REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal.

BACKGROUND: Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). OBJECTIVES: To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. METHODS: Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. RESULTS: Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. CONCLUSIONS: Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.

Optical Stability of High-translucency Resin-based Composites.

This study investigated the stability of the optical properties of high-translucent shades of dental resin-based composites. Four commercial materials (Filtek Z350 XT, Opallis, Amelogen Plus, and IPS Empress Direct) and 14 non-Vita shades were tested. Disc-shaped specimens for each resin-based composite-shade combination (n=6) were evaluated at T0 (baseline), T1 (after 30 days of storage in water), and T2 (after 30 days of storage each in water and a coffee solution). Color measurements were performed according to the L'C'h' color system. Translucency Parameter (TP) and CIEDE2000 color difference (ΔE00) were calculated. Data were statistically analyzed at α = 0.05. Baseline TP values varied from 43 ± 1 to 55 ± 1. Changes in TP at T1 varied from -3.0% (Opallis T-Neutral) to 4.2% (Amelogen Plus Trans Orange), with no major differences from T0. At T2, most resin-based composites showed significantly increased opacity, with changes varying between -15.0% (Empress Direct Trans 20) and -2.7% (Z350 XT Blue). However, the TP values were ≥40 throughout the study. Storage in water caused negligible color differences, with ΔE00 values at T1 ≤ 0.9 ± 0.6. At T2, all materials tested showed significant color difference, and ΔE00 ≥ 3.2 ± 0.2. The orange shades from Opallis and Amelogen Plus showed lower color variation than did the other shades. The most significant optical changes upon storage were detected in the hue and particularly the chroma color coordinate. In conclusion, the high-translucent resin-based composites showed large variability in the stability of their optical properties among the tested brands and different shades of the same material. Regardless of the storage condition, the tested resin-based composites retained their high-translucency character over time.

¿Qué significa estudiar terapia ocupacional? La perspectiva de estudiantes de la Universidad de Chile / What does studying occupational therapy means? The perspective of students of the University of Chile

El objetivo de este trabajo es analizar la percepción atribuida a estudiar Terapia Ocupacional según los estudiantes de la Universidad de Chile. La investigación es de tipo cualitativa fenomenológica, pues se pretende estudiar la dimensión subjetiva de un fenómeno en particular denominado "estudiar Terapia Ocupacional". Para recolectar los datos, se realiza una entrevista semiestructurada abierta. El análisis de los datos se inicia con la categorización de acuerdo a las dimensiones significado, sentido y propósito que se describe en el marco de referencia, y las subcategorías y códigos a partir de los relatos.En los resultados se observa que en la categoría significado, la opinión externa hace referencia a "estudiar Terapia Ocupacional" y a "estudiar en una universidad" en sí, encontrando principalmente desconocimiento y percepción positiva hacia la carrera. En la dimensión sentido se identifican factores que otorgan valor positivo y/o negativo que influyen en la autoeficacia, la importancia, la motivación, el interés y el disfrute, destacándose entre ellos, el enfoque biopsicosocial y el trabajo directo con las personas. Finalmente en el propósito se identifican metas y utilidades, tanto personales como profesionales.Dichos resultados, promueven la reflexión en torno a la visión que se tiene de la carrera y valoración de los estudios profesionales.

The main goal of this work is to analyze the attributed perception of studying occupational therapy according to the students of University of Chile. A qualitative and phenomenological methodology was used, as this investigation tries to study the subjective dimension of a particular phenomenon, such as studying Occupational Therapy. Data recollection was made with open-semistructured interviews. Data analysis initiated with a previous categorization according to meaning, sense and purpose, as described in the AOTA's framework; subcategories and codes were included from the interviews. Results show that in the Meaning category, external opinion makes reference to "studying occupational therapy" and "studying in a university", mainly finding ignorance and a positive perception of the career. At the sense dimension, factors that give positive and/or negative values that influence self-efficacy, importance, motivation, interest and enjoyment are identified; these factors included the biopsychosocial approach and working with people. Finally, in the purpose dimension, goals and utilities are identified, both in a personal and professional aspects.These results prompt reflection around the perception of the career and the value given to professional studies.

Evaluation of four DNA extraction protocols for Brucella abortus detection by PCR in tissues from experimentally infected cows with the 2308 strain.

