A double-blind randomised controlled study comparing subacromial injection of tenoxicam or methylprednisolone in patients with subacromial impingement.

We have carried out a prospective double-blind randomised controlled trial to compare the efficacy of a single subacromial injection of the non-steroidal anti-inflammatory drug, tenoxicam, with a single injection of methylprednisolone in patients with subacromial impingement. A total of 58 patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and group B 20 mg of tenoxicam as a subacromial injection along with lignocaine. The Constant-Murley shoulder score was used as the primary outcome measure and the Disability of Arm, Shoulder and Hand (DASH) and the Oxford Shoulder Score (OSS) as secondary measures. Six weeks after injection the improvement in the Constant-Murley score was significantly greater in the methylprednisolone group (p = 0.003) than in the tenoxicam group. The improvement in the DASH score was greater in the steroid group and the difference was statistically significant and consistent two (p < 0.01), four (p < 0.01) and six weeks (p < 0.020) after the injection. The improvement in the OSS was consistently greater in the steroid group than in the tenoxicam group. Although the difference was statistically significant at two (p < 0.001) and four (p = 0.003) weeks after the injection, it was not at six weeks (p = 0.055). Subacromial injection of tenoxicam does not offer an equivalent outcome to subacromial injection of corticosteroid at six weeks. Corticosteroid is significantly better than tenoxicam for improving shoulder function in tendonitis of the rotator cuff after six weeks.

Asymmetric inter- and intramolecular cyclopropanation of alkenes catalyzed by chiral ruthenium porphyrins. Synthesis and crystal structure of a chiral metalloporphyrin carbene complex.

Extensive investigations of asymmetric intermolecular cyclopropanation of terminal alkenes with diazoacetates catalyzed by ruthenium porphyrin [Ru(P*)(CO)(EtOH)] (1, H2P = 5,10,15,20-tetrakis[(1S,4R,5R,8S)-1,2,3,4,5,6,7,8-octahydro-1,4:5,8-dimethanoanthracene-9-yl]porphyrin) and the application of catalyst 1 to asymmetric intramolecular cyclopropanation of allylic or homoallylic diazoacetates are described. The intermolecular cyclopropanation of styrene and its derivatives with ethyl diazoacetate afforded the corresponding cyclopropyl esters in up to 98% ee with high trans/cis ratios of up to 36 and extremely high catalyst turnovers of up to 1.1 x 10(4). Examination of the effects of temperature, diazoacetate, solvent, and substituent in the intermolecular cyclopropanation reveals that (i) both enantioselectivity and trans selectivity increase with decreasing temperature, (ii) sterically encumbered diazoacetates N2CHCO2R, such as R = Bu(t), and donor solvents, such as diethyl ether and tetrahydrofuran, are beneficial to the trans selectivity, and (iii) electron-donating para substituents on styrene accelerate the cyclopropanations, with the log(k(X)/k(H)) vs sigma(+) plot for para-substituted styrenes p-X-C6H4CH=CH2 (X = MeO, Me, Cl, CF3) exhibiting good linearity with a small negative rho(+) value of -0.44 +/- 0.09. In the case of intramolecular cyclopropanation, complex 1 promoted the decomposition of a series of allylic diazoacetates to form the cyclopropyl lactones in up to 85% ee, contributing the first efficient metalloporphyrin catalyst for an asymmetric intramolecular cyclopropanation. Both the inter- and intramolecular cyclopropanations were proposed to proceed via a reactive chiral ruthenium carbene intermediate. The enantioselectivities in these processes were rationalized on the basis of the X-ray crystal structures of closely related stable chiral carbene complexes [Ru(P*)(CPh2)] (2) and [Ru(P*)(C(Ph)CO2CH2CH=CH2)] (3) obtained from reactions of complex 1 with N2CPh2 and N2C(Ph)CO2CH2CH=CH2, respectively.

Synthesis of a new chiral ligand, 6, 6'-dihydroxy-5, 5'-biquinoline (BIQOL) and its applications in the asymmetric addition of diethylzinc to aldehydes.

A new chiral ligand 6, 6'-dihydroxy-5, 5'-biquinoline (BIQOL, 2) was prepared via Cu2+ mediated coupling. The resolution was carried out by separating the corresponding ditrifluomethanesulfonate on chiral column. When applied to the enantioselective addition of diethylzinc to aromatic aldehydes, this ligand induced the reaction with enantioselectivity equivalent to that induced by BINOL. The effects of solvent and reaction temperature on enantioselectivity were also studied.

