New methods for the synthesis of certain alkaloids and terpenoids

The use of ring-fused gem-dihalocyclopropanes, Au(I)-catalyzed cyclization reactions, and chemoenzymatic techniques in the synthesis of natural products is described.We thank the Australian Research Council for generous financial support through the provision of various grants

Oxidative intramolecular cyclization reactions of Cinnamayl ethers mediated by cerium (IV) ammonium nitrate (CAN): a stereoselective synthesis of 3,4-trans-disubstitutedtetrahydrofuran derivatives

Various alkoxy-cinnamyl cinnamyl ethers and an alkoxy-cinnamyl prenyl ether underwent stereoselective oxidative cyclizations on treatment with a methanolic solution of cerium(IV) ammonium nitrate to afford 3,4-trans- disubstituted tetrahydrofuran derivatives. Different products were obtained under aerobic and anaerobic conditions

Facile synthesis of 4H-chromene derivatives via base-mediated annulation of ortho-hydroxychalcones and 2-bromoallyl sulfones

Abstract The cesium carbonate-mediated reaction of 2-bromoallyl sulfones and ortho-hydroxychalcones furnished 3-arylsulfonyl-4H-chromene derivatives in 58-67% yield (18 examples). 2-Bromoallyl sulfones functioned as synthetic surrogates for allenyl sulfones in the reaction. Findings Benzo [b]dihydropyran, commonly known as 4H-chromene (1), is a privileged heterocyclic scaffold that is found in a variety of biologically active natural and synthetic products The utility of some of these methods are limited by drawbacks such as lengthy substrate synthesis, high cost of catalysts and tedious procedures. Therefore, general synthetic methods for accessing substituted chromene derivatives from readily available materials are still in demand. During the course of our recent investigations on annulation reactions of unsaturated sulfones The facile cyclocondenzation of salicylaldehyde with 2a (Scheme 1, path c) prompted us to explore analogous annulation reactions for the synthesis of functionalized chromene derivatives. The biological activities exhibited by many 4H-chromene derivatives provided an added incentive for this investigation Scheme 2: Base-mediated cyclization reaction of o-hydroxychalcone 7a and 2-bromoallyl sulfone 2a. In the 1 H NMR spectrum of 8aa, three sets of doublet of doublets were visible at δ 4.52 (1H, J = 2.3 and 9.0 Hz), δ 3.58 (1H, J = 2.3 and 17.1 Hz) and δ 3.33 (1H, J = 9.0 and 17.1 Hz) arising from the -CH 2 -CH-fragment. The methyl group protons resonated as a singlet at δ 2.51. A peak at δ 197.4 in the 13 C NMR spectrum along with the absorption peak at 1680 cm −1 in the IR spectrum confirmed the presence of the keto group. All other signals were in agreement with the assigned structure. In order to explore the scope and generality of this facile 4H-chromene synthesis, a variety of o-hydroxychalcones were prepared as previously described (Scheme 3) The cesium carbonate-mediated reaction of 2-bromoallyl sulfones 2a,b with o-hydroxychalcones 7a-i proceeded uneventfully to afford the corresponding 2-methyl-3-arylsulfonyl-4H-chromene derivatives 8aa-8ib (Scheme 4). The annulation reaction appears to be general as evident from the results in Scheme 4. The chalcone component can accommodate chloro, bromo and methoxy groups as aromatic substituents. Polycyclic aromatic hydrocarbon frameworks (naphthalene and anthracene rings) as well as a representative heterocyclic ring (furan) may be incorporated into the 4H-chromene skeleton product by using chalcones (7c, 7d, and 7e, respectively) functionalized with these moieties. Disappointingly, attempts to extend the annulation reaction to phenols with other Michael acceptors at the ortho-position (such as unsaturated esters, enals and nitroolefins) were not successful. Additionally, a very low yield (ca. 10%) of the product 8aa was obtained when the chalcone formation (7a) and its annulation reaction with 2a were combined into a one-pot operation (mediated by KOH in ethanol). A plausible mechanistic rationalization of the 4H-chromene formation is presented in Scheme 5. Cesium carbonate mediates the dehydrobromination of 2a to produce the allenyl sulfone 5 (see Scheme 1, path d). Additionally, deprotonation of 7a by Cs 2 CO 3 generates the phenoxide anion 9. A hetero-Michael addition of 5 and 9 results in the formation of a stabilized carbanion which may be represented as the resonance structures 10 or 11. The α-sulfonyl carbanion 11 then undergoes an intramolecular Michael addition to the β-carbon of the enone unit to afford the enolate 12. Isomerization of the exocyclic olefin moiety of 12 into the endocyclic position may be assisted by internal proton transfer. Tautomerization of the resultant enol 13 to its keto form affords the final product 8aa. It may be Beilstein J. Org. Chem. 2016, 12, 16-21. 19 noted that the key carbon-carbon bond forming event (conversion of 11 to 12) here is completely regioselective as the Michael addition of the stabilized carbanion 11 occurs selectively at the α-sulfonyl position (not at the less hindered terminal of the allylic carbanion 11). Conclusion In conclusion, a base-mediated, facile synthesis of 3-sulfonyl-4H-chromenes from o-hydroxychalcones and 2-bromoallyl sulfones was developed. The starting materials are easily available and the reaction conditions are mild. 2-Bromoallyl sulfones Beilstein J. Org. Chem. 2016, 12, 16-21. 20 Scheme 5: A plausible mechanistic rationalization for the formation of 4H-chromene derivative 8aa from 7a and 2a

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe