Randomized adaptive selection trial of cryotherapy, compression therapy, and placebo to prevent taxane-induced peripheral neuropathy in patients with breast cancer

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of taxane therapy. Small non-randomized studies in patients with early-stage breast cancer (ESBC) suggest both cryotherapy and compression therapy may prevent CIPN. It is unknown which is more effective.

METHODS

We conducted a randomized phase IIB adaptive sequential selection trial of cryotherapy vs. compression therapy vs. placebo ("loose" gloves/socks) during taxane chemotherapy. Participants were randomized in triplets. Garments were worn for 90-120 min, beginning 15 min prior and continuing for 15 min following the infusion. The primary goal was to select the best intervention based on a Levin-Robbins-Leu sequential selection procedure. The primary endpoint was a < 5-point decrease in the Functional Assessment of Cancer Therapy Neurotoxicity (FACT-NTX) at 12 weeks. An arm was eliminated if it had four or more fewer successes than the currently leading arm. Secondary endpoints included intervention adherence and patient-reported comfort/satisfaction.

RESULTS

Between April 2019 and April 2021, 63 patients were randomized (cryotherapy (20); compression (22); placebo (21)). Most patients (60.3%) were treated with docetaxel. The stopping criterion was met after the 17th triplet (n = 51) was evaluated; success at 12 weeks occurred in 11 (64.7%) on compression therapy, 7 (41.1%) on cryotherapy, and 7 (41.1%) on placebo. Adherence to the intervention was lowest with cryotherapy (35.0%) compared to compression (72.7%) and placebo (76.2%).

CONCLUSION

Compression therapy was the most effective intervention in this phase IIB selection trial to prevent CIPN and was well tolerated. Compression therapy for the prevention of CIPN should be evaluated in a phase III study.

CLINICAL TRIAL REGISTRATION

ClinicaTrials.gov Identifier: NCT03873272.

Association Between Copayment Assistance, Insurance Type, Prior Authorization, and Time to Receipt of Oral Anticancer Drugs

PURPOSE

Oral anticancer drugs (OACDs) have become increasingly prevalent over the past decade. OACD prescriptions require coordination between payers and providers, which can delay drug receipt. We examined the association between insurance type, pursuit of copayment assistance, pursuit of prior authorization (PA), and time to receipt (TTR) for new OACD prescriptions.

METHODS

We prospectively collected data on new OACD prescriptions for adult oncology patients from January 1, 2018, to December 31, 2019, including demographic and clinical characteristics, insurance type, and pursuit of PA and copayment assistance. TTR was defined as the number of days from prescription to OACD receipt. We summarized TTR using cumulative incidence and compared TTR by insurance type, pursuit of copayment assistance, and PA activity using the log-rank test.

RESULTS

Our cohort of 1,024 patients was 53% male, and 40% were younger than 65. Twenty-six percent had commercial insurance only, 16% had Medicaid only, and 59% had Medicare with or without additional insurance. Eighty-six percent of prescriptions were successfully received. Across all prescriptions, 69% involved PA activity, and 21% involved the copayment assistance process. In unadjusted analyses, prescriptions involving the copayment assistance process had longer TTR compared with those not involving assistance (log-rank P value = .005) and OACDs covered by Medicare/commercial insurance had a longer TTR compared with Medicaid (log-rank P value = .006). The PA process was not associated with TTR (log-rank P value = .124).

CONCLUSION

The process for obtaining OACDs is complex. The copayment assistance process and Medicare/commercial insurance are associated with delayed TTR. New policies are needed to reduce time to OACD receipt.

Impact of a Hospital-Based Specialty Pharmacy in Partnership With a Care Coordination Organization on Time to Delivery and Receipt of Oral Anticancer Drugs

PURPOSE

Oral anticancer drug (OACD) prescriptions require extensive coordination between providers and payers, which can delay drug receipt. Specialty pharmacies facilitate communication between multiple entities. In 2018, our cancer center partnered with a freestanding organization to implement a hospital-based specialty pharmacy (HB-SP). We evaluated the time to drug receipt (TTR) before and after HB-SP implementation.

METHODS

Data were prospectively collected on all new OACD prescriptions for adult oncology patients from January 1, 2018, to December 31, 2019. In fall 2018, a HB-SP was initiated. We collected patient sociodemographic, clinical, and prescription data. TTR was the number of days from OACD prescription to drug receipt. We used multivariable logistic regression to examine factors associated with TTR ≤ 7 days before and after HB-SP implementation.

RESULTS

In total, 954 patients were included, representing 1,102 new OACDs. The majority of prescribed drugs were targeted OACDs (56%, n = 617), and 71% (n = 779) required prior authorization. Of all prescriptions, 84% (n = 960) were successfully received with an overall median TTR of 7 days. In unadjusted analysis, HB-SP implementation, drug class, race and ethnicity, and prior authorization requirement were significantly associated with TTR. Adjusted analyses found that patients were more likely to receive their drugs ≤ 7 days after HB-SP implementation (53% v 47%; adjusted odds ratio [aOR], 1.29; 95% CI, 1.00 to 1.68; P = .05).

CONCLUSION

The implementation of a HB-SP in partnership with a collaborative care model contributed to a decrease in TTR for OACDs. This difference is in part attributable to improved care coordination and communication. A centralized approach may improve overall efficiency due to fewer practice disruptions.

Implementation of Systematic Financial Screening in an Outpatient Breast Oncology Setting

PURPOSE

Implementation of routine financial screening is a critical step toward mitigating financial toxicity. We evaluated the feasibility, sustainability, and acceptability of systematic financial screening in the outpatient breast oncology clinic at a large, urban cancer center.

METHODS

We developed and implemented a stakeholder-informed process to systematically screen for financial hardship and worry. A 2-item assessment in English or Spanish was administered to patients through the electronic medical record portal or using paper forms. We evaluated completion rates and mode of completion. Through feedback from patients, clinicians, and staff, we identified strategies to improve completion rates and acceptability.

