Metal–organic frameworks (MOFs), constructed from organic linkers and inorganic building blocks, are well-known for their high crystallinity, high surface areas, and high component tunability. The ...stability of MOFs is a key prerequisite for their potential practical applications in areas including storage, separation, catalysis, and biomedicine since it is essential to guarantee the framework integrity during utilization. However, MOFs are prone to destruction under external stimuli, considerably hampering their commercialization. In this Review, we provide an overview of the situations where MOFs undergo destruction due to external stimuli such as chemical, thermal, photolytic, radiolytic, electronic, and mechanical factors and offer guidelines to avoid unwanted degradation happened to the framework. Furthermore, we discuss possible destruction mechanisms and their varying derived products. In particular, we highlight cases that utilize MOF instability to fabricate varying materials including hierarchically porous MOFs, monolayer MOF nanosheets, amorphous MOF liquids and glasses, polymers, metal nanoparticles, metal carbide nanoparticles, and carbon materials. Finally, we provide a perspective on the utilization of MOF destruction to develop advanced materials with a superior hierarchy for various applications.
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IJS, KILJ, NUK, PNG, UL, UM
Multi-component hierarchically porous materials are an emerging class of materials with tailored compositions, tunable distribution and sophisticated applications. An increasing demand for ...multifunctionalities and hierarchical structures has resulted in extensive studies on multi-component hierarchical metal-organic frameworks and other open framework compounds. This review article focuses on recent advances in multi-component and hierarchical framework materials, covering the design and synthetic strategies of these architectures, their characterization, and the latest applications. Multivariate MOFs prepared under various synthetic conditions (one-pot or post-synthetic) and their building block distributions are introduced and summarized. This is followed by a short review of characterization techniques including solid-state NMR and photothermal induced resonance, and their potential applications in gas storage, separation, heterogeneous catalysis, guest delivery, and luminescence. Furthermore, guided by the same design principles, the synthesis and applications of multi-component hierarchical covalent-organic frameworks, metal-organic cages and porous organic cages are introduced and discussed. Together, this review is expected to provide a library of multi-component hierarchically porous compounds, which could also guide the state-of-the-art design and discovery of future porous materials with unprecedented tunability, synergism and precision.
This review is expected to provide a library of multi-component hierarchically porous compounds, which shall guide the state-of-the-art design of future porous materials with unprecedented tunability, synergism and precision.
OBJECTIVETo update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
METHODSThe guideline panel systematically reviewed MCI prevalence, prognosis, and ...treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.
RESULTSMCI prevalence was 6.7% for ages 60–64, 8.4% for 65–69, 10.1% for 70–74, 14.8% for 75–79, and 25.2% for 80–84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.
MAJOR RECOMMENDATIONSClinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).
This article presents a practical approach to the evaluation of patients with rapidly progressive dementia.
The approach presented in this article builds upon the standard dementia evaluation, ...leveraging widely available tests and emergent specific markers of disease to narrow the differential diagnosis and determine the cause(s) of rapid progressive decline. The discovery of treatment-responsive causes of rapidly progressive dementia underscores the need to determine the cause early in the symptomatic course when treatments are most likely to halt or reverse cognitive decline.
A pragmatic and organized approach to patients with rapidly progressive dementia is essential to mitigate diagnostic and therapeutic challenges and optimize patient outcomes.
