Cultural adaptation, validation and evaluation of the psychometric properties of Childbirth Experience Questionnaire version 2.0 in the Spanish context.

BACKGROUND: Several instruments have been designed to assess the childbirth experience. The Childbirth Experience Questionnaire (CEQ) is one of the most widely used tools. There is an improved version of this instrument, the Childbirth Experience Questionnaire (CEQ 2.0), which has not been adapted or validated for use in Spain. The aim of present study is to adapt the CEQ 2.0 to the Spanish context and evaluate its psychometric properties. METHODS: This research was carried out in 2 stages. In the first stage, a methodological study was carried out in which the instrument was translated and back-translated, content validity was assessed by 10 experts (by calculating Aiken's V coefficient) and face validity was assessed in a sample of 30 postpartum women. In the second stage, a cross-sectional study was carried out to evaluate construct validity by using confirmatory factor analysis, reliability evaluation (internal consistency and temporal stability) and validation by known groups. RESULTS: In Stage 1, a Spanish version of the CEQ 2.0 (CEQ-E 2.0) was obtained with adequate face and content validity, with Aiken V scores greater than 0.70 for all items. A final sample of 500 women participated in Stage 2 of the study. The fit values for the obtained four-domain model were RMSEA = 0.038 [95% CI: 0.038-0.042], CFI = 0.989 [95% CI: 0.984-0.991], and GFI = 0.990 [95% CI: 0.982-0.991]. The overall Omega and Cronbach's Alpha coefficients were 0.872 [95% CI: 0.850-0.891] and 0.870 [95% CI: 0.849-0.890] respectively. A coefficient of intraclass correlation of 0.824 [95% CI: 0.314-0.936] (p ≤ 0.001) and a concordance coefficient of 0.694 [95% CI: 0.523-0.811] were obtained. CONCLUSIONS: The Spanish version of CEQ 2.0 (CEQ-E 2.0), has adequate psychometric properties and is a valid, useful, and reliable instrument for assessing the childbirth experience in Spanish women.

Sub-Nanomolar Detection of Oligonucleotides Using Molecular Beacons Immobilized on Lightguiding Nanowires.

The detection of oligonucleotides is a central step in many biomedical investigations. The most commonly used methods for detecting oligonucleotides often require concentration and amplification before detection. Therefore, developing detection methods with a direct read-out would be beneficial. Although commonly used for the detection of amplified oligonucleotides, fluorescent molecular beacons have been proposed for such direct detection. However, the reported limits of detection using molecular beacons are relatively high, ranging from 100 nM to a few µM, primarily limited by the beacon fluorescence background. In this study, we enhanced the relative signal contrast between hybridized and non-hybridized states of the beacons by immobilizing them on lightguiding nanowires. Upon hybridization to a complementary oligonucleotide, the fluorescence from the surface-bound beacon becomes coupled in the lightguiding nanowire core and is re-emitted at the nanowire tip in a narrower cone of light compared with the standard 4π emission. Prior knowledge of the nanowire positions allows for the continuous monitoring of fluorescence signals from each nanowire, which effectively facilitates the discrimination of signals arising from hybridization events against background signals. This resulted in improved signal-to-background and signal-to-noise ratios, which allowed for the direct detection of oligonucleotides at a concentration as low as 0.1 nM.

Efficacy of Immediate Lymphatic Reconstruction to Decrease Incidence of Breast Cancer-related Lymphedema: Preliminary Results of Randomized Controlled Trial.

OBJECTIVE: To conduct a randomized controlled trial (RCT) on the efficacy of immediate lymphatic reconstruction (ILR) for decreasing the incidence of breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND). BACKGROUND: Despite encouraging results in small studies, an appropriately powered RCT on ILR has not been performed. METHODS: Women undergoing ALND for breast cancer were randomized in the operating room 1:1 to either ILR, if technically feasible, or no ILR (control). The ILR group underwent lymphatic anastomosis to a regional vein using microsurgical techniques; control group had no repair and cut lymphatics were ligated. Relative volume change (RVC), bioimpedance, quality of life (QoL), and compression use were evaluated at baseline and every 6 months postoperatively up to 24 months. Indocyanine green (ICG) lymphography was performed at baseline and 12 and 24 months postoperatively. The primary outcome was the incidence of BCRL, defined as ≥10% RVC from baseline in the affected extremity at 12-, 18-, or 24-month follow-up. RESULTS: Of 72 patients randomized to ILR and 72 to control from January 2020 to March 2023, our preliminary analysis includes 99 patients with 12-month follow-up, 70 with 18-month follow-up, and 40 with 24-month follow-up. The cumulative incidence of BCRL was 9.5% in the ILR group and 32% in the control group ( P =0.014). The ILR group had lower bioimpedance values, decreased compression usage, better lymphatic function on ICG lymphography, and better QoL than the control group. CONCLUSIONS: Preliminary results of our RCT show that ILR after ALND decreases BCRL incidence. Our goal is to finish the accrual of 174 patients with 24-month follow-up.