RESULTS

From March, 2021, to February, 2022, 3,500 patients were seen in the breast oncology clinic. Of them, 39% (n = 1,349) responded to the screening items, either by paper or portal, 12% (n = 437) preferred not to answer, and the remaining 49% (n = 1,714) did not have data in their electronic health record, meaning they were not offered screening or did not complete the paper forms. Young adults (18-39 years) were more likely to respond compared with patients 70 years or older (61% v 30%, P < .01). English-preferring patients were more likely to complete the screening compared with those who preferred Spanish (46% v 28%, P < .01). Non-Hispanic White patients were more likely to respond compared with Non-Hispanic Black patients and with Hispanic patients (46% v 39% v 32%, P < .01). Strategies to improve completion rates included partnering with staff to facilitate paper form administration, optimizing patient engagement with the portal, and clearly communicating the purpose of the screening.

CONCLUSION

Systematic financial screening is feasible, and electronic data capture facilitates successful implementation. However, inclusive procedures that address language and technology preferences are needed to optimize screening.

Epitope-Specific IgE at 1 Year of Age Can Predict Peanut Allergy Status at 5 Years

BACKGROUND

Currently, there is no laboratory test that can accurately identify children at risk of developing peanut allergy. Utilizing a subset of children randomized to the peanut avoidance arm of the LEAP trial, we monitored the development of epitope-specific (ses-)IgE and ses-IgG4 from 4-11 months to 5 years of age.

OBJECTIVE

The aim of the study was to evaluate the prognostic ability of epitope-specific antibodies to predict the result of an oral food challenge (OFC) at 5 years.

METHODS

A Bead-Based Epitope Assay was used to quantitate IgE and IgG4 to 64 sequential (linear) epitopes from Ara h 1-3 proteins at 4-11 months, 1 and 2.5 years of age in 74 subjects (38 of them with a positive OFC at 5 years). Specific IgE (sIgE) to peanut and component proteins was measured using ImmunoCAP. Machine learning methods were used to identify the earliest time point to predict 5-year outcome, developing prognostic algorithms based only on 4-11 month samples, 1-year or 2.5-year, and a combination of them. Data from 74 children were iteratively split 3:1 into training and validation sets, and machine learning models were developed to predict the 5-year outcome. A test set (n = 90) from an independent cohort was used for final evaluation.

RESULTS

Elastic-Net algorithm combining ses-IgE and IgE to Ara h 1, 2, 3, and 9 proteins could predict the 5-year peanut allergy status of LEAP participants with an average validation accuracy of 64% at baseline. Samples taken at 1 year accurately predicted a 5-year OFC outcome with 83% accuracy. This performance remained consistent when evaluated on an independent CoFAR2 cohort with an accuracy of 78% for the 1-year model.

CONCLUSION

IgE antibody profiles at 1 year of age are predictive of peanut OFC at 5 years in children avoiding peanuts. If further confirmed, this model may enable early identification of infants who may benefit from early immunotherapeutic interventions.

Factors Associated With Patients Not Receiving Oral Anticancer Drugs

IMPORTANCE

Oral anticancer drugs (OACDs) are increasingly prescribed for cancer treatment and require significant coordination of care. Retrospective studies suggest that 10% to 20% of OACD prescriptions are never received by the patients, but the reasons behind this are poorly understood.

OBJECTIVES

To estimate the rate of failure to receive OACD prescriptions among patients with cancer and to examine the underlying reasons for this failure.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study was conducted among patients with cancer who were prescribed a new OACD from January 1, 2018, to December 31, 2019, at an urban academic medical center. Data analysis was conducted between 2021 and 2022.

MAIN OUTCOMES AND MEASURES

Patient demographic, clinical, and insurance data and OACD delivery dates were collected. The reasons for a failure to receive a prescribed OACD within 3 months were confirmed by manual review of medical records and were classified into 7 categories: clinical deterioration, financial access, clinician-directed change in decision-making, patient-directed change in decision-making, transfer of care, loss to follow-up, and unknown or other. A multivariable random-effects model was developed to identify factors associated with failure to receive a prescribed OACD.

RESULTS

The cohort included 1024 patients (538 men [53%]; mean [SD] age, 66.2 [13.9] years; 463 non-Hispanic White patients [45%], 140 non-Hispanic Black patients [14%], and 300 Hispanic patients [29%]), representing 1197 new OACD prescriptions. Of the 1197 prescriptions, 158 (13%) were categorized as having not been received by the patient. The most common reason for the failure to receive a prescribed OACD was due to patient and clinician decision-making (73 of 158 [46%]), and 20 cases (13%) in which prescriptions were not received were associated with financial access issues. In multivariable analysis, patients with a nonmetastatic solid malignant neoplasm were significantly less likely to not receive their OACDs than those with a hematologic malignant neoplasm (odds ratio, 0.57 [95% CI, 0.33-1.00]; P = .048).

CONCLUSIONS AND RELEVANCE

This cohort study of patients prescribed a new OACD found that 13% of prescriptions were not received. The failure to receive a prescribed OACD was most frequently due to a change in clinical decision-making or patient choice. Ultimately, the reasons for the failure to receive a prescribed OACD were multifactorial and may have been appropriate in some cases.

