COVID-19 Viral Load in the Severity of and Recovery From Olfactory and Gustatory Dysfunction.

OBJECTIVES/HYPOTHESIS: This study investigated olfactory and gustatory dysfunction in the 2020 novel coronavirus disease (COVID-19) patients, and their correlations with viral load evaluation. STUDY DESIGN: Prospective cross-sectional cohort study. METHODS: One hundred forty-three symptomatic patients being screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were invited to participate. The clinical data of 83 confirmed COVID-19 subjects were collected, with 60 patients who were symptomatic but negative for COVID-19 recruited as controls. The prevalence and severity of and recovery time for olfactory and gustatory dysfunction, and cycle threshold (Ct) values from a SARS-CoV-2 polymerase chain reaction assay of nasopharyngeal and deep throat swabs were collected. Their correlations with Ct values were reported. RESULTS: Thirty-nine (47.0%) and 36 (43.4%) COVID-19 patients reported olfactory and gustatory dysfunction, respectively. The results of one-way analysis of variance did not show statistically significant relationships between the Ct values and severity of olfactory and gustatory dysfunction (P = .780 and P = .121, respectively). Among the COVID-19 patients who reported smell and taste loss, 28/39 (71.8%) and 30/36 (83.3%) experienced complete recovery, respectively. The mean recovery time was 10.3 ± 8.1 days for olfactory dysfunction and 9.5 ± 6.8 days for gustatory dysfunction. The recovery time was not correlated with the Ct values (Pearson correlation coefficient, smell: -0.008, P = .968; taste: -0.015, P = .940). CONCLUSIONS: There is a high prevalence of olfactory and gustatory dysfunction in COVID-19. However, the severity of and recovery from these symptoms have no correlations with the viral load of SARS-CoV-2. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2680-2685, 2020.

Family medicine vocational training and career satisfaction in Hong Kong.

BACKGROUND: Postgraduate vocational training in family medicine (FM) is essential for physicians to build capacity and develop quality primary care. Inadequate standards in training and curriculum development can contribute to poor recruitment and retention of doctors in primary care. This study aimed to investigate: 1) the satisfaction level of doctors regarding vocational training in family medicine and associated demographics; and 2) the satisfaction level of doctors regarding their family medicine career and associated factors. METHOD: This is a cross sectional study of all family medicine physicians across all government-funded primary care clinics (GOPCs). The study questionnaire consisted of items from a standardized and validated physician survey named the Physician Worklife Survey (PWS) (Konrad et al., Med Care, 1999). We selected three scales (7 items) relating to global job satisfaction, global career satisfaction and global specialty (family medicine) satisfaction with additional items on training and demographics. All significant variables in bivariate analyses were further examined using stepwise logistic regression. RESULTS: Out of 424 eligible family medicine physicians, 368 physicians successfully completed the questionnaire. The response rate was 86.8%. Most participants were male (52.6%), were aged between 35 and 44 years (55.5%), were FM specialists (42.4%), graduated locally (86.2%), and had postgraduate qualifications. Eighty-two percent (82%) of participants were satisfied with their training. Having autonomy and protected time for training were associated with satisfaction with FM training. Satisfaction with family medicine as a career was correlated with physicians' satisfaction with their current job. Doctors who did not enroll in training (p < 0.001) and physicians who were older (p = 0.023) were significantly less satisfied. Stepwise multivariate regression showed that doctors who subjectively believed their training as "broad and in depth' had higher career satisfaction (p < 0.001). CONCLUSION: Overall, the satisfaction level of physicians on current family medicine training in Hong Kong was high. Having autonomy and protected time for training is associated with higher training satisfaction levels. Perceiving FM training as "broad and in-depth" is associated with higher family medicine career satisfaction.

Synthesis of a Macrocycle Bearing a Carbon Framework of [16]Cyclophenacene as a Carbon Nanobelt.

A synthetic pathway to a functionalized tetrahydro[5]phenacene was developed, which served as a precursor, leading to a dehydrobenzo[32]annulene macrocycle containing four carbon-carbon triple bonds. The high efficiency of the macrocyclization step can be attributed to the structural rigidity of its immediate precursor. Hydrogenation of the four carbon-carbon triple bonds produced a macrocycle bearing a carbon framework of [16]cyclophenacene as the shortest macrocyclic belt-like structure of an (8,8)armchair carbon nanotube.

