Force-sensing treadmill gait analysis system can detect gait abnormalities in haemophilia patients without arthropathy.

BACKGROUND: Joint damage in patients with haemophilia (PwH) is commonly assessed by imaging, but few reports have described how structural changes in joints, for example, haemophilic arthropathy (HA)-affect gait ability. OBJECTIVES: We evaluated gait function among PwH with HA, PwH without HA, and people without haemophilia (non-PwH) using a Zebris FDM-T treadmill (FDM-T), an easy-to-use gait assessment instrument with a force sensor matrix. METHODS: The following gait parameters were collected: centre of pressure trajectory intersection (COPi) anterior/posterior variability, COPi lateral variability, COPi anterior/posterior symmetry, COPi lateral symmetry, single-limb support line (SLSL) length, and SLSL variability. Participants walked at their typical gait speed. The physical function of the PwH was assessed by the Hemophilia Joint Health Score (HJHS). Parameters were compared among the three groups. RESULTS: Twelve PwH with HA, 28 PwH without HA, and 12 non-PwH were enrolled. Gait speed significantly differed between groups (non-PwH, 3.1 ± 0.7; PwH without HA, 2.0 ± 0.7; PwH with HA; 1.5 ± 0.4). The COPi anterior/posterior variability, COPi lateral variability, SLSL length, and SLSL variability were greater in the PwH groups than in the non-PwH group. The COPi lateral symmetry differed between PwH with HA and the other groups. The HJHS was not correlated with gait parameters among PwH with HA. CONCLUSIONS: Gait parameters and speed were abnormal in both PwH with HA and PwH without HA. The FDM-T can be used to identify early stages of physical dysfunction that cannot be detected by conventional functional assessments such as the HJHS.

Template Synthesis of Disilacycloalkanes Utilizing the Reactivity of a Siloxane Bond.

The investigation of large and flexible macrocyclic compounds has garnered significant attention due to their functions as host molecules and linkers. Although the synthetic yields of such compounds, achieved by linking two molecular fragments, are often hindered by the flexibility of the molecular skeleton, one of the effective solutions is template synthesis for the macrocycles. In this study, a novel template synthesis for disilacycloalkanes by leveraging the reactivity of a siloxane bond was investigated. The yields obtained through the template methods surpassed those of the nontemplate approach, and the introduction of substituents to the silicon atoms was also accomplished with success. All of the resulting disilacycloalkanes crystallized exceptionally well, enabling their structural determination through X-ray crystallography. Notably, the stability of these structures was elucidated by analyzing dispersion forces between alkyl chains, using density functional theory (DFT) calculations. This template synthesis method demonstrates its efficacy in synthesizing molecular systems that encompass two functional moieties linked with macroalkanes.

Ring-closing metathesis of dialkenylcycloalkanes for the synthesis of fused bicycloalkanes and tricycloalkanes.

Ring-closing metathesis of dialkenyldisilacycloalkane using the Grubbs catalyst, followed by hydrogenation, afforded a mixture of two disilabicycloalkanes and tetrasilatricycloalkanes. This method can synthesize a diastereomer mixture of disilabicycloalkanes with one differing alkyl side chain. The observed symmetries of the NMR spectra of anti-bicycloalkanes depend significantly on the length of the side chain. The findings may contribute to the molecular design of functional bicycloalkanes based on structural transformations of the stable forms.

Synthesis and structure of stannane-based molecular bevel gears having substituents on a tin linker.

Ditriptycylmethanes are known as molecular bevel gears because the two triptycyl groups act as wheels and display correlated rotation in solution. However, introduction of substituents on the methylene junction for chemical modification of the bevel gears has been difficult due to steric hindrance of the triptycyls. In this study, stannane-based molecular bevel gears with organic substituents on the tin linker were achieved by utilizing long Sn-C bonds. Ditriptycylstannanes with methyls or phenyls on the tin atoms were synthesized. Their structures were characterized by X-ray crystallography, and the angle of triptycyl-Sn-triptycyl in the diphenyl derivative was observed to be narrower than that of the dimethyl derivative due to steric hindrance of the phenyls. The gear rotation of these derivatives was observed by NMR spectroscopy through observations of the phase isomers of the corresponding methyltriptycyl derivatives. Gear slippage was observed in the high-temperature region, and the activation energy of the diphenyl derivative was higher than that of the dimethyl derivative. The observed relationship between gear rotation and substituents on the tin can aid in the molecular design of functional molecular bevel gears.

