Dynamic flow synthesis of porous organic cages

The dynamic covalent synthesis of two imine-based porous organic cages was successfully transferred from batch to continuous flow. The same flow reactor was then used to scramble the constituents of these two cages in differing ratios to form cage mixtures. Preparative HPLC purification of one of these mixtures allowed rapid access to a desymmetrised cage molecule.We thank the Engineering and Physical Sciences Research Council (EPSRC) for financial support under the Grants EP/H000925/1 (AIC), EP/K009494/1 (SVL) and EP/M004120/1 (SVL), and Pfizer Worldwide Research & Development (CB). The authors would like to thank EPSRC Dial-a-Molecule Grand Challenge Network (EP/K004840/1) for funding a placement with SVL via the Interdisciplinary Mobility Funding scheme (AGS).This is the author accepted manuscript. The final version is available from RSC via http://dx.doi.org/10.1039/C5CC07447

Acceso vascular guiado por ecografía en el niño crítico: ventajas, retos y nuevas técnicas = Ultrasound guided vascular access in critically ill children: Advantages, challenges and new techniques

278 p.El objetivo principal de esta tesis es evaluar si el uso de la ecografía mejora las tasas de éxito y reduce las complicaciones mecánicas en la canalización venosa central y arterial guiada en el niño y neonato crítico comparadas con la técnica clásica utilizando referencias anatómicas. Para testar la hipótesis de que la ecografía podría mejorar las tasas de éxito y reducir las complicaciones en el acceso vascular ecoguiado tanto venoso central como arterial se llevó a cabo un registro de acceso vascular en cuidados críticos a nivel nacional, denominado RECANVA, en el que se invitó a participar a todas las Unidades de Cuidados Intensivos Pediátricos en España. Dicho registro fue diseñado y coordinado como investigador principal por el autor de esta tesis, y se vehiculizó a través del Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos

Intravitreal Bevacizumab for Retinopathy of Prematurity Another Hit to the Immature Lung?

Laser photocoagulation has been the standard of treatment of ROP for many years. However, since its introduction in 2007, the use of intravitreal injection of anti-VEGF agents has been incorporated to ROP management. Several trials have shown that anti-VEGF drugs (bevacizumab, ranibizumab) may be superior to laser photocoagulation for type I ROP (zone I [any stage with plus disease] or zone I-stage 3 without plus disease)2 página

