Effectiveness of Recombinant Zoster Vaccine Against Herpes Zoster in a Real-World Setting.

BACKGROUND: A 2-dose series of recombinant zoster vaccine (RZV) was 97% effective against herpes zoster (HZ) in a pivotal clinical trial. OBJECTIVE: To evaluate real-world effectiveness of RZV against HZ. DESIGN: Prospective cohort study. SETTING: Four health care systems in the Vaccine Safety Datalink. PARTICIPANTS: Persons aged 50 years or older. MEASUREMENTS: The outcome was incident HZ defined by a diagnosis with an antiviral prescription. Cox regression was used to estimate the hazard of HZ in vaccinated persons compared with unvaccinated persons, with adjustment for covariates. Vaccine effectiveness (VE) was calculated as 1 minus the adjusted hazard ratio and was estimated by time since the last RZV dose and by corticosteroid use. RESULTS: The study included nearly 2.0 million persons who contributed 7.6 million person-years of follow-up. After adjustment, VE of 1 dose was 64% and VE of 2 doses was 76%. After 1 dose only, VE was 70% during the first year, 45% during the second year, 48% during the third year, and 52% after the third year. After 2 doses, VE was 79% during the first year, 75% during the second year, and 73% during the third and fourth years. Vaccine effectiveness was 65% in persons who received corticosteroids before vaccination and 77% in those who did not. LIMITATION: Herpes zoster could not be identified as accurately in these observational data as in the previous clinical trials. CONCLUSION: Two doses of RZV were highly effective, although less effective than in the previous clinical trials. Two-dose effectiveness waned very little during the 4 years of follow-up. However, 1-dose effectiveness waned substantially after 1 year, underscoring the importance of the second dose. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

Asymmetric by Design: Heteroleptic Coordination Compounds with Redox-Active Dithiolene and 1,2,4,5-Tetrakis(isopropylthio)benzene Ligands.

The 1,2,4,5-tetrakis(alkylthio)benzenes are redox-active organosulfur molecules that support oxidation to a stable radical cation. Their utility as ligands for the assembly of multimetal complexes with tailored functionality/property is unexamined. Here, 1,2,4,5-tetrakis(isopropylthio)benzene (tptbz, 1) is shown to bind PdCl2 at either one end, leaving the other open, or at both ends to form centrosymmetric [Cl2Pd(tptbz)PdCl2], 4. Ligand metathesis between Na2[(N≡C)2C2S2] (Na2mnt) and [Cl2M(tptbz)] (M = Pd, 2; M = Pt, 3) yields [(mnt)M(tptbz)] (M = Pd, 5; M = Pt, 6), but an alternative route involving transmetalation with [(mnt)SnMe2] delivers substantially greater yield. The mixed dithiolene-dithioether compound [(Ph2C2S2)Pt(tptbz)] (8) is formed by a similar transmetalation protocol using [(Ph2C2S2)SnnBu2]. Compounds 5, 6, and 8 are the first such heteroleptic complexes prepared by deliberate synthesis. The cyclic voltammetry of 8 reveals anodic waves at +0.14 and +0.97 V vs Fc+/Fc, which are attributed to successive dithiolene oxidation processes. While oxidized at +0.73 V as a free ligand, the redox-active MO of tptbz is pushed to a higher potential upon coordination to Pt2+ and is inaccessible. Calculations of the structures of [8]+ and of [((Cl2-3,5-C6H3)2C2S2)Pt(tptbz)]+ show that, in the latter, the dithiolene MOs are drawn down in energy into proximity with the tptbz MOs.

Post-recovery health domain scores among outpatients by SARS-CoV-2 testing status during the pre-Delta period.

