Recurrent spinal atypical teratoid/rhabdoid tumor with pulmonary metastasis.

BACKGROUND: Atypical teratoid/rhabdoid tumors (ATRT) are aggressive pediatric central nervous system malignancies that predominantly affect the brain and have poor survival outcomes. However, spinal ATRT is an uncommon subset of ATRT, and its clinical course and management are poorly understood. CASE: We describe a case of spinal ATRT in a previously healthy 5-year-old girl who initially presented with rapid-onset gait disturbance. Magnetic resonance imaging (MRI) revealed an extramedullary tumor at thoracic level 5 (T5) without bony destruction or metastasis. The patient partially recovered after surgical resection. One month was required for a definitive diagnosis, and the pathology confirmed ATRT characterized by the loss of INI-1 protein expression. Chemoradiotherapy with local irradiation and high-dose chemotherapy with autologous peripheral blood stem cell transplantation led to complete remission and functional recovery for 5 months. However, the condition exhibited progression in the cerebrospinal fluid (CSF) region, resulting in cerebellar, cerebral, and spinal tumor development. Eventually, the disease metastasized to the lungs and disseminated to the entire cerebrospinal cord and fluid. The patient died 15 months after the initial diagnosis. CONCLUSION: This case emphasizes the importance of considering ATRT as a potential diagnostic modality for pediatric spinal cord tumors, enabling prompt multidisciplinary intervention. The heterogeneous appearance of spinal ATRT may make distinguishing it from other spinal tumors difficult, resulting in delayed diagnosis and treatment. The treatment approach for ATRT remains challenging with no established standards. Local irradiation may be preferable to minimize neurodevelopmental effects, and initial craniospinal irradiation may potentially prevent recurrence. Our case emphasizes the likelihood of extracranial metastasis in ATRT, thereby highlighting the importance of a comprehensive assessment of both genetic and epigenetic profiles to identify any factors that may influence the clinical course of this disease. Prompt diagnosis and comprehensive therapeutic strategies are critical for improving outcomes in spinal ATRT patients.

Metal-free carbazole-thiophene photosensitizers designed for a dye-sensitized H2-evolving photocatalyst in Z-scheme water splitting.

Dye-sensitized photocatalysts with molecular dyes and widegap semiconductors have attracted attention because of their design flexibility, for example, tunable light absorption for visible-light water splitting. Although organic dyes are promising candidates as metal-free photosensitizers in dye-sensitized photocatalysts, their efficiency in H2 production has far been unsatisfactory compared to that of metal-complex photosensitizers, such as Ru(II) tris-diimine-type complexes. Here, we demonstrate the substantial improvement of carbazole-thiophene-based dyes used for dye-sensitized photocatalysts through systematic molecular design of the number of thiophene rings, substituents in the thiophene moiety, and the anchoring group. The optimized carbazole-thiophene dye-sensitized layered niobate exhibited a quantum efficiency of 0.3% at 460 nm for H2 evolution using a redox-reversible I- electron donor, which is six-times higher than that of the best coumarin-based metal-free dye reported to date. The dye-sensitized photocatalyst also facilitated overall water splitting when combined with a WO3-based O2-evolving photocatalyst and an I3-/I- redox shuttle mediator. The present metal-free dye provided a high dye-based turnover frequency for water splitting, comparable to that of the state-of-the-art Ru(II) tris-diimine-type photosensitizer, by simple adsorption onto a layered niobate. Thus, this study highlights the potential of metal-free organic dyes with appropriate molecular designs for the development of efficient water splitting.

Assessment of anthracycline-induced cardiotoxicity in childhood cancer survivors during long-term follow-up using strain analysis and intraventricular pressure gradient measurements.

