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Jiang YY, Li ZP, Yao M, Zhou QH. Standard opioid-containing versus opioid-sparing anesthesia on early postoperative recovery after video-assisted thoracic surgery: A propensity-weighted analysis. Front Surg 2022; 9:1015467. [PMID: 36338614 PMCID: PMC9634401 DOI: 10.3389/fsurg.2022.1015467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Opioids have several adverse effects. At present, there are no large clinical studies on the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery. This study was to investigate the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery. METHODS Adult patients who underwent video-assisted thoracic surgery from 1 January 2019 to 28 February 2021 were enrolled by reviewing the electronic medical records. Participants were divided into opioid-sparing anesthesia (OSA group) and opioid-containing anesthesia (STD group) based on intraoperative opioid usage. The propensity-score analysis was to compare the early postoperative recovery of two groups. The outcome measurements included the incidence of postoperative nausea and vomiting (PONV) during an entire hospital stay, need for rescue antiemetic medication, postoperative-pain episodes within 48 h after surgery, need for rescue analgesia 48 h postoperatively, duration of postoperative hospital stay, length of PACU stay, postoperative fever, postoperative shivering, postoperative atrial fibrillation, postoperative pulmonary infection, postoperative hypoalbuminemia, postoperative hypoxemia, intraoperative blood loss, and intraoperative urine output. RESULTS A total of 1,975 patients were identified. No significant difference was observed in patient characteristics between the OSA and STD groups after adjusting for propensity score-based inverse probability treatment weighting. The incidence of postoperative nausea and vomiting was significantly lower in the OSA group than in the STD group (14.7% vs. 18.9%, p = 0.041). The rescue antiemetic use rate was lower in the OSA group than in the STD group (7.5% vs.12.2%; p = 0.002). PACU duration was longer in the OSA group than in the STD group (70.8 ± 29.0 min vs. 67.3 ± 22.7 min; p = 0.016). The incidence of postoperative fever was higher in the STD group than that in the OSA group (11.0% vs.7.7%; p = 0.032). There were no differences between the groups in terms of other outcomes. CONCLUSIONS Our results suggest that opioid-sparing anesthesia has a lower incidence of postoperative complications than opioid-based anesthetic techniques.
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Affiliation(s)
- Yan-yu Jiang
- Graduate School, Bengbu Medical College, Bengbu, China,Graduate School, Bengbu Medical College, Bengbu, China
| | - Zhen-ping Li
- Graduate School, Bengbu Medical College, Bengbu, China
| | - Ming Yao
- Graduate School, Bengbu Medical College, Bengbu, China
| | - Qing-he Zhou
- Graduate School, Bengbu Medical College, Bengbu, China,Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China,Correspondence: Qing-he Zhou
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2
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Hallman MG, McCullough MA. Disaster Response-A Global Concern: Are You Prepared to Care for Victims of Chemical, Biological, Radiological, and Nuclear Attacks? Adv Emerg Nurs J 2022; 44:E10-E26. [PMID: 35551386 DOI: 10.1097/tme.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The threat of bioterrorism is increasing in lethality and numbers of events globally. Weapons of mass destruction include devices of chemical, biological, radiological, and nuclear origin and are often selected by terrorists because they are capable of causing widespread destruction, harm, and panic. Emergency personnel are often first to recognize and report potential terrorist activities. It is essential that emergency personnel maintain a high index of suspicion for symptom patterns that correspond with effects of bioterrorism agents. Health care providers must have a solid understanding of personal protective equipment for specific categories of bioterrorism agents to protect themselves and others while providing care to victims in the emergency department. A clear understanding of disaster protocols, established communication systems, reporting requirements, and available resources to aid in patient management following a bioterrorism event is crucial for optimal, safe, quality care to be administered.
