bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastric Emptying of Low- and High-Caloric Liquid Meals Measured Using Ultrasonography in Healthy Volunteers
Authors: Mazzawi Tarek , Bartsch Emily , Benammi Sara , Ferro Rosa , Nikitina Ekaterina , Nimer Nancy , Ortega Lara , Perrotte Charles , Pithon Joäo , Rosalina Safira , Sharp Alexis , Stevano Reza , Hatlebakk Jan , Hausken Trygve
Published: January 2019

Delayed gastric emptying is present in patients with functional dyspepsia (FD), diabetes mellitus, and neurological diseases. Diet may affect gastric emptying symptoms in patients with FD. We sought to determine the extent to which gastric emptying and symptoms of dyspepsia are influenced by caloric content in healthy subjects using ultrasonography.

32 healthy volunteers were given 2 meals with different caloric content in random order. Gastric emptying was determined using ultrasonography to measure antral area when fasting, and postprandially at intervals of 0, 10, 20, and 30 min. Dyspeptic symptoms including discomfort, nausea, and fullness were graded.

The antral area following a high-caloric meal compared to a low-caloric meal was significantly increased at 0, 10, 20, and 30 min (P=0.0203,<0.0001<0.0001,<0.0001, respectively), as was the median fullness (P<0.0048, 0.0001, 0.0009, 0.0001, respectively) measured at the same time points. There was a weak correlation (r2=0.1, P<0.0001) between the antral area and subjective fullness. No differences between gastric emptying in males and females were found.

The caloric content of a meal influences gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia.
Antikoagulation bei onkologischen Patienten
Authors: Struve Sabine , Ringwald Jürgen
Published: January 2019

Tumorpatienten zeigen im Vergleich zur Normalbevölkerung ein erhöhtes Risiko für
venöse Thromboembolien, welche erhebliche Auswirkungen auf Morbidität und
Mortalität haben. Daher sind adäquate prophylaktische Maßnahmen sowie eine
frühzeitige Diagnose und Therapie essenziell. Allerdings ist eine
Antikoagulation bei Tumorpatienten mit einem gehäuften Auftreten von Blutungen
und auch von Rezidiven verbunden. Angesichts dieser besonderen Herausforderungen
haben mehrere Fachgesellschaften und Arbeitsgruppen spezifische Leitlinien und
Empfehlungen zur Thromboseprophylaxe und -therapie bei Tumorpatienten
veröffentlicht. Über diese soll im Folgenden ein Überblick gegeben werden.
Phytotherapie in der S3-Leitlinie „Nicht erholsamer Schlaf / Schlafstörungen“
Authors: Koch Anna Katharina , Langhorst Jost
Published: January 2019

Innerhalb der im Dezember 2017 veröffentlichten Aktualisierung der S3-Leitlinie „Nicht erholsamer Schlaf / Schlafstörungen“ (AWMF-Registernummer 063 - 003) findet eine Reihe verschiedener komplementärer Verfahren Erwähnung. So auch einige Phytotherapeutika: Baldrianwurzel, Passionsblume, Melissenblätter und Hopfenzapfen. Für eine Empfehlung hinsichtlich dieser Phytotherapeutika jedoch reicht die Evidenz nicht aus. So finden sie lediglich im Hintergrundtext auf Grundlage von Statements der European Medicines Agency Erwähnung. Jetzt sind qualitativ hochwertige, randomisiert kontrollierte Studien nötig, um bei der anstehenden Leitlinienaktualisierung Ende 2020 auch den Phytotherapeutika ggfs. eine eigene Empfehlung zukommen lassen zu können.
Schmerzfrei stillen – die frei bewegliche Zunge, Vor- und Nachsorge der Frenotomie
Authors: Moghtader Darius
Published: January 2019

Ein zu kurzes Zungenband und Lippenband kann unbehandelt zu Stillproblemen und weiteren Einschränkungen führen. Die Frenotomie ist ein minimalinvasiver Eingriff, der Zunge und ggf. Lippe frei beweglich machen und schmerzfreies, effektives Stillen ermöglichen kann. Entscheidend ist eine konsequente Vorbereitung und Nachsorge. In seinem Vortrag auf dem Forum Hebammenarbeit 2018 in Wiesbaden beschrieb Dr. med. dent. Darius Moghtader anhand zahlreicher Fallbeispiele, welche Symptome die Hebamme bei Säugling und Mutter beachten sollte. Die Redaktion fasste den Inhalt für diesen Artikel zusammen.
Humane Milch-Oligosaccharide in aller (Babys) Munde
Authors: Petschacher Barbara
Published: January 2019

Wissenschaftlern weltweit gelingt es zunehmend, die wertvollen Inhaltsstoffe von Muttermilch und ihre große Bedeutung für die Säuglingsgesundheit zu entschlüsseln. Das Institut für Biotechnologie und Bioprozesstechnik der TU Graz forscht zum Thema humane MilchOligosaccharide (HMO). In ihrem Übersichtsartikel erklärt die Autorin bisherige Erkenntnisse über den Aufbau, das Vorkommen und die Wirkungsweise von HMO. Daraus ergeben sich spannende Perspektiven für mögliche zukünftige Anwendungen.
Stillen im Kontext von Bindungsaufbau und frühkindlicher Entwicklung
Authors: Erntl Christine
Published: January 2019

Jede Frau, die ein Kind erwartet, beschäftigt sich früher oder später damit, ob sie stillen möchte oder nicht. Die meisten Frauen entscheiden sich dafür. Doch es ist auch wichtig, wie lange Säuglinge gestillt werden. Viele gehen davon aus, dass eine längere Stilldauer positiven Einfluss auf die Bindungsqualität sowie auf die kognitive Entwicklung eines Kindes habe. Die Autorin ging dieser Frage in ihrer Diplomarbeit an der Universität Wien nach.
Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung zur Diagnostik des irreversiblen Hirnfunktionsausfalls
Authors: Walter Uwe , Brandt Stephan , Förderreuther Stefanie , Hansen Hans-Christian , Hinrichs Hermann , Kaps Manfred , Müllges Wolfgang , Weise David
Published: January 2019

Gemeinsam mit der Vierten Fortschreibung der Richtlinie der Bundesärztekammer zur Feststellung des irreversiblen Hirnfunktionsausfalls („Hirntod“) im Jahr 2015 erfolgte eine Revision der Empfehlungen der Deutschen Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung (DGKN) zu den ergänzenden elektrophysiologischen (Elektroenzephalografie, frühe akustisch evozierte Potenziale, somatosensorisch evozierte Potenziale) und neurovaskulären (Dopplersonografie, Duplexsonografie) Untersuchungen.

