Hessgonzales0352

Private equity (PE) has grown rapidly in medicine. The reintroduction of PE in ophthalmology has necessitated a greater understanding of the potential contractual relationships with PE firms from both a practice owner and an employee physician perspective. There are contractual obligations that need to be met as PE agreements are designed to ensure clear investment patterns and abide by legal mandates. A practice owner entering into a PE contract needs to consider how the practice is being valued, what their obligations are to the PE entity after the sale has been completed to attain full compensation and understand their new role at the practice. On the other hand, employee ophthalmologists must carefully evaluate the compensation package being offered in terms of the type of equity, vesting of shares, obligations to the PE firm under the agreement such as a noncompete clause, and what occurs under a subsequent sale of the practice. Overall, contractual considerations in the private equity era need to be carefully evaluated in order to ensure the agreement is in the best interest for the clinician, practice, and their patients.The coumarin core represents the quintessential scaffold of many natural products. While C-3 alkylation is easily achievable, effective greener strategies for C-4 alkylation have been less forthcoming. Herein, we report a metal-free photoinduced deaminative strategy for C-4 alkylation of coumarins using redox activated secondary and benzylic amine derived Katritzky pyridinium salts.Photoredox-catalyzed addition of the difluoromethylradical to unactivated alkenes has been found to trigger neophyl-like aryl and heteroaryl migrations which allowed the construction of a diverse series of difluoromethyl ketones. The reaction featured mild reaction conditions and broad substrate scope.

Sepsis is a highly prevalent condition and is associated with a reported in-hospital mortality rate up to 40% in patients with abdominal sepsis requiring emergency general surgery (EGS). The quick sequential organ failure assessment score (qSOFA) has not been studied for EGS patients.

Retrospective cohort study in adult patients undergoing abdominal EGS at a university tertiary care center from 2016 to 2018. The primary outcome was mortality. The effect of clinical variables on outcomes was assessed in univariable and multivariable logistic regression analyses. Based on these results, the qSOFA score was modified. The performance of scores was assessed using receiver operating characteristics.

Five hundred seventy-eight patients undergoing abdominal EGS were included. In-hospital mortality was 4.8% (28/578). Independent predictors for mortality were mesenteric ischemia (odds ratio [OR] 15.9; 95% confidence interval [CI] 5.2-48.6; p < 0.001), gastrointestinal tract perforation (OR 4.9; 95% CI 1.7-14.0; p = 0.003), 65 years or older (OR 4.1; 95% CI 1.5-11.4; p = 0.008), and increasing qSOFA (OR 1.8; 95% CI 1.2-2.8; p = 0.007). The modified qSOFA (qadSOFA) was developed. The area under the receiver operating characteristic curve of the qSOFA and qadSOFA for mortality was 0.715 and 0.859, respectively. Optimal cutoff value was identified as qadSOFA ≥ 3 (Youden Index 64.1%).

This is the first study investigating the qSOFA as a predictor for clinical outcomes in EGS. Compared with the qSOFA, the new qadSOFA revealed an excellent predictive power for clinical outcomes. Further validation of qadSOFA is warranted.

Diagnostic test/criteria; Level II.

Diagnostic test/criteria; Level II.

Metastasectomy in patients with metastatic colorectal cancer (mCRC) confers a significant survival benefit. We hypothesized that conversion to resectability (C2R) correlates with superior overall survival (OS) in patients with unresectable mCRC.

A prospectively registered systematic review (PROSPERO CRD42015024104) of randomized clinical trials published after 2003 was conducted. Exposure of interest was C2R with a primary outcome of OS. Clinical trials were classified based on difference in C2R between study arms (<2%, 2% to 2.9%, ≥3%). Generalized estimating equations were used to measure associations while adjusting for multiple observations from the same trial.

Of 2902 studies reviewed, 30 satisfied selection criteria (n=13,618 patients). Median C2R was 7.3% (interquartile range [IQR] 5% to 12.9%), with maximum C2R in the FOLFOX/FOLFIRI+cetuximab arm (28.6%). The median difference in C2R between 2 arms of the same study was 2.3% (IQR 1.3% to 3.4%) with a maximum difference of 15.4% seen in FOLFOX/FOLFIRI+cetuximab versus FOLFOX/FOLFIRI. selleck products Median OS for the entire patient cohort was 20.7 months (IQR 18.9 to 22.7 mo), with a between group difference of 1.3 months (IQR -1.2 to 3.6 mo). The median survival difference between the 2 study arms with <2% C2R difference was 0.8 months versus 1.6 months with ≥3% C2R rates . Increasing C2R had an incremental dose-effect response on OS ( P =0.021), and higher response rates correlated with C2R rates ( P =0.003).

C2R occurs infrequently and variably in clinical trials enrolling patients with unresectable mCRC. Prioritization of chemotherapeutic agents that enhance C2R might improve OS of patients.

