Synthesis of boronic ester γ‐lactam building blocks

Saturated heterocycles are found widely in biologically active compounds such as medicinal drugs and agrochemicals. However, boronic acid‐derived building blocks for these structures have limited availability, particularly in comparison to heteroaromatic boronic acids. We report the preparation of boronic ester γ‐lactams through a Cu‐catalysed conjugate borylation‐cyclisation protocol. Using a chiral catalyst, this can be performed in high enantioselectivity. Exploration of the further transformations of these reagents suggest that the boronic esters have much potential as chemical building blocks

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Effects of carotid artery repair following neonatal extracorporeal membrane oxygenation

Between 1 June 1991 and 30 June 1996, 62 neonates were placed on extracorporeal membrane oxygenation (ECMO). In 61 the right carotid artery was cannulated. At the time of decannulation, a decision was made regarding carotid artery repair (CAR) based on the condition of the vessel. Thirty-two patients underwent end-to-end CAR and 29 had artery ligation. There was no difference between groups in gestational age or birth weight, but the ligation group contained 11 patients with congenital diaphragmatic hernia, compared to 2 in the repair group. The time on ECMO was 148 h for the repair group and 297 h in the ligation group. Follow-up contrast-enhanced magnetic resonance imaging (MRI) studies and ultrasound (US) demonstrated 2 occluded vessels in the repair group (7%); 3 vessels appeared stenotic on MRI. Follow-up neurologic examination was normal or near-normal in 17 of 19 repair infants and 9 of 16 ligation patients. Two repair infants had slight delays in development, while 3 ligation patients had significant delays. Follow-up US showed 3 grade I changes in the repair group with 1 hydrocephalus. There was 1 grade I and 1 grade III change in the ligation group. Follow-up MRI showed 6 minimal changes in the repair group and 9 in the ligation group. CAR does not adversely affect neurologic outcome after neonatal ECMO. The early patency rate was 93%, although 12% of the vessels appeared stenotic. Long-term follow-up confirmed persistent patency. CAR, if technically feasible, should be encouraged following neonatal ECMO therapy