BACKGROUND: Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in childhood cancer survivors (CCS), and the cumulative incidence of cardiac events has continued to increase. This study identifies an adequate indicator of cardiac dysfunction during long-term follow-up. PROCEDURE: In total, 116 patients (median age: 15.5 [range: 4.7-40.2] years) with childhood cancer who were treated with anthracycline were divided into three age groups for analysis (C1: 4-12 years of age, C2: 13-18 years of age, C3: 19-40 years of age), and 116 control patients of similar ages were divided into three corresponding groups (N1, N2, and N3). Layer-specific strains were assessed for longitudinal strain (LS) and circumferential strain (CS). The total and segmental intraventricular pressure gradients (IVPG) were also calculated based on Doppler imaging of the mitral inflow using Euler's equation. RESULTS: Conventional echocardiographic parameters were not significantly different between the patients and controls. All layers of the LS and inner and middle layers of the basal and papillary CS in all ages and all IVPGs in C2 and C3 decreased compared to those of corresponding age groups. Interestingly, basal CS and basal IVPG in CCS showed moderate correlation and both tended to rapidly decrease with aging. Furthermore, basal IVPG and anthracycline dose showed significant correlations. CONCLUSIONS: Basal CS and total and basal IVPGs may be particularly useful indicators of cardiotoxicity in long-term follow-up.

Polyoxocationic antimony oxide cluster with acidic protons.

The success and continued expansion of research on metal-oxo clusters owe largely to their structural richness and wide range of functions. However, while most of them known to date are negatively charged polyoxometalates, there is only a handful of cationic ones, much less functional ones. Here, we show an all-inorganic hydroxyiodide [H10.7Sb32.1O44][H2.1Sb2.1I8O6][Sb0.76I6]2·25H2O (HSbOI), forming a face-centered cubic structure with cationic Sb32O44 clusters and two types of anionic clusters in its interstitial spaces. Although it is submicrometer in size, electron diffraction tomography of HSbOI allowed the construction of the initial structural model, followed by powder Rietveld refinement to reach the final structure. The cationic cluster is characterized by the presence of acidic protons on its surface due to substantial Sb3+ deficiencies, which enables HSbOI to serve as an excellent solid acid catalyst. These results open up a frontier for the exploration and functionalization of cationic metal-oxo clusters containing heavy main group elements.

Manipulation of charge carrier flow in Bi4NbO8Cl nanoplate photocatalyst with metal loading.

Separation of photoexcited charge carriers in semiconductors is important for efficient solar energy conversion and yet the control strategies and underlying mechanisms are not fully established. Although layered compounds have been widely studied as photocatalysts, spatial separation between oxidation and reduction reaction sites is a challenging issue due to the parallel flow of photoexcited carriers along the layers. Here we demonstrate orthogonal carrier flow in layered Bi4NbO8Cl by depositing a Rh cocatalyst at the edges of nanoplates, resulting in spatial charge separation and significant enhancement of the photocatalytic activity. Combined experimental and theoretical studies revealed that lighter photogenerated electrons, due to a greater in-plane dispersion of the conduction band (vs. valence band), can travel along the plane and are readily trapped by the cocatalyst, whereas the remaining holes hop perpendicular to the plane because of the anisotropic crystal geometry. Our results propose manipulating carrier flow via cocatalyst deposition to achieve desirable carrier dynamics for photocatalytic reactions in layered compounds.

[Thrombopoietin receptor agonists for pediatric refractory chronic immune thrombocytopenia].

Various treatments have been used to treat chronic immune thrombocytopenic purpura in children; however, none of it has been established as the standard of care. The administration of thrombopoietin receptor agonists (TPO-RAs) has been approved as a new treatment option in Japan. In this case series, TPO-RAs were administered to 16 patients (eltrombopag, n=9; romiplostim, n=7). Excluding the data of two patients who underwent splenectomy immediately after starting treatment with these medicines, platelet counts increased to ≥50,000/µl in seven patients. The adverse events recorded were grade 2 liver dysfunction (n=1), according to the common terminology criteria for adverse events version 4, and myelofibrosis (classified as MF1 or mild reticulin fibrosis), as observed on bone marrow biopsy (n=2). We continued the administration of TPO-RAs at the same dose in these patients because the complications they experienced were mild. The risk of adverse events associated with long-term use of TPO-RAs in this pediatric population remains unclear, and a prospective evaluation is needed.

