Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Programs and Activities for Gifted Youth at Pillar University

An important task of pillar university within the framework of the implementation of the “third mission” is the work with gifted schoolchildren and youth of the region. The education programs and activities are aimed at involving them in scientific and innovation activities, identifying talents, early career guidance, attracting talented students to the region. For this purpose, Sochi State University has developed a number of projects of various target orientations, including with partners (Educational Center “Sirius”, ANO “Sea of Ideas”, etc.), which allows us to expand the geography of admission and raise the initial level of applicants’ training. This article presents the experience of SSU in working with talented schoolchildren and young people, including such projects as the organization of the All-Russian Multidisciplinary Engineering Olympiad “Zvezda”, Classes with talented schoolchildren in preparing them for participation in competitions, “Venture Accelerator”, “Improving teachers’ qualification to work in regional research and educational centers”, “Formation of a sociological portrait of applicants, students and graduates of educational programs of secondary vocational education providing training for the most popular, new and promising professions and specialties of secondary vocational education”

On the Operational Conditions&rsquo; Effect on the Performance of an Anion Exchange Membrane Water Electrolyzer: Electrochemical Impedance Spectroscopy Study

The performance of an anion exchange membrane water electrolyzer under various operational conditions (including voltage, KOH-supporting electrolyte concentration, and flow rate) is studied using conventional time-domain technics and electrochemical impedance spectroscopy (EIS). The water electrolyzer EIS footprint, depending on the variation in operational conditions, is studied and discussed, providing valuable data on the faradaic and non-faradaic processes in MEA, considering their contribution to the total polarization resistance. The distribution of the AEMWE cell voltage contributions is valuable to accessing the key directions in the system performance improvement

On the Operational Conditions’ Effect on the Performance of an Anion Exchange Membrane Water Electrolyzer: Electrochemical Impedance Spectroscopy Study

The performance of an anion exchange membrane water electrolyzer under various operational conditions (including voltage, KOH-supporting electrolyte concentration, and flow rate) is studied using conventional time-domain technics and electrochemical impedance spectroscopy (EIS). The water electrolyzer EIS footprint, depending on the variation in operational conditions, is studied and discussed, providing valuable data on the faradaic and non-faradaic processes in MEA, considering their contribution to the total polarization resistance. The distribution of the AEMWE cell voltage contributions is valuable to accessing the key directions in the system performance improvement

Reduced Graphene Oxide-Supported Pt-Based Catalysts for PEM Fuel Cells with Enhanced Activity and Stability

Platinum (Pt)-based electrocatalysts supported by reduced graphene oxide (RGO) were synthesized using two different methods, namely: (i) a conventional two-step polyol process using RGO as the substrate, and (ii) a modified polyol process implicating the simultaneous reduction of a Pt nanoparticle precursor and graphene oxide (GO). The structure, morphology, and electrochemical performances of the obtained Pt/RGO catalysts were studied and compared with a reference Pt/carbon black Vulcan XC-72 (C) sample. It was shown that the Pt/RGO obtained by the optimized simultaneous reduction process had higher Pt utilization and electrochemically active surface area (EASA) values, and a better performance stability. The use of this catalyst at the cathode of a proton exchange membrane fuel cell (PEMFC) led to an increase in its maximum power density of up to 17%, and significantly enhanced its performance especially at high current densities. It is possible to conclude that the optimized synthesis procedure allows for a more uniform distribution of the Pt nanoparticles and ensures better binding of the particles to the surface of the support. The advantages of Pt/RGO synthesized in this way over conventional Pt/C are the high electrical conductivity and specific surface area provided by RGO, as well as a reduction in the percolation limit of the components of the electrocatalytic layer due to the high aspect ratio of RGO

Reduced Graphene Oxide and Its Modifications as Catalyst Supports and Catalyst Layer Modifiers for PEMFC

Reduced graphene oxide (RGO) and RGO modified by ozone (RGO-O) and fluorine (RGO-F) were synthesized. Pt nanoparticles were deposited on these materials and also on Vulcan XC-72 using the polyol method. The structural and electrochemical properties of the obtained catalysts were investigated in a model glass three-electrode electrochemical cell and in a laboratory PEM fuel cell. Among the RGO-based catalysts, the highest electrochemically active surface area (EASA) was obtained for the oxidized RGO supported catalyst. The EASA of the fluorine-modified RGO-supported catalyst was half as big. In the PEM fuel cell the performance of RGO-based catalysts did not exceed the activity of Vulcan XC-72-based catalysts. However, the addition of an RGO-O-based catalyst to Vulcan XC-72-based catalyst (in contrast to the RGO-F-based catalyst) allowed us to increase the catalyst layer activity and PEM fuel cell performance. Possible reasons for such an effect are discussed

Electrochemical hydrogen production on a metal-free polymer

The exploration for true electrocatalytic reactions at organic conducting polymer electrodes, including chemisorption of a reactant and desorption of a product, is receiving renewed interest due to the profound implications it could have on low-cost large area electrochemical energy technology. Here, we finalize the debate about the ability of an organic electrode, more specifically poly(3,4-ethylenedioxythiophene) (PEDOT), to be an electrocatalyst for hydrogen production. This paper proves and covers fundamental studies of the hydrogen evolution reaction (HER) on PEDOT films. Both theory based on DFT (Density Functional Theory) and experimental studies using electrochemical techniques and operando mass spectrometry suggest a Volmer-Heyrovsky mechanism for the actual HER on PEDOT. It is shown that PEDOT reaches an exchange current density comparable to that of metals (i.e. Cu, Ni, and Au) and in addition does not form passivating oxide layers or suffer from chemical corrosion in acidic media. Finally, an electrolyzer stack using the organic polymer electrode demonstrates HER performance in real applications.Funding Agencies|Goran Gustafssons Stiftelse [25034 300523]; Knut Alice Wallenberg Foundation (WWSC); Peter Wallenberg Foundation [PWS2016-0010]; VetenskapsradetSwedish Research Council; National Research Centre "Kurchatov Institute" [1808]; Swedish Government Strategic Research Area in Materials Science on Functional Materials at Linkoping University (Faculty Grant SFO-Mat-LiU) [2009-00971]</p

Pt/C and Pt/SnOx/C Catalysts for Ethanol Electrooxidation: Rotating Disk Electrode Study

Pt/C and Pt/SnOx/C catalysts were synthesized using the polyol method. Their structure, morphology and chemical composition were studied using a scanning electron microscope equipped with an energy dispersive X-ray spectrometer, transition electron microscope and X-ray photoelectron spectroscope. Electrochemical measurements were based on the results of rotating disk electrode (RDE) experiments applied to ethanol electrooxidation. The quick evaluation of catalyst activity, electrochemical behavior, and an average number of transferred electrons were made using the RDE technique. The usage of SnOx (through the carbon support modification) in a binary system together with Pt causes a significant increase of the catalyst activity in ethanol oxidation reaction and the utilization of ethanol