Role of Activated Protein C Resistance in Left Atrial Thrombogenesis in Patients with Mitral Stenosis
摘要:
激活蛋白C抵抗(APC-R)是临床明显的静脉血栓栓塞最常见的遗传性原因。先前的数据表明,左心房血栓(LAT)形成是二尖瓣狭窄(MS)的常见并发症,并且这些患者存在高凝状态。本研究旨在调查APC-R与MS患者中LAT形成之间的关联。本研究纳入了77例风湿性MS连续患者。对所有患者进行食管超声心动图检查,评估左心房腔或心耳中是否存在任何血栓或自发性回声对比(LASEC)。其中34例患者有LAT,43例没有。两组患者中APC-R的患病率相似(23% vs 16%,p=0.425)。LAT(+)患者与LAT(-)患者相比,房颤(AF)发生率更高(74% vs 51%,p=0.046),LASEC发生率更高(71% vs 19%,p<0.001)。多元回归分析显示,只有LASEC的存在在LAT形成中达到统计学意义上的独立风险因素(p=0.0001,比值比=9.589,95%置信区间[CI]=3.143-29.251)。因为在单变量分析中,LASEC和AF都与LAT相关,我们还比较了这些风险因素存在与不存在的子组中APC-R的患病率。在MS患者的AF(+)亚组中,APC-R的存在与LAT之间存在相关性(p=0.033,比值比=8.167,95% CI=1.001-72.812)。然而,在LASEC(+)患者中,APC-R的存在与LAT增加风险无关(p=0.217,比值比=1.200,95% CI=1.003-1.435)。尽管APC-R的存在本身不是MS中LAT形成的独立风险因素,但当与AF(作为额外风险因素)结合存在时,可能会增加这些患者LAT的风险。
Total Synthesis of a Dimeric Thymol Derivative Isolated from <i>Arnica sachalinensis</i>
作者:Irene De Silvestro、Samuel L. Drew、Gary S. Nichol、Fernanda Duarte、Andrew L. Lawrence
DOI:10.1002/anie.201701481
日期:2017.6.6
The totalsynthesis of a dimeric thymol derivative (thymarnicol) isolatedfrom Arnica sachalinensis was accomplished in 6 steps. A key biomimetic Diels–Alder dimerization was found to occur at ambient temperature and the final oxidative cyclization occurs when the substrate is exposed to air and visible light. These results indicate that this natural product is likely the result of spontaneous (non‐enzyme‐mediated)