Trigenic ADH5/ALDH2/ADGRV1 mutations in myelodysplasia with Usher syndrome.

Trio-next generation sequencing is useful to identify undiagnosed inherited diseases. We have attended a patient with trigenic ADH5/ALDH2/ADGRV1 pathogenic variants, which caused two distinct diseases, myelodysplastic syndrome and Usher syndrome. Whole genome sequencing of peripheral blood from the patient and his parents were applied to identify disease-causing genes. Sanger sequencing was performed to validate the identified ADH5/ALDH2/ADGRV1 variants. Our results identified disease-associated variants in ADGRV1 (disease inheritance autosomal recessive) and in ADH5 (disease inheritance also autosomal recessive) and a variant in ALDH2 (disease inheritance autosomal dominant). Although the variants identified in ADH5 and ALDH2 have been reported, their co-existence in association with disease-causing variation in a third gene has not. They broaden the spectrum of ADGRV1 in Usher syndrome. Findings on next generation sequencing guided rapid and accurate diagnosis, resulting in patient-tailored therapeutic intervention.

Layered Perovskite Oxyiodide with Narrow Band Gap and Long Lifetime Carriers for Water Splitting Photocatalysis.

The development of semiconductors with narrow band gap and high stability is crucial for achieving solar to chemical energy conversion. Compounds with iodine, which has a high polarizability, have attracted attention because of their narrow band gap and long carrier lifetime, as typified by halide perovskite solar cells; however, they have been regarded as unsuitable for harsh photocatalytic water splitting because iodine is prone to self-oxidation. Here, we demonstrate that Ba2Bi3Nb2O11I, a layered Sillén-Aurivillius oxyiodide, not only has access to a wider range of visible light than its chloride and bromide counterparts, but also functions as a stable photocatalyst, efficiently oxidizing water. Density functional theory calculations reveal that the oxygen 2p orbitals in the perovskite block, rather than the fluorite Bi2O2 block as previously pointed out, anomalously push up the valence band maximum, which can be explained by a modified Madelung potential analysis that takes into account the high polarizability of iodine. In addition, the highly polarizable iodide contributes to longer carrier lifetime of Ba2Bi3Nb2O11I, allowing for a significantly higher quantum efficiency than its chloride and bromide counterparts. Visible-light-driven Z-scheme water splitting was achieved for the first time in an iodine-based system using Ba2Bi3Nb2O11I as an oxygen-evolution photocatalyst. The present study provides a novel approach for incorporating polarizable "soft" anions into building blocks of layered materials to manipulate the band structure and improve the carrier dynamics for visible-light responsive functions.

Visible-Light-Responsive Oxyhalide PbBiO2Cl Photoelectrode: On-Site Flux Synthesis on a Fluorine-Doped Tin Oxide Electrode.

The performance of photoelectrodes is hugely affected by the preparation method. Although a flux synthesis is useful to endow semiconductor particles with the desired properties such as high crystallinity, there are only a few reports on its application to photoelectrode fabrication, probably because relatively high temperatures are necessary. In the present study, we introduce a new concept for on-site flux synthesis of semiconductor crystals on a commonly used fluorine-doped tin oxide (FTO) substrate; a seed layer is predeposited and then treated with an appropriate flux containing other required elements at a right temperature lower than the limit temperature of FTO but sufficiently high to transform the seed layer to the target material with the aid of flux. Here, an oxyhalide PbBiO2Cl, one of the promising semiconductors for achieving visible-light water splitting, is selected as a target material. Combination of a BiOCl seed layer and the NaCl-PbCl2 flux containing other precursors enables the seed layer to transform into PbBiO2Cl crystals even at 450 °C. The thickness of the PbBiO2Cl layer can be controlled by changing the thickness of the BiOCl seed layer for efficient photon-to-current conversion. Owing to a good contact at the semiconductor-substrate interfaces as well as the high quality of PbBiO2Cl crystals, the flux-synthesized PbBiO2Cl photoelectrode shows a significantly improved PEC performance compared with those prepared from the particulate PbBiO2Cl samples via the conventional squeegee method. In addition, the present PbBiO2Cl photoelectrodes exhibit both anodic and cathodic photoresponses with substantially high current values depending on the applied potentials; the unusual phenomenon is affected by the conditions in flux-assisted synthesis. The present study provides a new and effective way for fabricating efficient photoelectrodes of various semiconductors on various substrates and a possible option to control their morphologies and p/n types for further improvement in performance.

