A new Schiff base-fabricated pencil lead electrode for the efficient detection of copper, lead, and cadmium ions in aqueous media.

Cu2+, Pb2+, and Cd2+ were individually and simultaneously determined using a novel and effective electroanalytical approach that has been devised and improved. Cyclic voltammetry was used to examine the electrochemical properties of the selected metals, and their individual and combined concentrations were determined by square wave voltammetry (SWV) using a modified pencil lead (PL) working electrode functionalized with a freshly synthesized Schiff base, 4-((2-hydroxy-5-((4-nitrophenyl)diazenyl)benzylidene)amino)benzoic acid (HDBA). In a buffer solution of 0.1 M tris-HCl, heavy metal concentrations were determined. To improve the experimental circumstances for determination, scan rate, pH, and their interactions with current were studied. At some concentration levels, the calibration graphs for the chosen metals were linear. The concentration of each metal was altered while the others remained unchanged for both the individual and simultaneous determination of these metals, and the devised approach was proven to be accurate, selective, and rapid.

1,3-Dipolar Cycloaddition of 3-Chromonyl-Substituted Glycine Imino Esters with Arylidenes and in†situ Diastereodivergent via Retrocycloaddition.

1,3-Dipolar cycloaddition through in situ generation of azomethine ylide provides a straightforward and critically important sustainable approach for access to diverse pyrrolidine chemical space. Herein, we developed a metal-free AcOH-activated 1,3-dipolar cycloaddition protocol that permits the synthesis of uncommon pyrrolidine cycloadducts with excellent diastereoselectivity. The challenging substrates of 3-formylchromone, glycine ester.HCl and arylidene dipolarophile were reacted in the presence of AcONa, which played a dual role as a base and AcOH source, to deliver firstly endo-cycloadduct. Under prolonged reaction time at room temperature or heating; the endo-adduct underwent diastereodivergent via a sequence of retro-cycloaddition, stereomutation of the generated syn-dipole into anti-dipole and recycloaddition; to furnish the scarcely known exo'-cycloadduct with high diastereodivergency. The reaction worked well with a broad range of substrates and the stereochemistry of the obtained cycloadducts was determined without ambiguity using NMR- and X-ray analysis. Experimental and theoretical DFT calculation studies were performed to support the proposed reaction mechanism and elucidate the key role of AcOH in the process which seems more beneficial than other transition metal-catalyzed processes.

Endoscopic Versus Conventional Vein Harvest Technique: Histological and Immunohistochemical Evaluation of Venous Wall Integrity.

BACKGROUND: The introduction of endoscopic saphenous vein graft harvesting has been known for two decades. It offers benefits related to decreased rate of donner site complications. Debates related to its safety in terms of trauma to the wall of the venous graft and long-term graft patency have been raised, but few studies had investigated this point. Our aim is to compare the endoscopic saphenous vein harvest and conventional harvest techniques, in terms of the integrity of the wall of the vein graft. METHODS: A prospective study in which we examined 80 samples of saphenous vein from 80 patients to whom coronary artery bypass grafting was done. Patients randomly were assigned to either technique. Vein samples were taken from patients having the conventional technique (group 1, 40 patients) and from patients having endoscopic vein harvest (group 2, 40 patients). Vein samples were stained with Hematoxylin & Eosin, Masson's trichrome, and immunohistochemical stain for CD 31 and then examined by light microscopy. The degree of intimal staining was graded from 0% to 100%, which is directly related to the degree of intimal preservation (the least injury, the more the staining score) and vein media changes were reported. RESULTS: Patient characteristics were comparable in the groups. Group 1 (conventional group) was better than group 2 (endoscopic group), regarding endothelial integrity and medial changes although it was statistically not significant. CONCLUSION: Both the conventional and endoscopic techniques are comparable, regarding the intimal preservation of the venous graft.

Effect of titanium dioxide nanoparticles and ß-cyclodextrin polymer on physicochemical, antimicrobial, and antibiofilm properties of a novel chitosan-camphor polymer.

