Long-term health consequences of congenital adrenal hyperplasia.

Congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency accounts for 95% of all CAH cases and is one of the most common inborn metabolic conditions. The introduction of life-saving glucocorticoid replacement therapy 70 years ago has changed the perception of CAH from a paediatric disorder into a lifelong, chronic condition affecting patients of all age groups. Alongside health problems that can develop during the time of paediatric care, there is an emerging body of evidence suggesting an increased risk of developing co-morbidities during adult life in patients with CAH. The mechanisms that drive the negative long-term outcomes associated with CAH are complex and involve supraphysiological replacement therapies (glucocorticoids and mineralocorticoids), excess adrenal androgens both in the intrauterine and postnatal life, elevated steroid precursors and adrenocorticotropic hormone levels. Alongside a review of mortality outcome, we discuss issues that need to be addressed when caring for the CAH patient including female and male fertility, cardio-metabolic morbidity, bone health and other important long-term outcomes of CAH.

TBHP-mediated photochemical coupling/cyclization of N-arylacrylamides with thiols.

The effective photoredox-mediated oxidative thiolation and cyclization of N-arylacrylamides with thiols leads to biologically interesting 3-thionated oxindoles through C-S and C-C bond formation. This process represents a straightforward reaction that starts from non-prefunctionalized thiolating reagents. Mechanistic studies demonstrated that the TBHP serves as a key radical initiator with visible-light catalysis.

Recent Advances in Molecule Synthesis Involving C-C Bond Cleavage of Ketoxime Esters.

The synthetic strategies of oxime derivatives participating in radical-type reactions have been rapidly developed in the last few decades. Among them, the N-O bond cleavage of oxime esters leading to formation of nitrogen-centered radicals triggers adjacent C-C bond cleavage to produce carbon-centered free radicals, which has been virtually used in organic synthesis in recent years. Herein, we summarized the radical reactions involving oxime N-O bond and C-C bond cleavage through this special reaction form, including those from acyl oxime ester derivatives and cyclic ketoxime ester derivatives. These contents were systematically classified according to different reaction types. In this review, the free radical reactions involving acyl oxime esters and cyclic ketoxime esters after 2021 were included, with emphasis on the substrate scope and reaction mechanism.

Photoredox Neutral Decarboxylative Hydroxyalkylations of Heteroarenes with α-Keto Acids.

Photoredox neutral decarboxylative hydroxyalkylations of heteroarenes with α-keto acids under mild conditions are described. Stable and readily available α-keto acids were employed as hydroxyalkylating reagents with only CO2 released as the byproduct. A range of aromatic and aliphatic α-keto acids were successfully converted into hydroxyalkylated products with various heteroarenes. This transformation proceeded through a decarboxylation/Minisci addition/SCS sequence, generating a variety of valuable hydroxyalkylated heteroarenes.

Copper-catalyzed three-component N-alkylation of quinazolinones and azoles.

A Cu-catalyzed three-component N-alkylation coupling reaction of N-heteroarenes with methyl ketones and DMPA as a carbon source has been developed. Using methyl ketones as alkylation reagents and DMPA (N,N'-dimethylpropionamide) as a carbon source, the reaction proceeded smoothly under the Cu-based oxidative system and led to a series of functionalized N-heterocycles including 4-quinazolinones, triazoles and pyrazoles.

Study of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block to prevent pain syndrome by evaluating ccl2 gene expression after radical mastectomy.

