Harnessing Sulfur(VI) Fluoride Exchange Click Chemistry and Photocatalysis for Deaminative Benzylic Arylation

While among the most common functional handles present in organic molecules, amines are a widely underutilized linchpin for C-C bond formation. To facilitate C-N bond cleavage, large activating groups are typically used but result in the generation of stoichiometric amounts of organic waste. Herein, we report an atom-economic activation of benzylic primary amines relying on the Sulfur(VI) Fluoride Exchange (SuFEx) click chemistry and the aza-Ramberg-Bäcklund reaction. This two-step sequence allows the high-yielding generation of 1,2-dialkyldiazenes from primary amines via loss of SO2. Excitation of the diazenes with blue light and an Ir photocatalyst affords radical pairs upon expulsion of N2, which can be coaxed into the formation of C(sp3)-C(sp2) bonds upon diffusion and capture by a Ni catalyst. This arylative strategy relying on a traceless click approach was harnessed in a variety of examples and its mechanism was investigated.

Accessing Photoredox Transformations with an Iron(III) Photosensitizer and Green Light

Efficient excited-state electron transfer between an iron(III) photosensitizer and organic electron donors was realized with green light irradiation. This advance was enabled by the use of the previously reported iron photosensitizer, [Fe(phtmeimb)₂]⁺ (phtmeimb = {phenyl[tris(3-methyl-imidazolin-2-ylidene)]borate}, that exhibited long-lived and luminescent ligand-to-metal charge-transfer (LMCT) excited states. A benchmark dehalogenation reaction was investigated with yields that exceed 90% and an enhanced stability relative to the prototypical photosensitizer [Ru(bpy)₃]²⁺. The initial catalytic step is electron transfer from an amine to the photoexcited iron sensitizer, which is shown to occur with a large cage-escape yield. For LMCT excited states, this reductive electron transfer is vectorial and may be a general advantage of Fe(III) photosensitizers. In-depth time-resolved spectroscopic methods, including transient absorption characterization from the ultraviolet to the infrared regions, provided a quantitative description of the catalytic mechanism with associated rate constants and yields.

Mechanistic investigation of a visible light mediated dehalogenation/cyclisation reaction using iron(iii), iridium(iii) and ruthenium(ii) photosensitizers

The identification of reaction mechanisms unique to the iron, ruthenium, and iridium PS represents progress towards the long-sought goal of utilizing earth-abundant, first-row transition metals for emerging energy and environmental applications.

Immunohistochemical evaluation of bcl-2, ER-alpha, caspase -3, -8, -9, PCNA and Ki-67 expressions in canine mammary carcinomas

We investigated the expression of bcl-2, estrogen receptor alpha (ER-alpha), caspase-3, -8, -9, proliferating cell nuclear antigen (PCNA) and Ki-67 in canine mammary carcinomas. We used 65 paraffin embedded and re-diagnosed archival canine mammary tumor samples to which we applied the routine streptavidin-biotin-peroxidase technique. Seventeen cases were re-diagnosed as tubulopapillary carcinoma, 31 were re-diagnosed as complex carcinoma and 17 were re-diagnosed as carcinosarcoma. Differences of expression of bcl-2 and PCNA were statistically significant according to tumor type. Differences in expression of ER-alpha, caspase-3, -8, -9 and Ki-67 were not statistically significant. Differences of expression of bcl-2 and PCNA were statistically significant compared to ER-alpha, caspase-3, -8, -9 and Ki-67 in carcinosarcomas. We report the prognostic significance of bcl-2 and PCNA expression in canine mammary carcinosarcomas.

Left Inguinal Bladder Hernia that Causes Dilatation in the Ureter

The scrotal bladder hernia is a rare condition that may present as scrotal swelling and urinary system obstruction or infection symptoms. Diagnosis of this condition before the operation decreases the severe complications like bladder injury during operation. In this article, a 75-year-old man presented to our clinic with right inguinal swelling and lower urinary system infection. Inguinal bladder hernia was diagnosed after performing a computed tomography. The hernia was repaired without any complications.

Surgical outcomes of a civil war in a neighbouring country

OBJECTIVES

The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey.

METHODS

159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring.

RESULTS

The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients).

