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A bis-hypochlorite adduct of a manganese(IV) salen complex having a chiral (R,R)-cyclohexane-1,2-diamine linkage (2-Bu) is successfully prepared and characterized by various spectroscopic methods. The reactions of 2-Bu with various organic substrates show that 2-Bu is capable of sulfoxidation, epoxidation, chlorination, and hydrogen abstraction reactions. However, the enantioselectivity of the epoxidation reactions by 2-Bu is much lower than that reported for the catalytic reactions by Jacobsen's catalyst. The low enantioselectivity is consistent with a planar conformation of the salen ligand, which is suggested by circular dichroism spectroscopy. This study suggests that 2-Bu is not a reactive intermediate of Jacobsen's enantioselective epoxidation catalysis.

Infantile vitamin B12 deficiency, a rare nutritional disorder in developed countries, is characterized by megaloblastic anemia and non-specific symptoms, including failure to thrive, hypotonia, and seizure. Symptoms usually develop at 6 months of age. Exclusively breast-fed infants of vegan-diet mothers are particularly at risk. We report the case of a 7-month-old boy with West syndrome born to a mother with subclinical vitamin B12 deficiency due to autoantibodies. Electroencephalography revealed the characteristic hypsarrhythmia pattern, whereas cranial magnetic resonance imaging revealed cerebral atrophy and hypomyelination. Biochemical analysis revealed elevated urinary methylmalonic acid and homocysteine and reduced plasma methionine. Serum vitamin B12 levels were extremely low in both the child and his mother. The mother tested positive for both anti-intrinsic factor and anti-parietal cell antibodies. Low-dose adrenocorticotropic hormone was effective for seizure control. Contrary to previous reports, age-appropriate neurodevelopment was not achieved despite rapid normalization of metabolic profile with vitamin B12 supplementation. Further investigations failed to detect any causative mutations in the genes associated with developmental and epileptic encephalopathy as well as metabolic and other identifiable disorders known to cause West syndrome. To the best of our knowledge, this is the first reported case in which maternal anti-intrinsic factor antibody was considered to be the reason for infantile vitamin B12 deficiency with West syndrome. Differential diagnosis of West syndrome should include vitamin B12 deficiency due to its treatable nature, and early diagnosis is essential to prevent permanent neurological consequences.

An advanced second trimester tubal pregnancy is rarely encountered because almost all ecopic pregnancy are diagnosed at an early stage. Transvaginal sonography is simple and useful for diagnosing ectopic pregnancy. However, diagnosing the site of ectopic pregnancy and gestational age is sometimes difficult. We experienced a case of an unexpected 13-week tubal pregnancy that was not able to be diagnosed with an accurate pregnancy site and gestational age by transvaginal sonography before surgery. Under massive hemoperitoneum, forceps penetrated the area of pregnancy, which led to further massive bleeding. However, laparoscopic surgery was able to be performed. The findings in our case suggest the importance of examining with transabdominal sonography, especially in an emergency and in advanced tubal pregnancy. In addition, careful manipulation of forceps is required when the ectopic pregnancy mass is large.

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