Development of Highly Selective Pyrimidine-Based Aldosterone Synthase (CYP11B2) Inhibitors

Excess aldosterone production and signaling are primary contributors to numerous cardiovascular disorders including primary aldosteronism and resistant hypertension. Recently, inhibition of aldosterone synthesis via the enzyme aldosterone synthase (CYP11B2) has been pursued to ameliorate the negative effects of elevated aldosterone. Herein, we report the development of aldosterone synthase inhibitors using a pyrimidine-based metal binding group leading to the highly selective CYP11B2 inhibitor 22. Superior selectivity combined with robust pharmacokinetics afforded highly selective in vivo aldosterone suppression in a monkey model of adrenal steroidogenesis, demonstrating the potential for selective aldosterone lowering in humans with pyrimidine 22.

Identification of potent, nonabsorbable agonists of the calcium-sensing receptor for GI-specific administration

Modulation of gastrointestinal nutrient sensing pathways provides a promising a new approach for the treatment of metabolic diseases including diabetes and obesity. The calcium-sensing receptor has been identified as a key receptor involved in mineral and amino acid nutrient sensing and thus is an attractive target for modulation in the intestine. Herein we describe the optimization of gastrointestinally restricted calcium-sensing receptor agonists starting from a 3-aminopyrrolidine-containing template leading to the identification of GI-restricted agonist 19 (GSK3004774).

Exploration of phenylpropanoic acids as agonists of the free fatty acid receptor 4 (FFA4): Identification of an orally efficacious FFA4 agonist

The long chain free fatty acid receptor 4 (FFA4/GPR120) has recently been recognized as lipid sensor playing important roles in nutrient sensing and inflammation and thus holds potential as a therapeutic target for type 2 diabetes and metabolic syndrome. To explore the effects of stimulating this receptor in animal models of metabolic disease, we initiated work to identify agonists with appropriate pharmacokinetic properties to support progression into in vivo studies. Extensive SAR studies of a series of phenylpropanoic acids led to the identification of compound 29, a FFA4 agonist which lowers plasma glucose in two preclinical models of type 2 diabetes.

Identification of nonabsorbable inhibitors of the scavenger receptor-BI (SR-BI) for tissue-specific administration

The identification of a low-permeability scavenger receptor BI (SR-BI) inhibitor starting from the ITX-5061 template is described. Structure-activity and structure-permeability relationships were assessed for analogs leading to the identification of compound 8 as a potent and nonabsorbable SR-BI inhibitor.

Identification of diarylsulfonamides as agonists of the free fatty acid receptor 4 (FFA4/GPR120)

The exploration of a diarylsulfonamide series of free fatty acid receptor 4 (FFA4/GPR120) agonists is described. This work led to the identification of selective FFA4 agonist 8 (GSK137647A) and selective FFA4 antagonist 39. The in vitro profile of compounds 8 and 39 is presented herein.

Lipid-mediated release of GLP-1 by mouse taste buds from circumvallate papillae: putative involvement of GPR120 and impact on taste sensitivity

Glucagon-like peptide-1 (GLP-1) signaling modulates sweet-taste sensitivity in the mouse. Because circumvallate papillae (CVPs) express both GLP-1 and its receptor, a local regulation has been suggested. However, whether dietary lipids are involved in this regulation, as shown in the gut, is unknown. By using a combination of biochemical, immunohistochemical, and behavioral approaches, the present data i) confirm the role of GLP-1 signaling in the attraction for sucrose, ii) demonstrate that minute quantities of long-chain FAs (LCFAs) reinforce the attraction for sucrose in a GLP-1 receptor-dependent manner, iii) suggest an involvement of the LCFA receptor GPR120 expressed in taste buds in this system, and iv) support the existence of a regulation by GLP-1 of the lipid sensing mediated by lingual CD36. Therefore, oro-sensory detection of LCFAs may affect sweet and fatty taste responsiveness by controlling the secretion of lingual GLP-1. This regulatory loop, probably triggered by the LCFA-GPR120 interaction, might contribute to the high palatability of foods rich both in fat and sugar.

