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There is limited literature regarding the early postsurgical outcomes of anterior cruciate ligament (ACL) reconstruction in Asian populations, particularly in the rates of return to sports. We aimed to quantify early clinical outcomes for ACL reconstruction, determine the predictive value of surgeon- and patient-reported outcomes on the rate of return to sports in the early postoperative period, and identify factors predictive of return to sports. We analyzed the data of 55 patients who underwent ACL reconstruction at our tertiary medical center from 2015 to 2016. All patients underwent transportal ACL reconstruction and a standardized post-ACL reconstruction rehabilitation protocol. Patients with concurrent meniscal injury and repair were included. Patients were evaluated at the 3-month, 6-month, 1-year, and 2-year postoperative periods. Surgeon- and patient-reported outcome scores were collected at each follow-up through a systematic questionnaire designed to determine the patient's level of return to sport and reasons for not returning. Surgeon- and patient-reported outcome measures improved significantly over the 2-year postoperative period (p

Purpose The Forgotten Joint Score (FJS-12) is a scoring system initially created to assess post arthroplasty outcomes. It has since been used to evaluate Anterior Cruciate Ligament surgery outcomes. Our study aims to evaluate the applicability and validity of the FJS-12 in post Anterior Cruciate Ligament reconstructed patients, and to assess correlation with established Patient Reported Outcome Measure Scores in the same population. Design Case series, level 3 evidence. Methods We conducted a cross sectional study across patients who had undergone Anterior Cruciate Ligament reconstruction and carried out the FJS-12 questionnaire by phone interview. Patients who had undergone primary Anterior Cruciate Ligament reconstruction were considered for the study. Results The average Forgotten Joint Score-12 for all 82 patients was 71.4 (±22.9), which corresponded to a normal distribution. The average Lysholm and Tegner score at the 2-year post-operative visit was 93.5 ± 9.5 and 5.8 ± 1.8 respectively and the distribution was non-normal. We noticed a large ceiling effect of 42.7% in the Lysholm scores, but only 8.4% in FJS-12. There was a weak correlation with Lysholm and a positive correlation with Tegner. Conclusions Forgotten Joint Score-12 seems to be a promising patient reported outcome measure that can be used in evaluating post Anterior Cruciate Ligament reconstruction outcomes. It is more discerning than traditional scores and is easy to administer thus it can used in the clinical follow-up of patients. With the scores being normally distributed, it makes for a meaningful PROMS and would allow more accurate application of parametric statistical tests.

Although autologous matrix-induced chondrogenesis has grown increasingly popular, it can be technically challenging to place the scaffold within the knee efficiently without extending the arthroscopic incisions. To facilitate arthroscopic placement of the matrix into the knee, we developed a technique that involves fashioning a cannula from a standard 5-mL syringe. This technique enables surgeons to conveniently and efficiently place the matrix through the standard arthroscopic ports at minimal cost.

One major challenge in the context of the expanding research and developments of DC power and related technologies is the lack of well-developed and globally accepted standards for DC power distribution and equipment. This review investigates the fast-developing DC standards across the globe in the various stages of DC microgrids as well as their adaptability to New Zealand context to facilitate the future implementation scenarios of power electronic converters and other enabling technologies of Future Architecture of the Power System Network. A comprehensive literature survey is carried out collecting the latest relevant standards and related implementation scenarios for conveyance by DC at low and medium voltages for domestic/commercial and industrial customers. Also, recommendations for DC standards to follow in New Zealand context for the Future Architecture of the Network are provided in this paper.

Imaging of the shoulder joint, in particular for rotator cuff pathology, has improved tremendously over the past few years. Beyond plain radiographs, imaging capabilities that clinicians can rely on include MRI, MR arthrogram, CT scans, ultrasound scans, vascular Doppler studies, and more recently US Elastography. This chapter will focus on imaging capabilities and possibilities in failed cuff repairs. While it is known that failure to heal occurs in about 20% of cases [1], what is needed is to define a common understanding of failure of cuff repair, what is accepted as failure to heal as opposed to re-tear, and understand the various causes. The presence of high signals, thinning and even gaps in post repair tendons may not constitute a pathological state as patients remain relatively asymptomatic. Hence, an understanding of “normal” changes that might occur in tendons after cuff repair, and how these changes may change over time, is necessary.

Purpose The aim of this study was to (1) develop suture techniques in repairing radial meniscal tear; (2) to compare the biomechanical properties of the proposed repair techniques with the conventional double horizontal technique. Methods Thirty-six fresh-frozen porcine medial menisci were randomly assigned into four groups and a complete tear was made at the midline of each meniscus. The menisci were subsequently repaired using four different repair techniques: double vertical (DV), double vertical cross (DVX), hybrid composing one vertical and one horizontal stitch, and conventional double horizontal (DH) suture technique with suturing parallel to the tibia plateau. The conventional double horizontal group was the control. The repaired menisci were subjected to cyclic loading followed by the load to failure testing. Gap formation and strength were measured, stiffness was calculated, and mode of failure was recorded. Results Group differences in gap formation were not statistically significant at 100 cycles (p = .42), 300 cycles (p = .68), and 500 cycles (p = .70). A trend was found toward higher load to failure in DVX (276.8 N, p p p p p p Conclusion Our two proposed vertical suture techniques, as well as the double vertical technique, had superior biomechanical properties than the conventional technique as demonstrated by higher stiffness and higher strength.

