Clinical Decision Making in Inflammatory Bowel Disease Mimics: Practice Management from Inflammatory Bowel Disease LIVE.

Background: Since 2009, inflammatory bowel disease (IBD) specialists have utilized "IBD LIVE," a weekly live video conference with a global audience, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed IBD, a substantial number were diseases that mimic IBD. We have categorized all IBD LIVE cases and identified "IBD-mimics" with consequent clinical management implications. Methods: Cases have been recorded/archived since May 2018; we reviewed all 371 cases from May 2018-February 2023. IBD-mimics were analyzed/categorized according to their diagnostic and therapeutic workup. Results: Confirmed IBD cases made up 82.5% (306/371; 193 Crohn's disease, 107 ulcerative colitis, and 6 IBD-unclassified). Sixty-five (17.5%) cases were found to be mimics, most commonly medication-induced (n = 8) or vasculitis (n = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies (n = 13, 21%), surgical exploration/pathology (n = 10, 16.5%), biopsies from outside the GI tract (n = 10, 16.5%), genetic/laboratory testing (n = 8, 13%), extensive review of patient history (n = 8, 13%), imaging (n = 5, 8%), balloon enteroscopy (n = 5, 8%), and capsule endoscopy (n = 2, 3%). Twenty-five patients (25/65, 38%) were treated with biologics for presumed IBD, 5 of whom subsequently experienced adverse events requiring discontinuation of the biologic. Many patients were prescribed steroids, azathioprine, mercaptopurine, or methotrexate, and 3 were trialed on tofacitinib. Conclusions: The diverse presentation of IBD and IBD-mimics necessitates periodic consideration of the differential diagnosis, and reassessment of treatment in presumed IBD patients without appropriate clinical response. The substantial differences and often conflicting treatment approaches to IBD versus IBD-mimics directly impact the quality and cost of patient care.

Alimentación basada en plantas: la nueva tendencia nutricional / Plant-based diets: the new nutritional trend

En la actualidad cada vez más familias optan por seguir una alimentación basada en plantas (ABP). Es fundamental que pediatras y agentes de salud conozcan estos tipos de patrones alimentarios para asesorar adecuadamente a sus pacientes y derivarlos oportunamente a especialistas capacitados con el objetivo de garantizar un adecuado crecimiento y desarrollo principalmente en la edad pediátrica, evitando posibles consecuencias negativas sobre la salud. La mayoría de las sociedades científicas del mundo considera a las dietas vegetarianas apropiadas para todas las etapas de la vida si están correctamente planificadas, suplementadas y con un seguimiento adecuado por especialistas capacitados. Con respecto a las dietas veganas existen controversias por parte de las distintas sociedades con respecto a si son adecuadas o no en pediatría. Recientemente se han revisado las descripciones respecto a las tipificaciones de una ABP y se ha propuesto una definición estándar de estos tipos de dieta. Los riesgos más significativos asociados a la mala planificación de estas dietas son las deficiencias de calcio, vitamina D y vitamina B12, aunque también se debe tener en cuenta el estado del zinc, selenio, yodo y los ácidos grasos Omega 3. Es importante la planificación diaria de un plato nutricionalmente completo y es incuestionable que quienes siguen estos patrones alimentarios reciban suplementos con vitamina B12 adecuados para cada etapa de la vida. Se requieren más estudios en pediatría para evaluar los efectos de las distintas ABP sobre la ingesta de nutrientes, el estado nutricional, el crecimiento, desarrollo y la prevención de enfermedades no transmisibles (AU)

Currently, an increasing number of families are choosing to follow a plant-based diet (PBD). It is essential that pediatricians and healthcare agents know these types of dietary patterns in order to properly advise their patients and refer them to trained specialists to ensure adequate growth and development, especially in the pediatric age, avoiding possible negative health consequences. Most of the world's scientific societies consider vegetarian diets appropriate for all stages of life if they are adequately planned, supplemented and monitored by trained specialists. However, there is controversy among different societies regarding the appropriateness of vegan diets for children. Recently, there has been a review of descriptions concerning the characteristics of a plant-based diet, leading to a proposed standard definition for these types of diets. The most significant risks associated with poorly planned diets are calcium, vitamin D, and vitamin B12 deficiencies, although zinc, selenium, iodine and omega-3 fatty acid status should also be considered. The daily planning of a nutritionally complete meal is important and it is imperative that those who follow these dietary patterns receive vitamin B12 supplementation appropriate for each stage of life. Further studies in children are needed to evaluate the effects of different PBDs on nutrient intake, nutritional status, growth, development, and prevention of noncommunicable diseases (AU)

Structure and reactivity studies of the aluminum analogue of Piers' borane [HAl(C6F5)2]3.