Die Empfehlungen der DGKN wurden 2018 in einigen Punkten aktualisiert. Neben redaktionellen Änderungen (u. a. Ersetzen des Begriffs „Eichsignal“ durch „Kalibriersignal“, präzisere Formulierung der zu setzenden Elektroden für die Elektroenzephalografie) wurden Vorgaben zur Bildanzeige bei digitaler Elektroenzephalografie und altersbezogene Mindestgrößen des arteriellen Mitteldruckes bei Kindern für die Doppler- und Duplexsonografie neu aufgenommen. Diese hier präsentierten Empfehlungen stellen die Indikationen, Limitationen, Voraussetzungen und die Durchführung dieser Zusatzverfahren in der Diagnostik des irreversiblen Hirnfunktionsausfalls bei Kindern und Erwachsenen dar.
Betreuung der Schwangerschaft bei maternalen Nierenerkrankungen
Authors: Markfeld-Erol Filiz , Farthmann Juliane , Donauer Johannes , Kunze Mirjam
Published: January 2019

Anamnese und klinischer Befund Wir berichten über drei Schwangere: zwei in verschiedenen Stadien der Niereninsuffizienz und eine Nierentransplantierte. Pat. 1 ist eine 32-Jährige I/0 in der 20. SSW mit akutem Nierenversagen, nephrotischem Syndrom und familiärem Mittelmeerfieber in der Anamnese. Pat. 2 ist eine 23-Jährige mit Schrumpfnieren bds. und Niereninsuffizienz Stad. V unter Dialyse 3 × wöchentlich, die Schwangerschaft war eine Zufallsdiagnose. Pat. 3 ist eine 29-Jährige im Z. n. Nierentransplantation vor mehreren Jahren.

Diagnose, Therapie und Verlauf Bei Pat. 1 wurde die Verdachtsdiagnose einer AA-Amyloidose durch Nierenbiopsie bestätigt. Im Verlauf wurde sie zunehmend dialysepflichtig. Bei Pat. 2 musste die Dialyse ebenfalls eskaliert werden. Beide Schwangerschaften wurden vorzeitig beendet. Die transplantierte Pat. 3 wurde am Termin ohne Komplikationen im Verlauf entbunden.

Folgerung Die Verbesserung des fetalen Outcomes ist v. a. auf die interdisziplinäre Zusammenarbeit zurückzuführen. Ziel sollte sein, junge nierenkranke Frauen bereits vor einer Schwangerschaft umfassend über Risiken und Erfolgsaussichten zu beraten und zu betreuen.
Revaccination in Children Undergoing Autologous Hematopoietic Stem Cell Transplantation: Results of a Survey in Germany, Austria and Switzerland
Authors: Laws Hans-Jürgen , Simon Arne , Lehrnbecher Thomas
Published: January 2019

Background Due to the potential loss of protective antibody titers after autologous hematopoietic stem cell transplantation (HSCT), revaccination is important. The aim of the study was to evaluate the current strategies in Germany, Austria and Switzerland for revaccination of children after autologous HSCT.

Methods An internet-based survey was performed, and results were analyzed in a descriptive way.

Results Twenty-seven out of 31 centers (87%) centers responded, and all centers administer revaccination. More than 90% of the centers re-vaccinate against tetanus, diphtheria, hepatitis B, H. influenzae B, poliomyelitis, measles, mumps, and rubella, whereas considerable less centers vaccinate against encapsulated bacteria, in particular against meningococci. First revaccination with non-live vaccine is performed by almost all centers between 3 and 9 months. Timing of live-attenuated vaccines varied widely [6 months (4 centers), 9 months (1), 12 months (11) and 24 months (4)]. Similarly, there is a wide variation in the delay of live-vaccines after immunoglobulin administration (2 weeks to 9 months), and in the testing of immunological parameters prior to vaccination.

Conclusion Our survey demonstrates a wide variation regarding the timing of live-attenuated vaccines after autologous HSCT or after immunoglobulin administration and regarding immunization against encapsulated bacteria. Many centers do not adhere to current recommendations. Studies should focus on a detailed analysis of the epidemiology of infections with encapsulated bacteria after pediatric autologous HSCT as well as on the immune recovery and the response to revaccination in this setting.
Risk of cancer in 10 – 19 mm endoscopically detected colorectal lesions
Authors: Parsa Nasim , Ponugoti Prasanna , Broadley Heather , Garcia Jonathan , Rex Douglas K.
Published: January 2019

Background Recent data indicate that the risk of cancer in colorectal lesions < 10 mm is lower than previously reported, possibly reflecting improved detection of flat, low-volume lesions with a low risk of cancer. Few studies have examined the prevalence of cancer in colorectal lesions 10 – 19 mm in size.

Methods We reviewed a prospectively collected database of all colorectal lesions removed at a single endoscopy center in order to identify lesions of 10 – 19 mm in size and review their histology. Lesions ≥ 20 mm were evaluated as a control group. We reviewed photographs of cancerous lesions to determine the frequency of endoscopic features of cancer.

