tert-Butyl 5-methoxy-3-pentylindole-1-carboxylate

he molecule of the title compound, C₁₉H₂₇NO₃, is essentially planar, with all non-H atoms within 0.2 Å of the nine-membered indole plane, except for the three tert-butyl C atoms. The C₅ pentyl chain is in an extended conformation, with three torsion angles of 179.95 (13), 179.65 (13) and -178.95 (15)° (the latter two angles include the C atoms of the C5 chain only). Three intramolecular C-H...O=C contacts are present (C...O 115°), and an intermolecular C-H...O=C contact and π-π stacking complete the intermolecular interactions

6-(4-Fluorophenyl)-8-phenyl-2,3-dihydro-4H-imidazo[5,1-b][1,3]thiazin-4-one: an unusual [6-5] fused-ring system

The title compound, C₁₈H₁₃FN₂OS, is the first structural example of a [6-5] fused ring incorporating the 2,3-dihydro-4H-imidazo[5,1-b][1,3]thiazin-4-one molecular scaffold. The six-membered 2,3-dihydro-1,3-thiazin-4-one ring adopts an envelope conformation, with the S-CH₂ C atom displaced by 0.761 (2) Å from the five-atom plane (all within 0.05 Å of the mean plane). The imidazole ring is planar. The phenyl ring is twisted from coplanarity with the imidazole ring by 23.84 (5)° and the 4-fluorophenyl ring is twisted by 53.36 (6)°, due to a close C(aryl)-H...O=C contact with the thiazin-4-one carbonyl O atom. The primary intermolecular interaction involves a CH₂ group with the F atom [C...F = 3.256 (2) Å and C-H...F = 137°]

Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

AbstractBackgroundPost-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development.MethodsFrom a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed.ResultsSeven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification).ConclusionThis study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium

Tumour-specific HMG-CoAR is an independent predictor of recurrence free survival in epithelial ovarian cancer

<p>Abstract</p> <p>Background</p> <p>Our group previously reported that tumour-specific expression of the rate-limiting enzyme in the mevalonate pathway, 3-hydroxy-3-methylglutharyl-coenzyme A reductase (HMG-CoAR) is associated with more favourable tumour parameters and a good prognosis in breast cancer. In the present study, the prognostic value of HMG-CoAR expression was examined in tumours from a cohort of patients with primary epithelial ovarian cancer.</p> <p>Methods</p> <p>HMG-CoAR expression was assessed using immunohistochemistry (IHC) on tissue microarrays (TMA) consisting of 76 ovarian cancer cases, analysed using automated algorithms to develop a quantitative scoring model. Kaplan Meier analysis and Cox proportional hazards modelling were used to estimate the risk of recurrence free survival (RFS).</p> <p>Results</p> <p>Seventy-two tumours were suitable for analysis. Cytoplasmic HMG-CoAR expression was present in 65% (n = 46) of tumours. No relationship was seen between HMG-CoAR and age, histological subtype, grade, disease stage, estrogen receptor or Ki-67 status. Patients with tumours expressing HMG-CoAR had a significantly prolonged RFS (p = 0.012). Multivariate Cox regression analysis revealed that HMG-CoAR expression was an independent predictor of improved RFS (RR = 0.49, 95% CI (0.25-0.93); p = 0.03) when adjusted for established prognostic factors such as residual disease, tumour stage and grade.</p> <p>Conclusion</p> <p>HMG-CoAR expression is an independent predictor of prolonged RFS in primary ovarian cancer. As HMG-CoAR inhibitors, also known as statins, have demonstrated anti-neoplastic effects <it>in vitro</it>, further studies are required to evaluate HMG-CoAR expression as a surrogate marker of response to statin treatment, especially in conjunction with current chemotherapeutic regimens.</p

Development of a pathway to facilitate gastrostomy insertion for patients with MND

A pathway has been developed using a multidisciplinary group from within specialist palliative care to ensure a comprehensive approach to the insertion of gastromy tubes for patients with motor neurone disease (MND) with swallowing difficulties. The pathway has ensured that there is a coordinated approach and the professionals involved are clear as to their responsibilities in the discussion and planning of the insertion, ensuring the best support for the patient and family

Structural modeling of the catalytic subunit-regulatory subunit dimeric complex of the camp-dependent protein kinase.

