) and [Cu₄Ag₁₇{S₂P(OⁱPr)₂}₁₂](PF₆) (2), have been structurally characterized, in which the Cu(I) ions are randomly distributed on the eight outer positions capping the eight-electron [Ag₁₃]⁵⁺ core. DFT calculations show that the statistical disorder results from the nearly neutral preference of copper to occupy any of the eight outer positions. Surprisingly, the UV-Vis absorption spectra of the M₂₀ and M₂₁ bimetallic nanoclusters display an almost identical absorption profile as that of their homometallic [Ag₂₀{S₂P(OⁱPr)₂}₁₂] and [Ag₂₁{S₂P(OⁱPr)₂}₁₂]⁺ relatives. This is rationalized by TD-DFT calculations, which show that the frontier orbitals of such eight-electron alloys are largely independent from the nature of the capping metal ions. A blue-shifted absorption is observed upon replacing by Au the central Ag atom in 2, forming the trimetallic compound [Cu₄AuAg₁₆{S₂P(OⁱPr)₂}₁₂](PF₆) (3).

Synthesis and Luminescence Properties of Two-Electron Bimetallic Cu-Ag and Cu-Au Nanoclusters via Copper Hydride Precursors

The synthesis, structural characteristics, and photophysical properties of luminescent Cu-rich bimetallic superatomic clusters [Au@Cu₁₂(S₂CNⁿPr₂)₆(C≡CPh)₄]⁺ (1a⁺), [Au@Cu₁₂{S₂P(OR)₂}₆(C≡CPh)₄]⁺ (2⁺), (2a⁺ = ⁱPr; 2b⁺ = ⁿPr), [Au@Cu₁₂{S₂P(C₂H₄Ph)₂}₆(C≡CPh)₄]⁺ (2c⁺), and [Ag@Cu₁₂{S₂P(OⁿPr)₂}₆(C≡CPh)₄]⁺ (3⁺) were studied. Compositionally uniform clusters 1⁺-3⁺ were isolated from the reaction of dithiolato-stabilized, polyhydrido copper clusters with phenylacetylene in the presence of heterometal salts. By using X-ray diffraction, the structures of 1a⁺, 2a⁺, 2b⁺, and 3⁺ were able to be determined. ESI-mass spectrometry and elemental analysis confirmed their compositions and purity. The structural characteristics of these clusters are similar with respect to displaying gold (or silver)-centered Cu₁₂ cuboctahedra surrounded by six dithiocarbamate/dithiophosph(in)ate and four alkynyl ligands. The doping of Au and Ag atoms into the polyhydrido copper nanoclusters significantly enhances their PL quantum yields from Ag@Cu₁₂ (0.58%) to Au@Cu₁₂ (55%) at ambient temperature in solution. In addition, the electrochemical properties of the new alloys were investigated by cyclic voltammetry.

Isolation and Structural Elucidation of 15-Nuclear Copper Dihydride Clusters: An Intermediate in the Formation of a Two-Electron Copper Superatom

Highly reactive copper-dihydride clusters, [Cu₁₅ (H)₂ (S₂ CNR₂ )₆ (C₂ Ph)₆ ](PF₆ ) {R = ⁿ Bu (1_H ), ⁿ Pr (2_H ), ⁱ Bu (3_H )}, are isolated during the reaction of [Cu₂₈ H₁₅ {S₂ CNⁿ Bu₂ }₁₂ ](PF₆ ) with ten equivalents of phenylacetylene. They are found to be intermediates in the formation of the earlier reported two-electron superatom [Cu₁₃ (S₂ CNR₂ )₆ (C₂ Ph)₄ ]⁺ . Better yields are obtained by reacting dithiocarbamate sodium salts, [Cu(CH₃ CN)₄ ](PF₆ ), BH₄^- and phenylacetylene. The presence of two hydrides in the isolated clusters is confirmed by the synthesis and characterization of its deuteride analogue [Cu₁₅ (D)₂ (S₂ CNR₂ )₆ (C₂ Ph)₆ ]⁺ , and a single-crystal neutron structure of 2_H . Structural characterization of 1_H reveals a new bicapped icosahedral copper(I) cage encapsulating a linear copper dihydride (CuH₂ )^- unit. Reaction of 3_H with Au(I) salts yields a highly luminescent [AuCu₁₂ (S₂ CNⁱ Bu₂ )₆ (C₂ Ph)₄ ]⁺ cluster.