Results A total of 5093 lesions ≥ 10 mm were removed from 4020 patients (mean age 63.2 years, 34.4 % female). Among 3068 lesions 10 – 19 mm in size, 28 (0.9 %) had adenocarcinoma, including 1.2 % of conventional adenomas and 0.3 % of serrated class lesions. These rates were lower than the 6.9 % and 2.0 % rates of cancer found in conventional adenomatous lesions and serrated lesions ≥ 20 mm, respectively. Cancer was suggested by endoscopic features in 52.0 % of malignancies 10 – 19 mm in size compared with 79.2 % of lesions ≥ 20 mm.

Conclusions The prevalence of cancer in 10 – 19 mm colorectal lesions was much lower than previously reported. The cancer risk was higher in conventional adenomas than in serrated lesions. Cancer was endoscopically evident prior to resection in slightly more than half of colorectal lesions 10 – 19 mm in size.
Polyp detection with computer-aided diagnosis in white light colonoscopy: comparison of three different methods
Authors: Figueiredo Pedro , Figueiredo Isabel , Pinto Luís , Kumar Sunil , Tsai Yen-Hsi , Mamonov Alexander
Published: January 2019

Background and study aims Detection of polyps during colonoscopy is essential for screening colorectal cancer and computer-aided-diagnosis (CAD) could be helpful for this objective. The goal of this study was to assess the efficacy of CAD in detection of polyps in video colonoscopy by using three methods we have proposed and applied for diagnosis of polyps in wireless capsule colonoscopy.

Patients and methods Forty-two patients were included in the study, each one bearing one polyp. A dataset was generated with a total of 1680 polyp instances and 1360 frames of normal mucosa. We used three methods, that are all binary classifiers, labelling a frame as either containing a polyp or not. Two of the methods (Methods 1 and 2) are threshold-based and address the problem of polyp detection (i. e. separation between normal mucosa frames and polyp frames) and the problem of polyp localization (i. e. the ability to locate the polyp in a frame). The third method (Method 3) belongs to the class of machine learning methods and only addresses the polyp detection problem. The mathematical techniques underlying these three methods rely on appropriate fusion of information about the shape, color and texture content of the objects presented in the medical images.

Results Regarding polyp localization, the best method is Method 1 with a sensitivity of 71.8 %. Comparing the performance of the three methods in the detection of polyps, independently of the precision in the location of the lesions, Method 3 stands out, achieving a sensitivity of 99.7 %, an accuracy of 91.1 %, and a specificity of 84.9 %.

Conclusion CAD, using the three studied methods, showed good accuracy in the detection of polyps with white light colonoscopy.
Study of DNA-Binding Activity and Antibacterial Effect of Escitalopram Oxalate, an Extensively Prescribed Antidepressant
Authors: Valipour Reza , Yilmaz Mehmet Bertan , Valipour Ebrahim
Published: January 2019

Escitalopram oxalate (EO) is considered as one of the extensively prescribed antidepressant drug in Turkey and some other countries, therefore this research was aimed to study the interaction of the drug with DNA and study of the substance effect on bacterial growth. The absorption value of the drug solution at 238 nm was increased when DNA was added gradually to it and it showed hyperchromism effect. The value obtained for DNA binding constant (Kb) was 0.035 M
−1. When we added the CuCl2 2H2O to the mixture, any breakage was not shown in double strand DNA in comparison with control DNA. In addition low concentration of EO couldn’t protect DNA (0.5273 µmole bp) against Hydroxyl free radical (0.12 µmole) although it could protect the DNA when it was at the same or higher concentrations (0.5273, 5.273 and 252.73 µmole) than the DNA concentration. In addition, MIC of the drug for E.coli and Bacillus subtilis was almost 0.185 mM and 0.55 mM respectively. The E.coli strain was killed at concentrations 45, 15, 5 mM while the Bacillus subtilis was stable against all of the concentrations.
Arzneimittelsicherheit in und durch
Notaufnahmen
Authors: Ittner Karl Peter , Koeniger Ruth , Dormann Harald , Zimmermann Markus
Published: January 2019

Der individuelle Erfolg einer Arzneimitteltherapiesicherheit (AMTS) in der
Notaufnahme (NA) beruht auf der differenzierten Abstimmung von Pharmaka auf die
besondere Situation des Notfallpatienten. In der folgenden Übersichtsarbeit wird
an Fallbeispielen herausgearbeitet, welche Risiken bei der Indikationsstellung,
Applikation und Dosierung auftreten können. Die derzeitigen Systemprobleme für
eine sichere Notaufnahme-AMTS sind: keine EDV-basierte AMTS, nicht in allen
Notaufnahmen aktuelle EDV-Literaturdatenbanken und keine Einweisung analog MPG
(Medizinproduktegesetz)/kein Training in Notfallpharmakologie.
Weisheitseinstellungen und Lebensbewältigung bei psychosomatischen Patienten
Authors: Linden Michael , Lieberei Barbara , Noack Nils
Published: January 2019

Abstrakt Einleitung Weisheit ist eine menschliche Fähigkeit zur Bewältigung schwieriger Lebensprobleme, bzw. eine spezielle Art von Problemlösefähigkeit und damit eine wichtige Ressource in der Alltagsbewältigung. Sie findet in der psychologischen Forschung und auch der klinischen Praxis zunehmende Beachtung. Ziel der vorliegenden Studie ist die Untersuchung der Verteilung und Korrelationen von Weisheitseinstellungen bei psychosomatischen Patienten unter Anwendung der neu entwickelten 12-WD-Skala.

Material und Methoden Mit der 12-WD-Skala werden 12 Dimensionen der Weisheit erfasst. Diese Skala wurde bei 202 unausgelesenen stationären Patienten einer psychosomatischen Rehabilitationsklinik als Teil der Routine-Eingangsuntersuchung eingesetzt. Es standen zusätzlich Daten aus der Basisdokumentation zu Verfügung. Zusätzlich füllten die Patienten die Differentielle Lebensbelastungsskala (DLB), die Allgemeine Gerechtigkeitsskala (GWAL) und eine Verbitterungs-Skala (PTED-Skala) aus. Aus der Basisdokumentation konnten soziodemografische und klinische Daten hinzugezogen werden.

