Antibiotic prophylaxis for prevention of urinary tract infections in the first year of life in children with vesicoureteral reflux diagnosed in the workup of antenatal hydronephrosis: a systematic review.

BACKGROUND: Children with antenatal hydronephrosis (ANH) diagnosed with postnatal asymptomatic vesicoureteral reflux (VUR) are thought to be at higher risk of urinary tract infection (UTI). As such, continuous antibiotic prophylaxis (CAP) is empirically recommended until age of toilet training; however, there are limited data to support this. The objective of this systematic review was to summarize the existing data and compare UTI rates in infants with asymptomatic VUR on CAP during the first year of life, to those not on CAP. Secondary objectives were to determine associated risk factors with UTI development. METHODS: A systematic search of all relevant studies and abstracts was conducted using 4 electronic databases by utilizing appropriate key words by an expert hospital librarian. Eligible studies included children with prenatal hydronephrosis, asymptomatic VUR with or without CAP, and reported on development of UTI in the first year. RESULTS: Of 6903 citations screened, 18 were selected, giving a total population of 829 (69.4% male, median age 57 days) who met the inclusion criteria. Most studies were retrospective and of low-quality evidence. Overall, 15.4% of patients developed at least one breakthrough UTI and females had a higher risk of UTI (odds ratio (OR) 2.3, 95% CI 1.1-4.7). Comparison with children not taking CAP was not readily reported, and meta-analysis could not be completed. CONCLUSIONS: Randomized controlled trials and standardized reporting of clinical variables are required to understand the protective effect of antibiotic prophylaxis in this cohort.

Common, Difficult Questions about Providing Nutrition at End of Life: Bedside Application of Catholic Moral Teaching.

There is much confusion surrounding how to interpret provision of artificial nutrition and hydration (ANH) at the bedside in complicated clinical circumstances. The specific scenario that prompted these questions was a request by a patient and her family to remove a feeding tube that had become, in the patient's eyes and opinion, disproportionately burdensome in her particular set of clinical circumstances. This clinically relevant article can be viewed as a bedside interpretation of Catholic bioethical teachings on provision of ANH to the dying patient. Please note that this article does not address specific ethical issues that pertain to persistent vegetative state, which is beyond the scope of this particular discussion.

Enantioselective Protonation of Radical Anion Intermediates in Photoallylation and Photoreduction Reactions of 3,3-Diaryl-1,1-dicyano-2-methylprop-1-ene with Allyltrimethylsilane.

Photoreactions of acetonitrile solutions of 3,3-diaryl-1,1-dicyano-2-methylprop-1-enes (1a-c) with allyltrimethylsilane (2) in the presence of phenanthrene as a photoredox catalyst and acetic acid as a proton source formed photoallylation (3) and photoreduction (4) products via photoinduced electron transfer pathways. When (S)-mandelic acid was used as the proton source, the reactions proceeded with 3.4 and 4.8 %ee for formation of 3 and 4, respectively. The results of studies of the effect of aryl ring substituents and several chiral carboxylic acids suggested that the enantioselectivities of the reactions are governed by steric controlled proton transfer in intermediate complexes formed by π-π and OH-π interactions of anion radicals derived from 1a-c and chiral carboxylic acids.

A useful methoxyvinyl cation equivalent: α-t-butyldimethylsilyl-α-methoxyacetaldehyde.

Described are the synthesis and application of α-t-butyldimethylsilyl-α-methoxyacetaldehyde as a formal methoxyvinyl cation equivalent. Addition of Grignard reagents to the title aldehyde, followed by treatment of the intermediate ß-hydroxysilanes with KH, gives good yields of large Z-methoxyvinylated products. Assuming a Peterson-like elimination mechanism, one can infer that the Grignard addition proceeds with high syn selectivity. These results are consistent with a chelation control model involving coordination to the α-methoxy group in the title aldehyde rather than an alternative stereoelectronic Felkin-Anh-type model. It must be noted that a steric Felkin-Anh model also accounts for the observed stereochemistry. All told, the title reagent can be employed to efficiently append a Z-configured methoxyvinyl group to an appropriate R-M species, in two steps.

Postoperative long­term outcomes of acute normovolemic hemodilution in pancreatic cancer: A propensity score matching analysis.