[Gilteritinib for pediatric FLT3 internal tandem duplication-positive recurrent acute myeloid leukemia].

Gilteritinib is an FMS-like tyrosine kinase 3 (FLT3) inhibitor that has shown efficacy in patients with refractory or recurrent adult acute myeloid leukemia (AML) with FLT3 mutations. However, there are limited data for pediatric patients treated with this drug. Herein, we report the clinical courses of two children with FLT3-mutated recurrent AML who received gilteritinib. Case 1: An 11-year-old boy with secondary relapsed AML presented with an FLT3 internal tandem duplication (ITD) since the first recurrence. One week after gilteritinib initiation, blasts, which had comprised 90% of the white blood cells before treatment, almost disappeared from the peripheral blood without tumor lysis syndrome. The patient developed multiple adverse effects and died from the disease 2.5 months after gilteritinib initiation. Case 2: A 12-year-old girl diagnosed with AML was positive for FLT3 ITD. She received gilteritinib during her first relapse post-stem cell transplantation. After the drug was administered, the recipient cell counts increased, as determined by molecular tests (i.e., FISH), whereas microscopically, there was a complete response for 5 months with good performance status. Gilteritinib treatment in children with FLT3-mutated recurrent AML is feasible and effective. As a patient experienced several adverse effects with gilteritinib treatment, clinical trials are required to determine the appropriate pediatric dose of this medication.

Flux Synthesis of Layered Oxyhalide Bi4NbO8Cl Photocatalyst for Efficient Z-Scheme Water Splitting Under Visible Light.

An oxyhalide photocatalyst Bi4NbO8Cl has recently been proven to stably oxidize water under visible light, enabling the Z-scheme water splitting when coupled with another photocatalyst for water reduction. We herein report the synthesis of Bi4NbO8Cl particles via a flux method, testing various molten salts to improve its crystallinity and hence photocatalytic activity. The eutectic mixture of CsCl/NaCl with a low melting point allowed the formation of single-phase Bi4NbO8Cl at as low as 650 °C. Thus, synthesized Bi4NbO8Cl particles exhibited a well-grown and plate-like shape while maintaining surface area considerably higher than those grown with others fluxes. They showed three times higher O2 evolution rate under visible light than the samples prepared via a solid-state reaction. Time-resolved microwave conductivity measurements revealed greater signals (approximately 4.8 times) owing to the free electrons in the conduction band, indicating much improved efficiency of carrier generation and/or its mobility. The loading of RuO2 or Pt cocatalyst on Bi4NbO8Cl further enhanced the activity for O2 evolution because of efficient capturing of free electrons, facilitating the surface chemical reactions. In combination with a H2-evolving photocatalyst Ru/SrTiO3:Rh along with an Fe3+/Fe2+ redox mediator, the RuO2/Bi4NbO8Cl is an excellent O2-evolving photocatalyst, exhibiting highly effective water splitting into H2 and O2 via the Z-scheme.

Mimicking Natural Photosynthesis: Solar to Renewable H2 Fuel Synthesis by Z-Scheme Water Splitting Systems.