Factores de riesgo de las complicaciones del parto asociadas a adolescentes atendidas en un hospital paraestatal del Perú / Risk factors for complications of childbirth associated with adolescents treated at a Peruvian Public Hospital

El Objetivo fue identificar los factores de riesgo de las complicaciones del parto en adolescentes atendidas en el hospital Augusto Hernández Mendoza de Ica-Perú. Material y Métodos: Para el desarrollo se utilizó la metodología de tipo observacional, retrospectivo, transversal, analítico de nivel relacional. La muestra fue de tipo probabilístico 34 casos y 34 controles con partos atendidos en el hospital con la hipótesis de que algunos de los factores de riesgo están más vinculado a las complicaciones del parto en adolescentes. Resultados: Encontrando los siguientes resultados: El síndrome hipertensivo odds ratio (2,4), el desgarro vaginal odds ratio (2,1), la desproporción céfalo pélvica odds ratio (3,3) y la anemia no es un factor de riesgo ni de protección. Conclusiones: La preeclampsia, el desgarro vaginal y la desproporción céfalo pélvica son factores de riesgo; la anemia no es un factor de riesgo, para las complicaciones del parto en adolescentes. (AU)

The Objective was to identify the risk factors for childbirth complications in adolescents treated at the Augusto Hernández Mendoza Hospital in Ica-Peru. Material and Methods: For the development, the observational, retrospective, cross-sectional, analytical, relational level methodology was used. The sample was of a probabilistic type, 34 cases and 34 controls with deliveries attended in the hospital with the hypothesis that some of the risk factors are more linked to delivery complications in adolescents. Results:Finding the following results: Hypertensive syndrome odds ratio (2.4), vaginal tear odds ratio (2.1), cephalopelvic disproportion odds ratio (3.3) and anemia is not a risk factor or of protection. Conclusions: Preeclampsia, vaginal tear and cephalopelvic disproportion are risk factors; anemia is not a risk factor for complications of childbirth in adolescents. (AU)

Reactogenicity of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) against COVID-19 in workers of a tertiary hospital.

OBJECTIVE: To analyze the local and systemic reactions that appeared after the first and second dose of the BNT162b2 vaccine against COVID­19 (Pfizer- BioNTech) in a sample of workers from a tertiary hospital, and to identify the  factors related to greater vaccine reactogenicity. METHOD: A self-administered questionnaire was used to interview 291 workers  from a tertiary hospital who received the BNT162b2 vaccine against COVID-19  between January and March 2021. The questionnaire included questions about  the sociodemographic variables of the participants, previous COVID-19  infection, and local and systemic reactions after the first and second dose of  the vaccine. RESULTS: The most common adverse reaction was soreness at the injection site, which was reported more frequently after the first dose of the  vaccine. The systemic reactions evaluated were reported more frequently after the second dose of the vaccine. Women, younger adults, and  subjects with a prior COVID-19 infection reported increased reactogenicity. Furthermore, high reactogenicity after the first dose was found  to be related to a higher number of adverse reactions after the second dose of  the vaccine. CONCLUSIONS: The distribution of reactogenicity in the present study is consistent with the data reported in previous studies on the BNT162b2 vaccine, especially in terms of its association with the participants'  characteristics. These findings could facilitate the identification of people at a  higher risk of developing high reactogenicity to the vaccine, thereby making it  possible to anticipate the appearance of adverse reactions and plan for their  treatment.

