Impact of donation after circulatory death heart transplantation on waitlist outcomes and transplantation activity.

INTRODUCTION: Donation after circulatory death (DCD) heart transplantation has been shown to have comparable outcomes to transplantation using brain death donors (DBDs). This study evaluates the impact of this alternative source of allografts on waitlist mortality and transplant volume. METHODS: We compared waitlist mortality and transplant rates in patients who were registered before (2019 period) and after we adopted DCD heart transplantation (2021 period). RESULTS: We identified 111 patients who were on the waiting list in 2019 and 77 patients who were registered during 2021. Total number of donor organ offers received in 2019 was 385 (178 unique donors) versus 3450 (1145 unique donors) in 2021. More than 40% of all donors in 2021 were DCDs. Waitlist mortality was comparable for patients in 2019 and 2021 (18/100 person-years in 2019 vs. 26/100 person-years in 2021, p = .49). The transplant rate was 67/100 person-years in 2019 versus 207/100 person-years in 2021 (p < .001). After adjusting for acuity status, gender, blood type, and weight, patients listed in 2021 had 2.08 times greater chance of transplantation compared to patients listed in 2019 (HR 2.08, 95% confidence interval [CI] 1.26-3.45, p = .004). CONCLUSIONS: Use of DCD donor hearts significantly increased heart transplant rate in our institution.

Discontinuation and nonpublication of clinical trials for the pharmacologic treatment of posttraumatic stress disorder among military veterans.

Failures by researchers and clinicians to overcome barriers in veteran health-related research may result in clinical trial (CT) discontinuation and nonpublication. Such outcomes are a waste of limited academic resources. To determine rates of discontinuation and nonpublication among CTs for posttraumatic stress disorder (PTSD) with pharmaceutical interventions specific to the veteran population, we performed a systematic search of registered trials in ClinicalTrials.gov for pharmaceutical interventions for the treatment of PTSD. Extracted study characteristics included sample size, study design, trial status, phase, and funding source. Studies were classified as completed or discontinued based on the status listed in ClinicalTrials.gov. Descriptive statistics of trials were reported, and associations of trial termination and nonpublication were assessed using logistic regression. The final sample included 54 CTs, 15 of which (27.8%) had not been published within the FDA's required timeframe, and 11 (20.4%) were discontinued. The total number of trial participants was 3,463, with a median of 37 (interquartile range: 15-92). Of the 54 trials, 12 (22.2%) were nonrandomized, and 42 (77.8%) were randomized. There were 25 (46.3%) trials that were in either Phase 3 or Phase 4, and 39 (72.2%) were government-funded. We found high rates of CT discontinuation and nonpublication among PTSD pharmaceutical intervention studies in veterans, as has been shown in other fields of research.

High quantum yield molecular bromine photoelimination from mononuclear platinum(IV) complexes.

Pt(IV) complexes trans-Pt(PEt3)2(R)(Br)3 (R = Br, aryl and polycyclic aromatic fragments) photoeliminate molecular bromine with quantum yields as high as 82%. Photoelimination occurs both in the solid state and in solution. Calorimetry measurements and DFT calculations (PMe3 analogs) indicate endothermic and endergonic photoeliminations with free energies from 2 to 22 kcal/mol of Br2. Solution trapping experiments with high concentrations of 2,3-dimethyl-2-butene suggest a radical-like excited state precursor to bromine elimination.

Lanthanum(III) and uranyl(VI) diglycolamide complexes: synthetic precursors and structural studies involving nitrate complexation.

The synthesis and structural characterization of lanthanum(III) and uranyl(VI) complexes coordinated by tridentate diglycolamide (DGA) ligands O(CH2C(O)NR2)2[R=i-Pr (L1), i-Bu (L2)] are described. Reaction of L with UO2Cl2(H2O) n forms the uranyl(VI) cis-dichloride adducts UO2Cl2L [L=L1 (1a), L2 (1b)], while reaction of excess L with the corresponding metal nitrate hydrate produces [LaL3][La(NO3)6] [L=L1 (2a), L2 (2b)] for lanthanum and UO2(NO3)2L [L=L1 (3a), L2 (3b)] for uranium. Compounds 2b and 3a have been structurally characterized. The solid-state structure of the cation of 2b shows a triple-stranded helical arrangement of three tridentate DGA ligands with approximate D3 point-group symmetry, while the counteranion consists of six bidentate nitrate ligands coordinated around a second La center. The solid-state structure of 3a shows a tridentate DGA ligand coordinated along the equatorial plane perpendicular to the OUO unit as well as two nitrate ligands, one bidentate and oriented in the equatorial plane and the other monodentate and oriented parallel to the uranyl unit with the oxygen donor atom situated above the mean equatorial plane. Ambient-temperature NMR spectra for 3a and 3b indicated an averaged chemical environment of high symmetry consistent with fluxional nitrate hapticity, while spectroscopic data obtained at -30 degrees C revealed lower symmetry consistent with the slow-exchange limit for this process.

Fluoride abstraction and reversible photochemical reduction of cationic uranyl(VI) phosphine oxide complexes.

The syntheses, structural and spectroscopic characterization, fluoride abstraction reactions, and photochemical reactivity of cationic uranyl(VI) phosphine oxide complexes are described. [UO2(OPPh3)4][X]2 (1a, X = OTf; 1b, X = BF4) and [UO2(dppmo)2(OPPh3)][X]2 (2a, X = OTf; 2b, X = BF(4)) are prepared from the corresponding uranyl(VI) chloride precursor and 2 equiv each of AgX and phosphine oxide. The BF4- compounds 1b and 2b are prone to fluoride abstraction reactions in methanol, leading to dinuclear fluoride-bridged uranyl(VI) complexes. Fluoride abstraction of 2b in methanol generates two structural isomers of the fluoride-bridged uranyl(VI) dimer [(UO2(dppmo)2)2(mu-F)][BF4]3 (4), both of which have been structurally characterized. In the major isomer 4C, the four dppmo ligands are all chelating, while in the minor isomer 4B, two of the dppmo ligands bridge adjacent uranyl(VI) centers. Photolysis of 2b in methanol proceeds through 4 to form the uranium(IV) fluoride complex [UO2F2(dppmo)3][BF4]2 (5), involving another fluoride abstraction step. X-ray crystallography shows 5 to be a rare example of a structurally characterized uranium(IV) complex possessing terminal U-F bonds. Complex 5 reverts to 4 in solution upon exposure to air.