Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort.

BACKGROUND AND AIMS: The prevalence of lower extremity artery disease (LEAD) is increasing worldwide and sex-related differences are a current matter of debate. METHODS: We analysed claims data on unselected patients with in-patient treatment for LEAD with intermittent claudication (IC; Rutherford grade 1-3) from 01.01.2014 to 31.12.2015. Data files included diagnostic and procedural information from two years before index, and a five-year follow-up. RESULTS: Our analysis comprised 42,197 IC patients, thereof 28,520 (68%) male. Male patients were younger (median: 66.4 years vs. 72.6 years) but presented with higher frequency of cardiovascular risk factors such as diabetes (40% female vs. 46% male), atrial fibrillation (13% vs. 17%), chronic coronary syndrome (41% vs. 53%), chronic heart failure (23% vs. 27%), or chronic kidney disease (29% vs. 32%; all p < 0.001; age adjusted). Revascularisation applied in 80% of patients, thereof endovascular approach predominantly in female and surgery in male patients. Concomitant pharmacotherapy with statins (74% at 2 years) and platelet inhibitors (75% respectively) were long lasting below guideline recommendation, under-use being more pronounced in women. Two years after index, one-third of IC patients had subsequent revascularisation, one-quarter progressed to chronic limb threatening ischemia (CLTI), and 2% underwent amputation. Male sex was an independent risk factor for long-term mortality (female HR 0.75; 95%-CI 0.72-0.79; p < 0.001) and CLTI (female HR 0.89; 95%-CI 0.86-0.92; p < 0.001) during follow-up. CONCLUSIONS: The majority of in-patient treated patients for IC are male, presenting with worse cardiovascular risk profiles. In view of a general under-supply with statins and platelet inhibitors, women received somewhat less often preventive medication. Despite low LEAD stages at index, serious prognosis was observed in the long term. Particularly male patients were at high risk for all-cause mortality and the combined endpoint CLTI and death.

Pd(II)- and Pt(II)-cimetidine complexes. Crystal structure of trans-[Pt(N,S-cimetidine)(2)]Cl(2)(*)12H(2)O.

The influence of cimetidine on patients under cisplatin treatment for cancer is controversial. It has moderate or no effects on several types of cancer and its effects on the nephrotoxicity induced by cisplatin are uncertain. To examine the binding properties and antiproliferative effects of the known anticancer noble metals, cimetidine (cim) was complexed to platinum(II) and palladium(II). The crystal structure of the Pt-cim compound shows two molecules of cimetidine coordinated to the metal through thioether sulfur and imidazolic nitrogen whereas spectroscopic studies in solution for Pd-cim reveal that the ratio of the metal to cimetidine is 1:1 with identical coordination environments. To determine the antitumor activity of the drugs, the interaction of the metallic complexes and free cimetidine with DNA was assessed. Their cytotoxic activity was compared with that of cisplatin.

Metal-modified nucleobase sextet: joining four linear metal fragments (trans-a2PtII) and six model nucleobases to an exceedingly stable entity.

Crosslinking of three different model nucleobases (9-ethyladenine, 9-EtA; 9-ethylguanine, 9-EtGH; 1-methyluracil, 1-MeU) by two linear trans-aPtII (a = NH3 or CH3NH2) entities leads to a flat metal-modified base triplet, trans,trans-[(NH3)2Pt(1-MeU-N3)(mu-9-EtA-N7,N1)Pt(CH3NH2)2(9-EtGH-N7)]3+ (4b). Upon hemideprotonation of the 9-ethylguanine base at the N1 position. 4b spontaneously dimerizes to the metalated nucleobase sextet 5, [(4b)(triple bond)(4b-H)]5+. In this dimeric structure a neutral and an anionic guanine ligand, which are complementary to each other, are joined through three H bonds and additionally by two H bonds between guanine and uracil nucleobases. Four additional interbase H bonds maintain the approximate coplanarity of all six bases. The two base triplets form an exceedingly stable entity (KD = 500 +/- 150 M(-1) in DMSO), which is unprecedented in nucleobase chemistry. The precursor of 4b and several related complexes are described and their structures and solution properties are reported.

Metal-modified nucleobase pairs and triplets as cytosine receptors.

A preorganized cationic receptor 2 for cytosine (C) is described which is composed of trans-a2PtII (a= NH3 or CH3NH2) cross-linked modules with adenine (A), guanine (G), and uracil (U) or thymine (T) model nucleobases. The functions of these three modules are as follows: i) Adenine orientates the two other bases at right angles, thus producing the L-shape of the receptor. ii) Guanine is the primary receptor. iii) Uracil or thymine act as coreceptors. Compared with the normal Watson-Crick pair between G and C, the association constant between 2 and C increases by a factor of 3 (in DMSO). As deduced from 1H NMR spectroscopy and confirmed by the X-ray crystal structure of the C adduct 4b, cytosine is fixed through five hydrogen bonds to the receptor, one of which involves the aromatic H(5) of C. A comparison of C binding is made with a structurally related linkage isomer receptor as well as the precursor molecule trans[alpha2PtAG]2+. The potential of modular, cationic receptors is illustrated.

