Endoscopic ultrasound in patients with normal liver blood tests and unexplained dilatation of common bile duct and or pancreatic duct.

OBJECTIVE: To determine the yield of endoscopic ultrasound (EUS) in the investigation of patients with normal liver function tests (LFTs) and unexplained dilatation of common bile duct (CBD) and/or pancreatic duct (PD), following CT and/or magnetic resonance cholangiopancreatography. MATERIALS AND METHODS: Consecutive patients undergoing linear EUS between January 2007 and August 2011 for the indication of dilated CBD and/or PD, normal LFT, and nondiagnostic cross-sectional imaging formed the study group. The study was performed as a retrospective analysis of prospectively collected data. RESULTS: During the study period, 83 patients (CBD and PD dilatation n = 38, PD dilatation n = 5, CBD dilatation n = 40) met the inclusion criteria and underwent EUS. Five (13.1%) of the CBD and PD groups had a new finding, which in one (2.6%) case was causal. In this group, men were significantly more likely to have a new finding (p = 0.012). Eight (20%) of the CBD group had a new finding, which in seven (17.5%) cases was causal. In the CBD group, cholecystectomy was significantly (p = 0.005) more common in those without a finding. Three (60%) of the PD group had a finding on EUS, all of which were causal, including a case of pancreatic malignancy. CONCLUSION: There is a significant yield from EUS in individuals with isolated PD dilatation and isolated CBD dilatation. Previous cholecystectomy is significantly associated with a negative EUS in the group with isolated CBD dilatation. The yield in those with CBD and PD dilatation was low and a finding was more likely in males.

COVID-19 and liver cancer: lost patients and larger tumours.

BACKGROUND: Northern England has been experiencing a persistent rise in the number of primary liver cancers, largely driven by an increasing incidence of hepatocellular carcinoma (HCC) secondary to alcohol-related liver disease and non-alcoholic fatty liver disease. Here we review the effect of the COVID-19 pandemic on primary liver cancer services and patients in our region. OBJECTIVE: To assess the impact of the COVID-19 pandemic on patients with newly diagnosed liver cancer in our region. DESIGN: We prospectively audited our service for the first year of the pandemic (March 2020-February 2021), comparing mode of presentation, disease stage, treatments and outcomes to a retrospective observational consecutive cohort immediately prepandemic (March 2019-February 2020). RESULTS: We observed a marked decrease in HCC referrals compared with previous years, falling from 190 confirmed new cases to 120 (37%). Symptomatic became the the most common mode of presentation, with fewer tumours detected by surveillance or incidentally (% surveillance/incidental/symptomatic; 34/42/24 prepandemic vs 27/33/40 in the pandemic, p=0.013). HCC tumour size was larger in the pandemic year (60±4.6 mm vs 48±2.6 mm, p=0.017), with a higher incidence of spontaneous tumour haemorrhage. The number of new cases of intrahepatic cholangiocarcinoma (ICC) fell only slightly, with symptomatic presentation typical. Patients received treatment appropriate for their cancer stage, with waiting times shorter for patients with HCC and unchanged for patients with ICC. Survival was associated with stage both before and during the pandemic. 9% acquired COVID-19 infection. CONCLUSION: The pandemic-associated reduction in referred patients in our region was attributed to the disruption of routine healthcare. For those referred, treatments and survival were appropriate for their stage at presentation. Non-referred or missing patients are expected to present with more advanced disease, with poorer outcomes. While protective measures are necessary during the pandemic, we recommend routine healthcare services continue, with patients encouraged to engage.

The structure of water in p-sulfonatocalix[4]arene.

