Thoracic impedance pneumography in propofol-sedated patients undergoing percutaneous endoscopic gastrostomy (PEG) placement in gastrointestinal endoscopy: A prospective, randomized trial

STUDY OBJECTIVE

To assess the efficacy of an ECG-based method called thoracic impedance pneumography to reduce hypoxic events in endoscopy.

DESIGN

This was a single center, 1:1 randomized controlled trial.

SETTING

The trial was conducted during the placement of percutaneous endoscopic gastrostomy (PEG).

PATIENTS

173 patients who underwent PEG placement were enrolled in the present trial. Indication was oncological in most patients (89%). 58% of patients were ASA class II and 42% of patients ASA class III.

INTERVENTIONS

Patients were randomized in the standard monitoring group (SM) with pulse oximetry and automatic blood pressure measurement or in the intervention group with additional thoracic impedance pneumography (TIM). Sedation was performed with propofol by gastroenterologists or trained nurses.

MEASUREMENTS

Hypoxic episodes defined as SpO2 < 90% for >15 s were the primary endpoint. Secondary endpoints were minimal SpO2, apnea >10s/>30s and incurred costs.

MAIN RESULTS

Additional use of thoracic impedance pneumography reduced hypoxic episodes (TIM: 31% vs SM: 49%; p = 0.016; OR 0.47; NNT 5.6) and elevated minimal SpO2 per procedure (TIM: 90.0% ± 8.9; SM: 84.0% ± 17.6; p = 0.007) significantly. Apnea events >10s and > 30s were significantly more often detected in TIM (43%; 7%) compared to SM (1%; 0%; p < 0.001; p = 0.014) resulting in a time advantage of 17 s before the occurrence of hypoxic events. As a result, adjustments of oxygen flow were significantly more often necessary in SM than in TIM (p = 0.034) and assisted ventilation was less often needed in TIM (2%) compared with SM (9%; p = 0.053). Calculated costs for the additional use of thoracic impedance pneumography were 0.13$ (0.12 €/0.11 £) per procedure.

CONCLUSIONS

Additional thoracic impedance pneumography reduced the quantity and extent of hypoxic events with less need of assisted ventilation. Supplemental costs per procedure were negligible.

KEY WORDS

thoracic impedance pneumography, capnography, sedation, monitoring, gastrointestinal endoscopy, percutaneous endoscopic gastrostomy.

A generic approach based on long-lifetime fluorophores for the assessment of protein binding to polymer nanoparticles by fluorescence anisotropy

Quantitation of protein-nanoparticle interactions is essential for the investigation of the protein corona around NPs in vivo and when using synthetic polymer nanoparticles as affinity reagents for selective protein recognition in vitro. Here, a method based on steady-state fluorescence anisotropy measurement is presented as a novel, separation-free tool for the assessment of protein-nanoparticle interactions. For this purpose, a long-lifetime luminescent Ru-complex is used for protein labelling, which exhibits low anisotropy when conjugated to the protein but displays high anisotropy when the proteins are bound to the much larger polymer nanoparticles. As a proof of concept, the interaction of lysozyme with poly(N-isopropylacrylamide-co-N-tert-butylacrylamide-co-acrylic acid) nanoparticles is studied, and fluorescence anisotropy measurements are used to establish the binding kinetics, binding isotherm and a competitive binding assay.

Synthesis of TiO2/Al2O3 Double-Layer Inverse Opal by Thermal and Plasma-Assisted Atomic Layer Deposition for Photocatalytic Applications

