Letteratura scientifica selezionata sul tema "346.9 346.9403 23"

Although sexual behavior is multidimensional, little research has focused on the experience of nonintercourse behaviors for adolescents and emerging adults. This article uses open-ended coded data from a longitudinal study of college students ( N = 346; M age = 18.5, 52% female, 27% Hispanic/Latino [HL], 25% non-HL European American, 23% non-HL Asian American, 16% non-HL African American, 9% non-HL multiracial) to examine what emotional responses emerging adults report about their first experiences of six sexual behaviors. The four most common emotional reactions were happy, excited, fearful, and indifferent. Descriptions were largely positive, although mixed reactions were relatively common and emotional reactions varied by behavior. Results suggest the importance of including multiple types of sexual behaviors, as well as their possible positive and negative outcomes, in sexuality education programs.

Phosphatonin fibroblast growth factor-23 (FGF-23) is involved in phosphate (P) excretion and vitamin D metabolism. Recently, FGF-23 has been suggested to be responsible for the hypophosphatemia and inappropriately low calcitriol levels observed after renal transplantation. We performed a prospective study to investigate FGF-23 levels in patients with end-stage renal disease before and after renal transplantation and their probable association with markers of bone and mineral metabolism. Intact FGF-23 levels were determined before and at 3, 6, and 12 months posttransplantation in 18 renal transplant recipients. Intact parathyroid hormone (iPTH), calcium (Ca), P, 25(OH)VitD, and 1,25VitD levels were measured at the same time periods. Renal threshold phosphate concentration (/GFR) was also calculated at 3, 6, and 12 months posttransplantation. The results showed that FGF-23 levels decreased by 89% 3 months posttransplantation (346 146 versus 37 9 pg/mL, ) and remained stable throughout the study period. iPTH and P levels also decreased significantly after renal transplantation, while Ca and 1,25VitD increased. Pretransplantation FGF-23 was significantly correlated with P levels at 3 months posttransplantation (). In conclusion, FGF-23 levels decrease dramatically after successful renal transplantation. Pre-transplantation FGF-23 correlate with P levels 3 months posttransplantation.

Global cannabis use has risen 23% since 2010, with 209 million reported users, most of whom are males of reproductive age. Delta-9-tetrahydrocannabinol (THC), the main psychoactive phytocannabinoid in cannabis, disrupts pro-homeostatic functions of the endocannabinoid system (ECS) within the male reproductive system. The ECS is highly involved in regulating morpho-functional and intrinsic sperm features that are required for fertilization and pre-implantation embryo development. Previous work by our group demonstrated that THC altered sperm capacitation and the transcriptome, including several fertility-associated microRNAs (miRs). Despite the prevalent use of cannabis among males of reproductive age, clinical and pre-clinical research investigating the impact of paternal cannabis on sperm function and the outcomes of artificial reproductive technologies (ARTs) remains inconclusive. Therefore, the present study investigates the impact of in vitro THC exposure on morpho-functional and intrinsic sperm functions, including contributions to embryo development following IVF. Bovine sperm were used as a translational model for human and treated with concentrations of THC that reflect plasma levels after therapeutic (0.032μM), and low (0.32μM)-high (4.8μM) recreational cannabis use. After 6-hours of treatment, THC did not alter the acrosomal reaction, but 4.8μM significantly reduced mitochondrial membrane potential (MMP) (p<0.05), primarily through agonistic interactions with CB-receptors. Fertilization of bovine oocytes with THC-treated sperm did not alter developmental rates, but blastocysts generated from sperm treated with 0.32–4.8μM THC had fewer trophoblasts (p<0.05), while blastocysts generated from sperm exposed to any concentration of THC had fewer cells in the inner cell mass (ICM), particularly within the 0.032μM group (p<0.001). Fertility associated miRs, including miR-346, miR-324, miR-33b, and miR-34c were analyzed in THC-exposed sperm and associated blastocysts generated by IVF, with lower levels of miRs-346, -324, and -33b found in sperm treated with 0.32μM THC, while miR-34c levels were higher in sperm treated with 0.032μM THC (p<0.05). Levels of miR-346 were also lower in sperm treated with 0.032μM THC, but higher in blastocysts generated from sperm exposed to 0.32μM THC (p<0.05). Our findings suggest that THC may alter key morpho-functional and epigenetic sperm factors involved in fertilization and embryo development. This is the first study to demonstrate that sperm exposed to THC in vitro negatively affects embryo quality following IVF.