Synthesis of a Cyclophane Bearing Two Benz[a]anthracene Units Connected at the 5 and 7 Positions with Two Naphth-1,4-diyl Groups.

A synthetic pathway to a cyclophane bearing two benz[a]anthracene units connected at the 5 and 7 positions through two naphth-1,4-diyl groups was developed, and its structure was confirmed by X-ray structure analysis. Because of structural constraints, the two naphthyl groups are distorted from planarity and the bonds connecting them to the benz[a]anthracene units are bent significantly. The UV-vis and fluorescence spectra of the cyclophane are red-shifted from those of 7-(1-naphthalenyl)benz[a]anthracene, which is the corresponding monomeric polycyclic aromatic hydrocarbon.

Synthesis of Molecular Nanohoops Bearing a Tetrahydro[6]cycloparaphenylene Fused to a Hydrogenated or a Bithiophene-Inserted Cycloparaphenylene.

A synthetic pathway to a molecule bearing two molecular nanohoops, including a tetrahydro[6]cycloparaphenylene (4H[6]CPP) fused through two 1,4-dimethoxybenzene units to a 4H[10]CPP, was developed. Similarly, a molecule containing a 4H[6]CPP fused through two 1,4-dimethoxybenzene units to a molecular nanohoop bearing a [6]CPP inserted with two 2,2'-bithiophene-5,5'-diyl groups was synthesized. The Diels-Alder reactions of two (E,E)-1,4-diaryl-1,3-butadienes with 1,4-benzoquinone and the Ni-mediated homocoupling reactions are the key steps for the construction of macrocyclic ring structures. Oxidative aromatization with DDQ converted a hydrogenated system to a fully aromatized nanohoop with 10 aromatic units, including a [6]CPP inserted with two 2,2'-bithiophene-5,5'-diyl groups. The UV-vis and fluorescence spectra of the fused two-hoop systems were investigated.

Synthesis and Structure of a Functionalized [9]Cycloparaphenylene Bearing Three Indeno[2,1-a]fluorene-11,12-dione-2,9-diyl Units.

A synthetic pathway to a functionalized [9]cycloparaphenylene bearing three indeno[2,1-a]fluorene-11,12-dione-2,9-diyl units in the macrocyclic ring structure ([3]CIFO) has been developed. The 1H and 13C NMR spectra show that only the anti rotamer (anti-[3]CIFO) is produced. DFT calculations indicate that the anti rotamer is thermodynamically more stable than the syn rotamer by 4.3 kcal/mol, and the rotational barrier from the anti to syn rotamer is estimated to be 23.3 kcal/mol. The UV-vis and fluorescence spectra and cyclic voltammogram of anti-[3]CIFO were investigated.

Synthesis and Properties of Conjugated Macrocycles Containing 2,7-Bis(2-thienyl)-9H-fluoren-9-one Units.

Synthetic pathways to conjugated macrocycles containing one, two, or three 2,7-bis(2-thienyl)-9H-fluoren-9-one (TFOT) units in the macrocyclic frameworks bearing 10, 16, or 24 aromatic units were developed. The Diels-Alder reaction between (E,E)-1-(5-bromo-2-thienyl)-4-(5-iodo-2-thienyl)-1,3-butadiene and dimethyl acetylenedicarboxylate produced the key Diels-Alder adduct for the subsequent macrocyclic ring formation. UV-vis and fluorescence spectra of the TFOT-containing molecules were recorded, and their electrochemical properties were investigated by cyclic and differential pulse voltammetry. Solvatofluorochromic properties were observed for the TFOT-containing molecules.

Synthesis and Characterization of Functionalized [12]Cycloparaphenylenes Containing Four Alternating Biphenyl and Naphthyl Units.

Functionalized [12]cycloparaphenylenes ([12]CPPs) containing four alternating biphenyl and naphthyl units were synthesized. A macrocyclic furan-containing CPP precursor was used for the Diels-Alder reaction with the parent benzyne or 3,6-dimethoxybenzyne to form the corresponding macrocyclic carbon frameworks. The subsequent reductive deoxygenation of the Diels-Alder adducts with Fe2(CO)9 followed by oxidative aromatization with 2,3-dichloro-5,6-dicyano-1,4-benzoquinone produced the functionalized [12]CPPs. The effect of macrocyclic ring size on the reaction rate of oxidative aromatization was investigated.

