bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastric Protection and Gastrointestinal Bleeding with Aspirin Thromboprophylaxis in Hip and Knee Joint Replacements
Authors: Madhusudhan TR , Rangan A , Gregg PJ 
Published: May 2008

INTRODUCTION Upper gastrointestinal (GI) bleeding in patients who undergo hip and knee arthroplasty tends to be associated with non-steroidal anti-inflammatory drug use, steroid intake, pre-existing peptic ulcers and smoking. The use of aspirin for thromboprophylaxis is an added risk for the occurrence of GI bleed. The aim of this study was to determine the incidence of upper GI bleeding and whether the use of peri-operative oral ranitidine reduces the incidence of upper GI bleeding when aspirin thromboprophylaxis is used for hip and knee arthroplasty. PATIENTS AND METHODS Data from 1491 and 886 patients who underwent hip and knee replacements at the James Cook University Hospital (group 1) and at Friarage Hospital, Northallerton (group 2), respectively, were analysed in retrospect. All patients received 150 mg of aspirin per day for a period of 6 weeks from the day of surgery. Additionally, patients operated at the Friarage Hospital received 300 mg of oral ranitidine per day, for three postoperative days. RESULTS We observed that patients in group 1 had a higher incidence of overt upper GI haemorrhage, which was statistically significant (P <0.014) compared to patients in group 2. CONCLUSIONS Based on this experience, we recommend the use of peri-operative gastric protection with ranitidine when aspirin is used for thromboprophylaxis in hip and knee arthroplasty.
The Use of a Patient-Based Questionnaire (The Oxford Shoulder Score) to Assess Outcome After Rotator Cuff Repair
Authors: Olley LM , Carr AJ 
Published: May 2008

INTRODUCTION It is increasingly important for surgeons to monitor the outcome of their practice for the purpose of audit. The main difficulty has been the lack of appropriate methods of assessing outcome. Outcome has traditionally been assessed by clinical means which can be inaccurate, irreproducible and subject to surgeon bias. In addition, the perspective of the patient and surgeon may differ with respect to outcome and interest has grown in patient-based scoring systems. The Oxford Shoulder Score (OSS) is one such patient-based scoring system. The main aim of this study was to assess whether a patient-based questionnaire, in this case the OSS, could be effectively used to audit outcome from shoulder surgery. A secondary aim was to assess the value of gathering outcome information by post. PATIENTS AND METHODS A total of 24 patients (14 male; median age 59 years; age range, 43–73 years) who had completed a pre-operative OSS questionnaire and had undergone rotator cuff repair were included in the study. Participants were assessed postoperatively at regular intervals using the OSS at hospital visits and by postal questionnaire. RESULTS The completion level for the OSS was 97% and the response rate to the postal questionnaire was 96%. At 3 months' post-surgery, 21 of 24 patients had improved; at final review (16–37 months), 23 patients had improved following surgery. The OSS was observed to be a robust tool for the quantitative assessment and tracking of patient outcomes after surgery. CONCLUSIONS This study shows the value of using a postal questionnaire to follow-up patients after surgery and demonstrates the successful use of a patient-based questionnaire to audit the outcome from shoulder surgery.
Acute Appendicitis – A Benign Disease?
Authors: Simpson J , Samaraweera APR , Sara RK , Lobo DN 
Published: May 2008

INTRODUCTION Appendicitis is the most common cause of the acute abdomen and can affect all age groups. Most patients recover quickly but a minority can suffer postoperative complications. This case-note review was undertaken to assess the frequency of these complications. PATIENTS AND METHODS Adult patients (> 16 years) undergoing an emergency appendicectomy at a University teaching hospital between February 2004 and January 2005 were identified from pathology records. Details of operative procedure, histology and postoperative complications were noted from the hospital case notes RESULTS A total of 199 patients with a median age of 31 years (range, 16–89 years) were identified. Of these, 58 (29%) patients experienced a postoperative complication. Eight (4%) patients were admitted to the surgical high dependency unit or intensive care unit postoperatively and there was one death (0.5%). Re-operation for a postoperative complication was required in 9 (4.5%) patients and there was a 13% re-admission rate (26 patients). Comparison between patients with histologically proven appendicitis (164 patients; 82%) and those patients having a negative appendicectomy (35 patients; 18%) showed no significant difference in the rate of complications as defined (43 of 164, 26% versus 15 of 35, 43%; P = 0.08). However, patients with positive histology were more likely to experience a septic complication (29 of 164, 18% versus 1 of 35, 3%; P = 0.028) and all re-operations came from this group. Despite this, patients with a negative appendicectomy were more likely to be re-admitted (12 of 35, 34% versus 14 of 164, 8.5%; P = 0.0002), predominantly with persistent abdominal pain. CONCLUSIONS Appendicectomy is associated with a significant morbidity. Patients with an inflamed appendix were more likely to experience a septic complication but re-admission was more common in patients with a histologically normal appendix because of unresolved abdominal pain.
The Calcium Sensing Receptor: From Understanding Parathyroid Calcium Homeostasis to Bone Metastases
Authors: Mihai Radu 
Published: May 2008

