Fluorine-Containing Poly(Fluorene)-Based Anion Exchange Membrane with High Hydroxide Conductivity and Physicochemical Stability for Water Electrolysis

Improving the hydroxide conductivity and dimensional stability of anion exchange membranes (AEMs) while retaining their high alkaline stability is necessary to realize the commercialization of AEM water electrolysis (AEMWE). A strategy for improving the hydroxide conductivity and dimensional stability of AEMs by inserting fluorine atoms in the core structure of the backbone is reported, which not only reduces the glass transition temperature of the polymer due to steric strain, but also induces distinct phase separation by inducing polarity discrimination to facilitate the formation of ion transport channels. The resulting PFPFTP-QA AEM with fluorine into the core structure shows high hydroxide conductivity (>159 mS cm-1 at 80 °C), favorable dimensional stability (>25% at 80 °C), and excellent alkaline stability for 1000 h in 2 m KOH solution at 80 °C. Moreover, the PFPFTP-QA is used to construct an AEMWE cell with a platinum group metal (PGM)-free NiFe anode, which exhibits the current density of 6.86 A cm-2 at 1.9 V at 80 °C, the highest performance in Pt/C cathode and PGM-free anode reports so far and operates stably for over 100 h at a constant current of 0.5 A cm-2 .

MXene Hybrid Nanosheet of WS2/Ti3C2 for Electrocatalytic Hydrogen Evolution Reaction

Designing low-cost hybrid electrocatalysts for hydrogen production is of significant importance. Recently, MXene-based materials are being increasingly employed in energy storage devices owing to their layered structure and high electrical conductivity. In this study, we propose a facile hydrothermal strategy for producing WS2/Ti3C2 nanosheets that function as electrocatalysts in the hydrogen evolution reaction (HER). WS2 provides a high surface area and active sites for electrocatalytic activity, whereas MXene Ti3C2 facilitates charge transfer. As a result, the synthesized WS2/Ti3C2 offers an increased surface area and exhibits an enhanced electrocatalytic activity in acidic media. The WS2/Ti3C2 (10%) catalyst exhibited a low onset potential of -150 mV versus RHE for the HER and a low Tafel slope of ∼62 mV dec-1. Moreover, WS2/Ti3C2 (10%) exhibited a double-layer capacitance of 1.2 mF/cm-2, which is 3 and 6 times greater than those of bare WS2 and Ti3C2, respectively. This catalyst also maintained a steady catalytic activity for the HER for over 1000 cycles.

Constructing a NiMnS electrode with a Mn-rich surface for hydrogen production in anion exchange membrane water electrolyzers

Efficient alkaline hydrogen evolution electrodes must be used for hydrogen production in anion exchange membrane water electrolyzers (AEMWEs). Therefore, we fabricated a NiMnS catalyst with a Mn-rich surface, which was self-supported on Ti paper through one-step electrodeposition. Mn doping endowed the catalyst with a unique hollow morphology and lattice-distorted structure. Consequently, the NiMnS/Ti electrode exhibited a large number of exposed electrochemical surfaces and effective active sites and a high hydrogen evolution reaction (HER) activity. Specifically, in half-cell measurements, the NiMnS/Ti electrode exhibited an overpotential of 65 mV at 10 mA cm-2, which was lower than that of NiS/Ti (102 mV) and indicated its superior HER activity. When the proposed cathode was applied in an AEMWE single cell, the device achieved a high current density of up to 0.9 A cm-2 at a cell potential of 2.0 V.

Transition Metal Ion Doping on ZIF-8 Enhances the Electrochemical CO2 Reduction Reaction

The electrochemical reduction of CO2  to diverse value-added chemicals is a unique, environmentally friendly approach for curbing greenhouse gas emissions while addressing sluggish catalytic activity and low Faradaic efficiency (FE) of electrocatalysts. Here, zeolite-imidazolate-frameworks-8 (ZIF-8) containing various transition metal ions-Ni, Fe, and Cu-at varying concentrations upon doping are fabricated for the electrocatalytic CO2 reduction reaction (CO2 RR) to carbon monoxide (CO) without further processing. Atom coordination environments and theoretical electrocatalytic performance are scrutinized via X-ray absorption spectroscopy (XAS) and density functional theory (DFT) calculations. Upon optimized Cu doping on ZIF-8, Cu0.5 Zn0.5 /ZIF-8 achieves a high partial current density of 11.57 mA cm-2 and maximum FE for CO of 88.5% at -1.0 V (versus RHE) with a stable catalytic activity over 6 h. Furthermore, the electron-rich sp2 C atom facilitates COOH* promotion after Cu doping of ZIF-8, leading to a local effect between the zinc-nitrogen (Zn-N4 ) and copper-nitrogen (Cu-N4 ) moieties. Additionally, the advanced CO2 RR pathway is illustrated from various perspectives, including the pre-H-covered state under the CO2 RR. The findings expand the pool of efficient metal-organic framework (MOF)-based CO2 RR catalysts, deeming them viable alternatives to conventional catalysts.

Interplay between copper redox and transfer and support acidity and topology in low temperature NH3-SCR

Low-temperature standard NH₃-SCR over copper-exchanged zeolite catalysts occurs on NH₃-solvated Cu-ion active sites in a quasi-homogeneous manner. As key kinetically relevant reaction steps, the reaction intermediate Cu^II(NH₃)₄ ion hydrolyzes to Cu^II(OH)(NH₃)₃ ion to gain redox activity. The Cu^II(OH)(NH₃)₃ ion also transfers between neighboring zeolite cages to form highly reactive reaction intermediates. Via operando electron paramagnetic resonance spectroscopy and SCR kinetic measurements and density functional theory calculations, we demonstrate here that such kinetically relevant steps become energetically more difficult with lower support Brønsted acid strength and density. Consequently, Cu/LTA displays lower Cu atomic efficiency than Cu/CHA and Cu/AEI, which can also be rationalized by considering differences in their support topology. By carrying out hydrothermal aging to eliminate support Brønsted acid sites, both Cu^II(NH₃)₄ ion hydrolysis and Cu^II(OH)(NH₃)₃ ion migration are hindered, leading to a marked decrease in Cu atomic efficiency for all catalysts.

An electrochemically fabricated cobalt iron oxyhydroxide bifunctional electrode for an anion exchange membrane water electrolyzer

For an anion exchange membrane water electrolyzer (AEMWE), exploring bifunctional electrodes with low cost and high efficiency is a crucial task for future renewable energy systems. Herein, we report a simple method to fabricate cobalt iron oxyhydroxide (Co_zFe_1-zO_xH_y) bifunctional electrodes for AEMWEs. The bifunctional electrodes were prepared via one-pot electrodeposition on Ti paper (TP). By adjusting the electrodeposition conditions, the morphology and composition of Co_zFe_1-zO_xH_y/TP could be controlled. The Co₆₅Fe₃₅O_xH_y/TP electrode demonstrated the highest activity for overall water electrolysis owing to the maximized synergy effect between Co and Fe. The bifunctional activities of Co₆₅Fe₃₅O_xH_y/TP were well retained at -50 and 50 mA cm^-2 for 12 h. Co₆₅Fe₃₅O_xH_y/TP, which shows the highest bifunctional activity, was employed in an AEMWE single cell as the anode and cathode. The AEMWE single cell employing Co₆₅Fe₃₅O_xH_y/TP showed a current density of 0.605 A cm^-2 at a cell voltage of 2.0 V_cell. The calculated energy efficiency of the single cell is 55.7% at 2.0 A cm^-2, which is comparable with those of the state-of-the-art AEMWE single cells with bifunctional electrodes. Furthermore, the cell voltage of the single cell with Co₆₅Fe₃₅O_xH_y/TP showed negligible degradation for 50 h at 0.6 A cm^-2.