The aluminum analogue of Piers' borane, [HAl(C6F5)2]31, is prepared on a gram-scale. Density functional theory (DFT) calculations reveal 1 has a higher fluoride ion affinity (FIA) than Piers' borane, while the Al-H moiety proved to be a strong hydride donor, reacting with alcohol and terminal alkyne to give the corresponding dehydrogenative products 3 and 4. Hydroalumination product 5 was prepared via reaction of 1 with aldehyde. In addition, 1 catalyzes the hydrosilylation of alkynes and alkenes.

Five years of national policies: progress towards tackling obesity in England.

Obesity is a major burden on the health system in England and the rest of the UK. Obesity prevalence is high in adults and children and most of the UK population are consuming more energy than required, and not meeting other dietary recommendations, including those for saturated fat, free sugars, fibre, oily fish and fruit and vegetables. Over the past 5 years, a number of cross-government policies, both promoting voluntary action and legislative, have been put in place to tackle diet-related health and obesity. The food environment is complex with many influencing factors, some of which act through individual automatic choices. Other factors such as accessibility, advertising, promotion and nudging drive increased food and drink purchases. With continual changes in the food environment favouring fast-food outlets and meal delivery companies alongside the adverse impact of the COVID-19 pandemic on diets and physical activity levels, further governmental action is likely needed to deliver sustained improvements to diet and health.

Visible DNA microarray and loop-mediated isothermal amplification (LAMP) for the identification of Cryptococcus species recovered from culture medium and cerebrospinal fluid of patients with meningitis.

Cryptococcal meningitis affects normal hosts and immunocompromised patients exhibiting high mortality rates. The objective of this study was to design two molecular assays, visible microarray platforms and loop-mediated isothermal amplification (LAMP), to identify Cryptococcus spp. and the species neoformans and gattii from the cerebral spinal fluid (CSF). To identify Cryptococcus and the two species, we designed two microarrays DNA platforms based on the internal transcribed spacer (ITS) region and CAP59 gene and LAMP assays specific for Cryptococcus species. The assays were tested using CSF from patients with cryptococcal meningitis. CSF from patients with cryptococcal meningitis was cultured in Sabouraud culture medium, and the Cryptococcus spp. grown in the culture medium were also tested for LAMP and microarray platforms. The results were compared to DNA sequencing of the same genetic regions. A total of 133 CSF samples were studied. Eleven CSFs were positive for Cryptococcus (9 C. neoformans and 2 C. gattii), 15 were positive for bacteria, and 107 were negative. The CAP59 platform correctly identified 73% of the CSF samples, while the ITS platform identified 45.5%. CAP59 platform correctly identified 100% of the Cryptococcus isolates, and ITS platform identified 70%. The two sets of LAMP primers correctly identified 100% of the Cryptococcus isolates. However, for CSF samples, the amplification occurred only in 55.5% of C. neoformans. The methodologies were reliable in the identification of Cryptococcus species, mainly for isolates from culture medium, and they might be applied as adjunctive tests to identify Cryptococcus species.

Modeling uranium and 226Ra mobility during and after an acidic in situ recovery test (Dulaan Uul, Mongolia).

This article presents the results of groundwater monitoring over a period of six years and the interpretation of these results by a reactive transport model, following an In Situ Recovery (ISR) test on the Dulaan Uul uranium deposit in Mongolia. An environmental monitoring survey was set up using 17 piezometers, from which it has been possible to describe the changes in the water composition before, during and after the ISR test. The water quality before the start of mining activities rendered it unfit for human consumption. During and after the test, a descent of the saline plume was observed, resulting in a dilution of the injection solutions. After a rapid decrease to pH = 1.13 during the production phase of the ISR test, the pH stabilized at around 4 in the production area and 5.5 below the production cell one year after the end of the test. Uranium and radium were being naturally attenuated. Uranium returned to background concentrations (0.3 mg/L) after two years and the measured 226Ra concentrations represent no more than 10% of the expected concentrations during production (75 Bq/L). The modeling of the contaminants of concern mobility, namely pH and concentrations of sulfate, uranium and 226Ra, is based on several key complementary mechanisms: density flow, cation exchange with clay minerals and co-precipitation of 226Ra in the barite. The modeling results show that the observed plume descent and sulfate dilution can only be predicted if consideration of a high-density flow is included. Similarly, the changes in pH and 226Ra concentration are only correctly predicted when the cationic exchanges with the clays and the co-precipitation reaction within the barite using the solid solution theory are integrated into the models. Finally, the proper representation of the changes in water composition at the scale of the test requires the use of a sufficiently fine mesh (1 m × 1 m cell) to take into account the spatial variability of hydrogeological (permeability distribution in particular) and geological (reduced, oxidized and mineralized facies distributions) parameters.