BACKGROUND: Symptoms of COVID-19 including fatigue and dyspnea, may persist for weeks to months after SARS-CoV-2 infection. This study compared self-reported disability among SARS-CoV-2-positive and negative persons with mild to moderate COVID-19-like illness who presented for outpatient care before widespread COVID-19 vaccination. METHODS: Unvaccinated adults with COVID-19-like illness enrolled within 10 days of illness onset at three US Flu Vaccine Effectiveness Network sites were tested for SARS-CoV-2 by molecular assay. Enrollees completed an enrollment questionnaire and two follow-up surveys (7-24 days and 2-7 months after illness onset) online or by phone to assess illness characteristics and health status. The second follow-up survey included questions measuring global health, physical function, fatigue, and dyspnea. Scores in the four domains were compared by participants' SARS-CoV-2 test results in univariate analysis and multivariable Gamma regression. RESULTS: During September 22, 2020 - February 13, 2021, 2712 eligible adults were enrolled, 1541 completed the first follow-up survey, and 650 completed the second follow-up survey. SARS-CoV-2-positive participants were more likely to report fever at acute illness but were otherwise comparable to SARS-CoV-2-negative participants. At first follow-up, SARS-CoV-2-positive participants were less likely to have reported fully or mostly recovered from their illness compared to SARS-CoV-2-negative participants. At second follow-up, no differences by SARS-CoV-2 test results were detected in the four domains in the multivariable model. CONCLUSION: Self-reported disability was similar among outpatient SARS-CoV-2-positive and -negative adults 2-7 months after illness onset.

Extranodal Rosai-Dorfman Disease: a rare presentation involving anterior chest wall in a middle-aged female.

Rosai-Dorfman Disease is a rare benign disorder involving overproduction of immune cells, causing swollen lymph nodes and, in rare cases, the sternum. The sternal involvement may cause chest pain and masses. Diagnosis is confirmed through clinical examination, biopsy, and imaging. Treatment options may include surgery, radiation, or steroids. In this case study, we present an unusual example of extranodal Rosai-Dorfman Disease involving the sternum, bilateral clavicles and first three ribs, and pectoral muscle with no associated lymphadenopathy or systemic symptoms in a 57-year-old female. The etiology, pathology, immunohistochemistry, imaging findings, and treatment options of this unique disease are discussed.

COVID-19 Vaccine Safety Surveillance in Early Pregnancy in the United States: Design Factors Affecting the Association Between Vaccine and Spontaneous Abortion.

In the Vaccine Safety Datalink (VSD), we previously reported no association between coronavirus disease 2019 (COVID-19) vaccination in early pregnancy and spontaneous abortion (SAB). The present study aims to understand how time since vaccine rollout or other methodological factors could affect results. Using a case-control design and generalized estimating equations, we estimated the odds ratios (ORs) of COVID-19 vaccination in the 28 days before a SAB or last date of the surveillance period (index date) in ongoing pregnancies and occurrence of SAB, across cumulative 4-week periods from December 2020 through June 2021. Using data from a single site, we evaluated alternative methodological approaches: increasing the exposure window to 42 days, modifying the index date from the last day to the midpoint of the surveillance period, and constructing a cohort design with a time-dependent exposure model. A protective effect (OR = 0.78, 95% confidence interval: 0.69, 0.89), observed with 3-cumulative periods ending March 8, 2021, was attenuated when surveillance extended to June 28, 2021 (OR = 1.02, 95% confidence interval: 0.96, 1.08). We observed a lower OR for a 42-day window compared with a 28-day window. The time-dependent model showed no association. Timing of the surveillance appears to be an important factor affecting the observed vaccine-SAB association.

Early Water Seal of Chest Tubes Following Video-Assisted Thoracic Surgery Pleurodesis.

INTRODUCTION: Early water seal following minimally invasive pulmonary lobectomy has been shown to reduce chest tube duration and postoperative length of stay (LOS). We evaluated chest tube duration and postoperative LOS following a standardized chest tube management protocol change (water seal on postoperative day 1) after video-assisted thoracic surgery (VATS) pleurodesis. METHODS: We identified adult patients undergoing VATS pleurodesis from August 2013 to December 2021. The chest tube protocol was changed in January 2017 such that patients were placed to water seal on the morning of postoperative day 1. Patients were divided into two groups, before the change (Group 1: August 2013-December 2016) and after (Group 2: January 2017-December 2021). We compared demographics, clinical characteristics, operative details, postoperative chest tube duration and output, and postoperative LOS between the groups. Descriptive statistics and log-transformed multivariable linear regression models were used to identify differences in patient outcomes that were associated with the protocol change. RESULTS: A total of 488 patients underwent VATS pleurodesis during the study period (Group 1: 329 patients; Group 2: 159 patients). The median age was 61 y (interquartile range [IQR] 49-68), 51% were females, 69% were White, and 29% were Black. For postoperative LOS, Group 1 had an IQR of 3-7 d, while Group 2 had an IQR of 2-6 d (P < 0.001). The multivariable log-transformed linear regression models demonstrated that the practice change was associated with reduced chest tube duration (0.77 times the chest tube duration before the change; P < 0.001) and reduced LOS (0.81 times the LOS before the change; P = 0.006). There was an associated reduction in patients needing to return to the operating room (P = 0.048) and needing postoperative extended ventilatory support (P = 0.035). CONCLUSIONS: Development of a standardized protocol to water seal chest tubes on postoperative day 1 following VATS pleurodesis is associated with reduced chest tube duration and LOS without an increase in postoperative complication rates.

