A kinetic model and mechanism were developed for the heterogeneous chelation reaction of thin CuO films with hexafluoroacetylacetone (hfacH) in supercritical CO2. This reaction has relevance for processing nanoscale structures and, more importantly, serves as a model system to tune the reaction behavior of solids using supercritical fluids. Precise control over reaction conditions enabled accurate etching rates to be measured as a function of both temperature [(53.5-88.4) +/- 0.5 degrees C] and hfacH concentration (0.3-10.9 mM), yielding an apparent activation energy of 70.2 +/- 4.1 kJ/mol and an order of approximately 0.6 with respect to hfacH. X-ray photoelectron spectroscopy and scanning electron microscopy were used to characterize the CuO surface, and a maximum etching rate of 24.5 +/- 3.1 A/min was obtained. Solvation forces between hfacH and the dense CO2 permitted material removal at temperatures more than 100 degrees C lower than that of the analogous gas-phase process. In the low concentration regime, the etching reaction was modeled with a three-step Langmuir-Hinshelwood mechanism. Small amounts of excess water nearly doubled the reaction rate through the proposed formation of a hydrogen-bonded hfacH complex in solution. Further increases in the hfacH concentration up to 27.5 mM caused a shift to first-order kinetics and an adsorption-limited or Rideal-Eley mechanism. These results demonstrate that relatively modest increases in concentration can prompt a heterogeneous reaction in supercritical CO2 to switch from a mechanism most commonly associated with a low-flux gas to one emblematic of a high-flux liquid.

Sulfasalazine is an anti-inflammatory agent commonly used in the treatment of autoimmune conditions such as inflammatory bowel disease and rheumatoid arthritis. Sulfasalazine is converted by gut bacteria into sulfapyridine and the clinically active metabolite 5-aminosalicylic acid (5-ASA), and its efficacy is proportional to the 5-ASA concentration within the intestinal lumen. Renal complications are commonly reported for the chemically similar 5-ASA derivative mesalamine, but are not well-known side effects of sulfasalazine therapy. We report a 72-year-old patient with Crohn's disease managed with sulfasalazine for more than 10 years who presented with severe acute kidney injury (serum creatinine, 9.7mg/dL). Renal ultrasound revealed calculi and he subsequently spontaneously voided innumerable stones, which were composed of sulfasalazine metabolites. His renal calculi cleared and serum creatinine concentration improved to 3.1mg/dL after discontinuing sulfasalazine therapy and intravenous fluid hydration. His kidney function eventually returned to baseline. This case demonstrates that renal complications, in particular nephrolithiasis, may be an under-reported but potentially serious phenomenon in patients with inflammatory bowel disease treated with sulfasalazine and that their hydration status may play an important role in this process.

The stability of the human genome depends upon a delicate balance between replication by high- and low-fidelity DNA polymerases. Aberrant replication by error-prone polymerases or loss of function of high-fidelity polymerases predisposes to genetic instability and, in turn, cancer. DNA polymerase epsilon (Pol ε) is a high-fidelity, processive polymerase that is responsible for the majority of leading strand synthesis, and mutations in Pol ε have been increasingly associated with various human malignancies. The clinical significance of Pol ε mutations, including how and whether they should influence management decisions, remains poorly understood. In this report, we describe a 24-year-old man with an aggressive stage IV high-grade, poorly differentiated colon carcinoma who experienced a dramatic response to single-agent checkpoint inhibitor immunotherapy after rapidly progressing on standard chemotherapy. His response was complete and durable and has been maintained for more than 48 months. Genetic testing revealed a P286R mutation in the endonuclease domain of POLE and an elevated tumor mutational burden of 126 mutations per megabase, both of which have been previously associated with response to immunotherapy. Interestingly, tumor staining for PD-L1 was negative. This case study highlights the importance of genetic profiling of both early and late-stage cancers, the clinical significance of POLE mutations, and how the interplay between genetic instability and immune-checkpoint blockade can impact clinical decision-making.