OBJETIVO: Analizar las reacciones locales y sistémicas aparecidas tras la  primera y segunda dosis de la vacuna BNT162b2 (Pfizer-BioNTech) frente a  COVID-19 en una muestra de trabajadores de un hospital de tercer nivel, e  identificar los factores relacionados con una mayor reactogenicidad a la  vacuna.Método: Se empleó un cuestionario autoadministrado para entrevistar a 291  trabajadores de un hospital de tercer nivel que recibieron la vacuna BNT162b2  frente a COVID-19 entre enero y marzo de 2021. El cuestionario incluyó  preguntas acerca de las variables sociodemográficas de los participantes,  infección previa de COVID-19 y las reacciones locales y sistémicas tras la  primera y segunda dosis de la vacuna. RESULTADOS: La reacción más comúnmente informada fue el dolor en el lugar  de la inyección, siendo más frecuente tras la primera dosis de la vacuna. Las  reacciones sistémicas evaluadas se informaron con mayor frecuencia tras la  segunda dosis de la vacuna. Las mujeres, los adultos más jóvenes y las  personas con una infección previa por COVID-19 notificaron una mayor  reactogenicidad. Además, una alta reactogenicidad tras la primera dosis estuvo relacionada con un mayor número de reacciones adversas tras la segunda  dosis de la vacuna. CONCLUSIONES: La distribución de la reactogenicidad en el presente estudio es  consistente con los datos reportados en los estudios realizados  con la vacuna  BNT162b2, especialmente en términos de asociación con las características de  los participantes. Estos hallazgos pueden facilitar la identificación de personas  con mayor probabilidad de presentar una alta reactogenicidad a la vacuna,  permitiéndonos anticipar su aparición y tratamiento.

Self-reported adverse events within the seven days following the Spikevax® (Moderna) vaccination.

OBJECTIVE: Continuous monitoring of COVID-19 vaccines safety may provide  additional information to health care professionals and the general population.  The aim of the present study was to analyze the local and systemic adverse  events following the administration of the Spikevax® (Moderna) vaccine, and  to identify the factors related to greater reactogenicity. METHOD: Using a telephone survey, we interviewed 331 recipient of the  Spikevax® vaccine (50.2% men; Meanage = 46.4). Participants  haracteristics, prior COVID-19 infection and local and systemic adverse events  within seven days following the first and second vaccine doses were asked. Results: Injection site pain, fatigue and headache were the most common adverse events. The prevalence and intensity of local events was higher after the first dose, while systemic events were higher in the  second one. Most adverse events were mild/moderate; 1.2% of participants  needed hospitalization or emergency room visit. Women and participants aged  18-55 years were more likely to experience greater reactogenicity, participants  with prior COVID-19 infection had more systemic  events after the first dose, and participants with chronic diseases other than  hypertension reported fewer systemic adverse events following the second  dose. CONCLUSIONS: Our results are consistent with previous studies, identifying women, people aged 18-55 years and those with previous COVID- 19 infection as those who experienced the greatest reactogenicity to the  vaccine. A relationship was also found between reactogenicity and suffering from a chronic disease other than hypertension.

OBJETIVO: La monitorización continua de la seguridad de las vacunas COVID- 19 puede aportar información adicional a los profesionales sanitarios y a la  población general. El objetivo del presente estudio fue analizar los eventos  adversos locales y sistémicos tras la administración de la vacuna Spikevax®  (Moderna), e identificar los factores relacionados con una mayor  reactogenicidad.Método: Mediante un cuestionario telefónico entrevistamos a 331 receptores de la vacuna Spikevax® (50,2% hombres; mediaedad = 46,4). Se  preguntó acerca de las características de los participantes, infección previa  por  COVID-19 y eventos adversos locales y sistémicos en los siete días posteriores a la primera y segunda dosis de la vacuna. Resultados: El dolor en el lugar de inyección, la fatiga, y la cefalea fueron los  eventos adversos más frecuentes. La prevalencia e intensidad de eventos  locales fue mayor en la primera dosis, mientras que los sistémicos lo fueron en  la segunda. La mayoría de los eventos adversos fueron leves/moderados;  el 1,2% de los participantes necesitaron acudir a urgencias u hospitalización.  Las mujeres y participantes de 18-55 años presentaron mayor probabilidad de  experimentar mayor reactogenicidad, los participantes con infección previa por  COVID-19 presentaron más eventos sistémicos tras la primera dosis y los  participantes con enfermedades crónicas distintas de la hipertensión notificaron  menos eventos adversos sistémicos tras la segunda dosis.Conclusiones Nuestros resultados son consistentes con estudios previos, identificando a las mujeres, personas de 18-55 años y con infección previa por COVID-19 como los que mayor reactogenicidad a la  acuna experimentaron. También se encontró una relación entre la  reactogenicidad y padecer alguna enfermedad cronica distinta de hipertensión.

