Comparative study of accuracy and clinical agreement of the CoaguChek XS portable device versus standard laboratory practice in unexperienced patients

The objective of the study was to compare the accuracy and clinical agreement of the CoaguChek XS versus the standard laboratory practice. Forty-one patients on long-term anticoagulation with acenocumarol without previous experience in self-monitoring participated to obtain 218 pairs of data. Several methods for comparative statistics were applied to assess the possible disagreements between techniques as well as a range of previously published criteria of clinical agreement and the very recently described error-grid for INR comparison that we partially modify. The mean age was 52.1 and the indications for oral anticoagulation were prosthetic valves (36.59%), atrial fibrillation (34.15%), venous thromboembolic disease (21.95%) and others (7.31%) with a target range of 2–3 INR units (63.4%) or 2.5–3.5 (36.6%). Analyzing the whole series of data, the Pearsons ρ correlation coefficient for precision between methods was 0.95 and the Cb bias correction factor for accuracy 0.99 with a minimal bias of 0.1 INR units between methods applying the Bland-Altman plot. The linear regression procedure described by Passing and Bablok showed a minimal deviation from the best-fit line and a slope of 0.90. The mean of the absolute relative differences was 7% which is in the “very good” range of agreement. No results were found in the clinically “dangerous” D zone of the error-grids with 99% of data in the clinically irrelevant and low relevant areas A and B. In this study self-management with the CoaguChek XS was clinically safe and reliable.

Comparative study of accuracy and clinical agreement of the CoaguChek XS portable device versus standard laboratory practice in unexperienced patients

The objective of the study was to compare the accuracy and clinical agreement of the CoaguChek XS versus the standard laboratory practice. Forty-one patients on long-term anticoagulation with acenocumarol without previous experience in self-monitoring participated to obtain 218 pairs of data. Several methods for comparative statistics were applied to assess the possible disagreements between techniques as well as a range of previously published criteria of clinical agreement and the very recently described error-grid for INR comparison that we partially modify. The mean age was 52.1 and the indications for oral anticoagulation were prosthetic valves (36.59%), atrial fibrillation (34.15%), venous thromboembolic disease (21.95%) and others (7.31%) with a target range of 2-3 INR units (63.4%) or 2.5-3.5 (36.6%). Analyzing the whole series of data, the Pearsons rho correlation coefficient for precision between methods was 0.95 and the C(b) bias correction factor for accuracy 0.99 with a minimal bias of 0.1 INR units between methods applying the Bland-Altman plot. The linear regression procedure described by Passing and Bablok showed a minimal deviation from the best-fit line and a slope of 0.90. The mean of the absolute relative differences was 7% which is in the "very good" range of agreement. No results were found in the clinically "dangerous" D zone of the error-grids with 99% of data in the clinically irrelevant and low relevant areas A and B. In this study self-management with the CoaguChek XS was clinically safe and reliable.

Total synthesis of everninomicin 13,384-1--Part 4: explorations of methodology; stereocontrolled synthesis of 1,1'-disaccharides, 1,2-seleno migrations in carbohydrates, and solution- and solid-phase synthesis of 2-deoxy glycosides and orthoesters

Methods for the stereocontrolled construction of 1,1'-disaccharides, 2-deoxy glycosides, and orthoesters are reported. Specifically, a tin-acetal moiety was utilized to fix the anomeric stereochemistry of a carbohydrate acceptor leading to an efficient and stereoselective synthesis of 1,1'-disaccharides, while a newly discovered 1,2-phenylseleno migration reaction in carbohydrates opened entries to 2-deoxy glycosides and orthoesters. Thus, reaction of 2-hydroxy phenylselenoglycosides with DAST led to 2-phenylselenoglycosyl fluorides which reacted with carbohydrate acceptors to afford, stereoselectively, 2-phenylselenoglycosides. The latter compounds could be reductively deselenated to 2-deoxy glycosides or oxidatively converted to orthoesters via the corresponding ketene acetals.