Background:The gastrointestinal (GI) tract is frequently involved in systemic sclerosis (SSc). The University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) is validated to capture GI morbidity in patients with SSc (1). The routine clinical investigation of GI involvement in these patients is not standardized and there is no consensus about when and how frequently an esophagogastroduodenoscopy (EGD) should be performed.Objectives:The main aim of this study was to analyze the capacity of UCLA GIT 2.0 to identify patients with erosive esophagitis in an unselected, real-life SSc patients’ cohort. Secondary aim was to determine whether the UCLA GIT 2.0 could discriminate SSc patients for whom an expert rheumatologist would recommend an EGD.Methods:We selected patients fulfilling the ACR/EULAR 2013 criteria for SSc from the Zurich cohort, having completed at least once the UCLA GIT 2.0 questionnaire. We reviewed the medical charts of SSc patients from 2013 to 2019 and recorded data on EGD. We analyzed by univariable logistic regression several parameters, including UCLA GIT 2.0, considered as potentially associated with 1) the referral to EGD and 2) macroscopic esophagitis according to the Los Angeles criteria.Results:We identified 346 patients (82.7% female, median age 63 years, median disease duration 10 years, 23% with diffuse cutaneous SSc) satisfying the inclusion criteria, who filled in 940 UCLA GIT 2.0 questionnaires.From 940 visits, 31 were excluded because EGD was done within 3 months before completing the UCLA GIT 2.0. In the 909 remaining visits, EGD was recommended by the expert rheumatologists in 128 cases. In logistic regression, UCLA GIT 2.0 total score and some of its subscales, but also the modified Rodnan skin score (mRSS) and esophageal and stomach symptoms by past medical history, associated with the referral to EGD (Table 1).Table 1.Logistic regression of factors associated with referral to EGDOR (95% CI)p-valuemRSS1.04 (1.01 - 1.06)0.009Hemoglobin (Hb)1.00 (0.96 - 1.04)0.978Proton pump inhibitor (PPI)0.37 (0.12 - 1.15)0.086Esophageal symptoms3.37 (2.28 - 4.96)<0.001Stomach symptoms2.93 (2.02 - 4.26)<0.001Reflux subscale2.04 (1.52 - 2.73)<0.001Distention/bloating subscale1.53 (1.24 - 1.89)<0.001Social functioning2.20 (1.57 - 3.07)<0.001Emotional wellbeing1.42 (1.03 - 1.97)0.034Total score of UCLA GIT 2.02.27 (1.55 - 3.32)<0.001We found data on 177 EGD performed in 150 patients, meaning that 49 EGD were performed on indication by another physician. In logistic regression, mRSS and esophageal symptoms correlated with esophagitis, while neither the total ULCA GIT 2.0 score nor the reflux subscale or any of the other subscales showed an association with esophagitis (Table 2).Table 2.Logistic regression of factors associated with esophagitisOR (95% CI)p-valuemRSS1.09 (1.03 - 1.15)0.001Hb1.03 (0.99 - 1.06)0.126PPI0.52 (0.27 - 1.03)0.059Esophageal symptoms2.92 (1.29 - 6.61)0.010Stomach symptoms1.60 (0.80 - 3.21)0.183Reflux subscale1.07 (0.60 - 1.93)0.816Distention/Bloating subscale0.63 (0.39 - 1.01)0.054Social functioning0.65 (0.31 - 1.35)0.245Emotional wellbeing0.77 (0.36 - 1.61)0.483Total score of UCLA GIT 2.00.67 (0.28 - 1.60)0.367Conclusion:In a real-life setting, UCLA GIT 2.0 subscales (reflux, distention/bloating, social functioning, emotional wellbeing) and total score strongly associated with expert interpretation of gastroesophageal symptoms and consecutive referral to EGD. However, they showed no correlation with esophagitis on EGD. The main clinical association of esophagitis was the presence of esophageal symptoms.References:[1]Khanna D, et al. Reliability and validity of the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument. Arthritis Rheum. 2009;61(9):1257-63.Disclosure of Interests:Norina Zampatti: None declared, Alexandru Garaiman: None declared, Suzana Jordan: None declared, Mike O. Becker: None declared, Britta Maurer Grant/research support from: AbbVie, Protagen, Novartis, congress support from Pfizer, Roche, Actelion, and MSD, Speakers bureau: Novartis, Rucsandra Dobrota: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Carina Mihai: None declared

