The clinical and cost effectiveness of surgical repair of partial rotator cuff tears in patients with subacromial shoulder pain: a comparison of surgical repair versus surgery with no repair. Partial Rotator Cuff Repair Trial (PRoCuRe Trial)

Aims and objectives: To assess if surgical repair of partial rotator cuff tears is effective in patients with persistent shoulder pain despite physiotherapy and steroid injection. Background: Rotator cuff tears are shoulder tendon tears causing pain, weakness and loss of movement, leading to problems with daily activities, work, recreation and sleep. Tears can be full thickness (whole tendon) or partial. Patients who do not get better with non-operative treatments may choose surgery. Although rotator cuff tears cause pain and disability, it is not known which surgery is best or if repairing partial tears prevents full tears and worsening problems. Methods: We planned a randomised controlled trial across 20 UK NHS hospitals . Between July 2021 and August 2022 we aimed to recruit 376 patients over 18 years of age suffering persistent shoulder pain and partial rotator cuff tears . Eligible patients received arthroscopic (keyhole) surgery to either debride (shave away inflamed tissue, rough tear edges and bone spurs) and repair the tear, or debride only without repair. Patients were followed up using questionnaires. Key findings: This study of an elective surgical procedure was severely impacted by the COVID-19 pandemic, especially staff shortages, sickness and redeployment. Changes post pandemic to the patient pathway and national surgical prioritisation processes had a major impact on identifying eligible patients with partial tears. All these factors effected site set-up and patient recruitment. The study closed early due to slow recruitment. Only 10 patients from 9 NHS Trusts were randomised, precluding any meaningful analysis . Patient and public involvement: Patients were involved in the study design, set up and monitoring. Conclusions and future plans: The impact of the pandemic prevented trial progression and this research question is now likely to remain unanswered. Detailed post-pandemic feasibility work is needed before attempting a similar study

A short, stereodivergent synthesis of the racemic erythro and threo diastereomers of 6-acetoxy-5-hexadecanolide, a mosquito oviposition attractant pheromone

A versatile 3-step synthesis of the title lactones has been accomplished by the stereocontrolled addition of n-decylmetallic reagents to acrolein dimer. Stereocontrol of the first step enables selective synthesis of either diastereomeric lactone

Regioselective aldol condensations of boron and tin furanolates with aldehydes: an improved synthesis of 2-(1′-hydroxyalkyl)butenolides

Boron and tin(II) 2-furanolates generated in situ from 2-(5H)-furanone and α-angelica lactone undergo regioselective aldolization with aldehydes to furnish the corresponding 2-(1′-hydroxyalkyl)butenolides in good yields; a new formal synthesis of (±)-litsenolide C1 and (±)-dihydromahubanolide is described.</p

Total synthesis of bromobeckerelide

The first synthesis of (±)-bromobeckerelide has been accomplished in five steps from 5-methylfurfural by exploiting the regiospecific aldolization of a dialkylboron 2-furanolate

Diastereoselectivity in the directed aldol condensation of 2-trimethylsiloxyfuran with aldehydes. A stereodivergent route to <i>threo</i> and <i>erythro</i> δ-hydroxy-γ-lactones

Threo and erythro-δ-hydroxy-α,β-unsaturated γ-lactones are obtained with useful diastereoselection by condensing 2-trimethylsiloxyfuran and aldehydes by varying the reaction reaction conditions. A stereomechanistic rationale is presented together with a practical two-step synthesis of the threo and erythro 5-hydroxy-4-decanolides (L factors)

Structure of Synthetic Bromobeckerelide: a Case of Diastereomeric Selection in the Solid State

4-Bromo-5-hydroxy-3-(1-hydroxybutyl)-5- methyl-5H-furan-2-0ne, C₉H₁₃BrO₄, recrystallized from CH₂Cl₂/hexane, m.p. 359-360 K, Mr = 265.1, triclinic, P1, a=5.9067 (4), b=9.4807 (9), c=11.0895(11)Å, α=74.16(1), β=79.96(1), γ=71.87 (1) °, V=565.1 (1)ų, Z=2, F(000)=268, Dx=1.56 Mg m⁻³, λ(Mo Kα)=0.71069 Å, μ=3.59mm⁻¹, room temperature, R=0.044 [wR=0.043, w = l/σ²(F₀)] for 1273 observed reflections [|Fo| > 4σ(F₀)]. In the solid state, which is different from the situation in solution, only the diastereomer having the like configuration is observed. Molecules of the same configuration are linked by hydrogen bonds involving both hydroxyl groups of the same molecule

New methodology for the synthesis of biologically active lactones

New, regio- and diastereoselective processes are described in which readily accessible starting materials such as acrolein dimer and 2-trimethylsiloxyfuran are efficiently transformed into appropriately functionalized δ- and γ-lactones. Pertinent examples are provided by the syntheses of the mosquito oviposition attractant pheromone, cavernosine, epicarvernosine, eldanolide, L-factors, the "whisky" lactones, as well as other structurally related natural products

The synthesis of (±)-cavernosine

The title compound and its epimer were synthesized in three and two steps from dihydro-β-ionone and 2-trimethylsiloxyfuran in 38 and 63% overall yields respectively. Their relative configurations were confirmed by X-ray of an intermediate.</p

Intramolecular Oxygen Transfer on the Ozonolysis of a Diphenylcyclopentene Derivative

The ozonolysis of cis-3,4a,7,7a-tetrahydro-3,3-dimethyl-6,7a-diphenylcyclopenta[1,2,4]trioxine (1) in CH2Cl2 at −78° gave the secondary endo ozonide 2 (43% yield) and an acetal 3 (27% yield) derived from O-insertion at the ortho position of the C(7a) phenyl substituent. Both structures were elucidated by X-ray. Repetition of the ozonolysis in MeOH/CH2Cl220:3 at −78° also gave the same two products in 12 and 15% yields, repectively, together with the hemiperacetal 4 (54% yield) formally derived from the secondary ozonide by addition of MeOH.</p