Total synthesis of everninomicin 13,384-1--Part 1: retrosynthetic analysis and synthesis of the A1B(A)C fragment

In this first of a series of four articles we introduce everninomicin 13,384-1 (1), a powerful antibiotic effective against drug resistant bacteria, as a target for total synthesis and discuss its retrosynthetic analysis. From the three defined fragments required for the synthesis (2: A1B(A)C fragment; 4: DE fragment; 5: FGHA2 fragment), we describe herein two approaches to the A1B(A)C block. The first strategy relied on an olefin metathesis reaction to construct a common intermediate for rings B and C, but was faced with final protecting group problems. The second, and successful approach, involved a 1,2-phenylsulfeno migration and a sulfur directed glycosidation procedure to link rings B and C, as well as an acyl fluoride intermediate to install the sterically hindered aryl ester moiety (ring A1). The final stages of the synthesis of the required 2-phenylseleno glycosyl fluoride 2 required introduction of a phenylseleno group at C-1 of ring C followed by a novel, DAST-promoted 1,2-migration to produce the desired 2-beta-phenylseleno glycosyl fluoride moiety.

Total synthesis of everninomicin 13,384-1--Part 3: synthesis of the DE fragment and completion of the total synthesis

The stereoselective construction of the DE fragment (2) of everninomicin 13,384-1 (1) is reported. From the two possible ways of inserting the DE fragment between the A1B(A)C and FGHA2 domains of the natural product, the sequence involving the DEFGHA2 segment was found to be the most viable. This coupling was followed by attachment of a suitably protected and activated A1B(A)C fragment which led, after orthoester construction and final deprotection to the targeted everninomicin 13,384-1 (1), completing the total synthesis of this complex naturally occurring substance.

Total synthesis of everninomicin 13,384-1--Part 2: synthesis of the FGHA2 fragment

The stereoselective synthesis of everninomicin's 13,384-1 (1) FGHA2 fragment (2) in a suitable form for incorporation into the final target (1) is described. The construction of the FG 1,1'-disaccharide linkage relied on a new method based on tin-acetal chemistry, while for the GH orthoester bridge, a number of approaches were explored. Final success for the latter construction came when a novel 1,2-phenylseleno migration reaction was applied to couple rings G and H, followed by ketene acetal and orthoester formation.

Synthesis of Novel Polyethers in a Geometrically Precise Conformation

[reaction: see text] A convergent design for the preparation of a polyoxyethylene-based channel molecule is presented, and the synthesis of the key unit 2 required for the projected construction is described. The essential elements of the design included face to face oriented macrorings spaced by rigid trans-fused oxanes. The strategy combines conformational predictability of C-linked oxanyl systems and ring-closing metathesis for the synthesis of crown ethers with engineerable ion-binding abilities.

Effects of external pH variations on brain presynaptic sodium and calcium channels; repercussion on the evoked release of amino acid neurotransmitters

The effects of external pH (pHout) variations on the Na+ and on the Ca2+ dependent fractions of the evoked amino acid neurotransmitter release were separately investigated, using GABA as a model transmitter. In [3H]GABA loaded mouse brain synaptosomes, the external acidification (pHout 6.0) markedly decreased the Na+ dependent fraction of [3H]GABA release evoked by veratridine (10 microM) in the absence of external Ca2+, as well as the Ca2+ dependent fraction of [3H]GABA release evoked by high (20 mM) K+ in the absence of external Na+. The depolarization-induced elevation of [Na(i)] (monitored in synaptosomes loaded with the Na+ indicator dye, SBFI) and the depolarization-induced elevation of [Ca(i)] (monitored in synaptosomes loaded with the Ca2+ indicator dye fura-2) were also markedly decreased at pHout 6. On the contrary, the external alkalinization (pHout 8) facilitated all the above responses. A slight increase of the baseline release of the [3H]GABA was observed when pHout was changed from 7.4 to 8. This effect was only observed in the presence of Ca2+. pHout changes from 7.4 to 6 or to 7 did not modify the baseline release of the transmitter. All the effects of pHout variations on [3H]GABA release were independent on the presence of HCO3-. It is concluded that external H+ regulate amino acid neurotransmitter release by their actions on presynaptic Na+ channels, as well as on presynaptic Ca2+ channels.

[Clinical diagnosis of dementia associated with cortical Lewy bodies]

8 cases of dementia associated with cortical Lewy bodies are dealt with, that were diagnosed in 1993 in examinations for dementia, using the Nottingham's clinical criteria. They make up 15.4% of primary degenerative dementias diagnosed in this examination. All developed a predominantly cortical dementia with variable bradiphrenia and a parkinsonian syndrome which was predominantly of the rigid-bradikinetic type. The dementia established itself rapidly -between 1 and 3 weeks- in 3 cases (37.5%). 50% of patients (4 cases) showed marked psychiatric symptoms. In 2 cases stiffness was predominantly axial and another had supranuclear paralysis of vertical gaze. 3 patients had no tremor, and 2 of the 5 remaining patients showed postural tremor. CT and axial MR images of the encephalon were similar to those observed in dementia of the Alzheimer type. The coronal MR carried out on 3 patients revealed less atrophy of the hypocampus than is normally observed in patients with dementia of the Alzheimer type who are at the same stage of development.