7506 Background: Lenalidomide (Len) is a novel, orally administered, immunomodulatory drug (IMiD) that has single-agent activity against multiple myeloma (MM) and additive effects when combined with dexamethasone (Dex). At the interim analysis of MM-009/010, lenalidomide/dexamethasone achieved a significant benefit over dexamethasone, providing a longer median time to progression (TTP), higher response rates, and higher CR rates. Aim: This subgroup analysis of MM-009/010 was performed to evaluate thrombosis in patients receiving Len/Dex vs Dex. Thrombotic events included the following adverse event terms: thrombosis, deep venous thrombosis, thromboembolism, and pulmonary embolism. Methods: Patients (pts) with relapsed or refractory MM were randomized to either receive oral Len (25 mg daily for 3 weeks every 4 weeks) plus Dex (40 mg on Days 1–4, 9–12, 17–20 every 4 weeks for 4 months, then 40 mg on Days 1–4 every cycle thereafter) or placebo plus Dex. Results: Thrombotic events were reported in 39 (11.3%) of 346 pts treated with Len/Dex compared to 13 (3.8%) of 346 pts treated with Dex alone (p < 0.001). Multivariate analysis identified Len/Dex treatment and erythropoietic treatment to be independently correlated with thrombosis (Table). Older age, lower plasma cell percentage in marrow, and better ECOG performance status had a weaker association with thrombosis. Thrombosis occurred more frequently among pts with prior history of thrombosis, although that was not a significant predictor in the multivariate anlaysis. None of 23 pts who used aspirin or salicylate during the first month of treatment developed thrombosis and all events occurred in pts with rising M-paraprotein levels at baseline. Conclusions: The current study findings suggest that the administration of erythropoietic agents should be minimized in MM pts receiving Len/Dex. Prophylactic antithrombotic therapy should also be considered. [Table: see text] [Table: see text]

Abstract Single-source, Angus-cross steers (n = 204; 249 ± 23 kg) were utilized to determine the effect of supplemental vitamin (VE; ROVIMIX E-50 Adsorbate, DSM Nutritional Products) on performance and immunity during feedlot receiving. Seven days post-arrival, steers were blocked by BW and weaning protocol (pre-weaned or not) into pens (n = 5 or 6 steers/pen) and pens randomly assigned to VE treatments: no supplemental VE (CON), VE at 25 IU/kg DM (LOW; average 151 IU·steer-1·d-1), 500 IU·steer-1·d-1 (MED), or 1000 IU·steer-1·d-1 (HIGH). Steers were weighed on d -1, 0, 14, 26 and 27. On d 6, steers were boostered with Bovi-Shield Gold (One Shot, Zoetis). Serum collected from one steer per pen was analyzed for Se and α-tocopherol (d -1 and 26) and Bovine Viral Diarrhea Virus (BVDV) type 1 and 2 antibody titers (d 6, 14, 26). Data were analyzed using Proc Mixed of SAS with pen as the experimental unit (n = 9 pens/treatment), the fixed effects of treatment and block, and the random effect of pen. Linear, quadratic and cubic contrast statements were constructed. Serum Se and α-tocopherol concentrations from d -1 and titers from d 6 (prior to vaccination) served as covariates. From d 14 to 27, ADG and G:F quadratically increased (P ≤ 0.02), with MED being greatest; VE did not affect d 0 to 14 or overall trial performance (P ≥ 0.14). Day 26 BVDV type 1 antibody titers and α-tocopherol concentrations (2.7, 3.4, 4.6, and 5.8 mg/L for CON, LOW, MED, and HIGH, respectively) linearly increased due to VE (P ≤ 0.04). Increasing supplemental VE improved circulating VE concentrations and antibody response to a booster vaccine. Performance benefits were observed when VE was supplemented at 500 IU·steer-1·d-1, the dose recommended by NASEM (2016) for stressed cattle.