Fully Reduced and Mixed-Valent Multi-Copper Aggregates Supported by Tetradentate Diamino Bis(thiolate) Ligands.

Tetradentate diamino bis(thiolate) ligands (l-N2S2(2-)) with saturated linkages between heteroatoms support fully reduced [(Cu(l-N2S2))2Cu2] complexes that bear relevance as an entry point toward molecules featuring the Cu2ICu2II(µ4-S) core composition of nitrous oxide reductase (N2OR). Tetracopper [(Cu(l-N2(SMe2)2))2Cu2] (l-N2(SMe2H)2 = N1,N2-bis(2-methyl-2-mercaptopropane)-N1,N2-dimethylethane-1,2-diamine) does not support clean S atom oxidative addition but undergoes Cl atom transfer from PhICl2 or Ph3CCl to afford [(Cu(l-N2(SMe2)2))3(CuCl)5], 14. When introduced to Cu(I) sources, the l-N2(SArH)2 ligand (l-N2(SArH)2 = N1,N2-bis(2-mercaptophenyl)-N1,N2-dimethylethane-1,2-diamine), made by a newly devised route from N1,N2-bis(2-fluorophenyl)-N1,N2-dimethylethane-1,2-diamine, ultimately yields the mixed-valent pentacopper [(Cu(l-N2SAr2))3Cu2] (19), which has 3-fold rotational symmetry (D3) around a Cu2 axis. The single CuII ion of 19 is ensconced within an equatorial l-N2(SAr)2(2-) ligand, as shown by 14N coupling in its EPR spectrum. Formation of 19 proceeds from an initial, fully reduced product, [(Cu(l-N2SAr2))3Cu2(Cu(MeCN))] (17), which is C2 symmetric and exceedingly air-sensitive. While unreactive toward chalcogen donors, 19 supports reversible reduction to the all-cuprous state; generation of [19]1- and treatment with S atom donors only return 19 because structural adjustments necessary for oxidative addition are noncompetitive with outer-sphere electron transfer. Oxidation of 19 is marked by intense darkening, consistent with greater mixed valency, and by dimerization in the crystalline state to a decacopper species ([20]2+) of S4 symmetry.

MiR-214-3p targets Ras-related protein 14 (RAB14) to inhibit cellular migration and invasion in esophageal Cancer cells.

BACKGROUND: MicroRNA (miR)-214-3p is emerging as an important tumor suppressor in esophageal cancer. In this study, we examined the interaction between miR-214-3p and RAB14, a membrane trafficking protein shown to exert oncogenic functions in other malignancies, in esophageal cancer cells. METHODS: Studies were performed in a human esophageal epithelial cell line and a panel of esophageal cancer cell lines, as well in human specimens. MiR-214-3p expression was measured by digital PCR. Biotinylated RNA pull-down and luciferase reporter assays assessed binding. The xCELLigence RTCA system measured cell migration and invasion in real time. A lentiviral expression vector was used to create an esophageal cancer cell line stably expressing miR-214-3p. RESULTS: MiR-214-3p expression was decreased in esophageal cancer cell lines and human specimens compared to non-malignant controls. RAB14 mRNA stability and protein expression were decreased following miR-214-3p overexpression. Binding between miR-214-3p and RAB14 mRNA was observed. Either forced expression of miR-214-3p or RAB14 silencing led to a marked decrease in cellular migration and invasion. Esophageal cancer cells stably expressing miR-214-3p demonstrated decreased growth in a subcutaneous murine model. CONCLUSIONS: These results further support the tumor-suppressive role of miR-214-3p in esophageal cancer cells by demonstrating its ability to regulate RAB14 expression.

