Advances in Metal-Organic Frameworks for the Removal of Chemical Warfare Agents: Insights into Hydrolysis and Oxidation Reaction Mechanisms.

The destruction of chemical warfare agents (CWAs) is a crucial area of research due to the ongoing evolution of toxic chemicals. Metal-organic frameworks (MOFs), a class of porous crystalline solids, have emerged as promising materials for this purpose. Their remarkable porosity and large surface areas enable superior adsorption, reactivity, and catalytic abilities, making them ideal for capturing and decomposing target species. Moreover, the tunable networks of MOFs allow customization of their chemical functionalities, making them practicable in personal protective equipment and adjustable to dynamic environments. This review paper focuses on experimental and computational studies investigating the removal of CWAs by MOFs, specifically emphasizing the removal of nerve agents (GB, GD, and VX) via hydrolysis and sulfur mustard (HD) via selective photooxidation. Among the different MOFs, zirconium-based MOFs exhibit extraordinary structural stability and reusability, rendering them the most promising materials for the hydrolytic and photooxidative degradation of CWAs. Accordingly, this work primarily concentrates on exploring the intrinsic catalytic reaction mechanisms in Zr-MOFs through first-principles approximations, as well as the design of efficient degradation strategies in the aqueous and solid phases through the establishment of Zr-MOF structure-property relationships. Recent progress in the tuning and functionalization of MOFs is also examined, aiming to enhance practical CWA removal under realistic battlefield conditions. By providing a comprehensive overview of experimental findings and computational insights, this review paper contributes to the advancement of MOF-based strategies for the destruction of CWAs and highlights the potential of these materials to address the challenges associated with chemical warfare.

Intracranial Empyema in Children: A Single-center Retrospective Case Series.

We conducted a retrospective, observational study of 42 children with intracranial empyema admitted to a pediatric neurosurgical center over a 9-year period. Intracranial empyema is rare, but causes significant morbidity and mortality. Twenty-eight cases had neurosurgical source control, more commonly for subdural collections. Streptococcus anginosus group bacteria are important pathogens in subdural empyema, whose isolation predicts more complicated postoperative courses.

A Computational Study of Isopropyl Alcohol Adsorption and Diffusion in UiO-66 Metal-Organic Framework: The Role of Missing Linker Defect.

Defect engineering leads to an effective manipulation of the physical and chemical properties of metal-organic frameworks (MOFs). Taking the common missing linker defect as an example, the defective MOF generally possesses larger pores and a greater surface area/volume ratio, both of which favor an increased amount of adsorption. When it comes to the self-diffusion of adsorbates in MOFs, however, the missing linker is a double-edged sword: the unsaturated metal sites, due to missing linkers, could interact more strongly with adsorbates and result in a slower self-diffusion. Therefore, it is of fundamental importance to evaluate the two competing factors and reveal which one is dominating, a faster self-diffusion due to larger volume or a slower self-diffusion owing to strong interactions at unsaturated sites. In this work, via Monte Carlo and molecular dynamics simulations, we investigate the behavior of isopropyl alcohol (IPA) in the Zr-based UiO-66 MOFs, with a specific focus on the missing linker effects. The results reveal that unsaturated Zr sites bind strongly with IPA molecules, which in return would significantly reduce the self-diffusion coefficient of IPA. Besides this, for the same level of missing linkers, the location of defective sites also makes a difference. We expect such a theoretical study will provide an in-depth understanding of self-diffusion under confinement, inspire better defect engineering strategics, and promote MOF based materials toward challenging real-life applications.

Azithromycin in viral infections.

