Systematic review with meta-analysis: the efficacy and safety of tenofovir to prevent mother-to-child transmission of hepatitis B virus.

BACKGROUND: Preventing mother to child transmission of chronic hepatitis B infection in the setting of a high maternal viral load is challenging. The idea has emerged from antepartum tenofovir treatment with combination immunoprophylaxis. AIMS: To demonstrate the efficacy and safety of tenofovir to prevent mother to child transmission of hepatitis B virus. METHODS: PubMed, EMBASE, and Cochrane databases were searched through August 16, 2016. Comparative trials of second or third trimester tenofovir administration vs. controls for patients with chronic hepatitis B infection and non-comparative case series assessing mother to child transmission rates and evaluating maternal and foetal safety outcomes were included. RESULTS: Ten studies (one randomised controlled trial, four non-randomised controlled trials and five case series) that enrolled 733 women were included. The pooled results from comparative trials (599 pregnancies) showed that tenofovir significantly reduced the risk of infant hepatitis B surface antigen seropositivity by 77% (odds ratio=0.23, 95% confidence intervals=0.10-0.52, P=.0004) without heterogeneity (I2 =0%). In the case series analysis (134 pregnancies), only two cases (1.5%) of mother to child transmission with extremely high maternal viral load and non-compliance to treatment were identified. Maternal and foetal safety parameters including congenital malformation and foetal death were re-assuring. CONCLUSIONS: For pregnant women with high hepatitis B virus DNA levels, tenofovir administration in the second or third trimester can prevent mother to child transmission when combined with hepatitis B immunoglobulin and the hepatitis B vaccine. Tenofovir is safe and tolerable for both the mother and foetus.

Self-Assembled Silica Nanostructures: Simultaneous Discrimination of Handedness, Pitch and Diameter of Helical Silica Nanotubes.

The left- and right-handed helical silica nanostructures were obtained with the aid of organic templates, the formation of the nanostructures might follow a co-operation self-assembly mechanism. The chirality of the organogel self-assemblies was successfully transcribed in to the silica. The helical pitch and pore size of the silica nanotubes sensitively depended on the optical purity of the neutral gelator in the reaction mixtures.

Novel effects of sarcopenic osteoarthritis on metabolic syndrome, insulin resistance, osteoporosis, and bone fracture: the national survey.

UNLABELLED: This study compared the effects sarcopenic osteoarthritis on metabolic syndrome, insulin resistance, osteoporosis, and bone fracture. By using national survey data, we suggest that the relationship between sarcopenia and metabolic syndrome or insulin resistance is potentiated by the severity of osteoarthritis and is independent of body weight. INTRODUCTION: Sarcopenia and osteoarthritis are known risk factors for metabolic syndrome. However, their combined effects on metabolic syndrome, insulin resistance and osteoporosis remain uncertain. METHODS: We used data from the fifth Korean National Health and Nutrition Examination Survey using a total of 3158 adults (age >50 years). Sarcopenia was defined as a skeletal muscle index score (appendicular skeletal muscle mass/body weight) within the fifth percentile of sex-matched younger reference participants. Radiographic knee osteoarthritis was defined as a Kellgren-Lawrence (K-L) grade of 2 or greater. Metabolic syndrome was diagnosed using the National Cholesterol Education Program criteria. Insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance index (HOMA-IR). Osteoporosis was defined using the World Health Organization T-score criteria. RESULTS: In multivariable logistic regression analysis, the sarcopenic osteoarthritis group had a higher odds ratio (OR) for metabolic syndrome (OR = 11.00, 95 % confidential interval (CI) = 2.12-56.99, p = 0.013) than the non-sarcopenic osteoarthritis (OR = 1.02, 95 % CI = 0.65-1.62, p = 0.972) and sarcopenic non-osteoarthritis groups (OR = 7.15, 95 % CI = 1.57-32.53, p = 0.027). Similarly, sarcopenic osteoarthritis had a greater OR of highest HOMA-IR quartiles (OR = 8.19, 95 % CI = 2.03-33.05, p = 0.003) than the other groups. Overall, the association between the K-L grade and body mass index was significant; however, this significance was lower in individuals with sarcopenia and was lost in those with sarcopenic osteoarthritis. Additionally, osteoporosis and bone fracture were not associated to sarcopenic osteoarthritis (p > 0.05). CONCLUSIONS: These results suggest that the relationship between sarcopenia and metabolic syndrome or insulin resistance is potentiated by the severity of osteoarthritis and is independent of body weight.

Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma.

BACKGROUND: Robot-assisted gastrectomy (RAG) has been developed in the hope of improving surgical quality and overcoming the limitations of conventional laparoscopically assisted gastrectomy (LAG) and open gastrectomy (OG) for gastric cancer. The aim of this study was to determine the extent of evidence in support of these ideals. METHODS: A systematic review of the three operation types (RAG, LAG and OG) was carried out to evaluate short-term outcomes including duration of operation, retrieved lymph nodes, estimated blood loss, resection margin status, technical postoperative complications and hospital stay. RESULTS: Nine non-randomized observational clinical studies involving 7200 patients satisfied the eligibility criteria. RAG was associated with longer operating times than LAG and OG (weighted mean difference 61.99 and 65.73 min respectively; P ≤ 0.001). The number of retrieved lymph nodes and the resection margin length in RAG were comparable with those of LAG and OG. Estimated blood loss as significantly less in RAG than in OG (P = 0.002), but not LAG. Mean hospital stay for RAG was similar to that for LAG (P = 0.14). In contrast, hospital stay was significantly shorter, by a mean of 2.18 days, for RAG compared with OG (P < 0.001). Postoperative complications were similar for all three operative approaches. CONCLUSION: Short-term oncological outcomes of RAG were comparable with those of the other approaches. LAG was a shorter procedure and less expensive than RAG. Future studies involving RAG should focus on minimizing duration of operation and reducing cost.

Note on the use of reciprocity of chiral recognition in designing liquid chromatographic chiral stationary phases.

A new high-performance liquid chromatographic chiral stationary phase (CSP) was prepared from (S)-N-(3,5-dimethylbenzoyl)leucine N-phenyl N-allyl amide. The new CSP was applied for the resolution of N-(3,5-dinitrobenzoyl)-alpha-amino amides and esters and the chromatographic resolution results were compared with those on another CSP derived from (S)-N-(3,5-dimethoxylbenzoyl)leucine N-phenyl N-allyl amide. The new CSP was found to exert greater enantioselectivity than the other one. These results are contrary to what was expected from the reciprocity of chiral recognition. From these results it was concluded that the reciprocity of chiral recognition should be used with some degree of care in developing effective CSPs or in predicting chromatographic resolution behaviors.

New chiral crown ether stationary phase for the liquid chromatographic resolution of alpha-amino acid enantiomers.

A new chiral stationary phase (CSP) for the liquid chromatographic separation of enantiomers was prepared by bonding a novel enantiopure (diphenyl-substituted 1,1'-binaphthyl) crown ether to 5 microm silica gel. The resulting CSP was applied to the separation of the enantiomers of various natural and unnatural alpha-amino acids. All alpha-amino acids tested were resolved very well on the new CSP, with the exception of proline, which does not contain a primary amino group. The resolution of alpha-amino acid enantiomers on this new CSP was found to be dependent on the type and amounts of organic and acidic modifiers, and on column temperature.

Impact of triethylamine as a mobile phase additive on the resolution of racemic amino acids on an (+)-18-crown-6-tetracarboxylic acid-derived chiral stationary phase.

