Fatal borealpox in an immunosuppressed patient treated with antivirals and vaccinia immunoglobulin - Alaska, 2023.

BACKGROUND: Borealpox virus (BRPV, formerly known as Alaskapox virus) is a zoonotic member of the Orthopoxvirus genus first identified in a person in 2015. In the six patients with infection previously observed BRPV involved mild, self-limiting illness. We report the first fatal BRPV infection in an immunosuppressed patient. METHODS: A man aged 69 years from Alaska's Kenai Peninsula was receiving anti-CD20 therapy for chronic lymphocytic leukemia. He presented to care for a tender, red papule in his right axilla with increasing induration and pain. The patient failed to respond to multiple prescribed antibiotic regimens and was hospitalized 65 days postsymptom onset for progression of presumed infectious cellulitis. BRPV was eventually detected through orthopoxvirus real-time polymerase chain reaction testing of mucosal swabs. He received combination antiviral therapy, including 21 days of intravenous tecovirimat, intravenous vaccinia immunoglobulin, and oral brincidofovir. Serial serology was conducted on specimens obtained posttreatment initiation. FINDINGS: The patient's condition initially improved with plaque recession, reduced erythema, and epithelization around the axillary lesion beginning one-week post-therapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days postsymptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected. CONCLUSION: This report demonstrates that BRPV can cause overwhelming disseminated infection in certain immunocompromised patients. Based on the patient's initial response, early BRPV identification and antiviral therapies might have been beneficial. These therapies, in combination with optimized immune function, should be considered for patients at risk for manifestations of BRPV.

Au25 Cluster-Based Atomically Precise Coordination Frameworks and Emission Engineering through Lattice Symmetry.

The atomically precise metal nanoclusters (NCs) have attracted significant attention due to their superatomic behavior originating from the quantum confinement effect. This behavior makes these materials suitable for various photoluminescence-based applications, including chemical sensing, bioimaging, and phototherapy, owing to their intriguing optical properties. Especially, the manipulation of inter- or intracluster interaction through cluster-assembled materials (CAMs) presents significant pathways for modifying the photophysical properties of NCs. Herein, two distinct CAMs, Au25-Zn-Hex and Au25-Zn-Rod, were synthesized via forming a coordination bond between [Au25(p-HMBA)18]- (p-H2MBA = 4-mercaptobenzoic acid) and Zn2+. Au25-Zn-Rod exhibited a 6-fold higher luminescence intensity in the near-infrared region compared to Au25-Zn-Hex, attributed to synergistic inter- and intracluster interactions that induce exciton delocalization and structure rigidification at the atomic scale. This study highlights the potential of diverse lattice symmetries in cluster-based frameworks for tuning the photophysical properties, contributing to a deeper understanding of the structure-property relationship in Au NCs.

Cardiovascular Precision Medicine and Remote Intervention Trial Rationale and Design.

Background: It has recently been shown that excessive fluctuation in blood pressure readings for an individual over time is closely associated with poor outcomes, including increased risk of cardiovascular mortality, coronary heart disease and stroke. Fluctuations may be associated with inconsistent adherence to medical recommendations. This new marker of risk has not yet been incorporated into a monitoring and intervention strategy that seeks to reduce cardiovascular risk by identifying patients through an algorithm tied to their electronic health record (EHR). Methods: We describe the methods used in an innovative "proof of concept" trial using CP&R (Cardiovascular Precision Medicine and Remote Intervention). A blood pressure variability index is calculated for clinic patients via an EHR review. Consenting patients with excessive variability are offered a remote intervention aimed at improving adherence to medical recommendations. The outcomes include the ability to identify and engage the identified patients and the effects of the intervention on blood pressure variability using a pre-post comparison design without parallel controls. Conclusions: Our innovative approach uses a recently identified marker based on reviewing and manipulating EHR data tied to a remote intervention. This design reduces patient burden and supports equitable and targeted resource allocation, utilizing an objective criterion for behavioral risk. This study is registered under ClinicalTrials.gov Identifier: NCT05814562.

Molecular-Level Pore Tuning in 2D Conductive Metal-Organic Frameworks for Advanced Supercapacitor Performance.

