Preparative Scale Research Articles

Validity and Reliability of Turkish Language Version of Baby Preparation and Worry Scale

Introduction. The Baby Preparation and Anxiety Scale (Baby-PAWS) is the only instrument focusing on expectant mothers’ practical concerns about the transition to parenthood (being able to care for the baby, securing childcare, personal well-being, and partner involvement) and measuring these parameters. Objective. The aim of this study is to determine the validity and reliability of Baby-PAWS, by adapting it to the Turkish population. Method. Two hundred and twenty expectant mothers over the age of eighteen in the third trimester of pregnancy were included in our methodological study. The content and language of Baby-PAWS were also validated. Data were subsequently obtained through confirmatory and explanatory factor analysis, correlation analysis and the Cronbach’s alpha coefficient test. Results. It was found that although the Turkish language version of Baby-PAWS did not have three sub-dimensions as in the original, the one-dimensional Baby-PAWS was a valid, reliable scale tool suitable for the Turkish population. Cronbach’s alpha coefficient of the revised scale was .85. Discussion and conclusion. The Turkish language version of Baby-PAWS is a suitable instrument in terms of language and content validity, and its single-factor structure can be applied to the Turkish population and correctly identify expectant mothers’ concerns about self-care, partner/relationship issues, self-care, and relying on others to care for the baby after its birth.

Development and validation of the Open-Source Automatic Bowel Preparation Scale.

Development and validation of the Open-Source Automatic Bowel Preparation Scale.

Effect of an artificial intelligence-assisted recognition system on colonoscopy quality

Objective: To explore the value of the artificial intelligence (AI)-assisted recognition system in the detection quality of colonoscopy. Methods: From January 2023, the data on 700 patients who underwent colonoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University were collected prospectively. Based on a computerized number method, patients were divided into the AI assistance group and control group. The detection rate of adenomas (ADR) and polyps, number and size of adenomas, Boston bowel preparation scale (BBPS), intubation time, withdrawal time, and cecal intubation rate were compared between groups. Normally distributed data were analyzed with the t-test for independent samples. Non-normally distributed data were analyzed with the Rank sum test. Categorical data were analyzed with the Chi-square test. Results: In total, 691 patients were included in the analysis. According to the intention to treat (ITT) analysis and per-protocol (PP) analysis, the withdrawal time of the AI group was higher than that of the control group (ITT:436 (305, 620) vs 368 (265, 510) s, Z=-4.24, P<0.001;PP:439 (306, 618) vs 364 (262, 500) s,t=-4.50, P<0.001); however, there were no significant differences in the ADR (ITT:123(35.5%) vs 111(32.2%), χ2=0.88, P=0.349;PP:108(34.2%) vs 99(31.1%), χ2=0.67, P=0.414), the number of adenomas (ITT:0(0, 1) vs 0(0, 1),Z=-1.08, P=0.282;PP:0(0, 1) vs 0(0, 1),Z=-0.87, P=0.387), the polyp detection rate (ITT:85(24.6%) vs 85(24.6%),χ2=0.001, P=0.983;PP:79(25.0%) vs 77(24.2%),χ2=0.05, P=0.818), BBPS (ITT:6.5±0.9 vs 6.5±0.7,t=-0.59, P=0.555;PP:6.7±0.6 vs 6.6±0.6,t=-1.83, P=0.068), and cecal intubation rate (ITT:346(100.0%) vs 343(99.4%), χ2=0.50, P=0.478) between these two groups. After excluding inadequate bowel preparation and failed cecal intubation cases, the AI-assisted system was found to significantly improve the detection rate of small adenomas (≤5 mm) (PP:27.8%(88/316)vs 21.1%(67/318), χ2=3.94, P=0.047). Conclusions: The application of an AI-assisted system in colonoscopy can increase the withdrawal time and improve the detection rate of small adenomas.

Comparing Right-sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial

INTRODUCTION: Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy. METHODS: We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR. RESULTS: WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P &lt; 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P &lt; 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94). CONCLUSIONS: The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393).