Blast disease is considered as a major limiting factor in the global rice production because of its wide distribution and destructiveness and it has been causing significant yield loss in all rice growing areas of Nepal. Host resistance is the most desirable means of managing blast, especially in developing countries. Considering the importance of this disease field screening experiment was conducted to identify resistant rice genotypes against this disease. A total of 314 and 346 rice genotypes with resistant (Sabitri) and susceptible checks (Sankarika) were evaluated under epyphytotic conditions during 2016 and 2017 summer seasons at Rampur, respectively. During 2016 disease severity varied from 1 to 9 and only five genotypes; Sabitri, IR 12L 110, WAS122-IDSA14-WASB-FKRI, IR 10F 559and IR 10F 616 were resistant, 30 moderately resistant, 150 susceptible and 129 highly susceptible against blast disease. Similarly during 2016 out of 346 genotypes, 23 resistant as ARIZE SWIFT GOLD, IR95784-21-1-1-2, NR2169-10-4-1-1-1-1-1-2, NR2169-10-2-3-1-1-1-1-1, NR2181-165-1-1-1-1-1-1-1, NR2167-48-5-1-2-1-1, NR2171-2-1-1-3-1-1-2, NR2170-5-5-1-6-1-1-3-1, NR2170-31-1-1-5-1-1-1-1, NR2167-41-1-1-3-1, NR2172-34-1-1-1-1-1-1-1, Sabitri, IR82589-B-B-114-3, IR79913-B-238-3-3, IR93823-36, IR08L 152, IR82589-B-B-51-4, IR09F 434, IR55423-01, IR94391-131-353-19-B-1-1-1-1-1, NR2154-8-1-1-1-1-1, NR 2124-43-3-1-1-1, NR2160-68-1-1-1-1-1., 72 moderately resistant, 191 susceptible and 155 were highly susceptible. Most of the highly susceptible genotypes were knocked down at the time of disease scoring.Int. J. Appl. Sci. Biotechnol. Vol 5(4): 505-510