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Affiliation(s)
- Melanie Gibbons Hallman
- Emergency Nurse Practitioner Program, The University of Alabama at Birmingham School of Nursing (Dr Hallman); and Emergency Nurse Practitioner Program, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr McCullough)
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3
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Kitagawa DAS, Rodrigues RB, Silva TN, Dos Santos WV, da Rocha VCV, de Almeida JSFD, Bernardo LB, Carvalho-Silva T, Ferreira CN, da Silva AAT, Simas ABC, Nepovimova E, Kuča K, França TCC, Cavalcante SFDA. Design, synthesis, in silico studies and in vitro evaluation of isatin-pyridine oximes hybrids as novel acetylcholinesterase reactivators. J Enzyme Inhib Med Chem 2021; 36:1370-1377. [PMID: 34148470 PMCID: PMC8219220 DOI: 10.1080/14756366.2021.1916009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organophosphorus poisoning caused by some pesticides and nerve agents is a life-threating condition that must be swiftly addressed to avoid casualties. Despite the availability of medical countermeasures, the clinically available compounds lack a broad spectrum, are not effective towards all organophosphorus toxins, and have poor pharmacokinetics properties to allow them crossing the blood-brain barrier, hampering cholinesterase reactivation at the central nervous system. In this work, we designed and synthesised novel isatin derivatives, linked to a pyridinium 4-oxime moiety by an alkyl chain with improved calculated properties, and tested their reactivation potency against paraoxon- and NEMP-inhibited acetylcholinesterase in comparison to the standard antidote pralidoxime. Our results showed that these compounds displayed comparable in vitro reactivation also pointed by the in silico studies, suggesting that they are promising compounds to tackle organophosphorus poisoning.
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Affiliation(s)
- Daniel A S Kitagawa
- Laboratory of Molecular Modelling Applied to Chemical and Biological Defense (LMACBD), Military Institute of Engineering (IME), Rio de Janeiro, Brazil.,Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil
| | - Rafael B Rodrigues
- Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil
| | - Thiago N Silva
- School of Pharmacy, Universidade Castelo Branco (UCB), Rio de Janeiro, Brazil
| | - Wellington V Dos Santos
- Emergency and Rescue Department (DSE), Rio de Janeiro State Fire Department (CBMERJ), Rio de Janeiro, Brazil.,Universidade Estácio de Sá (UNESA), Rio de Janeiro, Brazil
| | - Vinicius C V da Rocha
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Nilópolis, Brazil
| | - Joyce S F D de Almeida
- Laboratory of Molecular Modelling Applied to Chemical and Biological Defense (LMACBD), Military Institute of Engineering (IME), Rio de Janeiro, Brazil
| | - Leandro B Bernardo
- Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil
| | - Taynara Carvalho-Silva
- Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil
| | - Cintia N Ferreira
- Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil
| | - Angelo A T da Silva
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Nilópolis, Brazil
| | - Alessandro B C Simas
- Instituto de Pesquisas de Produtos Naturais Walter Mors (IPPN), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Kamil Kuča
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Tanos C C França
- Laboratory of Molecular Modelling Applied to Chemical and Biological Defense (LMACBD), Military Institute of Engineering (IME), Rio de Janeiro, Brazil.,Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Samir F de A Cavalcante
- Brazilian Army Technological Center (CTEx), Institute of CBRN Defense (IDQBRN), Rio de Janeiro, Brazil.,School of Pharmacy, Universidade Castelo Branco (UCB), Rio de Janeiro, Brazil.,Instituto de Pesquisas de Produtos Naturais Walter Mors (IPPN), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
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4
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Cavalcante SFDA, Simas ABC, Barcellos MC, de Oliveira VGM, Sousa RB, Cabral PADM, Kuča K, França TCC. Acetylcholinesterase: The "Hub" for Neurodegenerative Diseases and Chemical Weapons Convention. Biomolecules 2020; 10:E414. [PMID: 32155996 PMCID: PMC7175162 DOI: 10.3390/biom10030414] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
This article describes acetylcholinesterase (AChE), an enzyme involved in parasympathetic neurotransmission, its activity, and how its inhibition can be pharmacologically useful for treating dementia, caused by Alzheimer's disease, or as a warfare method due to the action of nerve agents. The chemical concepts related to the irreversible inhibition of AChE, its reactivation, and aging are discussed, along with a relationship to the current international legislation on chemical weapons.
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Affiliation(s)
- Samir F. de A. Cavalcante
- Institute of Chemical, Biological, Radiological and Nuclear Defense (IDQBRN), Brazilian Army Technological Center (CTEx), Avenida das Américas 28705, Rio de Janeiro 23020-470, Brazil; (M.C.B.); (V.G.M.d.O.); (R.B.S.); (P.A.d.M.C.)