Patient factors associated with time to medication receipt of oral anti-cancer drugs

1519

Background: The past decade has seen a dramatic increase in the number of Food and Drug Administration approvals of oral anti-cancer drugs (OACDs). Most OACD prescriptions require coordination between providers, payers, specialty pharmacists, and financial assistance organizations, which can delay drug receipt. We evaluated median time to OACD receipt (TTR) from initial OACD prescription submission and assessed clinical and process-related factors associated with TTR. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients at a large, urban outpatient cancer center from 1/1/2018 to 12/31/2019. We collected patient demographic, medical, and insurance data; prescription submission and delivery dates; and interactions with payers and financial assistance groups. TTR was defined as the number of days from OACD initial prescription to patient receipt of the drug. We estimated the median TTR across all patients and used multivariable logistic regression to identify factors associated with TTR above the median. Results: The cohort included 1080 patients who were prescribed 1269 new OACDs. Of these prescriptions, 84% (N=1069) were received, and 71% (N=896) required prior authorization. The median patient age was 66, 44% identified as Non-Hispanic White (White), 25% of patients had commercial insurance, 16% had Medicaid alone, and 58% had Medicare alone or in combination with another plan. The median TTR per patient was 7 days (IQR 0 – 142; 25% ≥ 14 days and 5% ≥ 30 days). In unadjusted analyses, insurance and race/ethnicity were associated with TTR. Compared with patients covered by Medicaid, those with Medicare and supplemental insurance (a partial, not free-standing plan) had nearly 2.5 times the odds of TTR >7 days controlling for other factors. Race/ethnicity showed a trend toward longer TTR with Non-Hispanic Black (Black) patients having a longer TTR compared to White patients, controlling for other factors. We did not observe statistically significant effects of either comorbidity or prior authorization requirement on TTR. Conclusions: Though the majority of oncology patients prescribed OACDs receive the drug, 71% of prescriptions required prior authorization and a quarter of patients waited at least two weeks. Disparities in TTR are primarily driven by financial factors, specifically insurance type.[Table: see text]

Care Delivery Impact of the COVID-19 Pandemic on Breast Cancer Care

PURPOSE

COVID-19 has altered healthcare delivery. Previous work has focused on patients with cancer and COVID-19, but little has been reported on healthcare system changes among patients without COVID-19.

METHODS

We performed a retrospective study of patients with breast cancer (BC) in New York City between February 1, 2020, and April 30, 2020. New patients were included as were patients scheduled to receive intravenous or injectable therapy. Patients with COVID-19 were excluded. Demographic and treatment information were obtained by chart review. Delays and/or changes in systemic therapy, surgery, radiation, and radiology related to the pandemic were tracked, along with the reasons for delay and/or change. Univariate and multivariable analysis were used to identify factors associated with delay and/or change.

RESULTS

We identified 350 eligible patients, of whom 149 (42.6%) experienced a delay and/or change, and practice reduction (51.0%) was the most common reason. The patients who identified as Black or African American, Asian, or Other races were more likely to experience a delay and/or change compared with White patients (Black, 44.4%; Asian, 47.1%; Other, 55.6%; White, 31.4%; P = .001). In multivariable analysis, Medicaid compared with commercial insurance (odds ratio [OR], 3.04; 95% CI, 1.32 to 7.27) was associated with increased odds of a delay and/or change, whereas stage II or III BC compared with stage I (OR, 0.38; 95% CI, 0.15 to 0.95; and OR, 0.28; 95% CI, 0.08 to 0.092, respectively) was associated with decreased odds of a delay and/or change.

CONCLUSION

Almost half of the patients with BC without COVID-19 had a delay and/or change. We found racial and socioeconomic disparities in the likelihood of a delay and/or change. Further studies are needed to determine the impact these care alterations have on BC outcomes.

Evolution of epitope-specific IgE and IgG4 antibodies in children enrolled in the LEAP trial

BACKGROUND

In the LEAP (Learning Early About Peanut Allergy) trial, early consumption of peanut in high-risk infants was found to decrease the rate of peanut allergy at 5 years of age. Sequential epitope-specific (ses-)IgE is a promising biomarker of clinical peanut reactivity.

OBJECTIVE

We sought to compare the evolution of ses-IgE and ses-IgG₄ in children who developed (or not) peanut allergy and to evaluate the immunomodulatory effects of early peanut consumption on these antibodies.

METHODS

Sera from 341 children (LEAP cohort) were assayed at baseline, 1, 2.5, and 5 years of age, with allergy status determined by oral food challenge at 5 years. A bead-based epitope assay was used to quantitate ses-IgE and ses-IgG₄ to 64 sequential epitopes from Ara h 1 to Ara h 3 and was analyzed using linear mixed-effect models.

RESULTS

In children avoiding peanut who became peanut allergic, the bulk of peanut ses-IgE did not develop until after 2.5 years. Minimal increases of ses-IgE occurred after 1 year in consumers, but not to the same epitopes as those in children developing peanut allergy. No major changes in ses-IgE were seen in nonallergic or sensitized children. IgE in sensitized consumers was detected against peanut proteins. ses-IgG₄ increased over time in most children regardless of consumption or allergy status.

CONCLUSIONS

Early peanut consumption in infants at high risk of developing peanut allergy appears to divert the immunologic response to a presumably "protective" effect. In general, consumers tend to generate ses-IgG₄ earlier and in greater quantities than nonconsumers do, whereas only avoiders tend to generate significant quantities of ses-IgE.

Opioid prescribing practices in adolescent and young adults with sarcomas

136

Background: Adolescents and young adults (AYAs) with sarcoma undergo procedures that can result in acute and chronic pain. Adult cancer patients are at increased risk of chronic opioid use, and AYAs are vulnerable to misuse. However, opioid prescribing practices in AYAs with sarcoma are not known. We described opioid prescribing during active therapy and identify factors associated with continued opioid prescription post-treatment in AYAs with newly diagnosed sarcoma. Methods: Patients 10–26 years who were diagnosed with sarcoma between 2008–2016 were identified using IBM Marketscan database. Included subjects received anti-cancer therapy (chemotherapy, procedures, and/or radiation) within 30 days of diagnosis and were continuously enrolled in one insurance plan (commercial or Medicaid) >12-months both before diagnosis and after last therapy. Primary outcome was opioid use, defined as at least one opioid prescription during the 12 months following treatment completion. Covariates included age, sex, insurance, treatment type, mental health (MH) and substance use (SU) diagnoses. Results: We included 1,349 patients, 75% had commercial insurance, 21% had a previous MH, and 4% had previous SU diagnosis. 63% of subjects used opioids during treatment and 28% received at least 1 prescription in the year post-therapy. Medicaid insurance was associated with 60% higher likelihood of opioid use during treatment and those with prior use were three-times more likely to continue post- therapy. Conclusions: Opioid prescriptions in AYAs with sarcoma are common during treatment. A significant proportion of patients continue to receive opioids post-therapy, particularly those with a history of use pre-diagnosis. Medicaid insurance and MH disorder are also associated with continued use post-therapy. Further research is needed to establish safe and effective opioid prescribing practices in AYAs with sarcoma. [Table: see text]

