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1.
J Org Chem ; 89(11): 8243-8248, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38753315

RESUMO

Herein we have pioneered an innovative synthetic strategy for the efficient assembly of various heteroarene-condensed benzofuran derivatives, utilizing benzofuran-derived azadienes (BDAs) and quinolines as the starting materials. This method functions with transition-metal catalysis and uses cost-effective formic acid as the reducing agent. Mechanistic investigations indicate that this transformation would involve a [4 + 2] annulation cascade process. This approach demonstrates a high tolerance to various functional groups and yields excellent results.

2.
J Org Chem ; 89(16): 11513-11524, 2024 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-39051980

RESUMO

N-Acyl/sulfonyl-α-functionalized 1,2,3,4-tetrahydroisoquinolines (THIQs) are significant structural motifs in organic synthesis and drug discovery. However, the one-pot approach enabling direct difunctionalization of THIQs remains challenging. Herein we report a photomediated one-pot three-component strategy to access N-acyl/sulfonyl-α-functionalized THIQs. This method features the use of oxygen (from air) as the green oxidant, high atom and step economy, and decent structural diversity. The synthetic applicability of the method was further demonstrated via the facile construction of valuable bioactive molecules. Mechanistic studies indicated that oxidation with singlet oxygen and the acceptor-less dehydrogenation were involved in the photoredox process.

3.
Inorg Chem ; 63(34): 15915-15923, 2024 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-39121364

RESUMO

Carbon emission reduction is an important measure to mitigate the greenhouse effect, which has become a hotspot in global climate change research. To contribute to this, here, we fabricated two Co-based metal-organic frameworks (Co-MOFs), namely, {[Co3(NTB)2(bib)]·(DMA)2·(H2O)4}n (DZU-211) and {[Co3(NTB)2(bmip)]·(DMA)2}n (DZU-212) (H3NTB = 4,4',4″-nitrilotribenzoic acid, bib = 1,4-bis(imidazol-1-yl)-butane, bmip = 1,3-bis(2-methyl-1H-imidazol-1-yl)propane) to realize efficient CO2/N2 separation by dividing coordination spaces into suitable pores with narrow windows. DZU-211 reveals a 3D open porous framework, while DZU-212 exhibits a 3D double-fold interpenetrated structure. The two MOFs both possess large coordination spaces and small open pore sizes, via the bib ligand insertion and framework interpenetration, respectively. Comparatively, DZU-211 reveals superior selective CO2 uptake properties due to its more suitable pore characteristics. Gas sorption experiments show that DZU-211 has a CO2 uptake of 52.6 cm3 g-1 with a high simulated CO2/N2 selectivity of 101.7 (298 K, 1 atm) and a moderate initial adsorption heat of 38.1 kJ mol-1. Moreover, dynamic breakthrough experiments confirm the potential application of DZU-211 as a CO2 separation material from postcombustion flue gases.

4.
Org Biomol Chem ; 22(16): 3204-3208, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38563260

RESUMO

An efficient palladium-catalyzed [2 + 2 + 1] annulation of 3-iodochromones, bridged olefins, and iodomethane is described, affording a range of chromone-containing polycyclic compounds. Additionally, the corresponding deuterated products were smoothly obtained with iodomethane-d3 instead of iodomethane. Moreover, the synthetic utility of this method is further substantiated by gram scale preparation and application to late-stage modification of estrone.

5.
Am J Emerg Med ; 75: 72-78, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37967485

RESUMO

AIM: The objective of our research is to evaluate and compare the performance of ChatGPT, Google Bard, and medical students in performing START triage during mass casualty situations. METHOD: We conducted a cross-sectional analysis to compare ChatGPT, Google Bard, and medical students in mass casualty incident (MCI) triage using the Simple Triage And Rapid Treatment (START) method. A validated questionnaire with 15 diverse MCI scenarios was used to assess triage accuracy and content analysis in four categories: "Walking wounded," "Respiration," "Perfusion," and "Mental Status." Statistical analysis compared the results. RESULT: Google Bard demonstrated a notably higher accuracy of 60%, while ChatGPT achieved an accuracy of 26.67% (p = 0.002). Comparatively, medical students performed at an accuracy rate of 64.3% in a previous study. However, there was no significant difference observed between Google Bard and medical students (p = 0.211). Qualitative content analysis of 'walking-wounded', 'respiration', 'perfusion', and 'mental status' indicated that Google Bard outperformed ChatGPT. CONCLUSION: Google Bard was found to be superior to ChatGPT in correctly performing mass casualty incident triage. Google Bard achieved an accuracy of 60%, while chatGPT only achieved an accuracy of 26.67%. This difference was statistically significant (p = 0.002).