Influences of comorbidities on perioperative rehabilitation in patients with gastrointestinal cancers: a retrospective study.

BACKGROUND: Older patients are more likely to have comorbidities than younger patients, and multiple comorbidities are associated with mortality in patients with cancer. Therefore, we hypothesized that a functional comorbidity index could predict the therapeutic effects of rehabilitation. OBJECTIVES: In this study, we investigate whether the comorbidities influenced the execution and therapeutic effects of rehabilitation. METHODS: A consecutive cohort of 48 patients with gastrointestinal cancer who underwent surgery between January 1 and November 30, 2020, was analyzed. Charlson Comorbidity Index (CCI) scores were calculated based on data derived from medical records. The primary outcomes were ambulation status, duration (days) from the start of postoperative rehabilitation, and length of hospital stay. We investigated the relationship between CCI scores and primary outcomes. RESULTS: The CCI did not correlate with the duration of rehabilitation or the length of hospital stay. Subsequently, patients with functional recovery problems were evaluated, and we identified the conditions that were not included in the list using CCI scores. Most conditions are associated with surgical complications. Furthermore, using the Clavien-Dindo classification (CDC), we assessed the clinical features of the severity of complications. We found that the length of stay and the duration to start rehabilitation were significantly longer in the patients with higher severity of surgical complications (CDC≧III) than in those with lower severity (CDC≦II). CONCLUSIONS: Treatment-related conditions may significantly impact the perioperative period more than the original comorbidities. In addition to original comorbidities, events related to surgical complications should be assessed to determine the therapeutic effects of rehabilitation in patients with gastrointestinal cancer.

[Emergent Transcatheter Aortic Valve Implantation for Degenerated Surgical Aortic Valve Under Local Anesthesia:Report of a Case].

An 89-year-old man who had undergone aortic valve replacement with a 21 mm Mosaic bioprosthetic valve at another hospital 14 years ago was admitted to the emergency room for a sudden respiratory distress two days prior and was diagnosed with severe aortic regurgitation( AR) caused by valve insufficiency and acute heart failure secondary to low cardiac function. Upon admission, he was found to have severe hypoxia with PaO2 of 40 mmHg range, and transcatheter aortic valve replacement (TAVI, TAV in SAV) with a 20 mm SAPIEN3 was performed under local anesthesia for fear of hypotension while under general anesthesia. After confirming that AR had completely disappeared, the patient was intubated and discharged from the operating room on a mechanical ventilator. The patient was weaned from the ventilator on the second postoperative day and was transferred to the other hospital for rehabilitation, 48 days postoperatively. Although there is no report on the comparative study of anesthesia methods for emergency transcatheter aortic valve implantation( TAVI), TAVI under regional anesthesia is minimally invasive with a lower risk for hypotension than general anesthesia. Therefore, we believe it is useful for patients with acute heart failure and hypotension. In addition, it is important to use a balloon expandable valve with excellent implantability to complete the procedure in a short time.

Structures and Oxidation Properties of Phenylene-Bridged Diazacycloalkanes: Ring Size Effects on Structures and Properties.

Phenylenediamine derivatives have been investigated as functional molecules because of their characteristic oxidation properties. In this study, phenylene-bridged diazacycloalkanes, that is, C10, C12, and C14, in which numbers indicate the lengths of a side chain, were synthesized, and the effects of the macroring size on their structures and oxidation properties were investigated. X-ray crystallography revealed that the structures around the nitrogen atoms were remarkably dependent on the chain lengths. The benzene plane of C10 is arranged almost perpendicular to the macroring to avoid steric contact. However, the benzene plane of C14 and alkyl frame were co-planar. Stabilization resulting from conjugation was comparable to destabilization caused by macroring strain according to DFT calculations. Structural differences between C10 and C14 caused changes in the NMR chemical shifts of the inner methylene protons and first oxidation potentials in solution. Notably, the properties of C12 can be analyzed as those of distributed structures, which is of interest with respect to exploiting the metastable structure of the molecules. The observed relationships between the steric structures and properties can facilitate the design of functional molecules containing phenylenediamine moieties.