Tetrasodium p-sulfonatocalix[4]arene exists as a hydrate with approximately 14 water molecules and has three polymorphic modifications, all of which contain a water molecule in the molecular cavity that is engaged in OH···π interactions. Single-crystal neutron structures are reported for two of these three forms and reveal a "compressed" water molecule with short OH bonds. Partial atomic charges and hardness analysis (PACHA) calculations based on the neutron coordinates give an OH···π interaction energy of 6.9-7.5 kJ mol(-1). The PACHA analysis also reveals the dominance of the charge-assisted hydrogen bonds from the Na(+)-coordinated water molecules. The instability of the crystal towards dehydration can be traced to an uncoordinated lattice water site. The remarkable calixarene-Na(+)-hydrate motif is conserved almost unchanged across all three polymorphs. A single-crystal neutron structure is also reported for pentasodium p-sulfonatocalix[4]arene·12H(2)O, which exhibits an intracavity water molecule that is engaged in both OH···π and OH···O hydrogen bonding. The shorter covalent bond to the hydrogen atom that forms the interaction with the aromatic ring is again apparent.

Two different hydrogen bond donor ligands together: a selectivity improvement in organometallic {Re(CO)3} anion hosts.

Rhenium(I) compounds [Re(CO)(3)(Hdmpz)(2)(ampy)]BAr'(4) and [Re(CO)(3)(N-MeIm)(2)(ampy)]BAr'(4) (Hdmpz = 3,5-dimethylpyrazole, N-MeIm = N-methylimidazole, ampy = 2-aminopyridine or 3-aminopyridine) have been prepared stepwise as the sole reaction products in good yields. The cationic complexes feature two different types of hydrogen bond donor ligands, and their anion binding behavior has been studied both in solution and in the solid state. Compounds with 2-ampy ligands are labile in the presence of nearly all of the anions tested. The X-ray structure of the complex [Re(CO)(3)(Hdmpz)(2)(ampy)](+) (2) shows that the 2-ampy ligand is metal-coordinated through the amino group, a fact that can be responsible for its labile character. The 3-ampy derivatives (coordinated through the pyridinic nitrogen atom) are stable toward the addition of several anions and are more selective anion hosts than their tris(pyrazole) or tris(imidazole) counterparts. This selectivity is higher for compound [Re(CO)(3)(N-MeIm)(2)(MeNA)]BAr'(4) (5·BAr'(4), MeNA = N-methylnicotinamide) that features an amido moiety, which is a better hydrogen bond donor than the amino group. Some of the receptor-anion adducts have been characterized in the solid state by X-ray diffraction, showing that both types of hydrogen bond donor ligands of the cationic receptor participate in the interaction with the anion hosts. DFT calculations suggest that coordination of the ampy ligands is more favorable through the amino group only for the cationic complex 2, as a consequence of the existence of a strong intramolecular hydrogen bond. In all other cases, the pyridinic coordination is clearly favored.

Enhanced anion binding from unusual coordination modes of bis(thiourea) ligands in platinum group metal complexes.

Treatment of a range of bis(thiourea) ligands with inert organometallic transition-metal ions gives a number of novel complexes that exhibit unusual ligand binding modes and significantly enhanced anion binding ability. The ruthenium(II) complex [Ru(η(6)-p-cymene)(κS,S',N-L(3)-H)](+) (2b) possesses juxtaposed four- and seven-membered chelate rings and binds anions as both 1:1 and 2:1 host guest complexes. The pyridyl bis(thiourea) complex [Ru(η(6)-p-cymeme)(κS,S',N(py)-L(4))](2+) (4) binds anions in both 1:1 and 1:2 species, whereas the free ligand is ineffective because of intramolecular NH⋅⋅⋅N hydrogen bonding. Novel palladium(II) complexes with nine- and ten-membered chelate rings are also reported.

Preconception lifestyle advice for people with subfertility.