Safety Monitoring of JYNNEOS Vaccine During the 2022 Mpox Outbreak - United States, May 22-October 21, 2022.

JYNNEOS (Modified Vaccinia Ankara vaccine, Bavarian Nordic) is recommended in the United States for persons exposed to or at high risk for exposure to Monkeypox virus during the 2022 monkeypox (mpox) outbreak (1). JYNNEOS is a live, nonreplicating viral vaccine licensed for the prevention of smallpox and mpox in adults aged ≥18 years, administered as a 0.5-mL 2-dose series given 28 days apart by subcutaneous injection (2). On August 9, 2022, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for administration of 0.1 mL doses by intradermal injection for adults aged ≥18 years as a strategy to increase vaccine supply, and administration of 0.5 mL doses subcutaneously for persons aged <18 years (3). During May 22-October 21, 2022, a total of 987,294 JYNNEOS vaccine doses were administered in the United States. CDC has monitored JYNNEOS vaccine safety using the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) for vaccine recipients of all ages, and through single-patient emergency Investigational New Drug (EIND) procedures for persons aged <18 years vaccinated before August 9, 2022. The most common adverse health events reported to VAERS for adults were nonserious and included injection site reactions, which was consistent with the prelicensure studies. Adverse health events were reported at similar rates for doses received by intradermal and subcutaneous administration. Serious adverse events were rare in adults, and no serious adverse events have been identified among persons aged <18 years. Overall, postlicensure and postauthorization surveillance to date support JYNNEOS vaccine safety.

Heterotrimetallic Assemblies with 1,2,4,5-Tetrakis(diphenylphosphino)benzene Bridges: Constructs for Controlling the Separation and Spatial Orientation of Redox-Active Metallodithiolene Groups.

Metallodithiolene complexes of the type [(R2C2S2)M(η2-tpbz)] [R = CN, Ph, or p-anisyl; M = Ni2+, Pd2+, or Pt2+; tpbz = 1,2,4,5-tetrakis(diphenylphosphino)benzene] chelate transition metals ions to form trimetallic arrays [[(R2C2S2)M(tpbz)]2M']n+, where M' is square planar Pt2+, tetrahedral Cu+, Ag+, or Au+, or octahedral {ReBr(CO)}/{Re(CO)2}+. Forcing conditions (190 °C reflux in decalin, 72 h) are demanded for the Re+ compounds. With third-row metals at the nexus, the compounds are stable to air. Twelve members of the set have been characterized by X-ray diffraction and reveal dithiolene centroid-centroid distances ranging from 22.4 to 24.0 Å. Folding around each tpbz intrachelate P···P axis such that the MP2/M'P2 planes meet the tpbz P2C6P2 mean plane at non-zero values gives rise to core topologies that appear "S-like" or herringbone-like for M' = Pt2+ or {ReBr(CO)}/{Re(CO)2}+. Calculations reveal that departure from idealized D2h/D2d/C2v symmetries is induced by steric crowding between Ph groups and that dynamic, fluxional behavior is pertinent to the solution phase because multiple, lower-symmetry minima of comparable energy exist. Spectroscopically, the formation of the trimetallic arrays is marked by a shift of the open end 31P nuclear magnetic resonance signal from approximately -14.5 ppm to approximately +41, approximately +20.5, and approximately +28.5 ppm for M' = Pt2+, Au+, and {ReBr(CO)}/{Re(CO)2}+, respectively. Electrochemically, dithiolene-based oxidations are observed for the R = Ph and M' = Pt2+ or Au+ compounds but at potentials that are anodically shifted relative to charge-neutral [[(R2C2S2)M]2(µ-tpbz)]. The compounds reported clarify the possibilities for the synthesis of assemblies in which weakly coupled spins may be created in their modular (R2C2S2)M and M' parts.

MicroRNA-141-3p regulates cellular proliferation, migration, and invasion in esophageal cancer by targeting tuberous sclerosis complex 1.

