Intravenous thrombolysis for multi-ethnic Asians with acute ischaemia stroke in Malaysian public primary stroke centres versus acute stroke ready hospitals: Comparison of real-world clinical outcomes

INTRODUCTION

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS). We aim to compare the realworld clinical outcomes and service efficiency of IVT in Malaysian primary stroke centres (PSCs) versus acute stroke ready hospitals (ASRHs).

MATERIALS AND METHODS

We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.

RESULTS

A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.

CONCLUSION

Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.

An analog-AI chip for energy-efficient speech recognition and transcription

Models of artificial intelligence (AI) that have billions of parameters can achieve high accuracy across a range of tasks1,2, but they exacerbate the poor energy efficiency of conventional general-purpose processors, such as graphics processing units or central processing units. Analog in-memory computing (analog-AI)3-7 can provide better energy efficiency by performing matrix-vector multiplications in parallel on 'memory tiles'. However, analog-AI has yet to demonstrate software-equivalent (SWeq) accuracy on models that require many such tiles and efficient communication of neural-network activations between the tiles. Here we present an analog-AI chip that combines 35 million phase-change memory devices across 34 tiles, massively parallel inter-tile communication and analog, low-power peripheral circuitry that can achieve up to 12.4 tera-operations per second per watt (TOPS/W) chip-sustained performance. We demonstrate fully end-to-end SWeq accuracy for a small keyword-spotting network and near-SWeq accuracy on the much larger MLPerf8 recurrent neural-network transducer (RNNT), with more than 45 million weights mapped onto more than 140 million phase-change memory devices across five chips.

Natural quinones induce ROS-mediated apoptosis and inhibit cell migration in PANC-1 human pancreatic cancer cell line

Pancreatic cancer is one of the most devastating of all malignancies with poor prognosis and high mortality rates worldwide. Thymoquinone, plumbagin and juglone, which are naturally occurring quinones, have been reported for their promising anticancer effect on different cancer cells. However, their mechanism of action and antimetastatic effects are largely unknown against the human pancreatic cancer cell line (PANC-1). In this study, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cytotoxicity assay revealed a dose-dependent decrease of viability in quinone-treated PANC-1 cells. In addition, the assessment of changes in cells has demonstrated an occurrence of typical apoptotic morphology in treated PANC-1 cells compared with control. Besides this, the apoptosis induction was further quantitatively confirmed through flow cytometry analysis. Furthermore, thymoquinone, plumbagin and juglone were evaluated for their influence on reactive oxygen species (ROS) generation through 2,7-dichlorofluorescein diacetate (DCFDA) staining and they dramatically increased the intracellular ROS level in treated PANC-1 cells, suggesting the critical role of ROS in their apoptosis induction. This study also demonstrated the wound healing potential of these compounds and inhibited PANC-1 cell migration in a time-dependent manner compared with control. This inhibition was correlated with reduced expression of matrix metalloproteinase-9 (MMP-9) in juglone-treated cells detected through gelatin zymography. In conclusion, thymoquinone, plumbagin and juglone significantly inhibited cell growth and induced ROS-mediated apoptosis in PANC-1 cells. In addition, they could be potent antimetastatic agents due to their anti-migratory effect against PANC-1 human pancreatic cancer cells.

Olfactory dysfunction amongst children and adolescents with laboratory confirmed coronavirus disease 2019: a systematic review

BACKGROUND

Despite the rapidly emerging reports of olfactory dysfunction amongst adult patients with coronavirus disease 2019, cases involving children and adolescents are scarcely reported. The literature was reviewed to elucidate olfactory dysfunction amongst children and adolescents with coronavirus disease 2019.

METHODS

A search of the literature published from 1 December 2019 to 30 April 2021 was conducted using four databases, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed over one month (May 2021).

RESULTS

Only 9 articles were identified, with a total of 316 laboratory confirmed coronavirus disease 2019 positive children and adolescents, of whom 156 reported olfactory dysfunction. Four studies reported olfactory dysfunction based on subjective tests; four studies carried out objective assessment. Most studies reported on olfaction recovery.

CONCLUSION

The literature review revealed an olfactory dysfunction rate of 49 per cent amongst children and adolescents with coronavirus disease 2019. Persistence of olfactory dysfunction was reported in 7.1 per cent of the patients. Further studies involving objective measures need to be carried out in children and adolescents with coronavirus disease 2019.

Aberrantly low STAT3 and STAT5 responses are associated with poor outcome and an inflammatory gene expression signature in pediatric acute myeloid leukemia

The relapse rate for children with acute myeloid leukemia is nearly 40% despite aggressive chemotherapy and often stem cell transplant. We sought to understand how environment-induced signaling responses are associated with clinical response to treatment. We previously reported that patients whose AML cells showed low G-CSF-induced STAT3 activation had inferior event-free survival compared to patients with stronger STAT3 responses. Here, we expanded the paradigm to evaluate multiple signaling parameters induced by a more physiological stimulus. We measured STAT3, STAT5 and ERK1/2 responses to G-CSF and to stromal cell-conditioned medium for 113 patients enrolled on COG trials AAML03P1 and AAML0531. Low inducible STAT3 activity was independently associated with inferior event-free survival in multivariate analyses. For inducible STAT5 activity, those with the lowest and highest responses had inferior event-free survival, compared to patients with intermediate STAT5 responses. Using existing RNA-sequencing data, we compared gene expression profiles for patients with low inducible STAT3/5 activation with those for patients with higher inducible STAT3/5 signaling. Genes encoding hematopoietic factors and mitochondrial respiratory chain subunits were overexpressed in the low STAT3/5 response groups, implicating inflammatory and metabolic pathways as potential mechanisms of chemotherapy resistance. We validated the prognostic relevance of individual genes from the low STAT3/5 response signature in a large independent cohort of pediatric AML patients. These findings provide novel insights into interactions between AML cells and the microenvironment that are associated with treatment failure and could be targeted for therapeutic interventions.

