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Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

A new type of cyclic amino-functionalized s-cis boroxyvinylcarbene complex of group 6 metals has been synthesized. These complexes underwent Diels−Alder-type reactions with 2-amino 1,3-dienes that proceeded with complete regioselectivity and high exo or endo diastereoselectivity, which was found to be highly dependent on the nature of the substituents on the diene. When chiral 2-amino-5-alkoxy dienes derived from (S)-prolinol benzyl or methyl ether were used, an exclusive exo and highly diastereofacially selective [4 + 2] cycloaddition was achieved, affording spiro carbene complexes with three contiguous stereogenic centers and a high level of enantiomeric purity. Removal of the Cr(CO)5 fragment and the BF2 group provided an entry to α,α-branched β-amino aldehydes or β-amino acids. In addition, the stable form of an amino-substituted hydroxycarbene complex of chromium was characterized by X-ray diffraction.

Treatment of secondary aliphatic 2-bromoallylamines with an excess of an organolithium compound led to saturated amines in which the organic group of the organolithium compound is incorporated at the alpha carbon. On the other hand, the successive reaction of the former amines with BuLi and t-BuLi between -80 degrees C and rt gave 1,3-diamines or hexahydropyrimidines depending on the reaction time. The formation of these unexpected products involves initial generation of lithium propargylamides, which subsequently undergo cleavage of the C propargylic-C acetylenic bond induced by the organolithium present in each case in the reaction medium. A mechanism which takes into account all the different reaction products has been proposed and additionally supported by successful trapping of dilithium acetylide.

β-Nitrogen-functionalized vinylic organolithium compounds derived from secondary aliphatic allylamines have been found to undergo upon heating (reflux of THF) either a dimerization or a regio- and stereoselective cyclodimerization reaction affording diamino 1,4-dienes or cis-2,3-disubstituted 4-methylenepyrrolidines, respectively, according to reaction time. In contrast, the corresponding dianions derived from aromatic allylamines underwent protonation by the solvent under analogous thermal treatment. A mechanism accounting for all these results has been proposed, which involves a spontaneous β-elimination of lithium hydride and an intramolecular nucleophilic cyclization by addition of a lithium amide to an alkene group as critical steps. In addition, experimental evidence is provided about the formation of 3-lithio-1-aza 1,3-dienes as intermediates in these unusual thermal transformations.

A new type of cyclic amino-functionalized s-cis boroxyvinylcarbene complex of group 6 metals has been synthesized. These complexes underwent Diels−Alder-type reactions with 2-amino 1,3-dienes that proceeded with complete regioselectivity and high exo or endo diastereoselectivity, which was found to be highly dependent on the nature of the substituents on the diene. When chiral 2-amino-5-alkoxy dienes derived from (S)-prolinol benzyl or methyl ether were used, an exclusive exo and highly diastereofacially selective [4 + 2] cycloaddition was achieved, affording spiro carbene complexes with three contiguous stereogenic centers and a high level of enantiomeric purity. Removal of the Cr(CO)5 fragment and the BF2 group provided an entry to α,α-branched β-amino aldehydes or β-amino acids. In addition, the stable form of an amino-substituted hydroxycarbene complex of chromium was characterized by X-ray diffraction.

El carcinoma epidermoide primario de mama es una entidad muy poco frecuente. Típicamente se presenta como un tumor cístico en la mama de gran tamaño y evolución rápida. (También se caracteriza por diseminación a distancia y escasa afectación metastásica en ganglios). En la mayoría de los casos, los receptores hormonales son negativos y los hallazgos radiológicos son inespecíficos. Los tratamientos descritos en la literatura consisten en la combinación de cirugía, quimioterapia y radioterapia.

El meningioma primario de la vaina del nervio óptico es un tumor raro, cuyo manejo diagnóstico y terapéutico ha variado de manera sustancial en los últimos años. La aparición y desarrollo de las técnicas de diagnóstico por imagen, como son la Tomografía Computerizada de Alta Resolución y la Resonancia Magnética Nuclear, han permitido diagnósticos más precoces y precisos. La introducción de la Radioterapia Convencional (RT) a finales de los años 70, sola o en combinación con la cirugía, pero sobre todo la introducción de la Radioterapia Extereotáxica Fraccionada (RTEF) y la Radioterapia Conformacional Tridimensional (RTC3D), ha supuesto una alternativa terapéutica sumamente eficaz y con una toxicidad relativamente baja. En este artículo revisamos en primer lugar el desarrollo embriológico, anatomía, la historia natural, el tratamiento quirúrgico, así como el papel de la RT en esta entidad, y su integración en el patrón de cuidados actual. Analizamos las diferentes técnicas radioterápicas desde las más elementales como la Radioterapia Convencional (RT), siguiendo con la Radioterapia Conformada 3 D (RTC3D), hasta las más sofisticadas como la Radioterapia Exterotáxica Fraccionada (RTEF), todo ello a propósito de nuestra experiencia en un caso.