BACKGROUND: Infertility is a prevalent problem and has significant consequences for individuals, families and the wider community. People's chance of having a healthy, live birth may be impacted upon by factors such as weight, diet, smoking, other substance abuse, environmental pollutants, infections, medical conditions, medications and family medical history. However, there is no current guideline about what preconception advice should be offered to people presenting for infertility treatment. It is important to determine what preconception advice should be given about these types of factors to such people in order to help them to make positive changes and hopefully improve their chances of conception and delivering a healthy, live baby. OBJECTIVES: To assess the effects of preconception advice on the chances of a live birth for people who perceive that they may be infertile and are investigating the possibility of medical treatment to address subfertility. SEARCH STRATEGY: All published and unpublished randomised controlled trials addressing preconception advice to influence lifestyle factors in people who perceived that they may be infertile and investigated the possibility of medical treatment to address subfertility were sought from the Cochrane Menstrual Disorders and Subfertility Review Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, MEDLINE, PubMed, EMBASE, PsycINFO, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), LILACS, trial registers for ongoing and registered trials, citation indexes, ISI Web of Knowledge, Clinical Study Results database, OpenSIGLE database, China National Knowledge Infrastructure (CNKI) Periodical Index and Google (inception to 5 October 2009). SELECTION CRITERIA: Only randomised controlled trials (RCTs), including cluster-randomised (group-randomised) trials, that considered preconception advice given to individuals who perceived that they may be infertile and were investigating the possibility of medical treatment from subfertility specialist services were eligible for inclusion. The primary outcome was live birth, defined as delivery of a live fetus after 20 completed weeks of gestation. DATA COLLECTION AND ANALYSIS: Two review authors independently applied eligibility criteria to, extracted data from and assessed the risk of bias in the single included trial. MAIN RESULTS: One trial assessing smoking cessation advice for 94 infertile women smokers fulfilled the criteria for this review, but the trial did not report on the review's primary outcome of live birth or any other fertility-related outcomes. This trial of women attending a fertility clinic showed that smoking cessation advice tailored to a woman's "stage-of-change" (readiness to stop smoking) did not show significant evidence of a difference in stage (including smoking cessation rates) compared with standard clinical advice. AUTHORS' CONCLUSIONS: No RCTs were located that assessed the effects of preconception advice on the chance of a live birth or other fertility outcomes in people who perceived that they may be infertile and were investigating the possibility of medical treatment to address subfertility. Given the lack of RCTs evaluating the effectiveness of preconception lifestyle advice for people in the afore-mentioned population, this review cannot provide guidance for clinical practice in this area. However, it does highlight the need for further research into this important subject.

Lifestyle factors in people seeking infertility treatment - A review.

BACKGROUND: Clinical infertility is a prevalent problem with significant financial and psychosocial costs. Modifiable lifestyle factors exist that may affect a person's time to conception and their chance of having a healthy, live birth. However, no guideline delineates what preconception advice should be offered to people presenting for infertility treatment. AIM: The aim of this article is to review the literature regarding modifiable lifestyle factors in people seeking infertility treatment. RESULTS: A person's time to pregnancy and their chance of having a healthy, live birth may be affected by factors such as weight, vitamin and iodine intake, alcohol and caffeine consumption, smoking, substance abuse, stress, environmental pollutants, vaccinations and oxidative stress. CONCLUSIONS: Advice on modifiable lifestyle factors should be given to people presenting for infertility treatment to help them make positive changes that may improve their chances of pregnancy and delivering a healthy, live baby. Developing a guideline for this would be a prudent step towards helping clinicians to implement this aspect of preconception care.

One-pot oxidative hydrolysis-oxidative cleavage of 7-borylindoles enables access to o-amidophenols and 4-acylbenzoxazoles.

7-Borylindoles undergo a one-pot oxidative-hydrolysis of the arylboronate and oxidative cleavage of the indole C2-C3 double bond to afford o-amidophenol derivatives. Subsequent cyclisation delivers benzoxazoles bearing an acyl group at C4, a substitution pattern common to fungal-derived benzoxazole alkaloids. Using 7-borylindoles as substrates to access functionalised o-amidophenols circumvents the difficult preparation of these compounds from arenes, streamlining access to substituted 4-acylbenzoxazoles in the process.

Allosteric effects in a tetrapodal imidazolium-derived calix[4]arene anion receptor.

A ditopic tetrapodal imidazolium-based 1,3-alternate calix[4]arene host binds anions as 1 : 2 complexes via a range of CH...anion hydrogen bonds. Allosteric enhancement of the affinity for the second chloride anion is observed. X-Ray crystal structures of the chloride, bromide and nitrate complexes suggest that this behaviour is linked to inter-binding site communication mediated by the calixarene framework. The imidazolium groups exist as either in-out or out-out conformers with respect to the calixarene, with the chloride complex exhibiting conformational isomorphism such that both forms are present in the same crystal structure.