Enhanced Optical Biosensing by Aerotaxy Ga(As)P Nanowire Platforms Suitable for Scalable Production.

Sensitive detection of low-abundance biomolecules is central for diagnostic applications. Semiconductor nanowires can be designed to enhance the fluorescence signal from surface-bound molecules, prospectively improving the limit of optical detection. However, to achieve the desired control of physical dimensions and material properties, one currently uses relatively expensive substrates and slow epitaxy techniques. An alternative approach is aerotaxy, a high-throughput and substrate-free production technique for high-quality semiconductor nanowires. Here, we compare the optical sensing performance of custom-grown aerotaxy-produced Ga(As)P nanowires vertically aligned on a polymer substrate to GaP nanowires batch-produced by epitaxy on GaP substrates. We find that signal enhancement by individual aerotaxy nanowires is comparable to that from epitaxy nanowires and present evidence of single-molecule detection. Platforms based on both types of nanowires show substantially higher normalized-to-blank signal intensity than planar glass surfaces, with the epitaxy platforms performing somewhat better, owing to a higher density of nanowires. With further optimization, aerotaxy nanowires thus offer a pathway to scalable, low-cost production of highly sensitive nanowire-based platforms for optical biosensing applications.

Enhanced human T cell expansion with inverse opal hydrogels.

Advanced personalized immunotherapies still have to overcome several biomedical and technical limitations before they become a routine cancer treatment in spite of recent achievements. In adoptive cell therapy (ACT), the capacity to obtain adequate numbers of therapeutic T cells in the patients following ex vivo treatment should be improved. Moreover, the time and costs to produce these T cells should be reduced. In this work, inverse opal (IOPAL) 3D hydrogels consisting of poly(ethylene) glycol (PEG) covalently combined with heparin were engineered to resemble the environment of lymph nodes, where T cells get activated and proliferate. The introduction of an IOPAL strategy allowed a precise control on the porosity of the hydrogels, providing an increase in the proliferation of primary human CD4+ T cells, when compared with state-of-the-art expansion systems. Additionally, the IOPAL hydrogels also showed a superior expansion compared to hydrogels with the same composition, but without the predetermined pore structure. In summary, we have shown the beneficial effect of having an IOPAL architecture in our 3D hydrogels to help achieving large numbers of cells, while maintaining the desired selected phenotypes required for ACT.

Delta-like ligand 3-targeted radioimmunotherapy for neuroendocrine prostate cancer.

Neuroendocrine prostate cancer (NEPC) is a lethal subtype of prostate cancer with limited meaningful treatment options. NEPC lesions uniquely express delta-like ligand 3 (DLL3) on their cell surface. Taking advantage of DLL3 overexpression, we developed and evaluated lutetium-177 (177Lu)-labeled DLL3-targeting antibody SC16 (177Lu-DTPA-SC16) as a treatment for NEPC. SC16 was functionalized with DTPA-CHX-A" chelator and radiolabeled with 177Lu to produce 177Lu-DTPA-SC16. Specificity and selectivity of 177Lu-DTPA-SC16 were evaluated in vitro and in vivo using NCI-H660 (NEPC, DLL3-positive) and DU145 (adenocarcinoma, DLL3-negative) cells and xenografts. Dose-dependent treatment efficacy and specificity of 177Lu-DTPA-SC16 radionuclide therapy were evaluated in H660 and DU145 xenograft-bearing mice. Safety of the agent was assessed by monitoring hematologic parameters. 177Lu-DTPA-SC16 showed high tumor uptake and specificity in H660 xenografts, with minimal uptake in DU145 xenografts. At all three tested doses of 177Lu-DTPA-SC16 (4.63, 9.25, and 27.75 MBq/mouse), complete responses were observed in H660-bearing mice; 9.25 and 27.75 MBq/mouse doses were curative. Even the lowest tested dose proved curative in five (63%) of eight mice, and recurring tumors could be successfully re-treated at the same dose to achieve complete responses. In DU145 xenografts, 177Lu-DTPA-SC16 therapy did not inhibit tumor growth. Platelets and hematocrit transiently dropped, reaching nadir at 2 to 3 wk. This was out of range only in the highest-dose cohort and quickly recovered to normal range by week 4. Weight loss was observed only in the highest-dose cohort. Therefore, our data demonstrate that 177Lu-DTPA-SC16 is a potent and safe radioimmunotherapeutic agent for testing in humans with NEPC.