This study aimed to investigate the clinical effect of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block in preventing postoperative pain syndrome of breast cancer. For this purpose, 100 women treated for breast cancer from April 2018 to July 2019 were enrolled as research objects. Surgical procedures included local sentinel lymph node biopsy, mastectomy, sentinel lymph node biopsy for mastectomy, modified radical mastectomy, and implantation. The selected patients were randomly divided into two groups: control group (routine operation anesthesia; n = 50) and observation group (ultrasound-guided thoracic paravertebral block before induction of ropivacaine+butorphanol anesthesia; n = 50). The Real-time PCR technique was performed to evaluate CCL2 gene expression. VAS scores were recorded during the postoperative period. Compared with the control group, the observation group had lower VAS scores at six h, 24h, and 48h (P<0.05). The pain effect of the observation group was less than that of the control group. The observation group had better analgesic effects after anesthesia. The observation group had a lower incidence of pain syndrome at the 6th, 8th, and 12th months (P<0.05), and the incidence of pain syndrome in the two groups decreased with the extension of time. The observation group had lower levels of related factors (P<0.05), and the observation group had lower traumatic stress responses. The protein expression of IL-6, IL-17, and CRP in the observation group was lower than that in the control group (P<0.05). The results of CCL2 gene expression also showed that gene expression in the control group increased significantly (P=0.0047). Since the expression of this gene is one of the factors that stimulate pain signals in the body, the method used in the present study was able to reduce the amount of pain significantly. Therefore, the combination of ropivacaine combined with butorphanol ultrasound-assisted paravertebral block can reduce the intensity of postoperative pain in patients with breast cancer surgery, decrease the incidence of pain syndrome, and increase pain tolerance.

Photocatalytic aerobic α-thiolation/annulation of carbonyls with mercaptobenzimidazoles.

A concise aerobic photocatalysis using a blue LED combined with a Lewis acid has been developed to enable α-thiolation/annulation of carbonyls. Inexpensive, nontoxic Rose Bengal was demonstrated as the best catalyst. Hence, this transition-metal-free protocol allows mild Csp3-S couplings with both ketones and aliphatic aldehydes with a range of compatible useful functionalities.

Transition metal-catalyzed C-H functionalization of N-oxyenamine internal oxidants.

The transition metal-catalyzed C-H functionalization with hydroxylamine derivatives serving as both reactants and internal oxidants has attracted a lot of interest. These reactions obviate the need for external oxidants and therefore result in high reactivity and selectivity, as well as excellent functional group tolerance under mild reaction conditions, and moreover, water, methanol or carboxylic acid is generally released as the by-product, thus leading to reduced waste. This review focuses on the transition metal-catalyzed oxidative C-H functionalization of N-oxyenamine internal oxidants, with an emphasis on the scope and limitations, as well as the mechanisms of these reactions.

Internal Oxidant-Triggered Aerobic Oxygenation and Cyclization of Indoles under Copper Catalysis.

A concise synthesis of pyrazolo[1,5-a]indole derivatives by copper-catalyzed aerobic oxygenation and cyclization of indoles with oxime acetates is described. This protocol represents an elegant example of N-1, C-2, and C-3 tri-functionalization of indoles in one-pot. Mechanistic studies indicate the reaction proceeds through a radical procedure. Oximes as an internal oxidant have been demonstrated to be a driver to initiate aerobic oxidation, which provides a new oxidative pattern for C-H functionalization even with high atom- and step-economy.

Palladium-catalyzed oxidative C-N bond coupling involving a solvent-controlled regioselective bromination process.

Stereoselective palladium-catalyzed oxidative C-N bond coupling reactions between aromatic amines and alkenes involving a solvent-controlled regioselective bromination process under 1 atm of oxygen atmosphere are disclosed, providing easy access to two different brominated enamines. The addition of hydrogen peroxide (30% aq) as a co-oxidant in the system is crucial for the dehydrogenative aminohalogenation under molecular oxygen (1 atm), and in such a case, the C-N bond coupling/electrophilic bromination reaction cascade is proposed. Furthermore, the different reaction media leads to a switched regioselectivity of the process.

Hydroazidation of trifluoromethyl alkenes with trimethylsilyl azide enabled by organic photoredox catalysis.