Synthesis and Characterization of Silyl[n]acediynes (Linearly Fused Benzodehydro[12]annulenes): Utilizing Bulkiness of Silyl Groups to Improve Selectivity.

[n]Acediynes have unique properties owing to their highly strained and extended π-electron system. We have previously reported the selective synthesis of a silyl[1]acediyne, i.e., silyldibenzotetradehydro[12]annulene, utilizing the bulkiness of the silyl groups to improve the selectivity of the reaction. Herein, we report the facile synthesis of high-order silyl[n]acediynes via Eglington coupling between silyldiethynylbenzene and silyltetraethynylbenzene. In fact, silyl[2]acediyne as well as silyl[1]acediyne can be isolated from the reaction mixture. Their structures were determined using X-ray crystallography and discussed with reference to our previous report, and their spectroscopic properties, including absorption, fluorescence, Raman, and IR spectra, were fully characterized with DFT calculations. A drastic redshift in their absorption and fluorescence spectra occurred with an increase in the order number n of the [n]acediynes. The antiaromaticities of the dehydro[12]annulene moieties at the center of the annulene ring in these silylacediynes were also evaluated using NICS values. The calculated values were small and positive, which confirmed the weak antiaromatic character of the rings.

Design of rotational potential in a phenyltriptycene molecular rotor by exploiting CH/π-interaction between tripticil hydrogen and phenyl.

The chemistry of artificial molecular rotors has recently attracted considerable attention in the field of molecular machines. Phenyltriptycene could be used as a stepwise molecular rotor because it is composed of a phenyl rotor and a triptycene stator, in which the rotational potential can be designed by introducing substituents. In this study, a novel design of the relative energies among three rotamers of a substituted phenyltriptycene by exploiting the CH/π-interaction between a peri-hydrogen and phenyl was investigated. First, the structures of two different phenyltriptycenes were compared to confirm CH/π-interactions. Second, the effects of the substituents of 1,4,5-trichloro-3',5'-dimethoxyphenyltriptycene on the relative energies were investigated by structural analysis, temperature-dependent nuclear magnetic resonance studies, and density functional theory calculations. The obtained results should facilitate the design of novel molecular switches and/or molecular rotors.

Synthesis and rotational dynamics of diazamacrocycles having bridged 1,4-naphthylene as framed molecular rotors.

The rotation of a part of a molecule has attracted attention because of its possible role in the development of an artificial molecular rotor. In this study, 1,4-naphthylene bridged diazamacrocycles, in which the 1,4-diaminonaphthalene moiety is bridged by two long alkyl chains, were designed as novel framed molecular rotors, and the dependence of the rotation on the frame size were investigated. Framed rotors CnNp (n = 12, 14, 16, 18), where the number in the compound name indicates the length of a side chain, were synthesized by direct cyclization of 1,4-naphthalenediamine with α,ω-dihaloalkane in the presence of Na2CO3 as the base. The rotation of the naphthylene rotor in C12Np, C14Np, and C16Np was nearly suppressed in solution, whereas the rotor in C18Np showed rotation, as confirmed by the temperature-dependent coalescence of the NMR signals of the α-CH2.

Long-term outcomes of nasogastric tube with Gastrografin for adhesive small bowel obstruction.

BACKGROUND: We had previously reported that the administration of Gastrografin through a nasogastric tube (NGT-G) followed by long tube (LT) strategy could be a novel standard treatment for adhesive small bowel obstruction (ASBO); however, the long-term outcomes after initial improvement remain unknown. This study aimed to analyze the long-term outcomes of first-line NGT-G. METHODS: Enrolled patients with ASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018. Thereafter, the cumulative surgery rate, cumulative recurrence rate, and overall survival (OS) rate were analyzed. In addition, subset analysis was conducted to determine the cumulative recurrence rate according to colonic contrast with Gastrografin at 24 h. RESULTS: A total of 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed over a median follow-up duration of 550 days. The cumulative 1-year surgery rates, cumulative 1-year recurrence rates, and 1-year OS rates in the LT and NGT-G groups were 18.8% and 18.1%, 30.0% and 31.7%, and 99.1% and 96.6%, respectively; no significant differences were observed between both groups. In the NGT-G group, a negative colonic contrast at 24 h demonstrated a higher tendency for future recurrence compared with a positive colonic contrast at 24 h (1-year recurrence rate: negative contrast, 46.9% vs positive contrast, 27.6%). CONCLUSIONS: Gastrografin through a nasogastric tube followed by LT can be a promising treatment strategy for ASBO, with long-term efficacies equivalent to initial LT placement.