MicroRNA (miR)-141-3p, which functions as an oncogene in multiple malignancies, has been shown to be highly overexpressed in esophageal cancer cells in our previous work. miR-141-3p is predicted to bind the messenger RNA (mRNA) of tuberous sclerosis complex 1 (TSC1), a tumor suppressor, with high affinity. In this study, we investigated the expression and functional interaction between miR-141-3p and TSC1 in esophageal cancer cells. Experiments were conducted in four esophageal cancer lines and in tumor cells isolated from human esophageal cancer specimens by laser capture microdissection. miR-141-3p expression was measured by real time and droplet digital PCR. Biotinylated RNA pull-down and luciferase reporter assays were used to assess binding. miR-141-3p function was tested by assessing proliferation, migration, invasion, and induction of autophagy following its silencing. We found that miR-141-3p levels were increased in TE7, OE33, and TE10 esophageal cancer cells compared to FLO-1 cells, with similar heterogeneity observed in human esophageal cancer specimens. Silencing of miR-141-3p led to increased TSC1 protein expression in these cells and was associated with increased TSC1 translation. Binding studies reveal that miR-141-3p binds to each of the predicted binding sites in the 3'-untranslated region of TSC1 mRNA. Following miR-141-3p silencing, TE7, OE33, and TE10 cells exhibited decreased proliferation, migration, and invasion, as well as enhanced autophagy. Importantly, these phenotypic effects were replicated by overexpression of TSC1 alone in these cells. Our results indicate that miR-141-3p functions in an oncogenic capacity in a subset of esophageal cancer cells, in part by suppressing TSC1 expression.

COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021.

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020-May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020-May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18-24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19.

COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021.

COVID-19 vaccines are critical for ending the COVID-19 pandemic; however, current data about vaccination coverage and safety in pregnant women are limited. Pregnant women are at increased risk for severe illness and death from COVID-19 compared with nonpregnant women of reproductive age, and are at risk for adverse pregnancy outcomes, such as preterm birth (1-4). Pregnant women are eligible for and can receive any of the three COVID-19 vaccines available in the United States via Emergency Use Authorization.* Data from Vaccine Safety Datalink (VSD), a collaboration between CDC and multiple integrated health systems, were analyzed to assess receipt of ≥1 dose (first or second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Janssen [Johnson & Johnson] vaccine) of any COVID-19 vaccine during pregnancy, receipt of first dose of a 2-dose COVID-19 vaccine (initiation), or completion of a 1- or 2-dose COVID-19 vaccination series. During December 14, 2020-May 8, 2021, a total of 135,968 pregnant women were identified, 22,197 (16.3%) of whom had received ≥1 dose of a vaccine during pregnancy. Among these 135,968 women, 7,154 (5.3%) had initiated and 15,043 (11.1%) had completed vaccination during pregnancy. Receipt of ≥1 dose of COVID-19 vaccine during pregnancy was highest among women aged 35-49 years (22.7%) and lowest among those aged 18-24 years (5.5%), and higher among non-Hispanic Asian (Asian) (24.7%) and non-Hispanic White (White) women (19.7%) than among Hispanic (11.9%) and non-Hispanic Black (Black) women (6.0%). Vaccination coverage increased among all racial and ethnic groups over the analytic period, likely because of increased eligibility for vaccination† and increased availability of vaccine over time. These findings indicate the need for improved outreach to and engagement with pregnant women, especially those from racial and ethnic minority groups who might be at higher risk for severe health outcomes because of COVID-19 (4). In addition, providing accurate and timely information about COVID-19 vaccination to health care providers, pregnant women, and women of reproductive age can improve vaccine confidence and coverage by ensuring optimal shared clinical decision-making.

Open-Ended Metallodithiolene Complexes with the 1,2,4,5-Tetrakis(diphenylphosphino)benzene Ligand: Modular Building Elements for the Synthesis of Multimetal Complexes.