C-Aryl glycosides via tandem intramolecular benzyne-furan cycloadditions. Total synthesis of vineomycinone B2 methyl ester

A triply convergent total synthesis of vineomycinone B2 methyl ester has been achieved by an approach with a longest linear sequence of 16 steps. The synthesis features the use of silicon tethers as disposable linkers to control the regiochemistry in two tandem Diels-Alder reactions of substituted benzynes and glycosyl furans to provide rapid access to the fully intact anthrarufin core of vineomycinone B2 methyl ester.

Tandem Intramolecular Benzyne-Furan Cycloadditions. Total Synthesis of Vineomycinone B(2) Methyl Ester

We have exploited tandem intramolecular benzyne-furan cycloadditions employing three different benzyne precursors to generate substituted bisoxabenzonorbornadienes in a single operation. The regiochemical outcomes in these Diels-Alder reactions were effectively controlled by using disposable silicon tethers to link the reacting benzynes and furan moieties. Two different methods for converting the intermediate bisoxabenzonorbornadienes to substituted anthrarufins were developed. The first tactic entails the initial cleavage of the silicon tethers followed by regioselective ring opening of the oxabicycloheptadienes and oxidation of the central ring giving the target anthrarufin, whereas the second features the regioselective ring opening of the oxabicycloheptadienes followed by protiodesilylation and oxidation. When the starting furans bear carbohydrate substitutents, this new methodology enables the rapid assembly of the glycosyl-substituted aromatic cores of complex C-aryl glycoside antibiotics from simple starting materials. The utility of this novel approach to anthrarufins and C-aryl glycosides is exemplified in a triply convergent synthesis of vineomycinone B(2) methyl ester.

Glycogen phosphorylase inhibitors

Type 2 diabetes is a complex metabolic disease with hyperglycemia as its recognizable hallmark. Hepatic glucose output is elevated in Type 2 diabetic patients, and evidence suggests drugs which lower hepatic glucose production are effective antihyperglycemic agents. Glycogenolysis, which is the release of monomeric glucose from its polymeric storage form called glycogen, is a key contributor to hepatic glucose output. Glycogen phosphorylase is the enzyme that catalyzes this process. This review covers advances in the design of small molecule inhibitors of this enzyme, their biological activity, and their potential as effective antihyperglycemic agents for the treatment of Type 2 diabetes.

Type 2 intramolecular N-acylnitroso Diels-Alder reaction: scope and application to the synthesis of medium ring lactams

Heteroatom variants of the type 2 intramolecular Diels-Alder reaction provide an efficient method for the preparation of bridged bicyclic heterocycles. The type 2 variant of the intramolecular N-acylnitroso Diels-Alder reaction is an effective method for the synthesis of bridged bicyclic oxazinolactams. Structural studies of the cycloadducts have allowed for quantification of the deformations of the bridgehead functionalities and provided a strategy for the stereoselective synthesis of substituted seven- and eight-membered ring lactams. Diastereoselective cycloadditions followed by cleavage of the oxazine ring afford azepin-2-ones or azocin-2-ones.

Regioselective Synthesis of Unsymmetrical C-Aryl Glycosides Using Silicon Tethers as Disposable Linkers

Silicon tethers were employed to control the regiochemistry of Diels-Alder reactions between substituted benzynes and glycosyl furans as a key step in the syntheses of unsymmetrical representatives of three major groups of C-aryl glycosides. The cycloaddition precursors were readily prepared by O-alkylation of substituted phenols with various sugar-substituted furylsilane derivatives. Selective deprotonation on the benzene ring of these ethers led to a benzyne that underwent an intramolecular Diels-Alder reaction to give bridged cycloadducts. Fluoride-induced removal of the silicon tether and acid-catalyzed ring opening of the oxabicycloheptadiene subunit yielded the desired C-aryl glycosides as single isomers.