Recent Advances in Electrochemical, Photochemical, and Photoelectrochemical Reduction of CO2 to C2+ Products

Environmental problems such as global warming are one of the most prominent global challenges. Researchers are investigating various methods for decreasing CO₂ emissions. The CO₂ reduction reaction via electrochemical, photochemical, and photoelectrochemical processes has been a popular research topic because the energy it requires can be sourced from renewable sources. The CO₂ reduction reaction converts stable CO₂ molecules into useful products such as CO, CH₄ , C₂ H₄ , and C₂ H₅ OH. To obtain economic benefits from these products, it is important to convert them into hydrocarbons above C₂ . Numerous investigations have demonstrated the uniqueness of the CC coupling reaction of Cu-based catalysts for the conversion of CO₂ into useful hydrocarbons above C₂ for electrocatalysis. Herein, the principle of semiconductors for photocatalysis is briefly introduced, followed by a description of the obstacles for C₂₊ production. This review presents an overview of the mechanism of hydrocarbon formation above C₂ , along with advances in the improvement, direction, and comprehension of the CO₂ reduction reaction via electrochemical, photochemical, and photoelectrochemical processes.

Feasibility of mixed herbal medicine for improving gastric function in an alcohol-induced gastritis model

PURPOSE

Excessive exercise causes various gastric dysfunction. Gastritis is common among athletes who perform high-intensity training. Gastritis is a digestive disease involving mucosal damage caused by inflammatory reactions and oxidative stress. In this study, the effects of a complex natural extract on gastric mucosal damage and the expression of inflammatory factors were evaluated in an animal model of alcohol-induced gastritis.

METHODS

A mixed herbal medicine (Ma-al-gan; MAG) was prepared with four natural products (Curcumae longae Rhizoma, Schisandrae chinensis Fructus, Artemisiae scopariae herba, and Gardeniae Fructus) identified by a systemic analysis using the Traditional Chinese Medicine Systems Pharmacology platform. The effects of MAG on alcohol-induced gastric damage were evaluated.

RESULTS

MAG (10-100 μg/mL) significantly reduced the mRNA and protein levels of inducible nitric oxide synthase and cyclooxygenase-2 in lipopolysaccharide-stimulated RAW264.7 cells. MAG (500 mg/kg/d) effectively prevented alcohol-induced gastric mucosal injury in vivo.

CONCLUSION

MAG regulates inflammatory signals and oxidative stress and is a potential herbal medicine for gastric disorders.

Hollow Ni/NiO/C composite derived from metal-organic frameworks as a high-efficiency electrocatalyst for the hydrogen evolution reaction

Metal-organic frameworks (MOFs) constitute a class of crystalline porous materials employed in storage and energy conversion applications. MOFs possess characteristics that render them ideal in the preparation of electrocatalysts, and exhibit excellent performance for the hydrogen evolution reaction (HER). Herein, H-Ni/NiO/C catalysts were synthesized from a Ni-based MOF hollow structure via a two-step process involving carbonization and oxidation. Interestingly, the performance of the H-Ni/NiO/C catalyst was superior to those of H-Ni/C, H-NiO/C, and NH-Ni/NiO/C catalysts for the HER. Notably, H-Ni/NiO/C exhibited the best electrocatalytic activity for the HER, with a low overpotential of 87 mV for 10 mA cm^-2 and a Tafel slope of 91.7 mV dec^-1. The high performance is ascribed to the synergistic effect of the metal/metal oxide and hollow architecture, which is favorable for breaking the H-OH bond, forming hydrogen atoms, and enabling charge transport. These results indicate that the employed approach is promising for fabricating cost-effective catalysts for hydrogen production in alkaline media.

Regulating the surface of anion-doped TiO2 nanorods by hydrogen annealing for superior photoelectrochemical water oxidation

Dedications to achieve the highly efficient metal oxide semiconductor for the photoelectrochemical water splitting system have been persisted to utilize the TiO₂ as the promising photoanode material. Herein, we report notable progress for nanostructured TiO₂ photoanodes using facile sequential one-pot hydrothermal synthesis and annealing in hydrogen. A photocurrent density of 3.04 mA·cm^-2 at 1.23 V vs. reversible hydrogen electrode was achieved in TiO₂ nanorod arrays annealed in hydrogen ambient, which is approximately 4.25 times higher than that of pristine TiO₂ annealed in ambient air. 79.2% of incident photon-to-current efficiency at 380 nm wavelength demonstrates the prominence of the material at the near-UV spectral range region and 100 h chronoamperometric test exhibits the stability of the photoanode. Detailed studies regarding crystallinity, bandgap, and elemental analysis provide the importance of the optimized annealing condition for the TiO₂-based photoanodes. Water contact angle measurement displays the effect of hydrogen annealing on the hydrophilicity of the material. This study clearly demonstrates the marked improvement using the optimized hydrogen annealing, providing the promising methodologies for eco-friendly mass production of water splitting photoelectrodes.

A GO/CoMo3S13 chalcogel heterostructure with rich catalytic Mo-S-Co bridge sites for the hydrogen evolution reaction

Molybdenum disulfide (MoS₂)-based materials are extensively studied as promising hydrogen evolution reaction (HER) catalysts. In order to bring out the full potential of chalcogenide chemistry, precise control over the active sulfur sites and enhancement of electronic conductivity need to be achieved. This study develops a highly active HER catalyst with an optimized active site-controlled cobalt molybdenum sulfide (CoMo₃S₁₃) chalcogel/graphene oxide aerogel heterostructure. The highly active CoMo₃S₁₃ chalcogel catalyst was achieved by the synergetic catalytic sites of [Mo₃S₁₃]^2- and the Mo-S-Co bridge. The optimized GO/CoMo₃S₁₃ chalcogel heterostructure catalyst exhibited high catalytic HER performance with an overvoltage of 130 mV, a current density of 10 mA cm^-2, a small Tafel slope of 40.1 mV dec^-1, and remarkable stability after 12 h of testing. This study presents a successful example of a synergistic heterostructure exploiting both the appealing electrical functionality of GO and catalytically active [Mo₃S₁₃]^2- sites.