Open-ended, singly metalated dithiolene complexes with 1,2,4,5-tetrakis(diphenylphosphino)benzene (tpbz) are prepared either by ligand transfer to [Cl2M(tpbz)] from (R2C2S2)SnR'2 (R = CN, R' = Me; R = Me, R' = nBu) or by a direct reaction between tpbz and [M(S2C2R2)2] (M = Ni, Pd, Pt; R = Ph, p-anisyl) in a 1:1 ratio. The formation of dimetallic [(R2C2S2)M(tpbz)M(S2C2R2)] attends these syntheses in modest amounts, but the open-ended compounds are readily separated by silica chromatography. As affirmed by X-ray crystallographic characterization of numerous members of the set, the [(R2C2S2)M(tpbz)] compounds show dithiolene ligands in their fully reduced ene-1,2-dithiolate form conjoined with divalent Group 10 ions. Minor amounts of octahedral [(Ph2C2S2)2PtIV(tpbz)], a presumed intermediate, are isolated from the preparation of [(Ph2C2S2)PtII(tpbz)]. Heterodimetallic [(Ph2C2S2)Pt(tpbz)Ni(S2C2Me2)] is prepared from [(Ph2C2S2)PtII(tpbz)]; its cyclic voltammogram, upon anodic scanning, shows two pairs of closely spaced, but resolved, 1e- oxidations corresponding first to [R2C2S22-] - 1e- → [R2C2S•S-] and then to [R2C2S•S-] - 1e- → [R2(C═S)2]. The open diphosphine of [(R2C2S2)M(tpbz)] can be oxidized to afford open-ended [(R2C2S2)M(tpbzE2)] (E = O, S). Synthesis of the octahedral [(dppbO2)3Ni][I3]2 [dppbO2 = 1,2-bis(diphenylphosphoryl)benzene] suggests that the steric profile of [(R2C2S2)M(tpbzE2)] is moderated enough that three could be accommodated as ligands around a metal ion.

Surveillance for Adverse Events After COVID-19 mRNA Vaccination.

Importance: Safety surveillance of vaccines against COVID-19 is critical to ensure safety, maintain trust, and inform policy. Objectives: To monitor 23 serious outcomes weekly, using comprehensive health records on a diverse population. Design, Setting, and Participants: This study represents an interim analysis of safety surveillance data from Vaccine Safety Datalink. The 10 162 227 vaccine-eligible members of 8 participating US health plans were monitored with administrative data updated weekly and supplemented with medical record review for selected outcomes from December 14, 2020, through June 26, 2021. Exposures: Receipt of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccination, with a risk interval of 21 days for individuals after vaccine dose 1 or 2 compared with an interval of 22 to 42 days for similar individuals after vaccine dose 1 or 2. Main Outcomes and Measures: Incidence of serious outcomes, including acute myocardial infarction, Bell palsy, cerebral venous sinus thrombosis, Guillain-Barré syndrome, myocarditis/pericarditis, pulmonary embolism, stroke, and thrombosis with thrombocytopenia syndrome. Incidence of events that occurred among vaccine recipients 1 to 21 days after either dose 1 or 2 of a messenger RNA (mRNA) vaccine was compared with that of vaccinated concurrent comparators who, on the same calendar day, had received their most recent dose 22 to 42 days earlier. Rate ratios (RRs) were estimated by Poisson regression, adjusted for age, sex, race and ethnicity, health plan, and calendar day. For a signal, a 1-sided P < .0048 was required to keep type I error below .05 during 2 years of weekly analyses. For 4 additional outcomes, including anaphylaxis, only descriptive analyses were conducted. Results: A total of 11 845 128 doses of mRNA vaccines (57% BNT162b2; 6 175 813 first doses and 5 669 315 second doses) were administered to 6.2 million individuals (mean age, 49 years; 54% female individuals). The incidence of events per 1 000 000 person-years during the risk vs comparison intervals for ischemic stroke was 1612 vs 1781 (RR, 0.97; 95% CI, 0.87-1.08); for appendicitis, 1179 vs 1345 (RR, 0.82; 95% CI, 0.73-0.93); and for acute myocardial infarction, 935 vs 1030 (RR, 1.02; 95% CI, 0.89-1.18). No vaccine-outcome association met the prespecified requirement for a signal. Incidence of confirmed anaphylaxis was 4.8 (95% CI, 3.2-6.9) per million doses of BNT162b2 and 5.1 (95% CI, 3.3-7.6) per million doses of mRNA-1273. Conclusions and Relevance: In interim analyses of surveillance of mRNA COVID-19 vaccines, incidence of selected serious outcomes was not significantly higher 1 to 21 days postvaccination compared with 22 to 42 days postvaccination. While CIs were wide for many outcomes, surveillance is ongoing.

Synthesis and Structures of Polyphenylphenanthrenes.