Two-unit cantilevered resin-bonded fixed partial dentures--a retrospective, preliminary clinical investigation.

PURPOSE: The aim of this study was to retrospectively evaluate the clinical retention and abutment movement of 2-unit cantilevered resin-bonded fixed partial dentures (FPD) that were inserted at Prince Philip Dental Hospital in Hong Kong. MATERIALS AND METHODS: Of 45 patients who were identified from a hospital computer search after receiving a 2-unit cantilevered resin-bonded FPD, 31 were clinically examined (33 FPDs). For each patient the following data were recorded: gender, age, cementation date, endodontic treatment if performed, bone support, tooth mobility, and FPD tipping or drifting. Data about any debonds with subsequent treatment and patient satisfaction on a 10-point scale were also recorded. RESULTS: The mean service life for the 33 prostheses was 30 +/- 18 months, with a range of 72 days to 67 months. One prosthesis debonded, resulting in a clinical retention rate of 97%. No rotation, drifting, or tipping was observed for any of the prostheses during the short period of this study. CONCLUSION: Two-unit cantilevered resin-bonded FPDs are successful in the short term, but further research is required to determine if they offer a viable alternative to fixed-fixed resin-bonded FPD designs.

Antibody response in individuals infected with avian influenza A (H5N1) viruses and detection of anti-H5 antibody among household and social contacts.

The first documented outbreak of human respiratory disease caused by avian influenza A (H5N1) viruses occurred in Hong Kong in 1997. The kinetics of the antibody response to the avian virus in H5N1-infected persons was similar to that of a primary response to human influenza A viruses; serum neutralizing antibody was detected, in general, >/=14 days after symptom onset. Cohort studies were conducted to assess the risk of human-to-human transmission of the virus. By use of a combination of serologic assays, 6 of 51 household contacts, 1 of 26 tour group members, and none of 47 coworkers exposed to H5N1-infected persons were positive for H5 antibody. One H5 antibody-positive household contact, with no history of poultry exposure, provided evidence that human-to-human transmission of the avian virus may have occurred through close physical contact with H5N1-infected patients. In contrast, social exposure to case patients was not associated with H5N1 infection.

Case-control study of risk factors for avian influenza A (H5N1) disease, Hong Kong, 1997.

In May 1997, a 3-year-old boy in Hong Kong died of a respiratory illness related to influenza A (H5N1) virus infection, the first known human case of disease from this virus. An additional 17 cases followed in November and December. A case-control study of 15 of these patients hospitalized for influenza A (H5N1) disease was conducted using controls matched by age, sex, and neighborhood to determine risk factors for disease. Exposure to live poultry (by visiting either a retail poultry stall or a market selling live poultry) in the week before illness began was significantly associated with H5N1 disease (64% of cases vs. 29% of controls, odds ratio, 4.5, P=.045). By contrast, travel, eating or preparing poultry products, recent exposure to persons with respiratory illness, including persons with known influenza A (H5N1) infection, were not associated with H5N1 disease.

Empirical fitting with polycon II lenses.

Historically, rigid gas permeable (RGP) lens parameters have been determined through trial fitting. Nevertheless, practitioners would likely welcome the opportunity to empirically fit RGP lenses if they could be confident of the outcome. This clinical investigation sought to evaluate the potential success of empirically fitting 9.0 mm Polycon II lenses. Based on both objective and subjective outcomes, this study suggests that empirically fitting the larger 9.5 mm Polycon II design, in combination with a lid attachment approach, would yield greater initial patient satisfaction.

TABLASER: trace (element) analyzer based on laser ablation and selectively excited radiation.

Trace element analysis based on laser ablation and selectively excited radiation (TABLASER) is proposed as a new and reliable microultratrace technique for quantitative in situ element analysis. Measurements of trace quantities of chromium in samples of NBS standard reference steel, doped skim milk powder, and doped flour have been undertaken. A linear 45 degrees slope dependence of signal vs concentration that extends beyond 1% in the case of chromium was observed. Although the present sensitivity limit is in the ppm range, improved overlap between the probing dye laser beam and the wave of atomized material combined with a better design of the optical system could reduce the detection limit of the TABLASER to the ppb range. This would correspond to an absolute detection limit of about 10(-16) g. An important feature of this new technique is its relative freedom from chemical matrix effects, which suggests the possibility of a universal calibration curve for all elements irrespective of the substrate matrix in which they are contained. This technique is also adaptable to multielement analysis.