Acute normovolemic hemodilution (ANH) is a useful intraoperative blood conservation technique. However, the impact on long-term outcomes in pancreatic ductal adenocarcinoma (PDAC) remains unclear. The present study investigated the impact of ANH on long-term outcomes in patients with PDAC undergoing radical surgery. Data from 155 resectable PDAC cases were collected. Patients were categorized according to whether or not they had received intraoperative allogeneic blood transfusion (ABT) or ANH. Postoperative complications, recurrence-free survival (RFS) and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ANH. A total of 44 patients (28.4%) were included in the ANH group and 30 patients (19.4%) were included in the ABT group; 81 (52.3%) patients, comprising the standard management (STD) group, received neither ANH nor ABT. The ABT group had the worst prognosis among them. Before PSM, ANH was significantly associated with decreased RFS (P=0.043) and DSS (P=0.029) compared with the STD group before applying Bonferroni correction; however, no significant difference was observed after applying Bonferroni correction. Cox regression analysis identified ANH as an independent prognostic factor for RFS [relative risk (RR), 1.696; P=0.019] and DSS (RR, 1.876; P=0.009). After PSM, the ANH group exhibited less favorable RFS [median survival time (MST), 12.1 vs. 18.1 months; P=0.097] and DSS (MST, 32.1 vs. 50.5 months; P=0.097) compared with the STD group; however, these differences were not statistically significant. In conclusion, while ANH was not as harmful as ABT, it exhibited potentially more negative effects on long-term postoperative outcomes in PDAC than STD.

Greener Approach for Synthesis of δ-MnO2 Nanoparticles: Access to Pharmaceutically Important Pyrimidines and their Antimicrobial Activity Studies.

A sustainable approach for pharmaceutically important pyrimidine derivatives is achieved by using biogenically produced single-phase δ-MnO2 NPs under external ligand-free conditions. The phytochemicals that comprise the extract of Areca Nut Husk (ANH) have been discovered to serve as reducing agents. The role of phytochemicals is not only to aid in the reduction of Mn(VII) into Mn(IV), but they also have an important role in stabilizing the catalyst. The establishment of δ-MnO2 NPs was confirmed inveterate by FE-SEM, p-XRD, ICP-OES (Mn content = 43.17% w/w), EDX, and with an active Mn content of 43.17% w/w. A series of pyrimidine derivatives were prepared in good yields using a one-pot multicomponent synthesis approach under atmospheric conditions. In addition, hot filtration tests, control experiments, gram-scale synthesis, and mechanistic investigations were demonstrated. Additionally, antimicrobial activity studies of δ-MnO2 NPs and pyrimidine derivatives against the Gram-negative bacteria E. coli, growth curve and minimum inhibitory concentration were studied.

Society for fetal urology recommendations for postnatal evaluation of prenatal hydronephrosis--will fewer voiding cystourethrograms lead to more urinary tract infections?

PURPOSE: There is no consensus on the extent and mode of postnatal imaging after a diagnosis of prenatal hydronephrosis. We validated the protocol of our practice, which parallels current Society for Fetal Urology (SFU) recommendations, in limiting voiding cystourethrogram, while examining its impact on the incidence of febrile urinary tract infections. A secondary goal was to examine predictors of postnatal intervention. MATERIALS AND METHODS: We evaluated a cohort of 117 infants with prenatal hydronephrosis and retrospectively reviewed outcomes. Excluded from study were 30 infants with anatomical abnormalities. Third trimester prenatal ultrasound was done to evaluate SFU grade, laterality and anteroposterior diameter. Cox proportional hazard model and chi-square analysis were used to assess predictors of resolution and surgical intervention. RESULTS: A total of 87 infants with a median followup of 33.5 months were included in analysis. Postnatal voiding cystourethrogram was done in 52 patients, of whom 7 had vesicoureteral reflux. In 6 infants (6.9%) a febrile urinary tract infection developed, which was diagnosed with a catheter specimen during followup. In 3 infants a urinary tract infection developed immediately after catheterization. Anteroposterior diameter 9 mm or greater and SFU grade 3 or greater independently predicted the need for postnatal intervention (p = 0.0014 and 0.001, respectively). CONCLUSIONS: With adherence to our protocol, voiding cystourethrogram was avoided in almost half of evaluated infants. No infant diagnosed with vesicoureteral reflux had a urinary tract infection. Catheterization was associated with a urinary tract infection in 50% of cases. An anteroposterior diameter of 9 mm or greater and a SFU grade of 3 or greater were associated with postnatal progression to surgery. Patients with a SFU grade of 4 progressed to surgical intervention at a faster rate than those with a grade of greater than 3.

Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction.