Azithromycin (AZM) is a synthetic macrolide antibiotic effective against a broad range of bacterial and mycobacterial infections. Due to an additional range of anti-viral and anti-inflammatory properties, it has been given to patients with the coronaviruses SARS-CoV or MERS-CoV. It is now being investigated as a potential candidate treatment for SARS-CoV-2 having been identified as a candidate therapeutic for this virus by both in vitro and in silico drug screens. To date there are no randomised trial data on its use in any novel coronavirus infection, although a large number of trials are currently in progress. In this review, we summarise data from in vitro, murine and human clinical studies on the anti-viral and anti-inflammatory properties of macrolides, particularly AZM. AZM reduces in vitro replication of several classes of viruses including rhinovirus, influenza A, Zika virus, Ebola, enteroviruses and coronaviruses, via several mechanisms. AZM enhances expression of anti-viral pattern recognition receptors and induction of anti-viral type I and III interferon responses. Of relevance to severe coronavirus-19 disease (COVID-19), which is characterised by an over-exuberant innate inflammatory response, AZM also has anti-inflammatory properties including suppression of IL-1beta, IL-2, TNF and GM-CSF. AZM inhibits T cells by inhibiting calcineurin signalling, mammalian target of rapamycin activity and NFκB activation. AZM particularly targets granulocytes where it concentrates markedly in lysosomes, particularly affecting accumulation, adhesion, degranulation and apoptosis of neutrophils. Given its proven safety, affordability and global availability, tempered by significant concerns about antimicrobial stewardship, there is an urgent mandate to perform well-designed and conducted randomised clinical trials.

Medical student support for vulnerable patients during COVID-19 - a convergent mixed-methods study.

BACKGROUND: The coronavirus pandemic has exerted significant impacts on primary care, causing rapid digital transformation, exacerbating social isolation, and disrupting medical student and General Practice [GP] trainee education. Here we report on a medical student telephone initiative set-up by a final year GP trainee (the equivalent of a family medicine resident), which aimed to support patients at high risk and vulnerable to the Coronavirus Disease of 2019 [Covid-19]. In addition, it was hoped the project would mitigate a digital divide, enable proactive anticipatory planning, and provide an active learning environment to compensate for the pandemic's impact on medical education. METHODS: Thirty-three medical students conducted daily telephone conversations with high risk and vulnerable patients as specified by the initial NHSE published lists. They confirmed public health messages, offered details for voluntary support groups, established need for medication delivery, explored levels of digital connectivity, and prompted discussions around end-of-life choices. Students had access to online reflective resources and daily remote debriefing sessions with the GP trainee. A convergent mixed-methods evaluation was subsequently undertaken, using quantitative process and descriptive data and individual qualitative interviews were conducted according to a maximal variation sampling strategy with students, General Practitioners [GPs], and the GP trainee. Inductive thematic analysis was then applied with cross-validation, respondent validation, and rich evidential illustration aiding integrity. RESULTS: Ninety-seven 'high risk' and 781 'vulnerable' calls were made. Individuals were generally aware of public heath information, but some struggled to interpret and apply it within their own lives. Therefore respondents felt students provided additional practical and psychological benefits, particularly with regard to strengthening the links with the community voluntary groups. The project was widely liked by students who reported high levels of skill development and widened awareness, particularly valuing the active learning environment and reflective feedback sessions. CONCLUSION: This study demonstrates utilization of medical students as wider assets within the primary health care team, with an initiative that enables support for vulnerable patients whilst promoting active medical education. Ongoing integration of students within 'normal' primary health care roles, such as chronic disease or mental health reviews, could provide similar opportunities for supported active and reflective learning.

Unilateral Vulvar Pneumatocele (Pneumolabium) Diagnosed during Robotic Hysterectomy.

BACKGROUND: Persistent canal of Nuck may manifest in adulthood and be detected after increased abdominal pressure. CASE: A 52-year -old female undergoing a robotic hysterectomy developed an acute left labial enlargement. The patient was discovered to have an 8 × 4 × 4 cm swelling in the left labium majus. Palpation revealed the mass to be air-filled and reducible by gentle compression with slow redevelopment upon release of the pressure while intra-abdominal insufflation was maintained. CONCLUSION: We present the first case of a labial pneumatocele during robotic hysterectomy. We theorize that the underlying cause to be a patent canal of Nuck that, once supplied with increasing abdominal peritoneal pressure, allowed air to travel into the labia majora through the inguinal canal. Simple reduction corrected the pneumatocele and no complications or recurrence was noted postop. This case suggests that pathologies of the canal of Nuck should be considered in the differential of an adult presenting with inguinal or genital swelling.