- Walter Mors Institute of Research on Natural Products (IPPN), Federal University of Rio de Janeiro (UFRJ), CCS, Bloco H, Rio de Janeiro 21941-902, Brazil
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Rokitanskeho 62, 50003 Hradec Králové, Czech Republic
| | - Alessandro B. C. Simas
- Walter Mors Institute of Research on Natural Products (IPPN), Federal University of Rio de Janeiro (UFRJ), CCS, Bloco H, Rio de Janeiro 21941-902, Brazil
| | - Marcos C. Barcellos
- Institute of Chemical, Biological, Radiological and Nuclear Defense (IDQBRN), Brazilian Army Technological Center (CTEx), Avenida das Américas 28705, Rio de Janeiro 23020-470, Brazil; (M.C.B.); (V.G.M.d.O.); (R.B.S.); (P.A.d.M.C.)
| | - Victor G. M. de Oliveira
- Institute of Chemical, Biological, Radiological and Nuclear Defense (IDQBRN), Brazilian Army Technological Center (CTEx), Avenida das Américas 28705, Rio de Janeiro 23020-470, Brazil; (M.C.B.); (V.G.M.d.O.); (R.B.S.); (P.A.d.M.C.)
| | - Roberto B. Sousa
- Institute of Chemical, Biological, Radiological and Nuclear Defense (IDQBRN), Brazilian Army Technological Center (CTEx), Avenida das Américas 28705, Rio de Janeiro 23020-470, Brazil; (M.C.B.); (V.G.M.d.O.); (R.B.S.); (P.A.d.M.C.)
| | - Paulo A. de M. Cabral
- Institute of Chemical, Biological, Radiological and Nuclear Defense (IDQBRN), Brazilian Army Technological Center (CTEx), Avenida das Américas 28705, Rio de Janeiro 23020-470, Brazil; (M.C.B.); (V.G.M.d.O.); (R.B.S.); (P.A.d.M.C.)
| | - Kamil Kuča
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Rokitanskeho 62, 50003 Hradec Králové, Czech Republic
| | - Tanos C. C. França
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Rokitanskeho 62, 50003 Hradec Králové, Czech Republic
- Laboratory of Molecular Modelling Applied to Chemical and Biological Defense (LMACBD), Military Institute of Engineering (IME), Praça General Tibúrcio 80, Rio de Janeiro 22290-270, Brazil
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McGhee S, Finnegan A, Angus N, Clochesy J. Nerve agents: a guide for emergency nurses. Part 1. Emerg Nurse 2020; 27:27-31. [PMID: 31468803 DOI: 10.7748/en.2019.e1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
Abstract
Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment.
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Affiliation(s)
- Stephen McGhee
- College of Nursing, University of South Florida, Tampa, Florida, United States
| | - Alan Finnegan
- Mental health nursing, University of Chester, Chester, England
| | - Neil Angus
- University of the Highlands and Islands, Inverness, Scotland
| | - John Clochesy
- School of Nursing, University of Miami, Coral Gables, Florida, United States
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Cox MA, Bassi C, Saunders ME, Nechanitzky R, Morgado-Palacin I, Zheng C, Mak TW. Beyond neurotransmission: acetylcholine in immunity and inflammation. J Intern Med 2020; 287:120-133. [PMID: 31710126 DOI: 10.1111/joim.13006] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/24/2019] [Accepted: 09/10/2019] [Indexed: 12/21/2022]
Abstract
Acetylcholine (ACh) is best known as a neurotransmitter and was the first such molecule identified. ACh signalling in the neuronal cholinergic system has long been known to regulate numerous biological processes (reviewed by Beckmann and Lips). In actuality, ACh is a ubiquitous signalling molecule that is produced by numerous non-neuronal cell types and even by some single-celled organisms. Within multicellular organisms, a non-neuronal cholinergic system that includes the immune system functions in parallel with the neuronal cholinergic system. Several immune cell types both respond to ACh signals and can directly produce ACh. Recent work from our laboratory has demonstrated that the capacity to produce ACh is an intrinsic property of T cells responding to viral infection, and that this ability to produce ACh is dependent upon IL-21 signalling to the T cells. Furthermore, during infection this immune-derived ACh is necessary for the T cells to migrate into infected tissues. In this review, we will discuss the various sources of ACh that are relevant during immune responses and describe how ACh acts on immune cells to influence their functions. We will also address the clinical implications of this fascinating aspect of immunity, focusing on ACh's role in the migration of T cells during infection and cancer.
