Intracranial Relapse in Pediatric Sarcoma.

Advances in local control techniques, chemotherapy regimens, and imaging modalities have led to improvements in both morbidity and mortality in pediatric sarcoma patients. However, approximately one-third of patients develop disease relapse and intracranial metastasis was considered rare. The incidence of sarcoma brain metastasis is thought to have increased and is associated with grim outcomes. This was a retrospective study of 3 deidentified patient charts illustrating the possibility of the central nervous system as a potential site for pediatric sarcoma relapse and investigate the patterns of such relapses. We note this is the first report of infantile fibrosarcoma brain metastasis and a rare report of sarcoma lymph node metastasis. In addition, each patient was treated with targeted therapies, including entrectinib, Ruxolitnib, and pazopanib. Caregivers in cases 2 and 3 reported new-onset neurological manifestations before identification of new brain metastasis, indicating a lag in detection of new intracranial relapse in asymptomatic sarcoma patients. We suggest implementing a brief review of systems screening tool focused on concerning neurological manifestations to screen for new brain metastasis.

Tungsten disulfide thin films via electrodeposition from a single source precursor.

We report a simple process for the electrodeposition of tungsten disulfide thin films from a CH2Cl2-based electrolyte using a tailored single source precursor, [NEt4]2[WS2Cl4]. This new precursor incorporates the 1 : 2 W : S ratio required for formation of WS2, and eliminates the need for an additional proton source in the electrolyte to remove excess sulfide. The electrochemical behaviour of [NEt4]2[WS2Cl4] is studied by cyclic voltammetry and electrochemical quartz crystal microbalance techniques, and the WS2 thin films are grown by potentiostatic electrodeposition.

Synthesis, properties and structural features of molybdenum(v) oxide trichloride complexes with neutral chalcogenoether ligands.

Complexes of oxotrichloromolybdenum(v) with neutral group 16 donor ligands, [MoOCl3(L-L)] (L-L = RS(CH2)2SR, R = iPr, Ph; MeS(CH2)3SMe; MeSe(CH2)2SeMe; MeSe(CH2)3SeMe), [{MoOCl2(EMe2)}2(µ-Cl)2] (E = S, Se, Te), [(MoOCl3)2{o-C6H4(EMe)2}]n (E = Se or Te) and [(MoOCl3)2{MeTe(CH2)3TeMe}]n, have been obtained by reaction of the ligands with [MoOCl3(thf)2] or MoOCl3 in either CH2Cl2 or toluene, and characterised by microanalysis, IR and UV-visible spectroscopy and magnetic measurements. The telluroethers are the first examples containing Mo in a positive oxidation state. X-ray crystal structures are reported for the six-coordinate fac-[MoOCl3{MeS(CH2)3SMe}], mer-[MoOCl3{iPrS(CH2)2SiPr}] and mer-[MoOCl3{MeSe(CH2)2SeMe}], as well as the six-coordinate chloride-bridged dimers, [{MoOCl2(SMe2)}2(µ-Cl)2] and [{MoOCl2(SeMe2)}2(µ-Cl)2]. The structure of the mixed-valence decomposition product, [MoIVCl{o-C6H4(TeMe)2}2(µ-O)MoVOCl4], was also determined. In toluene solution MoOCl4 is reduced by MeS(CH2)3SMe to produce the Mo(v) complex, [MoOCl3{ MeS(CH2)3SMe}]. Crystal structures of the previously unknown diphosphine analogue, [MoOCl3{Me2P(CH2)2PMe2}], and the mixed-valence derivative [MoIVCl{Me2P(CH2)2PMe2}2(µ-O)MoVOCl4] are also reported for comparison and help to clarify earlier contradictory literature reports. In contrast to the dimeric EMe2 complexes, [{MoOCl2(EMe2)}2(µ-Cl)2], PMe3 forms the monomeric complex, fac-[MoOCl3(PMe3)2].