Prognostic factors in renal cell carcinoma: association of preoperative sodium concentration with survival.

PURPOSE: Conventional renal cell carcinoma (RCC) has a variable natural history, and determining individual prognosis is important to guide management. We have examined the prognostic significance of a large number of hematologic and biochemical variables, as well as traditional tumor-related factors in patients with RCC. EXPERIMENTAL DESIGN: Patients undergoing nephrectomy for newly diagnosed RCC between September 1998 and March 2005 were invited to participate. Clinical, pathologic, and laboratory data were recorded in each case, and immunophenotyping was carried out on a subset of patients. A planned subset analysis of patients presenting with N0M0 disease was done. RESULTS: Two hundred twelve patients with RCC formed the study population. In addition to tumor-related factors, multivariate analyses revealed preoperative serum sodium concentration to be independently and significantly associated with overall survival and disease-free survival when considered as both a continuous variable and when dichotomized to above and below the median value [139 mmol/L; reference range 135-145 mmol/L, hazard ratio 0.44, 95% confidence interval (95% CI) 0.22-0.88, P = 0.014]. Five-year overall survival estimates for patients above and below the median serum sodium were 67.6% (95% CI 54.2-80.9) and 44.3% (95% CI 32.8-55.8), respectively. These findings persisted in the N0M0 subgroup analysis. CONCLUSIONS: We have confirmed the prognostic value of traditional tumor-related factors but, to our knowledge, these are the first data to show that low preoperative sodium concentration may be an important factor associated with reduced survival in patients with RCC, suggesting that serum sodium should be considered with established prognostic variables in modeling survival in RCC.

Anion hydrogen bond effects in the formation of planar or quintuple helical coordination polymers.

A relatively inflexible 1D coordination polymer is induced to adopt either planar or quintuple helical supramolecular isomers according to the hydrogen bonding demands of the counter anions.

The assessment of student reasoning in the context of a clinically oriented PBL program.

BACKGROUND: Doctors' clinical reasoning ability significantly impacts upon their level of clinical competence. Throughout medical training students are given the opportunity to develop their reasoning ability in order to become appropriately clinically competent by graduation. AIM: To develop an instrument to assess students' reasoning ability on a written case-based question which was aligned to their learning in a PBL program. METHOD: An instrument with 10 criteria centred upon hypothesis generation, learning issues and mechanistic explanations was developed. Experienced clinical and medical educators validated the instrument, prior to its use with 145 undergraduate first-year medical students. RESULTS: The results enabled the establishment of the strengths and weaknesses in the reasoning performances of individuals, as well as the overall cohort. The instrument's Cronbach alpha coefficient was 0.94, and it had high inter-rater and intra-rater reliability. Further validation of the instrument's performance was established through qualitative evidence derived from student interviews and tutor reports for this cohort. CONCLUSIONS: Aligning written assessment to the PBL process enables students and teachers to better understand how the reasoning process is developing for individuals and a cohort, and provides a basis for further investigation into the development of student clinical reasoning.

A small tris(imidazolium) cage forms an N-heterocyclic carbene complex with silver(I).

A small, sterically rigid tris(imidazolium) cyclophane reacts with Ag2O to give an Ag(I) carbene complex in which one of the imidazolium moieties remains protonated.

COPD can mimic the appearance of pneumothorax on thoracic ultrasound.

