Photocatalytic Intramolecular Alkene Hydroamination of N-Alkoxy Ureas: An Approach to Imidazolinones.

Imidazolinones were obtained in good yields by intramolecular hydroamination of N-alkoxy ureas in the presence of an organic photocatalyst and an inorganic base. In this reaction, the N-alkoxy urea anion generated by deprotonation undergoes photocatalyzed single-electron-transfer oxidation to generate the corresponding radical, which cyclizes to afford the imidazolinone ring. This new protocol grants access to an array of complex molecules containing a privileged imidazolinone core.

Visible light-induced N-radical 5-exo/6-endo cyclization of alkenyl amides: facile access to isoindolinones/isoquinolinones.

An efficient N-centered radical intramolecular cyclization reaction of alkenyl amides induced by visible light was described. In this process, an alkenyl amide underwent 5-exo/6-endo cyclization to selectively yield two critical alkaloid structures, namely isoindolinones and isoquinolinones.

Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients.

BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China. METHODS: One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients. RESULTS: The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focal-type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) IgG4 positive cells were found in 20 (74.1%) patients. Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%. CONCLUSIONS: Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.

Endoscopic management of early-stage chronic pancreatitis based on M-ANNHEIM classification system: a prospective study.

OBJECTIVE: The aim of this study was to evaluate the M-ANNHEIM classification system to categorize patients with chronic pancreatitis (CP). METHODS: All symptomatic patients recruited from the gastroenterology outpatient clinic of Changhai Hospital (n = 89) were routinely evaluated by magnetic resonance cholangiopancreatography and contrast-enhanced computed tomography. M-ANNHEIM clinical staging was used to categorize patients. The primary outcome measure was pain during the 2-year follow-up period, expressed as mean Izbicki pain scores obtained before and after endotherapy. RESULTS: There was a significant improvement in mean (SD) Izbicki pain scores obtained at 24 months among patients receiving endoscopic therapy at stage 1a compared with those at stage 1b (4.9 [3.0] vs 14.5 [6.9], P = 0.012). Furthermore, significantly more patients receiving endoscopic therapy at stage 1a achieved complete + partial pain relief after 2-year follow-up than those at stage 1b (95.2% vs 78.0%, P = 0.021). There was no exocrine or endocrine insufficiency, but a significantly greater number of patients treated at stage 1a had post-endoscopic retrograde cholangiopancreatography pancreatitis compared with those at stage 1b (10.5% vs 2.7%, P = 0.025). CONCLUSIONS: We demonstrated that a sophisticated M-ANNHEIM classification system for CP will improve diagnosis by allowing for more timely intervention. Furthermore, prompt treatment of CP may achieve improved pain relief and patient outcomes.