AIM : To compare the measurements of knee rotation laxity by non-invasive skin pointer with a knee rotation jig in cadaveric knees against a skeletally mounted marker. METHODS : Six pairs of cadaveric legs were mounted on a knee rotation jig. One Kirscher wire was driven into the tibial tubercle as a bone marker and a skin pointer was attached. Rotational forces of 3, 6 and 9 nm applied at 0°, 30°, 45°, 60° and 90° of knee flexion were analysed using the Pearson correlation coefficient and paired t-test. RESULTS : Total rotation recorded with the skin pointer significantly correlated with the bone marker at 3 nm at 0° (skin pointer 23.9 ± 26.0° vs bone marker 16.3 ± 17.3°, r = 0.92; P = 0.0), 30° (41.7 ± 15.5° vs 33.1 ± 14.7°, r = 0.63; P = 0.037), 45° (49.0 ± 17.0° vs 40.3 ± 11.2°, r = 0.81; P = 0.002), 60° (45.7 ± 17.5° vs 34.7 ± 9.5°, r = 0.86; P = 0.001) and 90° (29.2 ± 10.9° vs 21.2 ± 6.8°, r = 0.69; P = 0.019) of knee flexion and 6 nm at 0° (51.1 ± 37.7° vs 38.6 ± 30.1°, r = 0.90; P = 0.0), 30° (64.6 ± 21.6° vs 54.3 ± 15.1°, r = 0.73; P = 0.011), 45° (67.7 ± 20.6° vs 55.5 ± 9.5°, r = 0.65; P = 0.029), 60° (62.9 ± 22.4° vs 45.8 ± 13.1°, r = 0.65; P = 0.031) and 90° (43.6 ± 17.6° vs 31.0 ± 6.3°, r = 0.62; P = 0.043) of knee flexion and at 9 nm at 0° (69.7 ± 40.0° vs 55.6 ± 30.6°, r = 0.86; P = 0.001) and 60° (74.5 ± 27.6° vs 57.1 ± 11.5°, r = 0.77; P = 0.006). No statistically significant correlation with 9 nm at 30° (79.2 ± 25.1° vs 66.9 ± 15.4°, r = 0.59; P = 0.055), 45° (80.7 ± 24.7° vs 65.5 ± 11.2°, r = 0.51; P = 0.11) and 90° (54.7 ± 21.1° vs 39.4 ± 8.2°, r = 0.55; P = 0.079). We recognize that 9 nm of torque may be not tolerated in vivo due to pain. Knee rotation was at its maximum at 45° of knee flexion and increased with increasing torque. CONCLUSION : The skin pointer and knee rotation jig can be a reliable and simple means of quantifying knee rotational laxity with future clinical application. Published version

Duck farming needs to be innovated from traditional maintenance management systems that must be abandoned, costly modern intensive maintenance management and pollute the environment into an efficient and eco-green intensive maintenance system by applying the same system partnership pattern to its core. Integrated eco-green intensive peking duck breeding farm utilizing Azolla Microphylla and hedge leaf as feed supplement and other germplasm utilization. The Azolla Microphylla plant serves as a phytoremediation where it can recycle livestock wastewater into clean water thereby reducing excessive water exploitation and reducing the pollution of the stench. The purpose of this research is to obtain information about the financial strategy to start up the business of peking duck integrated with eco-green model. Beginning from planning activities, the company implements project management system with its Gantt Chart. The mapping of operational strategy is carried out comprehensively by always making continuous improvement (kaizen) because in the current era to be good alone is not enough, but struggle is needed to be superior (market leader) by beginning by cost leader.

To study the influence of combined cortical thickness (CCT) of the proximal humerus on arthroscopic rotator cuff tear repair outcomes.The study included 210 patients who underwent arthroscopic repair of full-thickness supraspinatus tears. An independent reviewer measured CCT on preoperative radiographs, and patients were evaluated postoperatively at 3, 6, 12, and 24 months. Functional outcome was assessed with the Constant shoulder score (CSS), Oxford shoulder score (OSS), and University of California at Los Angeles Shoulder rating scale (UCLASS). The patients were divided based on CCT: ≥4 mm (higher CCT) and4 mm (lower CCT). Univariate analysis and multivariate linear regressions were applied to study the effect of higher CCT on functional scores.At 6 months' follow-up, CSS and UCLASS were higher in the patients with higher CCT (mean ± standard deviation, 59 ± 17 vs 54 ± 14, P = .020; and 30 ± 5 vs 28 ± 5, P = .020, respectively). At 12 months' follow-up, CSS, UCLASS, and OSS were higher in the patients with higher CCT (71 ± 13 vs 65 ± 14, P = .002; 30 ± 5 vs 28 ± 5, P = .009; and 15 ± 6 vs 18 ± 7, P = .001, respectively). At 24 months' follow-up, CSS and OSS were higher in the patients with higher CCT (74 ± 11 vs 69 ± 13, P = .006; and 14 ± 4 vs 16 ± 8, P = .041, respectively).We conclude that although a higher CCT is not associated with clinically significant differences in functional outcomes, further studies examining postoperative imaging as well as perioperative optimization of bone mineral density may yield valuable results regarding the impact of CCT on cuff healing and functional outcomes.III (retrospective comparative therapeutic trial).