C2R occurs infrequently and variably in clinical trials enrolling patients with unresectable mCRC. Prioritization of chemotherapeutic agents that enhance C2R might improve OS of patients.Oxidative coupling of methane (OCM) catalyzed by MnOx -Na2 WO4 -based catalysts has great industrial potential to convert CH4 directly to C2-3 products, but the high light-off temperature is a big challenge to OCM commercialization. The reaction mechanism studies disclosed that O2 /CH4 -activation relevant "Mn2+ ↔Mn3+ " redox cycle is tightly linked with the catalyst light-off. One concept is thus put forward that the OCM light-off temperature could be lowered once a "Mn2+ ↔Mn3+ " redox cycle was established to be triggered at low temperature over MnOx -Na2 WO4 -based catalysts. The relevant studies in recent years are reviewed, showing that the establishment of low-temperature light-off "Mn2+ ↔Mn3+ " redox cycle over the MnOx -Na2 WO4 -based catalysts indeed works effectively toward a low-temperature light-off OCM process. Moreover, three perspectives for the OCM industrialization are discussed based on this concept, including monolithic catalyst, fluidized-bed method and chemical-looping process.An efficient ruthenium(II)-catalyzed tandem C-C/C-N bond formation with aryl amides and 7-azabenzonorbornadienes has been developed to synthesize cis-fused dihydrobenzo[c]phenanthridinones. The amide group functions as a directing group as well as a leaving group and provides an easy access to the pharmaceutically useful benzo[c]phenanthridine alkaloids such as nitidine and fagaronine analogues. The present methodology is compatible with various functional groups with respect to azabicyclic alkenes and aromatic amides. The reaction mechanism involving directing-group-assisted C-H activation was proposed and supported by the deuterium labeling studies.Herein, we report a novel and unexpected metal-free oxygenation of 2,3-diphenyl-1-indenones, under an oxygen atmosphere (air), to either 2,3-epoxy-2,3-diphenyl-1-indenone or 2-hydroxy-2,3-diphenyl-1-indanone, depending on the conditions. Several bioactive epoxy indenones and one-pot α-hydroxy indanones (α-acyloin) were synthesized from 2,3-diaryl dihydroindanone and 2,3-diarylindenone, respectively. A plausible reaction mechanism is also proposed, where oxygenation would take place at the α-position and further proton abstraction from the β-position leads to epoxy indenone derivatives. A one-pot cis-hydroxy indanone protocol is also achieved directly from biaryl indenone via reduction, epimerization, and oxygenation. The synthesized compounds were evaluated for inhibitory activity against the DNA repair protein AlkB. Among the screened (17 tested) compounds, one epoxide derivative was found to be a specific inhibitor of AlkB enzyme function.

In the US, Medicaid covers over 80 million Americans. Comparing access, quality, and costs across Medicaid programs can provide policymakers with much-needed information. As each Medicaid agency collects its member data, multiple barriers prevent sharing Medicaid data between states. To address this gap, the Medicaid Outcomes Distributed Research Network (MODRN) developed a research network of states to conduct rapid multi-state analyses without sharing individual-level data across states.

To describe goals, design, implementation, and evolution of MODRN to inform other research networks.

MODRN implemented a distributed research network using a common data model, with each state analyzing its own data; developed standardized measure specifications and statistical software code to conduct analyses; and disseminated findings to state and federal Medicaid policymakers. Based on feedback on Medicaid agency priorities, MODRN first sought to inform Medicaid policy to improve opioid use disorder treatment, parging health challenges to facilitate evidence-based policymaking in Medicaid programs.Immunoglobulin A (IgA) pemphigus, also known as intercellular IgA dermatosis, is a rare autoimmune bullous disease presenting with IgA anti-keratinocyte cell surface autoantibodies. Concomitant lymphoproliferative disorders have been reported in IgA pemphigus, including IgA monoclonal gammopathy of undetermined significance and IgA type multiple myeloma (MM). A 35-year-old Japanese woman with a 3-year history of pruritic papulovesicles on her lower legs and trunk was referred to our department. Histopathological examination revealed acantholytic blisters, and results of both direct and indirect immunofluorescence were negative. Direct and indirect immunofluorescence were still negative 3 years and 7 months later. Approximately 7 years after her first visit, the patient was re-referred to us because of disease exacerbation. Histopathological findings revealed subcorneal blistering with acantholysis, in which neutrophil-dominant inflammatory cells were present. Indirect immunofluorescence was positive for IgA ohould be aware of the development of multiple myeloma during the clinical course of patients with SPD-type IgA pemphigus.

Hyperreflective dots (HRDs) can be observed in spectral domain optical coherence tomography (SD-OCT), which can provide a sensitive marker in the treatment decision process. Quantitative analyses of HRDs are the key to make appropriate decisions on observation, treatment, and retreatment. The purpose of this study is to automatically and accurately segment HRDs in SD-OCT B-scans with diabetic retinopathy (DR).

The authors propose an automatic segmentation algorithm of HRDs via focal priors and visual saliency. The algorithm is divided into three stages segmentation of retinal layers, calculation of the multiscale local contrast saliency map, and adaptive threshold segmentation. First, a method based on improved graph search is used to segment retinal layers to obtain the region of interest (ROI) and the reflectivity estimation of the retinal pigment epithelium (RPE) layer; then, the multiscale local contrast saliency map is obtained by using a local contrast measure, which measures the dissimilarity between the current pixels and corresponding neighborhoods; finally, an adaptive threshold is applied to segment HRDs.