Integrating Osimertinib in Clinical Practice for Non-Small Cell Lung Cancer Treatment

Treatment of non-small cell lung cancer (NSCLC) is evolving with the use of precision medicine for patients with sensitizing epidermal growth factor receptor (EGFR) mutation. First- and second-generation EGFR tyrosine kinase inhibitors (TKIs) remained the standard of care for patients with EGFR-mutated advanced NSCLC for about a decade. However, treatment resistance eventually develops for most patients who experience initial response to these agents. The most commonly acquired resistance mechanism is the T790M gatekeeper mutation. Poor drug penetration leading to central nervous system (CNS) relapse and dose-limiting toxicities are other concerns. The third-generation EGFR-TKI osimertinib, initially approved as the second-line treatment for patients with T790-mutant NSCLC, demonstrated survival benefits in TKI-naïve EGFR-mutated patients, especially in patients with CNS metastasis. The FLAURA study has shown statistically significant progression-free survival benefit and prolongation of all post-progression outcome endpoints, time to first subsequent therapy, second subsequent therapy, and second progression on subsequent treatment, along with acceptable toxicity and better quality of life outcomes. These data favor osimertinib in the first-line setting for EGFR-mutated NSCLC. This is an important milestone since sequencing the TKI therapy based on accurate prediction of T790M is clinically challenging. In countries like India, T790M testing is not routinely conducted and two-thirds of patients with NSCLC do not receive any second-line therapy. Osimertinib can be administered pragmatically as a first-line therapy. Mature overall survival data from the FLAURA study will be important and could help define the optimal personalized treatment for patients with advanced NSCLC.Funding: AstraZeneca Pharma India Ltd.

Crystal structure determination of two pyridine derivatives: 4-[(E)-2-(4-methoxyphenyl)ethenyl]-1-methylpyridin-1-ium hexafluoro-λ6-phosphane and 4-[(E)-2-[4-(dimethylamino)phenyl]ethenyl]-1-phenyl-1λ5-pyridin-1-ylium hexafluoro-λ6-phosphane

In both title pyridine derivatives, (I) and (II), the cation adopts an E configuration with respect to the C=C. In compound (I), the PF₆⁻ anion is disordered with occupancy factors of 0.614 (7):0.386 (7). In both the compounds, the crystal packing is stabilized by C—H⋯F inter­molecular inter­actions results into two-dimensional mol­ecular sheets, which are formed by (14) ring motifs in compound (I), (40) ring motifs in compound (II). In addition to that, the crystal packing is further stabilized by P—F⋯π inter­actions in compound (I) and π–π in compound (II).

The title mol­ecular salts, C₁₆H₁₆NO⁺·PF₆⁻, (I), and C₂₁H₂₁N₂⁺·PF₆⁻, (II), are pyridine derivatives. In compound (I), the cation comprises a methyl N-substituted pyridine ring and a meth­oxy-substituted benzene ring connected by a C=C double bond. The F atoms of the PF₆⁻ anion are disordered over two sets of sites with refined occupancy factors of 0.614 (7):0.386 (7). In compound (II), the cation comprises a pyridine ring attached to unsubstituted phenyl ring and a di­methyl­aniline ring, which are connected by a C=C double bond. The anion is PF₆⁻. In both salts, the cation adopts an E configuration with respect to the C=C bond. The pyridine ring makes a dihedral angle of 9.86 (12)° with the meth­oxy-substituted benzene ring in compound (I) and 11.2 (3)° with the di­methyl­amine-substituted benzene ring in compound (II). In compound (I), the crystal packing is stabilized by weak C—H⋯F inter­molecular inter­actions which result in R⁴₃(14) ring motifs, forming mol­ecular sheets running parallel to (03). These are further stabilized by weak P—F⋯π interactions. In compound (II), the crystal packing is stabilized by C—H⋯F inter­actions, which result in R⁶₆(40) ring motifs, forming mol­ecular sheets running parallel to (101) and these are further connected by π–π inter­actions.

Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group

The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.

