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Al Masri A, Schiffner U, Mourad MS, Schmoeckel J, Joseph P, Splieth CH. The impact of bias of underlying literature in guidelines on its recommendations: assessment of the German fluoride guideline. Eur Arch Paediatr Dent 2024; 25:65-73. [PMID: 38007707 PMCID: PMC10942900 DOI: 10.1007/s40368-023-00854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/20/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE The significance of the underlying literature in clinical guidelines can be weakened by the risk of bias, which could negatively affect the recommendations. Especially in controversial matters, such as fluoride use for caries prevention in children, biased results may be not reliable and lead to incorrect conclusions. This study was performed to detect bias in underlying literature of the German guideline for caries prevention using fluoride in children, where no consensus was reached between paediatricians and paediatric dentists. METHODS Three tools used for risk of bias assessments of different study designs were RoB 2 for RCTs, ROBINS-I for non-randomized studies, and ROBIS for systematic reviews. For each study cited in the guideline two independent risk of bias assessments were performed. Disagreements were resolved by consensus. RESULTS Out of 58 papers, 48.3% (n = 28) showed high risk of bias, with the majority in sections regarding fluoride tablets, fluoridated toothpaste, and paediatricians' recommendations. 9 out of 20 recommendations and statements were based on studies with high risk of bias, all of which were in these three controversial sections. 13 out of 29 RCTs showed high risk of bias (44.8%), as all 13 non-randomized trials did, while only 2 of 16 (12.5%) systematic reviews had high risk of bias. CONCLUSION Considering risk of bias of cited studies in clinical guidelines may result in substantial changes in its recommendations and aid in reaching consensus. Efforts should be made to assess risk of bias of underlying literature in future clinical guidelines.
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Affiliation(s)
- A Al Masri
- Department of Preventive and Pediatric Dentistry, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany.
| | - U Schiffner
- Department for Periodontology, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - M S Mourad
- Department of Preventive and Pediatric Dentistry, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany
- Department of Orthodontics, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany
| | - J Schmoeckel
- Department of Preventive and Pediatric Dentistry, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany
| | - P Joseph
- Department of Preventive and Pediatric Dentistry, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany
| | - C H Splieth
- Department of Preventive and Pediatric Dentistry, Greifswald University Dental Clinics, Walther-Rathenau-Straße 42a, 17475, Greifswald, Germany
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Mourad MS, Santamaria RM, Splieth CH, Schwahn C, Midani R, Schmoeckel J. Impact of operators' experience and patients' age on the success of nitrous oxide sedation for dental treatment in children. Eur J Paediatr Dent 2022; 23:183-188. [PMID: 36172911 DOI: 10.23804/ejpd.2022.23.03.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM To evaluate the success rates and potential influencing factors of nitrous oxide sedation for dental treatment in a specialised paediatric dental service. MATERIALS Medical records of all children treated under nitrous oxide sedation in a specialised pedodontics clinic between 2012 and 2017 were analysed retrospectively for parameters such as age of the patient, experience and change of operating dentists, treatment procedure and success or failure regarding the sedation and treatment. CONCLUSION Given the high overall success rate of over 90%, nitrous oxide sedation can be a highly effective treatment option for performing dental treatment in pre-cooperative and/or anxious children and adolescents. With age of the children and experience of the dentist, success rates increased.