Electrodeposition: An efficient method to fabricate self-supported electrodes for electrochemical energy conversion systems

The development of electrocatalysts for energy conversion systems is essential for alleviating environmental problems and producing useful energy sources as alternatives to fossil fuels. Improving the catalytic performance and stability of electrocatalysts is a major challenge in the development of energy conversion systems. Moreover, understanding their electrode structure is important for enhancing the energy efficiency. Recently, binder-free self-supported electrodes have been investigated because the seamless contact between the electrocatalyst and substrate minimizes the contact resistance as well as facilitates fast charge transfer at the catalyst/substrate interface and high catalyst utilization. Electrodeposition is an effective and facile method for fabricating self-supported electrodes in aqueous solutions under mild conditions. Facile fabrication without a polymer binder and controlability of the compositional and morphological properties of the electrocatalyst make electrodeposition methods suitable for enhancing the performance of energy conversion systems. Herein, we summarize recent research on self-supported electrodes fabricated by electrodeposition for energy conversion reactions, particularly focusing on cathodic reactions of electrolyzer system such as hydrogen evolution, electrochemical CO₂ reduction, and electrochemical N₂ reduction reactions. The deposition conditions, morphological and compositional properties, and catalytic performance of the electrocatalyst are reviewed. Finally, the prospective directions of electrocatalyst development for energy conversion systems are discussed.

Low-Crystalline AuCuIn Catalyst for Gaseous CO2 Electrolyzer

Despite its importance for the establishment of a carbon-neutral society, the electrochemical reduction of CO₂  to value-added products has not been commercialized yet because of its sluggish kinetics and low selectivity. The present work reports the fabrication of a low-crystalline trimetallic (AuCuIn) CO₂  electroreduction catalyst and demonstrates its high performance in a gaseous CO₂  electrolyzer. The high Faradaic efficiency (FE) of CO formation observed at a low overpotential in a half-cell test is ascribed to the controlled crystallinity and composition of this catalyst as well as to its faster charge transfer, downshifted d-band center, and low oxophilicity. The gaseous CO₂  electrolyzer with the optimal catalyst as the cathode exhibits superior cell performance with a high CO FE and production rate, outperforming state-of-the-art analogs. Thus, the obtained results pave the way to the commercialization of CO₂  electrolyzers and promote the establishment of a greener society.

Surface-Tailored Medium Entropy Alloys as Radically Low Overpotential Oxygen Evolution Electrocatalysts

Numerous studies have explored new materials for electrocatalysts, but it is difficult to discover materials that surpass the catalytic activity of current commercially available noble metal electrocatalysts. In contrast to conventional transition metal alloys, high-entropy alloys (HEAs) have immense potential to maximize their catalytic properties because of their high stability and compositional diversity as oxygen evolution reactions (OERs). This work presents medium-entropy alloys (MEAs) as OER electrocatalysts to simultaneously satisfy the requirement of high catalytic activity and long-term stability. The surface of MEA electrocatalyst is tailored to suit the OER via anodizing and cyclic voltammetry activation methods. Optimized electrical properties and hydrophilicity of the surface enable an extremely low overpotential of 187 mV for achieving the current density of 10 mA cm^-2 alkaline media. Furthermore, a combined photovoltaic-electrochemical system with MEA electrocatalyst and a perovskite/Si tandem solar cell exhibits a solar-to-hydrogen conversion efficiency of 20.6% for an unassisted hydrogen generation system. These results present a new pathway for designing sustainable high efficiency water splitting cells.

Metal-Organic-Framework- and MXene-Based Taste Sensors and Glucose Detection

Taste sensors can identify various tastes, including saltiness, bitterness, sweetness, sourness, and umami, and have been useful in the food and beverage industry. Metal-organic frameworks (MOFs) and MXenes have recently received considerable attention for the fabrication of high-performance biosensors owing to their large surface area, high ion transfer ability, adjustable chemical structure. Notably, MOFs with large surface areas, tunable chemical structures, and high stability have been explored in various applications, whereas MXenes with good conductivity, excellent ion-transport characteristics, and ease of modification have exhibited great potential in biochemical sensing. This review first outlines the importance of taste sensors, their operation mechanism, and measuring methods in sensing utilization. Then, recent studies focusing on MOFs and MXenes for the detection of different tastes are discussed. Finally, future directions for biomimetic tongues based on MOFs and MXenes are discussed.

Short-term outcomes of a multicentre randomized clinical trial comparing laparoscopic pylorus-preserving gastrectomy with laparoscopic distal gastrectomy for gastric cancer (the KLASS-04 trial)

BACKGROUND

There remain concerns about the safety and functional benefit of laparoscopic pylorus-preserving gastrectomy (LPPG) compared with laparoscopic distal gastrectomy (LDG). This study evaluated short-term outcomes of a randomized clinical trial (RCT) comparing LPPG with LDG for gastric cancer.

METHODS

The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial was an investigator-initiated, open-label, parallel-assigned, superiority, multicentre RCT in Korea. Patients with cT1N0M0 cancer located in the middle third of the stomach at least 5 cm from the pylorus were randomized to undergo LPPG or LDG. Participants, care givers and those assessing the outcomes were not blinded to group assignment. Outcomes were 30-day postoperative morbidity rate and death at 90 days.

RESULTS

Some 256 patients from nine institutions were randomized (LPPG 129 patients, LDG 127 patients) between July 2015 and July 2017 and outcomes for 253 patients were analysed. Postoperative complications within 30 days were seen in 19.3 and 15.5 per cent in the LPPG and LDG groups respectively (P = 0·419). Postoperative pyloric stenosis was observed in nine (7.2 per cent) and two (1·5 per cent) patients in the LPPG and LDG groups (P = 0·026) respectively. In multivariable analysis higher BMI was a risk factor for postoperative complications (odds ratio 1·17, 95 per cent c.i. 1·04 to 1·32; P = 0·011). Death at 90 days was zero in both groups.

CONCLUSION

Postoperative complications and mortality was comparable in patients undergoing LPPG and LDG. Registration number: NCT02595086 (http://www.clinicaltrials.gov).

WS2-WC-WO3 nano-hollow spheres as an efficient and durable catalyst for hydrogen evolution reaction

Transition metal dichalcogenides (TMDs), transition metal carbides (TMCs), and transition metal oxides (TMOs) have been widely investigated for electrocatalytic applications owing to their abundant active sites, high stability, good conductivity, and various other fascinating properties. Therefore, the synthesis of composites of TMDs, TMCs, and TMOs is a new avenue for the preparation of efficient electrocatalysts. Herein, we propose a novel low-cost and facile method to prepare TMD-TMC-TMO nano-hollow spheres (WS2-WC-WO3 NH) as an efficient catalyst for the hydrogen evolution reaction (HER). The crystallinity, morphology, chemical bonding, and composition of the composite material were comprehensively investigated using X-ray diffraction, Raman spectroscopy, field emission scanning electron microscopy, and X-ray photoelectron spectroscopy. The results confirmed the successful synthesis of the WS2-WC-WO3 NH spheres. Interestingly, the presence of nitrogen significantly enhanced the electrical conductivity of the hybrid material, facilitating electron transfer during the catalytic process. As a result, the WS2-WC-WO3 NH hybrid exhibited better HER performance than the pure WS2 nanoflowers, which can be attributed to the synergistic effect of the W-S, W-C, and W-O bonding in the composite. Remarkably, the Tafel slope of the WS2-WC-WO3 NH spheres was 59 mV dec-1, which is significantly lower than that of the pure WS2 NFs (82 mV dec-1). The results also confirmed the unprecedented stability and superior electrocatalytic performance of the WS2-WC-WO3 NH spheres toward the HER, which opens new avenues for the preparation of low-cost and highly effective materials for energy conversion and storage applications.