The COVID-19 pandemic impact on breast cancer care delivery at an academic center in New York City

88

Background: The coronavirus disease 2019 (COVID-19) pandemic has altered healthcare delivery. To save resources and reduce patient exposure, non-urgent care has been postponed. Previous work has focused on cancer patients with COVID-19, but little has been reported on the impact on patients without COVID-19. We aimed to characterize breast cancer (BC) patients without COVID-19 whose care was impacted by the COVID-19 pandemic at an academic center in New York City. Methods: We performed a retrospective cohort study of BC patients treated at a medical oncology practice between 2/1/2020-4/30/2020. Patients were included if they were scheduled to receive intravenous or injectable therapy or were scheduled as a new patient. Patients were excluded if they tested positive for COVID-19 or transferred care during the study period. Demographic and treatment information were obtained by chart review. Delays/changes in systemic therapy, imaging, interventional radiology procedures, radiation, and surgery were tracked. Delays were defined as postponements of scheduled care. Changes were defined as care alterations without postponements. Care impact was defined as any change/delay in any of the above oncologic care a patient was scheduled for. We conducted a univariate analysis to compare demographics and care impact using χ2 analyses. Results: Of 351 eligible patients, the majority had stage 0-III BC (71.9%) and hormone receptor-positive HER2-negative BC (69.5%). Less than half were Caucasian (43.9%). Care was impacted due to the pandemic in 149 (42.5%) of patients. Surgery changes/delays were most frequent (37 of 84 patients, 44.0%), followed by changes/delays in systemic therapy (90 of 351 patients, 25.6%) and imaging (58 of 282 patients, 20.6%). Patients of Asian, Black, and other non-reported races were more likely to experience a care impact vs. Caucasian patients (47.1% vs. 44.4% vs. 55.6% vs. 31.2%, p = 0.001). Hispanic patients were more frequently impacted vs. non-Hispanic patients (47.6% vs. 35.9%, p = 0.06). Medicaid and Medicare patients were also more frequently impacted vs. commercially insured patients (54.7% vs. 41.4% vs. 36.2%, p = 0.02). BC stage and hormone receptor status were not significantly associated with care impacts. Conclusions: We found that nearly half of our BC patients experienced a change/delay in workup or treatment during the COVID-19 pandemic. We also found significant racial and socioeconomic disparities in the likelihood of care impact. Ongoing studies will determine the impact of alterations in care on cancer outcomes.

0853 Fetal Heart Rate Variability Increases During Maternal Sleep Apnea Events

Introduction

While studies have established that SDB during pregnancy increases the risk of adverse maternal outcomes, fetal effects are less well studied. Evidence suggests that fetal heart rate decelerations, an indicator of fetal distress, may be elicited by SDB. We examined the relationship between maternal SDB events and fetal heart rate (FHR) and fetal heart rate variability (FHRV).

Methods

Obese (BMI≥30kg/m2) non-smoking women carrying singleton fetuses underwent overnight polysomnography (34-37 weeks gestational age), with simultaneous fetal heart rate monitoring. Standard methods were used to score sleep, SDB events (apneas/hypopneas) and to analyze fetal heart rate parameters. Using linear mixed effect models, we examined changes in mean FHR and FHR variability (expressed by FHR SD) between the 10-second period immediately before individual SDB events, during events to the end of the associated oxygen desaturation period, and the 10-second period immediately following the SDB event.

Results

Valid PSG and FHR data were obtained from 85 third trimester maternal-fetal dyads. Across all participants, there were 2779 maternal SDB events (apneas or hypopneas). Mean AHI for individual subjects was 9.04 (SD 13.75). 39 women had OSA (AHI≥5), which was mostly mild. Mean FHR did not change significantly during and after episodes of SDB episodes compared to pre-event FHR, and did not change afterwards compared to during events, in unadjusted or adjusted (sleep stage, apnea type, degree of desaturation, age) analyses. In unadjusted analyses, FHRV significantly increased during SDB episodes compared to pre-SDB FHRV. After SDB events, FHRV was significantly lower than during SDB events. In fully adjusted models, these findings remained highly significant. FHRV was not significantly different after SDB events compared to pre-SDB event FHRV in unadjusted or adjusted models.

Conclusion

We observed consistent changes in FHR variability during and after maternal SDB events. Mean FHRV significantly increased during maternal SDB episodes compared to baseline FHRV, and decreased after SDB episodes. In contrast, mean FHR did not change significantly before, during and after SDB episodes. These data demonstrate that the fetus reacts to maternal SDB events, and raise questions about persistent effects of maternal SDB on the developing fetus.

Support

NIH HD079411

Comprehensive Immunoprofiling of Pediatric Zika Reveals Key Role for Monocytes in the Acute Phase and No Effect of Prior Dengue Virus Infection

Zika virus (ZIKV) is an emerging, mosquito-borne flavivirus responsible for recent epidemics across the Americas, and it is closely related to dengue virus (DENV). Here, we study samples from 46 DENV-naive and 43 DENV-immune patients with RT-PCR-confirmed ZIKV infection at early-acute, late-acute, and convalescent time points from our pediatric cohort study in Nicaragua. We analyze the samples via RNA sequencing (RNA-seq), CyTOF, and multiplex cytokine/chemokine Luminex to generate a comprehensive, innate immune profile during ZIKV infection. Immunophenotyping and analysis of cytokines/chemokines reveal that CD14+ monocytes play a key role during ZIKV infection. Further, we identify CD169 (Siglec-1) on CD14+ monocytes as a potential biomarker of acute ZIKV infection. Strikingly distinct transcriptomic and immunophenotypic signatures are observed at all three time points. Interestingly, pre-existing dengue immunity has minimal impact on the innate immune response to Zika. Finally, this comprehensive immune profiling and network analysis of ZIKV infection in children serves as a valuable resource.