Visible light-driven water splitting using cheap and robust photocatalysts is one of the most exciting ways to produce clean and renewable energy for future generations. Cutting edge research within the field focuses on so-called "Z-scheme" systems, which are inspired by the photosystem II-photosystem I (PSII/PSI) coupling from natural photosynthesis. A Z-scheme system comprises two photocatalysts and generates two sets of charge carriers, splitting water into its constituent parts, hydrogen and oxygen, at separate locations. This is not only more efficient than using a single photocatalyst, but practically it could also be safer. Researchers within the field are constantly aiming to bring systems toward industrial level efficiencies by maximizing light absorption of the materials, engineering more stable redox couples, and also searching for new hydrogen and oxygen evolution cocatalysts. This review provides an in-depth survey of relevant Z-schemes from past to present, with particular focus on mechanistic breakthroughs, and highlights current state of the art systems which are at the forefront of the field.

HLA haploidentical hematopoietic cell transplantation using clofarabine and busulfan for refractory pediatric hematological malignancy.

Haploidentical hematopoietic cell transplantation (HCT) conditioning with clofarabine and target area under the blood concentration-time curve (AUC)-based busulfan adjustment was performed in three patients with refractory pediatric leukemia. The target AUC for two patients who had already received multiple transplantations was 3600 and 4000 µmol min/L, and that for the patient with Down's syndrome was 3000 µmol min/L. Regimen-related toxicity was well tolerated in all cases. All three maintained cytological remission throughout the follow-up period (between 31 and 167 weeks). Thus, haploidentical HCT conditioning with clofarabine and target AUC-based busulfan adjustment may be a preferable option for children with recurrent or refractory pediatric leukemia.

Manganese-Substituted Polyoxometalate as an Effective Shuttle Redox Mediator in Z-Scheme Water Splitting under Visible Light.

In the present study, a polyoxometalate is for the first time applied as a shuttle redox in two-step (Z-Scheme) photocatalytic water splitting. Photocatalytic H2 evolution using a Mn-substituted polyoxometalate [SiW11 O39 Mn(II) (H2 O)](6-) as an electron donor proceeded over a Ru-loaded SrTiO3 :Rh photocatalyst under visible light with relatively high selectivity, accompanied by the stoichiometric production of its oxidized form [SiW11 O39 Mn(III) (H2 O)](5-) . Photocatalytic O2 evolution using the oxidized [SiW11 O39 Mn(III) (H2 O)](5-) as an electron acceptor proceeded over PtOx -loaded WO3 photocatalyst under visible light with relatively high quantum efficiency and selectivity, whereas the loading of effective PtOx cocatalyst was necessary to facilitate the reduction of polyoxometalate. Finally, a two-step water splitting into H2 and O2 was demonstrated under visible light using the couple of Mn-substituted polyoxometalate as shuttle redox between Ru/SrTiO3 :Rh and PtOx /WO3 photocatalysts, under mildly acidic conditions with pH≈4.5.

Ph-like ALL-related novel fusion kinase ATF7IP-PDGFRB exhibits high sensitivity to tyrosine kinase inhibitors in murine cells.