[Cu{SC(O)OiPr}]96: A Giant Self-Assembled Copper(I) Supramolecular Wheel Exhibiting Photoluminescence Tuning and Correlations with Dynamic Solvation and Solventless Synthesis

The hierarchical self-organization of structurally complex high-nuclearity metal clusters with metallosupramolecular wheel architectures that are obtained from the self-assembly of smaller solvated cluster units is rare and unique. Here, we use the potentially heteroditopic monothiocarbonate ligand and demonstrate for the first time the synthesis and structure of a solvated non-cyclic hexadecanuclear cluster [Cu{SC(O)OⁱPr}]₁₆·2THF (1) that can simultaneously desolvate and self-assemble in solution and subsequently form a giant metallaring, [Cu{SC(O)OⁱPr}]₉₆ (2). We also demonstrate a luminescent precursor to cluster (2) can be achieved through a solventless and rapid mechanochemical synthesis. Cluster (2) is the highest nuclearity copper(I) wheel and the largest metal cluster containing a heterodichalcogen (O, S) ligand reported to date. Cluster (2) also exhibits solid-state luminescence with relatively long emission lifetimes at 4.1, 13.9 (μs). The synthetic strategy described here opens new research avenues by replacing solvent molecules in stable {Cu₁₆} clusters with designed building units that can form new hybrid and multifunctional finite supramolecular materials. This finding may lead to the development of novel high-nuclearity materials self-assembled in a facile manner with tunable optical properties.

Intercluster exchanges leading to hydride-centered bimetallic clusters: a multi-NMR, X-ray crystallographic, and DFT study

Encouraged by the successful syntheses of alloy nanoclusters (or nanoparticles) via intercluster (or interparticle) reactions, herein we apply this methodology to prepare a series of bimetallic hydride clusters. Mixing of two clusters, [Ag₇(H){E₂P(OⁱPr)₂}₆] (E = S, 1; Se, 3) and [Cu₇(H){E₂P(OⁱPr)₂}₆] (E = S, 2; Se, 4), yields two series of hydride-centered bimetallic clusters, [Cu_xAg_7-x(H){E₂P(OⁱPr)₂}₆] (x = 0-7; E = S, 5; Se, 6). Their compositions are fully characterized by positive-mode ESI-MS spectrometry, multi-NMR spectroscopy, and the structures of [Cu₆Ag(H){S₂P(OⁱPr)₂}₆] (5a) and [CuAg₆(H){Se₂P(OⁱPr)₂}₆] (6a) by single crystal X-ray diffraction. The presence of individual compounds in solution is the result of a (dynamic) chemical equilibrium primarily driven by metal exchanges. In fact, the process of inter-cluster exchange of 1 and 2 leading to hydride-centered bimetallic clusters 5 can be monitored by concentration-dependent ³¹P NMR spectroscopy of which the higher concentration of 1 in the reaction, the closer to its resonance will be the distribution, in accord with Le Chatelier's principle. The dynamic equilibrium is further confirmed by 2D exchange spectroscopy that reveals a stepwise process involving one metal exchange at a time. DFT calculations on a model series of clusters 6 show that silver prefers occupying the inner tetrahedral positions, while copper favors capping positions, in full agreement with the crystal structure of 5a and 6a.

A construction guide for high-nuclearity (≥50 metal atoms) coinage metal clusters at the nanoscale: bridging molecular precise constructs with the bulk material phase

Synthesis remains a major strength in chemistry and materials science and relies on the formation of new molecules and diverse forms of matter. The construction and identification of large molecules poses specific challenges and has historically lain in the realm of biological (organic)-type molecules with evolved synthesis methods to support such endeavours. But with the development of analytical tools such as X-ray crystallography, new synthesis methods toward large metal-based (inorganic) molecules and clusters have come to the fore, making it possible to accurately determine the precise distribution of hundreds of atoms in large clusters. In this review, we focus on different synthesis protocols used to form new metal clusters such as templating, alloying and size-focusing strategies. A specific focus is on group 11 metals (Cu, Ag, Au) as they currently predominate large metal cluster investigations and related Au and Ag bulk surface phenomena. This review focuses on metal clusters that have very high-nuclearity, i.e. with 50 or more metal centers within the isolated cluster. This size domain, it is believed, will become increasingly important for a variety of applications as these metal clusters are positioned at the interface between the molecular and bulk phases, whilst remaining a classic nanomaterial and retaining unique nano-sized properties.