Two-dimensional (2D) electrically conductive metal-organic frameworks (MOFs) have emerged as viable candidates for active electrode materials in supercapacitors due to their high electrical conductivity, high specific surface area, and intrinsic redox-active sites. Despite their promising electrochemical performance, their pseudocapacitive behavior via fast and reversible charge transfer reactions remains yet to be fully exploited. Here, we investigate the electrochemical energy storage mechanism of Cu3(HHTATP)2 (HHTATP = 2,3,6,7,10,11-hexahydroxy-1,5,9-triaminotriphenylene), a 2D conductive MOF featuring characteristic redox-active pendant aromatic amines. Cu3(HHTATP)2 exhibited pseudocapacitive charge storage with an average gravimetric capacitance of 340 ± 15 F g-1 at a discharge rate of 0.2 A g-1 and maintained a capacitance retention over 90% after 7000 galvanostatic cycles at 5 A g-1. The polar pendant amines not only enhanced capacitance via additional amine/imine redox activity but also reduced interfacial charge transfer resistance through modified electrode-electrolyte interactions. These results highlight the potential of molecular-level pore environment tuning as a strategic approach in materials design for energy storage applications.

Successful Treatment of Severe Pyoderma Gangrenosum and Ulcerative Colitis With Upadacitinib.

Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative skin disorder that is often associated with an underlying systemic disease, including inflammatory bowel disease. Many treatments used to treat inflammatory bowel disease are also used for the treatment of PG, including systemic therapies, immunomodulators, and tumor necrosis factor-α inhibitors; however, their efficacy in PG is limited. Novel treatments of PG are needed. We report the case of a 62-year-old woman with steroid-refractory PG and concomitant ulcerative colitis successfully treated for both conditions with upadacitinib, a selective Janus kinase inhibitor.

Evaluation for primary hyperparathyroidism after radioactive iodine treatment in patients with Graves' disease.

BACKGROUND: Retrospective studies are conflicting regarding the risk of primary hyperparathyroidism after radioactive iodine treatment. We hypothesized that primary hyperparathyroidism rates are greater after radioactive iodine than after thyroidectomy and that patients with hypercalcemia after treatment for Graves' disease are not adequately evaluated for primary hyperparathyroidism, contributing to underdiagnosis of radioactive iodine-associated primary hyperparathyroidism. METHODS: This retrospective review considers patients undergoing radioactive iodine or thyroidectomy for Graves' disease at a tertiary referral center between January 1, 2000, and January 31, 2022. Patients were identified using a hospital-based cohort discovery tool; exclusions included history of head/neck radiation, primary hyperparathyroidism/parathyroidectomy, renal dysfunction diagnoses, or treatment with both radioactive iodine and thyroidectomy. Patients with an elevated calcium (>10.2 mg/dL) level measured after treatment were classified as "incomplete workup" (no parathyroid hormone), "likely primary hyperparathyroidism" (parathyroid hormone >40 pg/dL), or "unlikely primary hyperparathyroidism" (parathyroid hormone <40 pg/dL). RESULTS: Of 900 patients, 468 (52%) had been treated with radioactive iodine and 432 (48%) with thyroidectomy. At a median follow-up of 9.39 years (interquartile range, 5.12-13.25), 25% (n = 224) of patients did not have a serum calcium measured and 52 (8%, n = 676) patients had an elevated calcium level. Hypercalcemia was more common after radioactive iodine (10%) than thyroidectomy (6%, P = .061). Of patients with hypercalcemia, 33 (63%) were "incomplete workup," 5 (10%) were "likely primary hyperparathyroidism," and 14 (27%) were "unlikely primary hyperparathyroidism." There was no difference in primary hyperparathyroidism workup rates between patients treated with radioactive iodine (n = 23) and thyroidectomy (n = 10, P = .389). CONCLUSIONS: Patients treated with radioactive iodine for Graves' disease may experience an elevated rate of hypercalcemia, but the majority are not adequately evaluated for primary hyperparathyroidism. Patients with a history of radioactive iodine should undergo regular calcium screening and, if elevated, appropriate workup for primary hyperparathyroidism.

A Review of Hidradenitis Suppurativa in Special Populations: Considerations in Children, Pregnant and Breastfeeding Women, and the Elderly.

Hidradenitis suppurativa (HS) is a chronic skin condition that significantly impacts patients' quality of life. HS is often challenging to treat. In this review, we discuss the unique characteristics of HS in four special populations: children, the elderly, pregnant individuals, and breastfeeding mothers. In children, diagnosis may be delayed due to atypical and early HS disease presentations. HS management plans must take into consideration the lack of rigorous efficacy and safety data of HS treatments in this population. However, it is important to weigh the risk of treatments against the risk of untreated HS and the morbidity and mortality risk that having HS confers. Pregnancy poses unique challenges for women with HS, with their condition possibly worsening during pregnancy and increased risk of fetal death. Management strategies during pregnancy must consider both maternal and fetal safety. Similarly, breastfeeding mothers require thoughtful medication selection to balance symptom management with infant safety. In the elderly, HS may present more severely and is often complicated by comorbidities. Treating HS in this population should safely accommodate patients' additional health conditions. Furthermore, this review highlights the overall paucity of primary literature addressing management in these populations, underscoring the need for further research to optimize HS care across all stages of life.

Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma.

This JAMA Clinical Guidelines Synopsis summarizes the 2023 American Association for the Study of Liver Diseases practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma.

Post-Modification Approach for Self-Exfoliated Synthesis of Pyridinium Sulfobetaine Covalent Organic Frameworks for Enhanced Lithium-Ion Conductivity.

While covalent organic frameworks (COFs) have been extensively investigated in the field of organic electrolyte materials, there is potential for further enhancement of their room-temperature ionic conductivity. This study introduces a novel methodology to induce self-exfoliation in the parent COF during synthesis through a postmodification technique. This process yields covalent organic nanosheets that feature pyridinium sulfobetaine groups, referred to as PS-CON. Due to the strategic arrangement of pyridinium cations and sulfobetaine anions, the charge distribution in PS-CON varies substantially, leading to a significant enhancement in lithium-ion dissociation. The methodically organized one-dimensional pore channels, along with the linear structure of the pyridinium sulfobetaine groups, facilitate the lithium-ion transport. PS-CON demonstrated a remarkable ionic conductivity of 2.19 × 10-4 S cm-1and a low activation energy (0.26 eV) coupled with a broad electrochemical stabilization window (4.05 V). Furthermore, the symmetrical cell (Li|Li@PS-CON|Li) demonstrates stable Li plating/stripping for more than 1200 h, which highlights the vast potential of pyridinium-sulfobetaine based zwitterionic nanosheets as high-performance organic electrolytes.

Modeling the human placenta: in vitro applications in developmental and reproductive toxicology.

During its temporary tenure, the placenta has extensive and specialized functions that are critical for pre- and post-natal development. The consequences of chemical exposure in utero can have profound effects on the structure and function of pregnancy-associated tissues and the life-long health of the birthing person and their offspring. However, the toxicological importance and critical functions of the placenta to embryonic and fetal development and maturation have been understudied. This narrative will review early placental development in humans and highlight some in vitro models currently in use that are or can be applied to better understand placental processes underlying developmental toxicity due to in utero environmental exposures.

Chemically synthesized poly(3,4-ethylenedioxythiophene) conducting polymer as a robust electrocatalyst for highly efficient dye-sensitized solar cells.

Chemically synthesized PEDOT (poly(3,4-ethylenedioxythiophene)) nanomaterials, with various nanostructured morphologies as well as different intrinsic electrical conductivities and crystallinities, were compared as electrocatalysts for Co(III) reduction in dye-sensitized solar cells (DSSCs). Electrochemical parameters, charge transfer resistance toward the electrode/electrolyte interface, catalytic activity for Co(III)-reduction, and diffusion of cobalt redox species greatly depend on the morphology, crystallinity, and intrinsic electrical conductivity of the chemically synthesized PEDOTs and optimization of the fabrication procedure for counter electrodes. The PEDOT counter electrode, fabricated by spin coating a DMSO-dispersed PEDOT solution with an ordered 1D structure and nanosized fibers averaging 70 nm in diameter and an electrical conductivity of ∼16 S cm-1, exhibits the lowest charge transfer resistance, highest diffusion for a cobalt redox mediator and superior electrocatalytic performance compared to a traditional Pt-counter electrode. The photovoltaic performance of the DSSC using chemically synthesized PEDOT exceeds that of a Pt-electrode device because of the enhanced current density, which is directly related to the superior electrocatalytic ability of PEDOT for Co(III)-reduction. This simple spin-coated counter electrode prepared using cheap and scalable chemically synthesized PEDOT can be a potential alternative to the expensive Pt-counter electrode for cobalt and other redox electrolytes in DSSCs and various flexible electronic devices.

Fabricating Large-Area Thin Films of 2D Conductive Metal-Organic Frameworks.