Herein, we report an organic photoredox-catalyzed hydroazidation of trifluoromethyl alkenes with user-friendly trimethylsilyl azide (TMSN3), enabling a direct access to a broad range of valuable ß-CF3-azides with exclusive selectivity under mild reaction conditions. The synthetic utility of this reaction was demonstrated by the late-stage modification of complex drug derivatives, scale-up of the reaction and diverse further derivatizations of the ß-CF3-azide product.

Photoredox Enabled Defluorinative Benzylation of Trifluoromethyl Alkenes with Alkylarenes.

Herein, we report a photoredox enabled defluorinative benzylation of trifluoromethyl alkenes with readily available alkylarenes, which provides convenient access to a series of structurally valuable benzylated gem-difluoroalkenes under mild reaction conditions. The synthetic value of this protocol has been demonstrated by the transformations of several substrates bearing drug moieties, gram-scale reactions, and various further derivatizations of the gem-difluoroalkene products. The preliminary mechanistic investigations suggest a reaction pathway with rate-determining benzyl C-H bond cleavage of toluene followed by benzylic radical formation.

Copper-Catalyzed 1,2-Sulfonyletherification of 1,3-Dienes.

A selective three-component 1,2-sulfonyl etherification of aryl 1,3-dienes enabled by copper catalysis to afford biologically interesting alkenyl 1,2-sulfone ether derivatives through C-S and C-O bond formation is described. The protocol proceeds with the sulfonyl chloride and alcohols under simple, mild, and base-free conditions, providing a straightforward route to sulfonylated allyl ether compounds with broad functional group tolerance and excellent chemo- and regioselectivity. Mechanistic studies indicate that the selective alkene difunctionalization includes a key copper-mediated single-electron transfer process.

Accessing 3,4-Dihydroquinolinone from N-Arylacrylamides via Tetralone-Mediated Energy Transfer and 1,3-Hydrogen Shift.

Herein, we introduce a tetralone-mediated photocyclization method of N-arylacrylamides. The protocol proceeds smoothly to deliver a diverse set of 3,4-dihydroquinolinones in moderate to good yields with excellent functional group compatibility and readily allows for late-stage modifications of a number of complex drug molecules. Mechanistic studies reveal that the present systems with ultraviolet light irradiation enable the cyclization via energy transfer and exclusive 1,3-hydrogen shift.

Accessing pyrrolo[1,2-a]indole derivatives via visible-light-induced dearomatizative cyclization of indoles.

Pyrrolo[1,2-a]indoles are structurally important scaffolds in many natural products and bioactive compounds. Herein, we report a novel synthetic method for pyrrolo[1,2-a]indole derivatives through visible-light-induced cascade dearomatizative cyclization of indoles with external nucleophiles. Moderate yields, good diastereoselectivities, and excellent regioselectivities were generally observed with the resultant indole-fused polycyclic compounds.

National service evaluation of the quality of care for children and young people with congenital adrenal hyperplasia in the United Kingdom: survey responses from patients and clinicians.

INTRODUCTION: Quantifying differences in service provision for children and young people (CYP) living with Congenital Adrenal Hyperplasia (CAH) across the United Kingdom. METHODS: A national service evaluation using online questionnaires circulated to patients and clinicians from secondary and tertiary UK centres managing CYP with CAH, and via the "Living with CAH" support group mailing list. RESULTS: Total of 195 responses relating to patients aged 0-20 years attending 33 clinics (43 patients, 152 carers), as well as 34 clinicians from 18 trusts working across the 33 clinics. Only 12% of clinicians were 'completely satisfied' with the service provided, compared to 68% of carers and 76% of patients. Whilst 94% of clinicians reported providing formal training to families with CAH, over 80% of both patients and carers reported not attending what they considered formal training. Appetite for further training was higher in carers (86%) than patients (55%), although further 'unsure' responses suggested formal training sessions would likely be well attended. Access to psychological services was difficult for 44% of clinicians. Biochemical monitoring of treatment was broadly in keeping with international guidelines, with 67% of clinicians reporting regular use of dried blood spots, and 12% regular urinary steroid metabolites. CONCLUSION: While there is overall good satisfaction with care provision among patients and carers with CAH in the UK, extra resources addressing the psychological and educational needs about the disease and its management would benefit patients and carers. Improved access to allied health professionals and psychologists will help support families and improve patient outcomes.