Electron counting and bonding patterns in assemblies of three and more silver-rich superatoms

DFT calculations were carried out on a series of cluster cores, the framework of which was made of the condensation of several Pt@Ag12-centered icosahedra. Icosahedral condensations through vertex-sharing, face-sharing, and interpenetration were considered and their favored electron counts were determined from their stable closed-shell configurations. A large number of the computed assemblies of n icosahedral superatomic units can be considered as isolobal analogs of stable, closed-shell n-atom molecules, most of them obeying the octet rule. The larger the degree of fusion between icosahedra, the stronger the interaction between them. For example, it was possible to design 3-icosahedral supermolecular cores analogous to CO2, SF2, or [I3]-, but also to the not-yet-isolated cyclic O3. Supermolecules equivalent to non-stable molecules can also be designed. Indeed, differences exist between atoms and superatoms, and original icosahedra assemblies with no "molecular" analogs are also likely to exist, especially with compact structures and/or systems made of a large number of fused superatoms.

Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis

The erector spinae plane block is a new regional anaesthesia technique that provides truncal anaesthesia for breast surgery. This systematic review and meta-analysis was undertaken to determine if the erector spinae plane block is effective at reducing pain scores and opioid consumption after breast surgery. This study also evaluated the outcomes of erector spinae plane blocks compared with other regional blocks. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomised controlled trials reporting the use of the erector spinae plane block in adult breast surgery. Risk of bias was assessed with the revised Cochrane risk-of-bias tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess trial quality. Thirteen randomised controlled trials (861 patients; 418 erector spinae plane block, 215 no blocks, 228 other blocks) were included. Erector spinae plane block reduced postoperative pain compared with no block: at 0-2 hours (mean difference (95% CI) -1.63 (-2.97 to -0.29), 6 studies, 329 patients, high-quality evidence, I²  = 98%, p = 0.02); at 6 hours (mean difference (95% CI) -0.90 (-1.49 to -0.30), 5 studies, 250 patients, high-quality evidence, I²  = 91%, p = 0.003); at 12 hours (mean difference (95% CI) -0.46 (-0.67 to -0.25), 5 studies, 250 patients, high-quality evidence, I²  = 58%, p < 0.0001); and at 24 hours (mean difference (95% CI) -0.50 (-0.70 to -0.30), 6 studies, 329 patients, high-quality evidence, I²  = 76%, p < 0.00001). Compared with no block, erector spinae plane block also showed significantly lower postoperative oral morphine equivalent requirements (mean difference (95% CI) -21.55mg (-32.57 to -10.52), 7 studies, 429 patients, high-quality evidence, I²  = 99%, p = 0.0001). Separate analysis of studies comparing erector spinae plane block with pectoralis nerve block and paravertebral block showed that its analgesic efficacy was inferior to pectoralis nerve block and similar to paravertebral block. The incidence of pneumothorax was 2.6% in the paravertebral block group; there were no reports of complications of the other blocks. This review has shown that the erector spinae plane block is more effective at reducing postoperative opioid consumption and pain scores up to 24 hours compared with general anaesthesia alone. However, it was inferior to the pectoralis nerve block and its efficacy was similar to paravertebral block. Further evidence, preferably from properly blinded trials, is required to confirm these findings.

[Molecular epidemiology of Listeria monocytogenes isolated from ready-to-eat food in 2017 in China]

Objective: To analyze the molecular characteristics of Listeria monocytogenes strains from ready-to eat food in China. Methods: A total of 239 Listeria monocytogenes strains isolated from ready-to-eat food in 2017, all strains underwent whole-genome sequencing (WGS) , and comparisons uncovered population structure derived from lineages, clonal complex, serogroups, antimicrobial susceptibility and virulence, which were inferred in silico from the WGS data. Core genome multilocus sequence typing was used to subtype isolates. Results: All strains were categorized into three different lineages, lineage Ⅱ was the predominant types in food, and IIa was the main serogroups. CC8, CC101 and CC87 were the first three prevalent CCs among 23 detected CCs, accounting for 49.4%. Only 4.6% (11 isolates) of tested strains harbored antibiotic resistance genes, which were mostly trimethoprim genes (7 isolates, 2.9%). All strains were positive for LIPI-1, and only a part of strains harbored LIPI-3 and LIPI-4, accounting for 13.8% (33 isolates) and 14.2% (34 isolates), respectively. ST619 carried both LIPI-3 and LIPI-4. 51.5% (123 isolates) of strains carried SSI-1, and all CC121 strains harbored SSI-2. Different lineages, serogroups and CCs can be separated obviously through cgMLST analysis, and 24 sublineages were highly concordant with CCs. Conclusion: Ⅱa was the main serogroups in ready-to-eat food isolates in China; CC8, CC101 and CC87 were the prevalent CCs, and CC87 isolates was hypervirulent isolates, cgMLST method can be adopted for prospective foodborne disease surveillance and outbreaks detection.

