Tunable Reactivity of Geminal Bis(silyl) Enol Derivatives Leading to Selective exo-IEDDA or Sakurai Allylation with [small beta],[gamma]-Unsaturated Ketoester

Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC04593F, Communication

zhenlei song, Zubao Gan, Zhiwen Chu, Jia Hu, Zhishan Su, Changwei Hu, Lu Gao
Two contrasting pathways in a SnCl4-catalyzed reaction of geminal bis(silyl) enol derivatives with [small beta],[gamma]-unsaturated ketoesters have been achieved by tuning the R group in the enol moiety. While electron-donating Bn-substituted...
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Sulodexide in Patients with Chronic Venous Disease of the Lower Limbs: Clinical Efficacy and Impact on Quality of Life

Abstract

Introduction

Chronic venous disease (CVD) of the lower limbs is a common problem. It is more prevalent in women than in men and has a significant impact on patients' quality of life (QoL) and on the healthcare system. The aim of this study was to evaluate the efficacy of sulodexide in adult patients with CVD of the lower limbs and its effect on patients' QoL.

Methods

Patients with CVD were treated with sulodexide [250 LSU (lipasemic units) twice daily] for 3 months in a setting of real-life clinical practice. The endpoints of this observational non-comparative, open-label prospective study were the clinical efficacy of sulodexide (evaluated by scoring objective and subjective symptoms with a Likert-type scale) and the impact of sulodexide therapy on patients' QoL [assessed using the chronic venous insufficiency quality of life questionnaire (CIVIQ)].

Results

The study included 450 patients (mean age 46.9 ± 10.5 years, range 17–78 years). A greater percentage of patients were female (65.4%). Three months of treatment with sulodexide significantly improved all objective and subjective symptoms (p < 0.0001). Overall, patients reported a significant improvement in all QoL scores (p < 0.0001). Adverse events were spontaneously reported by two patients (one case of epigastric pain and one of gastric pain with vomiting).

Conclusion

Oral sulodexide significantly improves both objective and subjective symptoms, as well as functional and psychological aspects of QoL in patients with CVD.

Funding

No funding or sponsorship was received for this study. Sponsorship for article processing charges and open access fees was provided by Alfa Wassermann.

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Assessment of Factors Related to the Understanding of Education and Knowledge of Self-Care among Patients with Diabetes Mellitus: A Cross-Sectional Prospective Study

Abstract

Introduction

The prevalence of diabetes mellitus is rapidly increasing particularly in developing countries. The aim of this study was to assess the knowledge and self-care practices of diabetes patients and to assess the contribution of the education to this knowledge level and glycemic control.

Methods

We formed patient groups consisting of 15–30 diabetic patients. First, patients were surveyed using a diabetes self-care knowledge questionnaire (DSCKQ-30). Sunsequently, a standard PowerPoint presentation about diabetes self-management was made to the patients who were then surveyed again using DSCKQ-30. All patients were invited to hospital to measure their control glycated hemoglobin (HbA1c) level 3 months later.

Results

Of the total 364 participants, 62.9% were females. Significant increases in the percentage of correct responses were determined in all components between, before and after education. There was a significant decline of 1.1 in HbA1c levels after 3 months of education. Married or active working patients had a better understanding of the education about diabetes and had a greater knowledge of self-care management regardless of their level of education or income.

Conclusion

Education about diabetes can significantly improve knowledge of self-care management and can help in achieving glycemic control. Continuing education about self-care management and complications is crucial and this should be accompanied by a regular assessment of pateients' diabetic knowledge.

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The long-term burden of severe sepsis and septic shock: Sepsis recidivism and organ dysfunction.

Background: Severe sepsis and septic shock mortality has improved, however rates of persistent (28 to 90 day) and long-term (>90 day) organ dysfunction in sepsis survivors are unknown. Methods: Secondary analysis of a prospective cohort of adult Emergency Department patients with severe sepsis. Results: Of 110 sepsis admissions, we obtained follow up on 51 of 78 survivors of whom 41% (21/51) had persistent organ dysfunction: pulmonary 18% (9/51), renal 22% (11/51), coagulopathy 10% (5/51), cardiovascular 6% (3/51), hepatic 2% (1/51), and neurologic 3% (3/51). We obtained follow up on 40 of 73 survivors at >90 days of whom 38% (15/40) had long-term organ dysfunction: pulmonary 13% (5/40), renal 18% (7/40), coagulopathy 3% (1/40), cardiovascular 5% (2/40), hepatic 0%, and neurologic 5% (2/40). Readmission rate within 90 days was 32% (25/78) and recurrent sepsis was the cause of readmission in 52% (13/25). Baseline SOFA scores from the index sepsis admission were compared using Wilcoxon's rank-sum test and were significantly different in participants with vs without organ dysfunction at

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Prevalence and mortality of abdominal compartment syndrome in severely injured patients; A systematic review.

