Assessment of Prognostic Scores for Emergency Department Patients With Upper Gastrointestinal Bleeding.

STUDY OBJECTIVE: Early prognostic stratification could optimize the management of patients with upper gastrointestinal bleeding and reduce unnecessary hospitalizations. The aim of this study was to assess and compare the performance of existing prognostic scores in predicting therapeutic intervention and death. METHODS: A systematic search of the literature identified existing prognostic scores. A multicenter retrospective cohort study included adult patients hospitalized for upper gastrointestinal bleeding from January 1, 2019, to December 31, 2020. The primary outcome was a composite including therapeutic intervention within 7 days (blood transfusion, endoscopic, surgical, or interventional radiology hemostasis) and/or 30-day death. Discrimination performance was estimated by the area under the curve (AUC). The ability to identify low-risk patients was analyzed using sensitivity and negative predictive value (NPV) for defined thresholds. RESULTS: The systematic search identified 39 prognostic scores, 12 of which could be analyzed. Among the 990 patients included, therapeutic intervention and/or death occurred in 755 (76.4%) patients. Scores with the highest discriminative performance to predict the primary composite outcome were Glasgow-Blatchford score (GBS) (AUC 0.869 [0.842 to 0.895]), modified GBS (AUC 0.872 [0.847 to 0.898]) and modified GBS 2 (AUC 0.855 [0.827 to 0.884]). The best performance to identify low-risk patients was for GBS≤1 (sensitivity 0.99 [0.99 to 1.00], NPV 0.89 [0.75 to 0.97]) and modified GBS=0 (sensitivity 0.99 [0.98 to 1.00], NPV 0.84 [0.71 to 0.94]). CONCLUSIONS: The GBS and the modified GBS are the 2 best performing scores because they achieve both key objectives: stratifying patients based on their risk of therapeutic intervention and/or death and identifying low-risk patients who may qualify for outpatient management.

Electrocatalytic dehydrogenative and defluorinative coupling between aldehyde-derived N,N-dialkylhydrazones and fluoromalonates: synthesis of 2-pyrazolines.

An electrocatalytic synthesis of 2-pyrazolines via dehydrogenative and defluorinative cross-coupling reactions between (hetero)arylaldehyde-derived N,N-dialkylhydrazones and fluoromalonates is disclosed. Salient features of this work include (i) readily available starting materials, (ii) practical reaction conditions, and (ii) a formal oxidative (4 + 1)-cycloaddition via triple C-H bond functionalization. Cyclic voltammetry analyses support the electrocatalytic formation of an α-fluoromalonyl radical.

Evaluation of use and identification of predictive factors for nonuse of peripheral venous catheters in the emergency department.

The placement of peripheral venous catheters (PVC) is a frequent procedure in the emergency department (ED), which exposes patients to complications (hematoma, fluid leakage, phlebitis, edema, infection), increases hemolysis of blood samples, is time-consuming and costly. The main aim of this study is to analyze the rate of PVC nonuse in the ED and to identify predictive factors of their nonuse. This prospective single-center observational study was conducted in the ED of the Saint-Antoine Hospital in Paris, France between February and March 2022. Adult patients receiving a PVC were included. In addition to demographic and medical data, the reason for PVC prescription and the prescribing physician's expectation of PVC use were collected. A total of 304 patients were included, with a median age of 61.5 years (IQR: 43-79 years), of whom 152 (50%) were men. PVC were primarily prescribed for intravenous medication administration. Seventy-two (23.7%) PVC were not used. In multivariable analysis, the predictive factors of nonuse were the prescribing physician's expectation of nonuse [OR 6.35, CI 95% (2.64-15.29), for "no" and "not sure" vs. "yes" responses] and the reason for prescribing "just in case" [OR 3.54, CI 95% (1.37-9.17)]. PVC were not used in 23.7% of cases. Predictors of nonuse were the prescribing physician's expectation of nonuse and the reason for prescribing "just in case". A PVC should probably not be prescribed if the prescribing physician thinks it will not be used or prescribes it "just in case".

Catalytic Synthesis of Trifluoromethylated Allenes, Indenes, Chromenes, and Olefins from Propargylic Alcohols in HFIP.

A general method to access CF3-substituted allenes from propargylic alcohols under Lewis acid catalysis in 1,1,1,3,3,3-hexafluoro-2-propanol (HFIP) as solvent is described. By tuning the reaction time and temperature, the obtained allenes rearrange to 1,3-biaryl-1-trifluoromethyl-1H-indenes. By tuning the structure of the propargylic alcohol substrates, a range of trifluoromethylated 2H-chromenes were successfully synthesized with the use of catalytic quantities of strong Brønsted acid in HFIP. The present method is therefore highly potent for the synthesis of a number of potentially pharmaceutically interesting new trifluoromethylated compounds and produces water as the only stoichiometric byproduct.