No Increased Risk of Posttransplant Lymphoproliferative Disorder Following Alemtuzumab Induction in Kidney Transplant.

OBJECTIVES: Posttransplant lymphoproliferative disorder is a known complication of solid-organ transplant. The use of depleting induction agents has demonstrated varying associations with incidence of posttransplant lymphoproliferative disorder. Alemtuzumab, a depleting induction agent for kidney transplant patients, has shown promising results in reducing the risk of acute rejection and graft loss in the first year. Its unique mechanism of depleting both T-cell and B-cell populations may be beneficial in preventing the occurrence of posttransplant lymphoproliferative disorder. MATERIALS AND METHODS: We examined the known risk factors for posttransplant lymphoproliferative disorder in the setting of alemtuzumab induction to determine whether incidence increases with this induction agent. We reviewed medical records of all alemtuzumab-induced kidney transplants from March 2006 to November 2015. RESULTS: Of the 675 transplant patients who received alemtuzumab induction, 10 developed posttransplant lymphoproliferative disorder, with a cumulative incidence rate of 1.5%. All diagnosed patients had several known risk factors associated with posttransplant lymphoproliferative disorder: 7 with advanced age over 60 years, 5 being cytomegalovirus-negative recipients, and all 10 donor kidneys being male patients and Epstein-Barr virus positive before transplant. CONCLUSIONS: The incidence rate seen in our patient population was within the range of the average in the United States but far lower than the incidence rates associated with other induction agents. Alemtuzumab is associated with a lower cumulative incidence rate of posttransplant lymphoproliferative disorder compared with published reports of other induction treatments.

Simultaneous Pancreas and Kidney Transplantation is Associated With Inferior Long-Term Outcomes in African Americans.

OBJECTIVES: Simultaneous pancreas and kidney transplant (SPK) is the most effective treatment for patients with type 1 diabetes mellitus and renal failure. However, the effect of ethnicity on SPK outcomes is not well understood. METHODS: We studied the influence of recipient ethnicity on SPK using the United Network for Organ Sharing database. A retrospective review of 20,196 SPK patients from 1989 to 2014 was performed. The recipients were divided into 4 groups: 15,833 whites (78.40%), 2708 African Americans (AA) (14.39%), 1456 Hispanics (7.21%), and 199 Asians (0.99%). RESULTS: Hispanics and Asians experienced the best overall graft and patient outcomes. Both groups demonstrated significantly superior graft and patient survival rates compared with whites at 1, 3, 5, 10, and 15 years (all P < 0.0001). African Americans experienced significantly superior 1- and 3-year patient survival compared with whites (both P < 0.0001). African Americans also experienced significantly superior 1-year kidney and pancreas graft survival compared with whites (P < 0.0001). However, AA experienced significantly inferior patient and allograft outcomes for all other time points compared with whites. CONCLUSIONS: Based on United Network for Organ Sharing data from 1989 to 2014, AA have worse long-term patient and graft survival rates compared with whites, Hispanics, and Asians undergoing SPK.

Challenging hepatitis C-infected liver transplant patients.

Caring for liver transplant patients suffering from chronic hepatitis C virus (HCV) infection is a challenging task for transplant surgeons and primary physicians alike. HCV is the leading cause of liver transplantation in the USA and comes with a myriad of complications that increase morbidity and mortality. This review focuses on patient follow-up, spanning from before the liver transplant occurs to the patient's long-term health. Pretransplant, both donor and recipient variables, must be carefully chosen to ensure optimal surgical success. Risk factors must be identified and HCV viral load must be reduced to a minimum. In addition to standard transplant complications, HCV patients suffer from additional problems, such as fibrosing cholestatic hepatitis and widespread viremia. Physicians must focus on the balance of immunosuppressive and antiviral medications, while considering possible side effects from these potent drugs. Over the years following surgery, physicians must identify any signs of failing liver health, as HCV-positive patients have an increased risk for cirrhosis and certain life-threatening malignancies.