Background: Abdominal Compartment Syndrome (ACS) in severely injured patients is associated with high morbidity and mortality. Many efforts have been made to improve outcome of patients with ACS. A treatment algorithm for ACS patients was introduced on January 1, 2005 by the World Society of the Abdominal Compartment Syndrome (WSACS). The aim of this study was to determine the prevalence and mortality rate of ACS among severely injured patients before and after January 1, 2005 using a systematic literature review. Method: Databases of Embase, Medline (OvidSP), Web-of-science, CINAHL, CENTRAL, PubMed publisher and Google Scholar were searched for terms related to severely injured patients and ACS. Original studies reporting ACS in trauma patients were considered eligible. Data on study design, population, definitions, prevalence, and mortality rates were extracted. Pooled prevalence and mortality of ACS among severely injured patients were calculated for both time periods using inversed variance weighting assuming a random effects model. Tests for heterogeneity were applied. Results: A total of 80 publications were included. Prevalence of studies that finished enrolling patients before January 1, 2005 ranged from 0.5% to 36.4% and 0.0% to 28.0% in studies after that date. For severely injured patients admitted to the ICU this range was 0.5-1.3% before 2005 and 0% in one publication in the second time period. For patients with visceral injuries ACS prevalence ranged 1.0% to 20.0%, one study in the second time period reported 11.1%. The prevalence among severely injured patients who underwent trauma laparotomy ranged from 0.9% to 36.4% in the first time period. Two studies after January 1, 2005 reported ACS prevalence of 2.3% and 13.2%, respectively. The mortality rate in both time periods ranged between 0.0% and 100.0%. Conclusion: The overall prevalence of ACS ranged from 0.0% to 36.4%. Future studies are needed in order to measure the effect of improved trauma care and effectiveness of the WSACS Consensus Statements. Level of evidence: Level III Study type: Systematic Review (C) 2016 Lippincott Williams & Wilkins, Inc.

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Prise en charge des carcinomes neuroendocrines de prostate : revue de la littérature

Publication date: June 2016
Source:Cancer/Radiothérapie, Volume 20, Issue 4
Author(s): S. Yossi, T. Brahmi, C. Enachescu, I. Selmaji, A. Lapierre, H. Samlali, O. Chapet
Le carcinome neuroendocrine de la prostate est une entité rare posant des problèmes aussi bien diagnostiques que thérapeutiques. On distingue essentiellement quatre formes histologiques (les adénocarcinomes à différenciation neuroendocrine, les tumeurs carcinoïdes, les carcinomes à petites cellules, les carcinomes à grandes cellules), pouvant être pures ou mixtes, associées à un adénocarcinome prostatique. Il n'existe pas de consensus sur la prise en charge ni sur le pronostic de ces divers sous-types tumoraux. Nous avons effectué une revue de la littérature afin de déterminer les implications thérapeutiques potentielles.Neuroendocrine prostate carcinoma is a rare entity causing both diagnostic and therapeutic issues. There are basically four histological forms (adenocarcinoma with neuroendocrine differentiation, carcinoid tumors, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinomas), which can be pure or mixed associated with prostatic carcinoma. There is no consensus on the management or the prognosis of these various tumor subtypes. We conducted a literature review aiming to determine the potential therapeutic implications.