Thymine-metal ion interactions: relevance for thymine quartet structures.

Apart from their function as counter ions for the charge neutralization of nucleic acids, alkali metal ions play important roles in stabilizing particular multistranded nucleic acids, e.g. guanine quartets in telomeres and uracil (U) or thymine (T) quartets. Here X-ray crystal structure determinations of a series of alkali metal ions (Na+, K+, Rb+, Cs+) as well as of Mg2+ and H5O2+ adducts with the model bases 1-methylthymine and 1-ethylthymine are reported, which bear relevance to the question of thymine quartet (T4) geometries. The compounds isolated differ in their stoichiometries (T:M = 4:1, 2:1, 1:1), and the ways the metal ions interact with the bases. The two extremes are exclusive metal coordination to exocyclic oxygen atoms of the T bases and exclusive H bonding between M aqua cations and the bases.

Effects of N7-methylation, N7-platination, and C8-hydroxylation of guanine on H-bond formation with cytosine: platinum coordination strengthens the Watson-Crick pair.

The hydrogen bonding properties of 1-methylcytosine (1-MeC) with the following guanine base derivatives have been studied in DMSO-d6, applying concentration-dependent 1H NMR spectroscopy: 9-ethylguanine, 7,9-dimethylguanine (7,9-DimeGH+), and 7,8-dihydro-8-oxo-9-methylguanine (8-O-9-MeGH), as well as three 9-ethylguanine complexes carrying different Pt(II) moieties at the N7 position. The association constants K for the Watson-Crick pairing schemes are by a factor 2-3 higher in the cases of platinated guanine complexes compared to the Watson-Crick pair between 9-ethylguanine and 1-methylcytosine (K = 6.9 +/- 1.3 M(-1)). Similar enhanced stabilities are observed for the pairs formed between 1-MeC and 7,9-DimeGH+ or 8-O-9-MeGH. The increase in N1H acidity of the guanine derivative upon modification at the N7 or C8 positions can be correlated with the association constants K; the result is a bell-shaped curve meaning that acidification initially stabilizes hydrogen bond formation up to a certain maximum; further acidification then leads to a destabilization. For two of the examples studied in solution, hydrogen bonding according to Watson-Crick between N7-platinated 9-ethylguanine and 1-methylcytosine has also been established by X-ray crystallography.

From simple trans-[a2Pt(2-hydroxypyrimidine)2]2+ (a = NH3, CH3NH2) complexes to structures of higher complexity. Molecular recognition of 2-aminopyrimidine by hydrogen bond formation and reactivity toward additional metal ions.

The new complexes trans-[a2Pt(Hpymo-N1)2]X2 (a = NH3, X = NO3 (1a); a = CH3NH2, X = NO3 (1b); a = CH3NH2, X = ClO4 (1c); Hpymo = 2-hydroxypyrimidine) have been prepared by reaction of trans-[a2Pt(H2O)2]-X2 with 2-hydroxypyrimidine at 80 degrees C in water. Complex 1c cocrystallizes in water with 2-aminopyrimidine (ampym) through formation of complementary pairs of hydrogen bonds to give the supramolecular hexagon [trans-[(CH3NH2)2Pt(pymo-N1)(Hpymo-N1)].Hampym[2(ClO4)4 (2). Molecular recognition of ampym by 1c is responsible for a conformational change of the two hydroxypyrimidine ligands in 1c from anti (1c) to syn and in addition for a proton transfer from a Hpymo residue to ampym against 1.5 units of pKa gradient. 1H NMR concentration-dependent studies as well as NOE experiments in dmso-d6 and dmf-d7 show that 2 dissociates in solution. Compound 1a reacts in NH3:H2O (1:3) with AgI to give the polymeric species [trans-[(NH3)2Pt(mu-pymo-N1,N3)2Ag(H2O)]-NO3]n (3). In contrast to 2, in the polymeric structure the trans-[NH3)2Pt(pymo)2] entities adopt an anti conformation. Nevertheless, the [(H2O)Ag(pymo)2] residues present a syn conformation that leads to a meander-like global structure. Compounds 1b, 1c, 2, and 3 have been studied by X-ray crystallography: (1b) triclinic space group, P1, a = 9.300(2) A, b = 10.483(2) A, c = 11.050(2) A, alpha = 68.21(3) degrees, beta = 75.47(3) degrees, gamma = 73.83(3) degrees, Z = 2, R1 = 0.025, and wR2 = 0.062; (1c) triclinic space group, P1, a = 5.692(1) A, b = 7.758(2) A, c = 11.236(2) A, alpha = 93.12(3) degrees, beta = 92.86(3) degrees, gamma = 102.58(3) degrees, Z = 2, R1 = 0.048, and wR2 = 0.119; (2) triclinic space group, P1, a = 8.355(2) A, b = 11.221(2) A, c = 13.004(3) A, alpha = 86.76(3) degrees, beta = 78.62(3) degrees, gamma = 77.96(3) degrees, Z = 2, R1 = 0.033, and wR2 = 0.080; (3) monoclinic space group, C2/c, a = 5.345(1) A, b = 23.998(5) A, c = 12.474(2) A, beta = 102.27(3) degrees, Z = 8, R1 = 0.041, and wR2 = 0.093.