To analyze the 15-year results of external irradiation combined with radioactive gold grain implantation (Au198) in the treatment of adenocarcinoma of the prostate and to discuss the therapeutic perspectives.The present study was conducted on 23 patients with localized prostate carcinoma (17 stage B; 6 stage C) that had been diagnosed and treated at our department from February 1981 to October 1986. The mean patient follow-up was 90.96 months. Au198 implantation (mean dose 3347.6 cGy) was performed through the abdominal approach prior to external irradiation (mean dose 39 Gy) with Co-60 (19 patients) or the 18-MV photon linear accelerator (4 patients). The mean fractionated dose was 180.43 cGy/day.Overall the 15-year locoregional control rate was 61% and disease-free survival was 38%. The overall survival rate was 25%, regardless of the cause of death. The tumor control rate was 61% for stage B and 83% for stage C lesions at 15 years. The disease-free survival rate was 40% for stage B and 50% for stage C tumors. The local control and disease-free survival rates were worse for patients in whom the diagnosis had been made by TUR (p = not significant).The locoregional tumor control and disease-free survival rates for this group of 23 patients who received combined therapy with external irradiation and radioactive gold grain implantation (Au198) were slightly lower than those obtained in another group of 104 patients treated at our Service of Radiotherapeutic Oncology with radical external radiation therapy and can be ascribed mainly to poor patient selection and inadequate radiation dose.

External irradiation is an accepted curative treatment modality for patients with localized prostatic tumor. The 15-year results in patients treated by radical irradiation alone are presented. The determinant prognostic factors for local tumor control and disease free survival are analyzed.135 patients with a histologically confirmed localized carcinoma of the prostate were treated at our department from May 1972 to January 1998. Fifty patients received Co-60 therapy; the linear accelerator and high energy photons were utilized in the remaining 80 patients. By tumor stage, 53 patients were B1, 49 B2 and 33 C. The mean follow-up was 61 months (range 1-180). Most patients were exposed to localized fields of irradiation; dose ranged from 50-74 Gy, fractionated at a dose of 180-200 cGy/day.Overall local tumor control was 77% at 5 years and 73% at 15 years, with a disease free survival of 63% and 45% at 5 and 15 years, respectively. Local tumor control at 13 years was 71% for stage B1, 82% for B2 and 70% for C. The disease free survival at 13 years for stages B1, B2 and C were 46%, 49% and 36%, respectively. The BD and MD tumors had a 15-year disease free survival of 48% vs 32% for the PD tumors (p = 0.005). Patients with PSAor = 20 ng/ml before treatment showed a disease free survival of 87% vs 48% for those with PSA20 ng/ml ((p = 0.011). Multivariate analysis showed dose to be a determinant prognostic factor for local tumor control (0.0432); dose and histological grade were determinants for disease free survival (p = 0.029 and 0.033).This retrospective study found dose to be a determinant prognostic factor for local tumor control and both dose and histological grade were determinants for disease free survival. Radiotherapy is a therapeutic option for these patients. The results can be enhanced if the dose delivered to the prostate can be increased while maintaining the complication rate within the same ranges.

Treatment of secondary aliphatic 2-bromoallylamines with an excess of an organolithium compound led to saturated amines in which the organic group of the organolithium compound is incorporated at the alpha carbon. On the other hand, the successive reaction of the former amines with BuLi and t-BuLi between -80 degrees C and rt gave 1,3-diamines or hexahydropyrimidines depending on the reaction time. The formation of these unexpected products involves initial generation of lithium propargylamides, which subsequently undergo cleavage of the C propargylic-C acetylenic bond induced by the organolithium present in each case in the reaction medium. A mechanism which takes into account all the different reaction products has been proposed and additionally supported by successful trapping of dilithium acetylide.

beta-Nitrogen-functionalized vinylic organolithium compounds derived from secondary aliphatic allylamines have been found to undergo upon heating (reflux of THF) either a dimerization or a regio- and stereoselective cyclodimerization reaction affording diamino 1,4-dienes or cis-2,3-disubstituted 4-methylenepyrrolidines, respectively, according to reaction time. In contrast, the corresponding dianions derived from aromatic allylamines underwent protonation by the solvent under analogous thermal treatment. A mechanism accounting for all these results has been proposed, which involves a spontaneous beta-elimination of lithium hydride and an intramolecular nucleophilic cyclization by addition of a lithium amide to an alkene group as critical steps. In addition, experimental evidence is provided about the formation of 3-lithio-1-aza 1,3-dienes as intermediates in these unusual thermal transformations.