Synthesis of Partially Hydrogenated Cycloparaphenylenes with Bent and Fused Structures Bearing Armchair Carbon Nanotube-like Connections.

The Diels-Alder reactions between 2 equiv of (E,E)-1,4-bis(4-bromophenyl)-1,3-butadiene and 1,4-benzoquinone led to the formation of a key intermediate with all four 4-bromophenyl substituents cis to one another. The subsequent nickel-mediated homocoupling reactions then produced partially hydrogenated cycloparaphenylenes, including a molecule bearing two units of tetrahydro[6]cycloparaphenylene (4H[6]CPP) fused together through two 1,4-dimethoxybenzene units in an armchair (6,6)carbon nanotube-like connection. Similarly, two 6H[9]CPPs were connected through three 1,4-dimethoxybenzene units in an armchair (9,9)carbon nanotube-like arrangement. A bent 8H[12]CPP and a bent 12H[18]CPP, which were fused intramolecularly with two and three 1,4-dimethoxybenzene units, respectively, to create the bent structures, were likewise synthesized. A molecule containing a bent 8H[12]CPP fused to a 4H[6]CPP was likewise constructed. The structures of these partially hydrogenated CPPs were established by X-ray structure analysis, NMR spectroscopy, and additional independent synthetic pathways.

Synthesis of Cycloparaphenylenes Bearing Furan-2,5-diyl or 2,2'-Bifuran-5,5'-diyl Units in the Macrocyclic Structures.

Synthetic pathways to furan-containing cycloparaphenylenes (CPPs) as molecular nanohoops bearing 10, 12, and 15 aromatic units including furan-2,5-diyl or 2,2'-bifuran-5,5'-diyl units have been developed. The X-ray structures of a partially hydrogenated bifuran-containing CPP precursor and the corresponding fully aromatized bifuran-containing CPP were obtained to allow the determination of their conformational arrangements in the crystal lattice. The optical and electrochemical properties of the furan-containing CPPs were investigated.

Syntheses and Structures of Functionalized [9]Cycloparaphenylenes as Carbon Nanohoops Bearing Carbomethoxy and N-Phenylphthalimido Groups.

Functionalized [9]cycloparaphenylenes ([9]CPPs) bearing nine aromatic units in the macrocyclic structures were synthesized. The macrocyclic structures were substituted with carbomethoxy or N-phenylphthalimido groups. The Diels-Alder reaction of (E,E)-1,4-bis(4-bromophenyl)-1,3-butadiene or a related diene with dimethyl acetylenedicarboxylate followed by the nickel-mediated homocoupling reactions and oxidative aromatization produced the functionalized [9]CPPs. Treatment of a resultant [9]CPP with aniline or 1,4-diaminobenzene gave the corresponding N-phenylphthalimides. The X-ray structure of a [9]CPP bearing six carbomethoxy groups was obtained.

Churg-Strauss syndrome from an orthopaedic perspective.

Churg-Strauss syndrome, which has been frequently described by physicians in the literature, is a small and medium-sized vessel systemic vasculitis typically associated with asthma, lung infiltrates, and hypereosinophilia. We report a case of Churg-Strauss syndrome with presenting symptoms of bilateral lower limb weakness and numbness only. The patient was admitted to an orthopaedic ward for management and a final diagnosis was reached following sural nerve biopsy. The patient's symptoms responded promptly to steroid treatment and she was able to walk with a stick 3 weeks following admission. This report emphasises the need to be aware of this syndrome when managing patients with neurological deficit in order to achieve prompt diagnosis and treatment.

Syntheses and Structures of Thiophene-Containing Cycloparaphenylenes and Related Carbon Nanohoops.

Thiophene-containing cycloparaphenylenes (CPPs) bearing 8, 10, and 16 aromatic and heteroaromatic units in the macrocyclic ring structures were synthesized. Specifically, two and four thiophene-2,5-diyl units were incorporated into functionalized [6]- and [12]CPP macrocyclic carbon frameworks, respectively. In addition, two 2,2'-bithiophene-5,5'-diyl units were inserted into a functionalized [6]CPP carbon framework. The cyclic and differential pulse voltammetry and the UV-vis and fluorescence spectra of the fully aromatized macrocycles and their precursors exhibited interesting electrochemical and optical properties.