This study compared 4 protocols for DNA extraction from homogenates of 6 different organs of cows infected with the Brucella abortus 2308 strain. The extraction protocols compared were as follows: GT (guanidine isothiocyanate lysis), Boom (GT lysis with the carrying suspension diatomaceous earth), PK (proteinase K lysis), and Santos (lysis by boiling and freezing with liquid nitrogen). Positive and negative gold standard reference groups were generated by classical bacteriological methods. All samples were processed with the 4 DNA extraction protocols and amplified with the B4 and B5 primers. The number of positive samples in the placental cotyledons was higher than that in the other organs. The cumulated results showed that the Santos protocol was more sensitive than the Boom (p=0.003) and GT (p=0.0506) methods and was similar to the PK method (p=0.2969). All of the DNA extraction protocols resulted in false-negative results for PCR. In conclusion, despite the disadvantages of classical bacteriological methods, the best approach for direct diagnosis of B. abortus in organs of infected cows includes the isolation associated with PCR of DNA extracted from the cotyledon by the Santos or PK methods.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of Traditional Psychomotor Development Evaluation versus a Self-Administered Test?

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79% en EEDP y 12,73% en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de los padres, madres y cuidadores en la observación del desarrollo de sus hijos.

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were conducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79% of patients through the use of EEDP and in 12.73% through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Adaptation and evaluation of polymerase chain reaction for Brucella ovis detection in semen, urine and organs of rams experimentally infected / Adaptação e avaliação da reação em cadeia da polimerase para detecção de Brucella ovis em sêmen, urina e órgãos de carneiros infectados experimentalmente

O objetivo do estudo foi adaptar e avaliar a PCR para detecção de Brucella ovis e comparar os resultados com aqueles obtidos por cultivo microbiológico do sêmen, urina e dos órgãos de carneiros infectados experimentalmente. Dos 31 animais infectados experimentalmente, amostras de PCR do sêmen apresentaram maior sensibilidade (21,6 por cento) do que o cultivo (8,0 por cento). Em amostras de urina, a sensibilidade das técnicas foi semelhante (10,1 por cento para a cultivo e 12,7 por cento para PCR). PCR detectou a presença do agente em 21,5 por cento das amostras testadas, enquanto os órgãos de cultivo detectaram em apenas 3,3 por cento das amostras. PCR detectou um maior número de amostras positivas do que o cultivo microbiológico.

Comparison of a PCR assay in whole blood and serum specimens for canine brucellosis diagnosis.

The performance of a serum PCR assay was compared with that of a blood PCR assay for the diagnosis of canine brucellosis caused by Brucella canis in 72 dogs. The dogs were classified into three groups (infected, non-infected and suspected brucellosis) according to the results of blood culture and serological tests. The sensitivities of blood PCR and serum PCR were, respectively, 97.14 per cent and 25.71 per cent. The specificities of both were 100 per cent. In the group of dogs with suspected brucellosis, three were positive by blood PCR and none was positive by serum PCR. Serum PCR showed little value for the direct diagnosis of canine brucellosis as the assay had low diagnostic sensitivity and fewer positive dogs were detected by this test than by blood culture, blood PCR, rapid slide agglutination test (RSAT) and RSAT with 2-mercaptoethanol.

Infecção em cão por Brucella abortus: relato de caso / Brucella abortus infection in dog: case report

Brucella abortus infection is reported in a dog from a rural area that presented at clinical evaluation left testicular enlargement and right testicular decrease. Serum resulted negative to rapid agglutination test and agar gel immunodifusion with Brucella ovis antigen but positive to buffered plate agglutination test, tube agglutination test and 2- Mercapthoetanol with B. abortus antigen. Brucella isolation was negative in blood, testicular material, semen and urine. Brucella DNA was detected in PCR from urine and blood

Metaflumizone is a novel sodium channel blocker insecticide.