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Affiliation(s)
- M S Mourad
- Greifswald University, Greifswald, Germany, Department of Preventive and Pediatric Dentistry, Department of Orthodontics
| | - R M Santamaria
- Greifswald University, Greifswald, Germany, Department of Preventive and Pediatric Dentistry
| | - C H Splieth
- Greifswald University, Greifswald, Germany, Department of Preventive and Pediatric Dentistry
| | - C Schwahn
- Greifswald University, Greifswald, Germany, Department of Prosthetic Dentistry, Gerodontology and Biomaterials
| | - R Midani
- Greifswald University, Greifswald, Germany, Department of Preventive and Pediatric Dentistry
| | - J Schmoeckel
- Greifswald University, Greifswald, Germany, Department of Preventive and Pediatric Dentistry
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Schmoeckel J, Haq J, Samietz S, Santamaría RM, Mourad MS, Völzke H, Kocher T, Splieth CH, Holtfreter B. Ten-year trends in DMF-S and DMF-T in a northeast German adult population. J Dent 2021; 111:103727. [PMID: 34119612 DOI: 10.1016/j.jdent.2021.103727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess 10-year trends in coronal caries in adults aged 20-83 years using data from the two-representative population-based Studies of Health in Pomerania (SHIP-0/SHIP-Trend-0). METHODS Repeated cross-sectional data from 4,286 SHIP-0 and 3,913 SHIP-Trend-0 participants were analysed. Carious, filled and missing teeth/surfaces were recorded in a half-mouth design and the DMF-T/S scores and sound surfaces/teeth were calculated according to WHO criteria. Trends in DMF-T/S scores and its single components were presented stratified by age group and sex. RESULTS A statistically significant decline in coronal caries experience (DMF-T and DMF-S) in adults aged 20 to 83 years as well as for D-T/S components was observed. The proportion of edentulous participants was almost halved from 8.7% (SHIP-0) to 5.1% (SHIP-Trend-0), while the number of M-T declined from 4.4 to 3.5 revealing an overall clear shift to a higher retention rate of teeth. In younger adults (25-34 years) 3.8 more sound teeth (17.2 sound surfaces) were found in average in the mouth and in elderly (65-74 years) a clear shift from extracted to filled teeth was observed (M-T reduced by 5.4, while F-T increased by 4). Regarding sex differences, females had consistently on average higher MF-T/S values, but lower D-T/S values than males. CONCLUSION A clinically relevant drop in the severity of coronal caries experience in all adult age groups in Northeast Germany shows that not only reductions in caries experience in adolescence translated into adulthood but also later improvements led to long-term oral health.
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Affiliation(s)
- J Schmoeckel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.
| | - J Haq
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - S Samietz
- Department of Prosthodontics, Gerostomatology and Biomaterials, Centre for Oral Health, University Medicine Greifswald, Greifswald, Germany
| | - R M Santamaría
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - M S Mourad
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany; Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany
| | - H Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - T Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - C H Splieth
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - B Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Mourad MS, Brendebach J, Alkilzy M, Splieth CH. Choosing a paediatric dentist: Factors influencing parents' decision. Eur J Paediatr Dent 2020; 21:74-79. [PMID: 32183534 DOI: 10.23804/ejpd.2020.21.01.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Choosing a paediatric dentist is an important decision for parents. The mechanisms of this selection have hardly been studied. This study assesses the factors influencing parents' decision choosing a specialised paediatric dentist for their child. MATERIALS AND METHODS A questionnaire consisting of 30 items that could potentially be relevant to decision-making was sent nationwide in Germany to paediatric dentists to be given to the parents of new patients (n=450). Eighty-nine out of 102 returned questionnaires (response rate=22.7%) were evaluated. RESULTS Parent's and children's experience in previous dental visits played an "important" or "very important" role in choosing a paediatric dentist (78.8% and 62.2%, respectively). The most frequently mentioned recommendation for the paediatric dentist was by friends and acquaintances (86.5%). Recommendations from other dentists were often included in the decision making (60.7%), while specialist journals or Internet portals were less important for the respondents (15% and 19%, respectively). Most of the parents used Internet search engines and the practice website to obtain information. CONCLUSION Previous negative experience with general dentists was the main reason for visiting a specialised paediatric dentist. Recommendations came mostly from the close social environment and the qualifications were the most important feature for choosing a paediatric dentist.
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Affiliation(s)
- M S Mourad
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Germany
| | - J Brendebach
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Germany
| | - M Alkilzy
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Germany
| | - C H Splieth
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Germany
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Mourad MS, Vielhauer A, Splieth CH. Kinderzahnheilkunde: 7 Mythen von der Zahnfee. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hashim H, Avery K, Mourad MS, Chamssuddin A, Ghoniem G, Abrams P. The Arabic ICIQ-UI SF: an alternative language version of the English ICIQ-UI SF. Neurourol Urodyn 2006; 25:277-282. [PMID: 16532458 DOI: 10.1002/nau.20212] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Urinary incontinence (UI) is a common and distressing condition. A variety of questionnaires are currently available to assess UI and its impact on patients' lives. However, most have not been adapted for international use. Following a systematic review of the literature and existing questionnaires the International Consultation on Incontinence short form questionnaire (ICIQ-UI SF) was developed, and has since been translated into many languages for local use. This paper reports the development and validation of the first UI questionnaire in the Arabic language. The development of this questionnaire will facilitate the assessment of UI in both clinical practice and research in the Middle-East. METHODS Translation and validation of the Arabic version of the ICIQ-UI is described. Standard methods of translation by native Arabic and English speakers (including translation and back translation) are followed. The psychometric properties of the questionnaire, including its validity, reliability and sensitivity to change, are examined. The validation of the questionnaire involved patients attending urology outpatient clinics in two Middle-Eastern countries. RESULTS The Arabic ICIQ-UI SF was found to be valid, reliable and responsive, indicating that the psychometric properties of the questionnaire have remained constant throughout the adaptation process. Furthermore, the findings of the psychometric testing confirm those found for the UK-English ICIQ-UI SF. CONCLUSIONS The development of this questionnaire will allow the study of Arabic speaking groups with UI in many countries around the world. This may act as an example to initiate the translation and validation of other patient reported outcomes into the Arabic language, thereby enabling more multinational and cross-cultural research into diseases in given areas.