PURPOSE: In this study we evaluate the diagnostic accuracy of renal pelvic dilatation for detecting infants with prenatal hydronephrosis who will need surgical intervention for ureteropelvic junction obstruction during followup. MATERIALS AND METHODS: Between 1999 and 2010, 371 newborns diagnosed with isolated prenatal hydronephrosis were prospectively followed. The main event of interest was the need for pyeloplasty. Diagnostic odds ratio, sensitivity, specificity and diagnostic accuracy (assessed by AUC) of fetal renal pelvic dilatation and postnatal renal pelvic dilatation were evaluated. RESULTS: A total of 312 patients were included in the analysis and 25 (7.5%) infants underwent pyeloplasty. The diagnostic performance for detecting the need for pyeloplasty was excellent for all ultrasonography measurements. The AUC was 0.96 (95% CI 0.92-0.98) for fetal renal pelvic dilatation, 0.97 (95% CI 0.95-0.98) for postnatal renal pelvic dilatation and 0.95 (95% CI 0.92-0.97) for the Society for Fetal Urology grading system. A cutoff of 18 mm for fetal renal pelvic dilatation and a cutoff of 16 mm for postnatal renal pelvic dilatation had the best diagnostic odds ratio to identify infants who needed pyeloplasty. Considering a diagnosis to be positive only if fetal renal pelvic dilatation was greater than 18 mm and postnatal dilatation was greater than 16 mm, sensitivity was 100% and specificity was 86% (95% CI 80.7-89.9). CONCLUSIONS: Our findings suggest that the combination of fetal and postnatal renal pelvic dilatation is able to increase the diagnostic accuracy for detecting infants who need a more comprehensive postnatal investigation for upper urinary tract obstruction.

Synthesis of ß-Methyl Alcohols: Influence of Alkyl Chain Length on Diastereoselectivity and New Attractants of Rhynchophorus ferrugineus.

The diastereoselectivity of adducts in the addition reaction via the Felkin-Anh model is affected significantly by the steric effect of bulky groups. However, the influence of steric alkyl chain length has not been studied for the diastereoselectivity. In this work, we present a new strategy for the racemic synthesis of ß-methyl alcohols to obtain various diastereomer ratios using the Felkin-Anh model. The addition of alkyl Grignard reagents to α-methyl aldehydes afforded diastereomer ratios of threo/erythro ≈ 2:1, while the reduction in structurally related ketones using LiAlH4 afforded ratios of threo/erythro ≈ 1:1. The experimental data showed no effect of alkyl chain length on either side on the stereoselectivity of adducts. All synthesized analogues were evaluated for attractiveness to Rhynchophorus ferrugineus weevils in the field. Five novel derivatives, including two alcohols and three ketones, were found to attract weevils in the field trials. Among them, 3-methyldecan-4-one (5b) and 4-methyldecan-5-ol (11a) were found to be the most attractive to the insects.

Association of acute normovolemic hemodilution with decreased length of hospital stay in rhesus-negative patients undergoing major cancer surgeries: a retrospective study.

BACKGROUND: Shortages of allogeneic blood supplies for rhesus (Rh)-negative patients who are scheduled for major cancer surgeries may cause delays in surgical procedure, resulting in a prolonged length of hospital stay (LOHS). This study investigated the relationship of acute normovolemic hemodilution (ANH) with LOHS in this patient population. METHODS: Rh-negative patients who underwent major cancer surgeries between January 2015 and April 2020 were included in this retrospective study. The primary outcome was LOHS. The secondary outcomes were length of preoperative stay (LOPS), perioperative laboratory data and allogeneic blood transfusion (ABT), and postoperative adverse events. Furthermore, relationships between these perioperative variables and LOHS were examined by both univariate analyses and multiple linear regression analysis. RESULTS: Seventy patients were divided into ANH (n=30) or Control (n=40) group. The two groups were well-matched for baseline data. LOHS, LOPS, perioperative ABT amount, and the overall rate of postoperative adverse events were all significantly lower in the ANH group (P=0.004, P=0.009, P<0.001, P=0.023, respectively). In the ANH group, levels of hemoglobin and hematocrit decreased on postoperative day 1 (P=0.023, P=0.012, respectively). Univariate analyses revealed significant association between LOHS and the following perioperative variables: ANH, body mass index, types of surgery, intraoperative colloids infusion, and perioperative ABT. Multiple linear regression analysis with correction for diagnosis identified ANH, intraoperative colloids infusion, and perioperative ABT as independent predictors. CONCLUSIONS: ANH was associated with the decreased LOHS in Rh-negative patients undergoing major cancer surgeries.