Tailoring the Structure of Low-Dimensional Halide Perovskite through a Room Temperature Solution Process: Role of Ligands

In this study, halide perovskite nanocrystals are synthesized by controlling the ligand length and amount, and investigated the effects on the change in the ligand length and amount on the shape, size, crystal structure, and optical properties of the perovskite nanocrystals. The results reveal the tendency and respective effects of amine and acid ligands on perovskite nanocrystals. The amine ligands bind directly to the perovskite nanocrystals. Consequently, the amine ligands with longer chains interfere with the aggregation of the initially formed nanocrystals, thus limiting the size of the halide perovskite nanocrystals. Similar to the amine ligands, the acid ligands directly bond with the perovskite nanocrystals; however, they are also indirectly distributed around the nanocrystals, thus affecting their structure and dispersion. Consequently, the acid ligands affect the assembly of the initially formed nanocrystals, which determine the shape and crystal structure of the nanocrystals. It is believed that the report will provide useful insight on the synthesis of halide perovskites for application in optoelectronic devices.

Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study

BACKGROUND

Fever is one of the most common symptoms in children and is the physiological response of the human immune system to external pathogens. However, effectiveness studies of single and combined antipyretic therapy are relatively few due to lack of data. In this study, we used large-scale patient-generated health data from mobile apps to compare antipyretic affects between single and combination antipyretics.

OBJECTIVE

We aimed to establish combination patterns of antipyretics and compare antipyretic affects between single and combination antipyretics using large-scale patient-generated health data from mobile apps.

METHODS

This study was conducted using medical records of feverish children from July 2015 to June 2017 using the Fever Coach mobile app. In total, 3,584,748 temperature records and 1,076,002 antipyretic records of 104,337 children were analyzed. Antipyretic efficacy was measured by the mean difference in the area under the temperature change curve from baseline for 6 hours, 8 hours, 10 hours, and 12 hours after antipyretic administration in children with a body temperature of ≥38.0 ℃ between single and combination groups.

RESULTS

The single antipyretic and combination groups comprised 152,017 and 54,842 cases, respectively. Acetaminophen was the most commonly used single agent (60,929/152,017, 40.08%), and acetaminophen plus dexibuprofen was the most common combination (28,065/54,842, 51.17%). We observed inappropriate use, including triple combination (1205/206,859, 0.58%) and use under 38 ℃ (11,361/206,859, 5.50%). Combination antipyretic use increased with temperature; 23.82% (33,379/140,160) of cases were given a combination treatment when 38 ℃ ≤ temperature < 39 ℃, while 41.40% (1517/3664) were given a combination treatment when 40 ℃ ≤ temperature. The absolute value of the area under the curve at each hour was significantly higher in the single group than in the combination group; this trend was consistently observed, regardless of the type of antipyretics. In particular, the delta fever during the first 6 hours between the two groups showed the highest difference. The combination showed the lowest delta fever among all cases.

CONCLUSIONS

Antipyretics combination patterns were analyzed using large-scale data. Approximately 75% of febrile cases used single antipyretics, mostly acetaminophen, but combination usage became more frequent as temperature increased. However, combination antipyretics did not show definite advantages over single antipyretics in defervescence, regardless of the combination. Single antipyretics are effective in reducing fever and relieving discomfort in febrile children.

Enhanced wound healing using a 3D printed VEGF-mimicking peptide incorporated hydrogel patch in a pig model

There is a need for effective wound healing through rapid wound closure, reduction of scar formation, and acceleration of angiogenesis. Hydrogel is widely used in tissue engineering, but it is not an ideal solution because of its low vascularization capability and poor mechanical properties. In this study, gelatin methacrylate (GelMA) was tested as a viable option with tunable physical properties. GelMA hydrogel incorporating a vascular endothelial growth factor (VEGF) mimicking peptide was successfully printed using a three-dimensional (3D) bio-printer owing to the shear-thinning properties of hydrogel inks. The 3D structure of the hydrogel patch had high porosity and water absorption properties. Furthermore, the bioactive characterization was confirmed by cell culture with mouse fibroblasts cell lines (NIH 3T3) and human umbilical vein endothelial cells. VEGF peptide, which is slowly released from hydrogel patches, can promote cell viability, proliferation, and tubular structure formation. In addition, a pig skin wound model was used to evaluate the wound-healing efficacy of GelMA-VEGF hydrogel patches; the results suggest that the GelMA-VEGF hydrogel patch can be used for wound dressing.

Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence

INTRODUCTION

The pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction.

AIM

To determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI).

METHODS

A total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection.

MAIN OUTCOME MEASURES

PISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures.

RESULTS

For the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression.

CONCLUSION

The female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.

Grain Boundaries Boost Oxygen Evolution Reaction in NiFe Electrocatalysts

In a polycrystalline material, the grain boundaries (GBs) can be effective active sites for catalytic reactions by providing an electrodynamically favorable surface. Previous studies have shown that grain boundary density is related to the catalytic activity of the carbon dioxide reduction reaction, but there is still no convincing evidence that the GBs provide surfaces with enhanced activity for oxygen evolution reaction (OER). Combination of various electrochemical measurements and chemical analysis reveals the GB density at surface of NiFe electrocatalysts directly affects the overall OER. In situ electrochemical microscopy vividly shows that the OER occurs mainly at the GB during overall reaction. It is observed that the reaction determining steps are altered by grain boundary densities and the meaningful work function difference between the inside of grain and GBs exists. High-resolution transmission electron microscopy shows that extremely high index planes are exposed at the GBs, enhancing the oxygen evolution activity. The specific nature of GBs and its effects on the OER demonstrated in this study can be applied to the various polycrystalline electrocatalysts.

Metal-Organic Framework Materials for Perovskite Solar Cells

Metal-organic frameworks (MOFs) and MOF-derived materials have been used for several applications, such as hydrogen storage and separation, catalysis, and drug delivery, owing to them having a significantly large surface area and open pore structure. In recent years, MOFs have also been applied to thin-film solar cells, and attractive results have been obtained. In perovskite solar cells (PSCs), the MOF materials are used in the form of an additive for electron and hole transport layers, interlayer, and hybrid perovskite/MOF. MOFs have the potential to be used as a material for obtaining PSCs with high efficiency and stability. In this study, we briefly explain the synthesis of MOFs and the performance of organic and dye-sensitized solar cells with MOFs. Furthermore, we provide a detailed overview on the performance of the most recently reported PSCs using MOFs.