The cloning of the calcium sensing receptor (CaR) confirmed that parathyroid cells monitor extracellular calcium concentration ([Ca2+]ext) via a receptor-type mechanism. This lead to the hypothesis that abnormalities in the expression and/or function of the CaR could explain the biochemical abnormalities in primary hyperparathyroidism (PHPT). Cultured cells from parathyroid adenomas of patients operated for PHPT were used to monitor real-time changes in intracellular calcium concentration ([Ca2+]i) as measured by fluorescent microscopy using the Fura-2/AM dye. We found that CaR agonists trigger release of intracellular calcium pools and such responses are amplified by increasing the affinity of IP3 receptors. Using confocal microscopy to monitor membrane trafficking in living parathyroid cells labelled with the fluorescent dye FM1-43, we found that a decrease in [Ca2+]i rather than an absolute change in [Ca2+]ext is the main stimulus for exocytosis from human parathyroid cells. These data suggest that, in PHPT, a defective signalling mechanism from the CaR allows cells from parathyroid adenomas to maintain low [Ca2+]i with uninhibited PTH secretion in the face of hypercalcaemia. Over longer periods of time, CaR controls parathyroid proliferation via changes in tyrosine phosphorylation. We found that multiple proteins of molecular weight 20–65 kDa are phosphorylated within 10–60 min in response to CaR agonists. Further work demonstrated that high [Ca2+]i stimulates the expression of bcl-2 oncoprotein in cultured human parathyroid cells and that, in parathyroid adenomas, predominant expression of bcl-2 rather than bax oncoprotein might prevent apoptosis and explain the slow growth rate of these tumours. More recently, it became apparent that CaR stimulates cell proliferation in several cell types not involved in calcium homeostasis. Using archived histological material from 65 patients who died with metastatic breast cancer, we identified CaR expression predominantly in tumours from patients who developed bone rather than visceral metastases (35 of 49 versus 7 of 16; P < 0.01, chi-squared test). These data suggest that CaR expression has the potential to become a new biological marker predicting the risk of bone metastases in patients with breast cancer. A prospective study should investigate if patients with CaR-positive tumours are more likely to develop bone metastases and whether they could benefit more from prophylactic treatment with bisphosphonates or the newly developed CaR antagonists.
Role of CYP3A5 in Abnormal Clearance of Methadone
Authors: Fazio Salvatore De , Gallelli Luca , Siena Antonella De , Sarro Giovambattista De , Scordo Maria Gabriella 
Published: May 2008