In comparison to conventional nano-infiltration approaches, the atomic layer deposition (ALD) technology exhibits greater potential in the fabrication of inverse opals (IOs) for photocatalysts. In this study, TiO₂ IO and ultra-thin films of Al₂O₃ on IO were successfully deposited using thermal or plasma-assisted ALD and vertical layer deposition from a polystyrene (PS) opal template. SEM/EDX, XRD, Raman, TG/DTG/DTA-MS, PL spectroscopy, and UV Vis spectroscopy were used for the characterization of the nanocomposites. The results showed that the highly ordered opal crystal microstructure had a face-centered cubic (FCC) orientation. The proposed annealing temperature efficiently removed the template, leaving the anatase phase IO, which provided a small contraction in the spheres. In comparison to TiO₂/Al₂O₃ plasma ALD, TiO₂/Al₂O₃ thermal ALD has a better interfacial charge interaction of photoexcited electron-hole pairs in the valence band hole to restrain recombination, resulting in a broad spectrum with a peak in the green region. This was demonstrated by PL. Strong absorption bands were also found in the UV regions, including increased absorption due to slow photons and a narrow optical band gap in the visible region. The results from the photocatalytic activity of the samples show decolorization rates of 35.4%, 24.7%, and 14.8%, for TiO₂, TiO₂/Al₂O₃ thermal, and TiO₂/Al₂O₃ plasma IO ALD samples, respectively. Our results showed that ultra-thin amorphous ALD-grown Al₂O₃ layers have considerable photocatalytic activity. The Al₂O₃ thin film grown by thermal ALD has a more ordered structure compared to the one prepared by plasma ALD, which explains its higher photocatalytic activity. The declined photocatalytic activity of the combined layers was observed due to the reduced electron tunneling effect resulting from the thinness of Al₂O₃.

Complexes of carboxylato pillar[6]arene with Brooker-type merocyanines: Spectral properties, pKa shifts and the design of a displacement assay for trimethyl lysine

The supramolecular complexes of three strongly solvatochromic dyes, Brooker's merocyanine (M1) and its two derivatives (M2, M3) with carboxylato pillar[6]arene (WP6) were studied in aqueous solutions. The dye-WP6 mixtures were described in terms of four equilibrium reactions: the acidic dissociations of the pyridinium phenols into the zwitterionic phenolates, the acidic dissociations of the complexed phenols, the bindings of the phenol form dyes to WP6 and the bindings of the phenolates to WP6. The equilibrium constants were determined by an analysis of the absorption spectra. It was found that the acidity of the phenol form merocyanines were largely reduced on complexation, pK_a shifts of 1.1-1.6 units were observed. In neutral solutions, the complexes of the phenol forms of M1 and M2 were dominant, in contrast to the more acidic M3 (a dibromo derivative), of which the phenolate complex was more stable. Comparing the spectral properties, the binding constants and the pK_a-s of the dye-WP6 complexes, the complex M3⋅WP6 was chosen to be tested as a displacement assay. It was demonstrated that this complex functioned as a colorimetric indicator displacement assay which discriminated trimethyl lysine from other lysine derivatives.

Binding Modes of a Phenylpyridinium Styryl Fluorescent Dye with Cucurbiturils

In order to explore how cucurbituril hosts accommodate an N-phenyl-pyridinium derivative guest, the complexation of the solvatochromic dye, 4-(4-(dimethylamino)styryl)-1-phenylpyridinium iodide (PhSt) with ,',δ,δ'-tetramethyl-cucurbit[6]uril (Me4CB6) and cucurbit[7]uril (CB7) was investigated by absorption spectroscopic, fluorescence and NMR experiments. In aqueous solutions, PhSt forms 1:1 complexes with both cucurbiturils, the complex with CB7 has a higher stability constant (Ka = 6.0 × 106 M-1) than the complex with Me4CB6 (Ka = 1.1 × 106 M-1). As revealed by NMR experiments and confirmed by theoretical calculations, CB7 encapsulates the whole phenylpyridinium entity of the PhSt cation guest, whereas the cavity of Me4CB6 includes only the phenyl ring, the pyridinium ring is bound to the carbonyl rim of the host. The binding of PhSt to cucurbiturils is accompanied by a strong enhancement of the fluorescence quantum yield due to the blocking of the deactivation through a twisted intramolecular charge transfer (TICT) state. The TICT mechanism in PhSt was characterized by fluorescence experiments in polyethylene glycol (PEG) solvents of different viscosities. The PhSt-CB7 system was tested as a fluorescence indicator displacement (FID) assay, and it recognized trimethyl-lysine selectively over other lysine derivatives.