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Radiothérapie postopératoire des carcinomes médullaires de la thyroïde à haut risque de rechute locorégionale

Publication date: Available online 5 July 2016
Source:Cancer/Radiothérapie
Author(s): F. Compagnon, S. Zerdoud, M. Rives, A. Laprie, J. Sarini, S. Grunenwald, L. Chaltiel, P. Graff
ObjectifÉvaluer les résultats au long cours de la radiothérapie externe postopératoire des carcinomes médullaires de la thyroïde localement évolués.Patients et méthodesÉvaluation rétrospective et exhaustive des dossiers de 29 patients atteints d'un carcinome médullaire de la thyroïde traités dans notre service entre janvier 1995 et décembre 2012. Tous les patients avaient bénéficié d'une prise en charge à visée curative par une chirurgie carcinologique optimale, suivie d'une radiothérapie en raison d'un risque de rechute locorégionale jugé élevé. Douze cancers étaient de stade III, 16 de stade IVa et un de stade IVb. Les berges chirurgicales étaient envahies microscopiquement (R1) chez dix patients, macroscopiquement (R2) chez un. Les concentrations sériques médiane et moyenne de calcitonine avant la radiothérapie étaient respectivement de 141 et 699pg/mL. Le temps médian écoulé entre la chirurgie et la radiothérapie était de 1,9 mois. Quatorze patients ont été traités par irradiation conformationnelle tridimensionnelle et 15 par irradiation avec modulation d'intensité. La dose médiane délivrée était de 63Gy dans le volume à haut risque et de 54Gy dans celui à bas. Le traitement a été délivré en 30 séances. Le suivi médian était de 76,4 mois.RésultatsLes probabilités de survie globale et de survie sans rechute locorégionale à 5ans étaient respectivement de 96 et 79 %. Deux des cinq cas de rechute locorégionale s'expliquent a posteriori par la présence d'adénopathies macroscopiques résiduelles qui n'avaient pas été emportées par le curage ganglionnaire. Huit des dix cancers en résection R1 ont été durablement contrôlés dans le lit de thyroïdectomie. Sur les huit patients qui avaient normalisé leur calcitonine après l'association chirurgie et radiothérapie, un seul a vu se développer une rechute locorégionale. Sur les 21 patients chez qui persistait une calcitonine élevée après la radiothérapie, dix seulement été atteints de rechute macroscopique locorégionale et/ou à distance. Un seul cas de toxicité aiguë de grade III a été décrit, aucun de grade IV. Quinze patients ont rapporté une toxicité chronique de grade II mais aucun de grade III/IV.ConclusionUne chirurgie carcinologique maximale, suivie d'une radiothérapie adjuvante, assure des taux de contrôle locorégional à long terme et de survie globale élevés avec une faible toxicité chez des patients traités pour un carcinome médullaire de la thyroïde localement évolué. La radiothérapie externe postopératoire peut être considérée en cas de facteurs de risque de rechute locorégionale à l'analyse histologique.PurposeTo assess the outcome of locally advanced medullary thyroid carcinoma treated with surgery and adjuvant external beam radiotherapy.Patients and methodsTwenty-nine consecutive patients with non-metastatic medullary thyroid carcinoma treated in our institution between January 1995 and December 2012 were retrospectively evaluated. All underwent curative-intended optimal surgery, followed by external beam radiotherapy because of high risk of locoregional relapse. Twelve patients were stage III, 16 IVa and 1 IVb. Positive surgical margins were present in 11 cases (10 R1 and 1 R2). Median and average preradiotherapy serum calcitonin were 141pg/mL and 699pg/mL, respectively. Fourteen patients received 3D-conformal radiotherapy and 15 received intensity-modulated radiotherapy. Median prescribed dose was 63Gy to the high-risk volumes and 54Gy to the low-risk volumes. Treatment was delivered in 30 fractions. The median gap between surgery and radiotherapy was 1.9months. Median follow-up was 76.4months.ResultsKaplan-Meier estimates of 5-year locoregional relapse-free survival and overall survival were 79 and 96 %, respectively. Among the five locoregional relapses, two were related to a macroscopic metastatic cervical lymph node that was unfortunately not removed during the lymphadenectomy. Eight of ten patients with microscopic positive margins (R1) were controlled regarding the thyroidectomy bed. Eight patients had normal serum calcitonin after external beam radiotherapy, of whom only one developed a locoregional relapse during follow-up. Regarding the 21 patients with persistent positive serum calcitonin after treatment, only ten developed a macroscopic locoregional or distant relapse. One grade III and no grade IV acute morbidity were reported. Fifteen patients reported grade II chronic morbidity and no grade III/IV.ConclusionMaximal surgery followed by adjuvant external beam radiotherapy as a treatment for locally advanced medullary thyroid carcinoma provides a high rate of long-term locoregional control and overall survival with limited toxicity. Postoperative external beam radiotherapy should be considered when patients present features indicating a high risk of locoregional relapse.



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