Ergebnisse Die Verteilung des globalen Weisheitsscores entspricht annähernd einer Normalverteilung. Der Mittelwert liegt mit M=4,50 (SD=0,71) im positiven Bereich. Eine Faktorenanalyse ergab 3 Faktoren, die als „Nüchternheit und Realitätssinn“, „Gelassenheit“ und „Selbstbescheidung“ bezeichnet werden können und insgesamt 53,7% der Gesamtvarianz erklärten. Es fanden sich positive Korrelationen des Weisheitsscores mit der allgemeinen Lebenszufriedenheit und dem Alter, negative mit Gerechtigkeitsansprüchen und Verbitterung, jedoch keine mit dem Bildungsgrad.

Diskussion Die Ergebnisse zeigen, dass die Patienten im Durchschnitt Weisheitseinstellungen eher bejahen. Eine höhere Zustimmung ist mit einer besseren Lebensbewältigung assoziiert. Weisheitskompetenzen bieten einen interessanten Ansatz in der psychotherapeutischen Behandlung von Menschen in schwierigen Lebenssituationen, wie dies typischerweise für psychosomatische Patienten gilt. Die 12-WD-Skala kann hierfür hilfreiche Informationen liefern.
Long-Term Treatment with Empagliflozin Attenuates Renal Damage in
Obese Zucker Rat
Authors: Manne Nandini D. P. K. , Ginjupalli Gautam Kumar , Rice Kevin M. , Arvapalli Ravikumar , Graffeo Vincent A. , Bandarupalli Venkata V. K. , Blough Eric R.
Published: January 2019

Introduction Empagliflozin, a known inhibitor of sodium-glucose
cotransporter type 2 (SGLT2) decreases glucose reabsorption by the renal tubules
and promotes glucose excretion into the urine. While the effectiveness of
Empagliflozin in the management of hyperglycemia along with associated
cardiovascular and all-cause mortality has been demonstrated previously, the
therapeutic benefits associated with the long-term use of this drug in obese
animals have yet to be investigated.

Methods Male 5-week-old lean and obese Zucker rats were randomly assigned
to one of the 4 groups- lean control, lean treated, obese control, obese treated
and treated with either Empagliflozin (10 mg/kg BW /
day) or placebo for 25 weeks to investigate the therapeutic effect of
Empagliflozin.

Results Empagliflozin treatment in the obese animals was associated with
decreased body weight, attenuated the loss of F-actin from the renal tubules and
improved renal structure and function. These changes in renal function were
associated with significant improvements in the glucose tolerance, and decreased
non-fasting circulatory levels of glucose, amylase, and other inflammatory
markers including NGAL, cystatin C, and clusterin.

Conclusion Long-term use of Empagliflozin in diabetic obese Zucker rats
is associated with improvements in glucose tolerance and decreased loss of renal
structure and function.
Hauptsymptome und Elternerwartung bei Adenotomie und
Adenotonsillotomie im Vorschulalter
Authors: Stupp Franziska , Hoffmann Thomas Karl , Grossi Anna-Sophia , Sommer Fabian , Lindemann Jörg
Published: January 2019

Hintergrund Um eine realistische Aufklärung vor Adeno(tonsillo)tomie zu
leisten, wurden im Rahmen dieser Studie die kindliche Symptombelastung und die
elterliche Erwartung an den Operationserfolg prospektiv erfasst.

Material und Methoden Es wurden n = 111 Kinder (3–6 Jahre, ♂ 65 % ♀ 35 %)
rekrutiert, welche an der HNO-Universitätsklinik Ulm eine Adenotomie (AT 66 %)
oder Adenotonsillotomie (ATT 34 %) erhielten. In der fragebogenbasierten
Befragung wurden die häufigsten Symptome und der Hauptgrund zur Operation aus
Elternsicht erfasst (Operationstag, follow-up: 3,5 Mo.) und in Balkendiagrammen
jeweils für Gesamtkollektiv und die Operationsgruppen AT und ATT visualisiert
(Signifikanzniveau auf α = 5 %).

Ergebnisse Am häufigsten wurden von den Eltern Zeichen einer
Atemproblematik (Mundatmung 87 %, Nasenatmungsbehinderung 86 %, Schnarchen 78
%), Hörminderung (68 %) und vermehrter Infektneigung (66 %) beobachtet. Als
Hauptgrund zur Operation wurden Nasenatmungsbehinderung (77,5 %) und
Hörminderung (53,2 %) genannt. Bei reiner Rachenmandelhyperplasie dominierten
Hörprobleme, während bei zusätzlich indizierter Tonsillotomie nächtlichen Apnoen
als Operationsgrund am häufigsten genannt wurden. Bei allen abgefragten
Symptomen konnte postoperativ eine wesentliche Verbesserung erzielt werden.

Schlussfolgerungen Bei differenzierter Indikationsstellung ist es möglich,
die Eltern über eine sehr gute und realistisch zu erwartende, effektive
Symptomreduktion nach AT und ATT zu informieren.
Entstehung eines hepatozellulären Karzinoms in einem inflammatorischen Adenom mit β-Catenin-Mutation bei einem Patienten mit hepatozellulärer Adenomatose und HNF1α-Keimbahnmutation
Authors: Ridder Dirk , Duret Diane , Wörns Marcus-Alexander , Schotten Sebastian , Heinrich Stefan , Kloth Michael , Springer Erik , Roth Wilfried , Straub Beate
Published: January 2019

Mutationen des hepatocyte nuclear factor 1 α-(HNF1α) Gens lösen einen MODY3-Diabetes aus und sind mit einer hepatozellulären Adenomatose assoziiert. Eine maligne Transformation von HNF1α-mutierten hepatozellulären Adenomen ist selten. Wir beschreiben hier den Fall eines 28-jährigen Mannes mit heterozygoter HNF1α-Keimbahnmutation mit MODY3-Diabetes und einer hepatozellulären Adenomatose mit multiplen, HNF1α-inaktivierten Adenomen, der ein inflammatorisches Adenom mit β-Catenin-Mutation mit maligner Transformation in ein gut differenziertes hepatozelluläres Karzinom (HCC) entwickelte.
Die Kriteriumsvalidität der 15-Item Geriatrischen Depressionsskala in der österreichischen Bevölkerung
Authors: Baumgartner Josef , Jahn Rebecca , Friedrich Fabian , Alexandrowicz Rainer , Wancata Johannes
Published: January 2019

Ziel der Studie Bisher liegen keine Studien zur Kriteriumsvalidität der GDS-15 in der deutschsprachigen Allgemeinbevölkerung vor.