Suppressing breast cancer by exercise: consideration to animal models and exercise protocols

PURPOSE

Exercise is thought to have a significant effect on chemotherapy, and previous studies have reported that exercise can increase patient survival. Thus, in this review, we aimed to summarize various animal models to analyze the effects of exercise on breast cancer.

METHODS

We summarized types of breast cancer animal models from various reports and analyzed the effects of exercise on anti-cancer factors in breast cancer animal models.

RESULTS

This review aimed to systematically investigate if exercise could aid in suppressing breast cancer. Our study includes (a) increase in survival rate through exercise; (b) the intensity of exercise should be consistent and increased; (c) a mechanism for inhibiting carcinogenesis through exercise; (d) effects of exercise on anti-cancer function.

CONCLUSION

This review suggested the necessity of a variety of animal models for preclinical studies prior to breast cancer clinical trials. It also provides evidence to support the view that exercise plays an important role in the prevention or treatment of breast cancer by influencing anticancer factors.

Microcellular Environmental Regulation of Silver Nanoparticles in Cancer Therapy: A Critical Review

Silver nanoparticles (AgNPs) play significant roles in various cancer cells such as functional heterogeneity, microenvironmental differences, and reversible changes in cell properties (e.g., chemotherapy). There is a lack of targets for processes involved in tumor cellular heterogeneity, such as metabolic clampdown, cytotoxicity, and genotoxicity, which hinders microenvironmental biology. Proteogenomics and chemical metabolomics are important tools that can be used to study proteins/genes and metabolites in cells, respectively. Chemical metabolomics have many advantages over genomics, transcriptomics, and proteomics in anticancer therapy. However, recent studies with AgNPs have revealed considerable genomic and proteomic changes, particularly in genes involved in tumor suppression, apoptosis, and oxidative stress. Metabolites interact biochemically with energy storage, neurotransmitters, and antioxidant defense systems. Mechanobiological studies of AgNPs in cancer metabolomics suggest that AgNPs may be promising tools that can be exploited to develop more robust and effective adaptive anticancer therapies. Herein, we present a proof-of-concept review for AgNPs-based proteogenomics and chemical metabolomics from various tumor cells with the help of several technologies, suggesting their promising use as drug carriers for cancer therapy.

Asymptomatic Cerebral Vasoconstriction after Carotid Artery Stenting

BACKGROUND AND PURPOSE

Carotid artery stent placement is widely performed for treatment of carotid stenosis. The purpose of this study is to present our observations on cerebral vasoconstriction in ipsilateral anterior circulation during immediate poststenting angiography in patients with near-total occlusion of the proximal ICA.

MATERIALS AND METHODS

We retrospectively reviewed patient data from December 2008 to December 2018. There were 28 patients with carotid near-total occlusion. Two neuroradiologists reviewed the final cerebral angiographic finding of carotid artery stent placement to evaluate the presence of vasoconstriction or vasodilation.

RESULTS

A total of 28 patients with near-total occlusion (mean ± standard deviation age, 69.0 ± 6.5 years; 92.9% male) were analyzed. Ten patients showed vasoconstriction in the treated territory, and 18 patients did not show vasoconstriction after carotid artery stenting. There were no statistically significant differences in comorbidity, frequency of symptomatic lesions, antiplatelet medication, mean procedure time, and initial NIHSS and baseline modified Rankin scale scores between the 2 groups. However, vasoconstriction is more likely to happen in patients with isolated territory from the contralateral anterior and posterior circulation (66.7% in the isolated territory group and 12.5% in the not-isolated territory group; P < .05). No headache or neurologic deficit was noted in all 10 patients with cerebral vasoconstriction.

CONCLUSIONS

Cerebral vasoconstriction may occur after carotid artery stenting more frequently than expected. It occurs more frequently in patients with near-total occlusion and with isolation of the cerebral circulation. A large-scale study is necessary to assess the clinical implications of cerebral vasoconstriction after carotid artery stenting.

Imaging Triage of Patients with Late-Window (6-24 Hours) Acute Ischemic Stroke: A Comparative Study Using Multiphase CT Angiography versus CT Perfusion

BACKGROUND AND PURPOSE

The role of collateral imaging in selecting patients for endovascular thrombectomy beyond 6 hours from onset has not been established. To assess the comparative utility of collateral imaging using multiphase CTA in selecting late window patients for EVT.

MATERIALS AND METHODS

We used data from a prospective multicenter observational study in which all patients underwent imaging with multiphase CT angiography as well as CTP. Two blinded reviewers evaluated patients' eligibility for endovascular thrombectomy using published collateral imaging (multiphase CTA) criteria compared with CTP using the selection criteria of the Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) and Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE-3) trials. CTP images were processed using automated commercial software. The outcomes of patients eligible for endovascular thrombectomy according to multiphase CTA, DAWN, or DEFUSE-3 criteria were compared using multivariable logistic regression modeling. Model characteristics were compared using the C-statistic for the receiver operating characteristic curve, the Akaike information criterion, and the Bayesian information criterion.

RESULTS

Eighty-six patients presented beyond 6 hours from onset/last known well (median, 9.6 hours; interquartile range, 4.1 hours). Thirty-five patients (40.7%) received endovascular thrombectomy, of whom good functional outcome (90-day mRS, 0-2) was achieved in 16/35 (47%). Collateral-based imaging paradigms significantly modified the treatment effect of endovascular thrombectomy on 90-day mRS 0-2 (P _interaction = .007). The multiphase CTA-based regression model best fit the data for the 90-day outcome (C-statistic, 0.86; 95% CI, 0.77-0.94) and was associated with the least information loss (Akaike information criterion, 95.7; Bayesian information criterion, 114.9) compared with CTP-based models.

CONCLUSIONS

The collateral-based imaging paradigm using multiphase CTA compares well with CTP in selecting patients for endovascular thrombectomy in the late time window.

Nanoporous Nickel Phosphide Cathode for a High-Performance Proton Exchange Membrane Water Electrolyzer

Hydrogen production via a proton exchange membrane water electrolyzer (PEMWE) is an essential technology to complement discontinuity of renewable energies. Development of a high-efficiency and cost-effective gas diffusion electrode (GDE), which is a key component of this technology, remains a challenge. Here, we report a high-performance Ni phosphide GDE prepared by simple electrochemical methods. Selective leaching of excess Ni in electrodeposited Ni_xP_1-x enabled fabrication of a nanoporous NiP GDE with a large electrochemical surface area (ECSA). In half-cell tests, the nanoporous NiP GDE demonstrated a hydrogen-evolving current density of -10 mA/cm² at an overpotential of 103 mV with good stability. In the single-cell tests, the PEMWE employing a nanoporous NiP cathode exhibited a current density of 1.47 A/cm² at a cell voltage of 2.0 V, which was the competitive performance among state-of-the-art non-noble cathodes reported to date.