Assuntos
Incidentes com Feridos em Massa , Triagem , Humanos , Triagem/métodos , Estudos Transversais , Ferramenta de Busca , Simulação por Computador
6.
Molecules ; 29(9)2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38731462

RESUMO

A novel and efficient method for functionalizing organosulfones has been established, utilizing a visible-light-driven intermolecular radical cascade cyclization of α-allyl-ß-ketosulfones. This process employs fac-Ir(ppy)3 as the photoredox catalyst and α-carbonyl alkyl bromide as the oxidizing agent. Via this approach, the substrates experience intermolecular addition of α-carbonyl alkyl radicals to the alkene bonds, initiating a sequence of C-C bond formations that culminate in the production of organosulfone derivatives. Notably, this technique features gentle reaction conditions and an exceptional compatibility with a wide array of functional groups, making it a versatile and valuable addition to the field of organic synthesis.

7.
Angew Chem Int Ed Engl ; 63(13): e202318887, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38237082

RESUMO

Trifluoromethyl cationic carbyne (CF3 C+ :) possessing dual carbene-carbocation behavior emulated as trifluoromethyl metal-carbynoid (CF3 C+ =M) has not been explored yet, and its reaction characteristics are unknown. Herein, a novel α-diazotrifluoroethyl sulfonium salt was prepared and used in Rh-catalyzed three-component [2+1+2] cycloadditions for the first time with commercially available N-fused heteroarenes and nitriles, yielding a series of imidazo[1,5-a] N-heterocycles that are of interest in medicinal chemistry, in which the insertion of trifluoromethyl Rh-carbynoid (CF3 C+ =Rh) into C=N bonds of N-fused heteroarenes was involved. This strategy demonstrates synthetic applications in late-stage modification of pharmaceuticals, construction of CD3 -containing N-heterocycles, gram-scale experiments, and synthesis of phosphodiesterase 10A inhibitor analog. These highly valuable and modifiable imidazo[1,5-a] N-heterocycles exhibit good antitumor activity in vitro, thus demonstrating their potential applications in medicinal chemistry.

8.
Nat Mater ; 21(6): 689-695, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35484330

RESUMO

In principle, porous physisorbents are attractive candidates for the removal of volatile organic compounds such as benzene by virtue of their low energy for the capture and release of this pollutant. Unfortunately, many physisorbents exhibit weak sorbate-sorbent interactions, resulting in poor selectivity and low uptake when volatile organic compounds are present at trace concentrations. Herein, we report that a family of double-walled metal-dipyrazolate frameworks, BUT-53 to BUT-58, exhibit benzene uptakes at 298 K of 2.47-3.28 mmol g-1 at <10 Pa. Breakthrough experiments revealed that BUT-55, a supramolecular isomer of the metal-organic framework Co(BDP) (H2BDP = 1,4-di(1H-pyrazol-4-yl)benzene), captures trace levels of benzene, producing an air stream with benzene content below acceptable limits. Furthermore, BUT-55 can be regenerated with mild heating. Insight into the performance of BUT-55 comes from the crystal structure of the benzene-loaded phase (C6H6@BUT-55) and density functional theory calculations, which reveal that C-H···X interactions drive the tight binding of benzene. Our results demonstrate that BUT-55 is a recyclable physisorbent that exhibits high affinity and adsorption capacity towards benzene, making it a candidate for environmental remediation of benzene-contaminated gas mixtures.


Assuntos
Estruturas Metalorgânicas , Compostos Orgânicos Voláteis , Adsorção , Benzeno/química , Gases
9.
J Org Chem ; 88(1): 371-383, 2023 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-36563325

RESUMO

A cooperative tertiary amine/palladium-catalyzed sequential reaction process, proceeding via a [4 + 3] cyclization of isatin-derived Morita-Baylis-Hillman Expansion (MBH) carbonates and tert-butyl 2-(hydroxymethyl)allyl carbonates followed by a [1,3]-rearrangement, has been found and developed. A range of structurally diverse spiro[methylene cyclopentane-1,3'-oxindolines] bearing two adjacent ß,γ-acyl quaternary carbon stereocenters, which are difficult to obtain by conventional strategies, were obtained in good yields. Further synthetic utility of this protocol is highlighted by its excellent regio- and stereocontrol as well as the large-scale synthesis and diverse functional transformations of the synthetic compounds. Moreover, the control experiments probably established the plausible mechanism for this sequential [4 + 3] cyclization/[1,3]-rearrangement process.


