A versatile new synthetic route to 2,4-diamino-6-substituted pteridines is described. Reaction of an -ketoaldoxime with aminomalononitrile gives 2-amino-3-cyano-5-substituted pyrazine 1 -oxides which yield 2,4diamino-6-substituted pteridine 8-oxides upon cyclization with guanidine. 2,4-Diaminopteridines are then obtained by deoxygenation of the corresponding 8-oxides, or alternately by prior deoxygenation of the above pyrazine 1-oxides, followed by cyclization with guanidine. The conversion of 2-amino-3-cyano-5-methylpyrazine 1-oxide to the corresponding 1,4-dioxide, and a number of chemical transformations of this latter intermediate, are also described.

No abstract

A versatile new synthetic route to pterins is described. Reaction of an -ketoaldoxime or a-ketoketoxime with esters of -aminocyanoacetic acid gives 2-amino-3-alkoxycarbonylpyrazine 1-oxides which are cyclized with guanidine to pterin 8-oxides. Deoxygenation of the pyrazine and pterin (V-oxides, and the conversion of the latter to 7,8-dihydropterins, are described.

A lthough physicians commit themselves to providing equitable treatment to all patients, significant disparities remain in the dermatologic care of Black patients, who constitute 13% of the US population, which continues to grow increasingly diverse. 1 Despite these changes in the population, the literature demonstrates that dermatologic training does not adequately focus on unique presentations of cutaneous pathology in the Black population. 2,3 Accordingly, medical students lack proper training in how skin disorders manifest in people of color. Compounding the problem, only 3% of dermatologists are Black, creating a cultural barrier that can compromise care for Black patients. 2,4 Racial disparities in dermatology training can compromise treatment, patient satisfaction, and outcomes. 3

Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.