1,2,3,4,5,6,7,8-Octaphenylphenanthrene (4) and decaphenylphenanthrene (5) were prepared by very short syntheses (two or three steps) from tetraphenylfuran and polybrominated benzene derivatives. The X-ray structures of compounds 4 and 5 show them to be quite crowded, with the phenanthrene cores twisted by about 40° due to the clash of the C4 and C5 phenyl groups. Compound 4 was resolved by chromatography on a chiral support, and its free energy of activation for racemization was determined to be 24.6 kcal mol-1 at 40 °C. Computational studies indicate that compound 5 has a racemization barrier approximately 6 kcal mol-1 lower than 4, and thus 5 would not be configurationally stable at room temperature.

Photocatalytic H2-Evolution by Homogeneous Molybdenum Sulfide Clusters Supported by Dithiocarbamate Ligands.

Irradiation at 460 nm of [Mo3(µ3-S)(µ2-S2)3(S2CNR2)3]I ([2a]I, R = Me; [2b]I, R = Et; [2c]I, R = iBu; [2d]I, R = CH2C6H5) in a mixed aqueous-polar organic medium with [Ru(bipy)3]2+ as photosensitizer and Et3N as electron donor leads to H2 evolution. Maximum activity (300 turnovers, 3 h) is found with R = iBu in 1:9 H2O:MeCN; diminished activity is attributed to deterioration of [Ru(bipy)3]2+. Monitoring of the photolysis mixture by mass spectrometry suggests transformation of [Mo3(µ3-S)(µ2-S2)3(S2CNR2)3]+ to [Mo3(µ3-S)(µ2-S)3(S2CNR2)3]+ via extrusion of sulfur on a time scale of minutes without accumulation of the intermediate [Mo3S6(S2CNR2)3]+ or [Mo3S5(S2CNR2)3]+ species. Deliberate preparation of [Mo3S4(S2CNEt2)3]+ ([3]+) and treatment with Et2NCS21- yields [Mo3S4(S2CNEt2)4] (4), where the fourth dithiocarbamate ligand bridges one edge of the Mo3 triangle. Photolysis of 4 leads to H2 evolution but at ∼25% the level observed for [Mo3S7(S2CNEt2)3]+. Early time monitoring of the photolyses shows that [Mo3S4(S2CNEt2)4] evolves H2 immediately and at constant rate, while [Mo3S7(S2CNEt2)3]+ shows a distinctive incubation prior to a more rapid H2 evolution rate. This observation implies the operation of catalysts of different identity in the two cases. Photolysis solutions of [Mo3S7(S2CNiBu2)3]+ left undisturbed over 24 h deposit the asymmetric Mo6 cluster [(iBu2NCS2)3(µ2-S2)2(µ3-S)Mo3](µ3-S)(µ3-η2,η1-S',η1-S″-S2)[Mo3(µ2-S)3(µ3-S)(S2CNiBu2)2(µ2-S2CNiBu2)] in crystalline form, suggesting that species with this hexametallic composition and core topology are the probable H2-evolving catalysts in photolyses beginning with [Mo3S7(S2CNR2)3]+. When used as solvent, N,N-dimethylformamide (DMF) suppresses H2-evolution but to a greater degree for [Mo3S4(S2CNEt2)4] than for [Mo3S7(S2CNEt2)3]+. Recrystallization of [Mo3S4(S2CNEt2)4] from DMF affords [Mo3S4(S2CNEt2)4(η1,κO-DMF)] (5), implying that inhibition by DMF arises from competition for a Mo coordination site that is requisite for H2 evolution. Computational assessment of [Mo3S4(S2CNMe2)3]+ following addition of 2H+ and 2e- suggests a Mo(H)-µ2(SH) intermediate as the lowest energy species for H2 elimination. An analogous pathway may be available to the Mo6 cluster via dissociation of one end of the µ2-S2CNR2 ligand, a known hemilabile ligand type, in the [Mo3S4]4+ fragment.

Restrictive Transfusion Practices After Esophagectomy Are Associated With Improved Outcome: A Review of the Society of Thoracic Surgeons General Thoracic Database.