Assuntos
Carbonatos , Paládio , Ciclização , Estrutura Molecular , Estereoisomerismo , Catálise , Aminas
10.
J Org Chem ; 88(5): 3238-3253, 2023 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-36866581

RESUMO

A practical and efficient electrochemical intramolecular amino- or oxysulfonylation of internal alkenes equipped with pendant nitrogen or oxygen-centered nucleophiles with sodium sulfinate was developed. Under undivided electrolytic cell conditions, a variety of sulfonylated N-heterocycles and O-heterocycles, such as tetrahydrofurans, tetrahydropyrans, oxepanes, tetrahydropyrroles, piperidines, δ-valerolactones, etc., were efficiently prepared from easily accessible unsaturated alcohols, carboxylic acids, and N-tosyl amines without the need for additional metal or exogenous oxidant. The robust electrochemical transformation features excellent redox economy, high diastereoselectivity, and broad substrate specificity, which provide a general and practical access to sulfone-containing heterocycles and would facilitate the related synthetic and biological studies based on this electrosynthesis.

11.
Org Biomol Chem ; 21(20): 4191-4194, 2023 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-37132390

RESUMO

Fused furans are commonly found units in natural products and medicinal molecules, and methods for their introduction are of fundamental importance. Here we report one-pot cycloadditions of ethynyl indoloxazolidones with 1,3-cyclohexanediones enabled by copper catalysis, leading to a series of functionalized furan derivatives in good yields. This method features mild reaction conditions, high efficiency, and wide substrate scope.

12.
Bioorg Chem ; 138: 106640, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37320911

RESUMO

Enantiopure ß-nitroalcohols, as an important class of nitro-containing compounds, are essential building blocks in pharmaceutical and organic chemistry, particularly for the synthesis of ß-adrenergic blockers. In this study, we present the successful protein engineering of halohydrin dehalogenase HHDHamb for the enantioselective bio-nitration of various phenyl glycidyl ethers to the corresponding chiral ß-nitroalcohols, using the inexpensive, commercially available, and safer nitrite as a nitrating agent. The chiral (R)- and (S)-1-nitro-3-phenoxypropan-2-ols were synthesized by the several enantiocomplementary HHDHamb variants through the whole-cell biotransformation, which showed good catalytic efficiency (up to 43% isolated yields) and high optical purity (up to >99% ee). In addition, we also demonstrated that the bio-nitration method was able to tolerate the substrate at a high concentration of 1000 mM (150 g/L). Furthermore, representative synthesis of two optically active enantiomers of the ß-adrenergic blocker metoprolol was successfully achieved by utilizing the corresponding chiral ß-nitroalcohols as precursors.


Assuntos
Antagonistas Adrenérgicos beta , Éteres Fenílicos , Antagonistas Adrenérgicos beta/química , Biocatálise , Catálise , Estereoisomerismo
13.
Sheng Li Xue Bao ; 75(6): 953-961, 2023 Dec 25.
Artigo em Zh | MEDLINE | ID: mdl-38151357

RESUMO

The study aimed to examine the effects of virtual reality (VR) technology-based phase I cardiac rehabilitation (CR) program in elderly coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI). Thirty-six cases of elderly CHD patients who underwent PCI in the First Affiliated Hospital of Chongqing Medical University from June 2022 to April 2023 were recruited by convenience sampling method. The patients were randomly assigned by means of random digital table method to two study groups: control group (n = 18), which received conventional nursing intervention after PCI, and experimental group (n = 18), which received a combined program of conventional nursing intervention together with CR program based on VR technology. The 6 min walk test (6MWT), Simple Physical Performance Battery (SPPB), SF-36 scale, Hospital Anxiety and Depression Scale (HADS) and Impact of Events Scale-Revised (IES-R) were tested before and after rehabilitation. Moreover, the incidence of major adverse cardiovascular events (MACE) was recorded at 3 months after PCI. After VR-based CR, the 6MWT distance and SPPB scores of patients in the experimental group were higher than those in control group (P < 0.05). The HADS scores and IES-R scores of the patients in the experimental group were lower than those in control group (P < 0.01), and the difference in SF-36 scale scores was not statistically significant between two groups (P > 0.05). The incidence of MACE was not significantly different at 3 months after PCI (P > 0.05). These results suggest that VR-based phase I CR program mitigates the degree of PCI postoperative stress, anxiety, and depression in elderly CHD patients, however, enhances the resistance to fatigue and does not increase the risk of adverse cardiac events, suggesting it is a safe intervention.


