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Peptoid Residues Create Varied, Hyperstable Bovine collagen Triple-Helices.
BACKGROUND & AIMS Many studies have suggested the feasibility and safety of early oral nutrition after gastrectomy; however, the tolerability of early oral nutrition has rarely been investigated. This study aimed to investigate the tolerability of early oral nutrition and factors affecting early oral nutrition failure after gastrectomy. METHODS We retrospectively reviewed 565 patients with gastric cancer who had undergone gastrectomy and who had received oral nutrition on postoperative day 1. Failure of early oral nutrition was defined as cessation of at least one meal for any reason. Preoperative clinical information and operative factors were analyzed concerning an association with early oral nutrition failure. RESULTS The tolerability of early oral nutrition after gastrectomy was 74.7%. Of 565 patients, 72 (12.7%) failed early oral nutrition due to adverse gastrointestinal symptoms, 52 (9.2%) failed due to gastric stasis or ileus, and 19 (3.4%) patients failed due to other postoperative complications. In the univariate analysis, age (≥70 years), male sex, preoperative tumor obstruction, remnant stomach cancer, open surgery, operating time (≥4 h), and an advanced preoperative stage were associated with failed early oral nutrition. Multivariable analysis of these factors revealed that male sex, preoperative tumor obstruction, operating time, and advanced preoperative stage were independent predictive factors for early oral nutrition failure after gastrectomy. CONCLUSIONS The tolerability of early oral nutrition after gastrectomy was comparable to that of other gastrointestinal surgeries. A tailored approach for postoperative oral nutrition is required based on identified risk factors for early oral nutrition failure. BACKGROUND Increased use of invasive coronary strategies in patients admitted to hospitals with on-site cardiac catheter laboratory (CCL) facilities has been reported, but the utilisation of invasive coronary strategies according to types of CCL facilities at the first admitting hospital and clinical outcomes is unknown. METHODS We included 452,216 patients admitted with a diagnosis of non-ST-segment-elevation myocardial infarction (NSTEMI) in England and Wales from 2007 to 2015. The admitting hospitals were categorized into no-laboratory, diagnostic, and PCI hospitals according to CCL facilities. Multilevel logistic regression models were used to study associations between CCL facilities and in-hospital outcomes. RESULTS A total of 97,777 (21.6%) of the patients were admitted to no-laboratory hospitals, and 134,381 (29.7%) and 220,058 (48.7%) were admitted to diagnostic and PCI hospitals, respectively. Use of coronary angiography was significantly higher in PCI hospitals (77.3%) than in diagnostic (63.2%) and no-laboratory (61.4%) hospitals. The adjusted odds of in-hospital mortality were similar for diagnostic (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.83-1.04) and PCI hospitals (OR 1.09, 95% CI 0.96-1.24) compared with no-laboratory hospitals. However, in high-risk NSTEMI subgroup (defined as Global Registry of Acute Coronary Events score > 140), an admission to diagnostic hospitals was associated with significantly increased in-hospital mortality (OR 1.36, 95% CI 1.06-1.75) compared with no-laboratory and PCI hospitals. CONCLUSIONS This study highlights important differences in both the utilisation of invasive coronary strategies and subsequent management and outcomes of NSTEMI patients according to admitting hospital CCL facilities. High-risk NSTEMI patients admitted to diagnostic hospitals had greater in-hospital mortality, possibly because of reduced PCI use, which needs to be addressed. BACKGROUND Vascular diseases, encompassing coronary heart disease (CHD), cerebrovascular disease (CVD), and peripheral artery disease (PAD), are leading causes of the global mortality and morbidity burdens. Our objective was to evaluate the temporal trends in the burden of vascular diseases in the province of Quebec from 2000 to 2015. METHODS We identified subjects aged ≥ 20 years with vascular diseases in the Quebec Integrated Chronic Disease Surveillance System (a combination of 5 provincial health administrative datasets). We identified Quebecers with CHD, CVD, or PAD by tracking codes identifying vascular diseases (and interventions for CHD) in the hospitalization datasets. We used the 2011 Quebec standard population for age standardization. RESULTS In 2015, the crude prevalence of vascular diseases was 7.3% (n = 473,305), and the all-cause crude mortality rate was 6.6% (n = 31,320). Age-standardized prevalence of vascular diseases increased relatively by 21.4% between 2000 (5.6%; 99% confidence interval [CI], 5.5-5.6) and 2015 (6.8%; 99% CI, 6.7-6.8), whereas the age-standardized incidence and mortality rates showed relative decreases of 46.2% and 32.6%, respectively. PAD and CVD had lower prevalence and incidence but higher mortality than CHD. Most patients with CHD only had this vascular disease in contrast to patients with PAD who generally had diseases involving more than 1 vascular bed. CHD only and CHD with PAD ranked first and second, respectively, in mortality burdens. CONCLUSIONS During the last decade, the age-standardized incidence and mortality rate of vascular diseases declined, but their prevalence increased with the overall burden of vascular diseases remaining substantial in Quebec, Canada. BACKGROUND Calyceal diverticula (CD) are abnormally dilated calyces caused by a narrowed infundibulum. Although rare, with incidence rates previously reported between 0.21% and 0.45%, CD pose diagnostic dilemmas in