PURPOSES: To determine the diagnostic accuracy of ultrasound in the diagnosis of pneumothorax in patients with COPD with particular regard to false-positive diagnoses. MATERIALS AND METHODS: This was a single-center, prospective, blinded study. Nine patients with pneumothorax, 9 patients with cystic fibrosis, 17 patients with COPD, and 6 control subjects were studied. Ultrasound clips were recorded at three positions in both hemithoraces of each patient and then reviewed by two observers blinded to patient status. Each clip was scored for the presence or absence of pneumothorax and the degree of observer confidence. RESULTS: The sensitivity and specificity for a pneumothorax were 100% and 84% for the experienced observer and 78% and 81% for the inexperienced observer, respectively. In the COPD patient group, specificity was 71% for the experienced observer and 65% for the inexperienced observer. There were no false-positive diagnoses in the cystic fibrosis or the control group. CONCLUSION: Patients with COPD commonly show signs on ultrasound mimicking a pneumothorax, but this was not seen in patients with cystic fibrosis. In patients with COPD, ultrasound may be used to exclude the presence of a pneumothorax, but it cannot be used to confidently diagnose pneumothorax without using other imaging modalities.

Anion binding inhibition of the formation of a helical organogel.

A chiral tris(urea) organogelator gels dmso-water and methanol-water mixtures at low weight percent. The formation of the helical gel fibres is partially inhibited by addition of chloride, which is bound by the gelator, resulting in fully crystalline material characterised by X-ray crystallography.

Unusual variations in the incidence of Z' > 1 in oxo-anion structures.

A series of Cambridge Structural Database studies show that ionic species generally form low Z' structures, even in those cases where charge assisted hydrogen bonding is a key feature, e.g. oxo-anion complexes. By introducing a competing pi-pi stacking interaction, two oxo-anion compounds are shown to crystallise with more than one molecule in the asymmetric unit, including the first hydrogen phosphate containing structure to have Z' > 2.

The d2/d3 alkyne redox pair [WF2(PhC identical to CPh)Tp']z (z = +1 or 0): missing links in a 'redox family tree'.

The d2/d3 redox pair [WF2(PhC identical to CPh)Tp']z [z = +1 or 0, Tp' = hydrotris(3,5-dimethylpyrazolyl)borate] is the missing link in a 'redox family tree' relating the d6 tricarbonyls [M(CO)3L]- to the d2 trihalides [MX3L] (M = Mo or W, L = Cp or Tp') by a series of stepwise reactions involving sequential one-electron oxidation followed by ligand substitution.

Tuberculosis and the pancreas: a diagnostic challenge solved by endoscopic ultrasound. A case series.

Pancreatic tuberculosis is a rare disease. It can be easily confused with malignancy or pancreatitis on imaging. This could result in unnecessary surgery. As this is a treatable disease it is imperative to diagnose this condition pre-operatively. We report three cases of pancreatic tuberculosis that were diagnosed by endoscopic ultrasound. In conclusion, endoscopic ultrasound is the diagnostic modality of choice for pancreatic tuberculosis facilitating high resolution imaging, as well as sampling of tissue for staining, cytology, culture and polymerase chain reaction assay.

Temporal trends in retinal detachment incidence in Scotland between 1987 and 2006.

AIM: Rhegmatogenous retinal detachment (RRD) is a common and sight-threatening condition. The reported incidence of RRD has varied considerably in published literature and few studies have examined the temporal trends in incidence rate over a long time period. Our aim is to examine the time trends of primary RRD in Scotland. METHODS: We obtained linked hospital episode statistics data for all patients admitted with a primary diagnostic code of RRD in Scotland between 1987 and 2006. Using this database as an estimate of RRD incidence, we calculated the annual age- and sex-specific incidence rates of RRD in Scotland. Log-linear Poisson regression analysis was used to explore age, period and cohort trends. RESULTS: The overall age-standardised incidence of RRD in Scotland has steadily increased from 9.36 per 100 000 (95% CI 8.19 to 10.53) in 1987 to 13.61 per 100 000 (95% CI 12.25 to 14.97) in 2006 with an average annual increase of 1.9% (p<0.001) during the 20-year period. Men have been affected more frequently than women in all age groups with a significant temporal trend towards earlier age of onset. The peak incidence of RRD in men and women is in the sixth decade of life. No significant period or recent birth cohort trend effects were found. CONCLUSIONS: The estimated incidence of RRD is within the range reported from previous population-based studies worldwide. The rise in RRD incidence between 1987 and 2006 is attributed in part to the changing demographic in Scotland. There is an increasing sex imbalance in incidence, with men being affected more frequently and at a younger age.