An arene-stabilized η5-pentamethylcyclopentadienyl antimony dication acts as a source of Sb+ or Sb3+ cations.

Double chloride abstraction from Cp*SbCl2 (Cp* = pentamethylcyclopentadienyl) affords an arene-stabilized η5-Cp*-bound antimony dicationic compound [(η5-Cp*)Sb(tol)][B(C6F5)4]2 (1) (tol = toluene), which exhibits strong Lewis acidity, abstracting chloride from Ph3CCl. 1 reacts with different Lewis bases via divergent pathways, giving rise to release of either Sb+ or Sb3+ cations.

The management of the hospitalized ulcerative colitis patient: the medical-surgical conundrum.

PURPOSE OF REVIEW: In this review article, we address emerging evidence for the medical and surgical treatment of the hospitalized patient with ulcerative colitis. RECENT FINDINGS: Ulcerative colitis is a chronic inflammatory disease involving the colon and rectum. About one-fifth of patients will be hospitalized from ulcerative colitis, and about 20-30%, experiencing an acute flare will undergo colectomy. Because of the significant clinical consequences, patients hospitalized need prompt evaluation for potential complications, stratification of disease severity, and a multidisciplinary team approach to therapy, which involves both the gastroenterologist and surgeon. Although corticosteroids remain first-line therapy, second-line medical rescue options, primarily infliximab or cyclosporine, are considered within 3-5 days of presentation. In conjunction, an early surgical consultation to present the possibility of a staged proctocolectomy as one of the therapeutic options is equally important. SUMMARY: A coordinated multidisciplinary, individualized approach to treatment, involving the patient preferences throughout the process, is optimal in providing patient-centered effective care.

Reactions of carbene-stabilized borenium cations.

In this paper we probe the reactivity of the borenium cations [C3H2(NCH2C6H4)(NCH2Ph)BH][B(C6F5)4] 2 and [C3H2(NCH2C6H4)2B][B(C6F5)4] 3. The reactions of 2 with cyclohexene or 3,3-dimethyl-1-butene gave the alkyl-aryl borenium salts [PhCH2(CHN)2CCH2C6H4BR][B(C6F5)4] (R = Cy 4, CH2CH2tBu 5) while the corresponding reactions with diphenylacetylene, 1-hexyne and 1-phenyl-1-propyne gave the aryl-alkenyl borenium cation salts [PhCH2(CHN)2CCH2C6H4BC(R1)C(H)R2][B(C6F5)4] (R1 = R2 = Ph 6, R1 = H, R2 = C4H97, R1 = Me, R2 = Ph 8a, R1 = Ph, R2 = Me 8b). In contrast, the reaction of 2 with ethynyldiphenylphosphane or 2-vinylpyridine lead to the formation of the adducts, [PhCH2(CHN)2CCH2C6H4B(H)P(Ph2)CCH][B(C6F5)4] 9, [PhCH2(CHN)2CCH2C6H4B(H)NC5H4C(H)CH2][B(C6F5)4] 10, respectively, while the more bulky donor H2C[double bond, length as m-dash]C(Ph)PMes2 gave 1,2-hydroboration of the phosphinoalkene affording [PhCH2(CHN)2CCH2C6H4BCH2CH(Ph)PMes2][B(C6F5)4] 11. In another vein of reactivity, one or two equivalents of the FLP, PtBu3/B(C6F5)3 is shown to react with 3 to give the zwitterionic borenium-borate species [C2H2(NCH(BC(CHNCH2C6H4)2)C6H4)(NCH(B(C6F5)3)C6H4)CB] 12 and the anionic bis-borate species[tBu3PH][C2H2(NCH(B(C6F5)3)2C6H4)2CB] 13. The implications of these findings are discussed.