Rotator cuff tears are among the most common disorders of the shoulder girdle requiring surgical intervention, and it is no surprise that orthopaedic surgeons have searched far and wide for means to improve on rotator cuff repair outcomes. Radiological parameters such as the critical shoulder angle have recently emerged and have been associated with the presence of degenerative rotator cuff tears. However, their true impact on postoperative outcomes are still unclear. Although radiological parameters, because of their objectivity, will always remain a critical part of a surgeon's preoperative assessment, we must remember that ultimately we are treating patients and not radiographs.

Background:Recent studies have shown a correlation between scapular geometry and the development of atraumatic rotator cuff tears. However, a paucity of literature is available on the effects of critical shoulder angle (CSA) and acromial index (AI) on functional outcomes after arthroscopic rotator cuff repair.Hypothesis/Purpose:The purpose was to investigate the influence of CSA and AI on 24-month functional outcomes after arthroscopic rotator cuff repair. The hypothesis was that a larger CSA or AI would result in poorer postoperative outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:The study included 147 patients who underwent arthroscopic double-row rotator cuff repair for radiologically documented full-thickness supraspinatus tears. An independent reviewer measured the CSA and AI on preoperative radiographs. These patients were prospectively enrolled and were evaluated preoperatively as well as at 3, 6, 12, and 24 months postoperatively. Functional outcome was assessed with the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and University of California at Los Angeles (UCLA) Shoulder Rating Scale. The patients were first divided based on CSA: (1) ≤35° (control CSA) and (2) >35° (increased CSA); and then based on AI: (1) ≤0.7 and (2) >0.7. The Student unpaired t test, Pearson chi-square test, and Pearson correlation were performed to examine the influence of CSA and AI on postoperative functional outcome scores.Results:At 6 months of follow-up, the CSS, OSS, and UCLA Shoulder Rating Scale were 10 ± 1, 4 ± 2, and 3 ± 1 points poorer in the increased CSA group compared with the control CSA group ( P = .005, P = .030, and P = .035, respectively). These scores were not significantly different between both AI groups. By 24 months of follow-up, all outcome scores were comparable between both CSA groups as well as between both AI groups. No significant correlation was found between either CSA or AI when compared with CSS, OSS, or UCLA Shoulder Rating Scale at 24 months of follow-up.Conclusion:CSA and AI do not appear to influence 24-month functional outcomes postoperatively and hence are not contraindications to arthroscopic rotator cuff repair.

Diels-Alder reaction of 5-methylthebaine (2) with ethyl acrylate, methyl vinyl ketone or p-benzoquinone yielded ethyl 4,5α-epoxy-3,6-dimethoxy-5,N-dimethyl-6α,14α-ethenoisomorphinan-7α-carboxylate (3), 7α-acetyl-4,5α-epoxy-3,6-dimethoxy-5,N-dimethyl-6α,14α-ethenoisornorphinan (4), and 4,5α-epoxy-3,6-dimethoxy-5,N-dimethyl-6α,14α-ethenobenzo[7,8]isomorphinan-3′,6′-diol (5b), respectively. Both ester 3 and ketone 4 were converted into 4,5α-epoxy-3,6-dimethoxy-α,α,5,N-tetramethyl-6α,14α-ethenoisomorphinan-7α-methanol (7) with methylmagnesium iodide. The 3-methoxy group was hydrolysed to give 4,5α-epoxy-3-hydroxy-6-methoxy-α,α,5,N-tetramethyl-6α,14α-etheno-isomorphinan-7α-methanol (8). Demethylation of 3 with boron tribromide afforded ethyl 4,5α-epoxy-3,6-dihydroxy-5,N-dimethyl-6α,14α-ethenoisomorphinan-7α-carboxylate (6). Structure elucidation was mainly based on 1H and 13CNMR spectroscopy. It is remarkable that, in all cases, β-face approach of the diene system of 2 has taken place. The new rigid metopon analogues 6, 7, and 8, will be tested for biological activity**.

The racemization-free synthesis of N-phthaloyl amino acids (Pht-amino acids) from amino acid esters, by using o-methoxycarbonylbenzoyl chloride in anhydrous media, is described. The N-phthaloyl amino acids and esters from proteins were obtained in high yields. Three N-phthaloyl amino acids were synthesized for the first time: N-Pht-LTrp, N-Pht-S-Bzl-LCys and N-Pht-Nim-Bzl-LHis. In the case of some sterically hindered amino acids, LIle and α-amino-isobutyric acid, the intermediate N-(o-methoxycarbonylbenzoyl) amino acid derivative could be isolated.

