Pediatric cancer incidence among individuals with overgrowth syndromes and overgrowth features: A population-based assessment in seven million children.

BACKGROUND: Overgrowth syndromes (e.g., Beckwith-Wiedemann) are associated with an increased risk of pediatric cancer, although there are few population-based estimates of risk. There are also limited studies describing associations between other overgrowth features (e.g., hepatosplenomegaly) and pediatric cancer. Therefore, cancer risk among children with these conditions was evaluated with data from a large, diverse population-based registry linkage study. METHODS: This study includes all live births in Texas during the years 1999-2017. Children with overgrowth features and syndromes were identified from the Texas Birth Defects Registry; children with cancer were identified by linkage to the Texas Cancer Registry. Cox regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between each overgrowth syndrome/feature and cancer, which were adjusted for infant sex and maternal age. RESULTS: In the total birth cohort (n = 6,997,422), 21,207 children were identified as having an overgrowth syndrome or feature. Children with Beckwith-Wiedemann syndrome were 42 times more likely to develop pediatric cancer (95% CI, 24.20-71.83), with hepatoblastoma being the most common, followed by Wilms tumor. The presence of any isolated overgrowth feature was associated with increased cancer risk (HR, 4.70; 95% CI, 3.83-5.77); associations were strongest for hepatosplenomegaly (HR, 23.04; 95% CI, 13.37-39.69) and macroglossia (HR, 11.18; 95% CI, 6.35-19.70). CONCLUSIONS: This population-based assessment confirmed prior findings that children with either overgrowth syndromes or features were significantly more likely to develop cancer. Overall, this study supports recommendations for cancer surveillance in children with these conditions and may also inform future research into cancer etiology.

Ethnic-specific predictors of neurotoxicity among patients with pediatric acute lymphoblastic leukemia after high-dose methotrexate.

BACKGROUND: High-dose methotrexate (HD-MTX; 5000 mg/m2 ) is an important component of curative therapy in many treatment regimens for high-risk pediatric acute lymphoblastic leukemia (ALL). However, methotrexate therapy can result in dose-limiting neurotoxicity, which may disproportionately affect Latino children. This study evaluated risk factors for neurotoxicity after HD-MTX in an ethnically diverse population of patients with ALL. METHODS: The authors retrospectively reviewed the medical records of patients who were diagnosed with ALL and treated with HD-MTX at Texas Children's Cancer Center (2010-2017). Methotrexate neurotoxicity was defined as a neurologic episode (e.g., seizures or stroke-like symptoms) occurring within 21 days of HD-MTX that resulted in methotrexate treatment modifications. Mixed effects multivariable logistic regression was used to estimate the odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between clinical factors and neurotoxicity. RESULTS: Overall, 351 patients (58.1% Latino) who received 1183 HD-MTX infusions were evaluated. Thirty-five patients (10%) experienced neurotoxicity, 71% of whom were Latino. After adjusting for clinical risk factors, the authors observed that serum creatinine elevations ≥50% of baseline were associated with a three-fold increased odds (OR, 3.32; 95% CI, 0.98-11.21; p = .05) for neurotoxicity compared with creatinine elevation <25%. Notably, predictors of neurotoxicity differed by ethnicity. Specifically, Latino children experienced a nearly six-fold increase in neurotoxicity odds (OR, 5.80; 95% CI, 1.39-24.17; p = .02) with serum creatinine elevation ≥50% compared with creatinine elevation <25%. CONCLUSIONS: The current findings indicate that serum creatinine elevations ≥50% may be associated with an increased risk for neurotoxicity among Latino children with ALL and may identify potential candidates for therapeutic or supportive care interventions.

Epigenetic age acceleration among survivors of pediatric medulloblastoma and primitive neuroectodermal tumor.