Visible DNA microarray and loop-mediated isothermal amplification (LAMP) for the identification of Cryptococcus species recovered from culture medium and cerebrospinal fluid of patients with meningitis

Cryptococcal meningitis affects normal hosts and immunocompromised patients exhibiting high mortality rates. The objective of this study was to design two molecular assays, visible microarray platforms and loop-mediated isothermal amplification (LAMP), to identify Cryptococcus spp. and the species neoformans and gattii from the cerebral spinal fluid (CSF). To identify Cryptococcus and the two species, we designed two microarrays DNA platforms based on the internal transcribed spacer (ITS) region and CAP59 gene and LAMP assays specific for Cryptococcus species. The assays were tested using CSF from patients with cryptococcal meningitis. CSF from patients with cryptococcal meningitis was cultured in Sabouraud culture medium, and the Cryptococcus spp. grown in the culture medium were also tested for LAMP and microarray platforms. The results were compared to DNA sequencing of the same genetic regions. A total of 133 CSF samples were studied. Eleven CSFs were positive for Cryptococcus (9 C. neoformans and 2 C. gattii), 15 were positive for bacteria, and 107 were negative. The CAP59 platform correctly identified 73% of the CSF samples, while the ITS platform identified 45.5%. CAP59 platform correctly identified 100% of the Cryptococcus isolates, and ITS platform identified 70%. The two sets of LAMP primers correctly identified 100% of the Cryptococcus isolates. However, for CSF samples, the amplification occurred only in 55.5% of C. neoformans. The methodologies were reliable in the identification of Cryptococcus species, mainly for isolates from culture medium, and they might be applied as adjunctive tests to identify Cryptococcus species.

Base-Stabilized [PO]+ /[PO2 ]+ Cations.

The salts [(BAC)2 PO][BF4 ] (5) and [(BAC)2 PO2 ][BF4 ] (4) (BAC=bis(diisopropylamino) cyclopropenylidene), consisting of the PO+ and PO2 + cations, respectively, coordinated to the singlet carbenes, have been prepared. Computational investigations reveal that the electronic structure of the PO+ cation is a hybrid between the charge-localized and charge-delocalized resonance forms, resulting in ambiphilic reactivity. Compound 5 reacts as a donor with the transition-metal complex K2 PtCl4 to furnish [[(BAC)2 PO]2 PtCl2 ][BF4 ]2 (6) and KCl. Remarkably, both 5 and 4 have shown to act as electrophiles undergoing reactions with fluoride anion, leading to [OPF2 ]- and (BAC)PO2 F, respectively.

Single Electron Transfer to Diazomethane-Borane Adducts Prompts C-H Bond Activations.

While (Ph2 CN2 )B(C6 F5 )3 is unstable, single electron transfer from Cp*2 Co affords the isolation of stable products [Cp*2 Co][Ph2 CNNHB(C6 F5 )3 ] 1 and [Cp*Co(C5 Me4 CH2 B(C6 F5 )3 )] 2. The analogous combination of Ph2 CN2 and BPh3 showed no evidence of adduct formation and yet single electron transfer from Cp*2 Cr affords the species [Cp*2 Cr][PhC(C6 H4 )NNBPh3 ] 3 and [Cp*2 Cr][Ph2 CNNHBPh3 ] 4. Computations showed both reactions proceed via transient radical anions of the diphenyldiazomethane-borane adducts to effect C-H bond activations.

Phosphaaluminirenes: Synthons for Main Group Heterocycles.

The phosphaaluminirenes HC[(CMe)(NDipp)]2Al[C(R)═P] (Dipp = 2,6-i-Pr2C6H3, R = tBu or adamantyl) 2 and 3, featuring an unsaturated three-membered AlCP ring, have been synthesized as crystalline solids via a [1 + 2] cycloaddition reaction of the aluminum(I) complex HC[(CMe)(NDipp)]2Al (1) with phosphaalkynes. Computational investigations infer three-centered 2π-electron aromaticity of the AlCP rings. Compound 3 is readily protonated by tBuOH to induce a ring-opening σ-bond metathesis, giving an alumina-substituted P-hydrogeno phosphaalkene 4. Remarkably, the high strain of the AlCP ring of 3 allows for facile ring enlargement in reactions with CyNC, bis(diisopropylamino) cyclopropenylidene (BAC), elemental Se, Ph2CO, PhCH═CHCOPh, and PhCN at room temperature. These furnish a series of unprecedented main group heterocycles 5-10 with the C═P unsaturated bonds remaining intact. The mechanisms are considered in light of thorough density functional theory (DFT) calculations.

Oligomerization of phosphaalkynes mediated by bulky N-heterocyclic carbenes: avenues to novel phosphorus frameworks.