Methodik Bei 504 Personen wurde die GDS-15 den psychiatrischen ICD-Diagnosen basierend auf einem SCAN-Interview gegenübergestellt.

Ergebnisse Die Diskrimination über alle Cut-offs betrug 0,851 (Receiver Operating Characteristics). Bei einem Cut-off von 2/3 fanden wir eine Sensitivität von 71,8 % und eine Spezifität von 82,4 %.

Schlussfolgerung Die GDS-15 zeigt eine zufriedenstellende Kriteriumsvalidität für beide Geschlechter und verschiedene Altersgruppen.
Natural Product Triterpenoids and Their Semi-Synthetic Derivatives with Potential Anticancer Activity
Authors: Ren Yulin , Kinghorn A. Douglas
Published: January 2019

Triterpenoids are distributed widely in higher plants and are of interest because of their structural diversity and broad range of bioactivities. In particular, there is a very large literature on the propensity of a variety of triterpenoids to act as potential anticancer agents. In the present review, the anticancer potential is summarized for naturally occurring triterpenoids and their semi-synthetic derivatives, including examples of lupane-, oleanane-, ursane-, and cucurbitane-type pentacyclic triterpenoids, along with dammarane-type tetracyclic triterpenes including ginsenosides and their sapogenins and dichapetalins, which have been characterized as antitumor leads from higher plants. Preliminary structure-activity relationships and reported mechanisms of the antineoplastic-related activity are included. Prior studies for triterpenoids of plant origin are supportive of additional work being conducted on the more detailed biological and mechanistic evaluation for the progression of this type of natural products as possible cancer chemotherapeutic agents.
Diagnosis and Management of Congenital Perilymph Fistula causing Recurrent Meningitis: A Review
Authors: Rupa Vedantam
Published: January 2019

Background Congenital perilymph fistula is a rare cause of recurrent meningitis and should be suspected in any child who has had more than one episode of meningitis.

Aim To define the entity of congenital perilymph fistula causing recurrent meningitis and review the literature on the subject.

Methods A search was made in the PubMed database for all articles using the MeSH search terms “congenital perilymph fistula” AND “recurrent meningitis” AND “congenital perilymph fistula” AND “meningitis.”

Results A total of 48 articles were obtained, of which only the relevant articles were reviewed. Diagnosis of this condition is based on typical radiological features seen on high-resolution CT scan or thin slice MRI scan of the temporal bone. A variety of congenital inner anomalies with typical radiological features may be associated with this condition. Clinical features are not diagnostic and delayed diagnosis may occur due to a low index of suspicion. All children should undergo otomicroscopic and audiological assessment too, as radiology may rarely be noncontributory. Surgical closure of these fistulae using a tympanotomy approach is successful in most patients.

Conclusion Congenital perilymph fistula causing recurrent meningitis is a rare entity whose diagnosis is dependent on a high index of suspicion and appropriate radiological assessment. Surgical closure of the fistula prevents further episodes of meningitis.
Cochlear Implant Surgical Technique: Our Experience
Authors: Kirtane Milind , Chavan Kashmira
Published: January 2019

Introduction Different surgical approaches have been adopted for cochlear implantation, with cortical mastoidectomy–posterior tympanotomy being the most commonly followed technique.

Method In this article, we describe the surgical technique for cochlear implant followed at our center, which has been successfully implemented in more than 2,500 cochlear implant surgeries. Cochlear implant surgery using the cortical mastoidectomy–posterior tympanotomy technique has been performed in more than 2,500 cases with some modifications to the original technique over a period of time.

Results In spite of not using tie-down holes and securing down the receiver–stimulator with sutures, no cases of receiver–stimulator displacement or outward electrode migration have been noted with the current technique of creating a snug-fitting subperiosteal pocket along with a hook for the electrode array.

Conclusion Adhering to a strict intraoperative surgical protocol plays an extremely important role in carrying out successful cochlear implant surgeries with minimal complications.
Synthesis of Chlorinated Arenes and Hetarenes by One-Pot Cyclizations of 1,3-Bis-silyl Enol Ethers
Authors: Langer Peter , Hassan Zahid
Published: January 2019

This account describes our recent findings and progress in synthesizing chlorinated arenes and hetarenes by one-pot cyclizations of 1,3-bis-silyl enol ether derivatives. These reactions allow for the preparation of highly functionalized products with a high level of regioselectivity. The synthetic routes are cost-effective avoiding additional functionalization steps. The products are difficult to be accessed by other methods. The chlorine atom is of relevance in medicinal and agriculture chemistry. In addition, it allows further functionalizations by transition-metal-catalyzed cross-coupling reactions.