Preparation of perhydroisoquinolines via the intramolecular Diels-Alder reaction of N-3,5-hexadienoyl ethyl acrylimidates: a formal synthesis of (+/-)-reserpine

The intramolecular Diels-Alder reaction of N-3,5-hexadienoyl ethyl acrylimidates provides an efficient method for the synthesis of cis-fused hexahydroisoquinolones. As a demonstration of the stereochemical control offered by this cycloaddition, two approaches to the construction of the DE rings of reserpine are reported. In the second entry, N-((4-(trimethylsilyl)ethoxymethoxy)methyl-6-benzyloxy-3Z,5E-hexadienoyl)-1-aza-2-ethoxy-1,3-butadiene (40) undergoes cycloaddition to produce as the major product (4aS,7R,8aS)-7-benzyloxy-5-((2-trimethylsilyl)ethoxymethoxy)methyl-3,4,4a,7,8,8a-hexahydroisoquinol-3-one (41). Cycloadduct 41 is then stereospecifically elaborated to (4aS,5S,6R,7R,8aR)-6-methoxy-5-methoxycarbonyl-7-(3,4,5-trimethoxy)benzoyldecahydroisoquinoline-2-carboxylic acid methyl ester (3), a key intermediate previously transformed to reserpine.

Type 2 intramolecular N-acylnitroso diels-alder reaction: stereoselective synthesis of bridged bicyclic oxazinolactams

[reaction: see text] The type 2 intramolecular N-acylnitroso Diels-Alder reaction has been employed for the synthesis of substituted bridged bicyclic oxazinolactams. Upon oxidation of hydroxamic acid 6, a 3-benzylated oxazinolactam (7) was synthesized with complete diastereoselectivity. Elaboration of cycloadduct 7 liberated a cis-3,7-disubstituted azocin-2-one (9).

Vinyl imidates in cycloaddition reactions: a formal synthesis of (+/-)-reserpine

[reaction: see text] The intramolecular Diels-Alder reaction of N-acylvinylimidates provides an efficient entry into cis-fused perhydroisoquinoline ring systems. This is demonstrated by the preparation of isoquinoline 2, an intermediate, which has been previously transformed to reserpine.

2-Amino-6-arylsulfonylbenzonitriles as non-nucleoside reverse transcriptase inhibitors of HIV-1

A series of 2-amino-5-arylthiobenzonitriles (1) was found to be active against HIV-1. Structural modifications led to the sulfoxides (2) and sulfones (3). The sulfoxides generally showed antiviral activity against HIV-1 similar to that of 1. The sulfones, however, were the most potent series of analogues, a number having activity against HIV-1 in the nanomolar range. Structural-activity relationship (SAR) studies suggested that a meta substituent, particularly a meta methyl substituent, invariably increased antiviral activities. However, optimal antiviral activities were manifested by compounds where both meta groups in the arylsulfonyl moiety were substituted and one of the substituents was a methyl group. Such a disubstitution led to compounds 3v, 3w, 3x, and 3y having IC50 values against HIV-1 in the low nanomolar range. When gauged for their broad-spectrum antiviral activity against key non-nucleoside reverse transcriptase inhibitor (NNRTI) related mutants, all the di-meta-substituted sulfones 3u-z and the 2-naphthyl analogue 3ee generally showed single-digit nanomolar activity against the V106A and P236L strains and submicromolar to low nanomolar activity against strains E138K, V108I, and Y188C. However, they showed a lack of activity against the K103N and Y181C mutant viruses. The elucidation of the X-ray crystal structure of the complex of 3v (739W94) in HIV-1 reverse transcriptase showed an overlap in the binding domain when compared with the complex of nevirapine in HIV-1 reverse transcriptase. The X-ray structure allowed for the rationalization of SAR data and potencies of the compounds against the mutants.

The Type 2 Intramolecular Diels-Alder Reaction: Synthesis and Chemistry of Bridgehead Alkenes

Anti-Bredt alkenes, bicyclic molecules that contain a bridgehead double bond, were for many years regarded as chemical curiosities. The type 2 intramolecular Diels-Alder (IMDA) reaction provides a one-step entry into this fascinating class of molecules. The reaction has made available numerous anti-Bredt alkenes for structural and chemical studies. X-ray crystallography has revealed the magnitude of the deformations associated with the bridgehead double bond, and rate studies of reactions of bridgehead alkenes have allowed quantification of the kinetic consequences of the torsional distortions. More recently, the type 2 intramolecular Diels-Alder reaction and the resulting anti-Bredt alkenes have found application in organic synthesis. The constraints resulting from the connectivity in the Diels-Alder precursor creates a strong regio- and stereochemical bias in the cycloaddition step. The end result of this bias is the stereoselective synthesis of highly substituted six-membered rings. The reaction also achieves a facile synthesis of seven- and eight-membered rings in a single step from acyclic precursors. The utility of this reaction has been verified in recent applications of the type 2 IMDA reaction as a key step in the total synthesis of complex natural products.

