RESUMO
BACKGROUND: To investigate the actual rate and quality of cardiac rehabilitation (CR) participation in South Korea and its short-term impact on clinical outcomes after acute coronary syndrome (ACS). METHODS: Data, including confirmed ACS diagnosis, socio-demographics, comorbidities, clinical outcomes, and CR claim codes, were collected from the Korean National Health Insurance Service claims database and compared between the CR and non-CR groups. RESULTS: Overall, 102,544 patients were included in the study, of which only 5.8% attended CR. Regarding testing, 83.6% of CR patients performed the cardiopulmonary exercise test, but follow-up testing was infrequently performed; in addition, 53.1% of them participated in an electrocardiogram monitoring exercise, but over half participated in only one session. After 1:1 propensity score matching, post-ACS cardiovascular events were significantly lower in the CR group than in the non-CR group. The cumulative 3-year hazard ratio for all-cause death was 0.612 (95% confidence interval [CI], 0.495-0.756), recurrent ACS was 0.92 (95% CI, 0.853-0.993), CR readmission was 0.817 (95% CI, 0.768-0.868), and major adverse cardiovascular events (MACE) was 0.827 (95% CI, 0.781-0.874) in the CR group. CR was associated with a significant dose-response effect on MACE, with a reduction in incidence from 0.854 to 0.711. CONCLUSION: The actual rate of CR participation in South Korea remains low, and participation quality was not outstanding despite National Health Insurance coverage. Nevertheless, the impact of CR on cardiovascular outcomes after ACS was significantly superior. Efforts to increase CR participation should be increased by establishing new CR facilities and strategies to resolve associated barriers.
Assuntos
Síndrome Coronariana Aguda , Reabilitação Cardíaca , Humanos , Prognóstico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/reabilitação , Comorbidade , Programas Nacionais de SaúdeRESUMO
Lysyl-tRNA synthetase (KRS), a protein synthesis enzyme in the cytosol, relocates to the plasma membrane after a laminin signal and stabilizes a 67-kDa laminin receptor (67LR) that is implicated in cancer metastasis; however, its potential as an antimetastatic therapeutic target has not been explored. We found that the small compound BC-K-YH16899, which binds KRS, impinged on the interaction of KRS with 67LR and suppressed metastasis in three different mouse models. The compound inhibited the KRS-67LR interaction in two ways. First, it directly blocked the association between KRS and 67LR. Second, it suppressed the dynamic movement of the N-terminal extension of KRS and reduced membrane localization of KRS. However, it did not affect the catalytic activity of KRS. Our results suggest that specific modulation of a cancer-related KRS-67LR interaction may offer a way to control metastasis while avoiding the toxicities associated with inhibition of the normal functions of KRS.
Assuntos
Lisina-tRNA Ligase/metabolismo , Metástase Neoplásica , Receptores de Laminina/metabolismo , Membrana Celular/metabolismo , Lisina-tRNA Ligase/antagonistas & inibidores , Transporte Proteico , Receptores de Laminina/antagonistas & inibidoresRESUMO
We report a new asymmetric synthetic method for (-)-swainsonine utilizing a chiral oxazoline precursor. The key features in this strategy are the diastereoselective oxazoline formation reaction catalyzed by palladium(0), diasteroselective dihydroxylation, and the stereocontrolled allylation reaction with TiCl(4).
Assuntos
Swainsonina/síntese química , Antineoplásicos Fitogênicos/síntese química , Antineoplásicos Fitogênicos/química , Oxazóis/química , Estereoisomerismo , Especificidade por Substrato , Swainsonina/químicaRESUMO
A concise, stereocontrolled synthesis of (+)-polyoxamic acid was achieved. Starting from trans-oxazoline as a chiral building block, the key step involves diastereoselective oxazine formation catalyzed by palladium(0).
Assuntos
Aminoácidos/síntese química , Oxazinas/síntese química , Açúcares Ácidos/síntese química , Aminoácidos/química , Conformação Molecular , Oxazinas/química , Estereoisomerismo , Açúcares Ácidos/químicaRESUMO
The enantioselective total synthesis of (-)-anisomycin, a potent antibiotic agent, has been achieved. The key steps are a Pd(0)-catalyzed stereoselective intramolecular oxazine formation from d-tyrosine and pyrrolidine formation by catalytic hydrogenation of the oxazine.
Assuntos
Anisomicina/síntese química , Antibacterianos/síntese química , Oxazinas/síntese química , Paládio/química , Anisomicina/química , Antibacterianos/química , Catálise , Estrutura Molecular , Oxazinas/química , Pirrolidinas/química , Tirosina/químicaRESUMO
In this study, we explored a convenient and concise route for synthesis of L-threo-sphingosine, D-threo-sphingosine, L-threo-sphinganine and D-threo-sphinganine from commercially available L- or D-serine. The key steps are the simple preparation of trans-oxazoline and intermolecular olefin cross metathesis.
Assuntos
Alcenos/química , Oxazóis/química , Proteína Quinase C/antagonistas & inibidores , Inibidores de Proteínas Quinases , Esfingosina/análogos & derivados , Estrutura Molecular , Inibidores de Proteínas Quinases/síntese química , Inibidores de Proteínas Quinases/química , Inibidores de Proteínas Quinases/farmacologia , Esfingosina/síntese química , Esfingosina/química , Esfingosina/farmacologia , Estereoisomerismo , Relação Estrutura-AtividadeRESUMO
In this study, we explored a convenient and concise route for synthesis of D-erythro-sphingosine 1 from commercially available and cheap L-serine. The key steps are simple preparation of amino ketone 5 from Weinreb amide 3 and high diastereoselective reduction of amino ketone 5 to give the natural erythro-(anti-) isomer.
Assuntos
Proteína Quinase C/antagonistas & inibidores , Inibidores de Proteínas Quinases/síntese química , Esfingosina/análogos & derivados , Tecnologia Farmacêutica/métodos , Amidas/síntese química , Química Farmacêutica , Cetonas/síntese química , Espectroscopia de Ressonância Magnética , Espectrometria de Massas , Estrutura Molecular , Oxirredução , Inibidores de Proteínas Quinases/farmacologia , Serina/química , Espectroscopia de Infravermelho com Transformada de Fourier , Esfingosina/síntese química , Esfingosina/farmacologia , EstereoisomerismoRESUMO
Palladium(II)-catalyzed carboxylation of chiral olefins 6a-d has been examined under various conditions. In the weak basic condition (K2CO3), 7a-d were obtained in good yields. Alternatively, in the strong basic condition, pyrrolidinones 8a-d were obtained resulting in excellent yields and with high diastereoselectivity.
Assuntos
Antineoplásicos/síntese química , Antineoplásicos/farmacologia , Pirrolidinonas/síntese química , Pirrolidinonas/farmacologia , Alcenos/química , Catálise , Cromatografia em Gel , Indicadores e Reagentes , Espectroscopia de Ressonância Magnética , Paládio/química , Solventes , EstereoisomerismoRESUMO
In this study, a highly diastereoselective synthesis of anti-1,2-aminoalcohol was explored starting from L-amino acids as chiral sources. The higher yield and diastereoselectivity was shown when the aza-Claisen rearrangement was performed with allylic trichloroacetimidate 6a in the presence of palladium(II) catalyst.