Carbon nanotube-supported Pt catalysts (Pt/CNT) for the cathode in a polymer electrolyte fuel cell (PEFC) were covered with silica layers using tetraethoxysilane (TEOS) and also methyltriethoxysilane (MTEOS) to improve the catalyst durability under the severe conditions at the PEFC cathode. Both the silica-coated Pt/CNT catalysts had excellent durability for potential cycling between 0.6 and 1.0 V (vs RHE) in N 2 -purged 0.1 M HClO 4 electrolyte, while Pt/CNT without silica coating was significantly deactivated due to an increase of the Pt metal particle size. Silica-coated Pt/CNT prepared from MTEOS had similar activity for the oxygen reduction reaction as Pt/CNT without silica coating, whereas the silica coverage obtained with TEOS slightly reduced the catalytic activity of the Pt/CNT catalyst. The silica layers prepared from MTEOS are more hydrophobic than those prepared from TEOS due to the presence of methyl groups. In addition, the silica layers prepared from MTEOS have larger pores than those prepared from TEOS. The hydrophobic silica layers with larger pores in the silica-coated Pt/CNT do not inhibit the diffusion of the reactants (oxygen) and the discharge of the products (water) during the oxygen reduction reaction.
An elderly Japanese woman developed acute decompensated heart failure caused by persistent atrial fibrillation (AF) and left ventricular systolic dysfunction. Approximately 6 days after starting intravenous administration of amiodarone (600 mg/day) for maintaining sinus rhythm after cardioversion of AF, electrocardiograms revealed a prolonged QT interval associated with torsade de pointes (TdP). The amiodarone‐induced TdP disappeared after intravenous administration of landiolol plus magnesium and potassium, without discontinuation of amiodarone or overdrive cardiac pacing, although the prolonged QT interval persisted. To the best of our knowledge, this is the first report that landiolol could be effective for amiodarone‐induced TdP.
Rationale: Recent studies have shown that QT interval prolongation is associated with disease severity and predicts mortality in systemic inflammatory diseases, particularly rheumatoid arthritis. Systemic pro-inflammatory cytokines released from synovial tissues in rheumatoid arthritis, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, could have direct effects on cardiac electrophysiology, particularly changes in the expression and function of potassium and calcium channels, resulting in QT interval prolongation on surface electrocardiogram (ECG) and an increased predisposition to develop lethal ventricular arrhythmias. However, reports on torsade de pointes (TdP) due to acquired long QT syndrome in patients with polymyalgia rheumatica (PMR) are limited. Patient concerns: An 85-year-old Japanese woman with active PMR developed first syncope. Diagnosis: Frequent premature atrial contractions (PACs) with multiple patterns of aberrant conduction, QT interval prolongation, and morphological T-U wave variability followed by TdP were documented. PACs were the first beat of TdP. Interventions: Amiodarone, together with magnesium and potassium, was intravenously administered. However, TdP resulted in a ventricular arrhythmic storm, for which sedation with mechanical ventilatory support, temporary overdrive cardiac pacing, and intravenous landiolol administration in addition to multiple direct current shocks were effective. Outcomes: Approximately 2 years later, the patient was treated with amiodarone, propranolol, and prednisolone. She did not undergo implantable cardioverter-defibrillator implantation and was quite well, with no recurrence of ventricular tachyarrhythmia. Lessons: IL-6 hyperproduction in inflamed tissues has been widely confirmed in PMR. Frequent PACs with various patterns of aberrant conduction, QT interval prolongation, and morphological T-U wave variability followed by TdP, for which IL-6-mediated enhancement of L-type Ca 2+ current and inhibition of the rapid component of the delayed rectifier K + current are the most likely mechanisms, were documented in an elderly Japanese woman with PMR. ECG may be recorded once in patients with active PMR even when these patients do not complain of palpitation or syncope. If QT interval prolongation or arrhythmia, including even PACs, is observed, follow-up ECG may be warranted, particularly for patients with some risk factors for QT prolongation that could lead to TdP, such as advanced age, female sex, hypopotassemia, and polypharmacy.
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