1,3-Dipolar Cycloaddition of 3-Chromonyl-Substituted Glycine Imino Esters with Arylidenes and in situ Diastereodivergent via Retrocycloaddition

1,3-Dipolar cycloaddition through in situ generation of azomethine ylide provides a straightforward and critically important sustainable approach for access to diverse pyrrolidine chemical space. Herein, we developed a metal-free AcOH-activated 1,3-dipolar cycloaddition protocol that permits the synthesis of uncommon pyrrolidine cycloadducts with excellent diastereoselectivity. The challenging substrates of 3-formylchromone, glycine ester.HCl and arylidene dipolarophile were reacted in the presence of AcONa, which played a dual role as a base and AcOH source, to deliver firstly endo-cycloadduct. Under prolonged reaction time at room temperature or heating; the endo-adduct underwent diastereodivergent via a sequence of retro-cycloaddition, stereomutation of the generated syn-dipole into anti-dipole and recycloaddition; to furnish the scarcely known exo'-cycloadduct with high diastereodivergency. The reaction worked well with a broad range of substrates and the stereochemistry of the obtained cycloadducts was determined without ambiguity using NMR- and X-ray analysis. Experimental and theoretical DFT calculation studies were performed to support the proposed reaction mechanism and elucidate the key role of AcOH in the process which seems more beneficial than other transition metal-catalyzed processes.

Ecthyma gangrenosum in an AIDS patient with normal neutrophil count

Ecthyma gangrenosum is the cutaneous manifestation of Pseudomonas aeruginosa septicemia, typically affecting immunosuppressed patients, particularly those with neutropenia. Association with HIV disease has been rarely reported. We describe an unusual presentation of solitary ecthyma gangrenosum on the face of a non-neutropenic patient with AIDS.

Changes in cerebral perfusion after acute head injury: comparison of CT with Tc-99m HM-PAO SPECT

Technetium-99m hexamethylpropyleneamine oxime (Tc-99m HM-PAO) was successfully used with single photon emission computed tomography (SPECT) on fourteen comatose patients who had acute head injuries. The SPECT scans were correlated with computed tomography (CT) scans obtained within 24 hours of the injury. Tc-99m HM-PAO SPECT was shown to have the following advantages: It reflected perfusion changes, was more sensitive than CT in demonstrating more lesions, and demonstrated lesions at an earlier stage than those demonstrated with CT. Different types of lesions, as evidenced by cerebral perfusion changes, have been described and categorized. The lesions that had a favorable prognosis could be separated from those with an unfavorable prognosis on the basis of the findings of Tc-99m HM-PAO SPECT.