Self-assembly of palladium(II) and platinum(II) complexes of 2-hydroxypyrimidine to novel metallacalix[4]arenes. Receptor properties through multiple H-bonding interactions.

Reaction of [enM(H2O)2](NO3)2 (en = ethylenediamine, M = PdII, PtII) with 2-hydroxypyrimidine (Hpymo) in water results in self-assembly to cyclic complexes of type [enM(pymo-N1,N3)]4(NO3)4 (1, M = PdII; 2, M = PtII) which are structurally analogous to calix[4]arenes. The tetranuclear cations in compounds 1 and 2 adopt, in the solid state, a 1,3-alternate orientation of the pymo residues. Attempts to coordinate either soft (PdII, PtII), borderline (CuII, ZnII), or hard (LaIII, BeII, NaI) metal ions to the oxo surface of the metallacalix[4]arene lower rim were fruitless. In fact, X-ray studies performed on [[enPt(pymo-N1,N3)]4(ClO4)4]2.[Cu(H2O)6](ClO4)2.9H2O (4) showed that multiple H-bonding interactions between the water coordination sphere of the copper center and the oxo surface of two tetranuclear cations take place instead of a direct interaction between the heterometal and the oxo surface of the metallacalix[4]arene. Encapsulation of [Cu(H2O)6]2+ is also responsible for the stabilization of the pinched-cone conformation of the tetranuclear cations in 4. pH* dependent 1H NMR spectra of compounds 1 and 2 indicate a very low basicity of the O-donor group of the pymo residues, revealing no protonation of this position down to pH* 0. Moreover, recrystallization of 2 from strongly acidic aqueous solution (approximately 1 M HClO4) affords the adduct [[enPt(pymo-N1,N3)]4(ClO4)4]2.[H20O8](ClO4)4 (6). Analogously to 4, the cationic [H20O8]4+ species is sandwiched between two tetranuclear cations as a result of multiple H-bonding interactions with the oxo surface of two metallacalix[4]arenes. Again a pinched-cone orientation of the pymo residues is realized.

Reactivity of an extremely sterically crowded monofunctional Pt complex, [Pt(1-MeC-N3)3(H2O)]2+ (1-MeC = 1-methylcytosine), toward model nucleobases and selectivity toward guanine in single- and double-stranded deoxyoligonucleotides.

Reactions of [Pt(1-MeC-N3)3Cl]NO3 (1-MeC-N3 = 1-methylcytosine, bound to Pt via N3) and the respective aqua species [Pt(1-MeC-N3)3(H2O)]2+ with the model nucleobases 9-ethylguanine (9-EtGH), 9-methyladenine (9-MeA), single-stranded 5'd(T3GT3), and double-stranded [5'd(GA-GA2GCT2CTC)]2 have been studied in solution by means of 1H NMR spectroscopy, HPLC, and electrospray ionization mass spectrometry. Reactions are generally slow, in particular with the chloro species, and guanine is the only reactive base in the oligonucleotides. However, unlike (dien)PtII, which binds randomly to the guanines in the ds dodecamer, (1-MeC-N3)3PtII binds selectively to the terminal guanine only, probably because base fraying takes place at the duplex ends. The X-ray crystal structures of [Pt(1-MeC-N3)3(9-EtG-N7)]ClO4.8H2O (1b) and of [Pt(1-MeC-N3)3(9-MeA-N7)](ClO4)2.0.5H2O as well as NMR spectroscopic studies of [Pt(1-MeC-N3)3(9-EtGH-N7)] (NO3)2.H2O (1a) are reported. The tetrakis(nucleobase) complexes adopt a head-tail-head orientation of the three 1-MeC bases and an orientation of the fourth base (purine) that permits a maximum of intracomplex H bonds between exocyclic groups. As far as the guanine adduct (1a, 1b) is concerned, relative orientations of the four bases are identical in the model and in the oligonucleotide adduct.