All the More Reason to Get a Flu Shot: An Instance of Acute Hemorrhagic Leukoencephalitis in a Patient With Influenza A.

Acute hemorrhagic leukoencephalitis (AHLE) is a rare demyelinating disease of the central nervous system that typically follows a viral or bacterial respiratory infection. We report the first described case of AHLE following influenza A (H3N2) in an otherwise healthy 15-year-old girl with no relevant past medical history who initially presented to the emergency department (ED) by emergency medical services (EMS) with decorticate posturing and right gaze deviation after being found unresponsive at home. Subsequent testing for Influenza A H3N2 via viral polymerase chain reaction (PCR) was positive. Clinical correlation and brain MRI confirmed AHLE. At follow-up three months after discharge, she was found to have intellectual functioning in the extremely low range and she still had deficits in motor skills eight months after discharge. While the patient was reportedly up-to-date on her routine scheduled childhood vaccinations, she had not received her annual influenza vaccination that year. Pediatric infectious disease physicians and neurologists should consider the diagnosis of AHLE in unvaccinated, previously healthy patients with new and rapid onset of neurological symptoms following influenza infection.

Synthesis of 2,3-dihydro-1-phenylbenzo[b]phosphole (1-phenylphosphindane) and its use as a mechanistic test in the asymmetric Appel reaction: decisive evidence against involvement of pseudorotation in the stereoselecting step.

Racemic 2,3-dihydro-1-phenylbenzo[b]phosphole was obtained by reduction of 1-phenylbenzo[b]phosphole-1-oxide, itself derived by ring-closing metathesis of phenylstyrylvinylphosphine oxide. The title compound was then reoxidized under asymmetric Appel conditions. Comparison of the sense and degree of the stereoselectivity to those obtained with an open-chain analogue indicated that the ring system does not affect the selectivity of the process. This in turn strongly suggests that the stereoselection is not related to pseudorotamer preferences in putative phosphorane intermediates.

An update on tobacco control initiatives in comprehensive cancer control plans.

INTRODUCTION: Comprehensive cancer control (CCC) coalitions address tobacco use, the leading cause of preventable death in the United States, through formal plans to guide tobacco control activities and other cancer prevention strategies. Best Practices for Comprehensive Tobacco Control Programs (Best Practices) and The Guide to Community Preventive Services (The Community Guide) are used to assist with this effort. We examined CCC plans to determine the extent to which they followed the Centers for Disease Control and Prevention's (CDC's) tobacco control and funding recommendations. METHODS: We obtained 69 CCC plans, current as of August 1, 2011, to determine which CDC recommendations from Best Practices and The Community Guide were incorporated. Data were abstracted through a content review and key word search and then summarized across the plans with dichotomous indicators. Additionally, we analyzed plans for inclusion of tobacco control funding goals and strategies. RESULTS: CCC plans incorporated a mean 4.5 (standard deviation [SD], 2.1) of 5 recommendations from Best Practices and 5.2 (SD, 0.9) of 10 recommendations from The Community Guide. Two-thirds of plans (66.7%) addressed funding for tobacco control as a strategy or action item; 47.8% of those plans (31.9% of total) defined a specific, measurable funding goal. CONCLUSION: Although most CCC plans follow CDC-recommended tobacco control recommendations and funding levels, not all recommendations are addressed by every plan and certain recommendations are addressed in varying numbers of plans. Clearer prioritization of tobacco control recommendations by CDC may improve the extent to which they are followed and therefore maximize their public health benefit.

Cow's milk elimination: a novel dietary approach to treat eosinophilic esophagitis.

OBJECTIVES: Cow's-milk protein is one of the food antigens responsible for causing eosinophilic esophageal inflammation in a majority of children. We describe our experience with treating eosinophilic esophagitis (EoE) in children by eliminating only cow's milk from their diets. METHODS: This retrospective study assessed the short-term clinical and histological response to eliminating cow's-milk protein from the diet of children with EoE. Only patients undergoing a subsequent upper endoscopy to assess their histological response were included in this analysis. RESULTS: We identified 17 (12 boys and 5 girls) children with EoE who excluded only cow's milk from their diet. Remission was induced in 11 of 17 (65%) patients; within the remission group, 7 (41%) achieved complete histological remission and 4 patients (24%) were in significant histological remission. The mean peak pre- and posttreatment counts for those in remission were 76 ±â€Š40 and 2 ±â€Š4 (P < 0.01), respectively. CONCLUSIONS: Elimination of cow's milk-induced clinical and histological remission in 65% (95% confidence interval 42%-88%) of children with EoE in whom it was attempted. This approach offers distinct advantages over other dietary treatment approaches for the initial management of children with EoE. The role of eliminating cow's milk alone for the treatment of EoE warrants further prospective study.

Chemoenzymatic synthesis of a mixed phosphine-phosphine oxide catalyst and its application to asymmetric allylation of aldehydes and hydrogenation of alkenes.

The chemoenzymatic synthesis of a Lewis basic phosphine-phosphine oxide organocatalyst from a cis-dihydrodiol metabolite of bromobenzene proceeds via a palladium-catalysed carbon-phosphorus bond coupling and a novel room temperature Arbuzov [2,3]-sigmatropic rearrangement of an allylic diphenylphosphinite. Allylation of aromatic aldehydes were catalysed by the Lewis basic organocatalyst giving homoallylic alcohols in up to 57% ee. This compound also functioned as a ligand for rhodium-catalysed asymmetric hydrogenation of acetamidoacrylate giving reduction products with ee values of up to 84%.

Diastereoselective ring-closing metathesis: synthesis of P-stereogenic phosphinates from prochiral phosphinic acid derivatives.

[reaction: see text] The preparation of phosphorus-containing trienes featuring two diastereotopic vinyl moieties followed by a diastereoselective ring-closing metathesis is described. This methodology allowed for the synthesis of novel highly functionalized P-stereogenic heterocycles featuring both an exo- and an endocyclic double bond. An investigation into the factors influencing the diastereochemical outcome of the ring-closing metathesis is also presented, revealing that the geometry of the double bonds conjugated to phosphorus is important and that 1,3-stereoinduction is superior to 1,4-stereoinduction for these reactions.