[The evaluation of the temporal lobe size by magnetic resonance in Alzheimer's disease]

The estimation of the size of the structures of the temporal lobe using magnetic resonance (MR) can be of assistance when diagnosing early degenerative dementia. We have carried out a survey on 17 patients with Alzheimer type dementia (ATD). They were classified in clinical stages according to the Reisberg global deterioration scale. As diagnostic criteria for ATD we used those developed by DSM-III-R and NINCDS-ADRDA. We carried out axial sequences of 10 mm thickness in protonic density and in T2, and crown sequences of 5mm in T1 perpendicular to the axis of the hypofield. We selected the crown incisions at the level of the interpeduncular cistern. We determined the areas of the temporal lobe, hypocampus and ventricular and two linear measurements (the interhypocampus distance and the maximum transverse diameter between internal layers of the craneum). The images were processed by means of a computer programme. The average area of both hypofields in patients at stages 3-5 on the Reisberg scale was 378.6 +/- 86.1 mm2 and in stages 6-7 was of 364.7 +/- 62.2 mm2. The average area of both temporal lobes in patients at stages 3-5 was of 2,177.03 +/- 411.4 mm2 and in stages 6-7, was of 1,945.0 +/- 303.3 mm2. The shrinkage in size of the temporal lobe and the hypocampus in patients with Alzheimer's disease was not found to be related with the degree of dementia.

[Effect of gene dosage on the glyceraldehyde-3-phosphate dehydrogenase enzyme (GAPD) in partial 12p13.3 pter trisomy]

A family with three brothers presenting 12p trisomy due to an adjacent-1 segregation of a paternal translocation (1;12) (q44;p12.2) is described. The patient's phenotype was compatible with the chromosomal imbalance including the gene dosage effect of the glyceraldehyde-3-phosphate dehydrogenase. The importance of the genetic counseling in these families is stressed.

[Clinical study and hormonal evaluation of a 48, XXYY male. Comparison with previously published cases]

A new case of the infrequent 48, XXYY syndrome is presented. The somatomedin C and HGH values were high, perhaps playing a role in the above of the mean height of Klinefeter patients, of which this cromosomic abnormality is a variant.

[A clinical description and hormonal assessment of a 48, XXYY male. A comparison with cases previously published]

A new case of the infrequent 48, XXYY syndrome is presented. The somatomedin C and HGH values were high, perhaps playing a role in the above of the mean height of Klinefelter patients, of which this chromosomic abnormality is a variant.

[Morphological changes induced by ampicillin in Campylobacter]

Morphologic changes in Campylobacter fetus ssp. jejuni were evaluated as cultivated on thioglycollute broth, containing minimum of 0.1, 1.3 and 10 Ampicillin minimal inhibitory concentration (MIC). During the first four hours of incubation, no changes occurred in the presence of 0.1 MIC; but with the rest of the ampicillin doses, even at the first hour, a proportion larger than 5% of filament-policurved forms was found, and it increased with the incubation time. The greatest number of altered bacteria was found with the use of 10 MIC. No other morphologic changes were observed.

A distinct dysmorphic syndrome with spinocerebellar ataxia and probable autosomal recessive inheritance

Two brothers and their sister aged 8, 13, and 7 years were found to have unusual facies (gross, rough and abundant hair, wide forehead, mild palpebral ptosis, small nose, anteverted nostrils, thick lips, and down-slanting corners of the mouth), dysarthria, delayed psychomotor development, scoliosis, feet deformities, and limb and gait ataxia. The characteristic clinical picture in the three sibs, once compared with other ataxic syndromes, allowed one to conclude that this could correspond to a distinct entity probably inherited as an autosomal recessive disorder.

Del (8) (q212q2200) de novo in a boy without Langer-Giedion syndrome

A two year-old boy with congenital malformations, psychomotor retardation and absence of phenotypical features of the Langer-Giedion syndrome (LGS) was found to have a de novo del (8) (q212q2200). The comparative analysis with other 8q monosomic cases suggests the existence of at least two distinct syndromes: one due to the monosomy of a part of the segment 8q22----q24, clinically manifested as the LGS, and the other to the deletion of the band 8q21.