Total Synthesis of Biselyngbyaside.

The first total synthesis of biselyngbyaside, an 18-membered macrolide glycoside, was achieved. The glycoside bond was introduced using the Schmidt method before construction of the 18-membered ring due to the instability of the conjugated diene and the ß-hydroxy ester moiety. The macrolactone ring was constructed using the Mitsunobu reaction followed by intramolecular the Stille coupling reaction.

Total Synthesis of Biselyngbyolide B.

The first total synthesis of biselyngbyolide B, an 18-membered macrolide, was achieved. The 18-membered ring structure was constructed by esterification using the Shiina reagent and an intramolecular Stille coupling reaction.

Total synthesis of biselyngbyolide A.

Biselyngbyolide A is an 18-membered macrolide that exhibits significant biological activities such as growth-inhibitory activity and apoptosis inducing activity against cancer cells. In this study, the first total synthesis of biselyngbyolide A by using an intramolecular Stille coupling reaction as a key step is achieved.

[Causes of death in hospitalized elderly patients].

AIM: The Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) is a community hospital catering for the health care needs of senior citizens, and 37.5% (120 beds) of its beds are psychiatric beds mostly for those with cognitive impairment. The purpose of this study was to analyze cause of death in a hospital like ours with its particular case mix. METHODS: All patients who passed away in our hospital between June 1st 2002 and November 30th 2007 were surveyed with regard to their age distribution and causes of death were analyzed and compared with available national statistics. RESULTS: The over 65 age group accounted for 93.5% of the total and consisted of 815 patients, including 461 men (56.6%) and 354 women (43.4%). The most common cause of death was malignant neoplasm, followed by pneumonia, cardiovascular diseases, cerebrovascular accidents, and renal failure. Among those who died from the primary disease diagnosed on admission, malignancy was most common (288 cases, 61.3%), followed by pneumonia, cerebrovascular accidents, cardiovascular diseases and renal failure. As for those who died from non-primary diagnosis on admission (patients dying due to any condition, not the direct reason of their admission), pneumonia was the most common diagnosis on admission (95 cases, 27.5%), followed by cardiovascular diseases, malignant neoplasm, sepsis and renal failure. In the general wards, above half of those who died due to the primary cause of admission was malignant neoplasm. On the other hand, 1/4 of those who died from causes other than the primary diagnosis on admission was pneumonia. In the mental health wards the most common cause of death due to the primary diagnosis was malignant neoplasm, followed by dementia of Alzheimer's type. The most common cause of death other than the primary reason for admission was pneumonia. More non-primary diagnosis deaths occurred in the mental health wards than in the general wards. CONCLUSION: In our hospital, malignancy and pneumonia were the most common causes of death, rather than cerebrovascular or cardiovascular diseases, but otherwise, the ranking order of the causes of death was very similar to those in other areas of Japan. Causes of the both in our hospital were closely linked with the high incidence of in-hospital mortality in Japan, accounting for 80% of all deaths. Although the case mix of our in-patients is influenced by a particular distribution of health care institutions and nursing care facilities in our catchment area for secondary care, the study demonstrated that our geriatric service responds to the needs of a wide spectrum of indications suffered by elderly citizens at the end of their life.

[Clinical study on lung disease caused by non-tuberculous mycobacteriosis in the elderly].

AIM: This study was done to clarify the characteristics of elderly patients with nontuberculous mycobacteriosis. METHODS: We investigated the clinical features of 10 patients at an advanced age who had been given diagnosis of nontuberculous mycobacteriosis. RESULTS: Mycobacterium avium intracellulare complex (MAC) were detected in all cases. The age of the patients ranged from 65 to 92. Four cases had underlying respiratory diseases (old pulmonary tuberculosis in 3 cases, pulmonary emphysema in 1 case, bronchiectasia in 1 case). Six cases suffered from dementia. The symptoms were relatively nonspecific, such as low grade fever, fatigue, appetite loss in almost all cases in this study. On computed tomography (CT) scans of the chest, mainly small nodular infiltrates were seen. MAC was detected in clinical samples such as sputum, gastric juice and bronchial lavage. The examination of gastric juice was performed in 6 out of the 10 cases. Gastric juice samples were smear-positive for acid-fast bacilli in 5 of 6, and culture-positive for MAC in 5 of 6. The detection of MAC in gastric juice samples was higher than that in sputum samples on admission. CONCLUSION: Gastric juice might be useful to differentiate infection from casual isolation of MAC in elderly patients.