Bioprospecting of seaweeds (Ulva lactuca and Stoechospermum marginatum): The compound characterization and functional applications in medicine-a comparative study

Seaweeds are considered to be one of the richest bio-reserves, comprising of numerous bioactive compounds with versatile properties and multiple activities. The present study examined the antibacterial activity of two types of seaweeds, Ulva lactuca (green) and Stoechospermum marginatum (brown) collected from Oman Coastal region against five multidrug-resistant bacteria. The aqueous extracts of the seaweeds showed better antibacterial activity compared to methanol extracts. The results of the antibacterial assay revealed the excellent inhibitory effects of U.lactuca with the maximum activity against E.coli(8 mm) followed by K.pneumonia(4 mm) and S.typhi(2 mm). S.marginatum formed a clear zone of inhibition only against E.coli(3 mm).The major phytochemical constituents identified in both the types of seaweeds were Alkaloids, Terpenoids, Saponins, Flavonoids, and Steroids. Fourier transform infrared spectroscopy (FTIR) results confirmed the presence of alcoholic/phenolic groups, and amide groups in the seaweed extracts. Gas chromatography-mass spectrometry (GC-MS) results evidenced the presence of bioactive compounds such as 5-Octadecenal, 1-Tricosanol, Neophytadiene, Lactaropallidin, Phytol, Fenretinide, Lucenin, Vincadifformine in U.lactuca. Additionally, U.lactuca displayed better antioxidant activity (33.05%) in the DPPH free radical scavenging activity test compared to the S.marginatum (21.51%). Thus, the green seaweed U.lactuca could be considered as a potential source of natural antioxidant and antibacterial agents for food and pharmaceutical products.

A facile synthesis of 1,3-diphenyl-4-arylspiro[pyrazoline-5, 3′-flavan-4′-one]

Synthesis of a series of novel 1,3-diphenyl-4-arylspiro[pyrazoline–5,3′-flavan-4′-ones] has been accomplished in good yields by the regioselective 1,3-dipolar cycloaddition of diphenylnitrilimine with (E) 3-benzylideneflavan-4-ones.

Impact of molecular structure on the physicochemical properties of starches isolated from different field pea (Pisum sativum L.) cultivars grown in Saskatchewan, Canada

The objective of this study was to determine the molecular structure and properties of recently released cultivars of field peas [CDC Golden (CDCG), Abarth (ABAR), CDC Patrick (CDCP) and CDC Amarillo (CDCA)] grown at different locations in Saskatchewan, Canada. Starch yield (on whole seed basis), apparent amylose, total lipid and specific surface area were in the range 34-37%, 38.2-42.6%, 1.07-1.38% and 0.31-0.38m2/g, respectively. The proportion of short (DP 6-12) amylopectin chains, amylopectin branching density, molecular order, crystallinity, crystalline heterogeneity, gelatinization transition temperatures, pasting temperatures, peak viscosity, extent of acid hydrolysis, and resistant starch content were higher in CDCG and ABAR. However, amylopectin long chains (DP 13-26), average chain length and thermal stability were higher in CDCP and CDCA. The results of this study showed that differences in physicochemical properties among cultivars were mainly influenced by amylopectin chain length distribution, amylopectin branching density and co-crystallization of amylose with amylopectin.

An expedient sequential one-pot four component synthesis of novel steroidal spiro-pyrrolidine heterocycles in ionic liquid

A facile one-pot synthesis of novel steroidal dispiro-indenoquinoxaline pyrrolidines via multicomponent-[3+2]-cycloaddition of azomethine ylides in ionic liquid is described. The structure of cycloadduct is confirmed by IR, (1)H NMR, (13)C NMR, high resolution mass spectroscopy and elemental analysis.

Crystal structure of methyl 3-(3-fluoro-phen-yl)-1-methyl-1,3a,4,9b-tetra-hydro-3H-thio-chromeno[4,3-c]isoxazole-3a-carboxyl-ate

In the title compound, C₁₉H₁₈FNO₃S, the five-membered oxazolidine ring adopts an envelope conformation with the methine C atom of the fused bond as the flap. Its mean plane is oriented at a dihedral angle of 50.38 (1)° with respect to the fluoro­phenyl ring. The six-membered thio­pyran ring has a half-chair conformation and its mean plane is almost coplanar with the fused benzene ring, making a dihedral angle of 4.94 (10)°. The two aromatic rings are inclined to one another by 85.96 (11)°, and the mean planes of the oxazolidine and thio­pyran rings are inclined to one another by 57.64 (12)°. In the crystal, mol­ecules are linked by C—H⋯π inter­actions, forming a three-dimensional structure.

Crystal structure of methyl 7-phenyl-6a,7,7a,8,9,10-hexa-hydro-6H,11aH-thio-chromeno[3,4-b]pyrrolizine-6a--carbox-ylate

In the title compound, C₂₂H₂₃NO₂S, the inner pyrrolidine ring (A) adopts an envelope conformation with the methine C atom opposite the fused C—N bond as the flap. The thio­pyran ring (C) has a half-chair conformation and its mean plane is inclined to the fused benzene ring by 1.74 (11)°, and by 60.52 (11)° to the mean plane of pyrrolidine ring A. In the outer pyrrolidine ring (B), the C atom opposite the fused C—N bond is disordered [site-occupancy ratio = 0.427 (13):0.573 (13)] and both rings have envelope conformations, with the disordered C atom as the flap. The planes of the phenyl ring and the benzene ring of the thio­chromane unit are inclined to one another by 65.52 (14)°. In the crystal, mol­ecules are linked by a pair of C—H⋯O hydrogen bonds forming inversion dimers.