Association between foot posture and tibiofemoral contact forces during barefoot walking in patients with knee osteoarthritis.

BACKGROUND: Accumulating evidence indicates that abnormal foot posture are risk factors for knee osteoarthritis (OA). However, the relationship between foot posture and tibiofemoral contact force (CF) during habitual weight-bearing activities remains unclear. This study aimed to determine the association between tibiofemoral CF and foot posture while walking. METHODS: In total, 18 patients with knee OA and 18 healthy individuals participated in this cross-sectional study. Foot parameters were evaluated by Foot Posture Index (FPI), Staheli Arch Index (SAI), hallux valgus angle, calcaneus inverted angle relative to the floor as a static rearfoot posture, navicular height, and toe grip strength. In addition, all participants underwent kinetic and kinematic measurements during a self-selected speed gait. The measurement device used was the three-dimensional motion analysis system with a sampling rate of 120 Hz. The musculoskeletal model, which has 92 Hill-type muscle-tendon units with 23 degrees of freedom, was used to calculate tibiofemoral CF. Partial correlations was used to investigate the association between foot parameters and total, medial, and lateral tibiofemoral CF of the first and second peaks while controlling for gait speed. RESULTS: A significant negative correlation was observed between Walking SAI and first peak medial tibiofemoral CF in control participants (r = -0.505, p = 0.039). SAI was also significantly positively correlated with first peak medial tibiofemoral CF in patients with knee OA (r = 0.482, p = 0.042). CONCLUSIONS: Our findings revealed a correlation between the medial first peak tibiofemoral CF and the SAI. This study indicates that people with knee OA and flatfoot have excessive first medial tibiofemoral CF during walking.

[Robot-Assisted Laparoscopic Radical Prostatectomy in a Short-Statured Man : A Case Report].

A 72-year-old man, who was extremely short-statured, underwent robot-assisted laparoscopic prostatectomy (RARP) for treatment of localized prostate cancer (cT1cNOMO). We report a case of congenital vertebral tip dysplasia with type II collagen dysplasia in a patient who underwent robot-assisted radical prostatectomy. Congenital vertebral tip dysplasia is characterized by short stature, and in this case, the height was 130 cm, which was equivalent to that of an 8-year-old child. The pelvic floor is narrow in short-statured individuals; therefore, the operative time tends to be longer than that required for routine surgery. However, using modifications in port positions and other adjustments, we performed RARP, and our perioperative results were similar to those obtained with routine RARPs.

Structure and Dynamics of Crystalline Molecular Gyrotops with a Difluorophenylene Rotor.

Macrocage molecules with a bridged π-electron system could be assumed as crystalline molecular gyrotops because of the structural similarity and the rotatable π-electron system. In this study, 1,2-difluoro-3,6-phenylene-bridged macrocages were designed and synthesized as crystalline molecular gyrotops with a dipolar rotor. The thermal ring dynamics of the dipolar rotor in the crystal were investigated by solid-state NMR and dielectric spectroscopy. The gyrotop that was surrounded by three C14-alkyl chains exhibited an exchange between two stationary positions in the crystalline state. In contrast, the gyrotop cage consisting of C18 chains exhibited no dynamics in the crystalline state. Although the corresponding phenylene derivatives exhibit a facile rotational motion of the phenylene group in the crystalline state, the dynamics of each derivative was observed to be different. The reason for this difference is ascribed to the difference in the bulkiness between the fluorine and hydrogen atoms in the rotor.

Steric effects on the intramolecular charge transfer fluorescence of benzo[b]thiophene-1,1-dioxide bridged macrocages.