In this paper, chitosan (Chi) was successfully reacted with natural mono ketone namely, camphor (Cam), through a condensation reaction to obtain a novel Chi-Cam polymer. The encapsulation of Chi-Cam polymer into the cavity of ß-cyclodextrin biopolymer by inclusion complex method, and the immobilization of TiO2 NPs into Chi-Cam matrix by metal complex method were performed. A set of characterizations (XRD, FTIR, SEM, UV-Vis., optical band gap, Urbach energy, refractive index, and thermogravimetric analysis) were implemented to incorporate their properties with applications. It was not observed the existence of any strange peaks in diffractogram patterns of all prepared samples, confirming the proper preparation and high purity polymers. The crystalline index was found to be 69.41, 41.58, 58.25 and 44.2 % for Chi, Chi-Cam, polyrotaxane, and nanocomposite, respectively. High surface area, lowest pores size, and lowest pores volume were confirmed the micropores of composite, which also could provide more reactive sites, and enhancing the bioactivity. The tested Chi-Cam/TiO2 NPs possessed the highest antimicrobial impact, followed by the Chi-Cam/ß-CD towards pathogenic microbes. The highest % inhibition of biofilm formation by Chi-Cam, Chi-Cam/ß-CD, and Chi-Cam/TiO2 NPs was noted for S. aureus (40.05 %, 80.21 %, and 87.49 %), E. coli (38.56 %, 74.32 % and 83.32 %), P. aureginosa (32.12 %, 58.80 %, and 74.53 %), and C. albicans (13.69 %, 27.89 % and 70.89 %), respectively. The obtaining findings pave the route towards useful utilization of potential materials for biomedical applications.

Crystal structure and Hirshfeld surface analysis of N-[(Z)-(2-hy-droxy-phen-yl)methyl-idene]aniline N-oxide.

The conformation of the title compound, C13H11NO2, is partially determined by a strong, intra-molecular O-H⋯O hydrogen bond. The crystal packing consists of strongly corrugated layers parallel to the ac plane and associated through C-H⋯π(ring) inter-actions. A Hirshfeld surface analysis of the crystal structure indicates that the most significant contributions to the crystal packing are from H⋯H (44.1%), C⋯H/H⋯C (29.4%) and O⋯H/H⋯O (17.3%) contacts.

Nitro-Substituted Benzaldehydes in the Generation of Azomethine Ylides and Retro-1,3-Dipolar Cycloadditions.

1,3-Dipolar cycloaddition of 2- and 3-nitrobenzaldehydes with 2-aminomethylpyridine and ethyl (2E)-2-cyano-3-(4-nitrophenyl)prop-2-enoate yielded endo-cycloadducts as the sole products under various reaction conditions. Fortuitously, 4-nitrobenzaldehyde behaved differently in three- and four-component cascades to produce a mixture of endo- and exo'-cycloadducts. This reaction is solvent- and temperature-dependent, and consequently, both the endo- and exo'-cycloadducts were synthesized in an excellent regio-, stereo-, and chemoselective fashion. Retro-1,3-dipolar cycloadditions of the endo-cycloadducts were conducted under mild reaction conditions, and the generated syn-dipoles were stereomutated into anti-dipoles which recycloadded with the dipolarophiles to provide the exo'-cycloadducts. Mechanistic studies were carried out to support the proposed mechanisms. Unprecedentedly, particular arylidene scaffolds participated as aldehyde or activated methylene precursors. Density functional theory calculations were performed to shed light on the importance of AcOH in the generation and isomerization of dipoles and to explain the high selectivity and the possibility of retro-cycloaddition.

Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma.

BACKGROUND: According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. OBJECTIVES: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. MATERIALS AND METHODS: We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. RESULTS: During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5years (95% CI=72.6-78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0±4.6 vs. 4.1±3.0, p=0.002) and lower hemoglobin (8.1±1.8 vs. 11.9±2.2, p<0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding. CONCLUSION: We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding.

Assessing clinical probability of pulmonary embolism: prospective validation of the simplified Geneva score.

Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice. SUMMARY: Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 µg L-1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.

Assessment of urinary dipstick in patients admitted to an ED for blunt abdominal trauma.

INTRODUCTION: Clinicians still face significant challenge in predicting intra-abdominal injuries in patients admitted to an emergency department for blunt abdominal trauma. This study was thus designed to investigate the value of dipstick urinalysis in patients with blunt abdominal trauma. METHODS: We performed a retrospective, multicenter, cohort study involving patients admitted to the emergency department for abdominal traumas, examined by means of urinary dipstick and abdominal CT scan. The primary endpoint was the correlation between microscopic hematuria detected via dipstick urinalysis (defined by the presence of blood on the dipstick urinalysis but without gross hematuria) and abdominal injury, as evidenced on CT scan. RESULTS: Of the 100 included patients, 56 experienced microscopic hematuria, 17 gross hematuria, and 44 no hematuria. Patients with abdominal injury were more likely to present with hypovolemic shock (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 2.7-26), abdominal wall hematoma (OR: 3.1; 95% CI: 1.2-7.9), abdominal defense (OR: 5.2; 95% CI: 1.8-14.5), or anemia (OR: 3.6; 95% CI: 1.2-10.3). Moreover, dipstick urinalysis was less likely to predict injury, with just 72.2% sensitivity (95% CI: 54.8-85.8), 53.1% specificity (95% CI: 40.2-65.7), and positive and negative predictive values of 46.4% (95% CI: 33.0-60.3) and 77.3% (95% CI: 62.2-88.5), respectively. CONCLUSION: Dipstick urinalysis was neither adequately specific nor sensitive for predicting abdominal injury and should thus not be used as a key assessment component in patients suffering from blunt abdominal trauma, with physical exam and vital sign assessment the preferred choice.

Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.

OBJECTIVES: Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years. PATIENTS AND METHODS: This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623. RESULTS: Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits. CONCLUSIONS: These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study.

A facile palladium catalysed 3-component cascade route to functionalised isoquinolinones and isoquinolines.

Palladium catalysed three component cascade process, involving coupling of 2-iodobenzoates, -benzaldehydes, or acetophenones with substituted allenes and ammonium tartrate as an ammonium surrogate, provides a novel and facile route to substituted functionalised isoquinolinones and isoquinolines in good yields.

[Retrospective study about 73 consecutive patients treated by direct oral anticoagulant and admitted to an emergency room]. / Étude rétrospective concernant 73 patients traités par un anticoagulant oral direct admis consécutivement dans un service d'urgence.

INTRODUCTION: Direct oral anticoagulants are a recent alternative to vitamin K antagonists but there is a lack of data regarding patients receiving these new types of treatment. The aim of the study was to identify and describe patients receiving direct oral anticoagulants admitted to an emergency unit. METHODS: All the patients taking direct oral anticoagulants, admitted to the emergency room of the Clermont-Ferrand Hospital from January to August 2013, were included in this retrospective and descriptive study. RESULTS: Among the 73 patients included, 47.9% were treated with dabigatran and 52.1% with rivaroxaban. The indication was stroke prevention in 62 patients with atrial fibrillation whose average CHADS2 score was 2.6 [2.3-3](IC95%). The average age was 76.4 years [73.7-79.1](IC95%). Twenty-nine patients (39.7%) had at least one drug association known for increasing the risk of bleeding. Average scores for bleeding risk were: HAS-BLED 3.1 [2.9-3.3](IC95%) and Beyth 1.5 [1.3-1.6](IC95%). Bleeding patients included a higher percentage of men (68.8 vs. 38.2%, P=0.032). Creatinine clearance was lower in patients with major bleeding (45.2% vs. 68.8 mL/min, P=0.002). The Beyth score was highest in both sub-groups. CONCLUSION: In our study, we have found that the bleeding risk factors were: male gender, a high Beyth score, and a lowered creatinine clearance. Overall, patients treated with direct oral anticoagulants admitted to the emergency room were old with many co-morbidities, especially cardiovascular conditions; polymedication was frequent.

Assessment of detached podocytes in the Bowman's space as a marker of disease activity in lupus nephritis.

Podocyte damage is an important pathogenic component of glomerular disease progression. This study is a trial to clarify the value of counting and scoring the number of shed Bowman's space podocytes as an activity parameter of lupus nephritis, a trial that has not been conducted before. This study was performed on 42 female patients with the clinical diagnosis of lupus nephritis. Beside the routine stains tissue sections were stained by colloidal iron and anti podocalyxin for sialomucin. Podocytes in the Bowman's space were counted and scored. Thorough statistical work was carried out to correlate the podocyte scores with the morphological lesions of lupus nephritis. This study revealed significant association and correlation of shed Bowman's space podocytes with histopathological parameters of activity in different classes of lupus nephritis. We concluded that counting and scoring shed Bowman's space podocytes is statistically significant as a marker of disease activity in lupus nephritis. It can be one of the parameters of activity index but not of chronicity index.

Stereoselective Pd(0) catalysed five component cascade synthesis of complex Z,Z-bisallylamines.

Catalytic 5-component cascade chemistry provides an effective stereo- and regioselective route to novel multi-functional Z,Z-bisallylamines. The process, which is capable of considerable further extension, utilises ammonium tartrate as a novel ammonia source which avoids the use of ammonia gas or aqueous ammonia.

Exploiting adamantane as a versatile organic tecton: multicomponent catalytic cascade reactions.

3- And 9-component Pd(0) catalysed assembly of allenes, aryl iodides and N-nucleophiles with concomitant installation of trisubstituted Z-alkenes is readily achieved.