Human papillomavirus in head and neck cancer in India: Current status and consensus recommendations

Human papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Crystal structures of three 1-oxo-1,2-dihydronaphthalene derivatives: dimethyl 4-(4-methoxyphenyl)-2-(4-methylphenyl)-1-oxo-1,2-dihydronaphthalene-2,3-dicarboxylate, dimethyl 1-oxo-2-(pyren-4-yl)-4-(thiophen-2-yl)-1,2-dihydronaphthalene-2,3-dicarboxylate and ethyl 1-oxo-2-phenyl-2,4-bis(thiophen-2-yl)-1,2-dihydronaphthalene-3-carboxylate

In the title 1-oxo-1,2-di­hydro­naphthalene derivatives, the cyclo­hexa-1,3-diene rings of the 1,2-di­hydro­naphthalene ring systems adopt half-chair, boat and half-chair conformations, respectively. In the crystal of the methyl­phenyl compound, the mol­ecules are linked via C—H⋯O, C—H⋯π and π–π inter­actions, forming a double-chain structure, while in the crystals of the other two compounds, mol­ecules are linked by π–π inter­actions, forming a chain structure.

In the title 1-oxo-1,2-di­hydro­naphthalene derivatives, C₂₈H₂₄O₆, (I), C₃₄H₂₂O₅S, (II), and C₂₇H₂₀O₃S₂, (III), the cyclo­hexa-1,3-diene rings of the 1,2-di­hydro­naphthalene ring systems adopt half-chair, boat and half-chair conformations, respectively. The carbonyl O atoms attached to the di­hydro­naphthalene ring systems are each significantly deviated from the mean plane of the 1,2-di­hydro­naphthalene ring system, by 0.6162 (12) Å in (I), 0.6016 (16) Å in (II) and 0.515 (3) Å in (III). The mean planes of the 1,2-di­hydro­naphthalene ring systems make dihedral angles of 85.83 (3), 88.19 (3) and 81.67 (8)°, respectively, with the methyl­phenyl ring in (I), the pyrene ring in (II) and the phenyl ring in (III). In (I), the mol­ecular structure is stabilized by an intra­molecular C—H⋯O hydrogen bond, generating an S(6) ring motif. In the crystal of (I), mol­ecules are linked by an inter­molecular C—H⋯O hydrogen bond, which generates a C(8) zigzag chain running along [100]. Adjacent chains are further connected by C—H⋯π and offset π–π inter­actions [centroid–centroid distance = 3.6572 (9) Å], forming a double-chain structure. In the crystals of (II) and (III), mol­ecules are linked into chain structures by offset π–π inter­actions with centroid–centroid distances of 3.5349 (12) and 3.8845 (13) Å for (II) and 3.588 (2) Å for (III). In (II) and (III), the thio­phene rings are orientationally disordered over two sites, with occupancy ratios of 0.69:0.31 for (II), and 0.528 (4):0.472 (4) and 0.632 (5):0.368 (5) for (III).

Crystal structures of three carbazole derivatives: 12-ethyl-7-phenylsulfonyl-7H-benzofuro[2,3-b]carbazole, (1), 2-(4,5-dimethoxy-2-nitrophenyl)-4-hydroxy-9-phenylsulfonyl-9H-carbazole-3-carbaldehyde, (2), and 12-phenyl-7-phenylsulfonyl-7H-benzofuro[2,3-b]carbazole, (3)

The three title compounds, C26H19NO3S, (1), C27H20N2O8S, (2), and C30H19NO3S, (3), are carbazole derivatives, where (1) and (3) are heterocycle-containing carbazoles with a benzofuran moiety fused to a carbazole unit. In (2), a dimethoxynitrophenyl ring is attached to the carbazole moiety. In the three derivatives, a phenylsulfonyl group is attached to the N atom of the carbazole unit. Compound (1) crystallizes with two independent molecules in the asymmetric unit (AandB). The carbazole skeleton in the three compounds is essentially planar. In compound (1), the benzene ring of the phenylsulfonyl moiety is almost orthogonal to the carbazole moiety, with dihedral angles of 85.42 (9) and 84.52 (9)° in moleculesAandB, respectively. The benzene ring of the phenylsulfonyl group in compounds (2) and (3) are inclined to the carbazole moiety, making dihedral angles of 70.73 (13) and 81.73 (12)°, respectively. The S atom has a distorted tetrahedral configuration in all three compounds. In the crystals, C—H...O hydrogen bonds give rise toR22(12) inversion dimers for compound (1), and toR22(24) inversion dimers andR44(40) ring motifs for compound (2). The crystal packing in (1) also features C—H...π and π–π interactions [shortest intercentroid distance = 3.684 (1) Å], leading to supramolecular three-dimensional aggregation. In the crystal of compound (2), the combination of the various C—H...O hydrogen bonds leads to the formation of a three-dimensional network. In the crystal of compound (3), molecules are linked by C—H...O hydrogen bonds, forming chains running parallel to theaaxis, and the chains are linked by C—H...π interactions, forming corrugated sheets parallel to theabplane.

Crystal structures of two new carbazole derivatives: 12-(4-nitrophenyl)-7-phenylsulfonyl-7H-benzofuro[2,3-b]carbazole and 2-methyl-4-(4-nitrophenyl)-9-phenylsulfonyl-9H-thieno[2,3-b]carbazole

The title compounds are carbazole derivatives, with a benzo­furan ring system in (I) and a methyl­thio­phene ring in (II) fused with the respective carbazole moiety. In the crystals of both compounds, mol­ecules are linked via C—H⋯O hydrogen bonds, forming sheets lying parallel to (10).

