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Objective: To describe rates of dexamethasone use in the nonoperative management of malignant small bowel obstruction (mSBO) and their outcomes. Background: mSBO is common in patients with advanced abdominal-pelvic cancers. Management includes prioritizing quality of life and avoiding surgical intervention when possible. The use of dexamethasone to restore bowel function is recommended in the National Comprehensive Cancer Network guidelines for mSBO. Yet, it is unknown how often dexamethasone is used for mSBO and whether results from nonresearch settings support its use. Methods: This is a multicenter retrospective cohort study including unique admissions for mSBO from January 1, 2019 to December 31, 2021. Dexamethasone use and management outcomes were summarized with descriptive statistics and multiple logistic regression. Results: Among 571 admissions (68% female, mean age 63 years, 85% history of abdominal surgery) that were eligible and initially nonoperative, 26% [95% confidence interval (CI) = 23%-30%] received dexamethasone treatment (69% female, mean age 62 years, 87% history of abdominal surgery). Dexamethasone use by site ranged from 13% to 52%. Among dexamethasone recipients, 13% (95% CI = 9%-20%) subsequently required nonelective surgery during the same admission and 4 dexamethasone-related safety-events were reported. Amongst 421 eligible admissions where dexamethasone was not used, 17% (95% CI = 14%-21%) required nonelective surgery. Overall, the unadjusted odds ratio (OR) for nonelective surgery with dexamethasone use compared to without its use was 0.7 (95% CI = 0.4-1.3). Using multiple logistic regression, OR after adjusting for site, age, sex, history of abdominal surgery, nasogastric tube, and Gastrografin use was 0.6 (95% CI = 0.3-1.1). Conclusion: Dexamethasone was used in about 1 in 4 eligible mSBO admissions with high variability of use between tertiary academic centers. This multicenter retrospective cohort study suggested an association between dexamethasone use and lower rates of nonelective surgery, representing a potential opportunity for quality improvement.
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Novel photocatalysts Gd2FeSbO7, Gd2InSbO7 and Gd2YSbO7 were synthesized by the solid state reaction method for the first time. A comparative study about the structural and photocatalytic properties of Gd2MSbO7 (M = Fe, In, Y) was reported. The results showed that Gd2FeSbO7, Gd2InSbO7 and Gd2YSbO7 crystallized with the pyrochlore-type structure, cubic crystal system and space group Fd3m. The lattice parameter a for Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7 was 10.276026 Å, 10.449546 Å or 10.653651 Å. The band gap of Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7 was estimated to be 2.151 eV, 2.897 eV or 2.396 eV. For the photocatalytic water-splitting reaction, H2 or O2 evolution was observed from pure water with Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7 as catalyst under visible light irradiation (wavelength > 420 nm). Moreover, H2 or O2 also spilt by using Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7 as catalyst from CH3OH/H2O or AgNO3/H2O solutions under visible light irradiation (λ > 420 nm). Gd2FeSbO7 showed the highest activity compared with Gd2InSbO7 or Gd2YSbO7. At the same time, Gd2InSbO7 showed higher activity compared with Gd2YSbO7. The photocatalytic activities were further improved under visible light irradiation with Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7 being loaded by Pt, NiO or RuO2. The effect of Pt was better than that of NiO or RuO2 for improving the photocatalytic activity of Gd2FeSbO7, Gd2InSbO7 or Gd2YSbO7.