Intramolecular charge transfer (ICT) fluorescence has been widely investigated and exploited in sensor molecules. However, steric effects on the ICT fluorescence properties have rarely been reported so far, although research in this area would promote an understanding of the basics of solvation. Herein, we report the detailed fluorescence properties of bis(trimethylsilyl)benzo[b]thiophene-1,1-dioxide (TMSBTO2) and its caged cyclophanes and non-cage isomers, which demonstrate ICT fluorescence in various solutions. The fluorescence band maxima for these benzo[b]thiophene-1,1-dioxides (BTO2s) showed a red-shift with increasing solvent polarity, confirming ICT fluorescence characteristics. The linearity of the Lippert-Mataga plots was confirmed for all ICT fluorescence measured in hexane, toluene, AcOEt, CH2Cl2, and EtOH. The slopes of the plots decreased in the following order: TMSBTO2, non-cage isomers, and caged BTO2s. It is concluded that the Onsager radii for these BTO2s were increased in the abovementioned order, assuming that the difference in the dipole moments between the excited and ground states for these BTO2s was identical.

Greater Change in the Eicosapentaenoic Acid to Arachidonic Acid Ratio Is Associated With Decreased Incidence of Cardiovascular Events in Acute Coronary Syndrome Patients With Elevated Triglyceride Levels.

BACKGROUND: This study investigated whether the percentage change (%Δ) in the eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio is associated with cardiovascular event rates among acute coronary syndrome (ACS) patients receiving contemporary lipid-lowering therapy other than polyunsaturated fatty acids (PUFAs).Methods and Results:This post hoc subanalysis of the HIJ-PROPER study included PUFA-naïve patients for whom EPA/AA ratio data were available at baseline and after 3 months. Patients were categorized into 2 groups based on the median %ΔEPA/AA ratio: Group 1, change less than the median; and Group 2, change greater than or equal to the median. The 3-year rates of the primary endpoint, a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and unstable angina pectoris, were compared between the 2 groups. The median %ΔEPA/AA ratio in Groups 1 and 2 was -26.2% (n=482 patients [49.9%]) and 42.2% (n=483 patients [50.1%]), respectively. At the 3-year follow-up, the occurrence of the primary endpoint was significantly lower in Group 2 than in Group 1 (29/483 [6.0%] vs. 53/482 [11.0%]; hazard ratio 0.53, 95% confidence interval 0.33-0.82; P=0.005). The same trend was observed after adjusting for patient factors (P=0.02). CONCLUSIONS: Among ACS patients receiving contemporary lipid-lowering therapy other than PUFAs, a greater change in the EPA/AA ratio was associated with a lower incidence of cardiovascular events.

Clinical outcomes after balloon angioplasty with Crosser device for heavily calcified common femoral and popliteal artery disease.

Data on the mid-term clinical outcomes after endovascular treatment (EVT) using a Crosser catheter (C. R. Bard, Inc.) as a crossing or flossing device for a heavily calcified lesion in the common femoral artery (CFA) or popliteal artery (PA) are lacking. The aim of this study was to investigate the safety and efficacy of EVT using a Crosser catheter for isolated and heavily calcified CFA or PA disease. We retrospectively analyzed 64 consecutive patients (72 lesions; CFA 30, PA 42) who underwent EVT for heavily calcified CFA or PA lesions with Crosser catheters between April 2015 and April 2019. The primary endpoint was clinically driven target lesion revascularization (CD-TLR). The median follow-up was 18.5 months. The mean age of the study population was 70 ± 9.5 years, with a male prevalence of 73.6%. The mean Proposed Peripheral Artery Calcification Scoring System grade was 2.9 ± 0.9. Procedure success, defined as 50% or less residual stenosis without suboptimal results, was achieved in 94.4% of lesions. There were no cases of bailout stenting or target lesion-related complications. After EVT, the 1-year CD-TLR-free rate for CFA and PA lesions was 87.4 and 76.8%, respectively. The corresponding rates at 2 years were 82.2 and 62.8%, respectively. In the multivariate analysis used to define CD-TLR predictors for CFA and PA lesions, hemodialysis was the only independent predictor (HR 3.35, 95% CI 1.02-13.95, P = 0.045). EVT with a Crosser device for heavily calcified CFA and PA lesions seems to be safe and feasible.

Silicate/zinc-substituted strontium apatite coating improves the osteoinductive properties of ß-tricalcium phosphate bone graft substitute.