CONCLUSIONS

In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Acute chest syndrome in severity of sickle cell diseases

BACKGROUND

Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand whether or not there are some positive correlations between acute chest syndrome (ACS) and severity of SCDs.

METHODS

All patients with the SCDs were taken into the study.

RESULTS

The study included 337 cases (167 females). There were 15 patients (4.4%) with the ACS. The mean ages were similar in both groups (29.4 versus 29.7 years in the ACS group and other, respectively, P > 0.05). The female ratios were similar in both groups, too (60.0% versus 49.0%, respectively, P > 0.05). Additionally, prevalences of associated thalassemia minors were similar in them (66.6% versus 65.5%, respectively, P > 0.05). Smoking was higher in the ACS group (20.0% versus 13.9%), but the difference was nonsignificant (P > 0.05). Although the mean white blood cell count and hematocrit value of peripheric blood were higher in the ACS group, the mean platelet count was lower in them, but the differences were nonsignificant again (P > 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, digital clubbing, pulmonary hypertension, rheumatic heart disease, cirrhosis, stroke, and mortality were higher in the ACS group, the difference was only significant for the stroke (P < 0.05), probably due to the small sample size of the ACS group.

CONCLUSION

SCDs are chronic destructive processes on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably ACS is one of the terminal consequences of the inflammatory processes that may indicate shortened survival in such patients.

Sickle cell diseases and ileus

BACKGROUND

We tried to understand whether or not there is an increased incidence of ileus in patients with sickle cell diseases (SCDs).

METHODS

All cases with SCDs were taken into the study.

RESULTS

The study included 325 patients (160 females). The mean ages were similar in both sexes (29.3 versus 29.8 years in females and males, respectively, p > 0.05). Incidence of ileus was higher in males, significantly (3.6% versus 1.2%, p < 0.01). All of the ileus cases were able to be treated with simple and repeated red blood cell (RBC) transfusions without any surgical procedure. Smoking was higher in males, too (21.8% versus 6.2%, p < 0.001). The mean hematocrit value was also higher in males, significantly (24.4% versus 23.0%, p = 0.016). RBC units transfused, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, and chronic renal disease were all higher in males, too (p < 0.05 for all). On the other hand, although the general mortality, white blood cell and platelet counts of peripheric blood, painful crises per year, rheumatic heart disease, avascular necrosis of bone, cirrhosis, and stroke were all higher in males, the differences were nonsignificant probably due to the small sample sizes of the groups (p > 0.05 for all).

CONCLUSION

Although the relatively young mean ages of the patients with SCDs, the very high incidences of ileus are probably due to the strong atherosclerotic and obstructive natures of the two pathologies, and ileus should be treated with simple and repeated RBC transfusions to restore bowel perfusion in such patients.

[The development of ventricular fibrillation due to etomidate for anesthetic induction: a very rare side effect, case report]

BACKGROUND AND OBJECTIVES

Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction with etomidate administration.

CASE REPORT

A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.

CONCLUSION

In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature.

Comparison of surgical procedures and percutaneous drainage in the treatment of liver hydatide cysts: a retrospective study in an endemic area

INTRODUCTION

Surgical procedures are still the golden standard option in the treatment of liver cystic echinococcosis. However, minimal invasive technics like percutaneous drainage are rising trends. We aimed to compare the efficacy of surgical and percutaneous options in the treatment of liver hydatidosis in an endemic area.

METHODS

Patients who underwent surgical or percutaneous procedures for hydatid disease between January 2007 and December 2012 were retrospectively evaluated. Recurrence rates, hospital stay time, and related factors were analyzed.

RESULTS

There were 44 (35.5%) male and 80 (64.5%) female patients in this study. Eighty two patients (Group I) had undergone surgery (66.1%) and 42 patients (Group II) had undergone percutaneous drainage (33.9%). The mean cyst size was 7.28 ± 2.51 cm in Group I and 8.76 ± 3.30 cm in Group II. Nine recurrences (7.3%) were detected during study. Five of the recurrences were in Group II (11.9%) and four (4.9%) of them were in Group I. The mean length of hospital stay of all patients was 5.42 ± 3.16 days.