BackgroundSafety is a driving factor when selecting treatment, but the risks should be balanced against the treatment benefits, relative to alternative treatment options. In JAKis, recent evidence of increased safety risks in older patients with cardiovascular (CV) risk factors, have led to concerns. However, an increased risk among certain patients might still be offset by an increasing benefit in the same patient segment, and vice versa. A full understanding of the JAKi benefit-risk profile thus requires a better understanding of the relative (JAKi vs other treatments) benefits in those patients where their relative safety profile may be worse.ObjectivesTo assess the observed and adjusted relative effectiveness (remission and response) of JAKis (and non-TNFi bDMARDs) when compared to TNFi, as used in clinical practice, and to assess whether the predicted effectiveness of either drug class is modified by age and the presence of CV risk factors.MethodsRA patients initiating treatment with a JAKi, non-TNFi, or TNFi 2016-2021 were followed using the Swedish Rheumatology Quality Register. Good EULAR response and remission (CDAI<=2.8) at 6 months were assessed at return visits (within 90 to 270 days after treatment initiation). Non-responder imputation was implemented where treatment ended prior to 210 days after initiation.Crude probabilities of outcomes were presented by age and having ≥1 CV risk factor (Y/N). Linear regression estimated the risk difference (versus TNFi) in age and CV risk groups, adjusted for sex, baseline DAS28 (response) and CDAI (remission), and line of therapy. Probability of outcome was predicted from logistic regression models, fitted to allow effect modification of treatment cohort by age and CV risk score (ERS-RA score), adjusted for sex, baseline DAS28 (response) and CDAI (remission), and line of therapy.Results10,309 treatment episodes contributed data on response at 6 months, and 12,016 episodes with data on remission. Overall, 21% achieved good EULAR response and 11% reached CDAI remission (Table 1).Crude observed risks overall indicated superior response and remission with TNFi versus JAKi (Table 1). Adjusted risk differences suggested superior outcomes in JAKi versus TNFi, overall, and in those with no CV risk for CDAI remission. Patterns of predicted response and remission varied across age and CV ERS-RA score (Figure 1), with JAKis having superior effectiveness overall once adjusting for line of therapy.ConclusionAge and CV risk may modify the absolute and relative effectiveness of JAKis vs. TNFi. Further analyses are planned with the aim of presenting these results at EULAR.Table 1.Observed crude proportions of patients who achieved response and remission, and adjusted* risk differences between JAKi, non-TNFi and TNFi using the latter as referenceProportion (N) achieving outcomeAdjusted* risk difference, versus TNFi (95%CI)JAKiNon-TNFiTNFiJAKiNon-TNFiGood EULAR responseN Treatments101220224032Overall20% (339)19% (595)24% (1490)4.0% (1.1, 7.0)2.2% (-0.1, 4.5)<65 years, no CV21% (142)23% (277)27% (803)3.5% (-0.3, 7.3)2.4% (-0.6, 5.5)<65 years, ≥1 CV32% (24)29% (35)26% (60)14.6% (1.3, 28.0)10.7% (-0.1, 21.5)≥65 years, no CV25% (83)24% (168)30% (352)4.3% (-1.4, 10.1)-0.0% (-4.3, 4.3)≥65 years, ≥1 CV23% (29)29% (64)29% (89)1.4% (-8.4, 11.1)3.3% (-4.9, 11.5)CDAI remissionN Treatments139927565533Overall11% (73)9% (114)15% (425)4.0% (2.3, 6.8)2.2% (0.1, 3.6)<65 years, no CV6% (4)5% (6)12% (26)5.0% (2.0, 8.1)2.7% (0.3, 5.0)<65 years, ≥1 CV13% (40)10% (64)14% (159)-1.8% (-9.3, 5.8)-2.9% (-8.7, 3.0)≥65 years, no CV10% (12)12% (26)8% (23)5.7% (1.0, 10.5)0.4% (-3.0, 3.9)≥65 years, ≥1 CV11% (73)9% (114)15% (425)6.9% (-0.2, 14.0)6.9% (0.9, 13.0)*adjusted for sex, baseline DAS28 (response) and CDAI (remission), line of therapy≥1 CV= more than one CV risk factorFigure 1.Predicted probability of response and remission at 6 months by age and CV risk of patients with RA treated with JAKi, non-TNFi and TNFi in Sweden, adjusted for sex, baseline DAS28 (response) and CDAI (remission), and line of therapyREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

e17562 Background: Prediction of patient recruitment in OCT is one of the most important variables to guarantee timely closure of the trial. Earlier data analysis and conclusions define further research or discontinuation of the development of a given drug. Methods: Retrospective analysis of the recruitment and clinical records of all the patients of the COR that were contacted to participate in an OCT from 2006 to 2008 to identify the causes according to which patients did not participate. Results: Total of candidates 346, 175 women (50.6%). Average age 60 years (range 36 to 89). 42 patients (12%) rejected to participate in an OCT. 80 patients (23%) were screening failures (SF). 59 patients (17%) for not fulfilling an inclusion criteria (IC). Non appropriate stage or absence of measurable disease at screening (35%), abnormal labs (14%) and state of receptors or biomarkers (9%). Total of clinically unpredictable IC SF was 57.5%. 21 patients (6%) were SF due to an exclusion criteria (EC). Presence of distant metastases (12,5%), abnormal labs (2.5%) and abnormal EKG (2.5%). Total of clinically unpredictable EC SF was 19%. Conclusions: 35% of candidate patients did not participate. The most frequent cause was SF (23%). 76.5% of these SF were impossible to determine when informed consent was signed. 12% of patients rejected to participate for different reasons. Our results did not identify a predominant modifiable reason to improve recruitment. For future feasibility analyses our estimation of 35% dropout will be considered standard. [Table: see text] No significant financial relationships to disclose.