Crystal structures of methyl 3-(4-iso-propyl-phen-yl)-1-methyl-1,2,3,3a,4,9b-hexa-hydro-thio-chromeno[4,3-b]pyrrole-3a-carboxyl-ate, methyl 1-methyl-3-(o-tol-yl)-1,2,3,3a,4,9b-hexa-hydro-thio-chromeno[4,3-b]pyrrole-3a-carboxyl-ate and methyl 1-methyl-3-(o-tol-yl)-3,3a,4,9b-tetra-hydro-1H-thio-chromeno[4,3-c]isoxazole-3a-carboxyl-ate

Three thio­chromeno[4,3-b]pyrrole esters have very similar conformations. Structurally two of the compounds differ only by the substituent on the benzene ring, i.e. 4-iso­propyl­phenyl and o-tolyl, while two of the compounds differ only in that one has a pyrrole ring and one has an isoxazole ring.

In the title compounds, C₂₃H₂₇NO₂S, (I), and C₂₁H₂₃NO₂S, (II), the pyrrole rings have envelope conformations with the C atom substituted by the benzene ring as the flap. In the third title compound, C₂₀H₂₁NO₃S, (III), the isoxazole ring has a twisted conformation on the C—C bond substituted by the benzene ring and the carboxyl­ate group. In all three compounds, the thio­pyran ring has a half-chair conformation. The mean plane of the pyrrole ring is inclined to the mean plane of the thio­pyran ring by 57.07 (9), 58.98 (9) and 60.34 (12)° in (I), (II) and (III), respectively. The benzene rings are inclined to one another by 73.26 (10)° in (I), 65.781)° in (II) and 63.37 (13)° in (III). In the crystals of all three compounds, there are no classical hydrogen bonds present. Only in the crystal of compound (I) are mol­ecules linked by a pair of C—H⋯π inter­actions, forming inversion dimers. The isopropyl group in compound (I) is disordered over two sets of sites and has a refined occupancy ratio of 0.586 (13):0.414 (13).

Crystal structure of 14-methyl-11-(3-methylphenyl)-12-oxa-8,14-diazatetracyclo[8.3.3.01,10.02,7]hexadeca-2(7),3,5-triene-9,13-dione

In the title compound, C₂₁H₂₀N₂O₃, the lactone ring adopts an envelope conformation with the quaternary C atom bonded to two other C atoms as the flap. The fused pyrrolidine ring adopts a twisted conformation about the C_q—N (q = quaternary) bond. In the crystal, inversion dimers linked by pairs of N—H⋯O hydrogen bonds generate R₂²(8) loops. The dimers are linked into [110] chains by pairs of C—H⋯O inter­actions, which generate R₂²(14) loops.

Crystal structure of methyl (2Z)-3-(4-chloro-phen-yl)-2-[(3-methyl-1H-indol-1-yl)meth-yl]prop-2-enoate

In the title indole derivative, C20H18ClNO2, the chloro-phenyl ring is almost perpendicular to the indole moiety, making a dihedral angle of 87.6 (1)°. The mol-ecular packing is stabilized by C-H⋯π inter-actions, which form a C(9) chain motif along [10-1]. In addition, there are weak π-π inter-actions [centroid-centroid distance 3.851 (1) Å] between the chains, involving inversion-related chloro-phenyl rings.

Crystal structure of 11-(2,3-dimethoxyphenyl)-14-methyl-12-oxa-8,14-diazatetracyclo[8.3.3.01,10.02,7]hexadeca-2(7),3,5-triene-9,13-dione

The title compound, C₂₂H₂₂N₂O₅, contains two conformationally similar mol­ecules (A and B) in its the asymmetric unit (r.m.s. overlay fit for the 29 non-H atoms = 0.194 Å). In each mol­ecule, the lactone ring has an envelope conformation with the spiro C atom as the flap. In the crystal, A+A and B+B inversion dimers linked by pairs of N—H⋯O hydrgen bonds occur; in both cases, R₂²(8) loops are generated. A weak C—H⋯O inter­action is also observed, which links the dimers into [010] chains.

Crystal structure of ethyl 2'',3-dioxo-7',7a'-di-hydro-1'H,3H,3'H-di-spiro[benzo[b]thio-phene-2,6'-pyrrolo-[1,2-c]thia-zole-5',3''-indoline]-7'-carboxyl-ate

In the title compound, C23H20N2O4S2, the central pyrrolidine ring adopts an envelope conformation with the spiro C atom, shared with the benzo-thio-phene ring system, as the flap. The thia-zole ring has a twisted conformation on the S-C bond, where the C atom is that closest to methine C atom. The mean planes of the benzo-thio-phene and indoline ring systems are inclined to the mean plane of the central pyrrolidine ring by 82.75 (8) and 80.03 (8)°, respectively, and to each other by 61.49 (6)°. In the crystal, mol-ecules are linked via pairs of N-H⋯O hydrogen bonds, forming inversion dimers with an R 2 (2)(8) ring motif. The dimers are linked via C-H⋯O and C-H⋯N hydrogen bonds, forming a three-dimensional structure. The eth-oxy-carbonyl group is disordered over two orientations, with an occupancy ratio of 0.717 (12):0.283 (12).

Crystal structure of ethyl 5′′-fluoro-2′′,3-dioxo-6′,7′,8′,8a'-tetrahydro-2′H,3H,5′H-dispiro[benzo[b]thiophene-2,1′-indolizine-3′,3′′-indoline]-2′-carboxylate

In the title compound, C₂₅H₂₃FN₂O₄S, the fused piperidine ring of the octa­hydro­indolizine ring system adopts a chair conformation and the five-membered ring has a twisted conformation on the N—C(spiro) bond. The mean planes of the benzo­thio­phene and indoline ring systems are inclined to the mean plane of the pyrrolidine ring by 83.1 (1) and 84.9 (1)°, respectively, and to each other by 29.37 (17)°. In the crystal, mol­ecules are linked via pairs of N—H⋯O hydrogen bonds, forming inversion dimers with an R₂²(8) ring motif. The dimers are linked via C—H⋯O hydrogen bonds, forming slabs lying parallel to (100). The packing between the slabs features a short [2.734 (2) Å] F⋯F contact.