Hydrated vanadium pentoxide/reduced graphene oxide-polyvinyl alcohol (V2O5⋠nH2O/rGO-PVA) film as a binder-free electrode for solid-state Zn-ion batteries.

Recently, solid-state aqueous Zn-ion batteries (ZIBs) have become the most promising wearable storage systems to replace Li-ion batteries owing to their advantages such as high safety and environmental friendliness. However, the critical challenge is to develop stable and robust cathode materials for excellent Zn2+ storage. In this study, a hydrated vanadium pentoxide/reduced graphene oxide-polyvinyl alcohol (V2O5⋅nH2O/rGO-PVA, abbreviated as VOH/rGO-P) film was synthesized as a binder-free cathode for solid-state aqueous ZIBs. The addition of PVA not only increases the layer spacing of VOH and forms a strong hydrogen bond network with GO and water molecules, but also enhances the mechanical properties of the film. As a binder-free cathode for solid-state aqueous ZIBs, the VOH/rGO-P film attains excellent electrochemical capacity as high as 481 mAh∙g-1 at 0.1 A∙g-1. Such a high specific capacity indicates that the VOH/rGO-P film shows great potential for the next generation solid-state aqueous ZIBs.

HOMOLOGOUS BLOOD TRANSFUSION: DO WE HAVE ANY ALTERNATIVES?

Homologous blood transfusion, despite numerous and serious transfusion associated hazards, is an important treatment modality. Transmission of infectious agents like HIV, hepatitis viruses, malaria, etc is a distinct possibility notwithstanding careful screening of the blood. Predeposit autologous blood transfusion (PABT) and per operative acute normovolemic haemodilution (ANH) are two comparatively safer, simpler and practical alternatives. Unfortunately, their potential remains unexploited. Earnest motivation efforts at PABT and ANH have paid handsome dividends in our hospital. These have now become very popular amongst surgeons as well as the patients. These techniques can be easily adapted at all hospitals to reduce the demand for homologous blood transfusion. ANH can be safely practised even in hospitals without a blood bank.

Comparison of anti-endotoxin activity of apoE and apoA mimetic derivatives of a model amphipathic peptide 18A.

Endotoxemia is a major cause of chronic inflammation, and is an important pathogenic factor in the development of metabolic syndrome and atherosclerosis. Human apolipoprotein E (apoE) and apoA-I are protein components of high-density lipoprotein, which have strong anti-endotoxin activity. Here, we compared anti-endotoxin activity of Ac-hE18A-NH2 and 4F peptides, modified from model amphipathic helical 18A peptide, to mimic, respectively, apoE and apoA-I properties. Ac-hE18A-NH2, stronger than 4F, inhibited endotoxin activity and disaggregated Escherichia coli 055:B5 (wild smooth serotype). Ac-hE18A-NH2 and 4F inhibited endotoxin activity of E. coli 026:B6 (rough-like serotype) to a similar degree. This suggests that Ac-hE18A-NH2 as a dual-domain molecule might interact with both the lipid A and headgroup of smooth LPS, whereas 4F binds lipid A. In C57BL/6 mice, Ac-hE18A-NH2 was superior to 4F in inhibiting the inflammatory responses mediated by E. coli 055:B5, but not E. coli 026:B6. However, in THP-1 cells, isolated human primary leukocytes, and whole human blood, Ac-hE18A-NH2 reduced responses more strongly than 4F to both E. coli serotypes either when peptides were pre-incubated or co-incubated with LPS, indicating that Ac-hE18A-NH2 also has strong anti-inflammatory effects independent of endotoxin-neutralizing properties. In conclusion, Ac-hE18A-NH2 is more effective than 4F in inhibiting LPS-mediated inflammation, which opens prospective clinical applications for Ac-hE18A-NH2.

Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol.