Survivors of childhood central nervous system (CNS) tumors experience early-onset aging-related phenotypes. DNA methylation (DNAm) age is an emerging epigenetic biomarker of physiologic age and may be predictive of chronic health conditions in long-term survivors. This report describes the course of epigenetic age acceleration using post-diagnosis blood samples (median: 3.9 years post-diagnosis; range: 0.04-15.96) from 83 survivors of pediatric CNS tumors. Epigenetic age acceleration was detected in 72% of patients, with an average difference between chronologic and DNAm age of 2.58 years (95% CI: 1.75-3.41, p < 0.001). Time from diagnosis to sample collection correlated with the magnitude of epigenetic age acceleration.

Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality.

Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

Electronic Processes within Quantum Dot-Molecule Complexes.

The subject of this review is the colloidal quantum dot (QD) and specifically the interaction of the QD with proximate molecules. It covers various functions of these molecules, including (i) ligands for the QDs, coupled electronically or vibrationally to localized surface states or to the delocalized states of the QD core, (ii) energy or electron donors or acceptors for the QDs, and (iii) structural components of QD assemblies that dictate QD-QD or QD-molecule interactions. Research on interactions of ligands with colloidal QDs has revealed that ligands determine not only the excited state dynamics of the QD but also, in some cases, its ground state electronic structure. Specifically, the article discusses (i) measurement of the electronic structure of colloidal QDs and the influence of their surface chemistry, in particular, dipolar ligands and exciton-delocalizing ligands, on their electronic energies; (ii) the role of molecules in interfacial electron and energy transfer processes involving QDs, including electron-to-vibrational energy transfer and the use of the ligand shell of a QD as a semipermeable membrane that gates its redox activity; and (iii) a particular application of colloidal QDs, photoredox catalysis, which exploits the combination of the electronic structure of the QD core and the chemistry at its surface to use the energy of the QD excited state to drive chemical reactions.

Subpicosecond Photoinduced Hole Transfer from a CdS Quantum Dot to a Molecular Acceptor Bound Through an Exciton-Delocalizing Ligand.

This paper describes the enhancement of the rate of hole transfer from a photoexcited CdS quantum dot (QD), with radius R = 2.0 nm, to a molecular acceptor, phenothiazine (PTZ), by linking the donor and acceptor through a phenyldithiocarbamate (PTC) linker, which is known to lower the confinement energy of the excitonic hole. Upon adsorption of PTC, the bandgap of the QD decreases due to delocalization of the exciton, primarily the excitonic hole, into interfacial states of mixed QD/PTC character. This delocalization enables hole transfer from the QD to PTZ in <300 fs (within the instrument response of the laser system) when linked by PTC, but not when linked by a benzoate group, which has a similar length and conjugation as PTC but does not delocalize the excitonic hole. Comparison of the two systems was aided by quantification of the surface coverage of benzoate and PTC-linked PTZ by (1)H NMR. This work provides direct spectroscopic evidence of the enhancement of the rate of hole extraction from a colloidal QD through covalent linkage of a hole acceptor through an exciton-delocalizing ligand.

Composition and Permeability of Oleate Adlayers of CdS Quantum Dots upon Dilution to Photoluminescence-Relevant Concentrations.

This paper describes the changes in surface chemistry that occur in oleate-capped CdS quantum dots (QDs) upon dilution from NMR-relevant concentrations (10 µM) to photoluminescence (PL)-relevant concentrations (0.1 µM) and the consequences these changes have on the relative probabilities of radiative and nonradiative decay of the QD exciton. Characterization of the QD surface by nuclear magnetic resonance (NMR) spectroscopy reveals that upon dilution in three solvents, C6D6, C6D12, and CDCl3, oleate ligands, in the form of cadmium oleate and Cd(x)OA(y) clusters, desorb. Changes in the ligand coverage by 30-40% do not impact the solubility of the QDs, do not have measurable influence on the absorption or PL line widths, produce small (±0.05), nonmonotonic changes in the relative PL quantum yield, and produce small, nonmonotonic changes the relative partitioning between band-edge and "trapped" exciton emission. Desorption of surface ligands as a result of dilution of the QDs does, however, make the QDs more redox-active with respect to a small-molecule photooxidant, benzoquinone (BQ), because less dense organic adlayers allow a greater number of BQs to permeate the ligand shell and adsorb to the QD surface. Unlike previous studies, in which the QD concentrations used for NMR characterization were more than a factor of 10 higher than those used for optical measurements, this study directly correlates the surface composition of the QDs to their photophysical properties.