Metaflumizone is a novel semicarbazone insecticide, derived chemically from the pyrazoline sodium channel blocker insecticides (SCBIs) discovered at Philips-Duphar in the early 1970s, but with greatly improved mammalian safety. This paper describes studies confirming that the insecticidal action of metaflumizone is due to the state-dependent blockage of sodium channels. Larvae of the moth Spodoptera eridania injected with metaflumizone became paralyzed, concomitant with blockage of all nerve activity. Furthermore, tonic firing of abdominal stretch receptor organs from Spodoptera frugiperda was blocked by metaflumizone applied in the bath, consistent with the block of voltage-dependent sodium channels. Studies on native sodium channels, in primary-cultured neurons isolated from the CNS of the larvae of the moth Manduca sexta and on Para/TipE sodium channels heterologously expressed in Xenopus (African clawed frog) oocytes, confirmed that metaflumizone blocks sodium channels by binding selectively to the slow-inactivated state, which is characteristic of the SCBIs. The results confirm that metaflumizone is a novel sodium channel blocker insecticide.

A polymerase chain reaction for detection of Brucella canis in vaginal swabs of naturally infected bitches.

A PCR assay for the detection of Brucella canis in canine vaginal swab samples was evaluated, comparing its performance with that of bacterial isolation, serological tests, and a blood PCR assay. One hundred and forty-four female dogs were clinically examined to detect reproductive problems and they were tested by the rapid slide agglutination test, with and without 2-mercaptoethanol (2ME-RSAT and RSAT, respectively). In addition, microbiological culture and PCR were performed on blood and vaginal swab samples. The results of the vaginal swab PCR were compared to those of the other tests using the Kappa coefficient and McNemar test. Of the 144 females that were examined, 66 (45.8%) were RSAT positive, 23 (15.9%) were 2ME-RSAT positive, 49 (34.02%) were blood culture positive, 6 (4.1%) were vaginal swab culture positive, 54 (37.5%) were blood PCR positive, 52 (36.2%) were vaginal swab PCR positive, and 50.69% (73/144) were positive by the combined PCR. The PCR was able to detect as few as 3.8 fg of B. canis DNA experimentally diluted in 54 ng of canine DNA, extracted from vaginal swab samples of non-infected bitches. In addition, the PCR assay amplified B. canis genetic sequences from vaginal swab samples containing 1.0 x 10(0) cfu/mL. In conclusion, vaginal swab PCR was a good candidate as a confirmatory test for brucellosis diagnosis in bitches suspected to be infected, especially those negative on blood culture or blood PCR; these animals may be important reservoirs of infection and could complicate attempts to eradicate the disease in confined populations.

Dificultades de lenguaje en preescolares: concordancia entre el test TEPSI y la evaluación fonoaudiológica / Language difficulties in pre-scholars: concordance between TEPSI test and speech therapist evaluation

Background: Language deficits cause difficulties in the family, school and social settings, so early detection and intervention are crucial. In Primary Care, children undergo developmental screening using the TEPSI test, which includes language at 4 years-old. Objective: Establish the frequency of language delay in children at pre-school, determined by specific language tests, in order to establish their concordance with TEPSI test. Method: Children between 3 and 5 years-old, attending 2 low-income pre-school facilities from the North Metropolitan Area, were evaluated during 2006. The information was obtained in a blind and simultaneous mode through TEPSI test performed by nurses and 3 specific language tests performed by speech therapists. A performance < p10 or < 2SD in one or was more language tests was considered a deficit. The concordance and discordance between both evaluations were established. Results: From a total of 219 children, 194 (89 percent) completed the evaluation. 48 percent had a language deficit by speech evaluation and 13,9 percent by TEPSI test. The concordance between both evaluations was poor (Kappa 0,2), with a significant discordance (p < 0,0000) by Mc NemarÆs X². Conclusion: The frequency of language problems in this population is high; a poor concordance between the tests used in Primary Care and language evaluations performed by speech therapists was found. The differences could be caused by the different aspects of language being evaluated. The findings lead to reconsider the screening strategies used in Primary Care and to implement language stimulation programs directed to low-income populations at high risk for language deficits.