DISCUSSION

Percutaneous drainage techniques can be a good alternative to surgery in selected patients. In complicated cases like cystobiliary fistula, surgery is superior to percutaneous approaches. The hospital stay time, recurrence rate and postoperative complications were not enhanced when compared to percutaneous treatment in our study. Despite all controversy about the low morbidity after percutaneous treatment, surgical approach is still a preferable option in patients with liver hydatidosis when it is performed by experienced surgeons.

Cholethorax (bilious effusion in the thorax): an unusual complication of laparoscopic cholecystectomy

Cholethorax or bilious effusion in the thorax, is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. In this article, we present a case of cholethorax as a complication of laparoscopic cholecystectomy (LC). The patient underwent a LC due to the presence of a gallbladder polyp. The clip attached to the Hartman opened, and the abdominal cavity became contaminated with biliary fluid. Postoperatively, the patient experienced severe right upper quadrant pain and dyspnea. Both the posteroanterior (PA) chest radiography and thoracic computed tomography (CT) were remarkable for marked effusion in the right hemithorax. The patient underwent thoracentesis which resulted in the removal of 250 cc bilious pleural effusion. The bilirubin level of the pleural fluid was 9.1 mg/dL. Following thoracentesis, the patient experienced significant improvement in dyspnea and pain. The patient was discharged without any complications on the seventh day postoperatively. Cholethorax may occur as a result of diaphragmatic injuries secondary to a laparoscopic instrument and can be successfully treated by a thoracenftesis.

Thyroid hemiagenesis, ectopic submandibular thyroid tissue, and apparent persistent subclinical thyrotoxicosis

BACKGROUND

Ectopic thyroid tissue (ETT) is a rare embryological abnormality characterized by the occurrence of thyroid tissue in a site other than its usual location. Thyroid hemiagenesis (HA) is also a very rare abnormality in which one thyroid lobe does not develop properly during embryology. We report a patient with left HA, submandibular ETT, and persistent mildly suppressed serum thyrotropin (TSH).

PATIENT

A 38-year-old female patient was admitted with complaints of sweating and palpitations. She had no symptoms of neck compression. Thyroid ultrasonography revealed heterogeneity and hypoechogenicity of the right lobe and absence of the left lobe, the latter being confirmed by computed tomography. There was no ETT in the neck. A thyroid Tc-99m pertechnetate scan demonstrated two distinct areas of radiotracer uptake, one in the right lobe of the thyroid gland and one in the right submandibular region and lobe, but no uptake in the left thyroid bed. The serum free triiodothyronine was 2.89 pg/mL (2.5-3.9 pg/mL), and the serum free thyroxine was 0.86 ng/dL (0.61-1.12 ng/mL). The serum TSH was 0.11 mIU/L (0.34-5.60 mIU/L).

CONCLUSIONS

This may be the first reported patient with HA and submandibular ETT. The patient probably also had thyroiditis with mild intermittent thyrotoxicosis based on her suppressed TSH and ultrasonography imaging of the right thyroid lobe.

The effect of diosmin on pancreatic injury induced by hepatic ischemia reperfusion in rats

PURPOSE

This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure.

METHODS

The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist.

RESULTS

No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess.

CONCLUSIONS

Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17).

Effects of diosmine-hesperidine on experimental colonic anastomosis

AIM

Our goal was to determine the effects of a diosmine-hesperidine combination on wound healing in a rat model of colonic anastomosis.

MATERIALS AND METHODS

In this study, 20 Wistar Albino female rats were randomized into four experimental groups containing five rats in each group. A segment of 1 cm of colon was excised 4 cm proximally to the peritoneal reflection in all rats without carrying out any mechanical or antibacterial bowel preparation. Colonic anastomosis was performed with interrupted, inverting sutures of 6/0 polypropylene. Beginning from the first postoperative day, the rats in Groups II and IV received 100 mg/kg per day of diosmine-hesperidine via orogastic route by 4F fine feeding catheter.

RESULTS

A significant difference was detected between groups in terms of their hydroxyproline levels (p<0.05); the hydroxyproline level of Group I was significantly lower than that of the other groups while no significant difference was noted between Groups II and III.

CONCLUSION

The administration of diosmine-hesperidine increased the amount of collagen and bursting pressures at the anastomotic site and thus had favorable influences on the healing of colonic anastomosis (Tab. 1, Fig. 3, Ref. 33).