Strong ion pair charge transfer interaction of 1,8-naphthalimide–bipyridinium conjugates with basic anions – towards the development of a new type of turn-on fluorescent anion sensors

Fluoride, acetate and benzoate anions reduce naphthalimide–viologen dyads into radicals, which is indicated by a strong fluorescence enhancement.

Hydrogen bonding effects on the fluorescence properties of 4'-diethylamino-3-hydroxyflavone in water and water-acetone mixtures

The fluorescence properties of 4'-diethylamino-3-hydroxyflavone (FET), a dye probe sensitive to the polarity as well as the hydrogen bonding ability of its environment, have been studied in acetone-water mixtures by measuring spectra and decay curves over the whole composition range and analyzing the results on the basis of theoretical calculations. In acetone, like in most of organic solvents, the dye showed dual fluorescence, due to an excited state intramolecular proton transfer (ESIPT), in which a quasi-equilibrium between the two excited species, N* and T*, was reached. In acetone-water mixtures with lower molar fractions of water, where the water molecules are largely dispersed, only one type of hydrate could be detected, a complex with 1:1 composition, showing only N* emission, but with a high (0.45) fluorescence quantum yield. At higher water concentrations, the interaction of FET with the hydrogen-bonded water clusters resulted in fluorescence quenching. In neat water the fluorescence quantum yield fell to ~0.001. Theoretical calculations on a FET-acetone complex, a FET-water complex and a FET-water-acetone triple complex (the latter as model for the samples with low water concentrations) concluded that ESIPT was energetically favored in all the models, but the E(N*)-E(T*) energy difference for the water complexes was much lower. The kinetic barrier of ESIPT was found greatly higher in the FET-water complex than in the isolated solute. The intermolecular hydrogen bonds in the water complexes became significantly stronger following the excitation, stabilizing the N* form of the hydrated dye.

An uracil-linked hydroxyflavone probe for the recognition of ATP

Background: Nucleotides are essential molecules in living systems due to their paramount importance in various physiological processes. In the past years, numerous attempts were made to selectively recognize and detect these analytes, especially ATP using small-molecule fluorescent chemosensors. Despite the various solutions, the selective detection of ATP is still challenging due to the structural similarity of various nucleotides. In this paper, we report the conjugation of a uracil nucleobase to the known 4'-dimethylamino-hydroxyflavone fluorophore. Results: The complexation of this scaffold with ATP is already known. The complex is held together by stacking and electrostatic interactions. To achieve multi-point recognition, we designed the uracil-appended version of this probe to include complementary base-pairing interactions. The theoretical calculations revealed the availability of multiple complex structures. The synthesis was performed using click chemistry and the nucleotide recognition properties of the probe were evaluated using fluorescence spectroscopy. Conclusions: The first, uracil-containing fluorescent ATP probe based on a hydroxyflavone fluorophore was synthesized and evaluated. A selective complexation with ATP was observed and a ratiometric response in the excitation spectrum.

Experimental evidence of TICT state in 4-piperidinyl-1,8-naphthalimide – a kinetic and mechanistic study

The excited state processes in N-propyl-4-piperidinyl-1,8-naphthalimide have been studied by measuring its fluorescence spectra and decay curves in solvents of different polarity and viscosity and also in a frozen solvent glass.

The kinetics and mechanism of photooxygenation of 4'-diethylamino-3-hydroxyflavone

The photolysis reactions of 4'-diethylamino-3-hydroxyflavone (D), a versatile fluorescent probe showing excited-state intramolecular proton transfer (ESIPT), and the magnesium chelate of D (MgD(2+)) have been studied in acetonitrile solution. Upon UV irradiation both species were oxidized into O-4-diethylaminobenzoyl salicylic acid, differently from the photoreaction of the parent compound 3-hydroxyflavone (3HF) which was described to undergo rearrangement to 3-hydroxy-3-phenyl-indan-1,2-dione. The photooxygenation of the Mg(2+) complex was found to be significantly faster than the reaction of the pure dye. As the kinetic analysis of the absorption spectra of samples under irradiation showed, the rate coefficients for the oxygenations of the excited state dye and complex have close values, kox(D*) = 2.4 × 10(7) min(-1), kox(MgD(2+)*) = 3.9 × 10(7) min(-1); the difference arises from the higher photooxygenation quantum yield of the complex, Φ(MgD(2+)) = 2.3 × 10(-3), than the respective value for the pure dye, Φ(D) = 1.5 × 10(-4). The potential energy surface of the photooxygenation of D was calculated assuming a reaction path in which the phototautomer formed from Dvia ESIPT, reacts in its triplet state with triplet molecular oxygen O2, a mechanism similar to that suggested for the photoreaction of the parent 3HF. The moderate values for the transition state energies confirmed the plausibility of the hypothetical mechanism.