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Affiliation(s)
- H Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - K Avery
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | | | | | | | - P Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
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Affiliation(s)
- F Nouh
- Department of Orthopedic Surgery & Nuclear Medicine, Concord Hospital, Sydney, Australia
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Aboseif S, Tamaddon K, Chalfin S, Freedman S, Mourad MS, Chang JH, Kaptein JS. Sacral neuromodulation in functional urinary retention: an effective way to restore voiding. BJU Int 2002; 90:662-5. [PMID: 12410743 DOI: 10.1046/j.1464-410x.2002.02989.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the long-term efficacy and complications of sacral nerve stimulation as an alternative therapy for functional unobstructive urinary retention, often considered to be psychogenic and effectively treated by clean intermittent catheterization, but for which pelvic floor dysfunction has been recognized as a possible cause. PATIENTS AND METHODS Twenty patients (17 women and three men, mean age 48 years) with idiopathic, unobstructive functional urinary retention and in whom other forms of therapy had failed, had a pulse generator implanted (Medtronic, Minneapolis, MN, USA) and a sacral nerve implant. Their mean duration of symptoms was 68 months; 13 patients had chronic pelvic and perineal pain associated with their obstructive voiding symptoms. All patients were managed with clean intermittent catheterization and pharmacological therapy (alpha-blockers) before the procedure. All patients had a percutaneous nerve evaluation before the permanent implant, which showed> 50% improvement in their symptoms. All patients were evaluated at 1, 6 12, 18 and 24 months, then yearly thereafter. The results were assessed both subjectively by patient's symptoms and objectively by checking the postvoid residual volume (PVR) and voided volume. RESULTS Eighteen patients were able to void spontaneously with a mean increase in voided volume from 48 to 198 mL, and a significant decrease in PVR from 315 to 60 mL. Eighteen of the patients had a > or = 50% improvement in their symptoms and said they would recommend the therapy to a friend or relative. Complications occurred in six patients. CONCLUSION Sacral nerve stimulation is an effective and durable new approach to functional urinary retention, with few associated complications. Test stimulation provides a valuable tool for selecting patients.
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Affiliation(s)
- S Aboseif
- Department of Urology, Southern California Permanente Medical Group, Los Angeles, California, USA.
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Abstract
BACKGROUND Neuromodulation has been used to treat voiding dysfunction caused by spinal cord injury (SCI). However, the underlying mechanism of this technique is not well understood. Recently, vanilloid receptor 1 (VR1) has been recognized as a capsaicin receptor and an agent for noxious stimuli. The purposes of this study were to evaluate whether development of bladder hyperreflexia after SCI involves VR1 upregulation and whether VR1 is involved in the process of neuromodulation. MATERIALS AND METHODS Sprague-Dawley rats (n = 20) were divided into five groups: sham control (n = 4); 3 days after SCI (n = 4); 7 days after SCI (n = 4); 14 days after SCI (n = 4), and 14 days after SCI with neurostimulation (n = 4). Bilateral electrode wires were implanted into S1 dorsal foramina and electrical stimulation was performed 8 h/day for 2 weeks. Spinal segments of L6, S1, and dorsal root ganglia were removed and cut into sections. The intensity of VR1 staining was evaluated by image analysis. RESULTS VR1-positive staining was confined to the superficial dorsal horn of the spinal cord. The staining was weak in the sham group (1/luminosity: 0.0050 +/- 0.0006), but the staining intensity was significantly increased in three SCI groups (3 days, 7 days, and 14 days) when compared with that in the sham group (P < 0.05). After neuromodulation, the staining intensity was reduced. CONCLUSIONS VR1 expression in the spinal cord is up-regulated after SCI. Sacral nerve root stimulation can down-regulate the VR1 expression.