The cAMP-dependent protein kinase (PKA) is a multifunctional kinase that serves as a prototype for understanding second messenger signaling and protein phosphorylation. In the absence of a cAMP signal, PKA exists as a dimer of dimers, consisting of two regulatory (R) and two catalystic (C) subunits. Based on experimentally derived data (i.e., crystal structures of the R and C subunits, mutagenesis data identifying points of subunit-subunit contacts), the neutron scattering derived model for the heterodimer (Zhao et al., 1998) and using a set of computational approaches (homology modeling, Monte Carlo simulation), they have developed a high-resolution model of the RII{alpha}-C{alpha} dimer. The nature of the subunit-subunit interface was studied. The model reveals an averaged size dimer interface (2100 Angstrom{sup 2}) that is distant from the pseudo-substrate binding site on the C subunit. The additional contacts made by the pseudosubstrate increases the stability of the dimeric complex. Based on a set of R-C dimer structures derived using a simulated annealing approach, specific interactions (hydrogen bonds) between the two subunits and were identified

RGD conjugated cell uptake off to on responsive NIR-AZA fluorophores: Applications toward intraoperative fluorescence guided surgery

The use of NIR-fluorescence imaging to demarcate tumour boundaries for real-time guidance of their surgical resection has a huge untapped potential. However, fluorescence imaging using molecular fluorophores, even with a targeting biomolecule attached, has a major shortcoming of signal interference from non-specific background fluorescence outside the region of interest. This poor selectivity necessitates prolonged time delays to allow clearance of background fluorophore and retention within the tumour prior to image acquisition. In this report, an innovative approach to overcome this issue is described in which cancer targeted off to on bio-responsive NIR-fluorophores are utilised to switch-on first within the tumour. Bio-responsive cRGD, iRGD and PEG conjugates have been synthesised using activated ester/amine or maleimide/thiol couplings to link targeting and fluorophore components. Their off to on emission responses were measured and compared with an always-on nonresponsive control with each bio-responsive derivative showing large fluorescence enhancement values. Live cell imaging experiments using metastatic breast cancer cells confirmed in vitro bio-responsive capabilities. An in vivo assessment of MDA-MB 231 tumour imaging performance for bio-responsive and always-on fluorophores was conducted with monitoring of fluorescence distributions over 96 h. As anticipated, the always-on fluorophore gave an immediate, non-specific and very strong emission throughout whereas the bio-responsive derivatives initially displayed very low fluorescence. All three bio-responsive derivatives switched on within tumours at time points consistent with their conjugated targeting groups. cRGD and iRGD conjugates both had effective tumour turn-on in the first hour, though the cRGD derivative had superior specificity for tumour over the iRGD conjugate. The pegylated derivative had similar switch-on characteristics but over a much longer period, taking 9 h before a significant emission was observable from the tumour. Evidence for in vivo active tumour targeting was obtained for the best performing cRGD bio-responsive NIR-AZA derivative from competitive binding studies. Overall, this cRGD-conjugate has the potential to overcome the inherent drawback of targeted always-on fluorophores requiring prolonged clearance times and shows excellent potential for clinical translation for intraoperative use in fluorescence guided tumour resections

Prognostic ability of a panel of immunohistochemistry markers – retailoring of an 'old solution'

An urgent requirement exists for new prognostic and predictive assays in breast cancer. Despite the development of high-throughput technologies such as DNA microarrays, it would now appear that immunohistochemistry (IHC) may play an increasingly important role in the clinical management of breast cancer. In this editorial, the authors discuss the potential prognostic ability of a panel of IHC markers, and question whether this well-established assay technology may in fact allow for improved prognostic and predictive tests in breast cancer