The title compounds, C₃₀H₁₈N₂O₅S, (I), and C₂₇H₁₈N₂O₄S₂, (II), are carbazole derivatives with a phenyl­sulfonyl group and a nitro­phenyl group attached to the carbazole moiety in identical positions in both mol­ecules. A benzo­furan ring system in (I) and a methyl­thio­phene ring in (II) are fused with the respective carbazole moieties on the same sides. The mean plane of the carbazole ring system makes a dihedral angle of 3.17 (7)° with the benzo­furan ring system in (I) and a dihedral angle of 3.39 (11)° with the methyl­thio­phene ring in (II), implying that both fused units are essentially planar. The mean planes of the carbazole ring systems in both the compounds are almost orthogonal to the respective nitro-substituted phenyl rings, making dihedral angles of 75.64 (10) and 77.63 (12)° in compounds (I) and (II), respectively. In (I), the phenyl­sulfonyl ring system is positionally disordered with a refined occupancy ratio of 0.63 (2):0.37 (2). In both compounds, the mol­ecular structures are stabilized by intra­molecular C—H⋯O hydrogen bonds, generating S(6) ring motifs with the sulfone group O atoms. In the crystal of compound (I), mol­ecules are linked by pairs of C—H⋯O hydrogen bonds, which generate R₂²(18) inversion dimers, and inter­connected by C(14) chains running along the c-axis direction, whereas in compound (II), the C—H⋯O hydrogen bonds generate R₄³(37) ring motifs. In the crystals of both compounds, C—H⋯O hydrogen-bonded sheets are formed lying parallel to (10-1). In addition, C—H⋯π and offset π–π inter­actions [inter­centroid distance = 3.7158 (14) Å in (I) and 3.9040 (15) Å in (II)] are also present in the crystals of both compounds.

Comparison of nested-multiplex, Taqman & SYBR Green real-time PCR in diagnosis of amoebic liver abscess in a tertiary health care institute in India

BACKGROUND & OBJECTIVES

Amoebiasis is a common parasitic infection caused by Entamoeba histolytica and amoebic liver abscess (ALA) is the most common extraintestinal manifestation of amoebiasis. The aim of this study was to standardise real-time PCR assays (Taqman and SYBR Green) to detect E. histolytica from liver abscess pus and stool samples and compare its results with nested-multiplex PCR.

METHODS

Liver abscess pus specimens were subjected to DNA extraction. The extracted DNA samples were subjected to amplification by nested-multiplex PCR, Taqman (18S rRNA) and SYBR Green real-time PCR (16S-like rRNA assays to detect E. histolytica/E. dispar/E. moshkovskii). The amplification products were further confirmed by DNA sequence analysis. Receiver operator characteristic (ROC) curve analysis was done for nested-multiplex and SYBR Green real-time PCR and the area under the curve was calculated for evaluating the accuracy of the tests to dignose ALA.

RESULTS

In all, 17, 19 and 25 liver abscess samples were positive for E. histolytica by nested-multiplex PCR, SYBR Green and Taqman real-time PCR assays, respectively. Significant differences in detection of E. histolytica were noted in the real-time PCR assays evaluated ( P<0.0001). The nested-multiplex PCR, SYBR Green real-time PCR and Taqman real-time PCR evaluated showed a positivity rate of 34, 38 and 50 per cent, respectively. Based on ROC curve analysis (considering Taqman real-time PCR as the gold standard), it was observed that SYBR Green real-time PCR was better than conventional nested-multiplex PCR for the diagnosis of ALA.

INTERPRETATION & CONCLUSIONS

Taqman real-time PCR targeting the 18S rRNA had the highest positivity rate evaluated in this study. Both nested multiplex and SYBR Green real-time PCR assays utilized were evaluated to give accurate results. Real-time PCR assays can be used as the gold standard in rapid and reliable diagnosis, and appropriate management of amoebiasis, replacing the conventional molecular methods.

Crystal structures and conformations of two Diels-Alder adduct derivatives: 1,8-bis-(thio-phen-2-yl)-14-oxa-tetra-cyclo-[6.5.1.0(2,7).0(9,13)]tetra-deca-2(7),3,5-trien-10-one and 1,8-diphenyl-14-oxa-tetra-cyclo[6.5.1.0(2,7).0(9,13)] tetra-deca-2,4,6-trien-10-one

The title compounds, C21H16O2S2 (I) and C25H20O2 (II), are products of a tandem 'pincer' Diels-Alder reaction consisting of [2 + 2] cyclo-additions between benzo[c]furan and cyclo-penta-none. Each comprises a fused tetra-cyclic ring system containing two five-membered rings (in envelope conformations with the O atom as the flap) and six-membered rings (in boat conformations). In addition, two thio-phene rings in (I) and two phenyl rings in (II) are attached to the tetra-cyclic ring system. The cyclo-penta-none ring adopts a twisted conformation in (I) and an envelope conformation in (II). In (I), the thio-phene rings are positionally disordered over two sets of sites, with occupancy ratios of 0.901 (2):0.099 (2) and 0.666 (2):0.334 (2). In (II), the oxygen atom of the cyclo-penta-none ring is rotationally disordered over two sites with an occupancy ratio of 0.579 (4):0.421 (4). The mol-ecular structure of (I) is stabilized by an intra-molecular C-H⋯O hydrogen bond, which generates an S(7) ring motif. In the crystal, the mol-ecules are linked via weak C-H⋯O hydrogen bonds, which generate R (2) 2(16) ring motifs in (I) and C(8) chains in (II). In both structures, the crystal packing also features C-H⋯π inter-actions. The crystal studied of compound (I) was twinned by non-merohedry. The twin component is related by the twin law [-1 0 0 -0.101 1 -0.484 0 0 -1] operated by a twofold rotation axis parallel to the b axis. The structure of (I) was refined with a twin scale factor of 0.275 (2).