ATF7IP-PDGFRB is a novel PDGFRB-related fusion gene identified in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) with a signature similar to that of Ph1 ALL, so-called Ph-like ALL. When we introduced ATF7IP-PDGFRB, murine Ba/F3 cells acquired the ability to proliferate in an interleukin (IL)-3-independent manner. On the contrary, the expression of wild-type PDGFRB is not sufficient to acquire the ability for IL-3-independent proliferation in Ba/F3 cells. The introduction of ATF7IP-PDGFRB also induces a typical gene expression profile for Ph1-ALL in Ba/F3 cells. A series of biochemical and cell biological experiments revealed the constitutive activation of ATF7IP-PDGFRB as well as downstream signaling molecules, including AKT and MAPK. Although the phosphoinositide 3-kinase inhibitor led to cell death in both cells into which ATF7IP-PDGFRB had been introduced and IL-3-maintained Mock cells, MEK inhibitor selectively led to cell death into which ATF7IP-PDGFRB had been introduced. The introduction of tyrosine to phenylalanine mutations at binding sites of adaptor molecules important in the MAPK pathway located in the PDGFRB portion abolished ATF7IP-PDGFRB-mediated cell transformation, suggesting that MAPK-mediated signals are critical in ATF7IP-PDGFRB-mediated cell transformation. On treatment with tyrosine kinase inhibitors, ATF7IP-PDGFRB-expressing, but not Mock, Ba/F3 cells underwent rapid apoptosis accompanied by reduced phosphorylation of MAPK. Importantly, the sensitivity of ATF7IP-PDGFRB-expressing Ba/F3 cells to imatinib is significantly higher than that of BCR-ABL1-transformed Ba/F3 cells, as assessed by the IC50. Taken together, ATF7IP-PDGFRB has transforming potential via the constitutive activation of MAPK and participates in the pathogenesis of Ph-like ALL. Our observations suggest the therapeutic importance of tyrosine kinase inhibitors and possibly MEK inhibitor for a subset of BCP-ALL harboring PDGFRB-related fusion kinases.

Amplitude-integrated EEG revealed nonconvulsive status epilepticus in children with non-accidental head injury.

OBJECTIVE: We describe the clinical course and amplitude-integrated EEG findings in three children with non-accidental head injury and discuss on the importance of continuous aEEG monitoring in infants. METHODS: NCSE was defined as a continuous 30-min seizure or briefer seizures occurring consecutively comprising at least 30 min of any 1-h period. Non-accidental head injury was diagnosed on the basis of neuroimaging findings such as subdural hemorrhage. Antiepileptic treatment was performed with continuous amplitude-integrated EEG monitoring. RESULTS: The age of the patients ranged from 48 days to nine months. All of them had loss of consciousness and seizures on presentation. Nonconvulsive status epilepticus without clinical symptoms were recognized in all patients. Vigorous antiepileptic treatment against nonconvulsive status epilepticus was made in two patients, whereas nonconvulsive status epilepticus disappeared within one hour without additional treatment in one. CONCLUSIONS: Our experience indicates that nonconvulsive status epilepticus were not uncommon in children with non-accidental head injury. Continuous amplitude-integrated EEG monitoring will be one of the useful methods in encephalopathic children in order to estimate seizure burden objectively and to treat seizures appropriately.

Significance of CD66c expression in childhood acute lymphoblastic leukemia.

Upon analyzing 696 childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) cases, we identified the characteristics of CD66c expression. In addition to the confirmation of strong correlation with BCR-ABL positivity and hyperdiploid, we further observed that CD66c is frequently expressed in CRLF2-positive (11/15, p<0.01 against chimeric gene-negative) as well as hypodiploid cases (3/4), whereas it is never expressed in ETV6-RUNX1, MLL-AF4, MLL-AF9, MLL-ENL, and E2A-PBX1-positive cases. Although the expression of CD66c itself is not directly linked to the prognosis, the accompanying genetic abnormalities are important prognostic factors for BCP-ALL, indicating the importance of CD66c expression in the initial diagnosis of BCP-ALL.

Poor responses to tyrosine kinase inhibitors in a child with precursor B-cell acute lymphoblastic leukemia with SNX2-ABL1 chimeric transcript.

In addition to BCR, various rare fusion partners for the ABL1 gene have been reported in leukemia. We have identified the fusion gene SNX2-ABL1 in a pediatric case of acute lymphoblastic leukemia (ALL), which has only once previously been reported in an adult patient. Cytogenetic analysis detected this fusion gene arising from a t(5;9)(q22;q34) translocation. ALL cells carrying a SNX2-ABL1 fusion exhibited a BCR-ABL1+ ALL-like gene expression profile. The patient poorly responded to dasatinib but partially responded to imatinib. Treatment using tyrosine kinase inhibitors requires further investigation to optimize the genotype-based treatment stratification for patients with SNX2-ABL1 fusion.