Molecular Imaging of Neuroendocrine Prostate Cancer by Targeting Delta-Like Ligand 3.

Treatment-induced neuroendocrine prostate cancer (NEPC) is a lethal subtype of castration-resistant prostate cancer. Using the 89Zr-labeled delta-like ligand 3 (DLL3) targeting antibody SC16 (89Zr-desferrioxamine [DFO]-SC16), we have developed a PET agent to noninvasively identify the presence of DLL3-positive NEPC lesions. Methods: Quantitative polymerase chain reaction and immunohistochemistry were used to compare relative levels of androgen receptor (AR)-regulated markers and the NEPC marker DLL3 in a panel of prostate cancer cell lines. PET imaging with 89Zr-DFO-SC16, 68Ga-PSMA-11, and 68Ga-DOTATATE was performed on H660 NEPC-xenografted male nude mice. 89Zr-DFO-SC16 uptake was corroborated by biodistribution studies. Results: In vitro studies demonstrated that H660 NEPC cells are positive for DLL3 and negative for AR, prostate-specific antigen, and prostate-specific membrane antigen (PSMA) at both the transcriptional and the translational levels. PET imaging and biodistribution studies confirmed that 89Zr-DFO-SC16 uptake is restricted to H660 xenografts, with background uptake in non-NEPC lesions (both AR-dependent and AR-independent). Conversely, H660 xenografts cannot be detected with imaging agents targeting PSMA (68Ga-PSMA-11) or somatostatin receptor subtype 2 (68Ga-DOTATATE). Conclusion: These studies demonstrated that H660 NEPC cells selectively express DLL3 on their cell surface and can be noninvasively identified with 89Zr-DFO-SC16.

Biogas-based production of glycogen by Nostoc muscorum: Assessing the potential of transforming CO2 into value added products.

The potential of the filamentous N2-fixing cyanobacterium Nostoc muscorum for CO2 capture from high-loaded streams (i.e. flue gas or biogas) combined with the accumulation of glycogen (GL) and polyhydroxybutyrate (PHB), was evaluated under nutrient-sufficient and nutrient-limited conditions. N. muscorum was able to grow under CO2 contents from 0.03 up to 30% v/v, thus tolerating CO2 concentrations similar to those found in raw biogas or flue-gas, with maximum CO2-fixation rates of 191.9 ± 46 g m-3 d-1 at a biomass concentration of 733.3 ± 207.4 mg TSS L-1. Despite N. muscorum was inhibited by the presence of H2S, the co-inoculation with activated sludge resulted in both CO2 and H2S depletion. Moreover, N. muscorum accumulated GL up to ∼54% dcw under N and P-deprivation, almost 36 times higher than that recorded under nutrients sufficient condition. The addition of 10% extra carbon in the form of valeric acid not only did not hamper the growth of N. muscorum (336.0 ± 113.1 mg TSS L-1) but also increased the GL content to ∼58% dcw. On the contrary, a negligible PHB accumulation was found under the tested conditions, likely due to the high CO2 concentration of 30% v/v in the headspace and therefore the high availability of inorganic carbon for the cultures. N. muscorum cultures achieved VFAs degradations up to ∼78% under controlled pH. These results supported N. muscorum as a sustainable alternative for CO2-capture and greenhouse gas mitigation or for photosynthetic biogas upgrading coupled with value added biomass production.

Perceived satisfaction of women during labour at the Hospital Universitario Materno-Infantil of the Canary Islands through the Childbirth Experience Questionnaire (CEQ-E). / Satisfacción percibida por las mujeres durante el parto en el Hospital Universitario Materno-Infantil de Canarias a través del Childbirth Experience Questionnaire (CEQ-E).