A case of pediatric acute lymphoblastic leukemia with invasive candidiasis: short review

Mortality rate associated with invasive fungal infections is very high. Early suspicion for fungal infections is important during intensive chemotherapy for acute leukemia. Empirical treatment with antifungals amphotericin B or caspofungin should be started if patient is not responding to broad spectrum antibiotics and if expected duration of neutropenia is prolonged. We are reporting a 3 years old girl child with diagnosis of pre-B acute lymphoblastic leukemia who developed invasive candidiasis with typical clinical and radiological findings during induction chemotherapy. Candida non-albicans was isolated and she was treated with amphotericin B followed by caspofungin. Patient deteriorated after initial response and succumbed to death. Species identification and sensitivity pattern of fungus can help in selecting appropriate antifungal drug.

Crystal structure of 2,9-diphenyl-17λ6-thiatetracyclo[8.7.0.03,8.011,16]heptadeca-1(10),2,4,6,8,11(16),12,14-octaene-17,17-dione

The title compound, C₂₈H₁₈O₂S, is composed of a naphthalene ring system fused with a benzo­thio­phene ring and attached to two phenyl rings. The phenyl rings make dihedral angles of 70.92 (8) and 79.23 (8)° with the essentially planar naphthalene ring system (r.m.s. deviation = 0.031 Å). There is an intra­molecular C—H⋯π inter­action present. In the crystal, mol­ecules are linked by C—H⋯O hydrogen bonds which generate C(7) zigzag chains running parallel to [10-1]. The chains are linked via further C—H⋯π inter­actions, forming a three-dimensional structure.

3,10,14,21-Tetra-kis(4-meth-oxy-phen-yl)penta-cyclo-[11.8.0.0(2,11).0(4,9).0(15,20)]henicosa-1(21),2,4(9),5,7,10,13,15(20),16,18-decaen-12-one chloro-form monosolvate

The asymmetric unit of the title compound, C₄₉H₃₆O₆·CHCl₃, contains half an organic mol­ecule, the complete mol­ecule being generated by the operation of a crystallographic twofold rotation axis, and half a highly disordered chloro­form mol­ecule. The contribution to the diffraction pattern of the latter was removed using the program SQUEEZE in PLATON [Spek (2009 ▶). Acta Cryst. D65, 148–155]; the unit-cell characteristics take into account the presence of CHCl₃. The dihedral angles between the planes of the naphthalene ring system and the meth­oxy­benzene rings are 71.05 (7) (syn to the central C=O group) and 57.27 (6)° (anti to the central C=O group). In the crystal, mol­ecules are linked by C—H⋯O inter­actions, generating C(12) chains running parallel to the b axis.

Afro Middle East Asian symposium on cancer cooperation

This manuscript captures the discussion and recommendations that came out of a special Afro Asian symposium involving 13 countries. Unmet needs and cost-effective solutions with special emphasis on training form the backbone of practical next steps.

2-(4,5-Dimeth-oxy-2-nitro-phen-yl)-4-meth-oxy-9-phenyl-sulfonyl-9H-carbazole-3-carbaldehyde

In the title compound, C₂₈H₂₂N₂O₈S, the carbazole ring system is roughly planar, with a maximum deviation of 0.084 (3) Å for the C atom connected to the 4,5-dimeth­oxy-2-nitro­phenyl ring. The dihedral angle between the carbazole system and the dimeth­oxy-substituted nitro­phenyl ring is 57.05 (10)°. The aldehyde C atom deviates by 0.164 (5) Å from its attached carbazole ring system. The mol­ecular structure is stabilized by C—H⋯O inter­actions which generate two S(6) and one S(7) ring motif. In the crystal, mol­ecules are linked by C—H⋯O hydrogen bonds, forming R₃³(15) ring motifs, which are further crosslinked by R₃²(19) ring motifs, resulting in (002) layers. The crystal packing also features C—H⋯π inter­actions.

Methyl 3′-(2,5-dimethylbenzyl)-1′-methyl-2-oxo-4′-phenylspiro[indoline-3,2′-pyrrolidine]-3′-carboxylate chloroform monosolvate

In the title solvate, C₂₉H₃₀N₂O₃·CHCl₃, the dihedral angle between the indole ring system (r.m.s. deviation = 0.050 Å) and the 4-methyl­pyrrolidine ring is 88.88 (8)°. The latter ring adopts an envelope conformation with the N atom as the flap. Its mean plane makes dihedral angles of 86.94 (11) and 42.08 (9)° with the phenyl and di­methyl­benzene rings, respectively. The mol­ecular conformation is stabilized by intra­molecular C—H⋯O hydrogen bonds, which generate S(6) and S(9) ring motifs. The chloro­form solvent mol­ecule is linked to the organic mol­ecule by a C—H⋯O hydrogen bond involving the carbonyl O atom of the carboxyl­ate group. In the crystal, mol­ecules are linked via bifurcated N—H⋯(N,O) and C—H⋯O hydrogen bonds, forming chains propagating along [001].

