Ir-Catalyzed Remote Functionalization by the Combination of Deconjugative Chain-Walking and C-H Activation Using a Transient Directing Group.

An Ir-catalyzed reaction of N-benzylideneanilines with functionalized alkenes such as α,ß-unsaturated esters gave ortho-substituted benzaldehyde derivatives with a functional group at the remote position after acidic treatment. The present transformation involves deconjugative long-range isomerization (chain-walking) up to 11 times and C-H activation using an imino group as a transient directing group.

Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is considered the route of choice for long-term enteral nutrition. In this study, we evaluated the short term outcomes of PEG and aimed to identify the risk factors for in-hospital mortality as well as adverse events such as aspiration pneumonia. METHODS: Three hundred and twenty-four patients who received PEG for enteral nutrition between January 2007 and December 2011 were included in this study. Data regarding baseline characteristics, preoperative biomarkers and clinical outcomes were collected and analyzed. RESULTS: The average patient age was 82.3±10.9 (SD) years old. 149 patients (46%) were men and 199 patients (61%) had stroke as a comorbidity. Postoperatively, feeding-related aspiration pneumonia was observed in 72 patients (22%), diarrhea in 40 patients (12%) and peristomal infection in 34 patients (11%). The average postoperative length of stay was 34.6 days. 51 patients (16%) died before discharge, 22 (6.8%) of them within 30 days after PEG. Two deaths (0.6%) were considered procedure-related (bleeding). Multivariate analysis revealed the male gender, lower serum albumin levels and higher blood urea nitrogen (BUN) levels as significant prognostic factors for in-hospital mortality. Higher C-reactive protein levels and BUN levels were found to be independently associated with the occurrence of postoperative aspiration pneumonia. CONCLUSIONS: Our experience reconfirmed PEG as a minimally invasive and safe procedure for long-term enteral nutrition in patients with impaired oral intake. However, significant prognostic factors should be taken into account during the preoperative evaluation of patients. Deferral of procedure or specialized postoperative care may be indicated in high risk patients.

Percutaneous transesophageal gastro-tubing (PTEG) as an alternative long-term tube feeding procedure when gastrostomy is not feasible.

BACKGROUND: Percutaneous transesophageal gastro-tubing (PTEG) is a minimally invasive technique to access the gut via an esophagostomy. However, this procedure is not well known and the literature available is still fairly limited. This observational study was conducted to evaluate our experience using this method as an alternative long-term tube feeding procedure when gastrostomy is not suitable. METHODS: A total of 15 patients (10 males and 5 females) who underwent PTEG at our institution from 2012 to 2016 were observed and analyzed in this study. RESULTS: The average age was 80.1 (71-93) years. Underlying conditions that required PTEG were previous gastric resection in 11 patients, left diaphragm disorder in 2 patients, interposing transverse colon between the abdominal wall and anterior gastric wall in 1 patient, and severe gastrostomy site leakage in 1 patient. Tube placement was successful in all patients by approaching the left side of the neck, using a 15 Fr size tube. The mean postoperative length of stay was 22 (8-48) days. Postoperative adverse events included accidental tube dislodgement in three patients, tracheoesophageal fistula in one patient, inferior thyroid artery injury in one patient and thyroid gland mispuncture in one patient. There was no procedure-related mortality nor mortality at 30 days. Eight patients were discharged with some oral intake. CONCLUSIONS: PTEG is feasible in patients requiring long-term tube feeding for whom gastrostomy is unsuitable. It is an effective long-term tube feeding procedure and should be offered as a more comfortable alternative to nasogastric tubing.

Virchow's node together with an Irish node.

Classical lymphadenopathies, such as Virchow's node (left supraclavicular lymph node metastasis) and Irish node (left axillary lymph node metastasis), are important findings that may indicate the presence of gastric cancer and other gastrointestinal malignancies.

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG).

Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 - 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.

Maintaining Enteral Nutrition in the Severely Ill using a Newly Developed Nasojejunal Feeding Tube with Gastric Decompression Function.