children as they mimic other cystic lesions of the kidney with different etiologies. Calyceal diverticula can become symptomatic if they become a locus for infections and stone formation, and the optimal treatment strategy is currently undefined. OBJECTIVE The aim of the study is to present a large series of consecutive cases of pediatric CD and investigate the authors' hypothesis that CDs are more common than previously reported, size of the lesion drives intervention, and laparoscopic ablation is the most effective intervention. STUDY DESIGN The authors conducted an observational case-control survey by reviewing all cases of pediatric CD through a prospectively maintained database of renal cystic lesions at their institution between 2012 and 2018. They analyzed the clinical and radiological presef ureteroscopic interventions required multiple sessions (11/17, 65%, median = 2 major procedures) to achieve resolution, whereas none in the laparoscopic group required a second procedure. There were a total of 30 ureteroscopic and 8 laparoscopic approaches. CONCLUSIONS The authors demonstrate that CD comprise at least 5% of cystic lesions and that CD size and pain at presentation predict intervention in 60% of children diagnosed at their institution. Laparoscopic ablation is the optimal treatment and has significantly higher success rates than the ureteroscopic approach. INTRODUCTION Ureteropelvic junction obstruction (UPJO) is one of the most common causes of hydronephrosis in pediatric populations. Many need surgical intervention. The aim of surgery is preserving renal function and reducing symptoms such as urinary tract infections and pain. OBJECTIVES The objectives were to evaluate differential renal function (DRF) in infants and children after surgery for UPJO and to identify factors predicting postoperative improvement. The difference in outcomes between patients with antenatal hydronephrosis and those diagnosed later was evaluated. STUDY DESIGN A total of 85 children (63 boys and 22 girls) aged 0-16 years, treated for UPJO with dismembered pyeloplasty, were followed up as per a structured protocol including ultrasounds and renal scans (MAG-3) pre-operatively and three and 18 months postoperatively. Selleckchem Semagacestat Five children with bilateral or single kidney UPJO were excluded. Patient records were retrospectively reviewed, and the patients were grouped as per prenatal (group 1, n = , and high APD (odds ratio [OR] = 1.1, P = 0.0023), antenatal diagnosis (OR = 0.23, P = 0.048), and low pre-operative DRF (OR = 0.90, P = 0.0045) built the best model of independent factors predicting improvement in DRF in multivariable analyses (Summary Figure). DISCUSSION The limitation of the study is that it is retrospective, but it has the advantage of a uniform follow-up protocol, including patients from a five-year period, with few lost to follow-up. The results can be of interest in evaluating factors of importance for predicting recovery of function in obstructive uropathies in children. CONCLUSION The majority of children had preserved or improved function after surgery for UPJO. Those with an antenatal diagnosis displayed a greater ability to catch up in DRF, and high APD, antenatal diagnosis, and low pre-operative DRF were independent predictive factors of an improvement in renal function after pyeloplasty. Cell-penetrating peptides (CPPs) are an attractive tool for delivering membrane-impermeable compounds, including anionic biomacromolecules such as DNA and RNA, into living cells. Amphipathic helical peptides composed of hydrophobic amino acids and cationic amino acids are typical CPPs. In the current study, we designed amphipathic helical 12-mer peptides containing α,α-disubstituted α-amino acids (dAAs), which are known to stabilize peptide secondary structures. The dominant secondary structures of peptides in aqueous solution differed according to the introduced dAAs. Peptides containing hydrophobic dAAs and adopting a helical structure exhibited a good cell-penetrating ability. As an application of amphipathic helical peptides, small interfering RNA (siRNA) delivery into living human hepatoma cells was investigated. One of the peptides containing dAAs dipropylglycine formed stable complexes with siRNA at appropriate zeta-potential and size for intracellular siRNA delivery. This peptide showed effective RNA interference efficiency at short peptide length and low concentrations of peptide and siRNA. These findings will be helpful for the design of amphipathic helical CPPs as intracellular siRNA delivery. A series of phthalide alkyl tertiary amine derivatives were designed, synthesized and evaluated as potential multi-target agents against Alzheimer's disease (AD). The results indicated that almost all the compounds displayed significant AChE inhibitory and selective activities. Besides, most of the derivatives exhibited increased self-induced Aβ1-42 aggregation inhibitory activity compared to the lead compound dl-NBP, and some compounds also exerted good antioxidant activity. Specifically, compound I-8 showed the highest inhibitory potency toward AChE (IC50 = 2.66 nM), which was significantly better than Donepezil (IC50 = 26.4 nM). Moreover, molecular docking studies revealed that compound I-8 could bind to both the catalytic active site and peripheral anionic site of AChE. Furthermore, compound I-8 displayed excellent BBB permeability in vitro. Importantly, the step-down passive avoidance test indicated that I-8 significantly reversed scopolamine-induced memory deficit in mice. Collectively, these results suggested that I-8 might be a potent and selective AChE inhibitor for further anti-AD drug development.
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