Roles of Microembolus and Plasma D-dimer in Evaluating the Warfarin Anticoagulant Therapy Efficacies for Patients with Atrial Fibrillation.

BACKGROUND: To investigate the roles of microembolus and plasma D-dimer in evaluating the warfarin anticoagulant therapy efficacies for patients with atrial fibrillation (AF). METHODS: Fifty-six AF patients were treated with aspirin antiplatelet therapy (Group ASP) and forty AF patients were treated with warfarin anticoagulant therapy (Group WAR). The microemboli and plasma D-dimer in these two groups were monitored and compared before and after treatment. RESULTS: Group ASP had 21 and 17 cases with positive microemboli before and after treatment, respectively, and there was no significant difference in the detection rate of microemboli before and after treatment; Group WAR had 14 and 5 cases with positive microemboli before and after treatment, respectively, and the detection rate of microemboli was significantly reduced after treatment. The levels of plasma D-dimer in the two groups were significantly reduced after treatment (327±73 µg/L vs 235±61 µg/L and 313±81 µg/L vs 170±67 µg/L, respectively, P<0.05), among which the reduction level in Group WAR was more significant. CONCLUSIONS: Microemboli and D-dimer can be used as the indicators for evaluating the embolism risk and therapeutic efficacies in AF patients.

Analysis of Variables Associated with Positive Micro-Embolic Signals Detected by Transcranial Doppler in Patients with Atrial Fibrillation and Their Predictive Value for Embolic Risk.

Objective: This study examined the factors associated with positive micro-embolic signals (MES) on transcranial Doppler monitoring in patients with atrial fibrillation (AF), as well as the predictive value of MES for the risk of embolism in AF. Methods: Sixty-six patients who had micro emboli with AF were included in the positive group, and 75 patients who did not have micro emboli with AF served as the control group. The clinical data, congestive heart failure, hypertension, age ≥ 75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65-74, female (CHA2DS2-VASc) score, D-dimer (D-d) level, echocardiography results, and brain magnetic resonance imaging (MRI) findings were compared between the two groups. Logistic regression models were used to analyze the relationship between positive micro emboli with CHA2DS2-VASc score, D-d, left atrial anteroposterior diameter (LAD), and silent cerebral ischemia (SCI) occurrence. Results: The CHA2DS2-VASc score, D-d level, and LAD were significantly higher in the positive group than in the control group (P < 0.05) and were accompanied by a higher detection rate of SCI by brain MRI (P < 0.01). Elevated D-d levels, increased LAD, and the detection rate of SCI were all highly positively correlated with positive micro emboli. Also, CHA2DS2-VASc score ≥ 2 showed a significant positive correlation with positive micro emboli, and the higher CHA2DS2-VASc score was associated with a stronger correlation. The multivariate regression analysis demonstrated that positive micro-embolic was independently associated with SCI and a CHA2DS2-VASc score of ≥ 4. Conclusion: Positive micro emboli in patients with persistent AF are consistent with an increased risk of embolism, and are independently associated with a higher CHA2DS2-VASc score and SCI, which can be used as an indicator of individual embolic risk in patients with AF.

A concise, protection-free and divergent approach for the enantioselective syntheses of two pheromonal epoxide components of the fall webworm moth and other species.

On the basis of Zhou's modified Sharpless asymmetric epoxidation, sequential coupling reactions, and a divergent strategy, the protection-free syntheses of two main pheromonal components 1 and 5, found in the fall webworm moth, Hyphantria cunea, and other species have been accomplished in 10 steps (for two compounds). The overall yields are 31% for 1, 28% for 5, and 25% for both 1 and 5, respectively. The ee values of the final products 1 and 5 are at least 99%.

(S)-5-Hexyl-1-[(S)-2-hydr-oxy-1-phenyl-ethyl]-4-meth-oxy-1H-pyrrol-2(5H)-one.

The title compound, C(19)H(27)NO(3), was obtained by the reaction of (3S,7aR)-7a-hexyl-7-meth-oxy-3-phenyl-2,3-dihydro-pyrrolo[2,1-b]oxazol-5(7aH)-one and triethyl-silane using titanium(IV) chloride as catalyst. In the mol-ecule, the phenyl and dihydro-pyrrolone rings form a dihedral angle of 83.8 (1)°. O-H⋯O hydrogen-bonding inter-actions lead to the formation of a chain parallel to the a axis.

(3S,7aR)-7-Meth-oxy-7a-methyl-3-phenyl-2,3-dihydro-pyrrolo[2,1-b]oxazol-5(7aH)-one.

In the title chiral butterfly-like bicyclic lactam, C(14)H(15)NO(3), the phenyl and methyl groups are syn with respect to each other. The dihydro-pyrrrole ring adopts a boat conformation, whereas the oxazole ring has a slightly distorted boat conformation. The packing of mol-ecules in the crystal structure is stabilized by inter-molecular C-H⋯O hydrogen bonds.