Assuntos
Reabilitação Cardíaca , Doença das Coronárias , Intervenção Coronária Percutânea , Realidade Virtual , Idoso , Humanos , Ansiedade , Reabilitação Cardíaca/métodos , Doença das Coronárias/cirurgia , Intervenção Coronária Percutânea/efeitos adversos
14.
Artigo em Inglês | MEDLINE | ID: mdl-37286498

RESUMO

BACKGROUND: Due to the continuous spread of the epidemic, some colleges and universities have implemented a campus lockdown management policy in China. In the context of the campus lockdown, this study aimed to explore whether anxiety mediated the association between interpersonal sensitivity and depression, and investigate whether psychological capital moderated the indirect or direct effect of mediation model. METHODS: A total of 12945 undergrad students were recruited in China from April 10 to 19, 2022. These participants were asked to complete the online questionnaires measuring interpersonal sensitivity, anxiety, psychological capital, and depression. A moderated mediation model was examined by using PROCESS macro for SPSS 25.0, in which anxiety was a mediating variable, and psychological capital was a moderating variable. RESULTS: Interpersonal sensitivity was positively associated with depression among Chinese college students (r = 0.47, P < 0.001). Anxiety partially mediated the association between interpersonal sensitivity and depression (indirect effect = 2.31, 95%CI [2.18, 2.44], accounting for 70% of the total effect). Moreover, the interaction effect of interpersonal sensitivity and psychological capital on anxiety (ß = -0.04, t = -17.36, P < 0.001) and the interaction effect of anxiety and psychological capital on depression (ß = 0.002, t = 1.99, P < 0.05) were statistically significant. CONCLUSIONS: The current study explained the mediation role of anxiety and the moderation role of psychological capital in the relation between interpersonal sensitivity and depression. The findings suggested that strict monitoring anxiety and promoting psychological capital may decrease the risk of depression among Chinese college students during the campus lockdown.


Assuntos
COVID-19 , Depressão , Humanos , Depressão/epidemiologia , Depressão/psicologia , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Ansiedade/epidemiologia , Estudantes/psicologia
15.
Zhonghua Nan Ke Xue ; 29(8): 746-750, 2023 Aug.
Artigo em Zh | MEDLINE | ID: mdl-38619524

RESUMO

The incidence of erectile dysfunction (ED) has been reported to increase after COVID-19 infection, and it is common in COVID-19 patients during recovery. This paper presents a summary of the latest research progress on COVID-19-induced ED and explores the traditional Chinese medicine (TCM) diagnosis and treatment approach based on TCM theory and clinical experience. COVID-19 infection may lead to ED through endothelial dysfunction, testicular injury, hormonal imbalance, and psychological factors. The pathogenesis of COVID-19-related ED is mainly characterized by deficiency of the body's essence and excess of pathogenic factors. In the early stage, it is dominated by deficiency of qi and yin, while in the middle stage, it is mainly due to deficiency of qi and blood stasis. In the long-term, ED is based on the imbalance of yin and yang, with liver stagnation and qi stagnation often co-existing. Clinical manifestations of ED vary, and treatment should focus on tonifying qi and nourishing yin, promoting blood circulation, regulating yin and yang, and soothing liver depression according to TCM diagnosis and treatment principles.


Assuntos
COVID-19 , Disfunção Erétil , Masculino , Humanos , Disfunção Erétil/diagnóstico , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Medicina Tradicional Chinesa , Fígado , Teste para COVID-19
16.
Opt Express ; 30(5): 7225-7237, 2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35299489

RESUMO

We demonstrate power-efficient, thermo-optic, silicon nitride waveguide phase shifters for blue, green, and yellow wavelengths. The phase shifters operated with low power consumption due to a suspended structure and multi-pass waveguide design. The devices were fabricated on 200-mm silicon wafers using deep ultraviolet lithography as part of an active visible-light integrated photonics platform. The measured power consumption to achieve a π phase shift (averaged over multiple devices) was 0.78, 0.93, 1.09, and 1.20 mW at wavelengths of 445, 488, 532, and 561 nm, respectively. The phase shifters were integrated into Mach-Zehnder interferometer switches, and 10 - 90% rise(fall) times of about 570(590) µs were measured.