Fabrication of a WS2/p-Si Heterostructure Photocathode Using Direct Hybrid Thermolysis

P-N heterostructures based on transition-metal dichelcongenides (TMDs) and a conventional semiconductor, such as p-Si, have been considered a promising structure for next-generation electronic devices and applications. However, synthesis of high-quality, wafer-scale TMDs, particularly WS₂ on p-Si, is challenging. Herein, we propose an efficient method to directly grow WS₂ crystals on p-Si via a hybrid thermolysis process. The WO₃ is deposited to prepare the p-Si surface for coating of the (NH₄)₂WS₄ precursor and converted to WS₂/p-Si during thermolysis. Moreover, the WS₂/p-Si heterojunction photocathode is fabricated and used in solar hydrogen production. The fabricated n-WS₂/p-Si heterojunction provided an onset potential of +0.022 V at 10 mA/cm² and a benchmark current density of -9.8 ± 1.2 mA/cm² at 0 V. This method reliably and efficiently produced high-quality, wafer-scale WS₂ crystals and overcame the challenges associated with previous approaches. The approach developed in this research demonstrates a magnificent progress in the fabrication of 2D material-based electronic devices.

Association of blood n-3 fatty acid with bone mass and bone marrow TRAP-5b in the elderly with and without hip fracture

The plasma n-3 fatty acid level was 26.2% lower in patients with osteoporotic hip fracture than in those with osteoarthritis. In all patients, n-3 fatty acid was positively associated with bone mineral density and inversely associated with tartrate-resistant acid phosphatase-5b level in bone marrow aspirates, reflecting the bone microenvironment.

INTRODUCTION

Despite the potential beneficial role of n-3 fatty acid (FA) on bone metabolism, the specific mechanisms underlying these effects in humans remain unclear. Here, we assessed whether the plasma n-3 level, as an objective indicator of its status, is associated with osteoporosis-related phenotypes and bone-related markers in human bone marrow (BM) samples.

METHODS

This was a case-control and cross-sectional study conducted in a clinical unit. n-3 FA in the blood and bone biochemical markers in the BM aspirates were measured by gas chromatography/mass spectrometry and immunoassay, respectively. BM fluids were collected from 72 patients who underwent hip surgery because of either osteoporotic hip fracture (HF; n = 28) or osteoarthritis (n = 44).

RESULTS

After adjusting for confounders, patients with HF had 26.2% lower plasma n-3 levels than those with osteoarthritis (P = 0.006), and each standard deviation increment in plasma n-3 was associated with a multivariate-adjusted odds ratio of 0.40 for osteoporotic HF (P = 0.010). In multivariate analyses including all patients, a higher plasma n-3 level was associated with higher bone mass at the lumbar spine (β = 0.615, P = 0.002) and total femur (β = 0.244, P = 0.045). Interestingly, the plasma n-3 level was inversely associated with the tartrate-resistant acid phosphatase-5b level (β = - 0.633, P = 0.023), but not with the bone-specific alkaline phosphatase level, in BM aspirates.

CONCLUSIONS

These findings provide clinical evidence that n-3 FA is a potential inhibitor of osteoclastogenesis that favors human bone health.

The effects of cortisol and adrenal androgen on bone mass in Asians with and without subclinical hypercortisolism

Analyses using the largest Korean cohort of adrenal incidentaloma (AI) revealed that subtle cortisol excess in premenopausal women and reduced dehydroepiandrosterone-sulfate (DHEA-S) in postmenopausal women and men are associated with bone mineral density (BMD) reduction in Asian patients with subclinical hypercortisolism (SH).

INTRODUCTION

Few studies evaluated bone metabolism in Asians with SH. We investigated associations of cortisol and DHEA-S, an adrenal androgen, with BMD in Asians with AI, with or without SH.

METHODS

We used cross-sectional data of a prospective multicenter study from Korea. We measured BMD, bone turnover markers, cortisol levels after 1-mg dexamethasone suppression test (1-mg DST), DHEA-S, and baseline cortisol to DHEA-S ratio (cort/DHEA-S) in 109 AI patients with SH (18 premenopausal, 38 postmenopausal women, and 53 men) and 686 with non-functional AI (NFAI; 59 premenopausal, 199 postmenopausal women, and 428 men).

RESULTS

Pre- and postmenopausal women, but not men, with SH had lower BMDs at lumbar spine (LS) than those with NFAI (P = 0.008~0.016). Premenopausal women with SH also had lower BMDs at the hip than those with NFAI (P = 0.009~0.012). After adjusting for confounders, cortisol levels after 1-mg DST demonstrated inverse associations with BMDs at all skeletal sites only in premenopausal women (β = - 0.042~- 0.033, P = 0.019~0.040). DHEA-S had positive associations with LS BMD in postmenopausal women (β = 0.096, P = 0.001) and men (β = 0.029, P = 0.038). The cort/DHEA-S had inverse associations with LS BMD in postmenopausal women (β = - 0.081, P = 0.004) and men (β = - 0.029, P = 0.011). These inverse associations of cort/DHEA-S remained significant after adjusting for cortisol levels after 1-mg DST (β = - 0.079~- 0.026, P = 0.006~0.029). In postmenopausal women, the odds ratios of lower BMD by DHEA-S and cort/DHEA-S was 0.26 (95% CI, 0.08-0.82) and 3.40 (95% CI, 1.12-10.33), respectively.

CONCLUSION

Subtle cortisol excess in premenopausal women and reduced DHEA-S in postmenopausal women and men may contribute to BMD reduction in Asians with SH.

Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study

BACKGROUND

Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children.

OBJECTIVE

This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach.

METHODS

Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ≥39°C).

RESULTS

The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05%) children had taken antipyretic drugs, and 3238 (89.15%) children took antibiotics at body temperatures above 38°C. The number of children taking antipyretics at a body temperature of 38°C was more than four times that of those taking antipyretics at 37.9°C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9°C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived.

CONCLUSIONS

These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care.

Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy

BACKGROUND AND PURPOSE

Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study.

MATERIALS AND METHODS

Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates.

RESULTS

Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients.

CONCLUSIONS

Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.

Abstract P3-13-01: Application of supine MRI-based 3D printing breast surgical guide for precision breast-conserving surgery

Background

If the size of the tumor is large, neoadjuvant systemic therapy (NST) is performed to reduce the size of the tumor and to conserve the breast. It is known that magnetic resonance imaging is more accurate than mammography (MMG) or ultrasonography (USG) in determining the area of residual cancer in breast-conserving surgery (BSG) after NST. However, there are some problems when performing BCS using MRI. Because the posture of MRI test is different from the posture at surgery, it is difficult to accurately mark the area of the tumor observed in MRI. Neoadjuvant systemic therapy reduces tumor size and often makes it difficult to detect the original tumor area on preoperative MRI. Even if the tumor is not visible in the image, the cancer cells may remain, so it is important to accurately indicate the extent of the initial tumor and remove it. Until now, however, there has been no way to accurately mark past breast tumors in the breast. We have developed a breast surgical guide (BSG) that can mark a range of tumor directly on the breast using three-dimensional printing technology based on supine MRI. This study analyzed the results of patients who underwent BCS using a 3D printing breast surgical guide (3D-BSG) based on supine MRI.