BACKGROUND: ß-Tricalcium phosphate (ß-TCP) is a popular synthetic bone graft substitute with excellent osteoconductive properties and bioabsorbability. However, its osteoinductive properties are inferior to those of autologous or allogeneic bone. Trace elements such as strontium (Sr), silica (Si), and zinc (Zn) have been reported to promote osteogenesis in materials. In this study, we aimed to determine whether a Si/Zn-substituted Sr apatite coating of ß-TCP could enhance osteoinductive properties. METHODS: The apatite-coated ß-TCP disks were prepared using nanoparticle suspensions of silicate-substituted Sr apatite (SrSiP) or silicate- and Zn-co-substituted Sr apatite (SrZnSiP). Bone marrow mesenchymal cells (BMSCs) from rat femur were cultured and subsequently seeded at a density of 1.0 × 106/cm2 onto apatite-coated and non-coated ß-TCP disks. In vitro, the ß-TCP disks were then placed in osteogenic medium, and lactate dehydrogenase (LDH) activity was measured from supernatants after culture for 2 days. Additionally, after culture for 14 days, the mRNA expression of genes encoding osteocalcin (OC), alkaline phosphatase (ALP), bone morphogenetic protein-2 (BMP-2), and vascular endothelial growth factor (VEGF) was evaluated by qRT-PCR. In vivo, the ß-TCP disks were transplanted subcutaneously into rats that were sacrificed after 4 weeks. Then, the harvested disks were evaluated biochemically (ALP activity, OC content, mRNA expression of OC, ALP, BMP-2, and VEGF measured by qRT-PCR), radiologically, and histologically. RESULTS: Significantly higher mRNA expression of almost all evaluated osteogenic and angiogenic genes was observed in the SrZnSiP and SrSiP groups than in the non-coated group, with no significant cytotoxicity elicited by the apatite coating in vitro. Moreover, in vivo, the SrZnSiP and SrSiP groups showed significantly higher osteogenic and angiogenic gene expression and higher ALP activity and OC content than the non-coated group (P < 0.05). Radiological and histopathological findings revealed abundant bone formation in the apatite-coated group. CONCLUSIONS: Our findings indicate that apatite coating of ß-TCP improves osteoinductive properties without inducing significant cytotoxicity.

The expression of human testis-specific actin capping protein predicts in vitro fertilization outcomes: A novel biomarker of sperm function for assisted reproductive technology.

PURPOSE: Sperm function tests do not adequately assess fertilization potential, and new indices are required. We have previously reported that human testis-specific actin capping proteins may be involved in both sperm morphology and function. This study aimed to determine whether testis-specific actin capping proteins can be a predictive marker of IVF success. METHODS: Ninety-seven infertile couples who underwent IVF at an infertility clinic were included. Sperm were immunohistochemically stained to evaluate capping protein expression, and the percentage of sperms with normal staining was calculated. The relationship between actin capping protein expression and IVF outcomes was examined. RESULTS: The couples were divided into four groups according to the percentage of normally expressing actin capping protein as follows: ≥90% Group Ⅰ, 80%-90% Group Ⅱ, 70%-80% Group Ⅲ, and <70% Group Ⅳ. Multiple regression analysis showed a significant trend in fertilization rates across the 4 groups (p for trend =0.008).There was no significant trend in pregnancy rates (p for trend =0.276). CONCLUSION: The human testis-specific actin capping protein may be a marker of male contributing factors that predict IVF outcomes.

Discovery and structure-activity relationships study of positive allosteric modulators of the M3 muscarinic acetylcholine receptor.

The M3 muscarinic acetylcholine receptor (mAChR) is a member of the family of mAChRs, which are associated with a variety of physiological functions including the contraction of various smooth muscle tissues, stimulation of glandular secretion, and regulation of a range of cholinergic processes in the central nerve system. We report here the discovery and a comprehensive structure--activity relationships (SARs) study of novel positive allosteric modulators (PAMs) of the M3 mAChR through a high throughput screening (HTS) campaign. Compound 9 exhibited potent in vitro PAM activity towards the M3 mAChR and significant enhancement of muscle contraction in a concentration-dependent manner when applied to isolated smooth muscle strips of rat bladder. Compound 9 also showed excellent subtype selectivity over other subtypes of mAChRs including M1, M2, and M4 mAChRs, and moderate selectivity over the M5 mAChR, indicating that compound 9 is an M3-preferring M3/M5 dual PAM. Moreover, compound 9 displayed acceptable pharmacokinetics profiles after oral dosing to rats. These results suggest that compound 9 may be a promising chemical probe for the M3 mAChR for further investigation of its pharmacological function both in vitro and in vivo.