1 Introduction

2 Cyclizations of 2-Chloro-1,3-bis(silyloxy)-1,3-butadienes

2.1 3,5-Dihydroxychlorophthalates

2.2 2,4-Dihydroxy-homochlorophthalates

2.3 2-(Arylsulfonyl)chloropyridines

2.4 1-Azaxanthones

3 Cyclizations of 4-Chloro-1,3-bis(trimethylsilyloxy)-1,3-butadienes

3.1 3-Chlorosalicylates

3.2 Functionalized Chlorobiaryls

3.3 3-Chloro-5-(2-chloroethyl)-salicylates

3.4 2,4-Dihydroxychlorobenzophenones

4 Cyclizations of 2-Chloro-3-(silyloxy)-2-en-1-ones

4.1 Functionalized Chlorophenols

4.2 Functionalized Chlorinated Biaryls and Chlorofluorenones

4.3 Functionalized Chlorochromenones

4.4 Functionalized 3-(Methylthio)chlorophenols

4.5 Functionalized 3-Chloromethylphenols

5 Conclusions

6 List of Abbreviations
Synthesis of 2-Azidomethyl-5-ethynylfuran: A New Bio-Derived Self-Clickable Building Block
Authors: Karlinskii Bogdan , Romashov Leonid , Galkin Konstantin , Kislitsyn Pavel , Ananikov Valentine
Published: January 2019

2-Azidomethyl-5-ethynylfuran, a new ambivalent compound with both azide and alkyne moieties that can be used as a self-clickable monomer, is synthesized starting directly from renewable biomass. The reactivity of the azide group linked to furfural is tested via the efficient preparation of a broad range of furfural-containing triazoles in good to excellent yields using a ‘green’ copper(I)-catalyzed azide–alkyne cycloaddition procedure. Access to new bio-based chemicals and oligomeric materials via a click-chemistry approach is also demonstrated using this bio-derived building block.
Annulations of 5-Phenylthiobutenolides and First Synthesis of (±)-Indanostatin
Authors: Wang Shuai , Kraus George
Published: January 2019

The first synthesis of indanostatin was achieved in 6 steps. Key steps included a butenolide annulation, oxidation to an indanetrione, and reaction with acetone.
Self-Immolative Prodrugs: Effective Tools for the Controlled Release of Sulfur Signaling Species
Authors: Matson John , Dillon Kearsley , Powell Chadwick
Published: January 2019

H2S, persulfides (R–SSH), and related sulfur species have recently received attention due to the pronounced physiological effects they elicit. Delivering sulfur signaling molecules in a controlled manner presents many challenges, as many available donors have short half-lives, lack water solubility, and exhibit poor trigger specificity. Self-immolative prodrugs provide a unique ability to impart stability to H2S precursors and persulfides while allowing for trigger specificity by tuning the functional group installed on the self-immolative linker. This strategy has proven successful in delivering sulfur signaling species under specific conditions and may lead to the further elucidation of persulfide interactions within biological systems, affording effective therapeutics.

1 Introduction

2 Currently Available Persulfide Donors

3 BDP-NAC: An ROS-Responsive Persulfide Prodrug

4 Conclusion
Copper(I)- and Mesoionic-Hydroxyamide-Catalyzed Chemoselective Aerobic Oxidation of Primary Benzylic Alcohols
Authors: Matsukawa Yuta , Hirashita Tsunehisa
Published: January 2019

A new aerobic oxidation system consisting of Cu(I)I, 2,2'-bipyridine, N-methyl imidazole, and a mesoionic hydroxyamide was developed, with which selective oxidation of a broad range of benzylic alcohols was achieved.
Molecular-Iodine-Promoted Synthesis of Dihydrobenzofuran-3,3-dicarbonitriles through a Novel Rearrangement
Authors: Medishetti Nagaraju , Kale Ashok , Nanubolu Jagadeesh , Atmakur Krishnaiah
Published: January 2019

The title compounds were synthesized from 5,5-dimethyl­cyclohexane-1,3-dione, benzaldehyde, and malononitrile promoted by molecular iodine in basic medium via 2-amino-7,7-dimethyl-5-oxo-4-phenyl-5,6,7,8-tetrahydro-4H-chromene-3-carbonitrile, by a novel protocol. The protocol involves a novel rearrangement in which the 4H-chromene fragment dissociates to a cyclopropane moiety and rearranges to the five-membered compound 6,6-dimethyl-4-oxo-2-phenyl-4,5,6,7-tetrahydrobenzofuran-3,3(2H)-dicarbonitrile. Simple reaction conditions, excellent yields, and high compatibility are the advantages of this protocol.
Alkyne-Forming Furan Fragmentation: A General Method to Convert Furans into Alkynoic Acids
Authors: Gui Jinghan , Deng Jiachen
Published: January 2019

Furans are readily available and highly reactive heterocycles that serve as versatile four-carbon synthons in organic synthesis. Recently, we discovered that furans, upon oxidation with singlet oxygen, can be transformed into alkynes via dual C–C double-bond cleavage. This Synpacts article presents an overview of the historical context and the development of this furan fragmentation reaction. We also discuss its application in natural product synthesis and a plausible reaction mechanism.

1 Introduction

2 Background of Alkyne-Forming Furan Fragmentation

3 Reaction Development

4 Conclusion
Thiolate-Initiated Synthesis of Dibenzothiophenes from 2,2′-Bis(methylthio)-1,1′-Biaryl Derivatives through Cleavage of Two Carbon–Sulfur Bonds
Authors: Masuya Yoshihiro , Kawashima Yuki , Kodama Takuya , Chatani Naoto , Tobisu Mamoru
Published: January 2019

A catalytic reaction involving the cleavage of two carbon–sulfur bonds in 2,2′-bis(methylthio)-1,1′-biaryl derivatives is reported. This reaction does not require a transition-metal catalyst and is promoted by a thiolate anion. Notably, based on DFT calculations, the product-forming cyclization step is shown to proceed through a concerted nucleophilic aromatic substitution (CSNAr) mechanism.
An Improved Synthesis of Balsaminone A
Authors: Daley Sharna-kay , Downer-Riley Nadale
Published: January 2019