Role of Interligand Coupling in Determining the Interfacial Electronic Structure of Colloidal CdS Quantum Dots.

Displacement of cadmium oleate (Cd(oleate)2) ligands for the exciton-delocalizing ligand 4-hexylphenyldithiocarbamate (C6-PTC) on the surfaces of CdS quantum dots (QDs) causes a decrease in the band gap (Eg) of the QD of ∼100 meV for QDs with a radius of 1.9 nm and ∼50 meV for QDs with a radius of 2.5 nm. The primary mechanism of this decrease in band gap, deduced in previous work, is a decrease in the confinement barrier for the excitonic hole. The increase in apparent excitonic radius of the QD that corresponds to this decrease in Eg is denoted ΔR. The dependence of ΔR on the surface coverage of C6-PTC, measured by (1)H NMR spectroscopy, appears to be nonlinear. Calculations of the excitonic energy of a CdS QD upon displacement of native insulating ligands with exciton-delocalizing ligands using a 3D spherical potential well model show that this response includes the contributions to ΔR from both isolated, bound C6-PTC ligands and groups of adjacent C6-PTC ligands. Fits to the experimental plots of ΔR vs surface coverage of C6-PTC with a statistical model that includes the probability of formation of clusters of bound C6-PTC on the QD surface allow for the extraction of the height of the confinement barrier presented by a single, isolated C6-PTC molecule to the excitonic hole. This barrier height is less than 0.6 eV for QDs with a radius of 1.9 nm and between 0.6 and 1.2 eV for QDs with a radius of 2.5 nm.

Enhanced rate of radiative decay in CdSe quantum dots upon adsorption of an exciton-delocalizing ligand.

This paper describes the enhancement of the quantum yield of photoluminescence (PL) of CdSe quantum dots (QDs) upon the adsorption of an exciton-delocalizing ligand, phenyldithiocarbamate. Increasing the apparent excitonic radius by only 10% increases the value of the radiative rate constant by a factor of 1.8 and the PL quantum yield by a factor of 2.4. Ligand exchange therefore simultaneously perturbs the confinement energy of charge carriers and enhances the probability of band-edge transitions.

The role of ligands in determining the exciton relaxation dynamics in semiconductor quantum dots.

This article reviews the mechanisms through which molecules adsorbed to the surfaces of semiconductor nanocrystals, quantum dots (QDs), influence the pathways for and dynamics of intra- and interband exciton relaxation in these nanostructures. In many cases, the surface chemistry of the QDs determines the competition between Auger relaxation and electronic-to-vibrational energy transfer in the intraband cooling of hot carriers, and between electron or hole-trapping processes and radiative recombination in relaxation of band-edge excitons. The latter competition determines the photoluminescence quantum yield of the nanocrystals, which is predictable through a set of mostly phenomenological models that link the surface coverage of ligands with specific chemical properties to the rate constants for nonradiative exciton decay.

Chemical and Electrochemical Manipulation of Mechanical Properties in Stimuli-Responsive Copper-Cross-Linked Hydrogels.

Inspiration for the design of new synthetic polymers can be found in the natural world, where materials often exhibit complex properties that change depending on external stimuli. A new synthetic electroplastic elastomer hydrogel (EPEH) that undergoes changes in mechanical properties in response to both chemical and electrochemical stimuli has been prepared based on these precedents. In addition to having the capability to switch between hard and soft states, the presence of both permanent covalent and dynamic copper-based cross links also allows this stimuli-responsive material to exhibit a striking shape memory capability. The density of temporary cross links and the mechanical properties are controlled by reversible switching between the +1 and +2 oxidation states.