Methyl 3′-benzyl-4′-(2,4-dichlorophenyl)-1′-methyl-2-oxospiro[indoline-3,2′-pyrrolidine]-3′-carboxylate

In the title compound, C₂₇H₂₄Cl₂N₂O₃, the indole ring system is essentially planar, with a maximum deviation of 0.082 (2) Å for the carbonyl C atom. It makes a dihedral angle of 88.53 (6)° with the mean plane of the 4-methyl­pyrrolidine ring, which adopts an envelope conformation with the N atom at the flap position. The mol­ecular structure is stabilized by intra­molecular C—H⋯O hydrogen bonds, which generate S(6) and S(7) ring motifs, and an intra­molecular π–π inter­action involving the benzyl and di­chloro-substituted benzene rings [centroid–centroid distance = 3.6291 (11) Å]. In the crystal, mol­ecules are linked via N—H⋯O hydrogen bonds, forming C(7) chains running parallel to [10-1].

2-(4,5-Dimethoxy-2-nitrophenyl)-4-methoxy-3-methyl-9-phenylsulfonyl-9H-carbazole

In the title compound, C₂₈H₂₄N₂O₇S, the carbazole system is essentially planar, with a maximum deviation of 0.0644 (19) Å for the C atom connected to the 4,5-dimeth­oxy-2-nitro­phenyl group. The dihedral angle between the carbazole moiety and the dimethoxy-substituted nitrophenyl ring is 58.55 (7)°. The sulfonyl group forms two intra­molecular C—H⋯O bonds with the adjacent carbazole system, forming two cyclic S(6) motifs. In the crystal, mol­ecules are linked along the a axis in bands consisting of cyclic R₃³(15) motifs through two further C—H⋯O hydrogen bonds.

Denosumab: A comprehensive review

The clinical sequelae from bone metastases, termed skeletal-related events (SREs), are among the most frequent and debilitating complications in patients with advanced cancer. Bone metastases are characterized by pathologically increased osteoclast activity, and accumulating evidence indicates that tumor cells interact within the bone to stimulate the receptor activator of nuclear factor kB (RANK)-RANK ligand (RANKL) pathway. RANKL is an essential mediator of osteoclast formation, function, and survival. Because of the central role of RANKL in cancer-induced bone destruction, the inhibition of RANKL has the potential to result in the reduction of pathologic bone resorption. Denosumab is a fully human monoclonal antibody specific for RANKL that inhibits the formation, activation, and survival of osteoclasts. This in turn decreases bone resorption and reduces cancer-induced bone destruction. In this review, we give an overview of the drug Denosumab with its history, mechanism of action, clinical trial data, adverse effects, and future challenges.

2-(4,5-Di-chloro-2-nitro-phen-yl)-4-meth-oxy-3-methyl-9-phenyl-sulfon-yl-9H-carbazole

In the title compound, C₂₆H₁₈Cl₂N₂O₅S, the carbazole ring system is essentially planar with a maximum deviation of 0.0498 (16) Å for the N atom. The carbazole ring system is almost orthogonal to the phenyl­sulfonyl and di­chloro-substituted nitro­phenyl rings, making dihedral angles of 84.23 (7) and 85.46 (12)°, respectively. The mol­ecular structure features intra­molecular C—H⋯O inter­actions, which generate two S(6) ring motifs. In the crystal, mol­ecules are linked by C—Cl⋯O halogen bonds [3.016 (3) Å, 166.63 (5)°], which generate infinite C(8) chains running parallel to [010].

2-(4-Chloro-2-nitrophenyl)-4-methoxy-9-phenylsulfonyl-9H-carbazole-3-carbaldehyde

In the sterically hindered title compound, C₂₆H₁₇ClN₂O₆S, the carbazole ring has a maximum deviation from planarity of 0.067 (4) Å for the C atom connected to the aldehyde group. The carbazole moiety forms a dihedral angle of 72.8 (1)° with the nitro-substituted benzene ring. The O atom of the meth­oxy group deviates by 0.186 (1) Å from the adjacent carbazole moiety. The phenyl­sulfonyl group forms intra­molecular C—H⋯O bonds between sulfone O atoms and the carbazole moiety, resulting in two S(6) rings. In the crystal, the nitrated benzene rings are linked via C—H⋯O inter­actions forming infinite C(7) chains along [100]. The crystal packing is also characterized by C—H⋯π inter­actions, which result in inversion dimers.

Association between proinflammatory cytokines and lipid peroxidation in patients with severe dengue disease around defervescence

OBJECTIVES

Proinflammatory cytokines and the oxidative stress response are reported to be involved in dengue viral disease. The present study investigated the correlation of proinflammatory cytokines and lipid peroxidation with dengue severity.

METHODS

Clinical samples from 27 dengue fever (DF) cases, 30 dengue haemorrhagic fever (DHF) cases, and 24 dengue shock syndrome (DSS) cases were studied around defervescence, along with samples from 30 healthy controls. Plasma samples were analysed for tumour necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) by ELISA and for malondialdehyde (MDA) by thiobarbituric acid assay.

RESULTS

Dengue-infected individuals had significantly higher levels of TNF-α, IFN-γ, and MDA in comparison to controls. The ratio of TNF-α to IFN-γ was significantly higher in DHF and DSS than in DF. A TNF-α/IFN-γ ratio value of 5.69 around defervescence predicted DHF and DSS with moderate accuracy and thus may serve as an indicator to study dengue severity. The study observed a significant positive correlation of lipid peroxides with TNF-α levels and the TNF-α/IFN-γ ratio in severe dengue cases.

CONCLUSIONS

We propose that the oxidative stress response induced by the dengue virus may trigger the inflammatory cytokine responses in dengue severity and thereby contributes to the pathogenesis of the disease; however the interplay between the oxidative response and inflammatory activity in disease virulence needs further study.

rac-4-(4-Chloro-phen-yl)-2-methyl-amino-3-nitro-5,6,7,8-tetra-hydro-4H-chromen-5-one

The title compound, C16H15ClN2O4, contains a chiral centre and crystallizes as a racemate. The methyl-ene group β-positioned to the carbonyl group is partially (21%) disordered. It flips to the opposite sides of the corresponding six-membered carbocycle by -0.304 (3) and 0.197 (11) Å, producing alternative envelope conformations. The planes of the pyran and chloro-phenyl rings form a dihedral angle of 86.25 (9)°. The mol-ecular structure is characterized by an intra-molecular N-H⋯O inter-action, which generates an S(6) ring motif. The corresponding amino N atom deviates from the plane of the pyran ring by 0.1634 (19) Å. In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds, forming C(8) chains running parallel to the b-axis direction. The crystal structure also features C-H⋯π inter-actions.

(4S*)-2-Methyl-amino-3-nitro-4-(4-nitro-phen-yl)-5,6,7,8-tetra-hydro-4H-chromen-5-one

The title compound, C16H15N3O6, is asymmetric with a chiral centre located in the pyran ring and crystallizes as a racemate. The six-membered carbocyclic ring adopts an envelope conformation with the central CH2 C atom as the flap. The amine N atom deviates from the mean plane of the pyran ring by 0.1365 (15) Å. The nitro-phenyl ring is almost orthogonal to the pyran ring and the mean plane of the six-membered carbocyclic ring, the dihedral angle between their mean planes being 88.30 (7) and 87.61 (8)°, respectively. The mol-ecular structure is stabilized by an intra-molecular N-H⋯O hydrogen bond, which generates an S(6) ring motif. In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds, forming infinite bands lying parallel to (-110) and composed of alternate R 2 (2)(24) and R 2 (4)(12) graph-set ring motifs. The crystal structure is further stabilized by C-H⋯π inter-actions, forming a three-dimensional structure.

4-(4-Bromo-phen-yl)-2-methyl-amino-3-nitro-5,6,7,8-tetra-hydro-4H-chromen-5-one

In the title compound, C₁₆H₁₅BrN₂O₄, the six-membered carbocyclic ring of the chromene moiety adopts an envelope conformation with the disordered methyl­ene C atom as the flap. The pyran ring is almost orthogonal to the chloro­phenyl ring, making a dihedral angle of 87.11 (12)°. The amine-group N atom deviates significantly from the pyran ring [0.238 (3) Å]. The mol­ecular structure is stabilized by an intra­molecular N—H⋯O hydrogen bond, which generates an S(6) ring motif. In the crystal, mol­ecules are linked via C—H⋯O hydrogen bonds, which generate C(8) chains running parallel to the b axis. The chains are linked by C—H⋯π inter­actions. The methyl­ene-group C atom of the chromene system that is disordered, along with its attached H atoms and the H atoms on the two adjacent C atoms, has an occupancy ratio of 0.791 (7):0.209 (7).

Rapid plasticity of motor corticospinal system with robotic reach training

Goal-directed reaching is important for the activities of daily living. Populations of neurons in the primary motor cortex that project to spinal motor circuits are known to represent the kinematics of reaching movements. We investigated whether repetitive practice of goal-directed reaching movements induces use-dependent plasticity of those kinematic characteristics, in a manner similar to finger movements, as had been shown previously. Transcranial magnetic stimulation (TMS) was used to evoke upper extremity movements while the forearm was resting in a robotic cradle. Plasticity was measured by the change in kinematics of these evoked movements following goal-directed reaching practice. Baseline direction of TMS-evoked arm movements was determined for each subject. Subjects then practiced three blocks of 160 goal-directed reaching movements in a direction opposite to the baseline direction (14 cm reach 180° from baseline direction) against a 75-Nm spring field. Changes in TMS-evoked whole arm movements were assessed after each practice block and after 5 min following the end of practice. Direction and the position of the point of peak velocity of TMS-evoked movements were significantly altered following training and at a 5-min interval following training, while amplitude did not show significant changes. This was accompanied by changes in the motor-evoked potentials (MEPs) of the shoulder and elbow agonist muscles that partly explained the change in direction, mainly by increase in agonist MEP, without significant changes in antagonists. These findings demonstrate that the arm representation accessible by motor cortical stimulation under goes rapid plasticity induced by goal-directed robotic reach training in healthy subjects.

