(S)-N-[1-(5-Benzyl-sulfan-yl-1,3,4-oxa-diazol-2-yl)-2-phenyl-eth-yl]-4-methyl-benzene-sulfonamide

The title compound, C(24)H(23)N(3)O(3)S(2), crystallizes with two independent mol-ecules in the asymmetric unit. They differ essentially in the orientation of the tolyl rings, between which there is π-π stacking (centroid-centroid distance = 3.01 Å). The absolute configuration was confirmed by the determination of the Flack parameter [x = 0.008 (9)]. In the crystal, mol-ecules are connected by two classical N-H⋯N hydrogen bonds and two weak but very short C-H⋯O(sulfon-yl) inter-actions, forming layers lying parallel to the bc plane.

(S)-N-{1-[5-(4-Chloro-benzyl-sulfanyl)-1,3,4-oxadiazol-2-yl]eth-yl}-4-methyl-benzene-sulfonamide

The title compound, C₁₈H₁₈ClN₃O₃S₂, adopts by folding the form of a distorted disc. Inter­planar angles are 29.51 (7) and 63.43 (7)° from the five-membered ring to the aromatic systems and 34.80 (6)° between these two latter rings. The absolute configuration was confirmed by determination of the Flack parameter. In the crystal, the mol­ecules are linked by four hydrogen bonds, one classical (N—H⋯N) and three ‘weak’ (C—H⋯O), forming layers parallel to the ac plane; these are in turn linked in the third dimension by Cl⋯N [3.1689 (16) Å] and Cl⋯O [3.3148 (13) Å] contacts to the heterocyclic ring.

Highly enantioselective Michael addition of 2-oxindoles to vinyl selenone in RTILs catalyzed by a Cinchona alkaloid-based thiourea

A highly enantioselective Michael addition of 2-oxindoles (1) to vinyl selenone (2) in RTILs catalyzed by a Cinchona alkaloid-based thiourea has been developed in high yields (80-91%) with excellent enantioselectivities (up to 95% ee).

Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle

The anterolateral thigh flap (ALTF) has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle.

Auditory hallucinations and migraine of possible brainstem origin

BACKGROUND

Concurrence of migraine and hallucinations is extremely rare and the underlying mechanism is poorly understood.

METHODS

We report a 22-year-old man with migraine associated with auditory hallucinations. Concurrent psychotic illness has been excluded.

RESULTS

Brain MR scans showed a stable, patchy FLAIR hyperintensity over the posterolateral aspect of the left cerebral peduncle, just below the level of the red nucleus. This was felt to represent an area of gliosis based on the interval stability over 19 months. There was absence of features for aggressive neoplasms, such as lesional high cellular turnover (choline/NAA ratio >1.0) or high cerebral blood volume on advanced MR imaging with MR spectroscopy and dynamic perfusion MR. EEG and brainstem auditory evoked potentials were unremarkable.

CONCLUSIONS

To our knowledge, there are no reports to date on similar auditory hallucinations in adult migraine patients, as well as with associated MRI brainstem lesions. The peduncular lesion could represent a previous migrainous infarct, and a possible analogy can be drawn from the descriptions of peduncular hallucinosis. Brainstem lesions, particularly in the midbrain and pons, have rarely been associated with this condition. It has been postulated that the damage to ascending reticular systems or thalamocortical circuitry may contribute to its pathogenesis.

Phase III, Open-Label, Randomized Study Comparing Concurrent Gemcitabine Plus Cisplatin and Radiation Followed by Adjuvant Gemcitabine and Cisplatin Versus Concurrent Cisplatin and Radiation in Patients With Stage IIB to IVA Carcinoma of the Cervix

Purpose

To determine whether addition of gemcitabine to concurrent cisplatin chemoradiotherapy and as adjuvant chemotherapy with cisplatin improves progression-free survival (PFS) at 3 years compared with current standard of care in locally advanced cervical cancer.

Patients and Methods

Eligible chemotherapy- and radiotherapy-naive patients with stage IIB to IVA disease and Karnofsky performance score ≥ 70 were randomly assigned to arm A (cisplatin 40 mg/m2 and gemcitabine 125 mg/m2 weekly for 6 weeks with concurrent external-beam radiotherapy [XRT] 50.4 Gy in 28 fractions, followed by brachytherapy [BCT] 30 to 35 Gy in 96 hours, and then two adjuvant 21-day cycles of cisplatin, 50 mg/m2 on day 1, plus gemcitabine, 1,000 mg/m2 on days 1 and 8) or to arm B (cisplatin and concurrent XRT followed by BCT only; dosing same as for arm A).

Results

Between May 2002 and March 2004, 515 patients were enrolled (arm A, n = 259; arm B, n = 256). PFS at 3 years was significantly improved in arm A versus arm B (74.4% v 65.0%, respectively; P = .029), as were overall PFS (log-rank P = .0227; hazard ratio [HR], 0.68; 95% CI, 0.49 to 0.95), overall survival (log-rank P = .0224; HR, 0.68; 95% CI, 0.49 to 0.95), and time to progressive disease (log-rank P = .0012; HR, 0.54; 95% CI, 0.37 to 0.79). Grade 3 and 4 toxicities were more frequent in arm A than in arm B (86.5% v 46.3%, respectively; P < .001), including two deaths possibly related to treatment toxicity in arm A.

Conclusion

Gemcitabine plus cisplatin chemoradiotherapy followed by BCT and adjuvant gemcitabine/cisplatin chemotherapy improved survival outcomes with increased but clinically manageable toxicity when compared with standard treatment.

Evidence of recombination in the Banana bunchy top virus genome

Viruses serve as good model for evolutionary studies, owing to their short generation times and small genomes. Banana bunchy top virus (BBTV) is a significant subject being multicomponent circular single stranded DNA virus. BBTV belongs to family Nanoviridae and contains DNA-R, -U3, -S, -M, -C, and -N as integral genomic components. Evolutionary studies have shown genetic re-assortment of components among its isolates and revealed a concerted type evolution in non-coding regions of its genome. The DNA U3 having been shown as the most diverse component in our previous studies, was subjected to sequencing from some Pakistani isolates for the first time. Sequence analysis revealed intergenomic recombination in DNA-U3 among the isolates of two sub-groups and a very rare intragenomic recombination in Pakistani BBTV population. This indicates that like other evolutionary processes including intergenomic recombination, intragenomic recombination among the genomic components of the same isolate may also have a significant contribution in the evolution of BBTV genome. Intragenomic recombination therefore appears to be a unique way to generate genetic diversity in the multicomponent ssDNA viruses.

6-(Adamantan-1-yl)-3-(3-fluoro-phen-yl)-1,2,4-triazolo[3,4-b][1,3,4]thia-diazole

The title mol­ecule, C₁₉H₁₉FN₄S, displays C_s mol­ecular symmetry, in which the crystallographic mirror plane bis­ects the adamantan-1-yl unit while the 3-fluoro­phenyl triazole ring is located on the mirror plane. The F atom of the 3-fluoro­phenyl ring is positionally disordered [occupancy ratio 0.9:0.1]. In the crystal, π–π inter­actions between the triazole and phenyl rings occur [centroid–centroid distance = 3.5849 (7) Å] and weak C—H⋯F inter­actions form a ribbon propagating in [010].

4-Methylbenzenecarbothioamide

In the title mol­ecule, C₈H₉NS, the mean plane of the carbothio­amide group is twisted slightly with respect to the mean plane of the benzene ring, making a dihedral angle of 17.03 (10)°. The crystal structure is stabilized by inter­molecular N—H⋯S hydrogen bonds, resulting in the formation of eight-membered rings lying about inversion centers and representing R₂²(8) and R₄²(8) motifs. Futhermore, these hydrogen bonds build up chains parallel to the b axis.

4-Methoxy-benzene-carbothio-amide

The asymmetric unit of the title compound, C(8)H(9)NOS, contains two independent mol-ecules with the meth-oxy groups oriented in opposite conformations. The mean planes of the carbothio-amide groups are tilted by 7.88 (15) and 11.16 (9)° from the mean planes of the benzene rings. In the crystal, the mol-ecules form dimers via intermolecular N-H⋯S inter-molecular hydrogen bonds, resulting in eight-membered rings of R(2) (2)(8) graph-set motif. The dimers are further linked by C-H⋯O hydrogen bonds into chains along the c axis. Adjacent chains inter-act through inter-molecular N-H⋯S hydrogen bonds, generating eight-membered rings of R(4) (2)(8) graph-set motif.

Significance of chest pain without ST changes during exercise treadmill testing

BACKGROUND

Exercise treadmill test is interpreted as positive or negative for ischemia in the presence or absence of ST depression respectively. This study was conducted to evaluate the diagnostic value of chest pain without ST depression during exercise treadmill test.

METHODS

A total of 180 patients who had abnormal exercise treadmill test result and subsequently underwent coronary angiography were studied. Patients were categorised as having ST depression and angina (group A), only ST depression (group B) and only angina (group C). Coronary angiograms of all patients were assessed and compared.