Palladium-catalyzed intermolecular dehydrogenative aminohalogenation of alkenes under molecular oxygen: an approach to brominated enamines.

A novel and efficient palladium-catalyzed dehydrogenative aminohalogenation of alkenes with molecular oxygen as the sole oxidant has been developed. This protocol provides a valuable synthetic tool for the assembly of a wide range of brominated enamines under mild conditions, with unprecedented stereoselectivity and exceptional functional group tolerance. This attractive route for the synthesis of brominated enamines is of great significance due to the products' versatile reactivity for further transformations.

Copper-catalyzed formal C-N bond cleavage of aromatic methylamines: assembly of pyridine derivatives.

An efficient copper-catalyzed C-N bond cleavage of aromatic methylamines was developed to construct pyridine derivatives. With neat conditions and facile operation, the fragment-assembling strategy affords a broad range of 2,4,6-trisubstituted pyridines in up to 95% yield from simple and readily available starting materials. Interestingly, when pyridin-2-yl methylamine was employed as the substrate, α-alkylation reaction of ketones readily occurred to give ß-(pyridin-2-yl) ketones instead of the 2,4,6-trisubstituted pyridines.

Palladium-catalyzed oxidative coupling of aromatic primary amines and alkenes under molecular oxygen: stereoselective assembly of (Z)-enamines.

An efficient Pd-catalyzed oxidative coupling of aromatic primary amines and alkenes under molecular oxygen is disclosed. Under mild reaction conditions, it provides a rapid access to (Z)-enamine compounds with exceptional functional group tolerance and excellent regio- and stereoselectivity. This attractive route is of great significance due to its applicability to a wide range of aromatic primary amines, most of which could not be efficiently converted into enamines previously. Moreover, this protocol is scalable, and the resultant enamines could be conveniently transformed into a series of N-containing heterocyclics, thus illustrating its potential applications in synthetic and medicinal chemistry.

Effect of comfort nursing on postoperative recovery and life quality of patients undergoing thoracic surgery.

OBJECTIVE: To evaluate the effect of comfort nursing on postoperative recovery and life quality of patients undergoing thoracic surgery. METHODS: A total of 400 patients undergoing thoracic surgery in our hospital from October 2017 to July 2020 were identified as research subjects and retrospectively studied. These patients were assigned to a control group (Con group, n=196, given conventional nursing) and an observation group (Obs group, n=204, given conventional nursing combined with comfort nursing) according to nursing modality. The following items of the two groups were compared: incidence of adverse reactions after surgery, MOS 36-Item Short-Form Health Survey (SF-36) score, visual analog scale (VAS) scores at 24, 48, and 72 h after surgery, length of stay, first postoperative exhaust time, drainage duration, nursing satisfaction, and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean atrial pressure (MAP), and heart rate before and after the intervention. RESULTS: Compared with the Con group, the Obs group showed a notably lower total incidence of adverse reactions and had higher SF-36 scores after surgery. The Obs group had lower VAS scores at 24, 48, and 72 h after surgery than the Con group. The Obs group also experienced significantly shorter length of stay and drainage duration and earlier first postoperative exhaust time in contrast to the Con group. In addition, the Obs group obtained a higher satisfaction rate than the Con group, and patients in the Obs group had better treatment compliance and emotionalal status than those in the Con group. Moreover, the two groups presented no significant difference in SBP, DBP, MAP, or heart rate before and after intervention (all P>0.05). CONCLUSION: For patients undergoing thoracic surgery, comfort nursing can greatly improve their life quality and contribute to their postoperative recovery.