Type 2 intramolecular nitroso Diels-Alder reaction. Synthesis and structure of bridgehead oxazinolactams

[reaction--see text] The type 2 intramolecular Diels-Alder cycloaddition utilizing N-acylnitroso dienophiles provides an efficient entry into bridged oxazinolactams. In contrast to the bimolecular counterpart, the reaction is completely regioselective. Structural characterization of the cycloadducts allows for evaluation of the olefin distortion and the degree of pyramidalization of the bridgehead oxazinolactam.

Twenty care components: an educational strategy to teach nursing science

The HHCC System's twenty care components and nomenclature provide a framework for the development of teaching strategies to prepare nurses for practice in the 21st century. The use of an integrated system of instruments accessible to students on-line allows for a smooth transition from course to course and later to clinical nursing practice. Faculty and/or instructors at Georgetown University School of Nursing use this innovative educational strategy and conceptual approach to facilitate collaboration with other healthcare providers and to model professional behavior for students.

World Wide Web search tools

This article describes and compares five popular general search tools and two popular general metasearch tools. The tools and their related files in February 1998 are the source of information and illustrations. A MEDLINE(R) search no longer guarantees retrieval of the most current, relevant, appropriate, and useful information. To meet demands for current information, the World Wide Web (WWW) must be searched. However, the enormous size of the WWW makes finding relevant information a difficult task. Fortunately, there are many automated search tools that can assist in locating relevant information quickly. Choosing the most appropriate tool depends on the type of information being sought.

Changes in bacterial flora associated with skin damage on hands of health care personnel

In a prospective observational study of 40 nurses (20 with diagnosed hand irritation and 20 without), nurses with damaged hands did not have higher microbial counts (P = .63), but did have a greater number of colonizing species (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses with damaged hands were significantly more likely to be colonized with Staphylococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nurses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses with damaged hands were colonized with Staphylococcus aureus compared with none of the nurses with normal hands (P = .11). Nurses with damaged hands were also twice as likely to have gram-negative bacteria (P = .20), entercocci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial resistance of the coagulase-negative staphylococcal flora (with the exception of S hominis) did not differ between the 2 groups, nor did a trend toward increasing resistance exist when compared with other studies during the past decade. Skin moisturizers and protectant products were used almost universally by nurses at work, primarily products brought from home. Efforts to improve hand condition are warranted because skin damage can change microbial flora. Such efforts should include assessment or monitoring of hand care practices, formal institutional policy adoption and control of use of skin protectant products or lotions, and prudent use of latex gloves or more widespread use of powder-free and nonlatex products.

Noun phrases for nursing diagnoses

TOPIC

The use of noun phrases for nursing diagnoses instead of the current mixture of phrases and clauses

PURPOSE

This article reviews the current list of qualifiers; discusses language clarity, precision, grammatical concerns; and defines noun phrases.

SOURCE

Literature review

CONCLUSIONS

The author proposes a list of qualifiers to replace the current list, and recommends a revised list of nursing diagnoses using noun phrases to improve their clinical usefulness, allow for alphabetization, and enhance clarity.

Using the Internet for nursing administration

The Internet offers unique communication opportunities that can be used advantageously by nurse administrators. The Internet supports electronic mail, file transfer protocol, telnet, Gopher, and World Wide Web protocols. Examples of nursing administration resources for each protocol are given. Issues involving the Internet include quality of the resource, confidentiality and privacy, taking advantage of the vision and support of nurse executives, licensure and reimbursement.

Use of the Internet for infection control and epidemiology

Infection control professionals are taking advantage of the Internet for the rapid transmission and distribution of information that includes sounds, still and motion images, and text to their peers, colleagues, patients, and the public. This article provides some background information on the Internet and examples of some electronic resources and offers suggestions of additional applications of the Internet for infection control and epidemiology.