The preparation of Diels-Alder adducts of (-)-thebaine and ethyl acrylate is described. Hydrolysis of the major adduct gave the 7α-carboxylic acid which was coupled with the ethyl esters of L-leucine, L-phenylalanyl-L-leucine and glycyl-L-phenylalanyl-L-leucine, respectively, three peptide segments derived from the endogenous opiate, leucine-enkephalin. These compounds, as well as the 7β-ethoxycarbonyl isomer, were O-demethylated to give the corresponding 3,6-dihydro-xymorphinan derivatives. N-(6,14-endo-Etheno-6,7,8,14-tetrahydrothebaine-7α-carbonyl)-L-phenylalanyl-L-leucine ethyl ester and its 7,8-dihydromorphine analogue were reduced to the corresponding leucinols. Pharmacological screening1 showed that several of these compounds are morphine-like analgesics, notably compound 11, N-(6,14-endo-etheno-7,8-dihydromorphine-7α-carbonyl)-L-leucine ethyl ester.

Deprotonation of 6-demethoxythebaine (1) with butyllithium, followed by reaction of the anion with dimethyl sulfate, gave the non-conjugated diene 4 as the major product and title compound 5β-methyl-6-demethoxythebaine (5) only in low yield. Therefore, 5 was prepared from 5β-methylthebaine (6), which was converted into 5β-methylcodeinone (7) and then reduced to 5β-methylcodeine (8). Mesylation of 8 yielded 6-O-mesyl-5β-methylcodeine (9). Reaction of 9 with lithium bromide gave 5β-methyl-bromocodide (10) as the major product, together with 5. When 10 was treated with potassium tert-butoxide, the desired 5 was obtained in good yield. Short treatment of 10 gave the intermediate 8-bromo-5-methyl-desoxycodeine-A (11), which reacted further to 5 after prolonged treatment. Diels-Alder reaction of 5 with ethyl acrylate yielded two products, ethyl 6α,14α-ethenoisomorphinan-7α-carboxylate 13 and ethyl 6β,14β-ethenomorphinan-8β-carboxylate 14, due to β-face and α-face approach, respectively. Similarly, with 3-buten-2-one as the dienophile, a mixture of 7α-acetyl-6α,l4α-ethenoisomorphinan 15 and 8β-acetyl-6β,14β-ethenomorphinan 16 was obtained. Diels-Alder reaction of 5 with maleic anhydride, followed by esterification of the adducts, yielded dimethyl 6α,l4α-ethenoisomorphinan-7β,8β-dicarboxylate 19 and dimethyl 60,140-ethenomorphinan-7β,8β-dicarboxylate 20 in a 7 : 3 ratio. The results of the Diels-Alder reaction are discussed in connection with the substituents in the 5β- and 6-position.

Reaction of the anions of thebaine and 6-demethoxythebaine with 2-propanone gave the 5β-(dimethylmethanol)-substituted analogues 3 and 5 and the isomeric C-7-substituted morphinan-5,8-dienes 4, 6 and 7, respectively. No reaction took place with methanal. Therefore, thebaine-5β-methanol (10) was prepared by reacting the anion with alkyl chloroformate followed by lithium aluminium hydride reduction. Diels-Alder reaction of diene 10 with ethyl acrylate gave the 6α,14α-ethenoisomorphinan 11. Of the morphinan-6,8-dienes 3 and 5, only diene 5 showed a reaction, namely rearrangement followed by cycloaddition with ethyl acrylate, yielding three adducts. The structure of the major adduct 13 was elucidated using 1D- and 2D-NMR techniques and revealed an aporphine-like structure. Furthermore, the conversion of 11 into a new etorphine analogue 16 was accomplished by treatment with methylmagnesium bromide followed by 3-O-demethylation.

Starting from 3,4,5-trihydroxybenzoic acid (gallic acid), racemic 1-(3,5-dibenzyloxy-4-methoxybenzyl)-1,2,3,4-tetrahydro-6-methoxyisoquinoline (3, Scheme) was synthesized. Resolution with (-)-(S)-malic acid yielded (+)-(R)-3. By a Birch reduction, followed by N-formylation, and by acid-catalysed cyclization, we obtained racemic and optically active N-formyl-2-hydroxynordihydrothebainone (6). 6 Was selectively converted into N-formyl-2-(1-phenyltetrazol-5-yloxy)nordihydrothebainone (7). Hydrogenolysis of (-)-7 and of racemic 7 yielded (-)-N-formylnordihydrothebainone (8) and racemic 8, respectively. Previously we had converted the N-formyl derivative (8) in various ways into dihydrothebainone. The conversion into (-)-codeine and (-)-morphine is known.

The morphinan peptides N-(4,5α-epoxy-3,6-dihydroxy-17-methyl-6α,14α-ethenoisomorphinan-7α-carbonyl)-L-phenylalanine ethyl ester (4), N-(4,5α-epoxy-3,6-dihydroxy-17-methyl-6α,14α-ethenoisomorphinan-7α-carbonyl)-D-phenylalanine ethyl ester (5) and N-[N-(4.5α-epoxy-3.6-dihydroxy-17-methyl-6α,14α-ethenoisomorphinan-7α-carbonyl)glycinyl]-L-phenylalanine ethyl ester (6) have been prepared from 4,5α-epoxy-3,6-dimethoxy-17-methyl-6α,14α-ethenoisomorphinan-7α-carboxylic acid (7) and the protected amino acids. The morphinan moiety was coupled to the peptide residue via the acid chloride of 7, after which the morphinan peptides were O-demethylated with the aid of hydrogen bromide in glacial acetic acid. The dipeptide N-glycinyl-L-phenylalanine ethyl ester was synthesized via the Excess Mixed Anhydride method (EMA). The new morphinan peptides have been characterized by 1H and 13C NMR spectroscopy. For conformational analysis, the relative stabilities of two possible hydrogen bonds around the C7-C20 bond have been calculated on a model compound 11, using molecular mechanics.

