45 research outputs found
A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn\u27s disease.
BACKGROUND:Small bowel stricture is one of the most common complications in patients with Crohn\u27s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.METHODS:Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.RESULTS:A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture lengthâ<â2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval ofââ€â446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.CONCLUSIONS:In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââ„âII, EF â€35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
(2,7-Dimethyl-1,8-biphenylenedioxy)bis(dimethylaluminum) as a Bidentate Lewis Acid:Â Its Reactivity and Selectivity in Organic Synthesis
Influence of shot peening and thermal aging treatment on resistance to intergranular corrosion in shielded metal arc weld metal for type 600 nickel base alloy
Differential Scanning Calorimetry and Circular Dichroism Spectrometry of Walleye Pollack Myosin and Light Meromyosin
Catalyst-Directed Guidance of Sulfur-Substituted Enediolates to Stereoselective CarbonâCarbon Bond Formation with Aldehydes
A highly chemo-, regio-, and stereoselective
glycolate aldol reaction
of sulfur-substituted enediolates with aldehydes was developed by
employing a l-cyclohexylglycine-derived chiral iminophosphorane
as a catalyst. The key for establishing this protocol is the distinct
ability of the iminophosphorane catalyst to precisely direct the equilibrium
mixture of the enediolates toward the intermolecular carbonâcarbon
bond formation with simultaneous yet rigorous control of relative
and absolute stereochemistry. The critical importance of the cyclohexyl
substituents on the catalyst backbone in dictating the reaction pathway
and the stereochemical outcome was elucidated through an extensive
quantum analysis by density functional theory calculations
Catalyst-Directed Guidance of Sulfur-Substituted Enediolates to Stereoselective CarbonâCarbon Bond Formation with Aldehydes
A highly chemo-, regio-, and stereoselective
glycolate aldol reaction
of sulfur-substituted enediolates with aldehydes was developed by
employing a l-cyclohexylglycine-derived chiral iminophosphorane
as a catalyst. The key for establishing this protocol is the distinct
ability of the iminophosphorane catalyst to precisely direct the equilibrium
mixture of the enediolates toward the intermolecular carbonâcarbon
bond formation with simultaneous yet rigorous control of relative
and absolute stereochemistry. The critical importance of the cyclohexyl
substituents on the catalyst backbone in dictating the reaction pathway
and the stereochemical outcome was elucidated through an extensive
quantum analysis by density functional theory calculations
Catalyst-Directed Guidance of Sulfur-Substituted Enediolates to Stereoselective CarbonâCarbon Bond Formation with Aldehydes
A highly chemo-, regio-, and stereoselective
glycolate aldol reaction
of sulfur-substituted enediolates with aldehydes was developed by
employing a l-cyclohexylglycine-derived chiral iminophosphorane
as a catalyst. The key for establishing this protocol is the distinct
ability of the iminophosphorane catalyst to precisely direct the equilibrium
mixture of the enediolates toward the intermolecular carbonâcarbon
bond formation with simultaneous yet rigorous control of relative
and absolute stereochemistry. The critical importance of the cyclohexyl
substituents on the catalyst backbone in dictating the reaction pathway
and the stereochemical outcome was elucidated through an extensive
quantum analysis by density functional theory calculations
Catalyst-Directed Guidance of Sulfur-Substituted Enediolates to Stereoselective CarbonâCarbon Bond Formation with Aldehydes
A highly chemo-, regio-, and stereoselective
glycolate aldol reaction
of sulfur-substituted enediolates with aldehydes was developed by
employing a l-cyclohexylglycine-derived chiral iminophosphorane
as a catalyst. The key for establishing this protocol is the distinct
ability of the iminophosphorane catalyst to precisely direct the equilibrium
mixture of the enediolates toward the intermolecular carbonâcarbon
bond formation with simultaneous yet rigorous control of relative
and absolute stereochemistry. The critical importance of the cyclohexyl
substituents on the catalyst backbone in dictating the reaction pathway
and the stereochemical outcome was elucidated through an extensive
quantum analysis by density functional theory calculations