P282 Elevated serum uric acid associated with both electrocardiographic and echocardiographic left ventricular hypertrophy independent of blood pressure in healthy individuals

Funding Acknowledgements

TSGH 108-11

Background

Elevated serum uric acid (SUA) is associated with cardiac fibrosis and hypertrophy. A growing body of evidence showed the positive correlation between hyperuricemia (HUA) and left ventricular hypertrophy (LVH), but most studies defined LVH by a single method such as electrocardiogram or echocardiogram; the former is generally used in massive screen but the latter take advantage of the accuracy of LVH.

Purpose

We conducted this study to concomitantly investigate the association between SUA and electrocardiographic and echocardiographic LVH.

Methods

We initially enrolled 17,913 healthy individuals, who routinely underwent an annual health exam at our hospital between 2016/1/1∼2016/12/31. Of them, 347 individuals received transthoracic echocardiography because of abnormal results in their electrocardiogram. Amplitudes of 12-lead electrocardiogram were artificially measured by a study assistant under the supervision and by artificial intelligence. HUA is defined as an SUA level of ≥7 mg/dl in men and ≥6 mg/dl in women. Electrocardiographic LVH is defined by the criteria of Cornel voltage and product and Sokolow-Lyon and the Minnesota Code ECG classification. Echocardiographic LVH is defined by LV mass index ≥115g/m² in men or ≥95g/m² in women.

Results

The HUA group (n = 233) vs. normouricemic group (n = 114) was older and predominant male with greater values of body mass index, systolic and diastolic blood pressure and laboratory biomarkers, including non-high density total cholesterol, fasting glucose impairment, creatinine clearance, and haemoglobin. The two groups had comparable lifestyle choices, including tobacco use, alcohol intake, and physical activities per week. The HUA group compared with the normouricemic group had greater values of S amplitude of V1 plus R amplitude of V5 (3031 ± 2055 uV vs. 2566 ± 1021 uV, P = 0.005), R amplitude in lead I plus S amplitude in lead III (842 ± 443 uV vs. 696 ± 386 uV, P = 0.002) and LV mass index (95 ± 23 g/m² vs. 85 ± 30 g/m², P = 0.001). The prevalence of electrocardiographic and echocardiographic LVH was greater in the HUA group than the normouricemic group (7.0% vs. 2.1%, P = 0.034 for electrocardiographic LVH and 15.8% vs. 7.7%, P = 0.025 for echocardiographic LVH). In multivariate logistic regression analyses, elevated SUA was associated with LVH after the confounders were fully adjusted (OR: 1.38, 95% CI: 1.07-1.77, P = 0.012 for electrocardiographic LVH and OR: 1.58, 95% CI 1.15-2.17, P = 0.004 for echocardiographic LVH).

Conclusion

Elevated SUA is independently associated with the prevalence of both electrocardiographic and echocardiographic LVH in healthy individuals from Taiwan. Future studies might evaluate urate-lowering effects on the regression of LVH.

P1684Elevated serum uric acid associated with hypertension in healthy individuals

Background

Elevated serum uric acid (SUA) induces endothelial dysfunction and is associated with hypertension according to the traditional definition of hypertension. The impact of a divergent definition of hypertension between contemporary guidelines is unclear.

Purpose

We conducted the present study to investigate the association between SUA and new-onset hypertension according to contemporary blood pressure guidelines.

Methods

We enrolled 10,537 healthy individuals aged more than 30 years, who routinely underwent an annual health exam with office blood pressure records at our hospital in 2016; of them, 7,349 individuals repeated the exam in 2017. The individuals with hypertension at baseline were excluded, and the rest of the study population were divided into the European Society of Cardiology (ESC) cohort and the American College of Cardiology (ACC) cohort. According to the ESC guideline, hypertension was defined as office BP ≥140/90 mm Hg, whereas ACC guidelines defined hypertension as blood pressure ≥130/80 mm Hg. Hyperuricemia (HUA) is defined as an SUA level of ≥7 mg/dl in men and ≥6 mg/dl in women.