5β-Ethylthebaine (3), together with 5β-butylthebaine (4), was obtained from thebaine (1) after reaction with butyllithium and ethyl iodide. With butyllithium and diethyl sulfate, thebaine yielded 5β-ethylthebaine (3), 5β, 10α-diethylthebaine (5), and 5β, 10α, 10β-triethylthebaine (6). The ratio of the compounds (3:4 and 3:5:6) depended on the excess of reagents used. Employing the reversed sequence of addition of reagents, that is, first diethyl sulfate and then butyllithium, we prepared 5β, 10α-diethylthebaine (5) and 5β-methyl-10α-ethylthebaine (8) from 5β-ethylthebaine (3) and 5β-methylthebaine (7), respectively. These alkylation reactions are discussed in terms of Pearson's hard-soft acid-base theory. Diels-Alder reaction of 3, 5 and 8 with ethyl acrylate gave exclusively 7α-substituted 6α, 14α-ethenoisomorphinans 9, 10 and 11, respectively. Esters of the cycloadducts 9 and 11 were converted into their tertiary alcohols 12 and 13 with methylmagnesium bromide. The 3-methoxy group in 12 and 13 was hydrolyzed with a solution of potassium hydroxide in 1,2-ethanediol to give phenols 14 and 15.

Cesium-assisted benzylation of morphine (1) gave 3-O-benzylmorphine (3) in high yield, leading to a convenient synthesis of 3-benzyloxy-7,8-didehydro-4-methoxy-N-methylmorphinan-6-one (8). This was accomplished by Oppenauer oxidation of 3, followed by 4,5α-epoxy ring opening and methylation, respectively. The key step in this sequence, viz. the reductive epoxy ring opening with retention of the 7,8-double bond, could also be applied to codeinone (4) giving quantitatively thebainone-A (6). The low-yield synthesis of 3 involving a classical procedure can be explained by the Hofmann degradation products 16 and 17. The morphinan-5,7-diene 14 was obtained from 8 via the p-toluenesulfonylhydrazone 13. Morphinan-6,8-dienes are accessible from 8 using known procedures.

The Delft total synthesis of morphinans starts from 1-benzylisoquinolines (Scheme 2, 7) and gives both the morphinans with the natural (-)-morphine configuration and the corresponding enantiomers. This route has been used as a basis for an improved synthesis of (-)-naloxone and also provides the possibility of preparing (+ )-naloxone, which is of interest in pharmacological research (Scheme 1, 6). We report here in particular on the conversion of 1-(3,5-dibenzyloxy-4-methoxybenzyl)-1,2,3,4-tetrahydro-6-methoxyisoquinoline (7) into dihydrocodeinone (2) via dihydrothebainone (1), the yield of which was raised from 6 to 17%. An improved procedure has been evolved for the conversion of noroxycodone (5) into naloxone (6).

Two different types of Diels-Alder additions to morphinan-6, 8-dienes have been found. 6-Demethoxythebaine (2) yielded ethyl 4, 5α-epoxy-3-methoxy-N-methyl-6, 14-ethenoisomorphinan–7α-carboxylate (3) with ethyl acrylate, in analogy to the reaction with thebaine. The ester 3 was converted into the alcohol 4, of which the 3-methoxy ether was hydrolyzed to yield 5. Similarly, 2 gave the 7α-acetyl-6, 14-ethenoisomorphinan 7 with methyl vinyl ketone. The latter compound was converted into 4 using methylmagnesium iodide. With propylmagnesium bromide, 7 afforded four compounds; two are new etorphine analogues (8 and 9), to which we were able to assign the absolute configuration; the other two are the Grignard reduction products 10 and 11. When the 4, 5α-epoxy bridge of 2 is first opened, the Diels-Alder reaction with methyl vinyl ketone proceeds from the other side of the diene system yielding the 7β-acetyl-6, 14-ethenomorphinan 6, which belongs to a novel class of rigid morphinans. Preliminary pharmacological screening of 5, 8 and 9 showed these compounds to be potent agonists.

The synthesis of 4, 5α-epoxy-α, α, 17-trimethyl-6α, 14α-ethenoisomorphinan-7α-methanol (6) via hydrogenolysis of the corresponding 3-(1-phenyltetrazol-5-yl) ether (5) is described. The etheno bridge was retained under the conditions used. Preliminary pharmacology of the title compound showed strong analgesic potency.

Reductive epoxy ring scission of 6-demethoxy-N-northebaine (5) with zinc and potassium hydroxide gave a 85:15 mixture of 6a and its non-conjugated isomer. Formylation with triethyl orthoformate, followed by acetylation with acetic anhydride in the presence of 4-(dimethylamino)pyridine gave a 4:1 mixture of the title compound 6c and its non-conjugated isomer in 80% overall yield. Diels-Alder reaction of 6c with methyl vinyl ketone afforded a 2:1 mixture of 7β-acetyl-and 8β-acetyl-6β, 14β-ethenomorphinan 7 and 8a. Cycloaddition of nitroethene yielded the 8β-nitro-6β, 14β-ethenomorphinan 8b as major product. N-Demethylation of 2b, the 4-O-phenyl ether of 6-demethoxy-β-dihydrothebaine (2a), with diethyl azodicarboxylate failed to give the N-norcompound.