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Affiliation(s)
- Yuan Zhou
- Division of Urology, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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Chien GW, Tawadroas M, Kaptein JS, Mourad MS, Tebyani N, Aboseif SR. Surgical treatment for stress urinary incontinence with urethral hypermobility: what is the best approach? World J Urol 2002; 20:234-9. [PMID: 12215853 DOI: 10.1007/s00345-002-0262-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A comparative study evaluating the results of three surgical procedures for stress urinary incontinence (SUI) with urethral hypermobility. This is a retrospective study of 189 patients, evaluating the outcomes of the percutaneous needle suspension using bone anchors (PNS), abdominal suspension (AS), and pubovaginal sling (PVS). The mean follow-up was 30.5 months. In our results, the patients were divided into three groups: PNS (49), AS (34), and PVS (106). No differences were found preoperatively. Intraoperatively, PNS had the shortest operative time and lowest estimated blood loss, and it is the only outpatient procedure. However, it had the highest complication rate. PNS had the lowest satisfactory rate (16.7%). This was followed by AS (78%), PVS with cadaveric fascia (90%), and PVS with autologous fascia (94%). In conclusion, PNS is a simple outpatient procedure, but the long-term results are disappointing. Both AS and PVS gave good results. PVS was superior to AS in shorter hospitalization, early recovery and overall patient satisfaction.
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Affiliation(s)
- G W Chien
- Department of Urology, Kaiser Permanente Medical Center, 4900 Sunset Boulevard, 2nd Floor, Los Angeles, CA 90027, USA
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Abstract
OBJECTIVE To evaluate the effect of sacral neuromodulation on interstitial cystitis (IC) and determine the underlying mechanism of neuromodulation in the treatment of IC. Materials and methods Twenty Sprague-Dawley rats (body weight 220-250 g) were randomly divided into four equal groups; normal controls, a sham treatment (IC induced by 0.4 mol/L HCl, + saline), a second sham treatment (HCl-induced IC + acetic acid) and a stimulated group (HCl-induced IC + acetic acid, with electrical stimulation). In the last group bilateral electrodes were implanted into the S1 dorsal foramina and electrical stimulation applied for 8 h/day for 3 weeks. Acetic acid was instilled into the bladder to induce c-fos expression. After 3 weeks the rats were perfused with 4% paraformaldehyde, spinal segments dissected out and an immunocytochemical method used to stain the segments for fos protein encoded byc-fos. RESULTS The mean (SEM) micturition frequency (voids/17 h) in the sham groups increased from 10.8 (2.7) to 23.4 (3.4) 3 weeks after the intravesical instillation of HCl. The micturition frequency in the stimulated group, at 16.2 (2.7), was significantly less than in the sham group (P = 0.04) after electrical stimulation for 3 weeks. There was no significant difference in the mean (SEM) number of fos-positive neurones in the L6 spinal cord segment between the stimulated and the sham + acetic acid group, at 43.6 (9.4) and 35.8 (7.8) cells/section, respectively (P = 0.32). CONCLUSIONS In rats with HCl-induced cystitis, electrical stimulation reduced the micturition frequency, but not by inhibiting afferent c-fibre activity.
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Affiliation(s)
- Y Wang
- Urology Research Laboratory, Division of Urology, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Mourad MS. Inverted Y ureteral duplication with a large ureterocele and draining a bifid renal pelvis in a man. J Urol 1997; 157:1353. [PMID: 9120941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M S Mourad
- Department of Urology, Ain Shams University, Cairo, Egypt
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Courtois A, Protas J, Mourad MS, Caubère P. Le p-bromobenzoate du cis tert-butyl-10 tricyclo[6.4.0.0 2,7]dodecatriène-2,4,6 ol-1. Acta Crystallogr Sect B 1977. [DOI: 10.1107/s0567740877003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Courtois A, Protas J, Mourad MS, Caubère P. Structure cristalline du benzosulfonyluréthane du diméthyl-8,l2 tricyclo[6,4,0,02,7]dodécatriène-2,4,6 ol-1. Revision d'une stéréochimie précédemment annoncée. ACTA ACUST UNITED AC 1975. [DOI: 10.1107/s0567740875006450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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