Methods

This trial was designed as a prospective single-institution cohort study. Our study protocol was approved by the Institutional Review Board of Asan Medical Center, Seoul, Korea (IRB No. 2016-1237). Patients who were expected to undergo BCS after NST were enrolled in this study and supine MRI was performed before and after NST. From MRI images, morphological shapes of breasts and tumors were modeled. The prepared digital model was saved in stereolithography file format and then exported to a 3D printer. 3D-BSG is designed to be able to mark the skin and attach the dye injecting column to mark the around the tumor. The breast tissue was removed with blue dye on the basis of the border. To obtain tumor free margin, intraoperative frozen sections were identified in several cavities and re-excision was performed if tumor positive.

Results

Between January 2016 and May 2017, 50 patients were enrolled in the study. BCS was applied to 40 patients, except for those who were rejected or mastectomy. Complete remission was observed in 15 patients after NST. Four patients had tumor positive on resection margins on frozen biopsy during operation, two with IDC and two with DCIS. Re-excision was performed in these patients and tumor negative margin was confirmed in all patients in the final pathology results. The median size of the long axis of the tumor was 1.7 cm (range, 0.5 to 4.5 cm) and the median size of the long axis of the removed breast tissue was 5.1 cm (range, 2.3 to 8.1 cm). The distance between tumor and resection margin was 1.2 cm (range, 0.1 to 4.8 cm)..

Conclusions

In BCS, the application of the supine MRI based 3D-BSG showed low rates of positive margins. Unlike conventional localization techniques, application of 3D-BSG does not cause pain to the patient, has no radiation exposure, and has no time required for the localization procedure, so it will be helpful for patients in BCS in the future.

Citation Format: Ko B, Kim N, Seo J, Kim H, Gong G, Kim S, Son B, Ahn SH. Application of supine MRI-based 3D printing breast surgical guide for precision breast-conserving surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-01.

Abstract P2-14-21: Not presented

This abstract was not presented at the conference.

Citation Format: Lee S, Ahn SH, Lee JW, Chung IY, Ko BS, Kim HJ, Kim J, Shon G, Son BH. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-21.

Abstract P6-09-09: Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients

Background: We aimed to evaluate the clinical implication of circulating tumor cell (CTC) counts in correlation with prognosis and radiologic/pathologic response to therapy in locally advanced breast cancer patients undergoing preoperative systemic therapy.

Methods: From Feb 2014 to May 2017, 207 patients without distant metastasis were prospectively enrolled from AMC. CTC counts were analyzed before-during-after the therapy. CTC isolation was performed using a SMART BIOPSY™ SYSTEM Isolation kit (Cytogen, Inc., Seoul, Korea). Recurrence-free and overall survival was analyzed according to CTC counts.

Result: The mean follow-up period was 22.46 months and mean age was 46.48 years. One or more CTC was identified in 132 of 203 patients(65.0%) before NST, in 135 of 186 patients(72.0%) during NST and 103 of 171 patients(60.2%) after NST. Initial tumor burden at diagnosis -tumor size, lymph node metastasis- was not correlated with CTC positivity. Overall, CTC count ((≥1 CTC, ≥2 CTCs, and ≥5 CTCs) was not correlated with response to therapy. Using RECIST criteria, 86.5% (179/204) were responders (complete, partial response, CR/PR) and 12.1% (25/204) were non-responders (stable, progressive disease, SD/PD). 14.5% (30/207) showed a pathologic complete response (pCR), yet no association was found between CTC count/changes and radiologic/pathologic response to therapy. Also, CTC count was not correlated with prognosis among the whole population. However, HR+ tumors, CTC detection before NST was significantly associated with treatment response by RECIST criteria (responder vs. non-responder) (p=0.003, p=0.017 and p=0.023, respectively).

Conclusions: Our findings support limited value of CTC count for locally advanced breast cancers undergoing neoadjuvant systemic therapy.

Citation Format: Gwark S-C, Kim J, Kim YH, Kim MS, Park JY, Lee SB, Sohn G, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH. Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-09-09.

Abstract P1-02-04: Is asymptomatic surveillance after standard treatment beneficial? : A 10yr-survival analysis of recurrent breast cancer patients by detection method of recurrence

Surveillance of recurrence after standard treatment of breast cancer (BC) for early detection and it's impact on overall survival are known to differ depending on recurrent site. Current guideline recommends asymptomatic surveillance to only detect loco-regional recurrences. As the evidences depend on historical randomized clinical trials we aimed to address questions whether earlier detection might have impact on survival now that plenty of new treatment strategies can be offered. Also to give answers to heterogeneous surveillance strategy in real-world practice we performed a retrospective 10yr-survival analysis of a large cohort of recurrent BC patients according to their detection method.

From 4188 operable breast cancer patients who completed standard treatment Asan Medical Center from 2006 to 2008 469 patients with recurrent BC were analyzed. Median disease free interval was 35.3 months (range 2.8-97.6) and overall survival (OS) was analyzed as time from initial diagnosis/surgery to death. Among 469 patients who developed recurrence 23.7% were local (ipsilateral breast skin chest wall) 22.6% were regional (ipsilateral axillary internal mammary lymph nodes) and 53.7% developed distant metastasis. 10yr-overall survival was analyzed according to recurrent site and it's detection method.

Detection of recurrence were categorized as 'asymptomatic surveillance (N=162, 34.5%)' and 'symptom-guided (N=307, 65.5%)'. Asymptomatic screening method included mammography breast-ultrasound serum tumor marker (CA15-3) and systemic images (eg. chest X-ray bone scan PET scans). Symptom-guided detection rate for local regional and distant metastasis was 14.9%, 5.5% and 15.1% respectively. Overall asymptomatic vs symptomatic 10yr-OS did not differ (81.3 vs 78.8 months, p=0.778). Among patients with distant metastasis 10ys-OS was not significantly different (70.3 vs 66.7 months p=0.846) and was similar according to stage/subtype. Among patients with local recurrence only 10yr-OS was 95.1 months ('symptomatic' vs 'aymptomatic 94.4 vs 94.5, p=0.809) which may be insufficient number of events to show significant difference. Among regional recurrent BCs, longer OS was observed in asymptomatically detected patients than symptom-guided group (86.1 vs 63.4, p=0.004). In Cox regression analyses asymptomatic detection showed significant better survival (HR=3.9, 95%CI:1.6-9.5) and this observation was more evident in patients with hormone receptor(HR) negative primary BCs (69.9 vs 47.9, p=0.029). Intriguingly, only 8.6% (7/80) of regional recurrence were diagnosed by mammography.

We observed survival benefit with asymptomatic screening in detecting regional recurrence especially in HR-negative primary BC patients. And role of systemic radiology even in advanced high risk breast cancer patients were limited. Although with limitation that surveillance method varied widely we emphasize the role of aymptomatic surveillance of regional nodal evaluation including breast-ultrasound. These findings are to be validated from a prospective clinical study along with using cutting edge modalities other than radiology which enable detection of micro-metastasis.

Citation Format: Lee Y, Lee HS, Ahn SH, Son BH, Kim J, Lee SB. Is asymptomatic surveillance after standard treatment beneficial? : A 10yr-survival analysis of recurrent breast cancer patients by detection method of recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-04.

