Multidisciplinary Breast Cancer Clinic: A Novel Approach to Decrease Time to Intervention.

Multidisciplinary clinics (MDCs) were created at high-volume surgical oncology centers to optimize breast cancer care, in which patients are seen by multiple subspecialists at one visit. We aim to evaluate our experience with this novel approach. We examined 492 patients with newly diagnosed invasive breast cancer from January 1, 2020, to September 1, 2022. Patients seen at our MDC had a decreased time to intervention across all measured intervals: 3 days faster (10 vs 13 days) from biopsy to clinic visit [t Sat 2.09 > t critical two tail 1.99], 5 days faster (23 vs 28 days) from diagnosis to initiation of neoadjuvant chemotherapy [t Sat 5.12 > t critical two tail 2.019], and 21 days faster (24 vs 45 days) from surgery clinic visit to operation [t Sat 5.12 > t critical two tail 2.019]. Although early in our experience, we have initiated a strategy for improved breast cancer care.

Cerebrotendinous xanthomatosis in a Saudi Arabian family-genotyping and long-term follow-up.

A Saudi Arabian family is described in which there were 2 siblings with typical features of cerebral xanthomatosis CTX including premature cataracts, xanthomata of the Achilles tendons, neuro-psychiatric disturbances, and atherosclerosis. The 2 patients were homozygous for a point mutation in the mitochondrial 27-hydroxylase gene CYP27A1, OMIM 606530 located in the splice site of intron 6, where G was exchanged for A IVS6+1G>A. Their parents were cousins, 5 siblings were healthy, 2 were heterozygous for the mutation, and one showed the wild-type genotype. The father was heterozygous for the mutation, while the other family members were not tested. The progress of the 2 CTX patients over 14 years is described; firstly when they were receiving treatment with chenodeoxycholic acid; when this medication was not available, and later when it was restored. A hereditary hyperlipidemia was also present in this family. It is suggested that when this occurs with CTX, a more serious illness results that merits more aggressive dual therapy.

New synthesis of vaulted biaryl ligands via the Snieckus phenol synthesis.

[reaction: see text] In an effort to develop a synthesis of the VAPOL ligand that avoids the use of a chromium carbene complex, a route was examined that involved the annulation of a naphthalene carboxamide via the method of Snieckus. The latter derivatives could be converted in a two-step sequence to 2-phenyl-4-phenanthrols in 60-72% overall yields. The utility of this method for the synthesis of VAPOL derivatives is demonstrated in the synthesis of (S)-7,7'-dimethyl-VAPOL.