Severe Sepsis During Treatment for Childhood Leukemia and Sequelae Among Adult Survivors.

Importance: Children undergoing treatment for leukemia are at increased risk of severe sepsis, a dysregulated immune response to infection leading to acute organ dysfunction. As cancer survivors, they face a high burden of long-term adverse effects. The association between sepsis during anticancer therapy and long-term organ dysfunction in adult survivors of childhood cancer has not been examined. Objective: To determine whether severe sepsis during therapy for leukemia in childhood is associated with subsequent chronic health conditions in adult survivors. Design, Setting, and Participants: This cohort study included 644 adult survivors of childhood leukemia who were diagnosed between January 1, 1985, and July 19, 2010, and participated in the St Jude Lifetime Cohort Study. Participants were excluded if they received hematopoietic cell transplant or had relapsed leukemia. Data collection ended June 30, 2017. Data were analyzed from July 1, 2020, to January 5, 2024. Exposures: Severe sepsis episodes, defined according to consensus criteria as septic shock, acute respiratory distress syndrome, or multiorgan dysfunction associated with infection occurring during anticancer therapy, were abstracted by medical record review for all participants. Main Outcomes and Measures: Common Terminology Criteria for Adverse Events-defined chronic health condition outcomes were independently abstracted. Associations between sepsis and cumulative incidence of chronic health conditions (eg, cardiovascular, pulmonary, kidney, neurological, and neurocognitive outcomes) were compared by adjusted hazard ratios from Cox proportional hazards logistic regression. Inverse propensity score weighting was used to adjust for potential confounders, including age, year of diagnosis, and leukemia type. Results: The study sample consisted of 644 adult survivors of pediatric leukemia (329 women [51.1%] and 315 men [48.9%]; including 56 with a history of acute myeloid leukemia and 585 with a history of acute lymphoblastic leukemia) who were most recently evaluated at a median age of 24.7 (IQR, 21.2-28.3) years at a median time after leukemia diagnosis of 17.3 (IQR, 13.7-21.9) years. Severe sepsis during treatment of acute childhood leukemia occurred in 46 participants (7.1%). Participants who experienced severe sepsis during treatment were more likely to develop moderate to severe neurocognitive impairment (29 of 46 [63.0%] vs 310 of 598 [51.8%]; adjusted hazard ratio, 1.86 [95% CI, 1.61-2.16]; P < .001) significantly affecting attention, executive function, memory and visuospatial domains. Sepsis was not associated with long-term risk of cardiovascular, pulmonary, kidney, or neurological chronic health conditions. Conclusions and Relevance: In this cohort study of long-term outcomes in survivors of pediatric leukemia, severe sepsis during anticancer therapy for leukemia was associated with a selectively increased risk for development of serious neurocognitive sequelae. Efforts to reduce the effects of anticancer therapy on long-term function and quality of life in survivors might include prevention of severe sepsis during therapy and early detection or amelioration of neurocognitive deficits in survivors of sepsis.

Tunable Molybdenum Disulfide-Enabled Fiber Mats for High-Efficiency Removal of Mercury from Water.

The application of molybdenum disulfide (MoS2) for water decontamination is expanded toward a novel approach for mercury removal using nanofibrous mats coated with MoS2. A bottom-up synthesis method for growing MoS2 on carbon nanofibers was employed to maximize the nanocomposite decontamination potential while minimizing the release of the nanomaterial to treated water. First, a co-polymer of polyacrylonitrile and polystyrene was electrospun as nanofibrous mats and pretreated to form pristine carbon fibers. Next, three solvothermal methods of controlled in situ MoS2 growth of different morphologies were achieved on the surface of the fibers using three different sets of precursors. Finally, these MoS2-enabled fibers were extensively characterized and evaluated for their mercuric removal efficiency. Two mercury removal mechanisms, including reduction-oxidation reactions and physicochemical adsorption, were elucidated. The two nanocomposites with the fastest (0.436 min-1 mg-1) and highest mercury removal (6258.7 mg g-1) were then further optimized through intercalation with poly(vinylpyrrolidone), which increased the MoS2 interlayer distance from 0.68 nm to more than 0.90 nm. The final, optimal fabrication technique (evaluated according to mercuric capacity, kinetics, and nanocomposite stability) demonstrated five times higher adsorption than the second-best method and obtained 70% of the theoretical mercury adsorption capacity of MoS2. Overall, results from this study indicate an alternative, advanced material to increase the efficiency of aqueous mercury removal while also providing the basis for other novel environmental applications such as selective sensing, disinfection, and photocatalysis.