IMPORTANCE: Autoimmune encephalitis misdiagnosis can lead to harm. OBJECTIVE: To determine the diseases misdiagnosed as autoimmune encephalitis and potential reasons for misdiagnosis. DESIGN, ...SETTING, AND PARTICIPANTS: This retrospective multicenter study took place from January 1, 2014, to December 31, 2020, at autoimmune encephalitis subspecialty outpatient clinics including Mayo Clinic (n = 44), University of Oxford (n = 18), University of Texas Southwestern (n = 18), University of California, San Francisco (n = 17), Washington University in St Louis (n = 6), and University of Utah (n = 4). Inclusion criteria were adults (age ≥18 years) with a prior autoimmune encephalitis diagnosis at a participating center or other medical facility and a subsequent alternative diagnosis at a participating center. A total of 393 patients were referred with an autoimmune encephalitis diagnosis, and of those, 286 patients with true autoimmune encephalitis were excluded. MAIN OUTCOMES AND MEASURES: Data were collected on clinical features, investigations, fulfillment of autoimmune encephalitis criteria, alternative diagnoses, potential contributors to misdiagnosis, and immunotherapy adverse reactions. RESULTS: A total of 107 patients were misdiagnosed with autoimmune encephalitis, and 77 (72%) did not fulfill diagnostic criteria for autoimmune encephalitis. The median (IQR) age was 48 (35.5-60.5) years and 65 (61%) were female. Correct diagnoses included functional neurologic disorder (27 25%), neurodegenerative disease (22 20.5%), primary psychiatric disease (19 18%), cognitive deficits from comorbidities (11 10%), cerebral neoplasm (10 9.5%), and other (18 17%). Onset was acute/subacute in 56 (52%) or insidious (>3 months) in 51 (48%). Magnetic resonance imaging of the brain was suggestive of encephalitis in 19 of 104 patients (18%) and cerebrospinal fluid (CSF) pleocytosis occurred in 16 of 84 patients (19%). Thyroid peroxidase antibodies were elevated in 24 of 62 patients (39%). Positive neural autoantibodies were more frequent in serum than CSF (48 of 105 46% vs 7 of 91 8%) and included 1 or more of GAD65 (n = 14), voltage-gated potassium channel complex (LGI1 and CASPR2 negative) (n = 10), N-methyl-d-aspartate receptor by cell-based assay only (n = 10; 6 negative in CSF), and other (n = 18). Adverse reactions from immunotherapies occurred in 17 of 84 patients (20%). Potential contributors to misdiagnosis included overinterpretation of positive serum antibodies (53 50%), misinterpretation of functional/psychiatric, or nonspecific cognitive dysfunction as encephalopathy (41 38%). CONCLUSIONS AND RELEVANCE: When evaluating for autoimmune encephalitis, a broad differential diagnosis should be considered and misdiagnosis occurs in many settings including at specialized centers. In this study, red flags suggesting alternative diagnoses included an insidious onset, positive nonspecific serum antibody, and failure to fulfill autoimmune encephalitis diagnostic criteria. Autoimmune encephalitis misdiagnosis leads to morbidity from unnecessary immunotherapies and delayed treatment of the correct diagnosis.
Does neuroinflammation promote neurodegeneration? Does neurodegeneration promote neuroinflammation? Or, is the answer to both questions, yes? These questions have proven challenging to answer in ...patients with typical age-related neurodegenerative diseases in whom the onset of neuroinflammation and neurodegeneration are largely unknown. Patients recovering from diseases associated with abrupt-onset neuroinflammation, including rare forms of antibody-mediated encephalitis (AME) and common complications of novel coronavirus disease 2019 (COVID-19), provide a unique opportunity to untangle the relationship between neuroinflammation and neurodegeneration. This review explores the lessons learned from patients with AME and COVID-19.
Persistent cognitive impairment is increasingly recognized in patients recovering from AME or COVID-19, yet the drivers of impairment remain largely unknown. Clinical observations, neuroimaging and biofluid biomarkers, and pathological studies imply a link between the severity of acute neuroinflammation, subsequent neurodegeneration, and disease-associated morbidity.
Data from patients with AME and COVID-19 inform key hypotheses that may be evaluated through future studies incorporating longitudinal biomarkers of neuroinflammation and neurodegeneration in larger numbers of recovering patients. The results of these studies may inform the contributors to cognitive impairment in patients with AME and COVID-19, with potential diagnostic and therapeutic applications in patients with age-related neurodegenerative diseases.
Timely diagnosis and treatment is essential to optimize outcomes in patients with antibody-mediated encephalitis (AME); yet even with early diagnosis and treatment, long-term outcomes may still fall ...short of expectations. Identifying patients at greater risk of adverse outcomes is key to personalizing care, supporting accurate counseling of patients and family members, and informing therapeutic decisions in patients with AME. This review considers long-term outcomes in recovering patients, including approaches to measure and manage common sequelae that influence life after AME.
Cognitive impairment, fatigue, and sleep disturbances affect most recovering AME patients. This realization highlights the need for outcome measures that encompass more than motor function. Standardized questionnaires, surveys, and clinical assessment tools may be adapted to support comprehensive and reproducible clinical assessments and to identify patients who may benefit from additional therapies.
Good outcomes continue to be reported in recovering patients, emphasizing the high potential for recovery following AME. However, cognitive, behavioral, and physical sequelae may limit the potential for great outcomes following AME. Multidisciplinary follow-up is needed to recognize and treat sequelae that compromise long-term recovery and limit quality of life in recovering patients.
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