Abstract P2-08-22: Clinical implication of HER2/neu status in hormone receptor positive pure mucinous breast cancer

Background: Mucinous carcinoma of the breast is a rare type of breast cancer with favorable outcome compared with other types of breast cancer. The current guideline does not recommend chemotherapy/anti-HER2 therapy for mucinous breast cancer with hormone receptor-positive subtype regardless of HER2/neu status. In this study, we evaluated the survival of pure mucinous breast cancer according to tumor stage and subtype.

Methods: Between 1989 and 2014, in Asan Medical Center, Korea, total 473 pure mucinous carcinomas (stage I-III) undergone curative surgery were reviewed retrospectively. 5yr disease-free and overall survival were analyzed according to size, lymph node metastasis, hormone receptor/HER2 status and given therapy.

Result: Total of 473 patients with pure mucinous breast cancer were analyzed and median follow-up duration was 78.00 months. 439 patients were hormone receptor-positive, 374 were node negative, 55 were HER2/neu positive. Among 374 patients with hormone receptor-positive and node-negative, tumor size was &lt;1cm in 46 patients, 1-2.9cm in 259 patients, ≥3cm in 69 patients. In HR-positive/Node-positive BCs, 90.8%(59/65)were given chemotherapy and 35.3%(6/17) were also given trastuzumab. Sixteen patients given trastuzumab were only included in the analysis to assess the benefit of trastuzumab among HER2 positive BCs.

Overall, 5-year disease-free survival (DFS) rate was 94.1% and the 5-year overall survival (OS) rate was 95.9%. Using Cox regression analysis, lymph node metastasis was the only significant prognostic factor for both DFS (HR4.0, 95%CI:1.8-9.0, p=0.001) and OS (HR3.5, 95%CI:1.3-8.9, p=0.008). Among HR-positive/node-negative with tumor size ≥3cm, HER2/neu positivity was only significantly associated with 5yr-DFS (71.4% in HER2/neu+ vs. 96.4% in HER2/neu-, HR9.5, 95%CI:1.3-67.5, p=0.024). This observation was consistently combining both 'HR-positive/node-negative/&gt;3cm' and 'HR-positive/node positive' BCs (N=127) that HER2 positive tumors showed worse survival (HR 3.7, 95%CI:1.2-10.8, p=0.015). Intriguingly, within this subgroup of HR-positive/node-negative/&gt;3cm' and 'HR-positive/node positive' BCs, among HER2 positive tumors, while 5yr-DFS was 63.7% in patients who didn't receive trastuzumab, 100% were disease free in patients who were given trastuzumab.

Conclusions: Overall, nodal status was the most significant prognostic factor for pure mucinous breast cancer. In hormone receptor-positive, lymph node negative mucinous breast cancer with tumor of ≥3cm, HER2 positive BCs showed worse survival, suggesting a potential role of anti-HER2 strategy in this subgroup.

Citation Format: Gwark S-C, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Ko BS, Kim HJ, Son BH, Ahn SH. Clinical implication of HER2/neu status in hormone receptor positive pure mucinous breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-22.

Abstract P4-01-11: Genomic alterations of cell-free DNA in early breast cancer patients with recurrence

Cell-free DNA (cfDNA), as a non-invasive strategy, provides substantial benefit to overcome tumor heterogeneity. Surveillance of recurrence after standard treatment in early breast cancer (BC) using cfDNA, enables to detect minimal residual disease (MRD), also to identify genomic alterations driving recurrences. We aimed to assess the role of cfDNA in detecting MRD by investigating genomic alterations of 1)primary, recurred tumor and 2)cfDNA at time of recurrence using deep targeted sequencing. Fifty-four early BC patients were enrolled prospectively between 2014 and 2017 at time of recurrence. Median disease free interval was 28.5 months (rage 6.2-49.8). 62.7% (32/51) were hormone receptor (HR) positive (28 HRpos/HER2neg, 4 HRpos/HER2pos), 11.8% (6/51) were HRneg/HER2pos and 25.5% (13/51) were triple negative BCs. 59.3% (32/54) patients developed loco-regional recurrence (15 local recurrence only, 13 regional only, 4 with both) and distant metastasis was observed among 40.7% (22/54) patients. Cell-free DNA was extracted from 5cc blood at time of recurrence. Deep targeted sequencing was performed using customized NGS panel –encompassing 426 cancer-related target coding region, 242 fusion and amplification-related region- of cfDNA and FFPE(formalin fixed paraffin embedded) tumor samples archived from surgical resection or biopsy. Deep targeted sequencing data was successfully performed in 72.1% (31/43) plasma samples and sequencing yield was significantly lower when stored for more than 2yrs (46.2% vs 83.3%).

Mutations of cfDNA and tumor (primary, recurred) were analyzed. Mean sequencing depth of cfDNA and FFPE were x425.7 and x777.6 respectively. Median number of pathogenic mutations found in primary tumor, cfDNA and recurred tumor were 27(range 12-99), 25(range 8-85) and 9(range 0-23). Among mutations found in primary tumor, 27.4% were shared mutations (range 8.1%-72.7%) with recurred tumor and 26.1% were shared mutations (range 4.7%-69.2%) observed in cfDNA sample. Among mutations found in recurred tumor, 40.9% were observed in cfDNA (range 17.7-87.5%). In primary tumor, median number of mutations with allelic fraction (MAF)&gt;10% were 12 (range 4-21) and at least one mutation was found in cfDNA at time of recurrence. Among mutations with MAF&gt;10%, 59.4% and 69.1% were found in cfDNA and recurred tumor. Known oncogenic mutations of PIK3CA, TP53, GATA3, AKT1, ESR1, RELN, ERBB2, ERBB3, BRCA1 mutation were found. PIK3CA gene (p.H1047R) was found in two cases both in primary tumor and cfDNA at recurrence (MAF 11.4% vs 5.3% and 12.3% vs 15.4%) suggesting de novo driver mutation. One patient developed regional recurrence during adjuvant aromatase inhibitor with ESR1 V392I mutation in both cfDNA and recurred tumor (MAF 48.1 and 54.5%), while another patient's recurred tumor during aromatase inhibitor harbored ESR1 D538G mutation exclusively in recurred tumor with MAF &lt;1%. Both patients had no ESR1 hotpot mutation in primary tumor.

Our data showed sequencing yield of 83.3% in plasma samples within 2yr. Pathogenic mutations in primary tumor, especially when MAF&gt;10%, half of them was observed in cfDNA at time of recurrence. ESR1 mutation should be included in cfDNA surveillance for patients undergoing endocrine therapy even absent in primary tumor.

Citation Format: Kim J, Jo WK, Kim KY, Kim BJ, Lee SB, Lee HJ, Yu JH, Kim HJ, Chung IY, Ko BS, Kim S-B, Jung KH, Ahn JH, Chang S, Lee JW, Son BH, Ahn SH. Genomic alterations of cell-free DNA in early breast cancer patients with recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-11.