Crystal structure of ethyl (2S,2′R)-1′-benzyl-3-oxo-3H-dispiro[1-benzothiophene-2,3′-pyrrolidine-2′,11′′-indeno[1,2-b]quinoxaline]-4′-carboxylate

In the title compound, C₃₅H₂₇N₃O₃S, the spiro-linked five-membered rings both adopt twisted conformations. The pyrrolidine ring makes dihedral angles of 80.5 (1) and 77.4 (9)° with the benzo­thio­phene ring system and the quinoxaline ring system, respectively. The S atom and C=O unit of the benzo­thio­phene ring system are disordered over two opposite orientations in a 0.768 (4):0.232 (4) ratio. The atoms of the ethyl side chain are disordered over two sets of sites in a 0.680 (16):0.320 (16) ratio. In the crystal, mol­ecules are linked by C—H⋯O, C—H⋯N and π–π inter­actions [shortest centroid–centroid distance = 3.4145 (19) Å], resulting in a three-dimensional network.

Crystal structure of ethyl 1',5-dimethyl-2'',3-dioxo-3H-di-spiro-[benzo[b]thiophene-2,3'-pyrrolidine-2',3''-indoline]-4'-carboxyl-ate

The title compound, C₂₃H₂₂N₂O₄S, crystallized with two independent mol­ecules (A and B) in the asymmetric unit. They have very similar conformations with the pyrrolidine ring having a twisted conformation, on the C_spiro—C_spiro bond, in both mol­ecules. In mol­ecule A, the mean planes of the benzo­thio­phene and indoline ring systems are inclined to the mean plane of the pyrrolidine ring by 87.59 (10) and 84.51 (11)°, respectively, and to one another by 72.69 (7)°. The corresponding angles in mol­ecule B are 87.15 (10), 84.58 (10) and 72.07 (7)°, respectively. In the crystal, the A and B mol­ecules are linked to one another by two N—H⋯O hydrogen bonds, forming a dimer. These dimers are linked via C—H⋯O hydrogen bonds, forming a three-dimensional structure.

Crystal structure of ethyl 1',1''-dimethyl-2'',3-dioxo-3H-di-spiro-[benzo[b]thio-phene-2,3'-pyrrolidine-2',3''-indoline]-4'-carboxyl-ate

In the title compound, C23H22N2O4S, the pyrrolidine ring has an envelope conformation with the spiro C atom, shared with the indoline ring system, as the flap. The mean planes of the benzo-thio-phene and indoline ring systems are inclined to the mean plane of the pyrrolidine ring by 88.81 (8) and 79.48 (8)°, respectively, and to each other by 68.12 (5)°. In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds, forming chains propagating along [001].

Crystal structure of 15-(naphthalen-1-yl)-7,7a,8,9,10,11-hexahydro-6a,12a-(methanoepoxymethano)indolizino[2,3-c]quinoline-6,13(5H)-dione

In the title compound, C27H24N2O3, the dihedral angle between the mean planes of the dihydrofuran and 3,4-dihydroquinoline ring systems is 70.65 (9)°. The dihydrofuran ring adopts an envelope conformation with the C atom adjacent to the methylene C atom of the pyrrolidine ring as the flap. The five-membered pyrrolidine ring adopts a twist conformation on the N—C(tetrasubstituted) bond. In the crystal, molecules are linkedviapairs of N—H...O hydrogen bonds, forming inversion dimers with anR22(8) ring motif. The dimers are linkedviapairs of C—H...O hydrogen bonds, forming ribbons enclosingR22(12) ring motifs lying in a plane parallel to (01-1).

Crystal structures of methyl 3-phenyl-4,5-di-hydro-1H,3H-benzo[4,5]imidazo[2,1-c][1,4]oxazepine-4-carboxyl-ate and methyl 1-methyl-3-phenyl-4,5-di-hydro-1H,3H-benzo[4,5]imidazo[2,1-c][1,4]oxazepine-4-carboxyl-ate

The title compounds, C19H18N2O3, (I), and C20H20N2O3, (II), differ only by a methyl substituent on the seven-membered oxazepine ring in (II). In both compounds, these rings have a twist-chair conformation. The phenyl ring makes a dihedral angle of 73.42 (10)° with the benzimidazole ring system mean plane (r.m.s. deviation = 0.015 Å) in (I) and 83.07 (7)° in (II) (r.m.s. deviation = 0.026 Å). The methyl carboxyl-ate groups are planar to within 0.031 (2) in (I) and 0.003 (2) Å in (II). They are inclined to the phenyl and benzimidazole ring system by 33.78 (16) and 87.56 (14)°, respectively, in (I) and by 53.04 (12) and 60.22 (11)°, respectively, in (II). In the crystal of (I), mol-ecules stack in a herringbone fashion and are linked by C-H⋯O hydrogen bonds, forming chains along [100]. In the crystal of (II), there are no significant inter-molecular inter-actions present.

Crystal structures of ethyl (2S*,2'R*)-1'-methyl-2'',3-dioxo-2,3-di-hydro-dispiro-[1-benzo-thio-phene-2,3'-pyrrolidine-2',3''-indoline]-4'-carboxyl-ate and ethyl (2S*,2'R*)-5''-chloro-1'-methyl-2'',3-dioxo-2,3-di-hydro-dispiro-[1-benzo-thio-phene-2,3'-pyrrolidine-2',3''-indoline]-4'-carboxyl-ate

The title compounds, (I) and (II), are di­spiro-indole-pyrrolidine-benzo­thio­phene derivatives, with (II) having a chlorine substituent on the oxo­indole unit. As a result, the conformation of the two mol­ecules differs in the angle of inclination of the indole moiety with respect to the benzo­thio­phene ring system, with a dihedral angle of 71.59 (5) in (I) and 82.27 (7)° in (II).