New CYP154C4 from Streptomyces cavourensis YBQ59 performs regio- and stereo- selective 3β-hydroxlation of nootkatone

Nootkatone, a sesquiterpenoid widely used in the food and cosmetics industries, exhibits diverse biological activities and pharmaceutical prospects. Modification of nootkatone to create new derivatives with desirable activities has attracted significant attention. For this purpose, cytochrome P450 monooxygenases (P450 or CYP) are attractive candidates due to their ability to perform regio- and stereoselective hydroxylation at allylic C–H bonds. In this study, CYP154C4 from Streptomyces cavourensis YBQ59 was cloned and expressed in Escherichia coli. By screening 64 candidate substrates, this P450 was found to catalyze the regio- and stereoselective hydroxylation of nootkatone, yielding a single product, 3β-hydroxynootkatone. Using a whole-cell E. coli system expressing CYP154C4, supported by the heterologous redox partners YkuN from Bacillus subtilis and FdR from E. coli, 3β-hydroxynootkatone was produced on a preparative scale. The structure of this compound was determined by 1H NMR, 13C NMR, NOESY, HMBC, and HSQC. The kinetics of product formation were analyzed using HPLC, and the Km and Kcat values were calculated. Furthermore, structural insights into the selective hydroxylation of nootkatone were elucidated by molecular docking. 3β-Hydroxynootkatone, recently synthesized semi-synthetically from nootkatone, has been reported to exhibit a higher insecticidal activity than its parent compound. Additionally, the functionalization of nootkatone with N-acyl-2-aminothiazole at the C3 and C2 positions, yielding an α-glucosidase inhibitor, has also been previously described. Therefore, 3β-hydroxynootkatone has great potential for further research and for synthesizing new derivatives with valuable biological activities for agricultural and medicinal applications.

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p&gt;0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p&gt;0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Acute Gastropathy Associated with Bowel Preparation According to Age: Oral Sulfate Tablets versus 1-L Polyethylene Glycol with Ascorbic Acid.

The use of 1-L polyethylene glycol with ascorbate (PEG/Asc) and oral sulfate tablets (OST) as low-volume bowel preparation agents has gradually increased. However, these agents may induce acute gastropathy during bowel preparation, particularly in elderly populations. This study aimed to compare the incidence of acute gastropathy of 1-L PEG/Asc and OST according to age, as well as efficacy and safety. This retrospective study included patients who underwent esophagogastroduodenoscopy (EGD) and colonoscopy for screening on the same day and underwent bowel preparation using OST or 1-L PEG/Asc. We collected EGD findings related to acute gastropathy, bowel-cleansing score using the Boston Bowel Preparation Scale (BBPS), polyp or adenoma detection rate (ADR), and laboratory parameters. Of 4,711 patients, 1,758, 2,241, and 712 were in the younger (18-49 years), middle-aged (50-64 years), and older (≥65 years) groups, respectively. In all age groups, the OST group had higher rates of acute gastropathy than the 1-L PEG/Asc group. The younger-, middle-, and older-aged groups had OST and 1-L PEG/Asc usage rates of 42.9% and 11.6%, 41.2% and 16.0%, and 41.5% and 16.4%, respectively. Notably, in the younger group, the total BBPS and ADR scores were significantly higher in the OST group than in the 1-L PEG/Asc group; however, these did not differ in the other age groups. Acute gastropathy was more strongly associated with OST than with 1-L PEG/Asc in all age groups. Therefore, physicians should consider acute gastropathy associated with low-volume agents in all age groups when performing bowel preparation.

Glucagon-like peptide-1 receptor agonists significantly affect the quality of bowel preparation for colonoscopy.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) affect gastrointestinal motility, slowing gastric emptying and colonic transit. GLP-1RAs have an impact on gastric residue before endoscopy, but only limited data are available regarding its effect on the adequacy of colonic preparation. We investigated the association between GLP-1RA use and inadequate bowel preparation (IBP) for colonoscopy. We performed a multicenter retrospective study with GLP-1RA cases matched with controls (using propensity scores for age, sex, diabetes mellitus [DM], obesity, and co-morbidities). Data on demographics, medication use, procedural indications, and colonoscopy findings were collected. IBP ("poor preparation" on Aronchik scale or Boston Bowel preparation scale <5) was the primary outcome. 4876 patients treated with GLP-1RAs were included in the analysis and compared with 4876 controls selected from 333 648 patients without GLP-1RA use. Among the GLP-1RA patients, 10% (n = 487) had IBP compared with 197 (4%) of the control group (P<0.001). Subgroup analysis showed a higher rate of IBP among diabetic patients treated with GLP-1RA (284/2364 [12%]) than among diabetic patients without GLP-1RA treatment (118/2364 [5%]; P<0.001). Additionally, 203/2512 nondiabetic patients treated with GLP-1RAs had IBP (8%) compared with 79 of the nondiabetic non-GLP-1RA group (3%; P<0.001). On multivariate analysis, diabetes and GLP-1RA use were both found to be independent risk factors for IBP (odds ratio [OR] 1.4 and OR 2.7, respectively; both P<0.001). Our findings highlight the necessity for special attention and tailored recommendations for both diabetic and nondiabetic patients treated with GLP-1RAs in terms of colonic preparation prior to colonoscopy.