Large-Area Electrodeposition of Few-Layer MoS2 on Graphene for 2D Material Heterostructures.

Heterostructures involving two-dimensional (2D) transition metal dichalcogenides and other materials such as graphene have a strong potential to be the fundamental building block of many electronic and optoelectronic applications. The integration and scalable fabrication of such heterostructures are of the essence in unleashing the potential of these materials in new technologies. For the first time, we demonstrate the growth of few-layer MoS2 films on graphene via nonaqueous electrodeposition. Through methods such as scanning and transmission electron microscopy, atomic force microscopy, Raman spectroscopy, energy- and wavelength-dispersive X-ray spectroscopies, and X-ray photoelectron spectroscopy, we show that this deposition method can produce large-area MoS2 films with high quality and uniformity over graphene. We reveal the potential of these heterostructures by measuring the photoinduced current through the film. These results pave the way toward developing the electrodeposition method for the large-scale growth of heterostructures consisting of varying 2D materials for many applications.

High-Risk Chief Complaints III: Neurologic Emergencies.

A careful history and thorough physical examination are necessary in patients presenting with acute neurologic dysfunction. Patients presenting with headache should be screened for red-flag criteria that suggest a dangerous secondary cause warranting imaging and further diagnostic workup. Dizziness is a vague complaint; focusing on timing, triggers, and examination findings can help reduce diagnostic error. Most patients presenting with back pain do not require emergent imaging, but those with new neurologic deficits or signs/symptoms concerning for acute infection or cord compression warrant MRI. Delay to diagnosis and treatment of acute ischemic stroke is a frequent reason for medical malpractice claims.

Thioether complexes of WSCl4, WOCl4 and WSCl3 and evaluation of thiochloride complexes as CVD precursors for WS2 thin films.

The red-brown [(WSCl4)2{µ-RS(CH2)2SR}] (R = Me, Ph, iPr) and [(WSCl4)2{µ-MeS(CH2)3SMe}] have been made by reaction of WSCl4 with the thioether in a 2 : 1 molar ratio, in anhydrous CH2Cl2 solution, and characterised by microanalysis, IR, UV/Vis and 1H NMR spectroscopy. The X-ray structures of the four dithioether complexes reveal square pyramidal WSCl4 units and bridging dithioethers with W[double bond, length as m-dash]S trans to thioether sulfur. Paramagnetic W(v) complexes, [WSCl3{RS(CH2)2SR}] (R = Me, iPr), have been made similarly using a 1 : ≥1 ratio of reactants or longer reaction times. The W(vi) complexes, [WSCl4(SMe2)] and [WSCl4(SeMe2)], are also described. Analogous complexes of WOCl4, [(WOCl4)2{RS(CH2)2SR}] (R = Ph, iPr), have been made similarly from WOCl4, but reactions using MeS(CH2)nSMe (n = 2, 3) led to reduction to W(v), forming [WOCl3{MeS(CH2)nSMe], both of which were identified crystallographically. Curiously, they are geometric isomers: [WOCl3{MeS(CH2)3SMe}] has the dithioether trans Cl/Cl whereas in [WOCl3{MeS(CH2)2SMe}] it is trans O/Cl. Remarkably, low pressure chemical vapour deposition (CVD) experiments using the dinuclear W(vi) species, [(WSCl4)2{iPrS(CH2)2SiPr}], as a single source precursor produced thin films of 4H-WS2, identified by grazing incidence X-ray diffraction, scanning electron microscopy, X-ray photoelectron spectroscopy and Raman spectroscopy; the tungsten thiochloride complex is the first single source low pressure CVD precursor for WS2. In contrast, the mononuclear W(v) complex, [WSCl3{iPrS(CH2)2SiPr}], does not deposit WS2 under similar conditions.

TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT).

BACKGROUND: Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. METHODS/DESIGN: Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. DISCUSSION: More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. TRIAL REGISTRATION: ISRCTN93952605.