Ultrasound-guided cannulation or by pulse palpation in the intensive care unit

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAMIntroducción El uso de la ecografía ha demostrado mejorar los resultados de la canalización venosa central. Sin embargo, sus beneficios en la canalización arterial en niños no han sido claramente establecidos. El objetivo de este estudio fue evaluar el uso de la ecografía en la canalización arterial en la unidad de cuidados intensivos pediátricos (UCIP). Métodos Estudio prospectivo multicéntrico en 18 UCIP en España durante un periodo de 6 meses. Se compararon los resultados de la canalización arterial ecoguiada (ECO) con la técnica tradicional basada en referencias anatómicas (REF) en cuanto a la tasa de éxito y las complicaciones inmediatas. Resultados Se incluyeron 161 procedimientos en 128 pacientes (78 procedimientos en el grupo ECO y 83 en el grupo REF). La mediana (rango intercuartil) de edad y peso de los pacientes fueron 11 meses (2-52) y 10 kg (4-17), respectivamente; el 59,6% eran varones. La ecografía se utilizó preferentemente en las UCIP de mayor tamaño (número de camas 11 [8-16] vs 6 [4-10], p < 0,001) y complejidad (cirugía cardiaca 76,9% vs 25,6%, p < 0,001), así como en pacientes más pequeños (peso 5,7 kg [3,8-13] vs 11,5 kg [4,9-22,7], p < 0,001). El 49,7% de los participantes era personal inexperto (residentes o personal con menos de 5 años de experiencia en UCIP) y solo el 24,4% de los participantes habían realizado más de 50 procedimientos de canalización ecoguiada antes del estudio. No hubo diferencias significativas entre ECO y REF en la tasa de éxito en una punción (35,8% vs 33,7%, p = 0,773), en la tasa de éxito global (75,6% vs 71,1%, p = 0,514), en el número de punciones (2 [1-4] vs 2 [1-3], p = 0,667) ni en la incidencia de complicaciones (16,6% vs 25,6%, p = 0,243). El ajuste por variables de confusión en los modelos de regresión no alteró estos resultados. En un análisis de subgrupos se mostró que la ECO mejoró la tasa de éxito global (83,7% vs 62,7%, p = 0,036) y redujo las complicaciones (10,8% vs 32,5%, p = 0,020) en las canalizaciones realizadas por operadores con menos de 5 años de experiencia en UCIP. Conclusiones En este estudio prospectivo no hemos observado que, globalmente, el uso de la ecografía mejore los resultados de la canalización arterial en la UCIP. La canalización ecoguiada podría tener ventajas para el personal con menos experienciaIntroduction: Ultrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children. Methods: A prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications. Results: A total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups). The median (interquartile range) age and weight of the cohort was 11 months (2-52), and 10 kg (4-17), respectively. More than half (59.6%) were male. US was used mainly in big (number of beds 11 [8-16] vs 6 [4-10], p &lt; 0,001) and high complexity intensive care units (cardiac surgery program 76.9% vs. 25.6%, P &lt; .001) as well as in smaller children [weight 5.7 kg (3.8-13) vs 11.5 kg (4.9-22.7), P &lt; .001]. Almost half (49.7%) of the procedures were performed by an inexperienced operator (paediatric resident, or staff with less than 5 years of clinical experience in the PICU), and only 24.4% had performed more than 50 US-guided vascular access procedures before the study. There were no significant differences between US and LM techniques in terms of first-attempt success (35.8% vs 33.7%, P = .773), overall success (75.6% vs 71.1%, P = .514), number of puncture attempts [2 (1-4) vs 2 (1-3), P = .667] and complications (16.6% vs 25.6%, P = .243). Adjustment by potential confounders using multivariate regression models did not modify these results. Subgroup analyses showed that US outperformed LM technique in terms of overall success (83.7% vs 62.7%, P = .036) and complications (10,8% vs 32.5%, P = .020) only when procedures where performed by less-experienced operators. Conclusions: In this prospective observational multicentre study, US did not improve arterial cannulation outcomes compared to the traditional LM technique in critically ill children. US-guided arterial cannulation may offer advantages when cannulation is performed by inexperienced operator

Lung ultrasound score has better diagnostic ability than NT-proBNP to predict moderate-severe bronchopulmonary dysplasia.

The N-terminal end of B-type natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) score have been proven to be adequate early biomarkers of bronchopulmonary dysplasia (BPD) in preterm infants. Our aim was to study if the predictive capacity of each one is increased by analyzing them together. We included infants born before 32 weeks with NT-proBNP and LUS scores on the first day of life (DOL) and on the 3rd, 7th, and 14th DOL and compared the diagnostic ability for moderate-severe BPD (msBPD) of each biomarker and in combination. We also compared them with a multivariate model of msBPD using only clinical variables. The sample size was 133 patients, and twenty-seven (20%) developed msBPD. The LUS score on the 7th DOL had better performance than NT-proBNP at the same moment: area under the receiver operating characteristic curve (AUC) 0.83 (0.75-0.89) versus 0.66 (0.56-0.75), p = 0.003, without differences in the rest of the times studied. These values did not increase when using the combination of both. A multivariate regression model that included only clinical variables (birth weight and invasive mechanical ventilation (IMV) at the 7th DOL) predicted msBPD with the same AUC as after the addition of any of these biomarkers, neither together. The LUS score is a better predictor of msBPD on the 7th DOL than NT-proBNP in preterm infants born before 32 weeks, although they have similar diagnostic accuracy on the 1st, 3rd, and 14th DOL. Neither of them, nor together, have a better AUC for msBPD than a clinical model with birthweight and the need for IMV at the 7th DOL. • NT-proBNP and LUS score are early predictors of moderate-severe bronchopulmonary dysplasia (msBPD). • The combination of both NT-proBNP and LUS score does not increase the predictive ability of each separately