7,8-Didehydro-3,4-dimethoxy-17-methylmorphinan-6-one (2) was prepared by reductive opening of the epoxy bridge of codeinone, followed by methylation with Rodionow's reagent. Reduction of the title compound with sodium tetrahydroborate in the presence of cerium(III) chloride afforded a mixture of 7,8-didehydro-3,4-dimethoxy-17-methylmorphinan-6α-ol (3) and -6β-ol (4) in a ratio of 4:1 from which the 6α-epimer was crystallized and converted into the acetate (7).

Aim: The aim of our study is to compare the improvement in clinical outcomes after conventional arthroscopic double-row rotator cuff repair and arthroscopic undersurface rotator cuff repair. Method: A consecutive series of 120 patients who underwent arthroscopic rotator cuff repair was analysed. Sixty-one patients underwent conventional double-row rotator cuff repair and 59 patients underwent undersurface rotator cuff repair. Several clinical outcomes, including numerical pain rating scale (NPRS), constant shoulder score (CSS), Oxford shoulder score (OSS) and University of California Los Angeles shoulder score (UCLASS), were prospectively recorded by a trained healthcare professional preoperatively and at 3, 6, 12 and 24 months after surgery. Result: Comparing both groups, there were no differences in age, gender and preoperative NPRS, CSS, OSS and UCLASS. However, the tear size was 0.7 ± 0.2 (95% confidence interval (CI) 0.3–1.1) cm larger in the conventional group ( p = 0.002). There was no difference in the improvement of NPRS, CSS, OSS and UCLASS at all time points of follow–up, that is, at 3, 6, 12 and 24 months after surgery. The duration of operation was shorter by 35 ± 3 (95% CI 28–42) min in the undersurface group ( p < 0.001). Conclusion: Both arthroscopic undersurface rotator cuff repair and conventional arthroscopic double-row rotator cuff repair showed marked improvements in clinical scores when compared preoperatively, and there was no difference in improvements between both groups. Arthroscopic undersurface rotator cuff repair is a faster technique compared to the conventional arthroscopic double-row rotator cuff repair.

Bei einem 55jahrigen Mann wurde 7 Monate nach orthotoper Lebertransplantation eine Lungentuberkulose diagnostiziert. Die tuberculostatische Therapie erfolgte mit Isoniazid (3 x 0,2 g/Wo) und Ethambutol (1,6 g/d) uber 11 Monate. Nach 3 Monaten waren keine Mycobakte rien mehr nachweisbar, und der Patient ist im 3. Jahr nach Transplantation ohne Zeichen einer aktiven Tuberkulose in gutem Gesundheitszustand bei guter Transplantatfunktion. Die Tuberculostatica-Dosierung sollte je nach Metabolisierungsleistung des Transplantats reduziert werden. Bei Beachtung dieses Kardinalpunktes konnte eine Tuberkulose nach Lebertransplantation erfolgreich behandelt werden.

Four patients (aged 35, 52, 53 and 62 years) with primary biliary cirrhosis (raised levels of gamma-GT, alkaline phosphatase and immunoglobulins, as well as of antimitochondrial antibodies) were treated with cyclosporine and methylprednisolone. Different from the regimen for immunosuppressive treatment after organ transplantation, the dosage of cyclosporine was set not according to whole-blood levels but individualized to variations in serum transaminases. An initial dose of 2-2.5 mg/kg proved to be optimal. Higher doses caused a rise in liver enzymes or bilirubin, because of toxic effects produced by the cyclosporine, which is predominantly metabolized in the liver. Optimal initial doses correlated positively with serum IgG levels. In all patients there was an improvement not only in the abnormally high levels of liver enzymes but also in their general condition. There was a marked fall in antimitochondrial antibody titres and immunoglobulin values. These findings indicate that treatment of primary biliary cirrhosis with low doses of cyclosporine and methylprednisolone is effective and low in side effects and can arrest the progression of the disease even in an advanced stage.

In the first four weeks after a liver transplantation, there was an invasive aspergillosis with a lethal course in three out of five patients who were treated postoperatively in the same room. The clinical symptoms were very different. One patient was asymptomatic, and the diagnosis could only be made by autopsy. In another patient, pulmonary symptoms, and in the third patient, cerebral symptoms were the most prominent. In the two latter patients, the infection was demonstrated in the sputum and by bronchoalveolar lavage. The disease course was fulminant in all patients, and therapy was without success. Owing to this high incidence, mycological investigations were carried out on the ward. A flower bench in the hall beside the ward was probably the main focus of distribution. To avoid such nosocomial infections, foci of aspergillus distribution should if possible be removed from the surroundings of patients with weakened immune resistance.