Objective:To report a case of unusually low concentrations of methadone in a polydrug abuser during maintenance treatment with methadone.Case Summary:A 25-year-old man (weight 55 kg, height 165 cm) with a 12-year history of polydrug abuse was admitted to an opiates withdrawal methadone program. At the time of our observation, he was using both cannabinoids and heroin; no other medical conditions were discovered. Within the opiates withdrawal methadone program, under medical supervision, the patient started methadone therapy (20 mg/day). Two weeks later, an Abuscreen assay for methadone screening in the urine was negative and, to prevent the development of withdrawal symptoms, the dose of methadone was increased to 60 mg/day. One day later, the patient was asked to collect another urine sample in the presence of a nurse. The Abuscreen for methadone in urine remained negative. Evaluation of urinary samples collected over 24 hours documented low concentrations of methadone and high levels of 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (the primary metabolite of methadone). Evaluation for the presence of the most common polymorphisms in the cytochrome P450 and P-glycoprotein genes showed that the patient was heterozygous for the CYP3A531 allele and for 2 single nucleotide polymorphisms in the P-glycoprotein gene (1236C/T and 3435C/T).Discussion:In this patient, poor methadone adherence was ruled out because of the presence of physicians and nurses during both methadone maintenance treatment and Abuscreen screening. Moreover, because the patient reported only heroin and cannabis at the time of evaluation, drug interactions were ruled out as possible causes for the rapid clearance of methadone.Conclusions:In this case, CYP3A5 polymorphism may have played a role in the rapid methadone metabolism.
Möbius Syndrome in a Neonate After Mifepristone and Misoprostol Elective Abortion Failure
Authors: Bos-Thompson Marie-Andrée , Hillaire-Buys Dominique , Roux Clarisse , Faillie Jean-Luc , Amram Daniel 
Published: May 2008

Objective: To report a case of a child born with Möbius syndrome following exposure in utero to mifepristone and misoprostol for elective abortion. Case Summary: In the seventh week of pregnancy, a woman was administered mifepristone 600 mg and, 2 days later, misoprostol 400 μg for abortion. One month later, despite significant metrorrhagia, an ultrasound examination showed ongoing gestation. At 33 weeks and 3 days of gestation, the woman gave birth to a male with left facial palsy, microretrognathia, and axial hypotonia related to Möbius syndrome. Discussion: Möbius syndrome is characterized by unilateral or bilateral palsy of the abducens (VI) and facial (VII) cranial nerves. Other cranial nerves (eg, the hypoglossal [XII]), craniofacial or orofacial anomalies, and limb malformations are often associated. The etiology of the Möbius syndrome remains largely unknown and probably involves multiple factors. The most likely etiological hypothesis is disruption of the developing vascular system, with transient ischemia (particularly in the vertebral arteries) and fetal hypoxia. A teratogenic cause of Möbius syndrome has been suggested. The critical period for the development of Möbius syndrome following teratogen exposure appears to be 5–8 weeks of gestation. To date, mifepristone alone does not appear to have induced Möbius syndrome. In contrast, oral or vaginal misoprostol administration can lead to a significant increase in Doppler-measured uterine artery resistance and may induce uterine contractions. If these occur during the critical embryonic period, they may cause flexion in the areas of the sixth and seventh cranial nerves and decreased blood flow. Conclusions: Ineffective use of mifepristone and misoprostol in the first trimester of pregnancy may be associated with a risk of Möbius syndrome, primarily due to misoprostol activity. Women with ongoing pregnancy after failed abortion with misoprostol administration should be informed of this risk.
Acarbose for Polycystic Ovary Syndrome
Authors: Kircher Christine , Smith Katherine P 
Published: May 2008

Objective: To review the evidence for use of acarbose in the management of polycystic ovary syndrome (PCOS). Data Sources: Relevant publications were identified through a systematic search of PubMed English-language literature (1950–February 2008) using the MeSH terms and key words acarbose and polycystic ovary syndrome. Study Selection and Data Extraction: The literature search retrieved 6 primary literature citations. Three randomized controlled clinical trials and one open-label study were evaluated. The other 2 citations were not evaluated due to only a peripheral mention of PCOS in relation to diabetes. Data Synthesis: PCOS is a complex disorder presenting most commonly with oligomenorrhea or amenorrhea, infertility, hirsutism, acne, and obesity. Acarbose is a promising therapy for PCOS because of its effects on postprandial insulin levels. In multiple clinical studies, acarbose improved hirsutism, acne, and menstrual irregularities through reduction in androgen concentrations and through increased androgen binding. When compared with metformin in women with PCOS and clomiphene-resistant infertility, acarbose induced greater weight loss and improved menstrual regularity and signs of fertility to a similar degree. Markers of cardiovascular risk were also significantly improved following 6 months of acarbose therapy in obese women with PCOS. Adverse effects, specifically gastrointestinal, were documented. Despite promising results, the studies were limited by small sample sizes and, in some cases, methods that were not clearly defined. Conclusions: Several trials have evaluated the use of acarbose in the management of PCOS with positive clinical evidence, but the results of these trials have not been corroborated by more rigorous studies.
High-Dose Carisoprodol During Pregnancy and Lactation
Authors: Briggs Gerald G , Ambrose Peter J , Nageotte Michael P , Padilla Guadalupe 
Published: May 2008