ObjectivesTo investigate the agreement between pulse oximetry (SpO2) and oxygen saturation (SaO2) measured by CO-oximetry on arterialised earlobe blood gas (EBG) in children and adolescents with sickle cell disease (SCD).Design and settingWe retrospectively reviewed 39 simultaneous and paired SaO2 EBG and SpO2 measurements from 33 ambulatory patients with SCD (32 subjects with Haemoglobin SS and one with Haemoglobin Sß+, 52% male, mean±SD age 11.0±3.6, age range 5–18). Measurements were performed between 2012 and 2015 when participants were asymptomatic. Hypoxaemia was defined as SaO2 ≤93%. A Bland-Altman analysis was performed to assess the accuracy of SpO2 as compared with EBG SaO2.ResultsThe mean±SD SpO2 and SaO2 values in the same patients were, respectively, 93.6%±3.7% and 94.3%±2.9%. The bias SpO2–SaO2 was −0.7% (95% limits of agreement from −5.4% to 4.1%) and precision was 2.5%. In 9/39 (23%) cases, the difference in SpO2–SaO2 was greater than the expected error range ±2%, with SaO2 more often underestimated by SpO2 (6/9), especially at SpO2values ≤93%. Thirteen participants (33%) were hypoxaemic. The sensitivity of SpO2 for hypoxaemia was 100%, specificity 85% and positive predictive value 76%.ConclusionsPulse oximetry was inaccurate in almost a quarter of measurements in ambulatory paediatric patients with SCD, especially at SpO2values ≤93%. In these cases, oxygen saturation can be confirmed through EBG CO-oximetry, which is easier to perform and less painful than traditional arterial blood sampling.

Shou-Fei Zhu of Nankai University developed (Angew. Chem. Int. Ed. 2014, 53, 13188) an iron catalyst that effected the enantioselective cyclization of 1 to 2. Bypassing diazo precursors, Junliang Zhang of East China Normal University used (Angew. Chem. Int. Ed. 2014, 53, 13751) a gold catalyst to cyclize 3 to 4. Taking advantage of energy transfer from a catalytic Ir complex, Chuo Chen of University of Texas Southwestern carried out (Science 2014, 346, 219) intramolec­ular 2+2 cycloaddition of 5, leading, after dithiane formation, to the cyclobutane 6. Intramolecular ketene cycloaddition has been limited in scope. Liming Zhang of the University of California Santa Barbara found (Angew. Chem. Int. Ed. 2014, 53, 9572) that intramolecular oxidation of an intermediate Ru vinylidene led to a species that cyclized to the cyclobutanone 8. James D. White of Oregon State University devised (J. Am. Chem. Soc. 2014, 136, 13578) an iron catalyst that mediated the enantioselective Conia-ene cyclization of 9 to 10. Xiaoming Feng of Sichuan University observed (Angew. Chem. Int. Ed. 2014, 53, 11579) that the Ni-catalyzed Claisen rearrangement of 11 proceeded with high diastereo- and enantiocontrol. The relative configuration of the product 12 was not reported. Robert H. Grubbs of Caltech showed (J. Am. Chem. Soc. 2014, 136, 13029) that ring opening cross metathesis of 13 with 14 delivered the Z product 15. Mn(III) cyclization has in the past required a stoichiometric amount of inorganic oxidant. Sangho Koo of Myong Ji University found (Adv. Synth. Catal. 2014, 356, 3059) that by adding a Co co- catalyst, air could serve as the stoichiometric oxidant. Indeed, 16 could be cyclized to 17 using inexpensive Mn(II). Matthias Beller of the Leibniz-Institüt für Katalyse prepared (Angew. Chem. Int. Ed. 2014, 53, 13049) the cyclohexene 20 by coupling the racemic alcohol 18 with the amine 19. Paultheo von Zezschwitz of Philipps-Universität Marburg added (Chem. Commun. 2014, 50, 15897) diethyl zinc in a conjugate sense to 21, then reduced the product to give 22. Depending on the reduction method, either diastereomer of the product could be made dominant. Nuno Maulide of the University of Vienna dis­placed (Angew. Chem. Int. Ed. 2014, 53, 7068) the racemic chloride 23 with diethyl zinc to give 24 as a single diastereomer.