S387 Single Center Assessment of the Boston Bowel Preparation Scale Score Among Patients With Obesity Who Are Receiving Semaglutide During the Time of Colonoscopy

S387 Single Center Assessment of the Boston Bowel Preparation Scale Score Among Patients With Obesity Who Are Receiving Semaglutide During the Time of Colonoscopy

Action pattern of Sulfolobus O-α-glycoligase for synthesis of highly water soluble resveratrol 3,4′-α-diglucoside

This study presents the enzymatic synthesis of resveratrol-3,4′-O-α-diglucoside (RDG) using a hyperactive O-α-glycoligase (MalA-D416R/Q450S) and α-glucopyranosyl fluoride as the donor substrate. The transglycosylation rate for resveratrol by MalA-D416R/Q450S was maximized in 100 mM Tris-HCl (pH 9.5) containing 20 % DMSO at 45°C. Because the pKa of the 4′-OH group of resveratrol is lower than that of the 3-OH group, the 4′-OH group is more nucleophilic at the alkaline pH, leading to a preference for glycosylation at the 4′-OH site rather than the 3-OH site. This preference makes resveratrol 3-O-α-glucoside (R3G) as the more efficient acceptor than resveratrol 4′-O-α-glucoside (R4′G), resulting in negligible production of resveratrol 3-O-α-glucoside (R3G) due to its complete consumption in the second transglycosylation reaction when using a 2:1 ratio of donor to acceptor substrates. From a preparative scale reaction, R4′G and RDG were isolated with yields of 41.2 % and 43.3 %, respectively. The water solubility of RDG exceeded 1.67 M, which represents more than a 9,800-fold improvement compared to resveratrol. In a hydrolysis experiment using intestinal α-glycosidase from rat, the α-glucosides of resveratrol (R4′G and RDG) were completely deglycosylated to the aglycone.

Evaluation of the efficacy of polyethylene glycol in combination with different doses of linaclotide in a fractionated bowel preparation for colonoscopy: a prospective randomized controlled study

Background and aimThe ideal bowel cleansing program still needs to be explored. The aim was to compare the bowel cleansing effect and patient tolerance of low-dose polyethylene glycol (PEG) combined with different doses of linaclotide in fractionated bowel preparation.MethodsThe subjects were randomly assigned to the 3LPEG group, 2LPEG + 2L group, or 2LPEG + L group. The primary outcome was to use the Ottawa Bowel Preparation Scale (OBPS) to evaluate the efficacy of bowel cleansing, and the secondary outcomes were the detection rate of adenomas and polyps, adverse reactions, tolerance, and defecation dynamics; subsets of patients with chronic constipation and irritable bowel syndrome were also analyzed.ResultsA total of 753 patients were randomly assigned. In ITT analysis, the success of preparation of the 2LPEG + 2L group was better than that of the 2LPEG + L group or the 3LPEG group (92.0% vs. 82.3% vs. 82.1%; P = 0.002). Compared with the 3LPEG group, the 2LPEG + L group showed similar but non-inferior results (82.3% vs. 82.1%, P > 0.05). The 2LPEG + 2L group was similar to the 2LPEG + L group in terms of adverse reaction, tolerance, willingness to reuse, and sleep quality, but both were superior to the 3LPEG group. In a subgroup analysis of chronic constipation, the 2LPEG + 2L group had the best cleansing effect on the right colon and mid colon, while in the subgroup analysis of irritable bowel syndrome, the tolerance was better in the 2LPEG + 2L group and the 2LPEG + L group than the 3LPEG group.Conclusions2LPEG + 2L is a feasible bowel preparation regimen.

Biochemical Characterization of Recombinant Enterococcus faecalis EntV Peptide to Elucidate Its Antihyphal and Antifungal Mechanisms against Candida albicans.