For nutritional support of critically ill patients, the enteral route is preferred over the parenteral route. Although nasojejunal feeding can be superior to gastric feeding when gastrointestinal symptoms occur, it does not necessarily solve the problem of large gastric residual volumes. We report the successful use of a newly developed nasojejunal feeding tube with gastric decompression function in an 84-year-old man with severe pneumonia. After gastric feeding was considered not well tolerated, the use of this tube improved the delivery of nutrition until the patient was stable enough to undergo percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) using a novel large-caliber introducer technique kit: a retrospective analysis.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) using the introducer technique is not only useful in patients with upper digestive tract stenosis but has been shown to reduce peristomal infection. In this study, we evaluated the safety and utility of a novel large-caliber introducer PEG kit (using 20 Fr size tube) compared with a push kit of similar size. PATIENTS AND METHODS: One hundred and thirty-six patients who received PEG at our hospital between January 2014 and December 2015 were retrospectively analyzed. Baseline characteristics, laboratory biomarkers, hemodynamic changes, postoperative adverse events and clinical outcomes with both kits were compared. RESULTS: The new introducer PEG kit was used in 61 patients while the remaining 75 patients received tube placement using a push technique PEG kit. Except for the prevalence of dementia, which was lower in the introducer PEG kit group, baseline characteristics were similar in both groups. Tube placements were 100 % successful with both PEG kits and there were no significant differences in the change of postoperative hemodynamic or laboratory biomarkers. The Introducer PEG kit group experienced fewer incidence of feeding-related aspiration pneumonia (8.2 % vs. 24 %, P = 0.02), lower peristomal infection scores (1.2 vs. 1.6, P < 0.01), shorter postoperative length of stay (16 days vs. 23.7 days, P = 0.01) and fewer deaths at day 60 (3.3 % vs. 16 %, P = 0.02). CONCLUSIONS: Gastrostomy using the new large-caliber introducer PEG kit is safe and produced non-inferior (with some favourable) results when compared to the push technique using similar size tubes.

Percutaneous endoscopic transgastric jejunostomy (PEG-J): a retrospective analysis on its utility in maintaining enteral nutrition after unsuccessful gastric feeding.

BACKGROUND/AIMS: Although percutaneous endoscopic gastrostomy (PEG) is the method of choice for long-term enteral nutrition, feeding-related adverse events such as aspiration pneumonia and peristomal leakage can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes may help by circumventing gastric passage during enteral nutrition and improving drainage of gastric secretions. METHODS: 20 patients (12 males and 8 females) who received PEG-J after unsuccessful PEG feeding during a 6-year period in our institution were analysed retrospectively to evaluate the efficacy of large-bore jejunal feeding tubes in maintaining enteral nutrition. RESULTS: The median age was 83.5 (71-96) years. The median period between PEG and PEG-J was 33 (14-280) days. Indications were aspiration due to gastro-oesophageal reflux in 18 patients and severe peristomal leakage in 2 patients. Tube placements were successful in all patients. There were 6 (30%) in-hospital mortalities, with 3 (15%) occurring within 30 days after procedure. CONCLUSIONS: PEG-J can be performed safely in patients with PEG and may facilitate the maintenance of enteral nutrition in most of the patients. Patients with unsuccessful PEG feeding can be offered the option of jejunal feeding before considering termination of enteral nutrition.

Different structural preference of Ag(I) and Au(I) in neutral and cationic luminescent heteropolynuclear platinum(II) complexes: Z (U)-shaped Pt2M2 type vs. trinuclear PtM2 type.

The reactions of monocationic Pt(II) complexes bearing N^C chelate ligands and Me2pzH, [Pt(N^C)(Me2pzH)2]PF6 (N^C = 2-phenylpyridinate (ppy(-)), 2-(2,4-difluorophenyl)pyridinate (dfppy(-)), benzo[h]quinolinate (bzq(-)); Me2pzH = 3,5-dimethylpyrazole), with Ag(I) ions gave Z (or U)-shaped neutral tetranuclear Pt2Ag2 complexes [Pt2Ag2(N^C)2(Me2pz)4], while those with Au(I) ions gave neutral trinuclear PtAu2 complexes [PtAu2(N^C)(Me2pz)3]. On the contrary, the reactions of the dicationic Pt(II) complex bearing a N^N chelate ligand and Me2pzH, [Pt(bpy)(Me2pzH)2](PF6)2 (bpy = 2,2'-bipyridine), with Ag(I) and Au(I) ions both gave Z (or U)-shaped dicationic tetranuclear Pt2M2 complexes, [Pt2M2(bpy)2(Me2pz)4](PF6)2 (M = Ag, Au). The structures of heteropolynuclear Pt(II) complexes were dominated by the nature of incorporated group 11 metal ions and the charge of complexes.