RESULTS

Out of 180 patients [159 (88.3%) men and 21 (11.7%) women], 84 patients were in Group A, 64 in Group B and 32 in Group C. Characteristics like age, sex distribution and risk factors were similar in three groups. Significant coronary artery disease was seen in 77 (91.7%), 40 (62.5%) and in 25 (78.1%) patients in groups A, B and C respectively (p=0.02). Triple vessel disease was seen in 21 (25%), 11 (17.2%) and 5 (15.6%) patients in groups A, B and C respectively. Significant disease of left anterior descending artery was seen in 61 (72.6%), 26 (40.6%) and 23 (71.9%) in groups A, B and C respectively (p=0.001).

CONCLUSION

Occurrence of both ST depression and angina during exercise treadmill test has strong association with angiographic coronary artery disease whereas occurrence of either of the two has similar association with angiographic coronary artery disease with a trend towards more disease in the latter.

Regulation of neuronal activity by Cav3-Kv4 channel signaling complexes

Kv4 low voltage-activated A-type potassium channels are widely expressed in excitable cells, where they control action potential firing, dendritic activity and synaptic integration. Kv4 channels exist as a complex that includes K(+) channel-interacting proteins (KChIPs), which contain calcium-binding domains and therefore have the potential to confer calcium dependence on the Kv4 channel. We found that T-type calcium channels and Kv4 channels form a signaling complex in rat that efficiently couples calcium influx to KChIP3 to modulate Kv4 function. This interaction was critical for allowing Kv4 channels to function in the subthreshold membrane potential range to regulate neuronal firing properties. The widespread expression of these channels and accessory proteins indicates that the Cav3-Kv4 signaling complex is important for the function of a wide range of electrically excitable cells.

Heterodimerization of ORL1 and opioid receptors and its consequences for N-type calcium channel regulation

We have investigated the heterodimerization of ORL1 receptors and classical members of the opioid receptor family. All three classes of opioid receptors could be co-immunoprecipitated with ORL1 receptors from both transfected tsA-201 cell lysate and rat dorsal root ganglia lysate, suggesting that these receptors can form heterodimers. Consistent with this hypothesis, in cells expressing either one of the opioid receptors together with ORL1, prolonged ORL1 receptor activation via nociceptin application resulted in internalization of the opioid receptors. Conversely, mu-, delta-, and kappa-opioid receptor activation with the appropriate ligands triggered the internalization of ORL1. The mu-opioid receptor/ORL1 receptor heterodimers were shown to associate with N-type calcium channels, with activation of mu-opioid receptors triggering N-type channel internalization, but only in the presence of ORL1. Furthermore, the formation of opioid receptor/ORL1 receptor heterodimers attenuated the ORL1 receptor-mediated inhibition of N-type channels, in part because of constitutive opioid receptor activity. Collectively, our data support the existence of heterodimers between ORL1 and classical opioid receptors, with profound implications for effectors such as N-type calcium channels.

Provision of a "same-day" ultrasound service in an inner-city NHS trust: report on experience and lessons learned after the first 2 years

AIM

To assess the effect of changing from an "appointment" to a "same-day" ultrasound (US) service on referral pattern, departmental workload, and patient satisfaction.

MATERIALS AND METHODS

To reduce US waiting time of 3 weeks for routine examinations, a "same-day" service was started for outpatients and general practitioner (GP) patients in September 2006. To examine the effect of this change a retrospective assessment was performed of workload during 1 week in June 2006 (appointments only) and the same week in 2008, 22 months after the implementation of the new service. Distance travelled by patients and waiting time was recorded. Patient satisfaction with the service was assessed by questionnaire in September 2008.

RESULTS

Hospital referrals remained stable, but GP referrals increased from 99 to 367 (270%) and distance travelled by patients increased from a median of 3.1 km (range 0.1-12.1 km) in 2006 to 4.8 km (range 0.2-19.8 km) in 2008 (p<0.001). Non-local GP referrals increased from 20/99 in 2006 (20%) to 198/367 in 2008 (54%). The increased workload was managed by flexible working by radiologists and two additional sonographers. Departmental waiting time increased for all patients with same-day patients waiting a median of 35 min (interquartile range 19-60 min). Ninety-one percent (79/87) of same-day patients rated the service excellent or good, but many requested better information on the waiting time.

CONCLUSION

There is a demand from GPs for same-day US, and it is feasible in a large hospital with flexible radiology working and increased sonographic staffing. Unless adjacent hospitals offer a similar service, continuing rise in demand could overwhelm the service.