ConspectusRecent years have witnessed significant interest in two-dimensional metal-organic frameworks (MOFs) due to their unique properties and promising applications across various fields. These materials offer distinct advantages, including high porosity and excellent charge transport properties. Their tunability allows precise control over various factors, including the electronic structure adjustments and local reactivity modulation, facilitating a wide range of properties and applications, such as material sensing and spin dynamics control. Moreover, the precise crystal structure of 2D MOFs supports rational design and mechanism studies, providing insights into their potential applications and enhancing their utility in various scientific and technological endeavors.To fully unveil the latent capabilities of 2D MOFs and advance their applications across diverse fields, thin film synthesis is crucial. Thin films provide a platform for investigating the intrinsic electrical properties of 2D MOFs with anisotropic structures, enabling the exploration of their unique characteristics comprehensively. Additionally, thin films offer the advantage of minimizing interference at contacts and junctions, thereby enhancing the performance of 2D MOFs for various applications. Furthermore, the properties of thin films can vary with thickness, presenting an opportunity to tailor their characteristics based on specific requirements.In this Account, we present an overview of our research focusing on the synthesis of 2D conductive MOF thin films encompassing two primary methods: chemical vapor deposition and solution processing. The chemical vapor deposition method allows for one-step, all-vapor-phase processes resulting in MOFs with edge-on orientation, controllable film thicknesses ranging from 55 to 662.7 nm, and smooth, homogeneous surfaces. On the other hand, solution-processing introduces a novel MOF, Cu3(HHTATP)2, by reducing interlayer interactions through the addition of pendent Brønsted bases on a ligand, enabling spin coating for thin film synthesis. This method yields a concentrated 2D MOF solution, enabling spin coating for thin film synthesis, where reversible electrical conductivity changes occur through doping with an acid and dedoping with a base. Additionally, we discuss various other synthesis methods, such as interfacial synthesis, layer-by-layer assembly, and microfluidic-assisted synthesis, offering versatile approaches for fabricating large-area thin films with tailored properties. Finally, we address ongoing challenges and potential strategies for further advancement in 2D conductive MOF thin film synthesis. We hope that this Account provides insights for selecting synthesis methods tailored to specific purposes, contributes to the development of varied synthesis techniques, and facilitates the exploration of diverse applications, unlocking the full potential of 2D conductive MOFs for next-generation technologies.

Outbreak of Human Trichinellosis - Arizona, Minnesota, and South Dakota, 2022.

Trichinellosis is a parasitic zoonotic disease transmitted through the consumption of meat from animals infected with Trichinella spp. nematodes. In North America, human trichinellosis is rare and is most commonly acquired through consumption of wild game meat. In July 2022, a hospitalized patient with suspected trichinellosis was reported to the Minnesota Department of Health. One week before symptom onset, the patient and eight other persons shared a meal that included bear meat that had been frozen for 45 days before being grilled and served rare with vegetables that had been cooked with the meat. Investigation identified six trichinellosis cases, including two in persons who consumed only the vegetables. Motile Trichinella larvae were found in remaining bear meat that had been frozen for >15 weeks. Molecular testing identified larvae from the bear meat as Trichinella nativa, a freeze-resistant species. Persons who consume meat from wild game animals should be aware that that adequate cooking is the only reliable way to kill Trichinella parasites and that infected meat can cross-contaminate other foods.

Expert Practices in Hidradenitis Suppurativa Flare Management: A Cross-Sectional Survey Study.

Introduction: Hidradenitis suppurativa (HS) is a chronic skin condition with recurrent, debilitating flares. Although the majority of patients with HS endorse flares, there is a lack of research regarding HS experts' flare management practices and perspectives. Methods: An anonymous online survey was distributed through an HS expert listserv. Board-certified dermatologists who saw 1 or more HS patient(s) per month were eligible for participation. Results: A total of 35 responses were collected; 97.1% self-identified as HS experts. Therapies used for HS flares by more than two-thirds of the respondents included systemic antibiotics (100%), nonprescription pain relievers (91.4%), intralesional triamcinolone injections (91.4%), prescription pain relievers (71.4%), oral corticosteroids (68.6%), and warm compresses (68.6%). The top 3 dermatologist-reported barriers that patients face in accessing care during flares include lack of clinic appointment availability (88.6%), distance that patients have to travel to reach clinic (85.7%), and lack of transportation for patients (62.9%). Conclusions: Overall, this study highlights variations in the ways that HS experts manage flares. Many of the treatment modalities used by the majority of respondents are not part of the official North American guidelines. Further prospective studies and expert consensus guidelines are needed to standardize the approach to flare management.

Strengthening Pediatric and Public Health Collaboration to Protect Children's Health During a Pandemic.

This article examines lessons learned from previous pandemics, including the 2009 H1N1 influenza and the coronavirus disease 2019 pandemic. Pediatric providers have a unique and important role and strategies to improve collaboration and communication between public health and pediatric providers are essential during public health emergencies. A robust network of communication channels, effective public health messaging, and pediatric-focused disease related, and program outcome data are key to supporting a coordinated response to future pandemics. Critical issues include real-time communication with and engagement of pediatric providers as well as optimizing best evidence approaches for pediatric care while considering the distinct challenges facing children and their families.