Chiral recognition between host and guest: a binaphthyl-18-crown-6 host with D-phenylglycinium methyl ester perchlorate guest. A difficult structure solved with CRUNCH.

The complex between (R)-4,5,7,8,10,11,13,14,16,17-decahydro-2,19- diphenyldinaphtho[2,1-q:1',2'-s][1,4,7,- 10,13,16]hexaoxa[2,5,8,11,14,17,19]cycloicosaheptene {Chemical Abstracts name: (R)-4,5,7,8,10,11,13,14,16,17-decahydro-2,19- diphenyldinaphtho[2,1-q:1',2'-s][1,4,7,-10,13,16]hexaoxacycloic osin} and D-2-phenylglycinium methyl ester perchlorate, C9H12NO2+.ClO4-.C42H40O6.-H2O, crystallizes in the orthorhombic space group P2(1)2(1)2(1) with two C9H12NO2+.C42H40O6 complexes, two ClO4- ions and two molecules of water in the asymmetric unit. Crystal data: M(r) = 924.44, a = 23.048 (7), b = 34.383 (6), c = 11.992 (6) A, V = 9503 (6) A3, Z = 8, Dx = 1.292 Mg m-3, F(000) = 3904, mu(Cu K alpha) = 1.261 mm-1, T = 175 K, R = 0.0896 for all 7784 reflections, 1208 parameters refined in three blocks with 29 restraints. Nearly twenty years elapsed between the first data collection and the solution of the structure with the direct-methods program CRUNCH. The structural details are of interest because enantiomers of this host show a high degree of discrimination between enantiomers of alpha-amino acids and their esters. The crystal structure demonstrates the influence of C-H...O and C-H...pi interactions on the unexpected orientation of the guest in the host cavity. The same orientation is found in both of the unique complexes, and the geometric details are in agreement with solution studies.

The tert-butylammonium perchlorate complex of 2,3-naphtho-18-crown-6 at 115 K.

In the title complex, tert-butylammonium perchlorate-2,5,8,11,14,17-hexaoxatricyclo[16.8.0.0(20,25]hexac osa- 1(26),18,20(25),21,23-pentaene-ethyl acetate-dichloromethane (4/4/1/1), C4H12N+.C20H26O6.ClO4-.0.25C4-H8O2.0.25CH2Cl2 , the tert-butylammonium cation binds to the macrocyclic host (Chemical Abstracts name: 2,3,5,6,8,9,11,12,14,15-decahydro-1,4,7,10,13,16-hexaoxanaphtho [2,3- b]cyclooctadecin) in the expected tripod arrangement, while the perchlorate anion links naphthyl groups in the crystal through C-H...O-Cl-O...H-C interactions. Thermal motion analysis indicates that the tert-butylammonium group and the perchlorate anion each librate with respect to the host, with amplitudes of 6.2 (4) and 11.4 (2) degrees, respectively.

Knowledge of disease and dietary compliance in patients with end-stage renal disease.

Noncompliance is a common problem in patients with end-stage renal disease. In this study, we assessed the relationship between knowledge of disease and dietary compliance in a cohort of 56 dialysis patients. Based on a health belief model of adherence, we predicted that dialysis patients who knew more about kidney disease and its treatment would be more complaint than those who knew less about these matters. We also examined the relationship between dietary compliance and patients' emotional well-being. We used a composite measure of compliance consisting of serum K, P, and interdialytic weight gain. A 30-item "Kidney Disease Questionnaire" was used to assess patients' knowledge of their illness. Contrary to prediction, compliers did not score higher on the knowledge questionnaire; in fact, the observed correlation of .32 was in the opposite direction. In the same vein, we found no relationship between compliance and emotional well-being. These results, although somewhat surprising, add to a growing body of research which indicates that medical compliance involves more than educating patients about the mechanisms and treatment of their illness.

Phase II study of high-dose busulfan, melphalan and thiotepa with autologous peripheral blood stem cell support in patients with malignant disease.

The purpose of this study was to determine the toxicities and potential effectiveness of high-dose busulfan, melphalan and thiotepa (Bu/Mel/TT) followed by autologous peripheral blood stem cell (PBSC) infusion in patients with a variety of diseases. A phase II clinical trial of Bu (12 mg/kg), Mel (100 mg/m2) and TT (500 mg/m2) followed by PBSC infusion in 104 patients with breast cancer (n = 48), malignant lymphoma (n = 25), ovarian cancer (n = 13), multiple myeloma (n = 7) and other malignancies (n = 11) was performed. Sixty-two patients were treated in an academic medical center and 42 in a community cancer center. Grade 3-4 regimen-related toxicities occurred in 14% of patients, causing regimen-related mortality in six (6%) patients with an overall transplant-related mortality of 9%. Transplant-related deaths occurred in 6/62 patients (10%) treated in an academic medical center and in 3/42 (7%) treated in a community cancer center. Complete remissions (CR) were achieved in 1/17 (6%) patients with refractory stage IV breast cancer, 4/4 patients with responsive stage IV breast cancer, 6/13 (46%) with more-advanced lymphoma and 4/4 with less-advanced lymphoma. These patients are alive and disease-free a median of 712, 279, 461 and 404 days after transplant, respectively. Nineteen of 22 patients with stage II-III breast cancer remain alive and disease-free a median of 365 days after transplant. Complete remissions were also seen in 4/9 patients with ovarian cancer and 3/7 with multiple myeloma. The Bu/Mel/TT regimen followed by autologous PBSC infusion is associated with acceptable morbidity and mortality, appears to have significant activity in patients with breast cancer and is well tolerated in the adjuvant setting of stage II-III breast cancer. Bu/Mel/TT also appears to have significant activity in patients with lymphoma, multiple myeloma and possibly ovarian cancer. Further phase II-III studies are warranted in patients with these and other malignancies.

AIDS-related Kaposi's sarcoma displays differential expression of endothelial surface antigens.

The authors studied 11 cases of Kaposi's sarcoma (KS) in patients with the acquired immunodeficiency syndrome (AIDS) for their reactivity with two monoclonal antibodies (B721 and E431) that recognize endothelial cell surface antigens. Reactivity of these antibodies with KS was compared with the reactivity of other known endothelial markers (F8rAg, Ia, HCL-1). Staining was done with avidin-biotin-alkaline phosphatase immunohistochemistry on acetone-fixed frozen sections. In all samples of tumor both the spindle cell component and the vascular lining cells stained with both B721 and E431. In general, the spindle cells stained less intensely than did the vascular lining cells. There was both intratumor and intertumor variability. B721 and E431 are proposed as two additional markers for KS, and it is suggested that their reactivity with the tumor supports the hypothesis that KS is derived from vascular endothelium. The possibility is also raised that the variability of staining for vascular markers could have diagnostic possibilities, and further studies for investigation of this hypothesis are suggested.