Using the Internet for urology nursing

Nurses can take advantage of the Internet for information on diseases, diagnosis, and treatment, patient teaching, and collaboration with colleagues. The Internet is briefly described in this article. Several specific Internet addresses are given. Issues such as quality of resources, confidentiality and privacy, professional licensure and reimbursement of services rendered, and cost are discussed. Search tools for finding information you want on the Internet are included.

Modification of the diagnostic content validity model

Diagnostic content validation of nursing diagnoses is a recommended means to confirm the defining characteristics necessary to establish a specific nursing diagnosis. The diagnostic content validity model has been used in numerous studies to develop lists of major and minor defining characteristics recommended by experts as being present in patients with specific diagnoses. The authors provide an overview of the diagnostic content validity model, review the meaning and purposes of content validity, discuss problems with information processing, and suggest revisions to the diagnostic content validity model. Incorporation of these changes may improve the usability of nursing diagnoses in clinical practice, education, and research.

Educational Technology Network: a computer conferencing system dedicated to applications of computers in radiology practice, research, and education

Educational Technology Network (ET Net) is a free, easy to use, on-line computer conferencing system organized and funded by the National Library of Medicine that is accessible via the SprintNet (SprintNet, Reston, VA) and Internet (Merit, Ann Arbor, MI) computer networks. It is dedicated to helping bring together, in a single continuously running electronic forum, developers and users of computer applications in the health sciences, including radiology. ET Net uses the Caucus computer conferencing software (Camber-Roth, Troy, NY) running on a microcomputer. This microcomputer is located in the National Library of Medicine's Lister Hill National Center for Biomedical Communications and is directly connected to the SprintNet and the Internet networks. The advanced computer conferencing software of ET Net allows individuals who are separated in space and time to unite electronically to participate, at any time, in interactive discussions on applications of computers in radiology. A computer conferencing system such as ET Net allows radiologists to maintain contact with colleagues on a regular basis when they are not physically together. Topics of discussion on ET Net encompass all applications of computers in radiological practice, research, and education. ET Net has been in successful operation for 3 years and has a promising future aiding radiologists in the exchange of information pertaining to applications of computers in radiology.

Electronic networking for nurses

Electronic networks can provide access to other nurses locally and around the world via electronic mail and on-line interactions. Networks can give nurses access to information and to the data that are processed and stored in computers in their own facility and in computers at remote sites. The major international networks, Internet, FidoNet, and BITNET each offer these opportunities. In addition, Internet, the network most useful to nurses, allows access to Sigma Theta Tau's International Nursing Library, E.T.Net, and the MEDLARS family of bibliographic data bases. Taking advantage of the services and resources networks offer can facilitate nursing practice, education, and research.

Clinical validation of pressure ulcer risk factors

The maintenance of skin integrity is considered to be a survival need in the human need nursing framework. Risk factors for the nursing diagnosis High Risk For Impaired Skin Integrity: Pressure Ulcer were identified in a diagnostic content validity study. The purpose of this study was to use a pressure ulcer risk assessment instrument based on results of that study. The clinical validation model was used to analyze the ulcer risk factor cluster present in a sample of older adults residing in two nursing homes in the Mid-Atlantic region of the United States. A convenience sample of 108 residents were each assessed independently by two research assistants. Interrater reliability of the instrument was 93 percent. There were eight risk factors present in more than 60 percent of the subjects in the pressure ulcer group; six in the high risk group, and five in the low risk group. Findings suggest that three factors may be the best discriminators for pressure ulcer risk: (1) friction, (2) being dependent in self-care, and (3) being confined to bed/chair.

Nurse validation of pressure ulcer risk factors for a nursing diagnosis

The nursing diagnosis "Potential Impaired Skin Integrity: Pressure Ulcer" provides a model for determining pressure ulcer risk. This article describes assessment parameters and risk factors that may be useful in the assessment of pressure ulcer risk. Results of a diagnostic content validity study of this diagnosis conducted by the author (Sparks, 1990) are presented.

The U.S. National Library of Medicine: a worldwide nursing resource

The National Library of Medicine, the world's largest library of the health sciences, will celebrate this year the 150th anniversary of its founding. The Library's material and its information services may be used by nurses and other health professional and health science students throughout the world.