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Affiliation(s)
- M A Cox
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C Bassi
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M E Saunders
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - R Nechanitzky
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - I Morgado-Palacin
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C Zheng
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - T W Mak
- The Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Department of Pathology, University of Hong Kong, Hong Kong, Hong Kong
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7
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Betapudi V, Goswami R, Silayeva L, Doctor DM, Chilukuri N. Gene therapy delivering a paraoxonase 1 variant offers long-term prophylactic protection against nerve agents in mice. Sci Transl Med 2020; 12:12/527/eaay0356. [PMID: 31969483 DOI: 10.1126/scitranslmed.aay0356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 11/02/2022]
Abstract
Chemical warfare nerve agents are organophosphorus chemical compounds that induce cholinergic crisis, leaving little or no time for medical intervention to prevent death. The current chemical treatment regimen may prevent death but does not prevent postexposure complications such as brain damage and permanent behavioral abnormalities. In the present study, we have demonstrated an adeno-associated virus 8 (AAV8)-mediated paraoxonase 1 variant IF-11 (PON1-IF11) gene therapy that offers asymptomatic prophylactic protection to mice against multiple lethal doses of G-type chemical warfare nerve agents, namely, tabun, sarin, cyclosarin, and soman, for up to 5 months in mice. A single injection of liver-specific adeno-associated viral particles loaded with PON1-IF11 gene resulted in expression and secretion of recombinant PON1-IF11 in milligram quantities, which has the catalytic power to break down G-type chemical warfare nerve agents into biologically inactive products in vitro and in vivo in rodents. Mice containing milligram concentrations of recombinant PON1-IF11 in their blood displayed no clinical signs of toxicity, as judged by their hematological parameters and serum chemistry profiles. Our study unfolds avenues to develop a one-time application of gene therapy to express a near-natural and circulating therapeutic PON1-IF11 protein that can potentially protect humans against G-type chemical warfare nerve agents for several weeks to months.
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Affiliation(s)
- Venkaiah Betapudi
- Medical Toxicology Research Division, Biochemistry & Physiology Department, Agent Mitigation, United States Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400, USA
| | - Reena Goswami
- Medical Toxicology Research Division, Biochemistry & Physiology Department, Agent Mitigation, United States Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400, USA
| | - Liliya Silayeva
- Medical Toxicology Research Division, Biochemistry & Physiology Department, Agent Mitigation, United States Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400, USA
| | - Deborah M Doctor
- Medical Toxicology Research Division, Biochemistry & Physiology Department, Agent Mitigation, United States Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400, USA
| | - Nageswararao Chilukuri
- Medical Toxicology Research Division, Biochemistry & Physiology Department, Agent Mitigation, United States Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD 21010-5400, USA.
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de A. Cavalcante SF, Simas ABC, Kuča K. Nerve Agents’ Surrogates: Invaluable Tools for Development of Acetylcholinesterase Reactivators. CURR ORG CHEM 2019. [DOI: 10.2174/1385272823666190806114017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use of nerve agents as warfare and in terrorist acts has drawn much attention from the governments and societies. Such toxic organophosphorus compounds are listed in Chemical Weapons Convention as Schedule 1 chemicals. The discussion about the chemical identity of the elusive Novichok agents, more potent compounds than best known G- and V-Agents, which have been implicated in recent rumorous assassination plots, clearly demonstrating the importance of the matter. Furthermore, accidents with pesticides or misuse thereof have been a pressing issue in many countries. In this context, the continued development of novel cholinesterase reactivators, antidotes for organophosphorus poisoning, a rather restricted class of pharmaceutical substances, is warranted. Testing of novel candidates may require use of actual nerve agents. Nonetheless, only a few laboratories comply with the requirements for storing, possession and manipulation of such toxic chemicals. To overcome such limitations, nerve agents’ surrogates may be a useful alternative, as they undergo the same reaction with cholinesterases, yielding similar adducts, allowing assays with novel antidote candidates, among other applications.
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Affiliation(s)
- Samir F. de A. Cavalcante
- Walter Mors Institute of Research on Natural Products (IPPN), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alessandro B. C. Simas
- Walter Mors Institute of Research on Natural Products (IPPN), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Kamil Kuča
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
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