Reactions of RC[triple bond, length as m-dash]P (R = tBu or Ad (admantyl)) with NHCs (SIMes, 1a; IMes, 1b and IDipp, 1d), leading to 1,2,3-triphosphetenes 2 and 3, a triphosphole 4, and a di-1,2-dihydro-1,2-diphosphete-substituted diphosphene 5, are reported. Compound 5 represents a novel P6 chain framework, as well as a newly discovered phosphaalkyne hexamer stabilized by two NHCs. Computational investigations suggest that the weak π-accepting ability of NHCs results in low stability of the initially formed 2H-phosphirenes, thus facilitating spontaneous oligomerization reactions. Such oligomerizations are highly susceptible to the electronic property and steric bulk of NHCs.

Reversible Intramolecular Cycloaddition of Phosphaalkene to an Arene Ring.

The phosphepinium cation 1 is deprotonated by base generating a phosphaalkene that undergoes cycloaddition to the N-bound aromatic ring affording the 2-phosphabicyclo[2.2.2]octa-5,7-diene 2. The analogous deprotonation reaction of the less bulky phosphepinium cation 3 affords a reversible equilibrium between the phosphaalkene 4 and the corresponding cycloaddition product 5. This latter observation represents the first reversible cycloaddition of a main group multiply bonded species with an arene ring. The bicyclic species 2 was also shown to be oxidized or alkylated in reactions with S8 and MeOTf, affording 6 and 7, respectively. This finding and its implications for related cycloadditions of other main group multiply bonded species are considered computationally.

The Arene-Stabilized η5 -Pentamethylcyclopentadienyl Arsenic Dication [(η5 -Cp*)As(toluene)]2.

Double chloride abstraction of Cp*AsCl2 gives the dicationic arsenic species [(η5 -Cp*)As(tol)][B(C6 F5 )4 ]2 (2) (tol=toluene). This species is shown to exhibit Lewis super acidity by the Gutmann-Beckett test and by fluoride abstraction from [NBu4 ][SbF6 ]. Species 2 participates in the FLP activation of THF affording [(η2 -Cp*)AsO(CH2 )4 (THF)][B(C6 F5 )4 ]2 (5). The reaction of 2 with PMe3 or dppe generates [(Me3 P)2 As][B(C6 F5 )4 ] (6) and [(σ-Cp*)PMe3 ][B(C6 F5 )4 ] (7), or [(dppe)As][B(C6 F5 )4 ] (8) and [(dppe)(σ-Cp*)2 ][B(C6 F5 )4 ]2 (9), respectively, through a facile cleavage of C-As bonds, thus showcasing unusual reactivity of this unique As-containing compound.

Facile Cleavage of the P=P Double Bond in Vinyl-Substituted Diphosphenes.

The reactions of the cyclic alkyl amino carbene (CAAC) 1 with phosphaalkynes generate the kinetically unstable CAAC-derived phosphirenes 4 and 5, which undergo rearrangement/dimerization reactions to give the vinyl-substituted diphosphenes 2, 3, and 6. The P=P double bond scission of 2 or 3 is unprecedentedly effected by S8 , [AuCl(tht)], or MeOTf at room temperature, which affords a dithiophosphorane 7, a phosphepine Au complex 8, or phosphepinium cations 9 and 10, respectively. The cationic species feature little homoaromaticity while representing the first examples of the phosphorus-containing analogue of the tropylium ion.

ELUCIDATING NUCLEAR SIZE CONTROL IN THE XENOPUS MODEL SYSTEM.

BACKGROUND: Nuclear size is a tightly regulated cellular feature. Mechanisms that regulate nuclear size and the functional significance of this regulation are largely unknown. Nuclear size and morphology are often altered in many diseases, such as cancer. Therefore, understanding the mechanisms that regulate nuclear size is crucial to provide insight into the role of nuclear size in disease. SCOPE AND APPROACH: The goal of this review is to summarize the most recent studies about the mechanisms and functional significance of nuclear size control using the Xenopus model system. First, this review describes how Xenopus egg extracts, embryos, and embryo extracts are prepared and used in scientific research. Next, the review focuses on the mechanisms and functional effects of proper nuclear size control that have been learned using the Xenopus system. KEY FINDINGS AND CONCLUSIONS: Xenopus is an excellent in vivo and in vitro experimental platform to study mechanisms of nuclear size control. Given its close evolutionary relationship with mammals and that most cellular processes and pathways are highly conserved between Xenopus and humans, the Xenopus system has been a valuable tool to advance biomedical research. Some of the mechanisms that regulate nuclear size include components of nuclear import such as importin α and NTF2, nuclear lamins, nucleoporins, proteins that regulate the morphology of the endoplasmic reticulum, and cytoskeletal elements.