Search

A chiral calcium phosphate-catalyzed enantioselective Friedel–Crafts alkylation reaction of pyrroles and α-trifluoromethyl-β-nitrostyrenes has been developed. Pyrroles bearing an all-carbon quaternary center at 2-position were obtained with high to excellent enantioselectivity. Use of 4,7-dihydroindole as a nucleophile and subsequent oxidation resulted in the formation a 2-substituted indole derivative with excellent enantioselectivity. A 3,4-dihydropyrrolo[1,2- c ]pyrimidine derivative was successfully synthesized by reduction followed by benzoylation of the product without loss of enantioselectivity. Application to a 1 mmol scale reaction was successfully achieved. [ABSTRACT FROM AUTHOR]

The application and scope of a new class of chiral Bronsted-acid organocatalysts used in number of enantioselective carbon-carbon bond-forming reactions is reviewed.

Background: The advanced lung cancer inflammation index (ALI), which comprehensively evaluates the patient body composition and inflammation/nutritional status, is reportedly associated with the patient outcome in lung cancer. However, the clinical significance in colorectal cancer (CRC) patients after curative resection remains unclear. Methods: A total of 813 CRC patients after curative resection between April 2005 and June 2019 in a single institution were retrospectively enrolled. The association of the preoperative ALI (calculated as follows: body mass index × albumin value/neutrophil‐to‐lymphocyte ratio) with clinicopathological factors, postoperative complications, and survival was analyzed. Results: A low ALI was significantly associated with male gender, older age, a higher depth of tumor invasion, progressed TNM stage, and preoperative carcinoembryonic antigen (CEA) positivity. Both postoperative complications and severe complications occurred more frequently in the ALI‐low group than in the ALI‐high group (P <.001 and P <.001, respectively), especially postoperative complications in stage III patients (P <.001) and severe complications in stages II and III patients (P =.024 and P =.004, respectively). In addition, a low ALI was an independent predictor of a poor overall survival (hazard ratio: 2.30, 95% confidence interval: 1.52–3.50, P <.001) and relapse‐free survival (hazard ratio: 1.73, 95% confidence interval: 1.22–2.44, P =.002), especially in older patients, and in patients without lymph node metastasis or severe postoperative complications. Conclusion: This study suggests that preoperative ALI may serve as a novel independent predictive index for severe postoperative complications and recurrence in CRC patients after curative resection. [ABSTRACT FROM AUTHOR]

Introduction: The present study assessed the utility of a dry box time trial during laparoscopic surgical training to improve laparoscopic surgical skills and surgical outcomes. Methods: In a monthly time trial, surgeon trainees twice completed a set task that involved grasping a suture, aligning a needle with a needle holder, passing the suture, making three knots, and cutting the two tails of the suture. The mean suturing time was then analyzed. To assess the utility of this time trial, we analyzed the short‐term outcomes of patients with stage I to III colon cancer who had undergone laparoscopic colectomy before and after the introduction of the time trial. Results: The monthly time trial was introduced in October 2018, and 52 surgeon trainees participated in the trials examined in this study. Within 6 months of the program's introduction, the mean suturing time had significantly declined to less than 70% of the time trial, while the standard deviations had declined to less than 30%. In comparisons of the short‐term outcomes of laparoscopic colon cancer surgery before (n = 49) and after (n = 46) the introduction of the time trial, the operative time tended to decline (P =.074) after the introduction of the time trial, and blood loss was significantly reduced (P =.018). The rate of postoperative complications was similar before and after the introduction. Conclusion: Regular time trials of laparoscopic surgical suture training using a dry box can be useful for improving laparoscopic surgical skills and surgical outcomes. Moreover, time trials can keep trainees motivated. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of old age on the perioperative, short-term, and long-term surgical outcomes of elderly patients undergoing curative surgery for colorectal cancer (CRC). Methods: The subjects of this retrospective study were 526 patients who underwent curative resections for stage I–III CRC between March 2005 and March 2016. We divided the patients into a young group (< 75 years old, n = 361) and an elderly group (≥ 75 years old, n = 165) and compared the clinicopathological factors and prognoses of the two groups. We performed a propensity score-matched (PSM) analysis with inverse probability of treatment weighting (IPTW) to avoid confounding bias. Results: The elderly group had more right-sided tumors and more comorbidities than the young group. After PSM, there were 148 patients in each group. Although the elderly group had significantly shorter overall survival than the young group, the two groups did not differ significantly in cancer-specific survival (CSS; P = 0.136) or recurrence rate (RR; P = 0.317). Multivariate analysis with IPTW also revealed no significant difference in CSS (P = 0.171) or RR (P = 0.284) between the young and elderly groups. Our findings were limited by the study's retrospective single-institute conditions, and the inclusion of only patients who underwent radical resections. Conclusion: Primary tumor resection is appropriate for elderly patients with CRC. [ABSTRACT FROM AUTHOR]

Thymic carcinoma, a rare mediastinal neoplasm, is characterized by extensive local invasion and distant metastasis. To our knowledge, this is the first case report demonstrating the efficacy of laparoscopic dissection for pelvic lymph node metastases from thymic carcinoma. A 64‐year‐old man was found to have a mediastinal mass by CT and underwent radical resection. Six months after resection of his thymic carcinoma, follow‐up CT revealed a gluteal tumor and enlarged pelvic lymph nodes. The gluteal tumor was resected percutaneously. Two months after this procedure, PET showed that the three pelvic lymph nodes had abnormal uptake of 18F‐fluorodeoxyglucose and had enlarged further. The patient accordingly underwent laparoscopic dissection of these lymph nodes. Pathological examination of all resected specimens showed metastatic thymic carcinoma. We recommend laparoscopic dissection of pelvic lymph node metastases because it provides a clear intraoperative view and is minimally invasive. [ABSTRACT FROM AUTHOR]

The density functional theory calculations are employed to analyze the chiral bronsted acid catalyzed enantioselective Mannich-type reaction of ketene silyl acetals with aldimines, which proceeds catalytically by means of a phosphoric acid diester. The results show that the reaction proceeds only through a diccordination pathway through the zwitterionic and nine-membered cyclic transition state (TS) consisting of aldimine and the phosphoric acid.