In the title compounds, C₂₂H₂₀N₂O₄S, (I), and C₂₂H₁₉ClN₂O₄S, (II), the pyrrolidine rings have twist conformations on the spiro–spiro C—C bonds. In (I), the five-membered ring of the oxindole moiety has an envelope conformation with the spiro C atom as the flap, while in (II) this ring is flat (r.m.s. deviation = 0.042 Å). The mean planes of the pyrrolidine rings are inclined to the mean planes of the indole units [r.m.s deviations = 0.073 and 0.069 Å for (I) and (II), respectively] and the benzo­thio­phene ring systems (r.m.s. deviations = 0.019 and 0.034 Å for (I) and (II), respectively) by 79.57 (8) and 88.61 (7)° for (I), and by 81.99 (10) and 88.79 (10)° for (II). In both compounds, the eth­oxy­carbonyl group occupies an equatorial position with an extended conformation. The overall conformation of the two mol­ecules differs in the angle of inclination of the indole unit with respect to the benzo­thio­phene ring system, with a dihedral angle between the planes of 71.59 (5) in (I) and 82.27 (7)° in (II). In the crystal of (I), mol­ecules are linked via pairs of N—H⋯O hydrogen bonds, forming inversion dimers enclosing R₂²(14) loops. The dimers are linked via C—H⋯O and bifurcated C—H⋯O(O) hydrogen bonds, forming sheets lying parallel to (100). In the crystal of (II), mol­ecules are again linked via pairs of N—H⋯O hydrogen bonds, forming inversion dimers but enclosing smaller R₂²(8) loops. Here, the dimers are linked by C—H⋯O hydrogen bonds, forming ribbons propagating along [010].

Methyl (2Z)-2-[(2-formyl-3-methyl-1H-indol-1-yl)meth-yl]-3-(4-meth-oxy-phen-yl)prop-2-enoate

In the title indole derivative, C₂₂H₂₁NO₄, the dihedral angle between the benzene and pyrrole rings of indole moiety is 1.8 (1)°. The plane of the 4-meth­oxy­phenyl ring is oriented with a dihedral angle of 60.7 (1)° with respect to the plane of the indole moiety. The mol­ecular packing is stabilized by C—H⋯O hydrogen bonds which form a V-shaped chain arrangement along the bc plane of the unit cell. In addition to this, C—H⋯π and π–π inter­actions [centroid–centroid distances = 3.8102 (11) and 3.8803(12) Å], which run along the b-axis direction, stabilize the mol­ecular packing.

Rapid assembly of heterocycle grafted macrocycles via tandem one-pot double 1,3-dipolar cycloaddition reaction

Synthesis of triazole linked macrocycles grafted with glycospiroheterocycle was accomplished by stereo- and regioselective tandem double 1,3-dipolar cycloaddition (1,3-DC) reaction.

6a-Nitro-6-(2,2,7,7-tetra-methyl-tetra-hydro-3aH-bis-[1,3]dioxolo[4,5-b:4',5'-d]pyran-5-yl)-6a,6b,7,8,9,11a-hexa-hydro-6H-spiro-[chromeno[3,4-a]pyrrolizine-11,11'-indeno-[1,2-b]quinoxaline]

In the title compound, C39H38N4O8, the quinoxaline and indene subunits are essentially planar, with maximum deviations of 0.071 (2) and 0.009 (2) Å, respectively. The indeno-quinoxaline system forms a dihedral angle of 72.81 (3)° with the chromenopyrrolizine system. The two dioxolane rings, as well as the pyran ring of the chromeno group and the terminal pyrrolizine, each adopt an envelope conformation with O and C as flap atoms. The central pyrrolizine ring adopts a twisted conformation. Intra-molecular C-H⋯O and C-H⋯N hydrogen bonds occur. The crystal structure exhibits C-H⋯O hydrogen bonds, and is further stablized by C-H⋯π inter-actions, forming a two-dimensional network along the bc plane.

2-[(Ferrocen-1-yl)(hydroxy)methyl]prop-2-enenitrile

In the title ferrocene derivative, [Fe(C5H5)(C9H8NO)], the dihedral angle between the enenitrile group and the substituted cyclopentadienyl ring is 71.2 (1)°. The cyclopentadienyl rings of the ferrocene moiety are arranged in an eclipsed conformation. The hydroxy group, and the corresponding methine H atom, are disordered over two sets of sites with site-occupancy factors of 0.744 (4) and 0.256 (4). An intramolecular C—H...O close contact is observed. In the crystal, O—H...N hydrogen bonds form aC(6) chain along [100].

(4'-Acet-yloxy-1,3,1'-trioxo-1,3,4,4a,4b,5,6,7,9,9a-deca-hydro-spiro-[indene-2,9'-pyrano[4,3-a]pyrrolizin]-3'-yl)methyl acetate

In the title compound, C₂₃H₂₃NO₈, the dihedral angle between the five- and six-membered rings of the indene-dione moiety is 3.09 (13)°. The mean plane of the five-membered ring (which has a flat envelope conformation with the spiro C atom as the flap) is inclined to the mean plane of the central five-membered ring of the pyrrolizine unit by 76.48 (12)°. This central ring has a twist conformation on the N—C(spiro) bond. The outer ring of the pyrrolizine unit has an envelope conformation with the N atom as the flap. The mean planes of these two fused rings are inclined to one another by 65.28 (15)°. The pyran ring has a screw-boat conformation and its mean plane makes a dihedral angle of 29.50 (11)° with the mean plane of the central five-membered ring of the pyrrolizine unit. In the crystal, mol­ecules are linked via C—H⋯O hydrogen bonds, forming two-dimensional networks lying parallel to the ab plane.