Candida albicans is a common opportunistic fungus in humans, whose morphological switch between yeast and hyphae forms represents a key virulence trait. Developing strategies to inhibit C. albicans hyphal growth may provide insights into designs of novel antivirulent therapeutics. Importantly, the gut commensal bacterium, Enterococcus faecalis, secretes a bacteriocin EntV which has potent antivirulent and antifungal effects against C. albicans in infection models; however, hampered by the challenges to access large quantities of bioactive EntV, the detailed understanding of its mechanisms on C. albicans has remained elusive. In this work, we biochemically reconstituted the proteolytic cleavage reaction to obtain recombinant EntV88-His6 on a large preparative scale, providing facile access to the C-terminal EntV construct. Under in vitro C. albicans hyphal assay with specific inducers, we demonstrated that EntV88-His6 exhibits potent bioactivity against GlcNAc-triggered hyphal growth. Moreover, with fluorescent FITC-EntV88-His6, we revealed that EntV88-His6 enters C. albicans via endocytosis and perturbs the proper localization of the polarisome scaffolding Spa2 protein. Our findings provide important clues on EntV's mechanism of action. Surprisingly, we showed that EntV88-His6 does not affect C. albicans yeast cell growth but potently exerts cytotoxicity against C. albicans under hyphal-inducing conditions in vitro. The combination of EntV88-His6 and GlcNAc displays rapid killing of C. albicans, rendering it a promising antivirulent and antifungal agent.

Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study.

Colonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre-colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG). In this prospective, single-center, randomized controlled trial, 322 participants were divided into two groups: a 3-L PEG+870-μg linaclotide group (administered as a single dose for 3days) and a 4-L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction. The study included 319 patients. The 3-L PEG+linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4-L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P<0.05). The mean BBPS score for the right colon in the 3-L PEG+linaclotide group was significantly higher than that in the 4-L PEG group. There were no significant between-group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P>0.05). There were no significant between-group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3-L PEG+linaclotide group. The combination of 3-L PEG and 870-μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.

Dehydrogenative N−N Coupling and Facile Synthesis of Cobalt Complexes Supported by Tetrazene Based Ligand: Synthesis of Quinolines and Quinazolinones via Activation of Alcohols

AbstractHerein we first report the unprecedented synthesis of tetrazene‐based cobalt complexes using unusual coupling of amines via dehydrogenation. These cobalt complexes were employed for dehydrogenative coupling reactions to synthesize N‐heterocycles (quinoline, and quinazolinone). Based on control experiments and IR identification of intermediates, we proposed a plausible reaction mechanism. Synthesis protocols were utilized for preparative scale synthesis and biologically active molecule (±)‐galipinine synthesis.

Simple Green Purification of Spilanthol from Natural Deep Eutectic Solvent and Ethanolic Acmella oleracea (L.) R.K. Jansen Extracts Using Solid-Phase Extraction

Spilanthol is a major N-alkylamide constituent of Acmella oleracea (L.) R.K. Jansen with diverse pharmacological properties. We recently showed the applicability of NADES (natural deep eutectic solvents) for the green extraction of spilanthol. However, the purification of targets from NADES poses a challenging step due to their non-volatility. A simple green method to retrieve spilanthol with minimal instrumental effort was devised, fractioning NADES (choline chloride/methylurea, choline chloride/1,2-propanediol, choline chloride/citric acid) and dry ethanolic extracts by SPE on C18 material, eluting merely with ethanolic solutions. The relative distribution of spilanthol and organic adulteration in SPE fractions were detected by HPLC-DAD, followed by scale-up, quantification and purity determination in an NMR-based approach. Isocratic elution with 52% ethanol (v/v) proved suitable in all experiments. The three purest 10 mL fractions combined yielded 12.21 mg spilanthol at 71.65% purity from NADES extract ChCl/P (choline chloride/1,2-propanediol, molar ratio 1:2, +20% m/m water). Ethanolic extract samples showed purities ranging from 77.27 to 80.27% in combined raw fractions. For all samples, purity increased by removing non-soluble substances from organic solutions. Pooled NADES extract fractions showed 89.71% in final samples, ethanolic extracts 87.25 to 91.93%. The highest purities of individual fractions per extract were 89.23 to 94.15%. This cheap and simple purification process is promising to acquire spilanthol for research purposes or as a sample preparation step before HPLC on a semi-preparative to preparative scale, as the substance is highly priced and scarcely available on the market. Organic solvents can be reused, and preliminary scale-up possibilities are shown.

Enantiocomplementary Bioreduction of 1-(Arylsulfanyl)propan-2-ones.