Introducción: Los déficit del lenguaje conllevan dificultades en el contexto familiar, escolar y social, siendo fundamental la pesquisa e intervención precoz. En la atención primaria (APS) el lenguaje se evalúa en el marco del desarrollo psicomotor (DSM), a los 4 años mediante el test de TEPSI. Objetivo: Describir la frecuencia de déficit de lenguaje en preescolares asistentes a jardín infantil según pruebas de lenguaje específicas y establecer la concordancia entre estas pruebas y el TEPSI. Metodología: Se evaluó a todos los niños entre 3 y 5 años, asistentes a dos jardines infantiles de nivel socioeconómico bajo, del área Norte de la Región Metropolitana. La información se obtuvo en forma simultánea y ciega mediante la aplicación del TEPSI por enfermeras y la evaluación del lenguaje con dos pruebas específicas aplicadas por fonoaudiólogos. Se consideró un desempeño deficitario cuando el rendimiento en una o más pruebas de lenguaje fue < p10 ó < 2DS para la edad. Se estableció la concordancia y discordancia entre ambas evaluaciones. Resultados: De un total de 219 niños, 194 (89 por ciento) completaron la evaluación con los instrumentos señalados. 48,8 por ciento presentó dificultades del lenguaje según la evaluación fonoaudiológica y 13,9 por ciento según TEPSI. La concordancia entre ambas evaluaciones fue pobre (Kappa 0,2), con una discordancia altamente significativa p < 0,0000 según X² de Mc Nemar. Conclusión: Destaca la alta frecuencia de problemas de lenguaje en la población estudiada y la pobre concordancia entre las pruebas aplicadas en APS y la evaluación fonoaudiológica. Las diferencias podrían deberse a los distintos aspectos del lenguaje considerados en las evaluaciones. Los hallazgos invitan a replantear las estrategias de pesquisa utilizadas en APS y a la implementación de programas integrales de estimulación en poblaciones desfavorecidas, consideradas de riesgo para problemas de lenguaje.

A polymerase chain reaction for the detection of Brucella canis in semen of naturally infected dogs.

The objective was to evaluate a PCR assay for the detection of Brucella canis in canine semen, comparing its performance with that of bacterial isolation, serological tests and PCR assay of blood. Fifty-two male dogs were examined clinically to detect reproductive abnormalities and their serum was tested by the rapid slide agglutination test, with and without 2-mercaptoethanol (2ME-RSAT and RSAT, respectively). In addition, microbiological culture and PCR assays were performed on blood and semen samples. The findings of the semen PCR were compared (Kappa coefficient and McNemar test) to those of blood PCR, culture of blood and semen, RSAT, and 2ME-RSAT. Nucleic acid extracts from semen collected from dogs not infected with B. canis were spiked with decreasing amounts of B. canis RM6/66 DNA and the resulting samples subjected to PCR. In addition, semen samples of non-infected dogs were spiked with decreasing amounts of B. canis CFU and the resulting suspensions were used for DNA extraction and amplification. Of the 52 dogs that were examined, the following tests were positive: RSAT, 16 (30.7%); 2ME-RSAT, 5 (9.6%); blood culture, 14 (26.9%); semen culture, 11 (21.1%); blood PCR, 18 (34.6%); semen PCR, 18 (34.6%). The PCR assay detected as few as 3.8 fg of B. canis DNA experimentally diluted in 444.9 ng of canine DNA (extracted from semen samples of non-infected dogs). In addition, the PCR assay amplified B. canis genetic sequences from semen samples containing as little as 1.0 x 10(0) cfu/mL. We concluded that PCR assay of semen was a good candidate as a confirmatory test for the diagnosis of brucellosis in dogs; its diagnostic performance was similar to blood culture or blood PCR. Furthermore, the PCR assay of semen was more sensitive than the 2ME-RSAT or semen culture. Examination of semen by PCR should be included for diagnosis of brucellosis prior to natural mating or AI; in that regard, some dogs that were negative on serological and microbiological examinations as well as blood PCR were positive on PCR of semen.

Diagnosis of canine brucellosis: comparison between serological and microbiological tests and a PCR based on primers to 16S-23S rDNA interspacer.