A short and efficient synthesis of balsaminone A, a dinaphthofuran-1,4-dione, is described. The eight-step synthesis features two alternate pathways including a base-induced coupling reaction of 4-methoxy-1-naphthol and 2,3-dichloro-1,4-naphthoquinone, as well as a light-mediated cyclization of 1,1'-binaphthoquinone to afford the dinaphthofurandione core. Subsequent ortho formylation yielded a known precursor to balsaminone A, affording the natural product in 20–27% yield. This represents a moderate increase from the previous synthesis of 7.4% yield.
Quantitative Radiographic Evaluation of Elbow Incongruity in Labrador and Golden Retrievers with Confirmed Medial Coronoid Disease
Authors: Mostafa Ayman , Nolte Ingo , Wefstaedt Patrick
Published: January 2019

Objectives The purpose of this study was to objectively estimate humeroradial (HR), humeroulnar (HU) and radioulnar (RU) congruity on mediolateral elbow radiographs of Labrador and Golden Retrievers without and with medial coronoid disease (MCD), and to determine the correlation between traditional and modified RU-step assessment techniques.

Materials and Methods Extended mediolateral elbow radiographs of Labrador and Golden Retrievers without MCD (control group) and with confirmed MCD (diseased group) were investigated. Absolute and average HR and HU distances were determined and standardized by the radius of the corresponding humeral condyle. Traditional RU-step was measured, and a modified procedure of RU-step assessment was generated. The correlation between the two RU-step assessment procedures was tested.

Results A total of 131 (197 elbows) Labrador and Golden Retrievers met the criteria for inclusion in the control and diseased groups. The normalized HR and HU distances increased significantly (p ≤ 0.002) in dogs with MCD. There was a significant increase (p < 0.0001) in the traditional and modified RU-step in dogs with MCD. A significant correlation (r
s = 0.74, p < 0.0001) was identified between traditional and modified RU-step calculated for control and diseased elbows.

Clinical Relevance Dogs with confirmed MCD had quantitative radiographic evidences of elbow incongruity. Modified RU-step procedure may be an alternative to the traditional technique and can be utilized during routine quantification of HR and HU congruity. Validation of the reported measurements is, however, warranted.
Statewide Clinic Registries: The Michigan Surgical Quality Collaborative
Authors: Regenbogen Scott , Nikolian Vahagn
Published: January 2019

Regional clinical registries provide a unique opportunity for shared learning and population-based analyses of the quality of surgical care. Through the “Michigan Model” of pay for participation in strategic Value Partnerships, exemplified by the Michigan Surgical Quality Collaborative (MSQC), the state's dominant private insurer, Blue Cross Blue Shield of Michigan, has sponsored 20 statewide clinical quality improvement collaboratives. MSQC represents a partnership among 73 Michigan hospitals with a robust data infrastructure and flexible platform for the promulgation of best practices in surgical quality improvement. This article will describe the organizational structure of the MSQC, the contributions the registry has made to quality improvement in colorectal surgery, and how future work will align to improve the reliability of improvement-relevant registry data.
Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery
Authors: Stringfield Sarah , Holubar Stefan , Eisenstein Samuel
Published: January 2019

The American College of Surgeons' National Surgical Quality Improvement Project (ACS-NSQIP) is probably the most well-known surgical database in North American and worldwide. This clinical database was first proposed by Dr. Clifford Ko, a colorectal surgeon, to the ACS, and NSQIP first started collecting data ca. 2005 with the intent of comparing hospitals (benchmarking) and for hospital-level quality improvement projects. Since then, its popularity has grown from just a few participating hospitals in the United States to more than 708 participating hospitals worldwide, and collaboration allows regional or disease-specific data sharing. Importantly, from a methodological perspective, as the number of hospitals has grown so has the hospital heterogeneity and thus generalizability of the results and conclusions of the individual studies. In this article, we will first briefly present the structure of the database (aka the Participant User File) and other important methodological considerations specific to performing clinical research. We will then briefly review and summarize the approximately 60 published colectomy articles and 30 published articles on proctectomy. We will conclude with future directions relevant to colorectal clinical research.
Copper Bead Therapy in Severe Bone Infection: A Rabbit Tibial Model
Authors: Vlase Ene , Barbuceanu Florica , Turcu Danut , Coman Mariana , Badulescu Marius , Oporanu Mariana , Coman Cristin , Surdu-Bob Carmen
Published: January 2019

Objective We investigated the benefits of a local preventive therapy based on copper beads against severe bone infection using a rabbit open tibial fracture model.

Materials and Methods Cotton mesh balls soaked in a very high concentration of Staphylococcus aureus ATCC 6538 culture were inoculated in drilled holes of the tibiae of treated and control groups. The treated group was also implanted with small copper beads simultaneously, as prevention therapy.

Results Survival rate in the treated group was 67% compared with 25% in the control group (difference 40%, for a 95% confidence interval: 40%, 93.4%). The few remaining animals in the control group had bone lesions which developed into osteomyelitis, while the tibiae of treated group had clear signs of reparatory processes. Sixty days after inoculation, signs of local-only toxicity were observed in healthy tibia of a separate non-infected control group. Drawbacks of copper toxicity were weighed against the threat of septicaemia and also against prolonged use of powerful systemic antibiotic medications in severe bone contamination.

Cinical Significance It was found that the proposed therapy prevented septicaemia and the spread of infection, and it also induced reparatory processes. The findings of this study may be relevant in antisepsis of open fractures in less appropriate medical settings (such as military camps or remote locations), as well as in severe bone infections.
Effects of Hole Diameter on Torsional Mechanical Properties of the Rabbit Femur
Authors: Massie Anna , Garcia Tanya , Guzman David , Chou Po-Yen , Stover Susan , Kapatkin Amy
Published: January 2019

Objective The aim of this study was to evaluate and compare the effect of three clinically applicable screw hole diameters on rabbit femoral torsional structural properties.

Sample Eighteen pairs of skeletally mature New Zealand White rabbit femora (36 bones).