Differences in hepatitis A seroprevalence among geographical regions in Turkey: a need for regional vaccination recommendations

Hepatitis A is a worldwide vaccine-preventable infection. Recommendation of vaccination depends on the endemicity of the disease. The World Health Organization recommends universal hepatitis A vaccination in intermediate areas; however, there is no need of mass vaccination in high and low endemicity regions. Therefore, most of the countries are using a vaccination policy according to the endemicity characteristic representing the whole of the country. The endemicity of this infection varies due to sanitary and hygiene conditions and socioeconomic differences among the countries and in various regions of the same country. A sample of 1173 persons between the age of 0 and 91 years from nine randomly selected medical centres from five different geographical centres of Turkey were tested for the level of anti-hepatitis A virus (anti-HAV) immunoglobulin-G antibodies using an enzyme-linked immunosorbent assay. The overall prevalence of anti-HAV antibodies was 64.4% (1142/1173). While the rate of sero-positivity was over 80% in the 5-9 age group and more than 90% after 14 years of age in south-eastern and eastern regions, it was lower than 50% at the age of 5-9 years in central and western regions and remains under 80% in those areas. We conclude that the differences observed in HAV sero-positivity among various geographical regions in Turkey support a universal HAV immunization policy for children currently living in regions of intermediate endemicity.

Effect of Povidone-Iodine Liposome Hydrogel on Colonic Anastomosis

BACKGROUND

To evaluate the effect of povidone-iodine liposome hydrogel on colonic anastomosis.

METHODS

70 Wistar-Albino male rats were randomly divided into seven groups. The left colon was transected and end-to-end anastomosis was performed. PVP-I liposome hydrogel was applied around the anastomoses in groups 2 and 5. Colonic bursting pressures and tissue hydroxyproline contents were measured on postoperative days 3 and 7.

RESULTS

PVP-I application did not cause any difference in the bursting pressures on postoperative day 3, but anastomotic strength was significantly increased by the use of PVP-I on postoperative day 7. The use of PVP-I liposome hydrogel had no effect on the level of perianastomotic hydroxyproline on postoperative day 3 but had positive effects on postoperativeday 7.

CONCLUSIONS

We concluded that the beneficial effects of PVP-I liposome hydrogel might be due to the combination of broad-spectrum antimicrobial activity of PVP-I with the drug delivery properties and moisturizing molecular film effects of the liposome hydrogel.

Effects of various enteral nutrition solutions on bacterial translocation and intestinal morphology during the postoperative period

Bacterial translocation is the passage of bacteria or endotoxins from the gastrointestinal tract to extraintestinal sites, such as mesenteric lymph nodes, liver, spleen, and bloodstream. In this study, the investigators examined the effects of various enteral nutrients on bacterial translocation and intestinal morphology during the postoperative period. Sixty rats were randomly divided into 5 groups, each of which included 12 animals; cecal mobilization was performed in all groups. Group I rats were fed rat chow and water; group II was given standard enteral nutrients; group III, high-energy enteral nutrients; group IV, enteral nutrients supplemented with fiber; and group V, immunonutrients. Bacterial translocation was detected in mesenteric lymph nodes, spleen, liver, and blood cultures. Changes in the terminal ileum were scored from 0 to 4 with the morphologic scoring system. Bacterial translocation was predominantly detected in mesenteric lymph nodes. Rats fed immunonutrients (group V) showed a significant reduction in bacterial translocation compared with other groups. Although minor morphologic alterations in the villi were observed in groups IV and V, the histologic scores of these groups were not statistically different from the scores of control group members. In the present study, investigators evaluated the effects of various enteral nutritional solutions on bacterial translocation and intestinal morphology during the postoperative period. Enteral diets supplemented with arginine, nucleotides, and omega-3 fatty acids were found to reduce bacterial translocation. The investigators concluded that this effect might be related to improvement in immune function resulting from the use of immunonutrients.

The Rett syndrome. A case report

A rare case of a 40 month old girl has been diagnosed clinically to be that of the Rett syndrome, i.e. demonstrating regression in the development, repetitive handwringing movements and inability to speak. There were no specific laboratory findings.