17.
J Org Chem ; 87(6): 4112-4123, 2022 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-35258307

RESUMO

An inexpensive copper-catalyzed sequential reaction process, proceeding via a nucleophilic attack of amine to Cu-carbene generated in situ from heterocyclic N-tosylhydrazone precursors followed by a 1,2-H shift/oxidative cyclization cascade of N-ylides, has been described, smoothly generating the corresponding structurally various spiro-dihydropyrrolo[1,2-a]quinoxaline derivatives. Furthermore, the significance of this protocol can be also highlighted by its diverse conversions of the synthetic compounds to the potentially bioactive molecules such as the 2-substituted pyrrolo[1,2-a]quinoxalins.


Assuntos
Cobre , Quinoxalinas , Compostos de Anilina , Catálise , Ciclização , Estrutura Molecular
18.
BMC Neurol ; 22(1): 134, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410158

RESUMO

BACKGROUND: We report a rare case of Godtfredsen syndrome caused by clival chondrosarcoma and perform a review of literatures. This article also explains the clinico-anatomical correlation of this rare neurological syndrome. CASE PRESENTATION: A 22-year-old gentleman presented with binocular diplopia. Clinical examination revealed an isolated right abducent nerve and right hypoglossal nerve palsy, with other cranial nerves intact. Neuroimaging revealed a right clival mass. Supraorbital craniotomy and tumour debulking were done in the same year. Histopathological examination showed low-grade chondrosarcoma. After 5-years of default, he came back with the tumour enlarged. He underwent a right orbitozygomatic craniotomy and tumour excision with 33 cycles of radiotherapy. Despite two surgeries and radiotherapy, the abducent nerve and hypoglossal nerve did not improve throughout 6 years of follow-up. Cranial nerve VI palsy is not always a false localizing sign, in Godtfredsen syndrome it serves as a localizing sign. CONCLUSION: To the best of our knowledge, this is the first case report of Godtfredsen Syndrome secondary to clival chondrosarcoma. Cranial nerve VI and XII palsy with no involvement of other cranial nerves, most likely the pathology is located at the clivus.


Assuntos
Doenças do Nervo Abducente , Neoplasias Ósseas , Condrossarcoma , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/cirurgia , Adulto , Condrossarcoma/diagnóstico , Condrossarcoma/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia , Síndrome , Adulto Jovem
19.
Nanotechnology ; 33(44)2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35878590

RESUMO

Developing highly efficient and stable electrocatalysts for oxygen evolution reaction is of significant importance for applications in energy conversion and storage. Modulation of electronic structure of catalysts is critical for improving the performance of the resulting electrodes. Here, we report a facile way to engineer the electronic structure of Ni3FeS by coating a thin polyaniline (PANI) layer for improving electrocatalytic activity for overall water splitting. Experimental investigations unveil that the strong electronic interactions between the lone electron pairs of nitrogen in PANI and d orbitals of iron, nickel in Ni3FeS result in an electron-rich structure of Ni and Fe, and consequently optimize the adsorption and desorption processes to promote the OER activity. Remarkably, the resulting PANI/Ni3FeS electrode exhibited much enhanced OER performance with a low overpotential of 143 mV at a current density of 10 mA·cm-2and good stability. Promisingly, coupled with the reported MoNi4/MoO2electrode, the two-electrode electrolyzer achieved a current density of 10 mA·cm-2with a relatively low potential of 1.55 V, and can generate oxygen and hydrogen bubbles steadily driven by a commercial dry battery, endowed the composite electrocatalyst with high potential for practical applications.

20.
BMC Cardiovasc Disord ; 22(1): 307, 2022 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-35799104

RESUMO

BACKGROUND: Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. METHODS: A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer-Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. RESULTS: The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53-0.57), 0.54 (95% CI 0.53-0.56), and 0.56 (95% CI 0.54-0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 µmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64-0.70) and a good calibration (Hosmer-Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. CONCLUSIONS: The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.


Assuntos
Insuficiência Cardíaca , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Fatores de Risco
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