Results

The study population consisted of 6,378 individuals in the ESC cohort and 4,330 individuals in the ACC cohort. The HUA group was predominantly male and older than the normouricemic group and had a greater ratio of alcohol intake and histories of gout, and greater values of laboratory cardiometabolic biomarker values. The incidence of hypertension was 5.8% in the ESC cohort and 19% in the ACC cohort. Incident hypertension was significantly greater in the HUA vs. normouricemic group (8.6% vs. 4.7%, P<0.001 for ESC and 25.5% vs. 16.9%, P<0.001 for ACC). In multivariate logistic regression analyses, each increment of SUA was associated with increased risks of incident hypertension after age, gender, body mass index, blood pressure at baseline, fasting glucose were adjusted (OR: 1.160, 95% CI: 1.056–1.274, P=0.002 for ESC and OR: 1.120, 95% CI: 1.040–1.207, P=0.031 for ACC).

Incidence of hypertension

Conclusion

Elevated SUA was associated with incident hypertension in healthy individuals from Taiwan regarding various contemporary blood pressure guidelines. Future studies might investigate the effect of urate-lowering therapy on lowering blood pressure.

Acknowledgement/Funding

TSGH 108-14

Mono- and hexa-palladium doped silver nanoclusters stabilized by dithiolates

The synthesis, via a co-reduction method, of the first Pd-containing silver-rich 21-metal-atom nanocluster passivated by dithiolates, [PdAg20{S2P(OnPr)2}12] (1), is reported. 1 is an 8 electron superatom isoelectronic to [Ag21{S2P(OiPr)2}12]+. The doping of Pd in 1 leads to its high stability against degradation in solution and shows red emission in MeTHF at 77 K. In addition, we report the X-ray crystal structure of a multi-palladium doped silver nanocluster, [Pd6Ag14(S){S2P(OnPr)2}12] (2), for the first time. Its X-ray structure exhibits a sulfide-centered Pd6Ag2 rhombohedron surrounded by twelve additional silver atoms with S6 symmetry. The XPS study and DFT calculations indicate that 2 contains Pd(0) and Ag(i) metals. A significant decrease in the electrochemical gap was observed in the SWVs of 2.

Incorporation of long non-coding RNA expression profile in the 2017 ELN risk classification can improve prognostic prediction of acute myeloid leukemia patients

Background

Expression of long non-coding RNAs (lncRNAs) has recently been recognized as a potential prognostic marker in acute myeloid leukemia (AML). However, it remains unclear whether incorporation of the lncRNAs expression in the 2017 European LeukemiaNet (ELN) risk classification can further improve the prognostic prediction.

Methods

We enrolled 275 newly diagnosed non-M3 AML patients and randomly assigned them to the training (n = 183) and validation cohorts (n = 92). In the training cohort, we formulated a prognostic lncRNA scoring system composed of five lncRNAs with significant prognostic impact from the lncRNA expression profiling.

Findings

Higher lncRNA scores were significantly associated with older age and adverse gene mutations. Further, the higher-score patients had shorter overall and disease-free survival than lower-score patients, which were also confirmed in both internal and external validation cohorts (TCGA database). The multivariate analyses revealed the lncRNA score was an independent prognosticator in AML, irrespective of the risk based on the 2017 ELN classification. Moreover, in the 2017 ELN intermediate-risk subgroup, lncRNA scoring system could well dichotomize the patients into two groups with distinct prognosis. Within the ELN intermediate-risk subgroup, we found that allogeneic hematopoietic stem cell transplantation could provide better outcome on patients with higher lncRNA scores. Through bioinformatics approach, we identified high lncRNA scores were correlated with leukemia/hematopoietic stem cell signatures.

Interpretation

Incorporation of lncRNA scoring system in 2017 ELN classification can improve risk-stratification of AML patients and help clinical decision-making.

Fund

This work was supported Ministry of Science and Technology, and Ministry of Health and Welfare of Taiwan.