Pressure mapping at the knee joint provides information regarding the contact stress, contact area and the alignment of the tibiofemoral interface. In this paper, preliminary cadaveric studies of a pressure-mapping sensor are presented. The sensor is made of fiber Bragg grating arrays embedded into the tibial spacer. The sensor can be used for in vitro and in vivo studies of the tibiofemoral interface. The results show that the sensor can detect malalignment and distribution of contact stresses in extension and flexion. This pressure-mapping tibial spacer sensor can be used for alignment of prostheses during total knee joint replacement surgery.

The anterior cruciate ligament (ACL) is the primary restraint to tibial anterior translation (anterior draw). Tibial anterior draw is normally accompanied by a “coupled” tibial internal rotation. Both internal rotation and anterior translation can be increased by rupture of the ACL, resulting in a large movement of the mobile lateral tibial plateau. Arthroscopic ACL reconstruction adequately restores the anterior draw; however, the peripheral structures that are the primary restraints to tibial rotation often are neglected. Recent work has shown that a residual or “mini” pivot shift can remain after successfully restoring the anterior-posterior laxity of the knee. The search for a better restoration of normal kinematics has reawakened interest in double-bundle reconstructions. Although biomechanical studies have demonstrated that this type of reconstruction may better restore the normal kinematics, there is as yet no clinical evidence. Draw testing should now be superseded by kinematics measures of both rotations and translations of the knee with quantified loads to provide objective measures that better assess the efficacy of new surgical techniques.

Introduction: The purpose of this study is to determine normative values relating to the glenohumeral joint and rotator cuff tendons namely length, width, thickness and footprint of supraspinatus (SS), infraspinatus (IS), teres minor ™ and subscapularis (SC) from 19 specimens. Methods: Rotator cuff tendons and humerus dimensions were measured directly using a digital vernier calliper. In addition, moduli values of rotator cuff tendons were obtained from tensile tests on twelve cadaveric shoulders. The tendon footprints were delineated onto a tracing paper and their dimensions were calculated using digitiser software. The glenoid dimensions were obtained from marking its outline onto a tracing paper and the cavity dimensions from wax moulds. The results were tabulated and statistical analyses, including Student's t-test and ANOVA, were performed. Conclusion: The normative anatomic values obtained can be used in finite element modeling, computer simulation, design of implants and surgery.

Proximal humerus fractures are commonly encountered in elderly patients. Surgical treatment demonstrates high complication rates, including varus construct collapse and screw cutout. In this study, the authors evaluate the clinical outcome of locking plate fixation with intramedullary fibular strut graft augmentation as a primary surgical treatment in the prevention of early collapse and screw cutout. A total of 9 patients were evaluated. Surgery was performed for displaced proximal humerus fractures between April and December 2011. Patients were either class 2, 3, or 4, according to Neer classification. Mean patient age was 75.4 years. Preoperative and immediate, 6-week, and 3-month postoperative radiographs were evaluated. Head-shaft angles were measured to assess for varus collapse and displacement. Range of motion, complication rates, and functional recovery were also evaluated. Patients underwent open reduction and internal fixation with placement of an intramedullary fibular strut graft. Fixation was achieved with a Philos plate (Synthes, Oberdorf, Switzerland). Reduction and fixation were evaluated with radiographs. Passive exercises and range of motion were allowed immediately postoperatively, and all patients achieved active abduction and forward flexion 6 weeks postoperatively. Shoulder radiographs taken 12 weeks postoperatively revealed no loss of reduction or screw cutout. The introduction of the locking plate has improved outcomes. The addition of an intramedullary strut graft has shown improved preliminary results. Maintained reduction was observed in all 9 patients in the early postoperative period, and good functional motion was achieved. No incidence of screw cutout was recorded.

A numerical model, in the form of a computer program, for evaluating the fire resistance of insulated wide-flange steel columns is presented. The three stages associated with the thermal and structural analysis in the calculation of fire resistance of columns is explained. The use of the computer program for tracing the response of an insulated steel column from the initial pre-loading stage to collapse, due to fire, is demonstrated. The validity of the numerical model used in the program is established by comparing the predictions from the computer program with results from full-scale fire tests. Details of fire tests carried out on wide-flange steel columns protected with ceramic fibre insulation, together with results, are presented. The computer program can be used to evaluate the fire resistance of protected wide-flange steel columns for any value of the significant parameters, such as load, section dimensions, column length, type of insulation, and thickness of insulation without the necessity of testing.

Two syntheses are described of (-)-6-demethoxythebaine (4), both starting from the 6-O-mesyl**** derivative 2 of (-)-codeine. Treatment with sodium hydride in toluene gives (-)-6-demethoxythebaine in 60% yield. The preparation via 8β-bromo-6,7-didehydro-4,5-epoxy-3-methoxy-17-methylmorphinan (3), which is obtained from the mesyl derivative with the aid of lithium bromide, has an overall yield of 80%.