This study explored the enantiocomplementary bioreduction of substituted 1-(arylsulfanyl)propan-2-ones in batch mode using four wild-type yeast strains and two different recombinant alcohol dehydrogenases from Lactobacillus kefir and Rhodococcus aetherivorans. The selected yeast strains and recombinant alcohol dehydrogenases as whole-cell biocatalysts resulted in the corresponding 1-(arylsulfanyl)propan-2-ols with moderate to excellent conversions (60-99%) and high selectivities (ee > 95%). The best bioreductions-in terms of conversion (>90%) and enantiomeric excess (>99% ee)-at preparative scale resulted in the expected chiral alcohols with similar conversion and selectivity to the screening reactions.

Oral sulfate solution versus polyethylene glycol for bowel preparation before colonoscopy, meta-analysis and trial sequential analysis of randomized clinical trials.

This study aimed to compare oral sulfate solution (OSS) with polyethylene glycol (PEG) for bowel preparation before colonoscopy. A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA). A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS. The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes.

Enantioselective Construction of Tetrahydroindole Skeletons by Rh‐Catalyzed [2+2+2] Cycloaddition of Homopropargyl Enamides with Alkynes

AbstractWe have developed the Rh‐catalyzed enantioselective [2+2+2] cycloaddition of homopropargyl enamides (tosylamide‐tethered 1,6‐enynes) with alkynes to construct tetrahydroindole skeletons found in natural alkaloids and pharmaceuticals. This cycloaddition proceeds at room temperature in high yields and regio‐ and enantioselectivity with a broad substrate scope. The preparative scale reaction followed by substituent conversion on the nitrogen atom and the diastereoselective [4+2] cycloaddition with singlet O2 affords hexahydroindole‐diols bearing three stereogenic centers and variable substituents on the nitrogen. Mechanistic studies have revealed that the substituents of the enynes change the ratio of intramolecular and intermolecular rhodacycle formation when using terminal alkynes, varying the ee values of the cycloadducts.

Enantioselective Construction of Tetrahydroindole Skeletons by Rh-Catalyzed [2+2+2] Cycloaddition of Homopropargyl Enamides with Alkynes.

We have developed the Rh-catalyzed enantioselective [2+2+2] cycloaddition of homopropargyl enamides (tosylamide-tethered 1,6-enynes) with alkynes to construct tetrahydroindole skeletons found in natural alkaloids and pharmaceuticals. This cycloaddition proceeds at room temperature in high yields and regio- and enantioselectivity with a broad substrate scope. The preparative scale reaction followed by substituent conversion on the nitrogen atom and the diastereoselective [4+2] cycloaddition with singlet O2 affords hexahydroindole-diols bearing three stereogenic centers and variable substituents on the nitrogen. Mechanistic studies have revealed that the substituents of the enynes change the ratio of intramolecular and intermolecular rhodacycle formation when using terminal alkynes, varying the ee values of the cycloadducts.

Performance of bowel preparation quality scales in patients with Crohn's disease.

The performance of bowel preparation (BP) in patients with Crohn's disease (CD) is unknown. To evaluate the operating properties of instruments used to assess BP quality in patients with CD. We used the Boston Bowel Preparation Scale, modified Boston Bowel Preparation Scale, Harefield Cleansing Scale, Food and Drug Administration Bowel Cleansing Assessment Scale (BCAS), and a 100-mm visual analogue scale of bowel cleanliness to assess BP quality in 50 videos from 40 patients with CD. We assessed endoscopic activity with the Simple Endoscopic Score for CD (SES-CD). Assessments were on endoscope insertion and withdrawal. Reliability was quantified using the intraclass correlation coefficient (ICC). We assessed validity by within-patient correlation between instruments and the visual analogue scale using mixed-effect models. The correlation between BP quality and SES-SD scores was assessed using Spearman's rho. Inter- and intra-rater reliability for all BP quality instruments was substantial (ICC ≥0.61) except for the Food and Drug Administration BCAS on insertion (inter-rater reliability ICC ≥0.41). The visual analogue scale had substantial inter- and almost perfect (ICC ≥0.81) intra-rater reliability. Correlation coefficients for the validity of the instruments exceeded 0.58. BP quality and endoscopic disease activity scores in the colon were negatively correlated. Most existing instruments reliably assess BP quality in patients with CD. These results support the use of these instruments in clinical practice, provide a framework for scoring BP quality in CD clinical trials, and support evaluation of novel BP agents in patients with CD.