Synthesis and structural characterization of inverse-coordination clusters from a two-electron superatomic copper nanocluster

We have synthesized and structurally characterized a series of centred cuboctahedral copper clusters, namely [Cu13{S2CNR2}6{C[triple bond, length as m-dash]CR'}4](PF6), 1a-d (where a: R = n Bu, R' = CO2Me; b: R = n Bu, R' = CO2Et; c: R = iPr, R' = CO2Et; d: R = n Pr, R' = 3,5-(CF3)2C6H3); [Cu12(μ12-S){S2CNR2}6{C[triple bond, length as m-dash]CR'}4], 2a-c; [Cu12(μ12-Cl){S2CNR2}6{C[triple bond, length as m-dash]CR'}4](PF6), 3a-e (where e: R = n Bu, R' = Ph); [Cu12(μ12-Br){S2CN n Bu2}6{C[triple bond, length as m-dash]CPh}4](PF6), 4e; and [Cu12(μ12-Cl)(μ3-Cl){S2CN n Bu2}6{C[triple bond, length as m-dash]CCO2Me}3]+ 5a. Cluster 1a is the first structurally characterized copper cluster having a Cu13 centered cuboctahedral arrangement, a miniature of the bulk copper fcc structure. Furthermore, the partial Cu(0) character in the 2-electron superatoms 1 was confirmed by XANES. Inverse coordination clusters 2-5 are the first examples of copper clusters containing main group elements (Cl, Br, S) with a hyper-coordination number, twelve. A combined theoretical and experimental study was performed, which shows that the central copper (formally Cu1-) in nanoclusters 1 can be replaced by chalcogen/halogen atoms, resulting in the formation of clusters 2-5 which show enhanced luminescence properties and increase in the ionic component of the host-guest interaction as Br ≈ Cl > S > Cu, which is consistent with the Cu-X Wiberg indices. The new compounds have been characterized by ESI-MS, 1H, 13C NMR, IR, UV-visible, emission spectroscopy, and the structures 2a-b, 3d-e, 4e and 5a were established by X-ray diffraction analysis.

[Clinical application of Acutegastrointestinal injury grading system assocaited with clinical severity outcome in critically ill patients: a multi-center prospective, observational study]

Objective: To investigate the feasibility of utilizing the current acute gastrointestinal injury(AGI) grading system, and explore the association of severity of AGI grade with clinical outcome in critically ill patients. Methods: The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24 h were recruited, and all clinical, laboratory, and survival data were prospectively collected. The AGI grade was daily assessed based on GIsymptoms, feeding details and organ dysfunctionon the first week of admission to ICU.The intra-abdominal pressures(IAP) was measured using AbViser device. Results: Of 550 patients enrolled, mean values for age and APACHE Ⅱ score were (64.9±17.2) years and (19.5±7.4), respectively. 456 patients(82.9%) took mechanical ventilation, and 470 patients were identified for AGI. The distribution of AGI grade on the frist day of ICU admission were 50.6%(Ⅰ grade, n=238), 34.2%(Ⅱ grade, n=161), 12.4%(Ⅲ grade, n=58) and 2.8%(Ⅳ, n=13), respectively, while the distribution of the global AGI grade based on the 7-day AGI assessment of ICU admission were 24.5%(Ⅰ grade, n=115), 49.4%(Ⅱ grade, n=232), 20.6%(Ⅲ grade, n=97) and 5.5%(Ⅳ, n=26), respectively. 28- and 60-day mortality rate was 29.3%(n=161) and 32.5%(n=179), respectively. The patients with AGI had a higher 28-(31.1% vs 18.8%, P=0.025) and 60-day survival rate(34.7% vs 20.0%, P=0.01) than those with non-AGI, and also there were positive correlations between AGI grade and 28- and 60-day mortality(P<0.001). Univariate Cox regression analysis showed that age, the source of medicial admission, diabetes mellitus, coronary heart disease, the use of vasoactive drugs, serum creatinine and lactate, mechanical ventilation, APACHE Ⅱ score, the AGI grade in the first day of ICU admission and feeding intolerance within the first week of ICU stay were significantly(P≤0.02) associated with mortality. In multivariate analysis including all these variables, the source of medical admission(χ(2)=4.34, P=0.04), diabete mellitus(χ(2)=3.96, P=0.05), the use of vasoactive drugs(χ(2)=6.55, P=0.01), serum lactate(χ(2)=4.73, P=0.03), the global AGI grade in the 7-day of ICU admission(χ(2)=7.10, P=0.008), and APACHE Ⅱ score(χ(2)=12.1, P<0.001) remained independent predictors for 60-day mortality.In the further subgroup analysis including 402 patients with 7-day survival, the feeding intolerance within the first week of ICU stay could provide independent and incremental prognostic value of 60-day mortality wtih increased χ(2)value of Cox regression model(χ(2)=52.2 vs 41.9, P=0.007) . Conclusion: The AGI grading system is useful for identifying the severity of gastrointestinal dysfunction, and could be used as a strong predictor of impaired outcome. The results provide evidence to support that feeding intolerance within 7 days of admission to ICU was an independent determinant of mortality.