Objective: To report a case of use of high-dose carisoprodol during pregnancy and breast-feeding. Case Summary: A 28-year-old woman with severe back muscle spasm took carisoprodol 2800 mg/day before and throughout an uncomplicated pregnancy and while exclusively breast-feeding her infant during the first month after birth. Serum drug concentrations of carisoprodol and the active metabolite meprobamate were measured in the mother and infant. Concentrations of these agents also were measured in breast milk. Developmental toxicity was not observed in the near-term infant, whose birth weight was at the 10th percentile for gestational age. Only slight sedation was noted in the infant during breast-feeding, and no signs or symptoms of withdrawal were noted when nursing was stopped. Discussion: Carisoprodol and meprobamate are excreted into breast milk. Although the published human pregnancy data are limited to 15 cases, carisoprodol does not appear to cause developmental toxicity (growth restriction, structural anomalies, functional/neurobehavioral deficits, or death), even when the mother is taking high doses. No signs or symptoms of withdrawal were noted in our infant or in a previously published case when breast-feeding was stopped. Long-term follow-up has not been conducted in exposed infants, and the possibility of functional/neurobehavioral I deficits appearing later in life cannot be excluded. Conclusions: Except for mild sedation, no other toxicity was observed in a near-term infant exposed to carisoprodol throughout gestation and during breast-feeding in the first month after birth.
Catalysts through self-assembly for combinatorial homogeneous catalysis
Authors: Breit Bernhard 
Published: May 2008

Abstract
Inspired by the principle of DNA base-pairing, a new concept for the self-assembly of molecular catalysts is described herein. Thus, employing A-T analogous complementary hydrogen-bonding templates, self-assembly of monodentate to bidentate ligands in the coordination sphere of a transition-metal salt occurs to give defined self-assembly catalysts. This approach is intrinsically combinatorial and allows the facile generation of defined catalyst libraries through simple component mixing. From the study of these ligand libraries, excellent catalysts for linear-selective hydroformylation, asymmetric hydrogenation, and anti-Markovnikov hydration of terminal alkynes have emerged.
Ruthenium catalysts for selective nucleophilic allylic substitution
Authors: Bruneau Christian , Renaud Jean-Luc , Demerseman Bernard 
Published: May 2008

Abstract
Recent developments in the chemistry of η3-allylruthenium(IV) complexes are due to their straightforward synthesis resulting from oxidative addition of allylic substrates to a ruthenium(II) center. Subsequent reaction with a nucleophile is the basis of their involvement in the catalytic allylic substitution reaction. We focus here on ruthenium-catalyzed substitution of allylic substrates by C-, N-, and O-nucleophiles and show that selected ligands make regio- and enantioselective reactions possible.
New methods in asymmetric catalysis based on new hemi-labile bidentate ligands
Authors: Charette André B. , Côté Alexandre , Desrosiers Jean-Nicolas , Bonnaventure Isabelle , Lindsay Vincent N. G. , Lauzon Caroline , Tannous Jad , Boezio Alessandro A. 
Published: May 2008

Abstract
Chiral bidentate hemi-labile bis(phosphine) monoxide ligands were shown to be quite effective in various copper-catalyzed transformations. Among them, the nucleophilic addition to imines, the conjugate addition to α,β-unsaturated nitro derivatives, and the conjugate reduction of α,β-unsaturated sulfones generally gave good to excellent yields and high enantiomeric excesses.
New preparative methods for allylic boronates and their application in stereoselective catalytic allylborations
Authors: Hall Dennis G. 
Published: May 2008