Materials and Methods Femora with a bicortical hole at mid-diaphysis from one of the 3-drill bit sizes, 1.1 mm, 1.5 mm, 2.0 mm, and intact bones were studied. Each bone was bi-axially loaded in a servo-hydraulic load frame with the bone positioned so the neutral axis of torsion was aligned with the centre of the bone diaphysis. Axial compression to 35% body weight was applied to represent compression at stance, and rapid external torsion was applied to failure. Torque and angular deformation data were plotted for each test, with pre-yield and post-yield stiffnesses derived. Yield and failure torques and angles were determined, along with calculated yield, failure and post-yield energies.

Results Failure torque was reduced compared with that of intact bone; weakened by 37% in 1.1-mm hole models, 53% in 1.5-mm hole models and 65% in 2.0-mm hole models. The torque angular deformation curves lacked plastic deformation.

Conclusions and Clinical Relevance This study demonstrates the unique, brittle biomechanics of rabbit bone. Based on data from other species that strength loss of no more than 50% is acceptable when placing orthopaedic implants, no defect greater than 1.1 mm (15% bone diameter) is recommended in rabbit femora.
Biomechanical Comparison of Two Locking Plate Constructs Under Cyclic Loading in Four-Point Bending in a Fracture Gap Model: Two Screws versus Three Screws Per Fragment
Authors: Palierne Sophie , Froidefond Baptiste , Swider Pascal , Autefage André
Published: January 2019

Objectives The number of locking screws required per fragment during bridging osteosynthesis has not been fully determined in the dog. The purpose of this study was to assess the survival of two constructs, with either two or three screws per fragment, under cyclic bending.

Methods A 10-hole, 3.5-mm stainless steel locking compression plate was fixed 1 mm away from a bone surrogate in which the fracture gap was 47 mm. Two groups of 10 constructs, prepared with either two or three bicortical locking screws placed at the extremities of each fragment, were tested in a load-controlled 4-point bending test (range 0.7 to + 7 Nm) until failure.

Results The 3-screw constructs were stiffer than the 2-screw constructs (19.73 ± 0.68 N/mm vs. 15.52 ± 0.51 N/mm respectively) and the interfragmentary relative displacements were higher for the 2-screw constructs (11.17 ± 0.88%) than for the 3-screw constructs (8.00 ± 0.45%). The difference between the number of cycles to failure for the 3-screw constructs (162,448 ± 30,073 cycles) and the 2-screw constructs (143,786 ± 10,103 cycles) was not significant. Failure in all constructs was due to plate fracture at the level of the compression holes.

Clinical Significance Omission of the third innermost locking screw during bridging osteosynthesis subjected to bending forces led to a 20% reduction in construct stiffness and increased relative displacement (+39.6%) but did not change fatigue life.
Prospective Evaluation of Surgical Wound Dressings and the Incidence of Surgical Site Infections in Dogs Undergoing a Tibial Plateau Levelling Osteotomy
Authors: Aktay Sevima , Giannetto Jessica
Published: January 2019

Objective The main aim of this study was to evaluate the efficacy of a topical 2-octyl cyanoacrylate (2OC) tissue adhesive and an adhesive barrier dressing (BD) in minimizing the incidence of surgical site infections (SSI) in dogs undergoing a tibial plateau levelling osteotomy (TPLO).

Materials and Methods In a prospective clinical study, 437 client-owned dogs undergoing a TPLO as treatment for cranial cruciate ligament disease with or without concurrent patellar luxations from July 2015 to September 2016 were included. In each dog, the type of postoperative wound dressing was randomly selected as either no dressing (ND), a 2OC tissue adhesive or an adhesive BD. Direct examination by a veterinarian was performed at 14, 30, 60 and 90 days postoperatively. If dogs did not return for direct examination, owners were contacted with a questionnaire for the final follow-up of at least 90 days.

Results The overall rate of SSI was 2.3% (10/437). Methicillin-resistant Staphylococcus pseudintermedius was the most common bacteria isolated in 9/10 cases. Infection was confirmed in 2.76% (4/145) of dogs with ND, 2.01% (3/149) of dogs with 2OC and 2.10% (3/143) of dogs with BD. Of the dogs that developed an SSI, type of dressing was not a significant risk factor (p = 0.5305) for infection. Increasing body weight was the only significant risk factor that increased the risk of overall infection (odds ratio = 1.03 [95% confidence interval: 1.02–1.05]).

Clinical Significance In dogs undergoing a TPLO, there may be no clear benefit in the usage of postoperative wound dressings for the prevention of SSI. Increasing body weight was the only significant factor associated with the development of an SSI.
Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment
Authors: Kheir Fayez , Majid Adnan
Published: January 2019

Excessive central airway collapse (ECAC) is characterized by excessive narrowing of the airway lumen during exhalation leading to dyspnea, cough, mucostasis, recurrent respiratory infections, and poor quality of life. Tracheobronchomalacia and excessive dynamic airway collapse are heterogeneous entities of ECAC and are characterized by a diverse nonspecific symptom profile. Although the pathophysiology of airway mechanics as well as morphology in both entities is different, current evidence so far shows no practical benefit in making such distinction since both have similar symptoms and the diagnostic and therapeutic work-ups are the same. The diagnosis of ECAC should be based on dynamic flexible bronchoscopy and/or dynamic computed tomography scan as well as clinical symptoms that are not fully explained by other lung diseases. Initial treatment of symptomatic ECAC includes treatment of coexisting conditions (such as chronic obstructive pulmonary disease, asthma, gastroesophageal reflux disease, and vocal cord dysfunction) and supportive treatment of dynamic central airway collapse (antibiotics for respiratory infections, aggressive therapy, pulmonary physiotherapy, pulmonary rehabilitation, and continuous positive airway pressure). A short-term stent trial in selected patients with severe symptomatic ECAC is needed to assess whether patients will have improvement in symptoms and thus identify patients who will benefit from surgical central airway stabilization. A multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population is essential for optimal outcomes.