OBJECTIVE: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. METHOD: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity', professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. RESULTS: The total sample comprised 257 women (n=257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). CONCLUSIONS: Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour.

Critically Ill Patient Due to Pneumonitis Secondary to the Use of Filgrastim.

Filgrastim is a granulocyte colony-stimulating factor commonly used in the prophylaxis and treatment of neutropenia associated with chemotherapy in cancer patients. It is a well-tolerated and safe drug but some unusual serious adverse effects may occur. We expose a case of a 37-year-old woman who was hospitalized with severe pancitopenia after the first cycle of chemotherapy with a cisplatin doublet and bevacizumab. Filgrastim was administered for 3 days with the aim of increasing neutrophils and not delay the next chemotherapy cycle. Due to acute respiratory failure she was transferred to the Intensive Care Unit for symptomatic control where required oxygen therapy. Fungal and bacterial culture were made and so blood serologies, all of them were negative. It was diagnosed as pneumonitis secondary to a probable side effect of filgrastim. Although the case was resolved properly it is important monitor the administration of filgrastim because of the severity of these events.

The Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED) improves physician assessment of asthma morbidity in pediatric emergency department patients.

OBJECTIVES: To determine whether the Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED), a 12-item questionnaire, can help ED attendings accurately assess a patient's asthma control and morbidity. METHODS: This was a randomized-controlled trial performed at an urban pediatric ED of children aged 1-17 years presenting with an asthma exacerbation. Parents answered PACCI-ED questions about their children's asthma. Attendings were randomized to view responses to the PACCI-ED (intervention group) or to be blinded to the completed PACCI-ED (control group). The two groups were compared on their empirical clinical assessment of: (1) chronic asthma control categories, (2) asthma trajectory (stable, worsening or improving), (3) patient adherence to controller medications, and (4) burden of disease for the patient's family. The validated PACCI algorithm was used as the criterion standard for these four outcomes. Accuracy of clinical assessment was compared between intervention and control groups using chi-squared tests and an intention-to-treat approach. RESULTS: Seventeen ED attendings were enrolled in the study and 77 children visits were included in the analysis. There were no significant differences between the intervention and the control groups for child's gender, age, race, and asthma characteristics. Intervention group attendings were more accurate than control group attendings in assessing the category of chronic asthma control (43% versus 19%; p = 0.03), disease trajectory (72% versus 45%; p = 0.02), and the disease burden for families (74% versus 35%; p = 0.001) over the past 12 months. There was a trend towards more accuracy of intervention versus control attendings for estimating patient adherence to controller medications (72% versus 48%; p = 0.06). CONCLUSIONS: The PACCI-ED improves the assessment of asthma control, trajectory, and burden by ED attendings, and may help assessment of asthma medication adherence and prior asthma exacerbations. The PACCI-ED can be used to improve provider assessment of asthma morbidity during pediatric ED visits for asthma exacerbations, and to identify children who may benefit from interventions to reduce asthma morbidity.

Brønsted acid-catalyzed benzylation of 1,3-dicarbonyl derivatives.

The direct alkylation of 1,3-dicarbonyl compounds with benzylic alcohols is shown to be efficiently catalyzed by simple Brønsted acids such as triflic acid (TfOH) and p-toluenesulfonic acid (PTS) to give rise to monoalkylated dicarbonyl derivatives in high yields. In the absence of the nucleophile, substituted alkenes, generated through a formal dimerization reaction, are obtained. The reactions are carried out in air using undried solvents, with water being the only side product of the process.

Brønsted acid catalyzed propargylation of 1,3-dicarbonyl derivatives. Synthesis of tetrasubstituted furans.

Simple Brønsted acids such as p-toluenesulfonic acid monohydrate (PTS) efficiently catalyze a direct substitution of the hydroxyl group in propargylic alcohols with 1,3-dicarbonyl compounds. Selective propargylation or allenylation is obtained depending on the nature of the alkynol. Reactions can be performed in air in undried solvents with water being the only side product of the process. By applying this reaction as the key step, a range of interesting polysubstituted furans can easily be synthesized in a one-pot procedure. [reaction: see text].

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux.

The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0-18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5-1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.