OBJECT: Children with craniosynostosis may require cranial vault remodeling to prevent or relieve elevated intracranial pressure and to correct the underlying craniofacial abnormalities. The procedure is typically associated with significant blood loss and high transfusion rates. The risks associated with transfusions are well documented and include transmission of infectious agents, bacterial contamination, acute hemolytic reactions, transfusion-related lung injury, and transfusion-related immune modulation. This study presents the Children's Hospital of Richmond (CHoR) protocol, which was developed to reduce the rate of blood transfusion in infants undergoing primary craniosynostosis repair. METHODS: A retrospective chart review of pediatric patients treated between January 2003 and Febuary 2012 was performed. The CHoR protocol was instituted in November 2008, with the following 3 components; 1) the use of preoperative erythropoietin and iron therapy, 2) the use of an intraoperative blood recycling device, and 3) acceptance of a lower level of hemoglobin as a trigger for transfusion (< 7 g/dl). Patients who underwent surgery prior to the protocol implementation served as controls. RESULTS: A total of 60 children were included in the study, 32 of whom were treated with the CHoR protocol. The control (C) and protocol (P) groups were comparable with respect to patient age (7 vs 8.4 months, p = 0.145). Recombinant erythropoietin effectively raised the mean preoperative hemoglobin level in the P group (12 vs 9.7 g/dl, p < 0.001). Although adoption of more aggressive surgical vault remodeling in 2008 resulted in a higher estimated blood loss (212 vs 114.5 ml, p = 0.004) and length of surgery (4 vs 2.8 hours, p < 0.001), transfusion was performed in significantly fewer cases in the P group (56% vs 96%, p < 0.001). The mean length of stay in the hospital was shorter for the P group (2.6 vs 3.4 days, p < 0.001). CONCLUSIONS: A protocol that includes preoperative administration of recombinant erythropoietin, intraoperative autologous blood recycling, and accepting a lower transfusion trigger significantly decreased transfusion utilization (p < 0.001). A decreased length of stay (p < 0.001) was seen, although the authors did not investigate whether composite transfusion complication reductions led to better outcomes.

Selecting patients for acute normovolemic hemodilution during hepatic resection: a prospective randomized evaluation of nomogram-based allocation.

BACKGROUND: Acute normovolemic hemodilution (ANH) decreases transfusion rates but adds to the complexity of anesthetic management during hepatectomy. A randomized controlled trial was conducted to determine if selecting patients for ANH using a transfusion nomogram improves management and resource use compared with selection using extent of resection. STUDY DESIGN: One hundred fourteen patients undergoing partial hepatectomy were randomized to a clinical arm (ANH used for resection of ≥ 3 liver segments) or a nomogram arm (ANH used for predicted probability of transfusion ≥ 50% based on a previously validated nomogram). The primary end point was appropriate management, defined as avoidance of ANH in patients at low risk or use of ANH in patients at high risk for allogeneic red blood cell transfusions. RESULTS: Between September 2009 and May 2011, 58 patients were randomized to the clinical arm and 56 to the nomogram arm. Demographics, diagnoses, extent of resection, blood loss, and incidence and grade of complications did not differ between the 2 groups. There were no differences in perioperative transfusions or laboratory values. Nomogram-based allocation did not change appropriate management overall (80% vs 76% in the clinical arm; p = 0.65), but did result in comparable perioperative outcomes and a trend toward decreased ANH use (30% vs 47%; p = 0.09), particularly in low blood loss (estimated blood loss ≤ 400 mL) cases (12% vs 25%; p = 0.04). CONCLUSIONS: Although allocation of intraoperative management using a transfusion nomogram did not improve appropriate management overall, it more effectively identified low blood loss cases and reduced ANH use in patients least likely to benefit.

The measurements of some biochemical values of hypertensive adults in Xuan Canh Dong Anh Hanoi

Hypertension is increasing in the world including the Vietnam. Changes in concentrations of bood lipid, glucose are often correlated with hypertension. Changes in bood lipid concentration are major cause of cardiovascular disease. Finding and treatment of dyslipidemia in hypertensive patients will reduce cardiac complications. Objective: To detemnine serum total cholesterol, glucose, creatinine and urine protein, glucose in adults with hypertension and to find out the correlation between biochemical values and hypertension grades. Objects and method: 379 people with hypertension (grade 1: 221 people; grade 2: 134 people; grade 3: 24 people) and 86 people without hypertension served as control. This cross-sectional study was conducted from 12/2004-3/2005. Results: Biochemical values in people with hypertension were: total cholesterol: 4.75- 5.95 mmol/l; glucose: 4.83-5.11 mmol/l; creatinine: 69.22-89.02mmol/l. Urine protein test was positive in 6.3% of people with hypertesion. Values of total cholesterol, creatinine in people with grade-3 hypertension were significantly higher than these in normotensive people (p< 0.01). There were significantly regressed between diastolic blood pressure (DBP), systolic blood pressure (SBP) with creatinin (DBP: r=0.157 P< 0.01 ; Y=(0.101 X creatinin)+83.668 - SBP: r=0.113 P=0.02 Y= (0.127 X creatinin)+139.369.