Cut-off values of haemoglobin and clinical outcomes in incident peritoneal dialysis: the PDTAP study.

BACKGROUND: To explore the cut-off values of haemoglobin (Hb) on adverse clinical outcomes in incident peritoneal dialysis (PD) patients based on a national-level database. METHODS: The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE (MACE+). The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis and permanent transfer to haemodialysis (HD). RESULTS: A total of 2591 PD patients were enrolled between June 2016 and April 2019 and followed up until December 2020. Baseline and time-averaged Hb <100 g/l were associated with all-cause mortality, MACE, MACE+ and hospitalizations. After multivariable adjustments, only time-averaged Hb <100 g/l significantly predicted a higher risk for all-cause mortality {hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.19-281], P = .006}, MACE [HR 1.99 (95% CI 1.16-3.40), P = .012] and MACE+ [HR 1.77 (95% CI 1.15-2.73), P = .010] in the total cohort. No associations between Hb and hospitalizations, transfer to HD and first-episode peritonitis were observed. Among patients with Hb ≥100 g/l at baseline, younger age, female, use of iron supplementation, lower values of serum albumin and renal Kt/V independently predicted the incidence of Hb <100 g/l during the follow-up. CONCLUSION: This study provided real-world evidence on the cut-off value of Hb for predicting poorer outcomes through a nation-level prospective PD cohort.

Manipulating the Dynamics of Dark Excited States in Organic Materials for Phototheranostics.

Manipulating the dynamics of dark excited states (DESs), such as higher excited singlet or excited triplet states with no or small radiative decay, are of both fundamental and practical interests, an important application being photoactivated diagnosis and therapy (phototheranostics), which include photoacoustic (PA) imaging, photodynamic therapy (PDT), and photothermal therapy (PTT). However, the current understanding of DESs in organic structures is rather limited, thus making any rational manipulation of DES in organic materials very challenging.A DES decays primarily by radiationless transition through two pathways: (i) singlet-to-triplet intersystem crossing (ISC) and (ii) internal conversion (IC) relaxation. The deactivation of a DES via ISC can generate cytotoxic reactive oxygen species (ROS) for PDT, while IC could convert photons into heat for PA imaging and PTT. In this Account, we highlight our research on developing a fundamental understanding of structure-property relationships for manipulation of DESs in organic materials in relation to phototheranostic applications. We describe the application of femtosecond transient absorption (fs-TA) spectroscopy for obtaining valuable insights into the DES dynamics. Afterward, we present our work on DESs in nonrigid molecules that revealed greatly enhanced ISC through geometry twisting, which leads to an innovative pathway to develop organic materials exhibiting external stimuli-responsive reversible switching of ISC. We introduce the concept of smart PDT where highly efficient ISC imparted by geometry twisting in the acidic environment specific to tumors leads to very efficient and highly localized PDT, thus leaving surrounding healthy tissues at a different pH unaffected. This insightful understanding of ISC can lead to the development of more advanced photosensitizers for PDT. Two other emergent concepts from our work presented here are (1) significantly enhanced IC producing strong local heating by combining two-photon absorption with excited state absorption for cumulative multiphoton absorption, thus greatly increasing the strength of the PA signal for nonlinear PA imaging, and (2) shown by an example of an organic molecule, BODIPY, nanoscale charge-transfer state mediated strong IC in aggregate nanoparticles resulting in exceptionally high photothermal conversion efficiency of 61% for both PA and PTT. Some in vivo results of the phototheranostic studies using BODIPY are presented, providing an elegant example of nanoscale manipulation of the excited state dynamics.This Account concludes with a summary and discussion of future perspectives. We hope this Account will deepen the understanding of molecular and nanoscale control of excited state dynamics in organic materials, hopefully enticing a broad range of scientists within different disciplinary areas.

Bioapplications of small molecule Aza-BODIPY: from rational structural design to in vivo investigations.

Boron-dipyrromethene (BODIPY) belongs to a family of organoboron compounds, commercialized as fluorescent dyes by Invitrogen™. As BODIPY derivatives, Aza-boron-dipyrromethene (Aza-BODIPY) dyes display superior spectral performances, such as red-shifted spectra and high molar extinction coefficients, and are considered to be extremely attractive organic materials for various bioapplications. Therefore, scientists from different disciplinary backgrounds would benefit from a review that provides a timely summary and outlook regarding Aza-BODIPY dyes. In this review, we report on the latest advances of Aza-BODIPY dyes, along with the empirical design guidelines and photophysical property manipulation of these dyes. In addition, we will discuss the biological applications of Aza-BODIPY dyes in probing various biological activities, as well as in fluorescence bioimaging/detection, newly-emerging photoacoustic bioimaging/detection, and phototherapy together with future challenges and implications in this field. We aim at providing an insightful design guideline and a clear overview of Aza-BODIPY dyes, which might entice new ideas and directions.

Rational design of near-infrared platinum(II)-acetylide conjugated polymers for photoacoustic imaging-guided synergistic phototherapy under 808 nm irradiation.

The preferable photoconversion tunability of conjugated polymers (CPs) is of great interest in cancer phototherapy. However, very few molecular design strategies have been developed for achieving CPs with highly efficient photoconversion performance. Herein, a rational design of near-infrared (NIR) Pt-acetylide conjugated polymer CP3 with highly efficient photoconversion behaviors for synergistic photodynamic therapy (PDT) and photothermal therapy (PTT) was demonstrated. CP3 containing boron dipyrromethene (BDP) units displayed intense absorption peaks in the NIR region, which were red-shifted approximately 60 nm compared to the corresponding small-molecule precursor of BDP. Compared with control polymers CP1 and CP2, after the introduction of Pt into CP3, the triplet state, which benefits the generation of reactive oxygen species for photodynamic therapy, was identified clearly in both CP3 and the prepared CP3 nanoparticles (CP3-NPs) by ultrafast femtosecond transient absorption (fs-TA) spectroscopy. Notably, different from the traditional nonradiative decay channel with lifetime of 1.1 ps in CP3, CP3-NPs possess an additional nonradiative decay channel with lifetime of 10 ps, both of which contribute to the superior photothermal conversion effect upon 808 nm irrradiation. All these photoconversion performances lead to excellent tumor ablation. This study elucidates the excited-state dynamics in Pt-acetylide CPs, which provide an insightful understanding and valuable guidelines for the future design of high-performance theranostic agents based on CPs for synergistic cancer phototherapy.

Stimuli-Responsive Reversible Switching of Intersystem Crossing in Pure Organic Material for Smart Photodynamic Therapy.

Photosensitizers (PSs) with stimuli-responsive reversible switching of intersystem crossing (ISC) are highly promising for smart photodynamic therapy (PDT), but achieving this goal remains a tremendous challenge. This study introduces a strategy to obtain such reversible switching of ISC in a new class of PSs, which exhibit stimuli-initiated twisting of conjugated backbone. We present a multidisciplinary approach that includes femtosecond transient absorption spectroscopy and quantum chemical calculations. The organic structures reported show remarkably enhanced ISC efficiency (ΦISC ), switching from nearly 0 to 90 %, through an increase in the degree of twisting, providing an innovative mechanism to promote ISC. This leads us to propose here and demonstrate the concept of smart PDT, where pH-induced reversible twisting maximizes the ISC rate, and thus enables strong photodynamic action only under pathological stimulus (such as change in pH, hypoxia, or exposure to enzymes). The ISC process is turned off to deactivate PDT ability, when the PS is transferred or metabolized away from pathological region.