Recently, a new HPLC chiral stationary phase (CSP) prepared by covalently bonding (+)-(18-crown-6)-2,3,11,12-tetracarboxylic acid on silica gel was successfully employed in resolving various racemic natural and unnatural amino acids containing a primary amino group. Current work details on-going efforts to improve the effectiveness of this type of material. The analytes used in this study included various substituted phenylalanines, phenylglycine homologues and other primary amino acids. In an attempt to increase enantioselectivity, the effect of methanol and triethylamine modifiers was evaluated in an aqueous mobile phase containing sulfuric acid. In general. retention time increased with increasing methanol and triethylamine concentration. In addition, highest enantioselectivities were obtained with high methanol and high triethylamine; however, these conditions produced excessively long retention. All of the analytes were well resolved on the CSP with a mobile phase of 20% methanol containing 14.3 mM triethylamine and 10.0 mM sulfuric acid.

Liquid chromatographic resolution of biphenyl dimethyl dicarboxylate (DDB) and its analogues on a chiral stationary phase.

Racemic biphenyl dimethyl dicarboxylate (DDB) and its analogues have been successfully resolved on a commercial HPLC chiral column, (3R,4S)-Whelk-O 1. In general, cyclic amide analogues of DDB, which were derived from pyrrolidine or piperidine, showed greater enantioselectivity and greater retention than the corresponding N,N-dialkyl amide or N-alkyl amide or ester analogues. From these results, it was concluded that the carbonyl oxygen of the DDB analogues plays an important role as a hydrogen bond acceptor, though the steric bulkiness of the amide functionality of DDB analogues may be another factor governing chiral recognition. The conformational stability of the two enantiomers of DDB and its analogues was also found to be high enough for the two enantiomers to be resolvable on (3R,4S)-Whelk-O 1.

Experimental support differenciating two proposed chiral recognition models for the resolution of N-(3,5-dinitrobenzoyl)-alpha-arylalkylamines on high-performance liquid chromatography chiral stationary phases.

In rationalizing the odd chromatographic behavior for the separation of the enantiomers of N-(3,5-dinitrobenzoyl)-alpha-arylalkylamines on HPLC chiral stationary phases (CSPs) derived from alpha-(6,7-dimethyl-1-naphthyl)alkylamines, we initially suggested the occurrence of two competing, opposite sense chiral recognition processes termed the "dipole-stacking process" and the "hydrogen-bonding process". A simplified "single mechanism" model was later suggested with the importance of face to edge pi-pi interaction between aromatic rings come to recognized. The initial and subsequent chiral recognition models can be differentiated by noting the chromatographic trends for the enantioseparation of a homologous series of N-(3,5-dinitrobenzoyl)-alpha-(p-alkylphenyl)ethylamines on the aforementioned CSPs. Data so obtained were consistent with the second "single mechanism" model but not with the first "two competing mechanism" model. From these results, it has been concluded that the "single mechanism" model is more plausible than the "two competing mechanism" model.

Liquid chromatographic separation of the stereoisomers of thiazide diuretics.

A number of racemic thiazide diuretics and analogues were resolved on two diastereomeric chiral stationary phases (CSPs) prepared from (S)- or (R)-alpha-[1-(6,7-dimethyl)naphthyl]-10-dodecenylamine and (S)-2-phenylpropanoic acid. Of the two diastereomeric CSPs, the (S,S) and the (R,S), the former is found to be better than the latter in separating the enantiomers of the racemic thiazide diuretics and their analogues with complete separation being observed on the (S,S)-CSP. Chiral recognition is controlled principally by the (R)- or (S)-alpha-[1-(6,7-dimethyl)naphthyl]-10-dodecenylamine portion of the CSPs. The second stereogenic center of the CSP provides but secondary effects on the chiral recognition presumably involving, in the case of the (S,S)-CSP, face-to-edge pi-pi interaction between the aromatic ring of the analytes and the phenyl on the second stereogenic center.

Liquid chromatographic resolution of 2-hydroxycarboxylic acids on a new chiral stationary phase derived from (S)-leucine.