AbstractStereocontrolled additions of allylic metal reagents to carbonyl compounds constitute one of the most useful classes of transformations in organic synthesis. The recent development of Lewis and Brønsted acid-catalyzed manifolds for the allylboration of carbonyl compounds has opened doors toward an ideal carbonyl allylation methodology using stable and nontoxic allylic boronates as reagents. This paper describes the development of acid-catalyzed allylborations, mechanistic investigations of these new processes, and ongoing efforts toward general catalytic enantioselective allylboration methodologies. The preparation of optically enriched α-substituted allylic boronate reagents is discussed, as well as their applications in Lewis acid-catalyzed additions to afford skeletally diverse products like propionate units, polysubstituted furans, vinylcyclopropanes, and larger ring systems.
Asymmetric synthesis: From transition metals to organocatalysis
Authors: Kočovský Pavel , Malkov Andrei V. 
Published: May 2008

AbstractUmpolung in the allylation reaction is discussed with examples drawn from transition-metal-catalyzed allylic substitution (with the allylic unit acting as an electrophile) and Lewis base-catalyzed allylation of aldehydes with allyltrichlorosilane (with the allyl acting as a nucleophile). Iridium-catalyzed electrophilic allylation ofO-nucleophiles has been employed in our new approach toC-nucleoside analogs, where the C-O bond (rather than C-C) was constructed stereospecifically. Variation of the absolute configuration in the starting segments allowed the synthesis of all four combinations of D/L-α/β-ribosides. In the nucleophilic allylation of aldehydes, chiral pyridine-typeN-oxide catalysts are presented, in particular QUINOX and METHOX, and the intriguing behavior of QUINOX is discussed. Here, the π-π interactions between the substrate aldehyde and the catalyst are suggested to rationalize the experimental observations. Good correlation between the calculated energies for the transition states and the experimentally observed enantioselectivities has been obtained.
Enantio- and regioselective CpRu-catalyzed Carroll rearrangement
Authors: Austeri Martina , Buron Frederic , Constant Samuel , Lacour Jerome , Linder David , Müller Jessica , Tortoioli Simone 
Published: May 2008

Abstract
The addition of unstabilized carbonyl nucleophiles to allyl-metal fragments still represents a challenge for generating stereoselectively tertiary (and quaternary) stereogenic centers. In this context, the decarboxylative Carroll rearrangement of secondary and tertiary allyl β-ketoesters is particularly interesting since chiral γ,δ-unsaturated ketones are obtained. Herein, we show that CpRu half-sandwich complexes can, in the presence of selected enantiopure diimine ligands, catalyze this transformation and afford complete conversions and decent level of enantiomeric excess. Zwitterionic adducts of a hexacoordinated phosphorus anion and CpRu moieties were also associated and shown to generate air-, moisture-, and microwave-stable catalysts that can be readily purified and recycled. Carroll rearrangements of allylic β-ketoesters performed with these zwitterionic species occur with better regio- and enantioselectivity.
Palladium-catalyzed selective activation of allyl alcohols as allyl cations, allyl anions, and zwitterionic trimethylenemethanes
Authors: Tamaru Yoshinao , Kimura Masanari 
Published: May 2008

Abstract
Pd-Et3B catalytic system promotes the generation of allyl cations, allyl anions, and zwitterionic trimethylenemethane species from the corresponding allylic alcohols. Allyl cations react with a wide variety of nucleophiles, e.g., amines, active methylene compounds, 1,3,5-trihydroxybenzene, indoles, aldehydes (at the α-position). The reaction is extended to dehydrative Grob fragmentation of 1,3-diols. Allyl anions react with aldimines to give homoallyl amines. Zwitterionic trimethylenemethane, generated from 2-methylene-1,3-propanediol, reacts with aldehydes and aldimines to provide 3-methylenecyclopentanols and 3-methylenepyrrolidines, respectively. Vinyl epoxide can be utilized as a synthetic equivalent of 3-butenyl 2-anion-1-cation.
Asymmetric Lewis acid-catalyzed 1,3-dipolar cycloadditions
Authors: Bădoiu Andrei , Brinkmann Yasmin , Viton Florian , Kündig E. Peter 
Published: May 2008

Abstract
Highly tuned, one-point binding chiral iron and ruthenium complexes selectively coordinate and activate α,β-unsaturated aldehydes and ketones toward asymmetric catalytic Diels-Alder cycloaddition reactions. Here we focus on the application of these transition-metal Lewis acids to asymmetric catalytic 1,3-dipolar cycloaddition reaction between enals and cyclic and acyclic nitrones as well as aryl nitrile oxides to give isoxazolidines and isoxazolines, respectively.