Lower extremity DVT is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, DVT risk factors, or pharmacologic prophylaxis. Previous studies have underestimated DVT rates by not investigating CVDVTs and not exclusively targeting critically ill patients. We recommend early and continued DUS DVT screening of all critically ill trauma patients.

Despite lack of statistical improvement in most functional test results, revascularization for CLI results in improved patient-perceived leg function. Significant improvements in isometric muscle strength may explain the measured improvement in quality of life after revascularization for CLI.

A two-step diastereoselective synthesis of linear-fused tricyclic nitrogen heterocycles has been developed from cyclic β-ketoesters. The cyclization substrates are readily prepared by alkylation of the methyl 2-oxocycloalkanecarboxylates with 2-nitrobenzyl bromide. Hydrogenation of these substrates initiates a reaction sequence involving (1) reduction of the aromatic nitro group, (2) condensation of the resulting hydroxylamine or aniline nitrogen with the cycloalkanone and (3) reduction of the imine. The products are isolated in high yield as single diastereomers having the trans-fused ring junction. The observed selectivity is rationalized in terms of a steric effect imposed by the ester group in the final reductive amination step which directs the incoming hydrogen to the opposite face of the molecule. By comparison, reductive cyclizations of substrates lacking the stereodirecting ester group give mixtures of cis and trans products with a preference for the cis-fused heterocycle.

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