OBJECTIVE: Blood transfusion has been associated with poor outcomes in many disciplines, yet transfusion practices and related outcomes in esophagectomy are unknown. We analyzed the Society of Thoracic Surgeons General Thoracic Database to determine patient factors associated with transfusion after esophagectomy, risk-adjusted variation in transfusion practice among institutions, and the association of transfusion practice with mortality. METHODS: We performed a retrospective review of patients undergoing esophagectomy for cancer from October 2008 to December 31, 2014. Patient comorbidities and procedure variables were used to construct a risk model for transfusion. Using this model, each institution was assigned an observed to expected (O:E) transfusion rate. We examined institutional factors associated with variation in O:E transfusion rate. Finally, O:E transfusion rate was compared to risk-adjusted mortality to determine if there was an association of transfusion practice and survival. RESULTS: Seven thousand one hundred thirty-seven patients underwent esophagectomy at 182 institutions during the study period. The median unadjusted transfusion rate was 23.1%. The risk model for transfusion demonstrated patients who received transfusions were more likely to be older, female, and have low preoperative hemoglobin and other comorbidities, such as CAD, COPD, and low creatinine clearance. Patients who received a minimally invasive procedure were less likely to have received a transfusion.After adjusting for the characteristics above, 13 centers (7.1%) were classified as having lower than average O:E transfusion rate and 16 centers (8.7%) were classified as higher than average O:E transfusion rate.Institutions with lower than expected transfusion rates also had lower risk-adjusted perioperative mortality than institutions with higher than expected transfusion rates (median [IQR] = 0.90 [0.77-0.94] vs. 0.99 [0.94-1.06], P = 0.028). CONCLUSION: Age, female sex, CAD, COPD, renal insufficiency, and open technique are associated with transfusion after esophagectomy, while tumor stage and preoperative chemoradiation are not. There is wide variation in transfusion practice. Centers with lower than expected transfusion rate also had lower than expected perioperative mortality. At an institutional level, lower transfusion rates are associated with improved outcomes.

Ligand Radicals as Modular Organic Electron Spin Qubits.

The intrinsic redox activity of the dithiolene ligand is presented here as the novel spin host in the design of a prototype molecular electron spin qubit, where the traditional roles of the metal and ligand components in coordination complexes are inverted. A series of paramagnetic bis(dithiolene) complexes with group 10 metals-nickel, palladium, platinum-provides a backdrop to investigate the spin dynamics of the organic ligand radical using pulsed EPR spectroscopy. The temperature dependence of the phase memory time (TM ) is shown to be dependent on the identity of the diamagnetic metal ion, with the short times recorded for platinum a consequence of a diminishing spin-lattice (T1 ) relaxation time driven by spin-orbit coupling. The utility of the radical ligand spin center is confirmed when it delivers one of the longest phase memory times ever recorded for a molecular two-qubit prototype.

Redox-Active Metallodithiolene Groups Separated by Insulating Tetraphosphinobenzene Spacers.

Compounds of the type [(S2C2R2)M(µ-tpbz)M(S2C2R2)] (R = CN, Me, Ph, p-anisyl; M = Ni, Pd, Pt; tpbz = 1,2,4,5-tetrakis(diphenylphosphino)benzene) have been prepared by transmetalation with [(S2C2R2)SnR'2] reagents, by direct displacement of dithiolene ligand from [M(S2C2R2)2] with 0.5 equiv of tpbz, or by salt metathesis using Na2[S2C2(CN)2] in conjunction with X2M(µ-tpbz)MX2 (X = halide). X-ray crystallography reveals a range of topologies (undulating, chair, bowed) for the (S2C2)M(P2C6P2)M(S2C2) core. The [(S2C2R2)M(µ-tpbz)M(S2C2R2)] (R = Me, Ph, p-anisyl) compounds support reversible or quasireversible oxidations corresponding to concurrent oxidation of the dithiolene terminal ligands from ene-1,2-dithiolates to radical monoanions, forming [(-S•SC2R2)M(µ-tpbz)M(-S•SC2R2)]2+. The R = Ph and p-anisyl compounds support a second, reversible oxidation of the dithiolene ligands to their α-dithione form. In contrast, [(S2C2(CN)2)Ni(tpbz)Ni(S2C2(CN)2)] sustains only reversible, metal-centered reductions. Spectroscopic examination of [(-S•SC2( p-anisyl)2)Ni(µ-tpbz)Ni(-S•SC2( p-anisyl)2)]2+ by EPR reveals a near degenerate singlet-triplet ground state, with spectral simulation revealing a remarkably small dipolar coupling constant of 18 × 10-4 cm-1 that is representative of an interspin distance of 11.3 Å. This weak interaction is mediated by the rigid tpbz ligand, whose capacity to electronically insulate is an essential quality in the development of molecular-based spintronic devices.