Enantiomers of racemic 2-hydroxycarboxylic acids have been resolved as their O-ethoxycarbonyl pi-basic anilide derivatives on a new chiral stationary phase (CSP) derived from N-(3,5-dinitrobenzoyl)leucine N-phenyl N-alkylamide and the resolution results have been compared with those on various commercial pi-acidic CSPs. The resolution results demonstrate that the new CSP derived from N-(3,5-dinitrobenzoyl)leucine N-phenyl N-alkylamide is most effective among the five CSPs tested for the resolution of 2-hydroxycarboxylic acid derivatives. In order to elucidate the chiral recognition mechanism exerted by the new CSP, the resolution of slightly differently modified derivatives of 2-hydroxycarboxylic acids on the new CSP has been investigated. Based on the resolution results, a chiral recognition mechanism utilizing three simultaneous interactions such as the face to face pi-pi interaction and the two hydrogen bonding interactions between the CSP and the more retained enantiomer of the analyte has been proposed.

Effect of the double bond pi-conjugation of the aromatic group of racemic analytes on the liquid chromatographic separation of enantiomers.

Various arylcarbinol esters were resolved on a commercial chiral column, (S, S) Whelk-O1. Among others, the analytes in which the aryl group is in conjugation with the double bond(s) to the chiral center were resolved much better on (S, S) Whelk-O1 than the corresponding non-double bonded analytes. From these results, it was proposed that the double bond pi-conjugation of the aromatic group of racemic analytes is very important for the chiral recognition. In addition, the size of the acyl group of arylcarbinol esters has been demonstrated to be important for the chiral recognition. In general, the large acyl group such as pivaloyl group was very effective for the chiral recognition of arylcarbinol esters on (S, S) Whelk-O1.

Separation of some enantiomeric di- and tripeptides on chiral stationary phases.

The chromatographic behavior of the N-3,5-dinitrobenzoyl derivatives of twelve dipeptide esters and two tripeptide esters was investigated on three different chiral stationary phases (CSPs). It is observed that the stereoisomers present in each sample may be cleanly separated on each chiral phase. A degree of regularity is noted in the elution order of the enantiomers and often of the diastereomers. Elution order of the enantiomers is related to a chiral recognition model for each CSP.

Liquid chromatographic separation of enantiomers of beta-amino acids using a chiral stationary phase.

The enantiomers of both alpha-substituted beta-alanines and beta-substituted beta-alanines may be chromatographically separated using silica-bonded chiral stationary phases derived from N-acetylated alpha-arylalkylamines. The amino acids are chromatographed as alkyl esters of N-3,5-dinitrobenzoyl derivatives; separability factors range from 1.11 to 1.65 for nine alpha-substituted beta-alanines and from 1.08 to 1.20 for nine beta-substituted beta-alanines. The enantiomers of beta-aminoisobutyrate and beta-leucine, chiral beta-amino acids occurring in animal tissues and physiological fluids, are among those resolved. The enantiomers of R,S-beta-aminoisobutyrate and several related alpha-alkyl-beta-alanines were prepared by chromatographic resolution of diastereomeric dipeptides.

A rational approach to the design of highly effective chiral stationary phases for the liquid chromatographic separation of enantiomers.

The design and rationale of some novel chiral stationary phases (CSPs) are discussed with respect to methods for determining enantiomeric purity, absolute configuration and for obtaining enantiomerically pure materials by liquid chromatography. The commercially-available dinitrobenzoylamino CSP type 1 is discussed with respect to the chiral recognition mechanisms which may operate in the resolution of some polycyclic and heterocyclic aromatic molecules and some benzodiazepines. N-Acyl alpha-arylalkylamines are also employed as models to formulate mechanisms for the chiral properties of type 1 CSPs in terms of enantiomeric stacking of the most stable conformations in solution. The properties of new types of 'reciprocal' CSPs are discussed and illustrated by enantiomeric separation of some amino acid and amino phosphoric acid derivatives, and by the separation of the following enantiomeric drugs as their 3,5-dinitrobenzoyl derivatives: metoprolol, oxoprenolol, ephedrine and alprenolol.