A pair of primers directed to 16S-23S rDNA interspacer (ITS) was designed directed to Brucella genetic sequences in order to develop a polymerase chain reaction (PCR) putatively capable of amplifying DNA from any Brucella species. Nucleic acid extracts from whole-blood from naive dogs were spiked with decreasing amounts of Brucella canis RM6/66 DNA and the resulting solutions were tested by PCR. In addition, the ability of PCR to amplify Brucella spp. genetic sequences from naturally infected dogs was evaluated using 210 whole-blood samples of dogs from 19 kennels. The whole-blood samples collected were subjected to blood culture and PCR. Serodiagnosis was performed using the rapid slide agglutination test with and without 2-mercaptoethanol. The DNA from whole blood was extracted using proteinase-K, sodium dodecyl sulphate and cetyl trimethyl ammonium bromide followed by phenol-chloroform purification. The PCR was capable of detecting as little as 3.8 fg of Brucella DNA mixed with 450 ng of host DNA. Theoretically, 3.8 fg of Brucella DNA represents the total genomic mass of fewer than two bacterial cells. The PCR diagnostic sensitivity and specificity were 100%. From the results observed in the present study, we conclude that PCR could be used as confirmatory test for diagnosis of B. canis infection.

Primary stenting in a young adult with aortic coarctation

A young male adult with significant aortic coarctation was initially referred to our clinics due to uncontrolled blood pressures. On evaluation the diagnosis of aortic coarctation was evident and confirmed with Magnetic Resonance Angiography (MRA). After discussing treatment options with the patient and his parents they opted for the least invasive procedure possible. Primary stenting of a simple discrete aortic coarctation was performed successfully. The following is a report on the methods used and immediate results.

Pneumocystis carinii diseminado en paciente tratado con inmunosupresores / Disseminated Pneumocystis carinii in a patient treated with immunosuppressive drugs

No disponible

Effect of electrical stimulation of the baso-lateral amygdala nucleus on defensive burying shock probe test and elevated plus maze in rats.

In the present report, the putative effect of a single electrical stimulation (75, 150 or 300 microA) to the baso-lateral amygdala (BLA) nucleus was assessed in shock probe defensive burying behavior test (DB) and elevated plus maze (EPM). These models have been used for measuring anxiety levels and screening putative anxiolytic compounds. A group of 28 rats were randomly divided for the following experimental conditions: Control-control, sham-operated, BLA stimulated groups: 75, 150 and 300 microA tested for DB. The cumulative defensive burying in a 15 min-test, the latency of burying, the number of shock received and the height of the bedding material in the probe were recorded. Another group of 28 individuals was also randomly distributed for the following experimental conditions: Control-control, sham-operated, BLA stimulated animals: 75, 150, 300 microA and tested in the EPM. The time the subjects spent in the open arms, the crosses and the faeces number excreted during the test were recorded. Decreased levels of defensive burying were observed in 75, 150 and 300 microA stimulated groups. The 150 and 300 microA groups reached statistical significance. The fact that 300 microA stimulated group showed statistically significant increase in the latency of defensive burying, in the number of shock received and decreased amount in bedding material suggests a sedative action of electrical stimulation. Increased time in the open arms and augmented number of crossings in 150 microA group was observed. No changes in the number of faeces were observed in any group. The evidence supported the notion of an inhibitory amygdaline mechanism triggered by sub-threshold electrical stimulation.

Synthesis of (+/-)-bakkenolide-A and its C-7, C-10, and C-7,10 epimers by means of an intramolecular Diels-Alder reaction.

(+/-)-bakkenolide-A (1) was prepared in five steps from ethyl 4-benzyloxyacetoacetate by sequential alkylations with tiglyl bromide and (Z)-5-bromo-1,3-pentadiene, followed by an intramolecular Diels-Alder reaction of (E,Z)-triene 25b as the key step. The hydrindane cycloadduct 28 was subjected to hydrogenation and spontaneous or acid-catalyzed lactonization, followed by a Witttig reaction to introduce the exocyclic methylene group of 1. The known 7-epibakkenolide-A (2) and novel 10-epi- and 7,10-diepibakkenolide-A (3 and 4, respectively) stereoisomers were obtained as minor byproducts. When (E)-5-bromo-1,3-pentadiene was used instead of the Z-isomer, the 10-epi- and 7,10-diepibakkenolides were the major products. In both cases exo cyclization was preferred over endo. An alternative approach was based on a similar intramolecular Diels-Alder cycloaddition, using dimethyl malonate instead of ethyl 4-benzyloxyacetoacetate as the starting material for the double alkylation preceding the cycloaddition step. The cycloadduct was then converted into the corresponding alpha-phenylseleno propargyl esters 16 or 22. However, attempted formation of the spiro center by a radical cyclization resulted chiefly in reductive deselenization.