Amino acid recognition by fine tuning the association constants: tailored naphthalimides in pillar[5]arene-based indicator displacement assays

Three naphthalimide derivatives were synthesized with different anchoring groups to adjust the supramolecular interactions with carboxylato-pillar[5]arene. The complexes were used as indicator displacement assays for basic amino acids and diamines.

Optical spectroscopic studies on the complexation of stilbazolium dyes with a water soluble pillar[5]arene

The host–guest interactions of carboxylato-pillar[5]arene (WPA5) and three stilbazolium dyes were studied by optical spectroscopy. A fluorescence indicator displacement based on WPA5 was shown to detect paraquat in aqueous solution.

Solvation and protonation of coumarin 102 in aqueous media: a fluorescence spectroscopic and theoretical study

The ground- and excited-state protonation of Coumarin 102 (C102), a fluorescent probe applied frequently in heterogeneous systems with an aqueous phase, has been studied in aqueous solutions by spectroscopic experiments and theoretical calculations. For the dissociation constant of the protonated form in the ground state, pKa = 1.61 was obtained from the absorption spectra; for the excited-state dissociation constant, pKa* = 2.19 was obtained from the fluorescence spectra. These values were closely reproduced by theoretical calculations via a thermodynamic cycle (the value of pKa* also by calculations via the Förster cycle) using an implicit–explicit solvation model (polarized continuum model + addition of a solvent molecule). The theoretical calculations indicated that (i) in the ground state, C102 occurs primarily as a hydrogen-bonded water complex, with the oxo group as the binding site, (ii) this hydrogen bond becomes stronger upon excitation, and (iii) in the ground state, the amino nitrogen atom is the protonation site, and in the excited state, the carboxy oxygen atom is the protonation site. A comprehensive analysis of fluorescence decay data yielded the values kpr = 3.27 × 10(10) M(–1) s(–1) for the rate constant of the excited-state protonation and kdpr = 2.78 × 10(8) s(–1) for the rate constant of the reverse process (kpr and kdpr were treated as independent parameters). This, considering the relatively long fluorescence lifetimes of neutral C102 (6.02 ns) and its protonated form (3.06 ns) in aqueous media, means that a quasi-equilibrium state of excited-state proton transfer is reached in strongly acidic solutions.

Resolution of 1-n-butyl-3-methyl-3-phospholene 1-oxide with TADDOL derivatives and calcium salts of O,O'-Dibenzoyl-(2R,3R)- or O,O'-di-p-toluoyl-(2R,3R)-tartaric acid

The resolution methods applying (-)-(4R,5R)-4,5-bis(diphenylhydroxymethyl)-2,2-dimethyldioxolane ("TADDOL"), (-)-(2R,3R)-α,α,α',α'-tetraphenyl-1,4-dioxaspiro[4.5]decan-2,3-dimethanol ("spiro-TADDOL"), as well as the acidic and neutral Ca(2+) salts of (-)-O,O'-dibenzoyl- and (-)-O,O'-di-p-toluoyl-(2R,3R)-tartaric acid were extended for the preparation of 1-n-butyl-3-methyl-3-phospholene 1-oxide in optically active form. In one case, the intermediate diastereomeric complex could be identified by single-crystal X-ray analysis. The absolute P-configuration of the enantiomers of the phospholene oxide was also determined by comparing the experimentally obtained and calculated CD spectra.