Abstract 4947: Inhibition of Rapamycin induced AKT activation elicits differential anti-tumor response in head and neck cancers

The PI3K/AKT/mTOR pathway is an important signaling axis that is perturbed in majority of cancers. Biomarkers such as pS6RP, GLUT1 and tumor FDG uptake are being evaluated in patient stratification for mTOR pathway inhibitors. In the absence of a clear understanding of the underlying mechanisms in tumor signaling, the biomarker strategy for patient stratification is of limited use. Here, we show that no discernible correlation exists between FDG uptake and the corresponding Ki67, GLUT1, pS6RP expression in tumor biopsies from Head and Neck Cancer (HNC) patients. Correlation between GLUT1 and pS6RP levels in tumors was observed but elevated pS6RP was noticed even in the absence of concomitant AKT activation, suggesting other downstream molecules of PI3K/AKT and/or other pathways upstream of mTOR, are active in these tumors. Using an ex-vivo platform, we identified putative responders to Rapamycin, an mTOR inhibitor in these tumors. However, Rapamycin did not induce anti-tumor effect in the majority of tumors with activated mTOR, potentially attributable to the observation that Rapamycin induces feedback activation of AKT. Accordingly, treatment of these tumors with an AKT inhibitor and Rapamycin uniformly resulted in abrogation of mTOR inhibition induced AKT activation in all tumors but failed to induce anti-tumor response in a subset. Phosphoproteomic profiling of tumors resistant to dual AKT/mTOR inhibitors revealed differential activation of multiple pathways involved in proliferation and survival. Collectively, our data suggest that in addition to biomarker based segregation, functional assessment of patient tumor prior to treatment with mTOR/AKT inhibitors might be useful for patient stratification.

Citation Format: Padhma Radhakrishnan, Ulaganathan Baraneedharan, Muthu Dhandapani, Allen Thyakumar, Dency Pinto, Arun Prasath, Ayyappan Velu, A Kamal, Nilesh Brijwani, Rohini Nair, R Basavaraja, Misti Jain, Saravanan Thiyagarajan, Biswanath Majumder, Mallik Sundaram, Prasad Narayanan, Vikram D. Kekatpure, Pradip K. Majumder. Inhibition of Rapamycin induced AKT activation elicits differential anti-tumor response in head and neck cancers. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4947. doi:10.1158/1538-7445.AM2013-4947

Retropharyngeal abscess - A complication of laryngeal mask airway

Retropharyngeal or parapharyngeal abscesses developing after intubation are rare. This can present as surgical emergency post extubation. We report a case of retropharyngeal abscess that probably occurred as a complication of laryngeal mask insertion.

4-(2-Benzoyl-benzoyl)-N,N-diphenyl-aniline

The asymmetric unit of the title compound, C₃₂H₂₃NO₂, comprises two crystallographically independent mol­ecules. In both mol­ecules, the geometries about the N atoms deviate significantly from the ideal trigonal–planar geometry with bond-angle sums about the N atom of 359.32° in one mol­ecule and 359.86° in the other. The O atoms of the carbonyl groups are deviated significantly from the central benzene rings by 0.6747 (14) and −1.1223 (13) Å in one molecule and −0.6230 (13) and 1.1559 (12) Å in the other. In the diphenyl­aniline units, the terminal phenyl rings are almost orthogonal to each other, with dihedral angles of 89.79 (9) and 89.76 (9)°. The crystal structure features C—H⋯O and C—H⋯π inter­actions.

{2-[(9,9-Dihexyl-fluoren-2-yl)carbon-yl]phen-yl}(4-meth-oxy-phen-yl)methanone

In the title compound, C₄₀H₄₄O₃, the fluorene ring system is essentially planar, with a maximum deviation of 0.075 (3) Å, and forms dihedral angles of 70.62 (8) and 70.31 (8)° with the mean planes of the central benzene ring and the meth­oxy­phenyl ring, respectively. Both the hexyl side chains have different conformations, i.e. an anti–gauche–anti–gauche conformation with C—C—C—C torsion angles of −169.3 (2), 74.2 (4), −178.0 (3) and −76.0 (6)° for one hexyl side chain and an anti–anti–anti–gauche conformation with C—C—C—C torsion angles of −177.9 (2), −176.5 (3), 171.7 (4) and 80.4 (9)° for the other. Four C atoms in one and two C atoms in the other hexyl side chains are each disordered over two sets of sites, with occupancy factors of 0.761 (3):0.239 (3) and 0.660 (6):0.340 (6). In the crystal, mol­ecules are via pairs of C—H⋯O hydrogen bonds, forming inversion dimers and resulting in R₂²(28) graph-set motifs.

5-Methoxy-3-[(5-methoxy-1H-indol-3-yl)(phenyl)methyl]-1H-indole

In the title compound, C₂₅H₂₂N₂O₂, the indole rings are individually almost planar [with maximum deviations of 0.0116 (19) and 0.0113 (18) Å] and are almost orthogonal to each other, making a dihedral angle of 84.49 (6)°. The benzene ring is inclined at 72.83 (9) and 80.85 (9)° with respect to the indole rings. In the crystal, mol­ecules are linked by N—H⋯O inter­actions into chains running parallel to the c axis. The crystal structure is further stabilized by C—H⋯π inter­actions.