The use of biomarkers such as cytochrome P4501A (CYP1A) or metallothionein (MT) for pollution monitoring is based on the assumption that an increased activity or concentration is primarily caused by exposure to contaminants. Previous studies have shown that the response of biomarkers may be affected by factors such as season, temperature, gender, nutritional status or size. The objective of the present study was to identify natural factors that affect the hepatic activity of CYP1A and hepatic concentration of MT in flounder ( Platichthys flesus L.). Thirty flounder were sampled at each of two sites in the Hvaler archipelago, southern Norway, monthly through one year. A set of variables were recorded for each sampling and individual including water temperature, salinity, external and internal lesions, intestinal content, sex, size and organ weights. Hepatic CYP1A activity (EROD), MT and metal concentrations were determined for each individual flounder. The influence of environmental and endogenous factors on the response of these two biomarkers was assessed in multiple regression models. For both biomarkers, 50–60% of the total variability could be explained from factors directly related to season, gender and maturation. Season contributed significantly in the model for EROD, as did external lesions. Size, condition and diet did not contribute greatly when the above factors were included. The results confirm previous findings that season, gender and maturation must be taken into account in biomarker monitoring, but also indicate that other factors such as external lesions should be considered.

Experimental and theoretical studies that have been carried out to predict the fire resistance of rectangular hollow steel columns filled with fibre-reinforced concrete are presented in this paper. A numerical model to calculate the temperatures, deformations, and the fire resistance of loaded, rectangular, hollow steel columns filled with steel-fibre-reinforced concrete is described. Predictions from the numerical model are compared with experimental data. The results indicate that the model is capable of predicting the fire resistance of square hollow steel columns filled with fibre-reinforced concrete with an accuracy that is adequate for practical purposes. The model can be used to evaluate the fire resistance of rectangular steel columns filled with steel-fibre-reinforced concrete for any value of the significant parameters, such as load, column section dimensions, column length, concrete strength, and aggregate type in concrete, without the necessity of testing. Resume : Cet article prOsente des Otudes thOoriques et expOrimentales effectuOes afin de prOdire la rOsistance au feu de colonnes rectangulaires creuses en acier remplies de bOton armO de fibres. Un modle numOrique calculant les tempOratures, les dOformations et la rOsistance au feu de colonnes creuses en acier remplies de bOton armO de fibres et soumises ‡ un chargement, est dOcrit. Les prOdictions du modle numOrique sont comparOes aux donnOes expOrimentales. Les rOsultats indiquent que le modle est capable de prOdire la rOsistance au feu des colonnes carrOes creuses en acier remplies avec du bOton armO de fibres avec une prOcision convenable ‡ des fins pratiques. Le modle peut Ovaluer la rOsistance au feu de colonnes rectangulaires en acier remplies de bOton armO de fibres utilisant niimporte quelle valeur pour les paramtres significatifs, tels que la charge, les dimensions de la section de la colonne, la longueur de colonne, la rOsistance du bOton et le type de granulats du bOton, sans nOcessiter des essais expOrimentaux.

For use in fire resistance calculations, the relevant thermal and mechanical properties of steel-fibre-reinforced concrete at elevated temperatures were determined. These properties included the thermal conductivity, specific heat, thermal expansion, and mass loss, as well as the strength and deformation properties of steel-fibre-reinforced siliceous and carbonate aggregate concretes. The thermal properties are presented in equations that express the values of these properties as a function of temperature in the temperature range between 0 °C and 1000 °C. The mechanical properties are given in the form of stress–strain relationships for the concretes at elevated temperatures. The results indicate that the steel fibres have little influence on the thermal properties of the concretes. The influence on the mechanical properties, however, is relatively greater than the influence on the thermal properties and is expected to be beneficial to the fire resistance of structural elements constructed of fibre-reinforced concrete. Key words: steel fibre, reinforced concrete, thermal properties, mechanical properties, fire resistance.

Parametric studies, using mathematical models, were carried out to determine the influence of various factors on the fire resistance of steel hollow structural section (HSS) columns filled with bar...

In wild pea varieties two genes, sym1 and sym2, have been identified that cause resistance to European Rhizobium leguminosarum bv. viciae (Rlv) strains. The sym2 gene has previously been studied in some detail and it was shown that the additional nodulation gene nodX is sufficient to overcome the sym2 controlled nodulation resistance. Here we characterize the sym1 gene. We show that the resistance conferred by sym1 can be overcome by the introduction of nodX in European Rlv strains, indicating that sym1 just as sym2 is involved in Nod factor recognition. Both sym1 and sym2 display a recessive or dominant nature depending on the Rlv strain used for inoculation. Furthermore, introgression lines containing either sym1 or sym2 are able to form nodules with Rlv strain 248 at 26°C, but not at 18°C, indicating that both sym1 and sym2 have a temperature sensitive nature. sym2 was mapped on the pea RFLP map. We found that sym1 maps in the same region of chromosome 1 as sym2. By crossing sym1 and sym2 containing introgression lines we demonstrate that sym1 and sym2 are allelic.

Experimental and theoretical studies have been carried out to predict the fire resistance of rectangular hollow steel columns filled with bar-reinforced concrete. A mathematical model to calculate the temperatures, deformations, and fire resistance of the columns is presented in this paper. Calculated results are compared with those measured. The results indicate that the model is capable of predicting the fire resistance of square hollow steel columns, filled with bar-reinforced concrete, with an accuracy that is adequate for practical purposes. The model enables the expansion of data on the fire resistance of square concrete-filled steel columns, which at present consists predominantly of data for columns filled with plain concrete with data for columns filled with bar-reinforced concrete. Using the model, the fire resistance of square concrete-filled steel columns can be evaluated for any value of the significant parameters such as load, column-section dimensions, column length, and the percentage of r...